Thursday, June 30, 2011

Biomedical waste management - Situation analysis and disposal

Everybody must read news about 6 people was battling for their lives in Mayapuri, scrapeyard area of New Delhi. The culprit was the radio active cobalt 60 isotope which was found in scrape area. Later it was found that the waste came form hospital waste.
It was estimated by the pollution control board that more than 4.2 lakh kg of biomedical waste generated per day in country. But only 2.4 lakh kg of bio-medical waste is reported to be treated at 157 qualified treatment facilities. Pollution control board, institutional report revealed that out of 84, 809 hospitals and healthcare facilities in India only 48,183 are either treating their wastes at source or are employing private agencies for same.
These two news are the witness of the Indian health care waste management scenario. The government of India has enacted the Bio-medical Waste (Management and Handling) Rules 1998. It is more than 12 years of implementation. Under these rules, it is mandatory for all hospitals and health care facilities to ensure that the bio-medical waste handled and managed without any harm to the human health and the environment. The law has defined the bio-medical waste means ‘any waste which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals, and including categories mentioned in Schedule I of law’.
The health care system in India is very complex and mixed economy where private, government and semi-government hospitals providing health and medical care. All these health care facilities are generating biomedical waste. The amount of waste generated in each facility depends on type of facility and practice. World Health Organization 1999 report on health care waste composition in Asian countries reported that India is generating 0.33 million ton biomedical waste per year, means 1-2 kg per day per bed. Over last 10 years the health care industry of India is growing big way. Large number of big and private hospitals added in list and also large research laboratories came in country. These have added more waste generation with sophistication. But the most important aspect in hospital waste is that the almost 80% of waste generated in hospital is the non-hazardous waste and only 20% of waste is the hazardous to human health and the environment. If hospital takes care of these 20% of the hazardous waste, it will surely reduce the hazardous waste. But majority of hospitals have no system of segregation of waste at source, which is best method of reduction of waste. All hospitals collecting waste in single container, which makes non-hazardous waste to become hazardous. As per February 2010, Central Pollution Control Board evaluation report on biomedical waste says that only 50-55% of biomedical waste is segregated, collected and treated as per the said law of Biomedical Management. Similarly Delhi Pollution Control Committee reported number of illegal dumping sites across the city. The city has reported many hazardous toxic materials and metals in the soil. They endanger to the health of human being.
The other important issue in the biomedical waste is that the 16 billion injections are used in country means 45 million injections in a day. It was reported that almost 30% of such injections are reused in the country. Such reuse of the material causes the more endanger to the health and life of patients and even health care staff. The diseases which can be transmitted through the improper handling of biomedical waste are Hepatitis-B, Hepatitis-C, HIV which can transmitted through the injury to sharps, hospital acquired infections (nosocomial infections), occupational hazards to chemicals and drugs and many more.
Simple guide line to manage proper biomedical waste –
1. Reduction in the production of waste – The first important issue is the genuine use of materials. Do not use unnecessary material for the unnecessary procedure. The inventory control system of hospital will help to find out the misuse of items in hospital. One can do audit and minimize such misuse.
2. Segregation of waste at Origin – The most important stapes in the management of hospital waste. Each hospital should have various containers at the source of waste generation. All waster generators should well trained for the segregation at origin. Once mixture of waste occurs, one can not separate the waste later which is again danger. The law has given very good categorization of waste and use of containers for each category.
3. Transport of waste – The hospital should have proper mechanism of waste transportation within hospital. The waste transportation should not disturb the routine hospital activities. It should be either early morning or late night. The transport vehicle should be close and leakage proof. The waste transporter should be trained and know the various risk aspects of biomedical waste.
4. Storage facility – The health care facility should have storage facility for the waste as per the bed capacity. The hospital must have ability to store 48 hours storage capacity in case of any unforeseen situation.
5. Final disposal facility – The law has suggested various final disposal methods for the biomedical waste. They are disinfection, autoclaving, incineration and microwaving. The law has given clear categorization and type of final treatment facilities to be used.
For application of above guideline, hospital has to appoint or delegate duty to the biomedical waste manager. If hospital is big means more than 50 bad, they should have one biomedical waste manager who looks after the above guideline for implementation. But if hospital smaller than 50 bad, they need to give responsibility to some trained person in waste management, he may be senior nursing staff or trained biomedical person. The biomedical waste manager should work closely with the Infection control committee. In majority of situation if hospital follows the above simple guideline for waste management, they will not have major problems.
Final Disposal technologies in BMW –

The most important issue in the management is the final disposal of waste. The law has suggested various methods for the final disposal of biomedical waste as per the category. But the hospital has taken the setting incineration means they have fulfill the law regulation or making contract with private agency for disposal means they have fulfill the law regulation. This is the weakling in the whole issue. The report says that various technologies for final disposal has set advantages and disadvantages. The popular suggested technologies are incineration, autoclave, microwave and chemical disinfection. But recently one new technology is introduced by the Facilitation Center for Industrial Plasma Technology, Institute of Plasma Research, which is known as plasma pyrolysis. The technology can handle all types of wastes and also eliminate the need of the waste segregation at origin. It uses extremely high temperatures to completely decompose waste in an oxygen-starved environment into very simple molecules. Plasma pyrolysis gasifies all organic material, while non-combustible materials – such as glass and metals – are reduced to an inert material with toxicity several orders of magnitudes lower than current landfill regulations. The gas produced after pyrolysis is high in hydrogen and carbon monoxide with traces of methane, acetylene and ethylene. It can be combusted very efficiently to yield carbon dioxide. The plasma pyrolysis with 25kg/hour capacity machine can handle the waste of 300 bad hospitals. Till date it is the best environment friendly technology. But still it is not reached to the market level for the implementation and production. The comparison of various technologies is given as below

Final Treatment technologies – A comparison




Looking to above table, the plasma technology looks very good if we take care of investment cost, operation cost and operation issue. Otherwise it is best environment friendly and large volume reduction technology. Also most important there is no need of segregation of the waste. In country like India, the municipal waste is also big problem and e-waste is up coming problem. In this scenario the environmental friendly technology need to promote.
(The author can be contacted for any issue related to Biomedical waste. He has vast experience in field. He has trained many health workers and help to establish the system of waste management.)



Authors –
1. Dr. Niraj Pandit, Associate Professor, Department of Community Medicine, SBKS Medical Institute and research Center, Sumandeep Vidyapeeth, Piparia, Vadodara
Email –deniraj74@gmail.com, mobile 09825371135
2. Dr. Gaurav Desai, 2nd year Resident, Department of Community Medicine, SBKS Medical Institute and research Center, Sumandeep Vidyapeeth, Piparia, Vadodara
THe paper is published in Conference paper book of 2nd National conferancen on Urban, Industrial and Hospital waste management 2011, Ahmedabad

8 comments:

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