Wednesday, November 30, 2011

Biomedical waste management - Situation analysis and update rule 2011

Everybody must read recent news headlines - 6 people were 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 year 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.
Looking to all above issues, the Central Government has revised the rules in August 2011. The salient features of revised rule are as follow –
- The rules are exclusively applicable to all person who generate, collect, receive, store, transport, treat, dispose or handle bio-medical waste in any form and they are not applicable to radio-active waste which covered under Atomic Energy act 1962, hazardous chemical waste which covered under Environment Protection act 1986, waste covered under Municipal Solid waste (Management and Handling) Rule 2000, Lead acid batteries which covered under Batteries (Management and Handling) Rule 2001 and hazardous waste which covered under Hazardous Waste (Management, Handling and Transboundary Movement) Rule 2008. Thus the revised rule is exclusively for hospital and related waste.
- The revised rule says that every occupier irrespective of quantum of BMW generation should apply for grant of authorization to prescribed authority.
- The revised rules have defined more details about the duty of occupier.
1. Occupier has to take al stapes to ensure that BMW is handled without any adverse effect to human health and environment.
2. Occupier is responsible for training for all its health care workers and other people involved in handling of BMW.
3. Occupier is responsible for immunizing all his/her staff who are involved in handling BME against diseases which can be transmitted through BMW.
4. Occupier has to ensure segregation of waste at origin.
5. Occupier has to ensure occupational health safety with providing all personal protective devices to BMW workers and health staff.
6. Occupier has to arrange health check up of all health staff and workers who are handling BMW.
7. Occupier has to install proper facilities and equipments with regular supply of consumables for proper handling of BMW.
8. He/she has to maintain proper record of BMW generation, segregation, various categories and final disposal as per given schedule in rules.
9. Occupier has to develop system of reporting of injuries, merquery spill, fire hazards etc and maintain record of same for authority.
10. Occupier has to inform authority, if operator of common treatment facility dose not collect waste within 48 hours as per prescribe rule.
- The rules are also defining the specific duty of common biomedical waste treatment facility. They are
1. To take necessary steps to collect waste from the occupier is transported, handled, stored, treated and disposed of without any adverse effect to the human health and the environment.
2. They should ensure biomedical waste collection timely and as per prescribed guideline.
3. They should inform the prescribed authority about those health care establishments or facilities who are not handling segregated waste to the treatment facility.
4. They should provide training to all workers who are handling the biomedical waste.
5. They have to conduct pre-placement examination and periodic examinations of all workers. Also provide the vaccination and related treatment if any accidents occur.
6. They should provide full occupational safety to all the workers working in the treatment facility.
7. The agency should keep accident injury reporting system, mercury spill, fire hazards and other accidents which likely to occur during handling the waste.
8. They have o maintain the log book of the waste disposal with all details.
- Under the treatment and final disposal of BMW, the rule are very open and accepting the innovation. It suggest that any person or any common treatment facility want to promote new technologies other than listed in schedule, they are welcome but they need to approach the Central Government or Central Pollution Control Board with sustainability of new technology, standard operating parameters or standards for that technology. Also Ministry will like to know the results of new technology and if suitable they will accept in the rule with modification. So here chance for innovators.
- All new commencing health care facilities or occupiers have to set up the BMW treatment facilities on site or ensure requisite treatment of biomedical waste management through authorized common treatment facility, before starting actual work.
- All big hospitals with more than 500 bed capacity have to install incinerator or suitable disposal facility as per location of hospital and environmental situation.
- Under new rules the use of chlorinated plastic bags for handling BMW is strictly prohibited. And if used, they should not go in incineration. It was long demand of environmental activist, as the chlorinated bags cause the emission of carcinogen on incineration.
- It was really bold statement of new rules, that they are accepting the recycling of plastic waste. The occupier of the hospital can dispose recyclable waste like plastics and glasses through the authorized recyclers who have consent of respective pollution control board. But the precondition is the proper disinfection and mutilation of the plastics and glass wares before handling to such recyclers. The occupier has to keep record of such waste and submit with annual report to the pollution control board. This step will help to the common treatment facility people in the manner that the final disposal waste bulk will reduce.
- The non-biomedical waste and properly treated biomedical waste which need to dispose in municipal waste will be collected by respective municipal corporation or body and will dispose at final disposal site.
- Supervision and Monitoring of BMW implementation – The Government of every state will constitute Advisory Committee under Chairmanship of State Health Secretary. The committee will constitute of representative of departments of health, environment, urban development, animal husbandry and veterinary science, state pollution control board or pollution control committee, local bodies urban or corporation, Indian Medical Association representative, representative of common biomedical waste treatment facility and Non Government Organization representative.
- Every state will make district level monitoring committee under Chairmanship of Chief District Medical officer. This committee is the key to monitor and supervise the compliance of BMW rules in the district. The committee will monitor day to day activities of BMW generation by various health care facilities and final treatment by common treatment facility. They will submit report every six month to the state advisory committee.
- Annual report submission procedure is same as previous BMW rule 1998.
- About common treatment facility, the revised rule has made very clear that municipal corporation or local bodies will be responsible for providing common disposal facility for waste generated under their jurisdiction. So now local body has special responsibility in small town or villages for disposal.
- The revised rule has also defined the liability of occupier and operator of common treatment facility – they are liable for all the damages caused to environment or public due to improper handling of BMW or disposal. They are also liable for action under section 5 and 15 of Environment (Protection) Act 1986.
- The revised rule has reduced the categories of waste from 10 to 8 categories. Category 9 and 10 are removed under revision. It is clearly mentioned that the liquid waste generated from laboratory washing, cleaning, house keeping and disinfecting activities should be treated properly and meet the discharge standard before final drainage. Incinerated ash should dispose with secure landfilling. The rule has also clearly stated that disposal of BMW under category 1 & 2 should not done by deep burial method in towns and cities. Only it is allow in rural area where there is no common treatment facility available.
- All plastics bags in waste collection should be non-chlorinated plastic material.
- The color code for BMW is more specific and clear in the new law. Yellow color container with non-chlorinated plastic bag is for human anatomical waste (cat-1), Animal waste (Cat-2), discarded and out dated medicine (cat-5) and soiled waste contaminated with blood, material like cotton, dressing materials, soiled plaster linen other incinerable material (cat-6). But no plastic materials come here. In red color container should use without plastic bag, preferably (if you want to use non-chlorinated bags) and should be puncture proof. In this container microbiological and laboratory waste (cat-3), sharp waste (cat-4) and infectious contaminated solid waste like blood bags, catheters, tubing, saline bottles, IV tubes, and other contaminated plastic (cat-7) will be collected. Blue color container use for chemical waste (cat-8). The black color container for municipal waste and kitchen waste mean general waste.
So the revised rules are more specific and clear in the guideline. The role and responsibility of occupier and treatment facility are very clear. This will sure improve the quality of waste management in health care establishment or facilities. There are agencies who are guiding for the proper implementation, day to day monitoring, training, management and evaluation of the whole biomedical waste management. The author has already conducted many surveys and training for the biomedical waste management system in many corporate and government hospitals. If any query, you can write to the author -

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