Biomedical waste – status as per CPCB report of situation analysis and some suggestions

Biomedical waste – status as per CPCB report of situation analysis and some suggestions

Author- Prof. Dr. Niraj Pandit, Professor, Department of Community Medicine, SBKS Medical Institute & Research Center and Deputy Director Research Cell, Sumandeep Vidyapeeth, Piparia, Vadodara, Gujarat – email- drniraj74@gmail.com

Even though it is known fact that biomedical waste is potential dangerous to community and after more than 17 years of implementation of BMW rules, still biomedical waste management and disposal is problematic area. The regulators are trying hard to make sufficient implementation. There are various actions taken place to make it proper implementation. As per the rule, each hospital or nursing home has to register with the authority state level and they have to submit report to state authority every year by 31 January. The compiled report of all HCF (Health care facilities) needs to submit to Central Pollution Control Board (CPCB) by 31 March of year. The CPCP is providing compiled report on the web page http://www.cpcb.nic.in/Bio_medical.php, which was accessed in first week of July 2015 and author prepared the situation analysis.

Table-1 Basic information

Key area / Year	2013	2012	2011	2010
No. of HCF	1,68,869	1,59,838	1,51,222	1,39,594
No. of beds	17,13,742	16,12,600	14,59,286	14,20,563
No of CBWTFs in operation	198	190	179	188
No of CBWTFs under installation	28	29	22	17
No of HCF using CBWTFs	1,31,837 (78%)	1,21,279 (76%)	1,12,187 (74%)	98,764 (71%)
No. of HCF using own Rx & disposal facilities	22,245 (13%)	21,870 (14%)	23,361 (15%)	20228 (14%)
Gap in own facility and CBWTFs use	9%	10%	11%	15%
BMW generated kg per/day	4,84,000	4,16,000	4,07,773	3,50,325
BMW generated bed per day	0.28 kg/day/ bed	0.25 kg/day/ bed	0.27 kg/day/ bed	0.24 kg/day/ bed
HCF violating rules	7,894 (4.6%)	12,990 (8.1%)	5472 (3.6%)	6653 (4.8%)
Notice issued	4,391 (55.6%)	11,583 (89.1%)	3585 (65.5%)	5829 (87.6%)

The above table is showing interesting information. As per World Bank report[i], India has 0.7 beds per 1000 population. But this record shows that the bed strength of country rose to 1.4 beds per 1000 population in 2013, which is almost double. In last four years the number of CBWTFs increased from 188 in 2010 to 198 in 2013. There is observed gap in the use of CBWTF and using own BMW treatment & disposal facilities. But the positive aspect is that the gap reduced from 15% in 2010 to 9% in 2013. The waste generated per bed per day is almost near constant 0.24 kg/day/bed in 2010 and 0.27 kg/day/bed in 2013. There are almost around 5% of registered health care facilities who are violating rules and pollution control board is issuing notice.

I enjoyed to analyze these reports. While analysis these reports I personally found some missing information in the reports. If CPCB starts to collect the missing information, they can monitor the waste management in better way. As per my personal opinion, the points which need to incorporate in report are-

1.      The number of HCF is divided to three category primary HCF, secondary and tertiary HCF. In report if type of HCF is collected, it will help to understand the distribution of beds in secondary and tertiary hospitals. The primary care centers and nursing homes may not have indoor facilities. Thus it will help to understand the bed distribution and waste production pattern.

2.      In this report it is not clear the category of waste. If the waste per bed per day if we calculate it is coming to 0.28 kg/day per bed. It looks like that the reported data is for infectious waste only. As it matches with 10-15% of infectious waste from total waste generated per bed per day. But plastic waste and non-infectious waste details can be collected.

3.      The report did not have anything on radioactive and cytotoxic waste. They are potential dangerous for community in different way. If authority plan to collect data on same will be helpful to track such hospitals.  

4.      There is no clarity on liquid waste. Also report also does not ask anything on liquid waste. But it was found in last committee meeting the CPCB has made committee on liquid waste disposal.  

5.      Many hospitals are doing training and capacity building workshops. If they report in yearly reporting system, it will help to monitor hospital’s involvement in capacity building of staff.

6.      As per BMW rules, each hospital needs to report accident or injury to authority. There is no discussion or report found in yearly report. This is a key to understand the needle stick injury pattern and incidence in a year. Also if hospital reports accidents like spillage blood on floor in ward or operation theater, leakage of BMW bags and similar other accidents to authority, it will help to understand the dangerous aspect of wastage management.

7.      One more suggestion to monitor the Hepatitis-B vaccination programme. All hospital staff should receive Hepatitis-B vaccine as per prescribe interval. If authority monitor, it will be great help to hospital staff and thus community.

In addition to this state pollution control board should spare some 5% to 10% of fees collected from health care facilities registration for the purpose of research and generation of evidence.  There are lots of gaps in available evidences in biomedical waste and require to generate. This research fund will be helpful to generate new knowledge and new technology in context to our country need. Every year pollution control board can invite applications form all health care people and medical – paramedical students or research associates. Team of expert will evaluate the proposal and best 10 proposals can be awarded with adequate funds.

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[i]http://data.worldbank.org/indicator/SH.MED.BEDS.ZS