The World Health Organization (WHO), defines biomedical waste as waste generated by healthcare activities such as diagnosis, treatment or immunization of animals or human beings or through research activities that include a wide range of materials from used syringes and needles to diagnostic samples, medical devices, pharmaceuticals, chemicals, blood, body parts, solid dressings, and radioactive materials. Animal research and testing laboratories, blood banks and collection services, hospital and health facilities, nursing homes for elderly, mortuary and autopsy centre’s all contribute to healthcare waste.
While 85 per cent of the waste generated is non-hazardous and comparable to domestic waste, about 15 per cent may be radioactive, toxic or infectious and considered extremely hazardous to health.
Quantifying/ Understanding the problem
On an average, high income countries generate up to 0.5 kg of hazardous waste per bed per day when compared to the 0.2 kg generated in low income countries. In the low income countries, however, the real quantity of hazardous waste could be higher. This is because quite often they are not properly segregated into hazardous and non-hazardous waste and this mix results in contamination of the entire waste leading to the development of infections and resistant organisms.
According to the Ministry of Environment and Forests almost 28 percent of the biomedical waste is left untreated and not disposed. It is an alarming fact that only two-third of the total waste is treated scientifically through recycling, the rest gets mixed up with the municipal waste.
Globally, lack of awareness, poor disposal mechanism and insufficient resources result in about 18 to 64 per cent of unsatisfactory biomedical waste management (BMWM) facilities in healthcare facilities.
India is a developing country. Poor waste management is a serious concern being identified by both governmental and non-governmental organizations.
Harmful Effects of Poorly Managed Biomedical Waste
Biomedical waste when not disposed properly can pose serious risks to society and the environment through air emissions, contamination of water and physical contact.
Improper disposal refers to open dumping, unrestrained burning, and improper handling of waste during generation, collection, storage, transport and treatment.
Improper handling involves unsafe procedures followed during handling of wastes i.e. without wearing protective equipment, poor storage (high temp, high residence), transporting manually for longer distances, uncovered or unpacked containers instead of puncture proof bags, etc. all of which effect hospital workers in different ways.
The following groups are exposed:
Inside Health Care Centres: staff- doctors, nurses, auxiliaries, stretcher bearers, patients, scientific and technical personnel, housekeeping staff, laundry, waste managers, maintenance, and lab technicians.
Outside: In site and off site transport personnel, waste processing personnel, public, and rag pickers.
Improper management of wastewater and sludge can result in contamination of air, soil and water with pathogens and toxic chemicals which may affect all forms of life. Inadequate waste management can cause environmental pollution, unpleasant odours, growth and multiplication of insects, rodents and worms and may lead to transmission of diseases like typhoid, cholera, etc. Infectious agents such as faeces, vomit, saliva, secretions, blood can cause serious health risks on individuals by affecting organs or systems like gastrointestinal, respiratory, eye, skin and cause Anthrax, Meningitis, AIDS, Haemorrhagic Fever, Hepatitis A, B, C, Influenza etc. Research and radio-immunoassay activities may generate small quantities of radioactive gases.
Infections Associated with Different Types of Waste
|Organism||Diseases Caused||Related waste|
HIV, Hepatitis B, Hepatitis A,
C, Arboviruses, Enteroviruses
|AIDS, Infectious, Hepatitis, Dengue, Japanese encephalitis, tick-borne, fevers, meningitis, etc.||Infected needles, body fluids, Human excreta, soiled linen, blood|
Salmonella typhi, vibrio, cholera, clostridium tetani, Pseudomonas, Streptococcus.
|Typhoid, Cholera, Tetanus, Wound infections, Septicaemia, Rheumatic, fever, endocarditis, skin and soft tissue infections, meningitis, bacteraemia.||Human excreta and body fluids in landfills, and hospital wards sharps such as needles, surgical blades in hospital waste.|
Wucheraria Bancrofti, Plasmodium
|Cutaneous leishmaniosis, Kala Azar, Malaria||Human excreta, blood and body fluids in poorly managed sewage system of hospitals|
The risk of being infected by HBV, HCV and HIV for a person who experiences one needle stick injury from an infected needle is 30%, 1.8% and 0.3% respectively.
In developing countries not disposing used medical items correctly often leads to items like syringes and needles getting illegally recycled, repacked and sold in the grey market.
Government Intervention and Biomedical Waste Management Regulations
In 2016 new guidelines for handling biomedical waste were released by the Ministry of Environment, Forest and Climate Change. Categorization and authorization with a bar code system for proper control has been made mandatory. They have also made provision for pre-treatment of blood samples, lab waste etc. It is required that the hospital put effective disposal mechanisms in place either directly or through common biomedical disposal and treatment facilities.
Major Differences between 1998 & 2016 Rules
|1998 Rules||2016 Rules|
|1||Occupier with more than 1000 patients per months required to obtain authorisation||Every occupier generating BMW including health camps or ayush requires to obtain authorisation|
|2||Operator duties absent||Operator duties listed.|
|3||Biomedical waste divided in 10 categories||Biomedical waste divided in 4 categories at source|
|4||No format for annual report||A Format for annual report appended with the rules.|
A proper biomedical waste management program should address-
• Identifying all departments generating the waste and the department’s handling the waste.
• Oversight of the waste management program by the Infection control department.
• Mechanism to identify and report incidents of improper waste segregation like needle stick injuries.
• Ensuring that the contractor responsible for carrying out treatment, transportation, and disposing of waste as per the pollution control board specifications actually does what he is says he is doing.
Concerned associates to be trained continuously in-
• Policies and processes of biomedical waste management
• Use of personnel protective equipment
• Handling emergency situations like waste spillage
• Following color codes for proper segregation of waste and labelling to indicate the nature of waste.
• Proper transportation and storage of waste as per the defined norms
• Storage area and bins should be cleaned and disinfected as defined
It is the responsibility of the entire healthcare industry along with the hospital staff to ensure that biomedical waste is managed efficiently. The new guidelines of 2016 need to be implimented not only on paper but also in spirit to ensure that the risks of these biomedical waste are minimised and in time eliminated completely.