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Rise In Biomedical Waste Amidst COVID-19

Posted on June 7, 2021 by admin1  417

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There has been a huge pile-up of biomedical waste generated in the aftermath of the second wave of the pandemic.

About

  • The quantity of biomedical waste generated during the second wave at its peak is definitely more than what was seen in the first wave.
  • The second wave saw more face shields, masks, PPE kits, disposable bed sheets, syringes, etc. Although the collection was relatively simpler.
  • This amount being generated is 4 to 5 times more than the normal scenario bio-medical waste generation.
  • Even the cost of disposal has increased to Rs. 58 per kilogram from Rs. 13 per kilogram.

 

Covid and its impact

  • The second wave has spread even to the rural areas unlike the first wave where spread was limited to major urban centres and/or metropolitan cities.
  • In addition to an approximately 25% increase in general waste due to work from home, there have been cases of masks and the like making their way into dry waste. 

 

Issues 

  • Improper Segregation: Lack of strictly monitored segregation and disposal makes biomedical waste management a serious public health issue. The segregation of waste is a major challenge as a large quantity of food waste is also becoming a part of biomedical wastes.
  • Unscientific Disposal: Domestic waste is being mixed with the covid waste coming out from the home quarantine of positive cases. Lot of it is dumped mixed in landfills and also “recklessly incinerated”, with serious consequences to public health.
  • Avoiding segregation due to high disposal Cost: For general waste disposal, hospitals are charged monthly. But for COVID-19 waste, they have to pay per kilo. So cases of passing this bio medical waste as general waste has been seen.
  • Management of Inventory: The bio medical waste is being put along with industrial toxic waste in the incinerator. The problem is the inventory of the waste as there is no surity of how much is reused, recycled or disposed, and it is hazardous.
  • Health concerns: Improper handling of hospital waste might aggravate the spread of SARS-CoV-2 to medical staff and people who handle waste.

 

NGT’s Order on Bio-medical Waste

  • Compliance Gaps: The NGT noted that it is clear from the report submitted by the Oversight Committee that there are huge gaps in compliance – in some states, compliance ranged from 17% to 38% only. 
  • Underutilization: There was underutilization of the common bio-medical facilities at many places. Facilities and their siting needed review and such facilities must obtain Environmental Clearance (EC). 
  • Authorised Recyclers: Recycling of bio-medical waste has to be done through authorised recyclers and the hazardous bio-medical waste must not be mixed with the general waste. 
  • Prevent Groundwater Contamination: While permitting deep burials, it should be ensured that groundwater contamination does not take place. 
  • Role of CPCB: The Central Pollution Control Board (CPCB) should review the compliance status from time to time and issue directions based on the observations from the reports received.
  • Common bio-medical facilities: There should be an adequate number of common bio-medical facilities. 
    • The Chief Secretaries of all the States/UTs have to ensure that authorization is secured by every health care facility in their respective jurisdiction and that there is adherence to the norms. 
    • Similarly, the District Magistrates may, at their level, take necessary steps in their Districts, in accordance with the District Environmental Plans. 

 

Suggestions

  • Aware clients on the scientific disposal of contaminated waste while ensuring the safety of their staff.
  • Keep separate colour-coded bins with foot-operated lids.
  • Use of a dedicated collection bin labelled as “COVID-19” to store COVID-19 waste.
  • Maintain separate records of waste generated from COVID-19 isolation wards.
  • A dedicated vehicle should collect only COVID-19 waste.
  • If waste is not treated by incinerators, deep burial systems as per protocols must be used properly while taking all due precautions to prevent harm to the environment.

 

Conclusion

  • Pollution control Boards need to put on their keen observations to check the negative actions and affects pertaining to biomedical waste. 
  • The rising issue of Bio-medical wastes in the country can be managed by segregating properly while emulating the Kerala Model.

 

Best Practices – Kerala Model

  • Common Bio-medical waste Treatment and Disposal Facility (CBWTF): The Kerala model is different as in the rest of the country, there are multiple treatment facilities run by private parties, while Kerala is the only state where the Indian Medical Association (IMA) is directly handling a Common Bio-medical waste Treatment and Disposal Facility (CBWTF) for the treatment of this highly contaminated waste. The IMA unit in Kerala is also the largest CBWTF in India.
  • Barcode System for segregation: In Kerala, regular Bio-medical wastes are managed through a barcode-based system through which the Indian Medical Association Goes Eco-friendly (IMAGE) picks up the waste directly from hospitals. 
  • Low Cost: Kerala also has the cheapest rate in terms of managing biomedical wastes. For COVID related biomedical wastes, the rates for Kerala government hospitals comes to the tune of Rs 22 per kg for government hospitals and Rs 30 per kg for private hospitals. This goes to as high as Rs 60-100 per kg in several states. In Maharashtra and Gujarat, it is over Rs 60 per kg.
  • During Pandemic:
    • Once the pandemic broke out, it linked all the hospitals separately with the Central Pollution Control Board’s (CPCB) mobile application. 
    • In addition, it appointed separate staff, vehicles and assigned independent treatment units for wastes from COVID care centres.
    • In addition, now the plants are running 24 hours to cater to the rising demand.

 

Bio-Medical Waste Management Rules, 2016

  • Introduced by the Ministry of Environment, Forest and Climate Change (MoEFCC) Government of India (GoI).
  • It initiated changes by prescribing simplified categories (color coded) for segregation of different BMWs.
  • An amendment in 2018 also came into force with the aim to improve the compliance to the rules.
  • Objective: To properly manage the per day bio-medical waste from Healthcare Facilities (HCFs) across the country
  • Features:
    • The CPCB to ensure strict compliance of biomedical waste management rules and scientific disposal of the waste.
    • While permitting deep burials, it may be ensured that groundwater contamination does not take place.
    • The ambit of the rules has been expanded to include vaccination camps, blood donation camps, surgical camps or any other healthcare activity;
    • Phase-out the use of chlorinated plastic bags, gloves and blood bags within two years;
    • Pre-treatment of the laboratory waste, microbiological waste, blood samples and blood bags through disinfection or sterilisation on-site in the manner as prescribed by WHO or NACO;
    • Provide training to all its health care workers and immunise all health workers regularly;
    • Establish a Bar-Code System for bags or containers containing bio-medical waste for disposal;
    • Report major accidents;
    • Existing incinerators to achieve the standards for retention time in secondary chamber and Dioxin and Furans within two years;
    • Bio-medical waste has been classified in to 4 categories instead 10 to improve the segregation of waste at source;
    • Procedure to get authorisation simplified. Automatic authorisation for bedded hospitals. The validity of authorization synchronised with validity of consent orders for Bedded HCFs. One time Authorisation for Non-bedded HCFs;
    • The new rules prescribe more stringent standards for incinerator to reduce the emission of pollutants in environment;
    • Inclusion of emissions limits for Dioxin and furans;
    • State Government to provide land for setting up common bio-medical waste treatment and disposal facility (CBWTF);
    • No occupier shall establish on-site treatment and disposal facility, if a service of `common bio-medical waste treatment facility is available at a distance of seventy-five kilometer.

Salient features of Bio-Medical Waste Management (Amendment) Rules, 2018

  • Bio-medical waste generators including hospitals, nursing homes, clinics, dispensaries, veterinary institutions, animal houses, pathological laboratories, blood banks, health care facilities, and clinical establishments will have to phase out chlorinated plastic bags (excluding blood bags) and gloves by March 27, 2019.
  •  All healthcare facilities shall make available the annual report on its website within a period of two years from the date of publication of the Bio-Medical Waste Management (Amendment) Rules, 2018.
  • Operators of common bio-medical waste treatment and disposal facilities shall establish a bar coding and global positioning system for handling of bio-medical waste in accordance with guidelines issued by the Central Pollution Control Board by March 27, 2019.
  • The State Pollution Control Boards/ Pollution Control Committees have to compile, review and analyze the information received and send this information to the Central Pollution Control Board in a new Form (Form IV A), which seeks detailed information regarding district-wise bio-medical waste generation, information on Health Care Facilities having captive treatment facilities, information on common bio-medical waste treatment and disposal facilities.
  • Every occupier, i.e. a person having administrative control over the institution and the premises generating biomedical waste shall pre-treat the laboratory waste, microbiological waste, blood samples, and blood bags through disinfection or sterilization on-site in the manner as prescribed by the World Health Organization (WHO) or guidelines on safe management of wastes from health care activities and WHO Blue Book 2014 and then sent to the Common bio-medical waste treatment facility for final disposal.

 

Sources: TH

 

 
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