After reading this article you will learn about:- 1. Introduction to Biomedical Waste Management 2. Process of Biomedical Waste Management 3. Rules 4. Cost 5. Biomedical Waste Management in Bengal.
Introduction to Biomedical Waste Management:
Hospital is one of the complex institutions which is frequented by people from every walk of life in the society without any distinction between age, sex, race and religion. This is over and above the normal inhabitants of hospital i.e. patients and staff. All of them produce waste which is increasing in its amount and type due to advances in scientific knowledge and is creating its impact.
The hospital waste, in addition to the risk for patients and personnel who handle these wastes poses a threat to public health and environment. Keeping in view inappropriate biomedical waste management, the Ministry of Environment and Forests notified the “Biomedical Waste (Management and Handling) Rules, 1998” in July 1998.
In accordance with these Rules (Rule 4), it is the duty of every “occupier” i.e. a person who has the control over the institution and or its premises, to take all steps to ensure that waste generated is handled without any adverse effect to human health and environment.
The hospitals, nursing homes, clinic, dispensary, animal house and pathological lab are therefore required to set in place the biological waste treatment facilities. It is however not incumbent that every institution has to have its own waste treatment facility. The rules also envisage that common facility or any other facilities can be used for waste treatment. However, it is incumbent on the occupier to ensure that the waste is treated within a period of 48 hours.
Process of Biomedical Waste Management:
Handling, segregation, mutilation, disinfection, storage, transportation and final disposal are vital steps for safe and scientific management of bio-medial waste in any establishment. There are various categories of Biomedical Wastes.
They must carefully segregated, disinfected and disposed off. The details are given in Table 21.1. The key to minimisation and effective management of biomedical waste is segregation (separation) and identification of the waste.
The most appropriate way of identifying the categories of biomedical waste is by sorting the waste into colour coded plastic bags or containers. Biomedical waste should be segregated into containers/bags at the point of generation in accordance with Schedule II of Biomedical Waste (Management and Handling) Rules 1998 as given in Table 21.2.
General waste like garbage, garden refuse etc. should join the stream of domestic refuse. Sharps should be collected in puncture proof containers. Bags and containers for infectious waste should be marked with Biohazard symbol. Highly infectious waste should be sterilised by autoclaving.
Cytotoxic wastes are to be collected in leak proof containers dearly labelled as cytotoxic waste. Needles and syringes should be destroyed with the help of needle destroyer and syringe cutters provided at the point of generation. Infusion sets, bottles and gloves should be cut with curved scissors.
Disinfection of sharps, soiled linen, plastic and rubber goods is to be achieved at point of generation by usage of sodium hypochlorite with minimum contact of 1 hour. Fresh solution should be made in each shift. On site collection requires staff to close the waste bags when they are three quarters full either by tying the neck or by sealing the bag. Kerb side storage area needs to be impermeable and hard standing with good drainage.
It should provide an easy access to waste collection vehicle. Biomedical waste should be transported within the hospital by means of wheeled trolleys, containers or carts that are not used for any other purpose. The trolleys have to be cleaned daily. Off site transportation vehicle should be marked with the name and address of carrier.
Biohazard symbol should be painted. Suitable system for securing the load during transport should be ensured. Such a vehicle should be easily cleanable with rounded corners. All disposable plastic should be subjected to shredding before disposing off to vendor. Final treatment of biomedical waste can be done by technologies like incineration, autoclave, hydro-clave or microwave.
Bio-Medical Waste (Management and Handling) Rules, 1998 — Implementation:
With a view to control the indiscriminate disposal of hospital waste/bio-medical waste, the Ministry of Environment and Forest, Govt. of India has issued a notification on Bio-medical Waste Management under the Environment (Protection) Act. Govt. of NCT of Delhi in its notification dated 6th July, 1999 has authorised Delhi Pollution Control Committee (DPCC) for the purpose of granting authorisation for collection, reception, storage, treatment and disposal of bio-medical waste to implement the Bio-medical Waste Management Rules, 1998. Govt. of NCT of Delhi has also constituted advisory committee, appellate authority in exercise of powers conferred under Bio-medical rules.
Some of the salient features of these rules are:
Rules are Applicable to:
These Rules will apply to Hospitals, Nursing Homes, Veterinary Hospitals, Animal Houses, Pathological Labs and Blood Banks, generating hospital wastes (except such occupier of clinics, dispensaries, pathological labs, blood banks providing treatment/service to less than 1000 (one thousand) patients per month).
It shall be the duty of the every occupier of an Institution generating bio-medical waste which includes a Hospital, Nursing Home, Clinic, Dispensary, Veterinary Institution, Animal House, Pathological Laboratory, Blood Bank by whatever name called to take all steps to ensure that such waste is handled without any adverse effect to the human health and the environment.
Management of Bio-Medical Waste:
Every occupier generating the bio-medical waste need to install an appropriate facility in the premises or set up a common facility to ensure requisite treatment of waste by 30.6.2000 in accordance with Schedule-I and in compliance with standards prescribed with Schedule-V.
The bio-medical waste need to be segregated into container/bags at the point of generation in accordance with Schedule-II, prior to its storage, transportation, treatment and disposal. The container shall be labeled according to Schedule-III.
Every occupier of an institution, generating, collecting, receiving, storing, transporting, treating, disposing and/or handling bio-medical waste in any other manner, shall make an application on Form-I along with the following fee structure to the Delhi Pollution Control Committee for grant of authorisation (Table 21.3).
The Form-I can be obtained after paying an amount of Rs. 100/- in the form of Draft in favour of DPCC. It can also be downloaded from this web site but an additional draft for Rs. 100/- in favor of DPCC may also be attached with the application at the time of submission of application.
An operator of bio-medical waste facility may also engage in transportation of bio-medical waste on payment of additional fees prescribed for a transporter of bio-medical waste. An application in Form-I appended to the aforesaid rule shall be made to the prescribed authority i.e. the Chairman, Delhi Pollution Control Committee, for grant of authorisation along with the checking of documents as given in check list, wherever applicable.
An authorisation shall be granted for a period of 3 years, including an initial trial period of one year for which a provisional authorisation will be granted. All authorisation shall be for a period of three years. Fee shall be payable for three years at a time. The above fee structure is subject to revision from time to time.
The Government’s notification No. F.23(522)/ 95-Env/99 dated the 6th July 1999, issued in pursuance of Rule 8(3) ibid shall stand superseded with immediate effect. An operator of a facility shall make an application form in Form-I with the fee as applicable for grant of authorisation.
In addition, they shall also submit an annual report to DPCC in Form-II by 31st January every year to include information about the categories and quantities of bio-medical wastes handled during the proceeding year and also maintain records related to the generation, collection, reception, storage, transportation, treatment, disposal, and/or any form of handling of bio-medical waste in accordance with rules and guidelines issued.
All records shall be subject to inspection and verification by the DPCC at any time. The transporter, operator of a facility shall label the Bio-Medical strictly in accordance with the procedure given in Schedule-IV.
The defaulting hospitals/nursing homes etc. are liable to be penalized as per the provisions of Environment (Protection) Act, 1986 and other pollution control Acts.
Any person aggrieved by an order made by the DPCC under these rules may within thirty days from date on which the order is communicated to him, prefer an appeal to the Financial Commissioner, Govt. of NCT of Delhi who is appointed as Appellate Authority under the rules.
With the objective to provide the common facility as envisaged under the rules Delhi Pollution Control Committee has authorised the operator of a facility who collects, transports, treats and disposes the waste in accordance with the provisions of the rules.
At present Delhi Pollution Control Committee has authorised three such operators of a facility out of which one of the operator of a facility namely M/S India Waste Energy Development Ltd authorisation had been cancelled by Delhi Pollution Control Committee and the matter is sub-judicial in the Hon’ble High Court of Delhi.
The names and addresses of the two other operators authorised by Delhi Pollution Control Committee are given below:
1. Metro Bio Care Technological Services (P). Ltd.,
55, Railway Road, Samaipur Industrial Area,
Phone No. 2789 8011/8033, 2786 6142
2. Synergy Waste Management (P) Ltd.,
Near Compost Plant, Okhla Tank
Mathura Road, New Delhi-110 020,
Phone No. 2693 3371/3372
In Delhi according to the records available as per the ANNUAL REPORT submitted by the individual hospitals and also by the operators of a facility 22446 kg/day waste are generated.
In Delhi besides these two operators of facility, a number of Government and private hospitals have installed their own waste disposal facilities in their hospitals for disposal of the waste generated. At present as per records in Delhi 11 incinerators, 18 autoclaves and 2 microwaves are in operation.
Besides this, a Government facilitated operator is in the process of installing the facility at Okhla, which is expected to come in 6 months time.
In Kolkata, M/S SEMB RAMKEY was entrusted for biomedical waste management on payment basis.
Cost of Biomedical Waste Management:
The cost of construction, operation and maintenance of system for managing biomedical waste represents a significant part of overall budget of a hospital if the BMW Handling Rules 1998 have to be implemented in their true spirit. Govt. of India in its pilot project for hospital waste management in Govt. hospitals has estimated Rs. 85 lakh as capital cost in 1000 bedded super speciality teaching hospital which includes on site final disposal of BMW.
Two types of costs are required to be incurred by hospitals for BMW. Two types of costs are required to be incurred by hospitals for BMW mgt., internal and external. Internal cost is the cost for segregation, mutilation, disinfection, internal storage and transportation including hidden cost of protective equipment. External cost involves off site transport of waste, treatment and final disposal.
Common Regional Facility for Final Disposal of Infectious BMW:
Hospitals, private practitioners, emergency care centers though aware of the Rules do not have the time or resources to arrange satisfactory disposal of biomedical waste. Self contained on site treatment methods may be desirable and feasible for large healthcare facilities. They will not be practical or economical for smaller institutes.
An acceptable common system should be in place which will provide free supply of colour coded bags, daily collection of infectious waste, safe transportation of waste to off site treatment facility and final disposal with suitable technology.
A study was conducted at the following hospitals:
A. Semi Govt. teaching hospital with/having 540 beds
B. Charitable trust hospital with/having 540 beds
C. Govt. hospital (state run hospital) with/ having 1296 beds
D. Private Hospital with/having 223 beds
E. Govt. hosp. (service hospital) with/having 1047 beds
Keeping in view the infrastructural requirement for BMW management and adherence to BMW Rules 1998, total cost in terms of capital cost as well as operational cost (per month) was worked out for BMW management.
Methods of storage and segregation at ward/department level, internal transportation, kerb side storage, external transportation and on site final disposal/off site disposal were studied for all 5 hospitals by direct observation and infrastructure for the same was studied. Informal discussion with various hospital functionaries was carried out. Common regional facility for final disposal of infectious waste was also studied.
Total cost of BMW management at each hospital in terms of capital cost and recurring expenditure is depicted in Table 21.4. Hospital E is following BMW Rules in totality, and hence has incurred high capital costs. Recurrent expenditure was found to be less in Hospital C vis-a-vis the quantity of waste due to non adherence to BMW Rules.
It was observed that Govt. service hospital where BMW management was implemented as per BMW 1998 Rules had process of segregation of waste at generation level into various colour coded bags and plastic drums, internal transportation of waste through trolleys to kerb site, storage at kerb site in various colour coded metallic drums, movement of plastic disposable waste to plastic shredders and transportation of infectious waste to on site incinerator was found to be completely in place.
Safai karmacharis were using complete protective equipment like gloves, masks, shoes etc. while handling waste and also sodium hypochlorite was available in each and every sharp generating site in wards as well as departments. The capital and recurring cost worked out for complete process thus was found to be high as compared to other hospitals as other hospitals had some shortcomings at every step of BMW management.
Plastic waste receptacles of different colour codes were being used in other non Govt. hospitals without any consideration of rules. However, all these hospitals were collecting infectious waste into yellow colour coded bags (biodegradable) provided by Image India, a central facility. No plastic bags were being used for lining plastic buckets/receptacles for other type of wastes and other waste was being collected in single container.
All the 3 hospitals were using needle destroyers for disposable needles. Plastic IV bottles, catheters and disposables were being mutilated physically and then either were sold to contractor or donated. Hospital B, a private hospital was utilizing facility of onsite incineration for infectious waste disposal. Incinerator was found to be twin chambered oil fired with regular checks from pollution control board.
Hospitals A and D were sending their infectious waste to central facility of incineration. No hospital safai karmacharis were found to be using complete protective equipment, some of them were using latex gloves. In hospital A, waste destined for incineration is physically checked by laying out the waste and manual segregation is carried out which can result in injury to health care workers and should be avoided at any cost.
Sodium hypochlorite is being very sparingly used and fresh solution was not available at most of the hospitals. State run hospital was having plastic buckets of assorted variety at ward and department levels for waste collection, however, most of them were in broken condition and no replacement was provided. Use of hypochlorite solution for sharps was non-existent.
Proper segregation was not being carried out. Plastic waste was taken by rag pickers and sold to contractors at hospital waste dump itself. Trolleys for transportation of waste were being used for other purposes like carnage of linen and stores etc. Needles were being destroyed at source, however, most of the needle destroyers were non-functional and physical mutilation was being resorted to, which can prove to be dangerous for Health Care Worker (HCW).
Onsite incinerator is available and is oil fired double chambered type of very old vintage, however, it remains non-functional most of the time resulting in all the infectious waste finding its place in main municipality dump. Local municipal body as well as State Pollution Control Board do not check existing waste disposal arrangements of this hospital.
This city has implemented common regional facility for final disposal of biomedical waste generated by health care establishments. It has appointed M/s Image India to offer the services of handling BMW on pay and use basis.
The services include provision of bags, collection of bags containing infectious waste from all the hospitals with more than 20 beds, their transportation to the incinerator site, its incineration and final disposal of ash. They are collecting infectious waste from 446 Nursing Homes/Hospitals all over the city.
Approximately 1000 kg per day collection of waste is made with the help of two modified Tata 407 trucks. Three incinerators of twin chamber variety with approved chimney size with a total capacity of 40 kg/ hr burning capacity each are functional. They are charging Rs. 20 Kg of waste. Billing is done through municipal body and facility is being monitored by Municipality/State Pollution Control Board regularly.
Municipal Corporation/State Pollution Control Board checks only common waste facility. Nursing Homes/Hospitals registered with this facility are under constant scrutiny and are punished by levying fine, if any disposable plastic/sharps are found in yellow bags leading to forced re-checks of their waste which can result in injuries to HCWs.
Other Nursing Homes, Dental practitioners, Hospitals, research facilities and private practitioners continue to dump their waste into main municipal garbage. Use of central incineration facility should be made compulsory for those hospitals who have defective incinerators as they are a source of pollution.
Biomedical Waste Management in West Bengal:
Since 1998, Biomedical Waste Management rules were implemented in Hospitals, Health Centre, Clinics and Nursing Home. Initially State Pollution Central Broad and Calcutta Corporation authority. Latter specified agencies are entrusted for the disposal of biomedical waste. The status of compliance of health care units in West Bengal are given in Table 21.5.
(i) Common Bio-Medical Waste Treatment and Disposal Facilities by Private Operator: Considering 80 per cent of the total capacity are being utilised, these facilities cover 80,000 beds.
The facilities are:
1. Howrah: M/s Semb Ramky Environmental Management Pvt. Ltd. (capacity 30,000 beds/day);
2. Kalyani: M/s Medicare Incin Pvt. Ltd. (capacity 30,000 beds/day);
3. Haldia: M/s West Bengal Waste Management Ltd. (capacity 10,000 beds/day); and
4. Asansol: M/s Medicare Incin Pvt. Ltd. (capacity 30,000 beds/day).
(ii) Common Bio-Medical Waste Treatment and Disposal Facilities under the West Bengal Health System Development Project (WBHSDP), Health Department, Government of West Bengal
1. Kalyani: JNM Hospital, Kalyani (Autoclave: capacity 50 kgs/cycle) covering 998 beds within Kalyani Municipal areas; and
2. Diamond Harbour: Diamond Harbour Sub-Divisional Hospital (Microwave) covering 200 beds within Diamond Harbour Municipal areas.