Biomedical waste: An unseen threat

Bangalore Capstone City COVID-19 Environment Government Health

Unregulated biomedical waste contributes to rising environmental hazards, say experts. Citizens demand biomedical waste management plants be relocated outside municipal borders.

Gayatri finds herself in a state of confusion as she notices that the regulation of biomedical waste treatment is being violated at hospitals. “If we want to find out the real truth about biomedical waste, you need to walk straight to the Sewage Treatment Plan (STE) of a hospital and see it,” she said.

Gayatri Handanahal, lead organiser, of Reimagine Waste, a waste management organization said that the unregulated disposal of Biomedical Waste (BMW) in Bengaluru has many environmental consequences and adds to the city’s rising pollution. “I have worked on this waste management programme for many years, and we have run hackathons to manage the waste. We have also worked inside the city and gained a good amount of knowledge regarding this,” she said.

Many people do not follow the waste management process properly. The biomedical treatment plan is a big process which consists of several steps. It starts with the collection of waste and then the waste is put in the treatment plant. From hospitals to waste management systems, no one follows it perfectly. BMW is 30 per cent more than what government data shows, she added.

According to a report on BMW generation, Karnataka is the fifth-largest producer of biomedical waste. It was also shown that hospitals in Bengaluru create more biological waste than what is recorded.

Ramesh D Nayak, Senior Environmental Officer (SEO), Karnataka State Pollution Control Board (KSPCB), said that Karnataka generates 82,604 kg of biological waste from around 41,709 healthcare institutions every day. Even though the board is yet to collect the recent numbers, board sources indicate that Karnataka created 14,000 kg of COVID biological waste in June 2021. 

A study on the impact of biomedical waste on the environment and human health states that bio-medical waste is separated first in healthcare institutions. A colour-coding process involving red, yellow, and blue bags is adapted for the segregation process. The mouths of these bags are closed by the health care institutions after which the waste is transported to the treatment plants in special vans.

Biomedical Waste Management: Segregation of Hospital Bio-Medical Waste

Dr Suresh Babu, Medical Oncologist, MACS Clinic, Jayanagar, said that he separates the waste into distinct containers. “When the biomedical waste management employees arrive in the morning, we deliver it to them. Most of the time in clinics, there is an only primary (non-hazardous) waste since clinical analysis is performed before any secondary therapy is performed. If we find that it is serious after evaluating the records, we will strongly encourage them to contact a specialist at the hospital,” he added.

Dr Nitin Manjunath, facility director, Narayana Hrudalaya Hospital, said, “Biomedical waste (BMW) is charged on a per-bed basis. During COVID, they charged more than Rs. 53 per kilogramme, up from Rs. 7 earlier. Managing the volume of biological waste generated in our hospitals is the most difficult challenge. We normally have waste management limitations in place, such as generating 750 grammes per bed each day. However, we are presently generating 1 to 1.5 kilograms of BMW each bed.”

His hospital had done 750 heart surgeries in the previous year, and a large amount of BMW is produced both during and after these sorts of procedures, he added.  The BMW generation will be more when more dressing is needed.

An overview of the Biomedical Waste Management.

Importance of segregation:

Dr K Ravi Babu, Chief Administrative Officer, Vydehi Hospital, said that they segregate the biomedical waste at the source level.

“If we do not segregate the biomedical waste at the source level, we will lose our National Assessment and Accreditation Council (NAAC) and Access, Assessment, and Continuity of Care (ACC) certification. We are required to monitor all biomedical waste by the regulations. If we do not manage it effectively, we will be fined by Karnataka State Pollution Control Board (KSPCB).” 

He added that they have a website where they must update the amount of bio-waste generated per day and then submit a link to the KSPCB. So, every day, they weigh the bio-medical waste and post the results on the website (or app), and the KSPCB keeps track of it.

Dr N Vijaya Lakshmi, the quality coordinator at Vydehi Hospital, said, “Our hospital has 1600 beds in total. Every bed has its waste can. Our nursing staff takes care of everything, sorting it into coloured containers and storing it till the biomedical waste management crew arrives in the morning to pick it up.”

Their hospital generated 29,499 kg of biological waste in the fiscal year 2020, with red bins accounting for 10278 kg, blue bins accounting for 3745 kg, yellow bins accounting for 14554 kg, and white bins accounting for 922 kg. She added that the total weight from June 2021 to June 2022 was 9117 kg.

Ratheesh Adukkadukkath, the hospital administrator at Santosh Hospital, said, “The biomedical waste is collected by our nursing team and stored in huge containers. Every morning, biomedical waste collectors will collect it from the large bins. We collect biomedical waste three times per day in the critical area, in the small containers every 48 hours, and patient side once or twice per day.”

But experts say that the process is not being followed properly all over the city. Handanahal said that according to KSPBC standards, there should be colour-coded dustbins outside the hospitals and instructions on how to dispose of biomedical waste.

“Many organisations, in my opinion, are not doing it. These regulations are not being followed by doctors and practitioners. When I visit hospitals, I look at the bins and how the garbage is disposed of, but I don’t see the hospitals following the guidelines. Also, the treatment plants should be located far away from communities so that people are not disturbed.”

She added that on some days, the generation of biomedical waste will be higher, and the incinerators may be unable to handle the volume of waste they receive. In such circumstances, biomedical waste management personnel usually dispose of the biomedical waste in a midway while travelling to the facility. Due to the city’s inability to discard all the biomedical waste as per the rules, it is usually disposed of improperly.

Risks for involved personnel:

Inadequate and unscientific management of biomedical waste is linked with risks to people who are directly and indirectly associated with this profession. As a result, these organizations’ poor waste management practices expose people to health risks. It also adds to the existing environmental issues. Hazardous compounds in the biomedical waste can damage the air, water, and land, producing health problems for residents. It is considered a source of contamination of land and water supplies if medical waste is not rendered harmless before being buried on land or disposed of in the water.

Mostly the workers working in the waste management plant are not educated, have not been immunized, and do not wear basic personal protection equipment. “Disposable latex gloves are often thin and provide little to no protection against sharp items. Hand-carrying medical trash in bin bags risks spilling hazardous or contagious liquids or injuring workers from protruding needles or other sharp things,” she added.

There was an increase in biomedical waste due to the Covid-19 pandemic. According to the Centre for Science and Environment’s analysis, India’s biomedical waste generation increased by 46 per cent from April to May 2021. However, CPCB’s report states that 15 CBWTFs out of 27 in Karnataka are not reporting the data on the dedicated waste management app.

Common Biomedical Waste Treatment Facilities (CBWTFs) and their app status.

According to the research on the impact of biomedical waste on the environment and human health, hospital cleaners and trash handlers are the worst sufferers of inadequate occupational safety practices. Many garbage handlers and cleaners are informal labourers who have no training to deal with the occupational hazards to which they are exposed.

Due to the lack of knowledge on the disposal process of biomedical waste citizens dispose of their biomedical waste with their normal household solid waste. Handanahal explained that the biomedical waste generated in homes is not properly disposed of. We all throw that waste into our dustbins, which are further carried out with municipal waste. Also, in other places, like these clinics, laboratories, and animal houses, BMW is not maintained properly. The waste should be segregated at the source itself only, but they never do it, Handanahal added.

Srinivas Gurram, an Electronic City resident, said that he has a patient with a skin problem in his house. “My mum is diagnosed with a skin condition. While the sickness was progressing, we had to change her wound dressings regularly. All of the rubbish that was placed into our house dustbins was also thrown into my dustbins, as did my medical waste and pharma medication.”

According to Dr Nitin, no one adequately handles BMW. “I don’t know how to dispose of the razor blade after shaving at home, so I bring it to the hospital and dispose of it there. Almost everyone throws their BMWs in garbage cans. That, however, is not so safe. Even if is small amounts, they must be managed appropriately.”

He added that the government should encourage individuals to dispose of their bio-medical waste at the local pharmacy, where it will be handled by biomedical waste management personnel. While burning the BMW these management people burn more than adequate waste for one incineration and that will again be a problem if it is not burned properly. Even this should be managed properly.

Even Ramesh D Nayak from KSPCB stated the same problem, “Residents’ disposal of sanitary waste has grown as well. This is frequently combined with household garbage. Even though some hospitals create more biological waste than others, no one controls it adequately,” he said.

He added that some hospitals and other medical institutions retain dried flowers and other non-biomedical waste in biomedical waste. Many waste management companies and hospital organizations were punished for inappropriate COVID waste collection, transportation, and disposal.”

Solutions on how to manage Biomedical Waste:

According to Handanahal, a suitable training programme should be created for workers to effectively handle biological waste in container handling, loading, and unloading processes.

Workers involved in this procedure should be given careful attention since they are frequently in danger of developing infectious illnesses as a result of inappropriate hospital waste disposal. Skin contact, injection, or inhalation can all lead to exposure. Inadequate sanitation of containers and plastic materials before recycling may result in the spread of infectious illnesses.

Ravi Babu said, “We ask our cleaners to wear the proper gear while segregating the biomedical waste, but sometimes we see our workers removing the gear as they feel uncomfortable while dealing with it. We always ask them to wear the proper gear as it will affect their families too.”

Process of how Biomedical waste is treated.

Possible hazards:

Untreated bio-medical waste must not be combined with other types of garbage. Bio-medical waste should be separated into containers or bags at the place of the generation before storage, transportation, treatment, and disposal. For any failure or violation of the regulations, legal measures under Section 15 of the Environment (P) Act, 1986 include imprisonment for up to five years or a fine of up to one lakh rupees or both.

If the violation continues, an additional punishment of up to Rs. 5,000 will be assessed for each day the violation continues. If the violation persists for more than a year from the initial date of contravention, the offender shall be punished with imprisonment for a term of up to seven years (as determined by the Honourable Courts).

“A few months ago, my pet Pablo was diagnosed with parvovirus, and around that time, my dog also harmed herself, and I had to bring the doctor to my home,” said Madhu Sree, a resident of Jaya Prakash Nagar. He used to come to my house and cure her, then give us the rubbish to dispose of in dustbins, which we would do.

Animal waste that comes out from veterinary facilities and homes is also a part of a large amount of biomedical waste generated. Dr Satya, a veterinarian, at Neha Veterinary Clinic, Yelahanka, New Town, said that animal waste is also considered biomedical waste. It should also be managed properly, but most of our doctors themselves won’t pay proper attention to it.

Some experts say that even though there are rules laid by the government, they are not followed properly.

Professor Krishna Raj, a climate expert, said that the medical waste rules are there, but the problem is that hospitals try to hide information. “So many times hospitals dump this waste by mixing it with municipal waste. It is entirely a case of bad governance. The hospitals are also not taking an interest, and the state is also not imposing rules properly. This reason leads to medical waste pollution. Everything like this causes climate change. There are new scientific methods available, but they are costly, so hospitals follow traditional methods, not scientific ones, even though the government says to do so. Hospitals are increasing in number, and the waste is also increasing. The government should also think about and regulate it for better impact. They should monitor it better,” he added.

According to Dr Yellapa Reddy, an environmentalist, at Bangalore Environment Trust, the hospital administration does not care about biomedical waste. They outsource it.

 He added, “A collector gets there and gathers it, which is then deposited without being separated. Nobody is concerned about the garbage. There is a legislation that stipulates the pollution control board should monitor it and take action if it is not discarded correctly in every hospital, but the committee has not been constituted. Members of the committee should observe how it is run.”

The majority of CBWTFs are located inside Bangalore. Many citizens, as well as our experts, believe that the treatment plants should be located outside the city limits. So that pollution in the city may be kept to a minimum.

Yellappa reddy said, “As the city expands on all sides, the plants that were located outside the city ten years ago are now occupied, and people certainly do not want to live near them. As a result, the government should be in charge of relocating these treatment facilities to areas outside of the city or outsourcing them to less populous areas. If breathed in, the smoke produced by these plants is dangerous to humans. As a result, it is preferable to relocate these treatment plants away from densely inhabited regions.”

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