BIO-MEDICAL WASTE MANAGEMENT

Bio-Medical Waste Management in North-Zone

The hospitals and bio medical facilities meant to ensure better health have unfortunately become a potential health risk due to mismanagement of the infectious waste. Realizing this, Ministry of Environment and Forests, Govt. of India notified the rules, called Bio-Medical Waste (Management and Handling) Rules, 1998, which has come into force since July 27,1998.

Bio-medical waste from hospitals, nursing home and other health centers composed of variety of wastes like hypodermic needles, scalpels blades, surgical cottons, gloves bandages, clothes, discarded medicine, blood and body fluids, human tissues and organs, radio-active substances and chemicals etc. This area of waste management is grossly neglected.

The situation of bio medical waste management in entire north zone is pathetic. In Punjab a common facility has been developed to cater to the cities of Ludhiana,Jallandhur,Patiala and Amritsar. In Haryana clearance have been given for a common facilities, which however is yet to be developed. In H.P out of total 10 incinerators installed one each at Shimla and Paonta Sahib is also working as common incinerators for the hospitals in that region. In U.P. only 5 common facilities have been so far developed and few more are in process.

The common facilities at Ludhiana in Punjab and in Kanpur are comprehensive as stipulated in the Act but at other places common facilities are mainly having incinerators as treatment facility. Segregation is the most neglected aspect and progress on this part paint dismal picture.

In order to effectively implement the bio-medical waste management rules a comprehensive survey and monitoring was undertaken at various hospitals in Uttar Pradesh. In all thirty-three medical establishments were inspected and monitoring conducted for incinerators which are installed as per norms.

Status of incinerators in individual medical establishments and common facilities are as below:

Single chamber incinerators : 10

Double chambered incinerators with
Inadequate stack height : 07

Incinerators installed but not commissioned : 04

Bhatti type facilities : 04

Observations

· The segregation of waste in almost all hospitals is not satisfactory.

· Colour coding for various categories of waste is not followed.

· The storage of bio-medical waste is not in isolated area and proper hygiene is not maintained.

· Personal protective equipment and accessories are not provided.

· Most of the hospitals do not have proper waste treatment and disposal facilities. In the cities where common treatment facilities have come up, many medical establishments are yet to join the common facility.

· Emission monitoring of five incinerators indicated that they do not meet the emission norms.

· Most of the incinerators are not properly operated and maintained, resulting in poor performance.

· Sometimes plastics are also incinerated leading to possible emission of harmful gases.

· Several hospitals have not applied to State Pollution Control Board for authorization under the rules.

· General awareness among the hospital staff regarding bio-medical waste is lacking.

Recommendations and Follow-up

· All health care facilities generating Bio-medical waste shall strictly ensure segregation, colour coding and other provisions of Bio-medical waste (Management & Handling) rules, 1998 and amendments thereof.

· Hospitals should apply to state Pollution Control Board for authorization to handle and treat the waste.

· Incinerators, which do not conform the design & emission norms as per rules, must be modified and air pollution control system may be retrofitted to minimize the emission level.

· The operator should ensure proper O&M of incinerator through attainment of required temperature in both the chambers, regular operation of the incinerator, proper maintenance of the logbook and storage of the waste in isolated area, plastic incineration should not be undertaken.

· Proper training and personal safety equipment / accessories should be provided to waste handling staff.

· Records of waste generation, treatment and disposal should be maintained by the hospital.

· Steps should be taken to set up common bio waste treatment facility in each city/town with strict monitoring of these facilities by regulatory agency and individual facilities should be discouraged. This is on account of the fact that improper operation may lead to increase in air pollution problem. Better siting, management and monitoring is possible in common facilities only.

· The amounts changeable for the waste in most of the common facilities are for below the minimum O&M cost. This needs to be rationalized else it may lead to non-operation of facilities.

· Various regulatory agencies, Hospitals, Medical Association & Municipal Corporation should work together for proper management of Bio-medical waste in the cities/towns.

Action has been initiated against 3 medical colleges (KGMC, Lucknow, GSVM, Kanpur and JLN Medical College, Aligarh) having bed capacities more than 1000 that do not manage the bio-medical waste as per rules. Steps are also being taken against other hospitals, which do not follow the rules and operate the incinerators, to meet the emission norms.

A project on 'Model Segregation Practices' was also completed in Vivekanand Polyclinic, Lucknow and in Govt. Medical College Jammu for practical demonstration of segregation of bio-medical waste in bio-medical waste management.

Bio-medical Waste Management in Himachal Pradesh

The Himachal Pradesh State Environment Protection & Pollution Control Board has conducted study in major hospitals. It has been decided to set up the demonstration model named Dr. Rajinder Prasad Govt. Medical college & Hospital at Dharmshala with following objectives;

· Assessment of existing waste management practices.

· Classification, quantification & characterization of waste streams.

The hospital is having 258 beds and equipped with all the medical facilities like Emergency, Maternity, Gynecology & Child wards, ENT Deptt., Surgical, Orthopaediatric, OPD, Blood Bank and other radiological facilities. The quantity of bio-medical waste generation is estimated to be 100 kg/day. Besides this 30 lit./day of liquid waste is being generated from washing of laboratories and kitchen. As per the data, per bed waste generation is estimated as 380 gm/day. Major contribution is from disposable, waste sharp and soiled waste. The following methods are adopted in the hospital;

· Provisions of needle destroyer in some wards. Discarded needles and syringes are rarely destroyed and disinfected.

· The transportation of waste by hand lifting in the bins or gunny bags.

· Final treatment of waste by incineration.

Lack of awareness amongst the hospital staff including doctors towards the segregation of infectious waste is one of the main reasons for mismanagement of Bio-medical waste in the hospital. Mass awareness programme for management of bio-medical waste should be carried out at regular interval.