Biomedical Waste Management during pandemic – Explained, Pointwise

Introduction

Prior to the pandemic, India’s biomedical waste management capacity was already limited. Now, with the advent of the pandemic, biomedical waste generation has increased manifold. CPCB has given guidelines to discard the biomedical waste generated in Covid-19 camps and Covid-related material such as gloves and masks in households. However, the implementation of the guidelines is limited as local bodies are not equipped to handle biomedical waste, and even the public doesn’t have enough knowledge about segregating it. All this is leading to the piling up of biomedical waste.

According to the environment ministry, nearly 146 tonnes of biomedical waste is generated per day in the country due to diagnostic activities and treatment of Covid-19 patients. Since India is fighting with the second wave of Covid-19 and still producing and using numerous masks, Personal Protection Equipments, etc. the medical waste generation is going to increase further. So, India needs practical solutions to tackle this silent menace created by the pandemic.

Biomedical waste generation during the pandemic

1. According to the Indian Medical Association (IMA), the quantity of Biomedical wastes generated per day in the country has almost doubled from 7.22 lakh kg in pre-Covid times to nearly 14 lakh kg now. This rise in waste generation is directly related to the number of Covid-19 cases in the country.
2. The IMA also noted that the per-bed Biomedical waste generation was 250 grams per day before the pandemic. But today, per-bed Biomedical waste generation is around 400 grams per day.
3. The majority of biomedical waste generated during the pandemic is related to Covid-19 treatment. Such as personal protective equipment (PPE), gloves, face masks, head cover, plastic coverall, hazmat suit, syringes, and other medical equipment used by both healthcare providers and patients.
4. According to scientists, these biomedical wastes will take thousands of years to biodegrade. During the process, they will also release tonnes of microplastics into our environment.

To tackle this menace the CPCB even launched a COVID19BWM App to track biomedical waste.

What is biomedical waste?

In simple terms, it means any waste generated during diagnosis, treatment, or immunization of human beings or animals or in research activities. Management of biomedical waste is an integral part of infection control and hygiene programs. Without proper treatment, these medical wastes can create an adverse impact on the environment and public health.

Only about 10% – 25% of BMW is hazardous, and the remaining 75%–95% is non-hazardous. So, the segregation of biomedical waste is the key to its management.

Biomedical waste management rules in India

In July 1998 the government of India notified the biomedical waste management rules. There was modification of rules in 2000, 2003, and 2011. But the 2011 medical waste management rules remained as a draft due to a lack of consensus on categorization and standards.

After the consensus and standardization, the Indian government released Biomedical Waste Management rules in 2016. The salient features of this rule are,

1. Expansion of the ambit: The scope of the rules have been expanded to include various health camps such as vaccination camps, blood donation camps, and surgical camps
2. Role of State governments: The State Government has to provide land for setting up a common biomedical waste treatment and disposal facility (CBMWTF). Apart from that, the State government will also have to set up a district-level committee (This committee shall submit its report to the State Pollution Control Board every 6 months).
3. Segregation: Biomedical waste has been classified into 4 categories instead of the earlier 10 categories. This is to improve the segregation of waste at the source.
   • Yellow – This includes post-operated body parts, caps, masks, pathological wastes, bedding, placenta, plaster of Paris, etc
   • Red – This includes syringe, IV Sets, catheters, gloves, urine bags, blood bags, dialysis kits, etc
   • White – This category contains waste sharps including needles, syringes, etc.
   • Blue – This category contains glassware and metallic body implants
4. Role of health care facilities: The health care facilities have a larger role in medical waste management. Such as,
   • Compulsory pretreatment of the laboratory, microbiological waste, and blood bags before disposal
   •  Phasing out chlorinated plastic bags, gloves, blood bags, etc
   • Maintaining a registry of biomedical wastes generated in their facility and updating them daily.

Biomedical waste management practice in India

1. The management of Biomedical wastes begins at the bedside of the patient. The hospitals categorize, segregate, pre-treat, and dispose of the medical waste in different containers.
2. As per the 2016 rules, these wastes have to be treated and disposed of by Common Bio-medical Waste Treatment and Disposal Facility (CBWTF).
3. In case, there is no CBWTF within the reach of a healthcare facility, then such healthcare facility should install a captive treatment and disposal facility.

According to the government data, India had 200 authorized CBWTFs in 28 States in 2020 for the environmentally safe disposal of biomedical waste. The remaining states do not have such facilities.

As per official government data for 2018, India generated 608 tonnes per day of Bio-medical Waste. Of that, 528 tonnes of waste was treated and disposed of properly. So, every day there are few tonnes of biomedical waste that went untreated. The impact of Covid-19 also affects the waste handling capacity of CBWTF and captive treatment centers.

Effects of biomedical waste in India

Pollution and health hazards are the two important impacts of medical wastes.

Pollution due to biomedical waste

1. Land Pollution: If not treated and dumped into landfills then there is a high chance for heavy metals like cadmium, lead, mercury, etc. get released. Further, there is a chance these metals get absorbed by plants and can then enter the food chain also.
2. Air Pollution: Pathogens present in the waste can enter and remain in the air for a long period in the form of spores or pathogens. As the Covid-19 spread through the air, improper treating/not treating it might lead to a new wave of Covid-19.
3. Radioactive pollution: Hospitals are increasingly using radioactive isotopes for diagnostic and therapeutic applications. The main radioisotopes used in hospitals are technetium-99m (Tc-99m), Iodine-131(I-131), etc. This radioactive material can come from research laboratories, ICUs in liquid form. These have carcinogenic properties.

Health hazards due to biomedical waste

1. Spread of infectious diseases: According to the WHO study, improper waste management is one of the major causes of an increase in infectious diseases globally. This is why the Covid-19 pandemic wastes require proper treatment.
2. Operational health hazards: Improper handling of biomedical waste might lead to Injuries from sharps and exposure to harmful radioactive wastes. This will create issues for nurses, emergency medical personnel, sanitary workers.
3. Increase antimicrobial resistance (AMR): The biomedical wastes aggravate the problem of AMR. Ever since the pandemic, the use of biocides (sanitizers, disinfectants, and antibiotics) increased manifold. If there is no proper treatment of biocides then the AMR will increase rapidly.

Suggestions to improve biomedical waste management

1. Improving the sustainability of the health care sector: The government has to move beyond monitoring and enforcement. Instead, the government has to invest along with the health service providers to scale up the proper treatment of biomedical waste.
2. Equipping Municipalities and Panchayats: The government has to provide training to ground-level workers to segregate biomedical wastes. Further, the government can even allot sufficient funds through central funding from National Rural Health Mission (NRHM).
3. Stringent actions against defaulters: The ill-operated health care facilities and CBWTFs have to be strictly punished. The government can even initiate the Extended Producer Responsibility (EPR) for producers of biomedical equipment.
4. Trigger Innovation: The government can incentivise start-ups and Small and Medium Enterprises (SMEs) that offer solutions for waste segregation and treatment.
5. Awareness campaigns for waste segregation in households: Due to home quarantine and home treatment many individuals do not use yellow and red color bags for segregating their medical wastes. So, during the supply of medicine, the health officials have to create awareness about waste segregation. They should also provide garbage bags(Red and Yellow) along with their medicines.

Conclusion

With the opening-up of vaccination for all above 18 years, the volume of infectious waste generated from the vaccination clinics will increase manifold. So, the government has to ensure proper awareness regarding waste segregation, and  creation of proper facilities to treat the medical waste in India.