The hazardous and toxic by products of bio-medical waste from healthcare establishments, which usually comprise infectious bio-medical and radio-active material as well as sharps (hypodermic needles, knives, scalpels, etc.), constitute a grave risk. If not addressed, treated or disposed off properly, and if allowed to mix with other municipal waste, the results can be hazardous not only to health but also to the environment at large.

Bio-Medical waste

Bio-medical waste (BMW) is any waste that includes any solid and/or liquid waste including its container and any intermediate product generated during the diagnosis, treatment or immunisation of human beings or animals or in research, production and testing of these. The proper management or treatment of biomedical waste has become a worldwide humanitarian topic.

According to the Draft BMW (Management and Handling) Rules, 2011, every occupier of a healthcare establishment (HCE) must either set up requisite bio-medical waste treatment facilities like autoclaves, microwaves or hydroclaves; shredders or any other technology as approved by the Central Pollution Control Board (CPCB) or Ministry of Environment and Forests (MoEF). These facilities should be used to treat bio-medical waste generated in the premises as part of on-site treatment of the institution, prior to commencement of its operation. They can also be used to ensure requisite treatment of bio-medical waste at any approved waste treatment facility.

Diseases and their victims

Inadequate BMW management may cause environmental pollution; multiplication of vectors; and may lead to the transmission of diseases like typhoid, cholera, hepatitis and AIDS. Various communicable diseases, which spread through water, sweat, blood, body fluids and contaminated organs, must be prevented. The BMW scattered in and around the hospitals invites flies, insects, rodents, cats and dogs that are responsible for spreading epidemic disease like plague and rabies. Also, it may exacerbate the health conditions of patients admitted in these hospitals.

BMW is also a potential health hazard to the healthcare workers who come in direct contact while treating or transporting it. The major issue with BMW management is the implementation of bio-waste regulations. Many hospitals still dispose waste in a haphazard, improper and indiscriminate manner. Lack of segregation practices results in mixing of hospital waste with municipal waste making the entire waste stream hazardous and leading to an incorrect method of waste disposal. In fact, Bruhath Bengaluru Mahanagara Palike (BBMP) recently netted Rs. 2.02 lakh in penalties from nursing homes, clinics and hospitals that failed to follow BMW norms in the city. It is mandatory for such establishments to tie up with an authorised agency to dispose of medical waste.

Furthermore, rag pickers who are responsible for sorting the waste are at high risks of contracting tetanus and HIV infections. The recycling of disposable syringes, needles, IV sets and other articles like glass bottles without proper sterilisation can lead to Hepatitis, HIV and other viral diseases. Hence, it becomes the primary responsibility of health administrators to manage and treat hospital waste in the safest and most eco-friendly manner.

Managing BMW

One of India’s major achievements may be the changing attitude of healthcare operators to incorporate better BMW management practices in their daily operations and to purchase on-site waste management services from the private sector. Take for instance, Thane, a city in Maharashtra that generates around 1,100 kg of BMW per day. Over time, several entities have aided in the successful management of BMW – of which Enviro Vigil is one.

Enviro Vigil was established with an SWM awareness campaign on segregation of waste and soon took on BMW management when approached by the Thane Municipal Corporation. Prof. V. A. Walavalkar, Director, Enviro Vigil says, “The five directors of our NGO invested some money and time to work for the society and environment. Having attended many seminars and conferences, we went to the core of the subject of BMW and now run 21 big and small projects in the district.” Enviro Vigil’s efforts have been recognised for its contribution in managing and treating BMW and is the first ISO certified organisation to do so (it has now been upgraded to ISO:2008 and aims to achieve an ISO:14000 certification).

The process

Enviro Vigil’s role in collecting, treating and disposing BMW begins with a one-to-one contract. The organisation has around 10 vehicles and a driver and helper per vehicle assigned to collect the segregated waste and deliver it to the facility centre. Interestingly, every vehicle has a GPS satellite for the authorities to keep a watch on their activities. The collection begins from around 5 a.m. and ends by late evening around 8 p.m. The satellite helps locate the vehicles and prevents any pilferage of waste. As Walavalkar informs, Enviro Vigil is the first organisation to put GPS tracking on its vehicles along with six cameras in the facility. This also gives the authorities access to the activities of the facility.

Once the segregated waste is brought to the facility, the highly contagious waste (like body parts or cotton soaked in body fluids) is burnt and turned into ash. Plastic, metal and glass is then separated in three different containers. While plastic is first sent for autoclaving, shredding and then for recycling, glass and metal is collected and after chemical treatment sent directly to the secured landfill. According to Walavalkar, “As an alloy, metal cannot be utilised for any further process. It is too costly to recycle, too; hence it is burned electrically and then disposed of.” Even medicines, which are usually burnt out should practically have a proper disposal system. Walavalkar adds that all pharmaceutical companies should come out with a disposal method for medicines (responsibility of taking expired medication back.). Like distributorship there should be collectorship.

The final destination

Enviro Vigil treats all the segregated waste that it collects in an incineration plant on its premises. The plant has an online monitoring system that keeps a check on the working of the plant. Walavalkar says, “Incineration which produces lots of smoke may pollute the air, so a treatment at this level is necessary. The chimney has an indicator that senses the presence of pollutant gases in the smoke, detects any malfunctioning in the machine, the amount of water, air supply, etc and gives out a warning signal.” In fact, Enviro Vigil’s is the only facility that has been equipped to help the Maharashtra Pollution Control Board to allow them to study the microbial content in the air.

Once the waste is treated, all the BMW goes to secured landfills where Enviro Vigil has to pay Rs. 70 to 80 per kg of treated waste(incinerated ash, waste sharps, etc.). Walavalkar says, “It’s a costlier affair but a systemised one. The segregated waste that we incinerate, releases ash as a by product, which is then disposed off in a secured landfill in Navi Mumbai near Turbhe.

Situation in Thane

In India, given the climatic conditions and environment, any BMW becomes inhuman to touch and poses a threat to those that come in contact with it. The waste should ideally be treated within 24 hours, but this increases the cost of the whole process from collecting to disposal. Despite this, Walavalkar informs that there are a few doctors who do come with their staff to attend the organisation’s conferences and follow the process of proper BMW management.

Hazards of poor management of BMW have aroused concerns the world over, especially in the light of its far-reaching effects on humans, health and the environment. The physio-chemical and biological nature of these components, their toxicity and potential hazard differ along with the various methods or options for their treatment or disposal. It, therefore, becomes necessary to understand the kind of waste generated, the environment and the technologies applicable before attempting to manage the BMW