Context

The National Green Tribunal has pointed out a huge lack of compliance of biomedical waste management rules across the country.
The tribunal has asked for the implementation of the framework, which emphasizes on strict adherence to the norms related to the maintenance, storage, and movement of Biomedical Waste Treatment.

What is Biomedical Waste?

Biomedical waste/hospital waste is any kind of waste containing infectious materials. It may also include waste associated with the generation of biomedical waste that visually appears to be of medical.

Hospital waste: It refers to all waste, biological or non‐ biological that is discarded and not intended for further use.
Bio-medical waste: It means any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biological and including categories mentioned in Schedule I, of the BMW rules, 2016.

Biomedical waste consists of-

Human anatomical waste like tissues, organs and body parts
Animal wastes generated during research from veterinary hospitals
Microbiology and biotechnology wastes
Waste sharps like hypodermic needles, syringes, scalpels and broken glass
Discarded medicines and cytotoxic drugs
Soiled waste such as dressing, bandages, plaster casts, material contaminated with blood, tubes and catheters
Liquid waste from any of the infected areas
Incineration ash and other chemical wastes

How is biomedical waste treated in India?

Autoclaving: The process of autoclaving involves steam sterilization. Instead of incineration, which can be expensive, autoclaving simply introduces very hot steam for a determined amount of time.
Incineration: The major benefits of incineration are that it is quick, easy, and simple. It effectively removes the waste entirely and safely removes any microorganisms.
Chemicals disinfection: When it comes to liquid waste, a common biomedical waste disposal method can be chemical disinfection. Chlorine is a regular choice for this process, and is introduced to the liquid waste in order to kill microorganisms and pathogens.
Microwaving: Microwave technology can also disinfect wastes. Wastes are first placed into a shredder. This wastes are mixed with water and internally heated that neutralizes present biologicals.
Irradiation: This method involves waste sterilization by exposing waste to cobalt sources. Cobalt emits gamma rays that kill all the microbes in wastes.
Shredding: It is a process by which waste are deshaped or cut into smaller pieces so as to make the wastes unrecognizable. It helps in prevention of reuse of bio-medical waste and also acts as identifier that the wastes have been disinfected and are safe to dispose-off.

Who deals with biomedical wastes in India?

Central Pollution Control Board: The CPCB has been following up with all SPCBs/PCCs to ensure effective management of biomedical waste in States/UTs.
National Green Tribunal (NGT): The NGT has been stringent on the application of the BMW 2016.
Common Bio-Medical Waste Treatment and Disposal Facilities (CBWTDF): There are now over 200 licensed CBWTDF or Common Treatment Facility (CTF) in India.

Salient Features of Biomedical Waste Rules, 2016

Compulsory pre-treatment: The method of sterilization/disinfection should be in accordance with National AIDS Control Organization (NACO) or WHO.
Phasing out plastic use: The use of chlorinated plastic bags, gloves, blood bags, etc. should be gradually stopped and this phasing out should be within 2 years from the date of notification of these rules
Safe disposal of Liquid waste: They need to be separated at source by pre-treatment before mixing with other liquid waste
Incineration guidelines: The existing incinerator should be upgraded/modified to achieve the new standard within 2 years from the date of this notification

Color coding of Biomedical wastes in India

As per Bio-medical Waste Management Rules, 2016, Bio-medical waste is required to be segregated in following color coded waste categories-

Red Bag: Syringes (without needles), soiled gloves, catheters, IV tubes etc. should be all disposed of in a red coloured bag, which will later be incinerated.
Yellow Bag: All dressings, bandages and cotton swabs with body fluids, blood bags, human anatomical waste, body parts are to be discarded in yellow bags.
Cardboard box with blue marking: Glass vials, ampules, other glass ware is to be discarded in a cardboard box with a blue marking/sticker.
White Puncture Proof Container (PPC): Needles, sharps, blades are disposed of in a white translucent puncture proof container.
Black Bags: These are to be used for non-bio-medical waste. In a hospital setup, this includes stationary, vegetable and fruit peels, leftovers, packaging including that from medicines, disposable caps, disposable masks, disposable shoe-covers, disposable tea cups, cartons, sweeping dust, kitchen waste etc.

International Agreement and Conventions

There are three international agreements and conventions which are particularly pertinent in BMWM. These are-

Basel Convention on Hazardous Waste: It is the most inclusive global environmental treaty on hazardous and other wastes. It has 170 member countries, and its objectives are to protect human health and the environment against the adverse effects resulting from the generation, management, and disposal of hazardous wastes, specifically clinical wastes from health care in hospitals, health centers, and clinics.
Stockholm Convention on POPs: It is a global treaty to protect human health and the environment from POPs (POPs – dioxins and furans). POPs are toxic chemicals that accumulate in the fatty tissue of living organisms and cause damage. These chemicals are formed by medical waste incinerators and other combustion processes. It deals with BEP including source reduction, segregation, resource recovery and recycling, training, and proper collection and transport.
Minamata Convention on Mercury: It is a global treaty to protect human health and the environment from the adverse effects of mercury. On October 10, 2014, in Japan, more than 90 nations signed the first new global convention on environment and health. This treaty includes the phasing out of certain medical equipment in health-care services, including mercury-containing medical items such as thermometers and blood pressure device.

Environmental impacts of Biomedical Wastes

Improper management of health care waste can have both direct and indirect health consequences for health personnel, community members and on the environment.

Toxin emissions: The most serious effect that biomedical waste has on our seas is the discharge of poisons into the waters that could then be consumed by ocean life creatures.
Food chain contamination: Toxins would interject into the food chain and eventually reach humans who consume sea creatures.
Plastic pollution: 85% of disposable plastic materials make up all medical equipment.
Groundwater Contamination: Deep burials of biomedical wastes may result in groundwater contamination.

Broader concerns with biomedical wastes

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

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.
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 Covid-19 spread through the air, improper treating/not treating it might lead to a new wave of respiratory syndromes.
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. These have carcinogenic properties.

Health hazards due to biomedical waste

Epidemic: 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.
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, and sanitary workers.
Increase antimicrobial resistance (AMR): 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.

Challenges in India

Increase in waste: In a highly populous country like India, there is a rise in residential biomedical waste and its collection without adhering to safety protocols could also trigger a surge in caseload.
Poor Compliance of BMW rules: States are not following the CPCB guidelines.
Non-segregation: In some states, improper segregation of waste has been reported.
Improper disposal: The non-segregation of waste results in the incineration of contaminated plastics producing toxic gases and adding to air pollution.
Lack of infrastructure: Currently, in India, there are only 198 CBMWTF in operation and 28 are under construction. .
No alternative to incineration: During incineration and post-combustion cooling, waste components dissociate and recombine forming new particles.

Why addressing this is important?

Preventing another pandemic: The COVID pandemic was the outcome of virus leak from Wuhan.
Uncontrolled outcomes: This has presented a challenge in terms of the capacity to scientifically dispose of generated waste and a challenge for civic authorities in charge of its collection and disposal.
Hazard to healthcare personnel: Without proper scientific management of such waste, it can potentially affect patients and can affect the concerned workers and professionals.

Way forward

Multi-stakeholder involvement: Proper management of Bio medical waste is a concern that has been recognized by both government agencies and the NGOs.
Stringent regulatory push: In order to accelerate the rate at which proper processing and management methods are designed, timely regulatory and legislative policies and procedures are needed.
Raising awareness: An effective communication strategy is imperative keeping in view the low awareness level among different categories of staff in the healthcare establishments regarding biomedical waste management.
Infrastructure push: The centre and states in liaison should set up recycling plants across the country as envisaged under the Smart cities project.
Proper collection: To properly separate, process and isolation of wastes, they must be well-characterized, which is challenging.
Safe disposal: Several hazards and toxic materials containing should be disposed-off with proper take and care.

Conclusion

Safe and effective management of biomedical waste is not only a lawful obligation but also a civil duty.
The current BMWM 2016 rules are an improvement over earlier rules in terms of improved segregation, transportation, and disposal methods, to decrease environmental pollution and ensure the safety of the staff, patients, and public.

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