Health Care Waste Management in India - Towards a Healthier Environment

 

N.T.Mary Rosana¹*, K.L.Vincent Joseph², S. Sowmiya¹

¹Department of Chemical Engineering, Rajalakshmi Engineering College, Rajalakshmi Nagar, Thandalam, Chennai-602105, India

²Department of S & H, Chennai Institute of Technology,Chennai- 600069,India

 

ABSTRACT:

The generation of solid waste is enormous in the present Indian Scenario. Though there are various developmental activities carried out to enhance the economy of India, the environmental pollution and accumulation of hazardous health care waste has had a major impact on the society. In the recent times, the handling and management of health care waste is an emerging concern among the sources responsible for generating hazardous waste. Improper management of these wastes may, in turn, result in occupational health risks and infectious surroundings. An initiative has been taken to analyse the sources, classification, legislative measures, handling and disposal technologies available for health care waste in India. This paper aims to promote awareness on hospital waste management among health care providers and emphasize their commitment towards a sustainable environment. It emphasises on the good practices to be followed by the hospital staff at the source.

 

 

 

1. INTRODUCTION:

India currently has the second largest population in the world and contributing to 17.6 % of the total world’s population¹. The ever-growing population, increased standard of living, and industrialization has contributed to the pollution of towns and cities in India. The fast-growing cities in India have failed to effectively manage the huge amount of waste materials generated^2,3. In India, most of the waste generated finds its way onto the open dump yards and roads, thereby contributing to environmental pollution and potential health hazard. Therefore, waste management is a very important term, which has attracted many academicians, environmentalists all across the globe⁴. In the recent times, there is a significant increase in the number of hospitals for treating the patients, with the proportional increase in the generation of healthcare waste to the environment.

 

The health care institutions, which are supposed to impart good health to the public, are turning out to be a source of contamination to the environment and human health⁵. It is reported that, according to the World Health Organization, out of the waste generated from health care activities, 75%-90% is considered as non-hazardous, and the remaining 10-25% consists of infectious, radioactive, and toxic materials which needs considerable attention. The mixing of these wastes with other municipal wastes may create lot of potential hazards to the people and environment. Therefore, good sanitation practices have to be followed to ensure a greener and a healthier environment⁶. It is reported that, in India, about 0.33 million tons of hospital waste is generated every year, and 0.5 – 2 kg of biomedical waste is generated per bed every day in hospitals⁷. Hospitals are definitely essential for human wellbeing, but the effective management of the hazardous waste generated, out of these activities, still remains a challenging issue. The prime objective of this article is to review about the health care waste generated from various sources, their classification, handling, transport, treatment and disposal technologies. It is anticipated that, this work may project a clear picture on the existing situations of handling health care waste and paves a way for the improvement.

 

2. Biomedical waste:

As per the Basel Convention, Wastes are defined as the substances, which are disposed of, or are intended to be disposed of, or are required to be disposed of, by the provisions of national law⁸. According to The Waste Management and Handling rules, 1998 of India, Biomedical waste is defined as any waste, which is generated during diagnosis, treatment or immunization of human beings or animals, in research activities, pertaining thereto, or in the production or testing of biologicals⁹. The Infectious and non-infectious wastes are generated from various sources, such as hospitals both government and private, private clinics, primary health centres, nursing homes, veterinary hospitals, laboratories, research institutes, etc¹⁰.

 

2.1 Categories of Biomedical Waste:

The following are the categories and components of biomedical waste, listed by the biomedical waste management and handling rules, 1998. Table 1 represents the various categories of biomedical waste.

 

Table 1: Categories of biomedical Waste ⁹

Category	Waste Content	Components	Treatment method and Disposal
1.	Human Anatomical Waste.	Human tissues, organs, body parts.	Incineration/Deep Burial.
2.	Animal Waste.	All types of Animal Tissues, organs, body parts carcasses, bleeding parts generated by all health units.	Incineration/Deep Burial.
3.	Microbiology and Biotechnology Waste.	Wastes from laboratory cultures, stocks or specimens of micro-organisms used in research	Local Autoclaving/Microwaving /Incineration.
4.	Waste Sharps.	Needles, Syringes, Blades, Glass, Scalpels.	Disinfections/chemical treatment/ Autoclaving/Microwaving/Mutilation Shredding.
5.	Discarded Medicines and Cytotoxic Drugs.	Out-Dated, contaminated and discarded medicines.	Incineration/ Destruction and Drug disposal in secured landfills.
6.	Solid Waste.	Blood contaminated cotton, Dressings, Soiled plaster Casts, lines, etc.	Autoclaving/Microwaving/ Incineration.
7.	Solid Waste.	Tubings, Catheters, Intravenous sets.	Disinfections/chemical treatment/ Autoclaving/Microwaving/Mutilation Shredding.
8.	Liquid Waste.	Waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities.	Disinfection by chemical treatment and discharge into drains.
9.	Incineration Ash.	Ash from incineration of biomedical waste.	Disposal in Municipal landfill.
10.	Chemical Waste.	Chemicals used in the production of biologicals.	Chemical treatment and discharge into drains.

 

Table 2: Infections caused by biomedical waste ¹¹

S.no	Infection Type	Pathogens	Transmission Path
1.	Infection in Gastrointestinal tract.	Enterobacteria.	Faeces and/or vomiting liquid.
2.	Infection in Respiratory Path.	Mycobacterium, Spectro coccus, Pneumonae	Respiratory secretions, saliva.
3.	Infection in the Eye.	Herpes Virus.	Eye secretions.
4.	Infection in the Genital Area.	Neisseria, gonorrhoeae herpes virus.	Genital secretions.
5.	Skin Infection.	Spectro coccus Spp.	Purulent secretions.
6.	Meningitis.	Neisseria Meningitides.	LCR.
7.	AIDS.	HIV.	Blood, Semen, Vaginal secretions.
8.	Anthrax.	Bacillus Antracis.	Secretions of skin lesions.
9.	Septicaemia.	Staphylococcus Spp.	Blood.
10	Viral Hepatitis type A.	VHA.	Faeces.
11.	Viral Hepatitis type B and C.	VHB, VHC.	Blood, Biological fluids.
12.	Haemorrhagic fevers.	Junín viruses, Lassa, Ebola Marburg.	Biological fluids and secretions.

 

2.2 Potential health risks of biomedical waste:

Improper and mishandling of biomedical waste may lead to adverse health effects on humans and environment. Among the health care workers, some of the groups exposed to health risks are doctors, nurses, maintenance staff, patients, skeletal workers, visitors and other service workers dealing with treatment and disposal. Table 2 provides a list of infections caused by biomedical waste generated from various sources.

Not only the occupational health hazards, improper disposal of biomedical waste on barren land, water bodies and municipal dustbins may also result in health hazards to general public and environment. Exposure to harmful gases from open burning, and emissions from incinerators, can cause cancer and other respiratory disorders. Plastic materials may choke the soil and reduce its fertility. Waste sharps are very dangerous, and cause injuries to the rag pickers, animals, etc. Heavy metal contaminants from biomedical waste sources can cause soil and water pollution. Therefore, biomedical waste has to be effectively managed in order to minimize the harm caused to the environment and public health.

 

3. Biomedical waste management process:

Effective management of biomedical waste is very essential in the present scenario. Though there are legislations framed by the government of India in this regard, lack of awareness about the health hazards, financial constraints, human resource constraints are some of the critical problems existing ¹².

 

a.    Training of the personnel in health care units:

For the successful implementation of biomedical waste management in hospitals and other health care units, the participation of all the staff involved plays a pivotal role. Health care personnel are at immediate risk of occupational health hazards, if the waste generated is mismanaged. Training Programs have to be conducted by the hospital management to create awareness among the doctors, nurses and other skeletal workers involved. Education and training have to be provided on regular basis. Sound Regulatory framework has to be used in association with other scientific efforts. The importance of biomedical waste management and its health impacts has to be clearly emphasized, in all stages, to every member of the community. Not only to the key personnel, awareness has to be spread to the patients as well through mass media¹³.

 

b.    Segregation of Biomedical waste:

It is the first stage involved in the biomedical waste management process. Segregation involves separating the different components of biomedical waste generated at the source to reduce the occupational risks associated. It has to be carried out based on the Schedule I of biomedical waste management and handling rules, 1998. Different coded containers or bags are to be placed at the points of generation, in order to facilitate employees and public safety. Additionally, this method need to be practiced to reduce the occupational health hazards associated with it. The bags/containers should meet certain specifications such as leakage proof, puncture resistant containers, to withstand the volume and weight of the waste to be treated. Table 3 provides information on the colour coding to be followed for the effective segregation of biomedical waste.

 

c.    Transportation and Storage:

The biomedical waste of different storage sites has to be collected from the hospital premises and transported. The transportation of biomedical waste to the disposal site has to be carried out in a very safe manner. The vehicles meant for this purpose need to meet certain criteria, such as it has to be covered, and secured to avoid accidental opening of door and spillage, the interior of the vehicle should be designed for easy handling, and disinfection. Additionally, the vehicle has to carry a label, with the information provided in Schedule IV. The biomedical waste collected should not be stored for more than 48 hours. For any reasons, if further storage period is required, permission from concerned authorities is essential to protect the environment and public health^{14, 15}.

 

Table 3: Colour coding for segregation of biomedical waste¹⁴

S.no	Colour  Coding	Container Type	Category of waste
1.	Yellow.	Plastic Bag.	Categories 1,2,3 and 6.
2.	Red.	Disinfected Container/ Plastic Bag.	Categories 3,6 and 7.
3.	Blue/White Translucent.	Plastic Bag/ Puncture proof container.	Categories 4 and 7.
4.	Black.	Plastic Bag.	Categories 5,9 and 10 (solid).

 

d.    Treatment and Disposal:

The health care waste has to be treated and disposed in accordance with the biomedical waste management handling rules, 1998. Various treatment methodologies have been developed to dispose the waste in an environmental friendly and aesthetic manner. Some of the technologies adopted to treat the health care waste are as follows.

 

(1) Incineration (2) Autoclaving (3) Microwaving (4) Hydroclave treatment (5) Mechanical/Chemical Disinfecting (6) Sanitary and Secure Landfilling^14,15.

 

4. CONCLUSION:

Population explosion and urbanisation are the key reasons for the major environmental issues faced recently. Biomedical waste management is very essential in the present scenario. Training need to be provided not only to the medical professionals, but also to the staff involved in the waste management process. Use of personal protective equipment should be emphasized to the staff and workers. Proper attention has to be given by government and health care providers to maintain public and employees’ safety and health. All hands including Government and non-governmental organizations and the public to face this challenge and march towards sustainable waste management system.

Source of Support:

Nil

 

5. CONFLICT OF INTEREST:

None Declared.

 

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Accepted on 30.08.2018        © RJPT All right reserved

Research J. Pharm. and Tech 2018; 11(12): 5687-5690.