Gobar Times
Open Forum

Medical Menace

Handle with care

“Hepatitis outbreak” – these two words have set the state of Gujarat and the entire nation on fire. The total number of people with hepatitis infection has reached 184, out of which 56 have already died. The uproar over the spread of this deadly virus triggered off a drive to check unsafe medical practices. It led to the discovery of an appalling racket – bio-medical waste recycling. More than 50 tonnes of bio-medical wastes have been recovered from several scrap dealers across the state. They buy used syringes, needles, multiple vials, I-V sets, empty medicine bottles, catheters and even blood bottles, which have crossed the stipulated expiry dates. And recycle them back to the doctors! But, is it just true of Gujarat? Are the other states safe?Which is safer?

– a private hospital or a government-run one?

There are many such unnerving issues. But let’s first know the basics…

Bio-medical waste is any waste, which is generated during the diagnosis, treatment or immunisation of human beings or animals. It also includes the wastes generated during research activities involving the production or testing of biologicals, which means any preparation made from organisms or microorganisms or product of metabolism and biochemical reaction. Common producers of biomedical waste include hospitals, nursing homes, other health care units, pathological and research laboratories, blood banks, veterinary institutions, home health care, funeral homes, and animal slaughter houses. Clearly, these wastes are potentially infectious or dangerous. Then, what should be done with these?

What should be done?

It is estimated that India generates more than three lakh tonnes of waste, annually. The solid waste from the hospitals consists of bandages, linen and other infectious waste (30–35 per cent), plastics (7–10 per cent), disposable syringes (0·3–0·5 per cent), glass (3–5 per cent) and other general wastes including food (40–45 per cent). Out of these, the bio-medical
waste has to be disposed of according to the Bio-Medical Waste (manage ment and handling) Rules 1998. Here are few of the important directions –

  • Every occupier, where required, shall set up requisite bio-medical waste treatment facilities like incinerator, autoclave, microwave system for the treatment of waste, or, ensure
    requisite treatment of waste at a common waste treatment facility or any other waste treatment facility.
  • Bio-medical waste shall not be mixed with other wastes.
  • Bio-medical waste shall be segregated into containers/bags at the point of generation… prior to its storage, transportation, treatment and disposal. The containers shall be labeled…
  • No untreated bio-medical waste shall be kept/stored beyond a period of 48 hours…
  • Every authorised person shall maintain records related to the generation, collection, reception, storage, transportation, treatment, disposal and/or any form of handling of bio-medical waste in accordance with these rules and any guidelines issued.
  • All records shall be subjected to inspection and verification by the prescribed authority at any time. But, are things really as smooth as they sound?

How to handle?

Gamma irradiation and solar heating are two of the latest technologies
that are being tried to disinfect medical waste

There are various methods of dealing with biomedical wastes, including incineration, deep burial, autoclaving, micro-waving, chemical disinfection, shredding, and disposal in municipal landfill.

Category
Biomedical waste Treatment and Disposal
1
Human Anatomical Waste (Human tissues and organs) Incineration/deep burial
2
Animal Waste (tissues, organs, carcasses fluid, blood) Incineration/deep burial
3
Microbiology and Biotechnology Waste (wastes from lab. cultures, from production of biologicals, toxins and devices used) Autoclaving/micro-waving.
4
Waste Sharps (used or unused needles, syringes, scalpels, blades, glass, etc. that may cause puncture and cuts) Chemical disinfection/autoclave/Micro-waving and mutilation/shredding
5
Discarded Medicines and Cytotoxic drugs Incineration/disposal in landfills
6
Soiled Waste (Items contaminated with blood and body fluids including cotton, dressing, plaster casts, lines and beddings) Incineration/autoclave/micro-waving
7
Solid Waste Chemical disinfection/ autoclave/
micro-waving/mutilation/ shredding
8
Liquid Waste (Waste generated from laboratory and washing, cleaning house-keeping and disinfecting activities) Disinfect-chemically and discharge into drains
9
Incineration Ash Disposal in municipal landfill
10
Chemical Waste (Chemical used in production of biologicals, chemicals used in insecticides, etc Chemical treatment disinfection and discharge of drains for liquid and secured landfill for solids.
(To know more, check out:
http://www.nihfw.org/ndcnihfw/html/egislations/BiomedicalWasteManagement...)


Last year, a committee of the Bombay High Court carried out a survey in the state. It found that in eight hospitals, including the state-run JJ (Jamshedji Jijibhoy), King Edward Memorial (KEM) and Bhagwati hospitals, there were used syringes, vials of blood and other biomedical waste lying on the hospital premises with dogs and stray animals foraging in them.

1. Hospitals wastes thrown
in garbage dumps

2. Rag pickers sort out the
useful Items

 

3. These articles are sold
for recycling

4. The same items are re-sold
in the market...

 

What actually happens?

The management of biomedical waste is a crucial issue in health and environ - mental management. However, the reality remains far from satisfactory. Last year, a committee of the Bombay High Court carried out a survey in the state. It found that in eight hospitals, including the state-run JJ (Jamshedji Jijibhoy), King Edward Memorial (KEM) and Bhagwati hospitals, there were used syringes, vials of blood and other biomedical waste lying on the hospital premises with dogs and stray animals foraging in them.

What is the solution?

The proper management of bio-medical waste has several aspects: political, social, economic, technical and of course, environmental. While the aims of waste management policy may be similar in most countries, the methods used to achieve them must be tailor-made. Why? Because every country differs in the availability of technical, economic, human resources, and other such factors. So, the management policies must adapt to the circumstances in every country. There is more. Every country must have adequate knowledge of the types of waste, how much is being produced, who produces it, and what happens to it. This will help them to know what should be done with waste, and prepare for the future. There are certain aspects that must be taken into account:

- Before licensing institutions for managing the bio-medical wastes, it is necessary to carry out an Environment Impact Assessment (EIA). This will spread awareness among the people about the environmental effects of dumping of bio-medical wastes.

- Community-based waste manage - ment or treatment facility must be emphasised.

- The management practice must monitor land-use plannin, and prohibit or impose restrictions on undesirable land use for dumping the bio-medical wastes. There are two blocks: there is limited land resource; and there is no set “perfect rule”, which can be followed.

- The handling of such wastes requires constant monitoring by a specific agency. There should also be periodic monitoring of the level of pollution. So, it is necessary to have a strong enforcement mechanism within the framework of law.

As of now, the environmental manage ment authorities are either hand capped or are not equipped with manpower potential to discharge the function. So, it becomes the duty of the owner of the institutions to act respon - sibly in dealing with such hazardous substance. The scenario is critical. Because lives are at stake here.

 

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Medical Menace