Monday, March 8, 2010

Hospital Waste Causing Havoc with Human Health

Hospital waste has become a very important source of spreading infection in the society. It is not that it was not so earlier but the population explosion has reduced the natural barrier and made the spread of infection that much easier. Moreover the generation of waste – per-capita has grown exponentially. Hospitals of today, which were always considered a seat of healing, have become seat of infection

Apart from the above consideration, infection contracted in a hospital settting is more difficult to treat because of mutated varients of microbes. Mutation in a hospital takes place in two ways. One in vivo and another in vitro. In other words infected waste strewn allover would undergo a process of mutation, which will be in proportion to the time the waste was left unattended before disinfection (limited up to desiccation). There have been doubts whether mutation in vitro is a known phenomenon. Many literatures have been consulted and it is now well established that mutation is very much possible in vitro as well.

Regeneration is a basic instict of any living species. So when the bacterial flora has to grow against an impinging atmosphere of antibiotic presence, where it cannot grow in its nascent form it has to acquire certain new features or property. That is precisely what must be happening. That would lead to mutated variety of microbial which would then dissipate as aerosol.

If the abovementioned hypothesis is accepted then it would be explainable as to why the hospital acquired infections are more difficult to treat.

It is a well-established fact that mutated varieties of microbial flora have been found in the underground water where Terramycin has been used as a food supplement of the chicks. Most glaring possible example of mutation in the

The AIDS virus has probably developed as a result of serialization of the otherwise non-viulent siman immunodeficiency virus (SIDS). It has been brought out by a researcher and published in the Lancet of Dc 8, 2001. During 1950s mass scale inoculation was given in Uganda and Somalia to fight against yaws. As an accepted practice, the syringes were not disinfected (considering the poverty of the countries), and many individuals were vaccinated with using the same syringe.

How and why this so far neglected topic has caught the attention of everyone in India suddenly? And if so it is certainly not too late. With the population explosion the natural barrier, which existed due to sparse population, has reduced. Spread of infection would therefore be that much easier and that much faster. At the same time the waste generation has become voluminous as per the increasing population, since generation of waste is directly proportionate to the population. Rural to urban migration has further caused havoc to the old civic amenities, which were laid out decades ago. So the population overload is one of the very important reasons for the condition of today. Most of the urban sewage systems are at the breakdown point, and are on the verge of collapse. The society does not have budget for replacing the age-old systems. One thing leads to another and the result is that the situation is becoming bad to worse, by the day.

A large portion of resources in terms of money or trained manpower is devoted to treating diseases, and for clinical preventable measures but hardly any concerted efforts are in the offing to improve the conditions where occurrence of these preventable disease itself, becomes a remote possibility. Hospitals are supposed to be seat of healing but with the present trend it has become a seat of infection. Spread of diseases by nosocomial infection is the order of the day. At the same time hospital acquired infections are more tenacious and difficult to deal with since the infection is by a more virulent strain, which is the result of mutation. There are a number of macro-observations indicating mutation in vitro.

Similar is the case with other infections. The society spends a very large portion of its resources on the treatment of patients who have been afflicted by disease process but not much is being done to root out the cause of spread of nosocomial infection. Cross infection in a hospital and hospital acquired infection have remained an area of great concern. Much deliberations take place the year around but no one pay much heed to the root cause. Hospital waste strewn allover the hospital compound is a major source of the spread of infection but still no focused concept has been developed yet. Rag pickers still are as active as ever. Studies done in a major hospital has brought out clearly that heaps of plastic syringes are carted away to a slum area and washed, repacked and brought to their collaborators in the city. These are then stocked as new ones and sold to the unsuspecting buyers. In certain cases the nexus between the rag pickers, the medicine shop owners and some of the nursing homes as well as hospitals are well-established .

On an average about 30% to 50 % one time use plastic syringes come back into the circulation. In fact the plastic syringes were encouraged and introduced so that nosocomial infections reduce. However that has not happened, at least in not in the developing countries, including India. As per the WHO “whereas introduction of the plastic syringes had the desired result in reducing the nosocomial infection in the developed countries it did not have any effect amongst the developing or the underdeveloped countries". It has been attributed to the wrong practices in the lower income group countries. It is estimated that in and around Delhi itself the total trade value of the recycled plastic ware (used in the medical management) is about Rs fifty million per year.

In the US, about one billion waste syringes are generated by patients of Diabetes taking domiciliary treatment. Each plastic syringe cost about $ 1 to 1.5. So that is a lucrative trade of about one to one and half a billion $. However the better part is that in the US the regulatory authorities, general awareness of the public is such that reuse of used plastic syringes is limited to group of drug abusers or drug peddlers. Unfortunately no such statistics is available in India, but it must be matching (of course in rupees). This being the monetary attraction effective measures will be required to deal with this menace.

In an urban area in India not all the nursing homes are rgistered, besides the umpteen numbers of quacks practicing and flourishing at every nook and corner of the cities, semi urban, and rural areas. In Delhi alone there are about 2500 nursing homes and hospitals registered. But there would be an equal number unregistered. Apart from the nursing homes there would easily be about 10,000 quacks in Delhi. Also there are domiciliary patients to cater to. Thus taking a comprehensive care of the biomedical waste in an urban area like Delhi would be a nightmare. The task may appear insurmountable. But with elaborate planning this can be planned and executed.

The WHO reports : -

1. Each person in the developing world receives 1.5 injections per year on the average. Hosp patients receive 10 to 100 times more injections.

2. At least 50% of all injections are unsafe

3. There was convincing link between unsafe injections and transmission of Hep B&C, Lassa virus and Malaria.

4. 20-80% of all new Hep B infections were due to unsafe injections.

5. In the world it is estimated that 16 billion syringes are sold every year, out of which 1 billion injections are given in the course of childhood vaccination program. Total manufacture capacity of plastic syringes reains at about 12 billion. Shortfall is obviously made up by reuse of plastic syringes, mostly in the developing world.

6. In Britain, an outbreak of Malaria took place in 1917 among soldiers who were given injections for Syphilis.

7. Introduction of disposable syringes largely reduced the problem in the developed world but not in the developing countries.

8. In India, 96% of injections were for antibiotic, vitamins and analgesics (in 1987).

9. 20% of 67 million new Hep B infections, each year in the developing world are due to unsafe injection.

10. Annual estimate of infection due to unsafe injection, worldwide is

( (i) Hep B --------------8-16 million
(ii) Hep C ------------- 2.3 – 4.7 million
(iii) HIV ---------------80,000-160,000

% Isolates with Methicillin resistant staph aureus has increased over a period of time from less than .1% in 1960 to 4% in 1969, 10% in 1984, 75 % in 1999, in a study carried out in the UK.

Of all hospital acquired infection the largest group is of upper respiratory tract infection-49.01% in the study carried out at an ICU at BHU, Varanasi.

The above mentioned research findings are indicative of mutation taking place in the infected discards of the hosp waste. More work is required to be undertaken to find out and establish on scientific platform the damage the untreated or uncared for hospital waste is causing to the society.

Though it can never be tangible the advantage the society will gain out of proper hosp waste management are tremendous. Perhaps the prevention of communicable diseases in number and quantity can never be specified, perhaps not even the number of cases thus prevented but the fact would remain that managing the hosp waste in a proper and scientific manner could bring about a very substantial change. This not only may save the resources of the society but also bring up the gradation of health. Could the chemicals in waste also contribute to the changed behavior and the mental outlook? It would be an interesting study if such a study can be undertaken.

Lalji K Verma

New Delhi
Apr 15, 2005

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