Monday, March 8, 2010



The bio-medical rules (in India) were issued on 20 Jul 1998. The deadline was extended noticing that the health care institutions were nowhere near achieving it. The Rules have been further amended to include alternate technologies, and Common Biomedical Waste Treatment Facility (CBWTF). In essence the CBWTF system provides for periodic collection of waste from different health care facility, transportation of the waste to the designated area far from the city limits, disinfection, and disposal. Large as well as small hospitals have joined the system, and more are likely to opt for it. As per the Rules waste should not be kept in storage for more than 48 hrs. The turnaround time for the pick up transports would be at least 12 to 30 hrs, if not more.

As per CAG report, removal of the waste from the health care facilities in Delhi varied between 3 to 58 days. There are no air conditioned vans, nor can be expected without escalating the cost of waste treatment.

Bacterial flora multiplies in the waste, and normal cycle is 20 to 40 minutes, depending on the species and the climate. Therefore proliferation, spread of infection in the ambient air would already have taken place before the waste is lifted. Thus the very purpose of investing in waste management gets defeated.

The large hospitals should be encouraged to have their own disinfection system, but by and large all go for the easier alternative that is the CBWTF. To think that smaller health care facilities will bring their waste to the facility at a larger place/hospital is too utopian to succeed in Indian scenario, given the callous attitude of the health care providers, the work culture, level of awareness, and loose controls. Moreover in case of litigation it would be impossible to trace the source of the particular waste (could be an amputated limb or a fetus) unless a well defined and thorough tracking system is put in place.

A very large number of nursing homes, dispensaries, laboratories, dental clinics etc (registered and unregistered) in any urban locality is yet to establish waste management system. Unless all these are ensnared into the waste management system there will hardly be any success. Spread of infection is not governed by geographical boundaries and therefore a holistic control mechanism will have to be put in place to achieve successful implementation.

Each small hospital or nursing home cannot be expected to have their own system. That would jack up the hospitalization cost to unacceptable level. If the aim of treating the biomedical waste at the earliest opportunity is to be achieved the answer is a mobile system. The concept of mobile system is already available. Requirement is to test it in the field conditions. It is possible to have an Eco-friendly system, or a combination mounted on a vehicle with captive power, or power drawn from predetermined outlets.

The vehicle can be customized as per the requirement. Considering different ingredients in hospital waste, a multi-option approach will have to be adopted, and the equipments mounted on the vehicle accordingly. There are two main groups of waste generated by health care facility. These are bio-degradable, and bio-non-degradable. Both carry infection and have to be disinfected closest to the point of generation.

For the bio-non-degradable waste a microwave system should be used, and for the bio-degradable waste, a waste sterilization unit. Both these equipments can work by captive electrical supply, or supply at predetermined points. The system would be able to treat waste of all categories generated by a health care facility (HCF).

One mobile system would be able to treat waste from a number of HCF, and therefore cost-effective. It can be started as a pilot project, and the efficacy tested in the field conditions. The advantage will be eliminating transport network, and treatment of the waste nearest to the point of generation. The system will be less labor oriented, and thus eliminate ‘human factor and failure’. There will be no requirement of secured landfill since the treated waste can be put in a dumping pit without causing any environmental pollution or posing any danger to the human health The treated waste does not attract flies, scavengers, birds etc, and since it is disinfected it does not pose any danger of spread of infection. The treated bio-degradable waste (including the food waste) can also be used as manure, or fuel-source since the system does not destroy the stored chemical energy. The non-degradable (treated and shredded) waste can be sold to vendors for recycling. With this system there will not be any requirement for each health care facility to have individual system, thus will help the environment from destabilizing. It would be much cheaper in the immediate and long run since it will take care of the waste generated by many health care institutions, simultaneously.

The Rules have not been successfully implemented. That is the fact, whatever may be the reason. A number of large hospitals have not even bothered to apply for permission to operate, and obtain license. Nursing homes and labs etc still lack a proper waste management system. Most of the private hospitals have contracted vendors to take care of their wastes. They are not concerned as to what happens to the waste after it is lifted from their premises (though as per Rules the Occupier is responsible to ensure safe disposal). In the meantime the population is exposed to many hazards of improper bio-medical waste disposal. Are we not ignoring a very important societal responsibility?

When known and seemingly easy solutions are not effective it is necessary to look for doing things differently to achieve success.

New Delhi
Jan 04, 2003 (LK Verma)

No comments:

Post a Comment