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1.Introduction:-
“Bio Medical Waste” 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 including containers.
Bio-medical waste means “any solid and/or liquid waste including its container and any
intermediate product, which is generated during the diagnosis, treatment or immunization of
human beings or animals.
Sources of BMW:-
The major sources of health-care waste are hospitals and other health-care establishments,
laboratories and research centres, mortuary and autopsy centres, animal research and testing
laboratories, blood banks and collection services, and nursing homes for the elderly.
Quantity of BMW :-
Health-care activities - for instance, immunizations, diagnostic tests, medical treatments, and
laboratory examinations - protect and restore health and save lives. But what about the wastes
and by-products they generate?
Hospitals and other health care facilities generate lots of waste which can transmit infections,
particularly HIV, Hepatitis B & C and Tetanus, to the people who handle it or come in contact
with it. High-income countries can generate up to 6 kg of hazardous waste per person per year.
In the majority of low-income countries, health-care waste is usually not separated into
hazardous or non-hazardous waste. In these countries, the total health-care waste per person per
year is anywhere from 0.5 to 3 kg.
Segregation
Segregation refers to the basic separation of different categories of waste generated at source and
thereby reducing the risks as well as cost of handling and disposal. Segregation is the most
crucial step in bio-medical waste management. Effective segregation alone can ensure effective
bio-medical waste management. The BMWs must be segregated accordance to guidelines laid
down under schedule 1 of BMW Rules, 1998.
• Segregation reduces the amount of waste needs special handling and treatment
• Effective segregation process prevents the mixture of medical waste like sharps with the
general municipal waste.
• Prevents illegally reuse of certain components of medical waste like used syringes,
needles and other plastics.
• Provides an opportunity for recycling certain components of medical waste like plastics
after proper and thorough disinfection.
• Recycled plastic material can be used for non-food grade applications.
• Of the general waste, the biodegradable waste can be composted within the hospital
premises and can be used for gardening purposes.
• Recycling is a good environmental practice, which can also double as a revenue
generating activity.
Reduces the cost of treatment and disposal (80 per cent of a hospital’s waste is general waste,
which does not require special treatment, provided it is not contaminated with other infectious
waste)
People at Risk:-
The main groups at risk are the following:
• Doctors, nurses, ambulance staff and hospital sweepers;
• Patients in health-care establishments or under home care;
• Workers in support services to health-care establishments, such as laundries, waste
handling and transportation, waste disposal facilities including incinerators and other
persons separating and recovering materials from waste;
• Inappropriate or inadvertent end-users such as scavengers and customers in secondary
markets for reuse (i.e. households, local medical clinics, etc.)
Biomedical waste poses hazard due to two principal reasons – the first is infectivity and other
toxicity. According to the WHO, the global life expectancy is increasing year after year.
However, deaths due to infectious disease are also increasing. A study conducted by the WHO
reveals that more than 50,000 people die everyday from infectious diseases. One of the causes
for the increase in infectious diseases is improper waste management. Blood, body fluids and
body secretions which are constituents of bio-medical waste harbour most of the viruses, bacteria
and parasites that cause infection. This passes via a number of human contacts, all of whom are
potential ‘recipients’ of the infection. Human Immunodeficiency Virus (HIV) and hepatitis
viruses spearhead an extensive list of infections and diseases documented to have spread through
bio-medical waste. Tuberculosis, pneumonia, diarrhea diseases, tetanus, whooping cough etc.,
are other common diseases spread due to improper waste management.
HEALTH IMPACTS:-
Health-care waste is a reservoir of potentially harmful micro-organisms which can infect hospital
patients, health-care workers and the general public. Other potential infectious risks include the
spread of, sometimes resistant, micro-organisms from health-care establishments into the
environment. These risks have so far been only poorly investigated. Wastes and by-products can
also cause injuries, for example radiation burns or sharps-inflicted injuries; poisoning and
pollution, whether through the release of pharmaceutical products, in particular, antibiotics and
cytotoxic drugs, through the waste water or by toxic elements or compounds such as mercury or
dioxins.Some of these are given below:-
Cytotoxic Waste:-Cytotoxic drugs have the ability to stop the growth of certain living cells and
are used as chemo-therapeutic agents. They are carcinogens and can also be mutagenic. Any
material used to handle these products and contaminated in due course would also need to be
disposed off in the same manner.Adverse health effects from both acute and chronic exposures to
cytotoxic drugs have been demonstrated in healthcare personnel.Over a long term, almost all of
these drugs have the potential of damaging cells or adversely affecting cellular growth and
reproduction. The drugs bind directly to genetic material in the cell nucleus, or affect cellular
protein synthesis. In-vivo, in-vitro and human studies have implicated anti-neoplastic drugs in
chromosomal damage, teratogenesis, and carcinogenesis.Testicular and ovarian dysfunction,
including permanent sterility, have been demonstrated in male and female patients, respectively,
who have received these drugs singly, or in combination. Studies in Finland have shown an
increased incidence of foetal loss among nurses routinely working with anti-neoplastic agents
than among those who do not. Other studies have suggested a correlation between exposure to
anti-neoplastic agents and foetal malformation in pregnant nurses. Additionally, organ damage
has been associated with exposure to some anti-neoplastic agents. Liver damage has been
reported in oncology employees, and appears to be related to the duration and the concentration
of the exposure. The risks to workers handling anti-neoplastic agents are a result of the inherent
toxicity of the drugs themselves, and the actual dose that a worker receives. The dose is
dependent on the concentration of the drug, the duration of the exposure, and the route of entry.
The adverse health effects as a result of exposure to a particular drug may depend on whether the
drug enters the body through inhalation, through the skin, or ingestion.
Sharps:-Anything that can cause a cut or a puncture wound is classified as ‘sharps’. These
include needles, hypodermic needles, scalpel and other blades, knives, infusion sets, saws,
broken glass, and nails. Whether or not they are infected, sharps are usually considered highly
hazardous healthcare waste because they have the potential to cross the passive and primary
immunology barrier of the body the skin and thus establish contact with blood. Because of this
double risk of injury and disease transmission sharps are considered very hazardous. The
principal concerns are infections that may be transmitted by subcutaneous introduction of the
causative agent, for example, viral blood infections. Hypodermic needles constitute an important
part of the sharps waste category and are particularly hazardous because they are often
contaminated with blood .Throughout the world every year an estimated 12 000 million
injections are administered. And not all needles and syringes are properly disposed of, generating
a considerable risk for injury and infection and opportunities for re-use.
• Worldwide, 8-16 million hepatitis B, 2.3 to 4.7 million hepatitis C and 80 000 to 160 000
HIV infections are estimated to occur yearly from re-use of syringe needles without
sterilization2. Many of these infections could be avoided if syringes were disposed of
safely. The re-use of disposable syringes and needles for injections is particularly
common in certain African, Asian and Central and Eastern European countries.
• Regarding injection practices, public health authorities in West Bengal, India, have
recommended a shift to re-usable glass syringes, as the disposal requirements for
disposable syringes could not be enforced.
• In developing countries, additional hazards occur from scavenging on waste disposal sites
and manual sorting of the waste recuperated at the back doors of health-care
establishments. These practices are common in many regions of the world. The waste
handlers are at immediate risk of needle-stick injuries and other exposures to toxic or
infectious materials.
Mercury:- Mercury is the only heavy metal that can exist in all three states of matter: it readily
changes from solid to liquid to gaseous form and is a persistent bio-accumulative toxin. It
circulates constantly in the environment. Three major forms of chemical mercury circulate in the
atmosphere: mercury (0), mercury (II) and methyl mercury. Methyl mercury can accumulate in
muscle tissue and bio-magnify via the food chain. Mercury is a neurotoxicant and affects the
brain and the nervous system. Other vital organs like kidneys and lungs are also affected.
Mercury poisoning can be difficult to diagnose since the symptoms are common to other
afflictions. Pregnant women and children are most vulnerable to the effects of mercury. A foetus
exposed to mercury shows nervous system damage.
Vaccine waste:-In June 2000, six children were diagnosed with a mild form of smallpox
(vaccinia virus) after having played with glass ampoules containing expired smallpox
vaccine at a garbage dump in Vladivostok (Russia). Although the infections were not life-
threatening, the vaccine ampoules should have been treated before being discarded.
Chemicals:- are generally used in diagnostic and experimental work, and in cleaning,
housekeeping and disinfecting procedures. Many chemicals and pharmaceuticals used in
hospitals are hazardous. They are termed hazardous if they have any one of the following
properties: toxic, corrosive, flammable, reactive, genotoxic. Examples of such waste are
formaldehyde, glutaraldehyde and photographic chemicals. They may cause injuries, including
burns. Disinfectants are particularly important members of this group as they are used in large
quantities and are generally corrosive.
The general public’s health can also be adversely affected by bio-medical waste.
Although treatment and disposal of health-care wastes aim at reducing risks, indirect health risks
may occur through the release of toxic pollutants into the environment through treatment or
disposal.
Bio-medical waste can cause health hazards to animals and birds too:-
Most countries of the world, especially the developing nations, are facing the grim situation
arising out of environmental pollution due to pathological waste arising from increasing
populations and the consequent rapid growth in the number of health care centres. India is no
exception to this and it is estimated that there are more than 15,000 small and private hospitals
and nursing homes in the country. This is apart from clinics and pathological labs, which also
generate sizeable amounts of medical waste.
India generates around three million tonnes of medical wastes every year and the amount is
expected to grow at eight per cent annually.
Barring a few large private hospitals in metros, none of the other smaller hospitals and nursing
homes have any effective system to safely dispose of their wastes. With no care or caution, these
health establishments have been dumping waste in local municipal bins or even worse, out in
the open. Such irresponsible dumping has been promoting unauthorized reuse of medical
waste by the rag pickers for some years now.
The Central Government, to perform its functions effectively as contemplated under sections 6,
8, and 25 of the Environment Protection Act, 1986, has made various Rules, Notifications and
Orders including the Bio-medical wastes (Management & Handling) Rules, 1998.A brief
summary of the provisions in Bio-medical wastes (Management & Handling) Rules, 1998 is
given below.
• Section 3 establishes the authority of the government to undertake various steps for
protection and improvement of the environment.
• Section 5 provides for issuance of directions in writing.
• Section 6 empowers the government to make rules.
• Section 8 permits the education of individuals dealing with hazardous wastes regarding
various safety measures.
• Section 10 bestows authority to enter the premises and inspect.
• Section 15 allows the government to take punitive steps against defaulters. This
involves imprisonment up to five years or penalty of upto rupees one lakh or both.
In case the default continues, it would then attract a penalty of rupees five thousand
per day up to one year and thereafter imprisonment up to seven years.
• Section 17 provides for punishment in case of violations by government departments.
Even after the June, 2000 deadline most of the large hospitals have not complied with these
Rules, as there is no specified authority to monitor the implementation of these Rules. But, the
fact is that in most of the states, the pollution control boards that are connected with waste in
general do not have adequate powers or commitment to enforce the Rules.
The Common Biomedical wastes treatment facility, (see rules 14, amended in June 2000, which
cast the responsibilities on municipal bodies to collect biomedical wastes/treated biomedical
wastes and also provide sites for setting up of incinerator.) The owner of CBWTFs are service
providers, who are providing services to health care units for collection of BMWs for its final
disposal to their site.
CATEGORIES OF BIOMEDICAL WASTE SCHEDULE – I