4,066 instances of violations by healthcare establishments identified in 2018

Poor disposal escalates hazards of biomedical waste

It was like any other day for Ranga (name changed), 38, a pourakarmika, who starts his work at 5 am by cleaning the streets of Bengaluru. As usual, Ranga tried to lift some garbage, but felt an excruciating pain in his hand. Before he could realise, blood oozed out of his palm.  

A surgical blade, which was discarded on the street along with some used bandages, had caused the injury to Ranga. The incident took place at Doddanekundi in the city four months ago. As one speaks to the pourakarmikas in Bengaluru, several such incidents come to light. Cotton soaked in blood, unwrapped sanitary napkins, discarded syringes and needles, surgical blades and diapers — pourakarmikas pick such hazardous wastes barehanded, on an everyday basis. 

At a time when solid waste management crisis is widely discussed, one of the aspects that require utmost attention is biomedical waste. Karnataka is the second highest producer of biomedical waste after Maharashtra. Though Karnataka is one of the first states to adopt a scientific method of biomedical waste disposal, there are many challenges to its effective implementation. 

The reason — there is no official data on the exact quantity of biomedical waste generated in the state. The available figure on the total quantity generated is taken from the Common Biomedical Waste Treatment Facilities (CBMWTF). It is evident from various reports, including the one by the Karnataka State Pollution Control Board (KSPCB), that the entire biomedical waste is not collected by the CBMWTFs and that a large quantity of waste is getting mixed with municipal solid waste.        

The pollution control board has identified 4,066 instances of violations by healthcare establishments in 2018. This apart, the board has issued 20 show-cause notices to CBMWTFs in 2018. Recently, KSPCB detected a case wherein biomedical waste was found to be pilfered before reaching the designated CBMWTF. An official from the KSPCB said that there are instances of biomedical wastes such as syringes and glasses not reaching the CBMWTFs.

The recent report of the CAG’s (Comptroller and Auditor General of India) performance audit on ‘Solid Waste Management in Urban Local Bodies’ mentioned that mixing of municipal solid waste with special wastes, mainly biomedical waste, was commonly found in the government and veterinary hospitals in the state. Of the 36 government and 34 veterinary hospitals inspected by the CAG, 21 hospitals and 19 veterinary hospitals were functioning without the required authorisation.

“The effluent treatment plant required for treating liquid waste before letting into the drains was not working in any of the test-checked hospitals (except one in Mangaluru) and untreated liquid chemical waste was being discharged directly into the drains. The compliance to biomedical waste rules was found to be weak in the test-checked urban local bodies, which is bound to affect public health and lead to contamination of environment,’’ the report stated.

The efforts to streamline biomedical waste disposal is on for the last two decades. The first biomedical waste rules (BMW) was introduced in 1998. After that, there has been a lot of changes in the handling of biomedical waste. The present rules — Biomedical Waste (Management and Handling) Rules 2016 — has been amended in 2018. 

As per the Biomedical Waste Rules 2016, state pollution control boards are the prescribed authority for implementation of the provisions under the rules. These rules apply to all persons who generate, collect, receive, store, transport, treat, dispose or handle biomedical waste in any form. According to details with the KSPCB, the state has a total of 25 CBMWTFs. And in 2018, around 32,364 Health Care Establishments (HCEs) — which include bedded and non-bedded hospitals, and clinics — have generated an average of 67,339 kg of biomedical waste per day.

Need attention

The biggest drawback of the data available with the KSPCB is that there are large deviations in the recorded numbers of biomedical waste generators and the quantity of biomedical waste generated in the state. It is an admitted fact that all those who generate biomedical waste are not covered by CBMWTFs. For example, the statistics with KSPCB indicate that a total of 32,364 HCEs have been identified in the state. As per a report with the Drugs Control Department, there are around 26,658 licenses issued for pharmaceutical and cosmetic outlets in the state.

An article published in the Journal of Indian Society of Hospital Waste Management, the registered body of professionals to address the issue of hospital waste, highlights that there is a lack of data on various biomedical waste generators. The article states that many small HCEs that cater to humans and animals do not even maintain a register.

Dr S Pruthvish, who served as an international expert consultant on healthcare waste management with the World Health Organization (WHO), points that the primary flaw is in identifying the biomedical waste generators.

“Apart from hospitals and nursing homes, places like clinics, dispensaries, veterinary institutions, animal houses, Ayurvedic, pathological laboratories, blood banks, blood donation camps, Ayush hospitals, research institutions and vaccination camps generate biomedical waste. The situation should improve in both government and private setups. It is a continuous process, and awareness and active participation in biomedical waste disposal should be more,’’ he said.

No accountability

To streamline this, the KSPCB brought out a notification fixing accountability and service area on the jurisdictional CBMWTFs. “Through the notification, issued in February 2017, the board intended to fix up jurisdiction, introduce rational pricing for collecting biomedical waste and shouldered the responsibility of reporting on non-compliance of BMW rules by the HCEs. Some CBMWTFs challenged the notification before the Karnataka High Court and the notification has been stayed,’’ a senior official of the KSPCB told DH. In this notification, KSPCB proposed to assign the task of identification of all the biomedical waste generators and reporting about non-compliance of rules with the CBMWTFs.

The situation is no different in other states, it emerges. As per a report on biomedical waste on the Central Pollution Control Board website, the number of HCEs/CBWTFs violating the provisions of BMW Rules in 2016 has been increased from 6,074 in 2015 to 12,034 in 2016. Besides, the annual report is not submitted regularly within the due date by most of the state pollution control boards, making it difficult to compile the national status on biomedical waste management scenario.

Reusing or unscientific recycling of biomedical waste will have an impact on public health and environment. “The risk involved in unscientific disposal of biomedical waste is high because of the sharp and infectious materials. The healthcare workers and pourakarmikas face the highest risk while it may also affect the general public. The needle prick injuries or exposure to infectious waste can contract HIV and hepatitis B and C,’’ an official said.      

Manoj Kumar, member secretary of KSPCB, told DH that continuous efforts are being made to address the issues pertaining to scientific disposal of biomedical waste. “There is no provision to penalise biomedical waste generators for violating rules. BMW rules empower state pollution control boards to issue show-cause notices upon finding non-compliance. The board then provides an opportunity to the waste generator for comments and either suspend or close the case. We are now involving the Health Department in our further efforts to cover all the biomedical waste generators,’’ he said.

The reports of both CPCB and KSPCB indicate that there are a lot of grey areas in the management of biomedical waste. The State of Environment Report (2015-16) by Environmental Management and Policy Research Institute (EMPRI) explains that biomedical waste generation starts right from the child or animal birth.  It is stated that biomedical waste is generated right from child or animal birth and subsequently at all stages of diagnosis, immunisation, treatment and research. All major consumables used in healthcare sector generate biomedical waste, be it bandages, electrodes, paper products, skin closure, sterilisation consumables or laboratory consumables.

Grey areas

“The per capita waste generation in any healthcare establishment depends on the patients and diseases. Hence, there is an urgent need to estimate and check the waste generation reported by the healthcare establishments. The other important aspect to keep in mind while dealing with biomedical waste is to keep a check on the medical consumable market, which is increasing every year. The estimated requirement of blood in the state is also an important factor. The pharmaceutical shops, animal farms and local bodies which generate biomedical waste are yet to establish biomedical waste treatment facility,’’ a former senior official of KSPCB said.

With all these challenges in biomedical waste disposal, KSPCB faces severe staff crunch. Being the only agency for implementation of the provisions under BMW Rules, the KSPCB has around 150 staff, across the state. “It is not possible to achieve the objectives as the board is understaffed,’’ an official said.

The BMW rules 2016 was introduced as an amendment of the 1998 rules. The rules that came into existence in 2016 had set various deadlines to achieve the targets. Since most of the targets could not be achieved, an amendment was brought in 2018 by extending the deadlines. The huge gap in the quantity of medical consumables and biomedical waste generated needs immediate attention. A combined effort by the KSPCB, Health and other related departments is required to cover all the generators of biomedical waste.

Do liquid waste treatment facilities function?

Davanagere district, which was in news recently for the improper disposal of biomedical waste, has 1500 HCEs including clinics and laboratories. The district generates 1500 kg of biomedical waste every day. The CBMWTF situated at Amaravathi in Harihar taluk has the capacity of treating 150 kg of waste every hour.

Regional pollution control board official,K  B Kotresh, said that 80 notices have been issued to HCEs for violations this year. “A majority of hospitals and nursing homes have liquid waste treatment facilities. However, it is difficult to ascertain if all of them are functioning effectively,” said Kotresh.

District health and family welfare officer, Dr Tripulamba, said that earlier the disposal of biomedical waste was not well managed. “However, with the setting up of the waste management facilities, the quantity of waste reaching these centres is known. The situation has improved a lot now,” said Tripulamba.

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