Gaps in handling biomedical waste in Bengaluru

The state capital with the highest number of hospitals and pharmacies and one-fourth of the population of the state needs a better system to manage biomedical waste.

Bengaluru: Recently, the Central Pollution Control Board wrote to the Karnataka State Pollution Control Board (KCPSB) seeking action against healthcare facilities that operate without authorisation and for violating the rules for disposal.

Biomedical waste disposal in Bengaluru, the capital of the state with the highest number of healthcare facilities in the state, has faced serious challenges, with several hospitals and healthcare facilities penalised for improper handling and dumping of medical waste. However, the dumping continues when monitoring takes a backseat. 

“Every hospital is supposed to have a tie-up with the biomedical waste management firm authorised to collect such waste in Bengaluru. However, sometimes smaller clinics can be seen throwing the waste along with household garbage,” says a garbage contractor. He says BBMP autos end up collecting it. Otherwise, it may be thrown on the roadside.

Bigger hospitals do follow the norms largely. However, even their waste goes and gets dumped in the landfills when the collection system goes for a toss. Unopened yellow bags filled with medical waste were seen in the Mitaganahalli landfill on the outskirts of Bengaluru three years ago.

A report from the Comptroller and Auditor General (CAG) in 2018 highlighted the serious mismanagement of biomedical waste disposal. It said that despite non-compliance to rules by hospitals and authorised disposal companies, the BBMP paid in full for the services without holding them accountable for their lapses. 

The World Health Organisation (WHO) estimates that around 15% of hospital waste, including infectious and toxic materials, is hazardous. Bengaluru’s failure to implement proper biomedical waste management has led to pollution and health risks. The BBMP and Karnataka State Pollution Control Board (KSPCB) have been urged to strengthen monitoring and impose stricter penalties to ensure safe biomedical waste disposal.

Disposing of household biomedical waste

Syed Imran, a member of a resident welfare association in HSR Layout, shares his experience. “We regularly have biomedical waste like glass containers or ampoules, syringes and other things as my father is diabetic and bedridden. I spoke to the BBMP officials here about the disposal, and they devised a system. They told me to hand over all biomedical waste in a white bag to the dry waste collectors and mention specifically that it is a biomedical waste.”

Biomedical waste management rules of 2016 say that household biomedical waste containing sharps and medicines should be collected in puncture-proof bags or bins. “Ideally, the first line of waste collectors should wear masks and gloves, but they never do. It can turn dangerous for them,” says Imran.

What happens to it later? “The waste collectors give it to the authorised collection agency, which collects it from all the hospitals. It is disposed of responsibly by the agency,” says a BBMP supervisor, adding that the same agency collects biomedical waste across the city.

Another BBMP official says household sanitary waste, such as diapers and sanitary pads, still gets loaded with dry waste wherever the collection system is broken. “Though these are supposed to be incinerated under controlled conditions, they get burnt on the roadside or go to the landfill,” he adds.

No system for expired medicines

Bengaluru clearly lacks a mechanism to dispose of expired medicines or unfinished doses of medicines. As per the rules, medicals and hospitals should be equipped to collect expired drugs from people. Is this followed in the city?

A reality check by DH in three different pharmacies in Mahalakshmi Layout, Rajajinagar and Malleshwaram in Bengaluru revealed that the pharmacies do not collect expired medicines from citizens if there is no bill or proof that it was purchased in the same store. Sometimes, they do not take back the medicine, even if there is proof. In case of expired drug stock in their own pharmacy, it is handed over to the distributor. There is no monitoring to ensure the distributor disposes of it responsibly.

“Despite existing systems, several improvements can make biomedical waste management, especially expired medicines, more effective and sustainable,” says Dr B R Mukkuppi, Vice President of the Karnataka Association of Resident Doctors.

According to him, much is needed to spread public awareness about the dangers of discarding expired medicines in household waste or drains. Medicine collection points at pharmacies and hospitals for safe disposal is something Bengaluru badly needs. Incentives must be offered to those returning expired medicines to encourage participation, he adds.

“Strengthening and monitoring waste treatment facilities to prevent illegal dumping is the need of the hour. Conduct regular inspections and impose penalties for non-compliance,” says B R Mukkuppi. He says waste segregation at hospitals and clinics must be improved to streamline treatment.

He also advocates the implementation of tracking techniques for expired medicines to ensure proper disposal and a public dashboard with disposal data for transparency. 

“A combination of strict enforcement, public participation, and better technology can make Bengaluru a model for biomedical waste management,” he adds.

What careless disposal of drugs can do

This becomes a problem when the expired drugs contain sensitive classes of medicines, especially antibiotics. Throwing it along with household waste or dumping it in the sanitary lines creates bigger problems, such as antibiotic resistance among humans and organisms.

This was proved by many research studies, including one on water pollution and the characterisation of multidrug-resistant superbugs from the Byramangala tank located 40km west of Bengaluru in the Ramanagara district. This tank receives polluted household treated and untreated sewage from Bengaluru through the Vrushabhavati River.

A study published on Environmental Technology & Innovation in 2021 showed the presence of antibiotic-resistant organisms in Bellandur Lake. “When tested against 44 antibiotics, most of the isolates were found to be multidrug-resistant in which IS1 and IS2 showed resistance to the highest percentage of antibiotics,” says the study done by researchers of the Department of Biotechnology, Dayananda Sagar College of Engineering.

Doctors and pharmacists say the KSPCB and the BBMP should tighten the system and ensure all pharmacies and hospitals return expired medicines to authorised disposal agencies.

Scientific management

The rules say an authorised biomedical waste management firm should have many specialised machines to handle the waste properly. Different types of biomedical waste include plastic disposables needles and syringes hygiene products expired or out-of-use medicines biohazard waste from infected patients and more. An authorised recycler should have all the required modern facilities to process all types of medical waste. Autoclave (a machine that uses steam under pressure to kill harmful bacteria viruses fungi and spores) plasma pyrolysis (a thermal process that uses high temperatures to break down organic compounds into gases and solids) hydroclave (a device that uses high-pressure steam to sterilise waste) shredders incinerators effluent treatment plants encapsulation or concrete pits deep burial pits and needle tip cutter or destroyers are the mandated facilities.