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Biomedical
Waste: A Ticking Bomb |
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The failure on the part of the government as
well as private hospitals, clinics and nursing
homes to dispose off biomedical waste in a safe
manner is posing a major health hazard to the
residents of Goa, particularly those residing
in the urban areas of the state. |
An effective policy is urgently needed to tackle the
problem of medical waste disposal, as these wastes
are a shade more dangerous than normal waste matter,
in that they contain disease-causing micro-organisms
and have the potential for spreading dangerous ailments
like cholera, typhoid, gastro-enteritis, tuberculosis,
diphtheria, and even AIDS.
Hospital waste includes glass slides with bloodstains,
used needles and syringes, biopsy tissues, placenta,
dressings, etc. Nearly 25 percent of these wastes
are infectious and the hospitals are supposed to segregate
the wastes and dispose them off separately and in
a safe manner. However, most of the hospitals and
clinics are dumping untreated waste on municipal grounds
or on the roadsides in front of their buildings. It
is alarming to note that these materials are disposed
off in the manner of other waste, leading to their
reuse after they are carted away by ragpickers, who
are themselves at a great risk while handling these
wastes without adequate protection.
Public-health-conscious citizens have expressed surprise
that most doctors have neglected the importance of
safe disposal of hospital waste, by allowing untreated
and infectious medical waste to be discarded on municipal
dumping grounds. The key to handling medical waste,
according to environmentalists, is to segregate it
in order to facilitate the reduction of wastes that
require special treatment. Plastic used for medical
purposes, for instance, is not suitable for reuse
as their uneven surfaces tend to harbour pathogens.
The wastes generated by various medical institutions
are increasing, with more disposable items being used.
While it is not so much the liquid wastes that are
causing the problem; solid wastes are finding their
way to municipal dumps along with other regular types
of wastes, putting the public at grave risk. With
the annual outbreaks of a. host of communicable diseases,
civic dumps are becoming breeding grounds, not only
for viruses, but also for vector hosts like mosquitoes
and rats. The most hazardous wastes are the sharps
- mainly needles, syringes, blades and broken glass
- which are the main source of infection transmission.
Another category of infectious waste is contaminated
gauze and bandages. The third is contaminated body
tissues.
The Union Ministry of Environment and Forest (MOEF),
in a set of guidelines issued in July 1998, had acknowledged
the environmental hazards of using incinerators, the
most sought after mode of burning hospital waste.
Now their use is being limited to disposing human
anatomical and microbiological waste only. As per
the new rules, hospital waste has been classified
into ten categories, depending on which treatment
will vary - ranging from autoclaving, microwaving,
chemical treatment, shredding, incineration and disposal
in secured landfills. For instance, as per these guidelines,
body parts and other human anatomical tissues needed
to be burnt in an incinerator, while used syringes,
blades, needles, bloodstained cotton swabs and bandages,
etc are needed to be subjected to high pressure steam
at 122ºC in an autoclave before their disposal
in a landfill. Biomedical waste has to be separated
from other regular waste and segregated at the joint
of generation. Every institution generating biomedical
waste needs to install an appropriate facility in
the premises or set up a common facility to ensure
requisite treatment of waste, as per the new rules.
The MOEF has recommended colour coding for categories
of biomedical waste. For instance, yellow includes
human anatomical waste, animal waste, laboratory waste
and solid waste items contaminated with blood. These
have to be put in plastic bags and incinerated or
buried deep in the ground. However, chlorinated plastics
should not be incinerated. Segregation of medical
waste, which has been made mandatory in the Bio-Medical
Waste (Management and Handling) Rules, 1998, can best
be undertaken by using appropriate containers and
labels to distinguish the different types. Though
it is acknowledged that the best method of waste disposal
is incineration, if handled badly, it could be a source
of serious environmental pollution.
According to environmentalists, incineration of medical
waste emits toxic chemicals like dioxins, furans,
mercury and cadmium into the atmosphere. Dioxins are
the most persistent and potent manmade toxic and carcinogenic
substances known to science, and can enter the food
chain, causing reproductive and developmental defects
in both animals and human beings. Hospital waste contains
chlorinated plastics, which, if incinerated, releases
dioxins, furans and heavy metals like lead and mercury.
Dioxins are not created unless waste is burned. Hence,
a more viable option is to separate infectious waste
and disinfect it, by non-burn technologies, such as
autoclaving or chemical disinfection. Once disinfected,
it can be safely disposed in landfills. However, if
untreated, infectious waste is mixed with the general
waste including garbage, the entire quantum of waste
gets infected. The guidelines also make it mandatory
for containers carrying hospital waste to display
washproof labels with 'biohazard'and 'cytotoxic hazard'
symbols. Standards have been laid down for treatment
and disposal. For incineration, combustion efficiency
has to be minimum 99 percent.
Neither the authorities in charge of the State's public
health nor voluntary organisations here have initiated
a serious debate on the steps to be taken for improving
hospital waste management, despite the Supreme Court's
order directing all hospitals with more than 50 beds
to adopt an effective waste disposal system. The Medical
Association and the State Pollution Control Board
also seem confused or rather unconcerned.
The
state health authorities, however, say that government
is aware of the negligence of most government hospitals,
private nursing homes and clinics to dispose of
waste safely. Recycled used syringes and needles
from hospitals make their way to drugstores, making
ragpickers and even hospital staff themselves open
to risk of serious infections, including AIDS.
The number of HIV-positive persons has been increasing
rapidly and the government, public health officials
and doctors running private hospitals and clinics
have to seriously focus their attention on the problem.
Only recently, the Goa State Pollution Control Board
(GSPCB), on the direction of the Bombay High Court
at Goa, had conducted an inspection of bio-medical
waste disposal facilities available with all the
hospitals, health centres, clinics as well as pathological
laboratories around the state, and had issued notices
to 133 healthcare institutions which were not adhering
to the provisions of the Bio-Medical Waste (Management
and Handling) Rules, 1998, nor following the guidelines
under the Municipal Solid Waste Management Rules
of 2000.
The Goa Medical College (GMC) hospital at Bambolim
itself is still grappling with the problem of bio-medical
waste handling and management, even as it has made
some improvement in the existing facilities, following
a notice from the GSPCB. The board officials, who
inspected the hospital on June 9, found that .the
incinerator unit was not in operation and the authorities
were disposing of the waste generated by the hospital
in an unhygienic and unscientific manner. According
to the GSPCB officials, GMC had blatantly defied
directives specified for handling and treatment
of bio-medical waste by dumping broken vials, bottles,
plastic, etc,on its premises in a hazardous manner.
Moreover, during inspection, none of the hospital
officials concerned were able to give proper information
to the GSPCB officials about the facilities available
for managing and treating of biomedical waste on
their premises.
It is true that the medical waste disposal has become
a major problem even in developed countries, and
as a result, many have now re-introduced glass syringes
and bottles as well as the practice of sterilisation.
But standards of hygiene need to be much greater
before we can contemplate such a move here. It is
high time that the government gave more importance
to the issue and suggested a time-bound action plan
for safe disposal of hospital waste in the interest
of maintaining public health as well as ecological
balance of the state.
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