Bio-Medical Waste Management Practices in Bhubaneswar: A Review Md.

Saif Ahmed, Sixth Semester B-Tech Civil Engineering, Raajdhani Engineering College Abstract: The paper presents the various handling and disposal procedures of Bio-Medical Waste (BMW), and its the potential impacts on both human health and the natural environment generated from hospitals, veterinaries and pharmaceutical companies in Bhubaneswar, capital of Odisha. This paper defines different categories of BMW. The purpose of study is to provide direction for further study. The paper highlights loop- holes involved in dealing with BMW and suggestion for new handling and monitoring technology of the same. The data was mainly collected from different hospitals, dental clinics of Bhubaneswar, bio-medical waste treatment plant, and literatures reviews. Keywords: Biomedical waste, Hospital waste, Waste management, BMW Treatment plant Introduction Bio-Medical Waste (BMW) Management was not an issue until human immunodeficiency virus (HIV) and hepatitis B virus (HBV) led to questions about potential risks inherent in medical waste and intricacies involved in it. The main bottleneck to sound bio-medical waste management is lack of training and appropriate skills, insufficient resource allocation and lack of adequate equipment. This document has been developed to create basic awareness about biomedical waste management practices, equip the readers with enough skills for effectively managing biomedical waste, safe guard themselves and the community against adverse health impact. Any anthropogenic activity generates some waste. A large part of hospital waste usually consists of clinical and non-clinical waste. Such pollutants can, therefore, be broadly classified into a) solid wastes, and b) liquid waste (wastewater). Both are important source of physical and natural environmental degradation and constitute a health hazard. The soil associated or under the disposed wastes is one of the main reservoirs of microbial life, and contaminated water contains pathogenic microorganisms, which are causative agents of different types of disease. Method This study is based on the review of available information on medical waste, as relates to their nature, impacts and management techniques. The techniques described are either practiced or recommended by different countries. Information was obtained through literature review, online search, and discussion with thesis committee members. Study has also included the authors work experience and field data collection. Defining Bio-medical waste: Biomedical waste (BMW) is generated in hospitals, research institutions, health care teaching institutes, clinics, laboratories, blood banks, animal houses and veterinary institutes. Very broadly medical waste is defined as any solid or liquid waste that is generated in the diagnosis, treatment or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biologicals (BAN & HCWH, 1999) Noting that there are multiple risks inherent in medical waste including toxic chemicals and radioactive materials, the WHO has chosen to use the term health care risk waste instead of medical waste.

Category of BMW: According to BIOMEDICAL WASTE (MANAGEMENT AND HANDLING) RULE 1998 SCHEDULE-I (Rule 5), BMW is categorized as follows

Waste Category Category No. 1 Category No.2

Type Human Anatomical Waste (Human tissues, organs, body parts) Animal Waste (animal tissues, organs, body parts carcasses, bleeding parts fluid, blood and experimental animals used in research waste generated by vetennary hospitals, colleges, discharged from hospitals, animal houses. Microbiology and Biotechnology Waste Waste from laboratory culture stocks or specimens of micro-organisms live or attenuated vaccines human and animal cell culture used in research and infectious agents from research and industrial laboratories wastes from production of biological toxins dishes and devices used for transfer of cultures) Waste Sharps (Needles, syringes, scalpels, blades, glass etc. that may cause puncture and cut. This includes both used and unused sharps) Discarded Medicines and Cytotoxic Drugs (waste comprising of outdated contaminated and discarded medicines) Soiled Waste fluids including cotton, dressing, soiled plaster casts, lines, beddings, other material contaminated with blood) Soiled Waste (Wastes generated from disposable items other than the waste sharps such as tubings) catheters intravencus sets etc.) Liquid Waste (waste generated from laboratory and washing, cleaning, housekeeping and disinfecting activities) Incineration Ash (ash from incineration of any biomedical waste) Chemical Waste (chemical used in production of biological chemicals used in disinfection as insecticides etc.)

Treatment & Disposal Option incineration@/deep burial* incineration@/deep burial*

Pharmaceutical Waste

Category No.3

local autoclaving/microwaving/incineration@

Anatomical waste

Category No.4

disinfection (chemical treatment@01/autoclaving/microwaving and mutilation/shredding" incineration n@/destruct ion and drugs disposal in secured landfills incineration@ autoclaving/microwaving

Solid Waste

Category No.5 Category No.6

Plastic waste

Category No.7

Category No.8 Category No.9 Category No.10

disinfection by chemical treatment@@ autoclaving/ microwaving and mutilation/ shredding## Disinfection by chemical treatment@@ and discharge into drains. disposal in municipal landfill chemical treatment@@ and discharge into drains for liquids and secured landfill for solids

Sharp Waste

Fig. 1

@@ Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It must be ensured that chemical treatment ensures disinfection. ## Multilation/shredding must be such so as to prevent unauthorised reuse. @ There will be no chemical pretreatment before incineration. Chlorinated plastics shall not be incinerated. * Deep burial shall be an option available only in towns with population less than five lakhs and in rural areas.

Table-1. Color coding Yellow Red Blue/White translucent Black Type of Container-I Waste Category Plastic bag Cat. 1, Cat. 2, and Cat. 3, Cat. 6. Disinfected container/plastic bag Cat. 3, Cat. 6, Cat.7. Plastic bag/puncture proof Cat. 4, Cat. 7. Container Plastic bag Cat. 5 and Cat. 9 and Cat. 10. (solid) Table-2 Treatment option as Schedule I Incineration/deep burial Autoclaving/Microwaving/ Chemical Treatment Autoclaving/Microwaving/ Chemical Treatment and destruction/shredding Disposal in secured landfill per

Apart from the above classification, hazardous wastes like radioactive substances (used in treatment of cancer), X-ray films, scrap dental amalgam and general waste are generated in hospitals.

Nature of Bio-Medical Waste Medical waste is a small fraction of urban municipal waste. There should be a greater consensus on how much of the waste generated is actually infectious or hazardous. Infectious or hazardous hospital waste represents only a small part of total medical waste; yet, because of ethical questions and potential health risks, it is a focal point of public interest. Most hazardous and toxic waste is coming from clinical and hospital. According to World Health Organization (WHO) 1999), approximately 85% or hospital wastes are actually non-hazardous, 10% are infectious, and around 5% are non-infectious but hazardous.

Fig.1

Fig.2

Fig.3

Status in case of Bhubaneswar The capital city of Odisha, Bhubaneswar has fivegovernment hospital, seventeen dispensaries, more than twenty nursing homes and one hundred eleven private hospitals and number of veterinaries. There are about thirty pharmaceutical companies, out of which only fourteen companies follow BMWM practices. In the year, 2010 and 2011 278020.76 kg and 287419.825 kg BMW generated (refer the fig.4) As per prescribed norms of The Ministry of Environment and Forests, Govt. of India and Pollution Control Board, private hospitals follow following flowchart for managing BMW:

Fig.4

The first step in BMWM is to identify BMW, separate it from municipality waste. Then process of segregation and storing comes into play, segregation takes place according to Table-2. Next step is to transport BMW for treatment and disposal. After the BMW is reached to treatment plant, it undergoes microwaving where it is Segregation according to color coding, Neelachal Hospital disinfected. After microwaving, two processes take place, Pvt. Ltd. Bhubaneswar autoclaving and incineration. Last step is land filling of ash generated through autoclaving and

incineration takes place in remote forest area and tightly sealed.

There is huge discrepancy in the practice of BMWM in hospitals Bhubaneswar. On visit of different hospital is was found that there is non-uniform practice of segregation. Which created a big problem of incomplete combustion of waste. Field survey revealed that Government Hospitals are not part of the Bio-Medical Waste Management (BMWM) practices rather they dispose their waste in municipality dustbin. Few cases, like throwing of placentas in drains, cotton, dressing gouge, gloves, syringes, saline bottles in public places were Incomplete combustion, Sani Clean Pvt. Ltd. Khordh discouraging. Even the veterinaries and dental clinics and many nursing homes are not are aware of BMWM. The dental clinic waste like dental x-ray films, lead blankets, dental amalgam etc and radioactive nuclides used in chemotherapy which come under the Bio-Hazard waste are not treated scientifically. It was also found that medical staff Issues of worker safety-Neglected sold saline bottles, plastic bottles, glass bottles, syringes and other medical waste to kabadiwal and earned money. Out of 31 pharmaceutical companies in Bhubaneswar only 14 of them sent expired medicines for proper disposal and others threw the same in municipality dustbins or burnt openly in public places. Non-uniform segregation practices in different hospitals create incineration problems like incomplete combustion of waste. Workers who deal with waste were ill equipped and unskilled. They were not even vaccinated against infectious deceases like Hepatitis, Tetanus, etc. Recycling is nowhere in horizon. Potential Impacts (Risks) Associated with Bio-Medical Waste: Potential impacts associated with BMW are discussed under the two headings viz. (A) Health hazard; (B) Environmental Hazard; A. Health Hazard: There is a risk of injuries related to medical waste handling and carrying by waste hauler and/or cleaner. Almost 85% of sharp injuries are caused between their usage and subsequent disposal. For example, hands cut due to handling broken glass, skin diseases on legs and hands/ body, laceration, strain and sprain of the joint of limbs and backache due to load hauling. Ten percent BMW is infectious, which contains different kind of pathogens or organisms that is potential for infection or disease if it is not properly disposed. Table below shows few examples of different pathogen and diseases caused by them. Table 3
Bacterial Tetanus, gas gangrene and other wound infection, anthrax, cholera, other diarrhoeal diseases, enteric fever, shigellosis, plague etc.

Viral Parasitic Fungal

Various hepatitis, poliomyelitis, HIV-infections, HBV, TB, STD rabies etc. Amoebiasis, giardiasis, ascariasis, ankylomastomiasis, taeniasis, echinococcosis, leishmaniasis, filariasis etc. infections Various fungal infections like candidiasis, cryptococcoses, coccidiodomycosis etc. malaria,

B. Environmental hazards: Improper disposal of BMW is threat to environment, discussed as follows: 1. Windblown dusts from indiscriminately dumping also have the potential to carry hazardous particulates. 2. Accumulation of toxic chemicals within soil lowers soil fertility. 3. Disposal of incinerator ash in landfills without a sufficient soil or other impermeable cover may cause leachate to contaminate groundwater decrease in water quality. 4. Combination of both degradable and non-degradable waste increase the rate of habitat destruction due to the increasing number of sites necessary for disposal of wastes (degradation of habitat) 5. Plastic-bags, plastic containers, if not properly destroyed may contaminate the soil and reduces the chance for water percolation into the soil during precipitation. 6. Open air burning does not guarantee proper incineration, and releases toxic fumes (dioxin) into the atmosphere from the burning of plastics i.e., PCBs. Conclusions Keeping in view the health hazards and environmental problems caused by BMW, safe and effective management of waste is not only a legal necessity but also a social responsibility. Therefore, there is urgent need for raising awareness and education on BMW. Proper collection and segregation of biomedical waste are important. At the same time, the quantity of waste generated is equally important a lesser amount of biomedical waste means a lesser burden on waste disposal work, cost saving and a more efficient waste disposal system. Proper training of scientifically dealing with BMW should be provided to persons involved in BMWM. Their remuneration, insurance, vaccination should be taken care. Government hospitals, veterinaries, dental clinics, pharmaceutical companies that are not practicing BMWM should be heavily penalized and motivated to join the main stream. Proper and uniform segregation policy should be followed. X-ray films should be recycled for silver extraction. Radioactive substances and dental amalgams should be properly disposed off. Glass bottles should be recycled, as it does not decompose of its own on passage of time. New technology like e-Sushrut3 should be used to track malpractice of waste in hospitals. Groundwater condition, soil condition, air contents should be monitored through Remote Sensing and GIS around the periphery of Waste Treatment Plant and Landfills.

Acknowledgement: Ayush Hospital, and Neechal Hospital Pvt.Ltd, Bhubaneswar for providing data related to BMW. M. K Agrawalla and Er. Mohan, Sani Clean Pvt Ltd, Bhubaneswar for providing data related to BMW. R&D cell of Raajdhani Engineering College, Bhubaneswar
Reference 1. Nasima Akter. (2000) Medical Waste Management: A Review 2. Veda Hegde, RD Kulkarni, GS Ajantha. Biomedical waste management 3. Priti Razdan, Amarjeet Singh Cheema. Bio-Medical Waste Management System 4. Web site Pollution Control Board of Odisha.