According to the World Health Organization (WHO), 20% of the total waste generated by medical care activities are hazardous. Improper management of waste generated in the medical care facilities causes a direct health impact on the community, the health care workers as well as the environment. Currently due to the COVID-19 Pandemic and encouraged use of disposable items the amount of production of plastics has increased. For instance, masks, Sanitizer bottles, disposable gloves, etc. are being widely used. In addition to this, bio-medical Wastes are being immensely generated from medical institutions and quarantine centres. Now the proper management of bio-medical waste has become a worldwide environmental and humanitarian topic. 

WHAT IS BIO-MEDICAL WASTE?

Bio-Medical Waste is a comprehensive term specified to the wastes generated during medical care activities such as diagnosis, treatment, immunisation, etc. of humans, animals and research, or activities relate to it, or in the production and testing of biologicals. Bio-medical waste management has recently arisen as an issue of significant concern not only to the medical institutions, quarantine centres but also to the environment. These wastes are commonly generated in medical institutions and health care units and have a huge capacity to cause infections if discarded without proper management. Insufficient bio-medical waste management triggers environmental pollution, unpleasant smell, growth and multiplication of vectors such as worms, insects, rodents, etc. that might lead to the transmission of diseases such as typhoid, cholera, hepatitis, and AIDS due to injuries from contaminated syringes and needles. Therefore, bio-medical wastes must be disposed properly to protect the environment as well as public health.

TYPES OF BIO-MEDICAL WASTE:

There are various kinds of bio-medical wastes.

HUMAN ANATOMICAL WASTES:

Human anatomical wastes consist of human tissues, organs, body parts and foetus below the viability period as per the Medical Termination of Pregnancy Act, 1971 which is amended on occasions. These wastes are disposed into yellow coloured non-chlorinated plastic bags or containers.

ANIMAL ANATOMICAL WASTE:

These wastes consist of experimental animal corpses, body parts, organs, tissues, as well as the waste generated from animals used in experiments, or testing in veterinary hospitals, colleges, and animal houses. These wastes are disposed into yellow coloured non-chlorinated plastic bags or containers.

SOLID WASTES:

Solid wastes consist of items contaminated with blood, body fluids like cotton swabs, dressings, plaster casts, and bags containing residuals, discarded blood, and blood components. These wastes are disposed into yellow coloured non-chlorinated plastic bags or containers.

EXPIRED OR DISCARDED MEDICENES:

Pharmaceutical wastes like antibiotics, cytotoxic drugs comprising all items contaminated with cytotoxic drugs along with glass, vials, plastic ampoules, etc. These wastes are disposed into yellow coloured non-chlorinated plastic bags or containers.

CHEMICAL WASTES:

These wastes comprise of the chemicals used in the production of biological and used, or discarded disinfectants. These wastes are disposed into yellow coloured non-chlorinated plastic bags or containers.

CHEMICAL LIQUID WASTES:

Liquid wastes generated as a result of the chemicals used in the production of biological, Silver X-ray film developing liquid, used or discarded disinfectants, discarded Formalin, infected secretions, aspirated body fluids, liquid from laboratories and floor washings, cleaning, house-keeping, and disinfecting activities, etc. These wastes are disposed into yellow coloured non-chlorinated plastic bags or containers. Additionally, these wastes have a separate collection system leading to the waste treatment system.

MICROBIOLOGY, BIOTECHNOLOGY AND OTHER CLINICAL LABORATORY WASTES:

These wastes consist of blood bags, laboratory cultures, stocks or specimens of micro-organisms, live or diluted vaccines, human and animal cell cultures used in research, industrial laboratories, production of biological, residual toxins, dishes and devices used for cultures. These wastes are disposed into yellow coloured autoclave safe plastic bags or containers.

CONTAMINATED WASTES:

These wastes are generated from disposable items such as tubing, bottles, intravenous tubes and sets, catheters, urine bags, syringes without needles and fixed needle syringes and vacutainers with their needles cut and gloves. These wastes are disposed into red coloured non-chlorinated plastic bags or containers.

WASTE SHARPES:

Sharps are objects sharp enough to cut or puncture the skin such as needles, syringes with fixed needles, needles from needle tip cutter or burner, scalpels, blades, etc. This includes both used, discarded and contaminated metal sharps. They can transmit infections directly into the bloodstream. Sharps are generally treated as highly hazardous medical waste regardless of whether they are contaminated or not. These wastes are disposed into white coloured puncture proof, leak proof, and tamper proof containers.

GLASSWARE:

Broken or discarded and contaminated glass comprising medicine vials and ampoules except those contaminated with cytotoxic wastes. These wastes are disposed into cardboard boxes with blue coloured markings.

INFECTIOUS WASTE:

Infectious waste is that which is suspected of containing pathogens such as bacteria, viruses, parasites, or fungi in a sufficiently large quantity or concentration to result in disease in susceptible hosts. For instance, waste from operations and autopsies on patients with infectious diseases, waste originating from infected patients in isolation wards, waste having come into contact with infected haemodialysis patients and so on.

RULES AND REGULATIONS REGARDING BIO-MEDICAL WASTE MANAGEMENT IN INDIA:

BIO-MEDICAL WASTE MANAGEMENT RULES, 2016:

In the year of 1998, the Indian government issued Bio Medical Waste Management Rules, 1998. These BMWM Rules were amended in 2011 to include all people who generates, collects, receives, stores, and transports bio-medical wastes. The BMWM Rules, 2011 were further amended in 2016 with the objective to develop the segregation, transportation, disposal methods, and to reduce environmental pollution in order to change the system of bio-medical waste disposal and treatment in the nation. The range of the rules had been stretched to incorporate blood donation camps, vaccination camps, surgical camps, etc. Pre-treatment of the microbiological wastes, laboratory wastes, blood samples, and blood bags by disinfecting or sterilising these wastes on-site in the way recommended by WHO or NACO. Under these 2016 rules, bio-medical wastes had been categorized into four categories instead ten to improve the segregation of wastes. The process to get approval was abridged with automatic approval for the bedded hospitals. 

The legality of the approval is coordinated with the legality of the permission for bedded HCFs. A one-time approval for non-bedded HCFs. The BMWM Rules 2016, also installed a Bar-Code System for bags and containers that contain bio-medical wastes for disposal. These rules recommend strict guidelines for incinerators to decrease the discharge of pollutants into the environment. The State Governments are directed to provide land to establish Common Bio-Medical Waste Treatment and Disposal Facilities (CBWTFs). A CBWTF is a system where bio-medical wastes generated from numerous medical institutions and health care units is given the required treatment to diminish the adverse effects these wastes. The CBWTFs are established based on the requirement to ensure an environmentally sound management of bio-medical wastes keeping in view the techno-economic feasibility and viable operation of the facility with minimal impact on human health and the environment.

 However, these 2016 Rules have been further amended to improve the flexibility in the execution of this environmentally sound bio-medical waste management in India. According to the amended BMWM rules 2018, blood bags have been exempted for phase-out. The amended rules also stipulate that the generators of bio-medical wastes such as hospitals, nursing homes, clinics, dispensaries, etc. should not use chlorinated plastic bags and gloves beyond March 27, 2019 to save the environment.

REVISED GUIDELINES ISSUED FOR DISPOSAL OF BIO-MEDICAL WASTE DURING COVID-19 PANDEMIC:

The Indian Government was forced to revise the already existing Bio-Medical Waste Management Rules of 2016 due to the COVID-19 pandemic. The latest revision of the BMWM Rules, 2016 have been published on July 21, 2020. These guidelines stipulate revised guidance on segregation of general solid wastes and bio-medical wastes from quarantine centres, home care, healthcare facilities treating COVID-19 patients, and recommends disposal of Personal Protective Equipment (PPE) kits. In addition to the existing practices under the BMWM Rules, 2016, the new Guidelines must be followed by all the participants including quarantine centres, isolation wards, sample collection centres, laboratories, Urban Local Bodies (ULBs), and CBWTFs. 

The Revised Guidelines also specify the method valid to the sample collection centres and laboratories who are responsible to report the opening and operation of COVID-19 sample collection centres and laboratories. They also suggest pre-treatment of plastic vials, plastic cryovials, viral transport media, vacutainers, Eppendorf tubes, pipette tips which are to be collected in red bags according to the BMWM Rules, 2016. They fix the responsibilities of the people who are operating in the quarantine centres, home Care and healthcare units. Furthermore, the revised guidelines recommend thorough guidelines and responsibilities of the CBWTFs regarding collection and disposal of COVID-19 bio-medical wastes. This revision also puts explicit responsibility on the ULBs, State Pollution Control Boards (SPCBs), Pollution Control Committees, and people operating in the quarantine centres and health care units. This helps stakeholders in the management, treatment and disposal of the bio-medical wastes.

CONCLUSION:

Disposal of the Bio-medical waste is an environmental concern as these wastes are classified as infectious and biohazardous that might lead to the spread of various infectious diseases. The proper and adequate management of the bio-medical wastes is extremely necessary due to the alarming rise of numbers of the COVID-19 patients. It is also very necessary to minimise the waste generation for the protection of environment and public health. Eco-friendly systems for disposal of bio-medical wastes should be encouraged.

REFERENCES:

1. Mohit Sharma, “Laws on Bio-Medical Waste in India” AMIE LEGAL, available at https://amielegal.com/laws-on-bio-medical-waste-in-india/ (Visited on October 14, 2020).
2. Biomedical waste types, definition and disposal management, celitron, available at https://celitron.com/en/types-of-biomedical-waste-definition (Visited on October14, 2020).
3. Jigyasa watwani, “New rules for biomedical waste management released” Down To Earth, available at https://www.downtoearth.org.in/news/health/new-rules-for-biomedical-waste-management-released-53330 (visited on October 15, 2020).
4. Astha Ahuja and Sonia Bhaskar, “Coronavirus Pandemic Exposes Broken System Of Bio-medical Waste Management; Experts Discuss The Issue And Solutions” available at https://swachhindia.ndtv.com/coronavirus-pandemic-exposes-broken-system-of-bio-medical-waste-management-experts-discuss-the-issue-and-solutions-49427/ (visited on October 16, 2020).