Biomedical Waste 

While municipal and industrial solid waste has attracted the attention of the authorities, yet there is lack of concern for some special management of biomedical waste generated primarily from hospitals and other health care centers in the state. Biomedical waste is any solid or liquid waste which may present a threat of infection to humans. Biomedical waste is generated from healthcare establishments such as hospitals, blood banks, laboratories and research institutes, veterinary hospitals,  etc. Agriculture and food-processing industry is also generating biomedical waste up to some extent. Hospital waste includes non-liquid tissue, body parts, blood, blood products, and body fluids from humans and other primates, laboratory and veterinary wastes which contain human disease-causing agents, and discarded sharps. Discarded sharps include needles, syringes, blades, scalpels, slides, broken glass, blood-stained clothes, cotton, etc. Biomedical waste management is a special case wherein the hazards and risks exist not just for the generators and operators but also the general community.

 Generally Bio medical waste is classified into infectious waste and non-infectious waste categories though the proportion of infectious waste is low. If infectious waste was not disposed off scientifically, it could contaminate non-infectious waste. At the last available count there are 220 hospitals, 1482 dispensaries and 441 primary health centers in the state.  Apart from these, there are 1362 Veterinary Hospitals, and 25362 medical institutions in the state. With the ever growing population and the number of hospitals and other medical, the problems of pollution from biomedical waste are also increasing simultaneously. The quantities of hospital waste generated  in the Districts/ Regional Offices of  Punjab are shown in the Bar Diagram below:

                                                                                Source:PPCB

 The Hazards….

Though waste from hospitals and nursing homes are required to be collected and treated separately and it have to be transported in a hygienic manner to the waste disposal site and are to be disposed of in a scientific manner. But in most cities and towns of the state such waste continues to form a part of the MSW in absence of any dedicated disposal facilities for hospital waste. Respective municipalities collect MSW in cities and transport it to the designated disposal sites, which is normally a low-lying area on the outskirts of a city. The choice of a disposal site is more a matter of what is available than what is suitable.  In the state, only 41.2% of the total Biomedical waste generated is treated, rest is dumped in the dumping grounds along with the domestic waste.

Dumping of heaps of hazardous medical wastes consisting of bandages, syringes, plastic and aluminum equipment etc. outside the hospitals are creating a lot of health problems. At the waste dump sites there are several rag pickers trying to salvage any discarded material to sell them and make a living.  These rag pickers are exposed to the risk of injuries from contaminated needles and other sharp objects and to various infectious diseases. The biomedical waste (BMW) also emitts a foul smell during the rainy season. The stagnant waste and unsanitary conditions are potential breeding ground for flies, Mosquitoes, rodents and insects, which maintain the already existing disease cycle.  Due to these acts, diseases like hepatitis, tetanus and dengue fever, HIV infection, etc. are spreading in addition to affecting water, soil and environment at large in the state.  In the last two months, 353 dengue fever/dengue haemorrhagic fever (DF/DHF) cases have occurred in the state so far and seven confirmed deaths have been reported (Source: The Hindu). The burning of plastic and untreated Pharmaceuticals produce extremely toxic gases like dioxin and furans, which further add up to the environment pollution.  Apart from this littered garbage around the hospitals has little to encourage confidence in the staff and the quality of care they offer.

The Biomedical Waste Management 

The MoEF, Government of India has issued the Municipal Solid Wastes (management and handling) Rules in the year 2000, which identify the CPCB (Central Pollution Control Board) as the agency to monitor the implementation of these rules. For the management of bio-medical waste, the MoEF has notified Bio-Medical Waste (management and handling) Rules in 1998 under sections 6, 8 and 25 of the Environment (Protection) Act of 1986. ( Source:www.envfor.nic.in/legis/legis.html)

The Biomedical Waste Management Act, 1998, mandates hospitals to handle their wastes in an environmentally and scientifically sound manner. The  incineration of infectious medical wastes is mandatory for hospitals in the country, but many hospitals do not have this facility  and even if there are some, they are lying idle. The effective waste management includes many steps like identification of the infectious waste, segregation of the waste at its site of production, proper  handling, packaging, transporting and treatment. There are 3 recommended colours of the containers used for the collection of bio medical waste in the hospitals. These are yellow (for infectious waste), blue (waste for shredding) and black ( non infectious for municipal dumps). In Punjab, there are 3   common Bio medical waste treatment facility (CBWTF) sites at Ludhiana, Mohali and Jalandhar. The Segregated medical waste from all the surrounding districts brought at these CBWTF plants for treatment and disposal.  Only 44 hospitals in the State have their own bio medical treatment plants. The detailed status of the treatment facilities of the BMW in the state is given below in the Table no.2

HCFs: Health care facilities                                                   Source: PPCB( As on 30/9/03)         
CBWTE: Common Bio medical waste treatment facility( Ludhiana, Mohali, Jalandhar)                
BWTF  : Bio medical waste treatment facility 
PPCB:    Punjab Pollution  Control Board

For the treatment of medical and hazardous waste different type of technologies and equipments are used. This includes the processes like Incineration, Autoclaving, Microwaving and Hydroclaving. All waste treatment technologies have their advantages and disadvantages and no single method is applicable to all wastes.  Hence, treatment depends upon the nature of the waste, technology that is technically and economically viable and environmentally safe and must meet public acceptance.  In Punjab,12 incineration, 19 autoclave, 1 microwave and 16 shredder,  treatment equipments are used  for disposal of bio medical waste. But still a lot of yet to be done. The magnitude of the problems from the BMW can be gauged from the fact that more than 50% HCFs in the state are still violating the BMW management rules.

Awareness campaigns are necessary to inform small clinics and dispensaries to undertake proper management of BMW. Several states have successfully launched such awareness drives through audio-visual media. Ministry of Environment and Forests has also appointed professional agencies to launch mass awareness campaign through electronic and print media on a number of subjects including BMW. Training of hospital staff towards proper segregation of bio-medical wastes is also necessary. In the end we can say that education, training, proper protective equipment and promotion of environmentally sound and cost effective technologies are the ultimate solution to this problem.