Intervention on Bio-Medical Waste

Toxics Link has been engaged with the issue of bio medical waste management since 1995, when the draft Bio Medical Waste (Management & Handling) Rules came into light. Since then, Toxics Link has come across a long path of revolution, as managing healthcare waste was always essential, but was never an easy task. Toxics Link had challenged against the government order of installing incinerator in the Supreme Court in the year 1996 which paved the way for CPCB to include alternative technologies as an option for treating bio medical waste in the Bio Medical Waste (Management & Handling) Rules, 1998.

Toxics Link has conducted an economic feasibility study of onsite incinerators across the country, which contributed in CPCB coming up with two National Guidelines on Design & Construction of Bio Medical Waste Incinerator and ‘Common Bio Medical Waste Treatment Facility’ respectively. In the year 2004, Toxics Link raised its concern over the issue of waste disposal during immunization programme and opposed the WHO idea of using ‘De Montfort’ single chamber incinerator for disposal of syringes. Following this intervention, in the year 2004 CPCB came out with the National Guidelines for Disposal of Bio-medical Waste generated during Universal Immunization Programme (UIP).

Then onwards, we are still trying to win the battle of bio medical waste management system across the country. Currently, our main objective is to improve the bio medical waste management system beyond the city of Delhi. At the outset, we tie up with various regional groups/grass root NGOs, working on similar issues in different states. The message of improving compliance of bio medical waste is spread through the capacity building of these NGOs, media personnel, healthcare institutions and various other groups working in similar issues.

CURRENT INTERVENTION

Awareness generation, Training & Capacity Building:

Toxics Link endeavor of toxics free healthcare, currently spreading awareness in various states among the healthcare staff and the general public through workshops, training programmes & media coverage held from time to time. The main focus of these programmes is to bring the issue of mismanagement in handling biomedical waste and the subsequent infection into the public domain. These help to sensitize the healthcare staff to minimize the production of such waste and help in its safe disposal. These types of activities & training programmes lay the path of reforms in state level regulations, which govern medical waste.
Documentaries/movies on BMW, pamphlets/posters, manuals on Safe handling of BMW etc. are provided to the trainees to further generate awareness.

Training programme(s) at various places with an active participation of the healthcare staff from various hospitals across the city/ state and the regulatory authorities such as PCBs, Municipal Council etc. are organized. They are made aware of the threat posed by the biomedical waste and the importance of its effective management. People from different strata, like doctors, medical officers, nursing & Para medical staffs as well as the administrative sections are put together on a common platform to discuss the problems & subsequent solutions. Sometimes the participants are also asked to prepare a model plan in small groups to strengthen their understanding of the issue and for identification of the week links in the system. All the recommendations and suggestions are analyzed and the hospitals are encouraged to bring safe practices into force.

At some point of time, the negotiations have been made at the regulator’s level to introduce the necessary changes in the system required for successful implementation of bio medical waste management. The situation of Ranchi, Jharkhand is a case study of such kind of intervention. For further information, click here.

Various such workshop and training programmes have been organized in the places, like Hubli-Dharwad, Odisha, Gujarat, Meghalaya, Assam, Manipur, Punjab (Amritsar, Ludhiana), Uttaranchal, Himachal Pradesh, Tamil Nadu, Kerala and Andhra Pradesh. At all these places, the workshops and training programmes have been highly successful and the creation of model hospitals in various states is under progress.

Model Hospital(s) creation at state level:

Model hospitals are the ones where effective biomedical waste management is carried out. Our regional partners in different states are asked to select few sample hospitals in various districts and assist them in effective implementation of bio medical waste rules in their respective hospitals within a prescribed time frame. Their progress is assessed continuously and assistance in the form of training, expertise etc. is provided to them to further strengthen their process. These hospitals serve as the role model for other hospitals in their respective districts.

This stimulates a continuous chain of improvement in the healthcare sector to make it toxics free.

Research & Advocacy

Cytotoxic Drugs:

This is an upcoming and one of the most crucial issues in the healthcare sector because of the steep rise in cancer patients over the last few years. Cytotoxic drugs, mainly used in treating cancer and rheumatoid arthritis etc. has potential to cause toxicity in humans and animals.

Rise in cancers in India have put an increasing amount of pressure on hospitals to handle the very toxic Cytotoxic drugs. Cancer annually affects 10 million people and causes 6 million deaths worldwide. It is expected that 300 million new cases of cancer and 200 million deaths from the disease will occur globally in the next 25 years, with almost two third of cases arising in developing countries (WHO, 1999).

Some Indian hospitals dealing with these drugs have developed very sophisticated SOPs for the management of these drugs, from preparation, handling, administering to disposal, but there is a lack of a unified & specific set of guidelines, which applies to the entire country and whose implementation can be monitored.

Toxics Link, recognizing the potential threat it causes, held a meeting on Cytotoxic drugs with an objective of coming up with a stringent National level Guideline on Cytotoxic drugs & contaminated waste. The meeting was attended by major cancer hospitals including Rajiv Gandhi Cancer Institute & Research Centre, Tata Memorial Hospital, Dharamshila Hospital etc. The representatives from regulatory bodies like CPCB, DGHS, IDMA etc were also involved in the discussion, as such to assess the need for further research in this particular field, since India is seriously lacking of strong database in the area.

Toxics Link is currently negotiating the issue at the level of Directorate General Health Service, GoI, following the first meeting.The Minutes of the Meeting, is now available in our website.

Effluent Treatment Plants (ETP’s):

Hospitals discharge considerable amounts of chemical and microbial agents in the environment through their waste water. Hospital effluents constitute antibiotics, X-ray contrast agents, disinfectants and pharmaceuticals. Many of these chemical compounds resist normal waste water treatment. Besides recalcitrant and potent chemicals, hospitals discharge plenty of undesired potentially pathogenic pro-pagules, antibiotic resistant bacteria and viruses.

Hospitals wastewater has similar quality to municipal wastewater but is an important source of pharmaceutical residues in all wastewater treatment plants. Moreover, hospital wastewater includes a great variety of micro-contaminants that are chemicals, heavy metals, disinfectants and specific detergents resulting from diagnosis, laboratory, research activities and medicine excretion by patients. Indeed hospital wastewater has an adverse impact on environmental and human health; therefore, the proper management of hospital wastewater quality and quantity is needed.

The main objective is to present the existing paradigms of hospital waste water treatment and its various facets. Our research was focused on environment risk assessment as well as risk management related to hospital effluents.

There is an urgent need for research and discussions among concerned stakeholders in these aspects because the lack of it would mean that we are waiting for a health disaster to respond to this issue. It will be a good investment from the point of view of public health and the environmental sensitivity to be pro-active on this issue.

Hospital wastewater urgently merits to be addressed as critical discharges to the environment in both developing and industrialized countries.