'Addressing challenges on ground is more important'
Dr Ashok K Agarwal, April 03, 2016
India is among the first country in South Asia to come out with the biomedical waste management rules for the first time in 1998, followed by Thailand in 2002.
Lot of water has flowed down since then, the Ministry of Environment and Forest (and Climate Change), Central Pollution Control Boards and the State Pollution Control Boards/ Committee have been playing a vital role in monitoring the implementation of these rules.
Further, the Indian Society of Hospital Waste Management (ISHWM) and IGNOU together with WHO SEARO and UNDP have made significant contributions in capacity building, training, awareness and certified education programmes in biomedical waste management in India as well as South East Asia. The exercise to revise and update these rules has been going on for more than five years. Finally, the Ministry of Environment Forest and Climate Change has notified the new rules ‘The Biomedical Waste Management (BMW) Rules, 2016’.
Second most hazardous waste
The United Nation Basel convention has described healthcare waste as the second most hazardous waste after the radioactive waste. Inadequate and inappropriate handling of healthcare waste may have serious public health consequences and a significant impact on the environment. Thus, sound management of healthcare waste is a crucial component of environmental health protection. In both, the short term and the long term, the actions involved in implementing effective healthcare waste management programmes require multisectoral cooperation and interaction at all levels.
Policies should be generated and coordinated globally, with the management practices implemented locally. Establishment of a national policy and a legal framework, training of personnel, and raising public awareness are essential elements of successful healthcare waste management. Improved public awareness of the problem is vital in encouraging community participation in generating and implementing policies and programmes. Management of healthcare waste should thus be put into a systematic, multifaceted framework, and should become an integral feature of healthcare services.
Recently in 2014, the World Health Organisation has come out with the second edition of ‘Safe management of wastes from healthcare activities’, more popularly known as the Blue Book.
It is the global reference book for framing national and international guidelines for heath care waste management. This handbook is intended to be comprehensive, yet concise, ‘user-friendly’ and oriented towards practical management of healthcare waste in local facilities. It provides guidelines for responsible national and local administrators, and is the first publication to offer globally relevant advice on the management of healthcare waste. The guidelines complement and supplement those produced in different regions in the past.
WHO strongly encourages the widespread implementation of these guidelines and is ready to assist users in adapting them to national settings.
In many countries and particularly in India, the knowledge about the potential for harm from healthcare wastes has now become more prominent to governments, medical practitioners and civil society. Increasingly, managers and medical staff are expected to take more responsibility for the wastes they produce from their medical care and related activities.
The indiscriminate and erratic handling and disposal of waste within healthcare facilities is now widely recognized as a source of avoidable infection, and is synonymous with public perception of poor standards of healthcare. Coming back to the BMW Rules, 2016, some of the salient features of the rules are:
The ambit of the rules has been expanded to include vaccination camps, blood donation camps, surgical camps or any other healthcare activity; Phase-out the use of chlorinated plastic bags, gloves and blood bags within two years;
Pre-treatment of the laboratory waste, microbiological waste, blood samples and blood bags throughdisinfection orsterilisation onsite in the manner as prescribed by WHO or NACO; Provide training to all its health care workers and immunise all health workers regularly;
Establish a Bar-Code System for bags or containers containing bio-medical waste for disposal; Report major accidents;
Existing incinerators to achieve the standards for retention time in secondary chamber and dioxin and furans within two years;
Bio-medical waste has been classified in to 4 categories instead 10 to improve the segregation of waste at source; (i) Procedure to get authorisation simplified. Automatic authorisation for bedded hospitals. The validity of authorization synchronised with validity of consent orders for Bedded HCFs. One time Authorisation for Non-bedded HCFs.
Exclusion from new rules
Following categories / types of waste have been excluded in the new rules
Radioactive wastes as covered under the provisions of the Atomic Energy Act, 1962(33 of 1962) and the rules made there under;
Hazardous chemicals covered under the Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989 made under the Act;
Solid wastes covered under the Municipal Solid Waste (Management and Handling) Rules, 2000 made under the Act;
The lead acid batteries covered under the Batteries (Management and Handling) Rules, 2001 made under the Act;
Hazardous wastes covered under the Hazardous Wastes (Management, Handling and Transboundary Movement) Rules, 2008 made under the Act;
Waste covered under the e-Waste (Management and Handling) Rules, 2011 made under the Act; and Hazardous microorganisms, genetically engineered microorganisms and cells covered under the Manufacture, Use, Import, Export and Storage of Hazardous Microorganisms, Genetically Engineered Microorganisms or Cells Rules, 1989 made under the Act.
Gaps still exist
However, there are many gaps and weak links in the implementation and monitoring of these rules and the healthcare waste management in general. Still, large number of healthcare facilities, laboratories and clinics are not practicing the safe management of health care waste from their sites.
There is a perceptible deficiencies in the level of knowledge and skills in this area. This is posing serious health hazardous and infections, not only in hospital employees but also to the community at large. The environment degradation on account of toxic emissions from incinerators, landfills, recycling of plastics among others, has become a serious public health hazard. Notification as the rule is one thing but addressing these challenges on the ground is more important and needs urgent attention from one and all.
(The author is the President of Indian Society of Hospital Waste Management)
Lot of water has flowed down since then, the Ministry of Environment and Forest (and Climate Change), Central Pollution Control Boards and the State Pollution Control Boards/ Committee have been playing a vital role in monitoring the implementation of these rules.
Further, the Indian Society of Hospital Waste Management (ISHWM) and IGNOU together with WHO SEARO and UNDP have made significant contributions in capacity building, training, awareness and certified education programmes in biomedical waste management in India as well as South East Asia. The exercise to revise and update these rules has been going on for more than five years. Finally, the Ministry of Environment Forest and Climate Change has notified the new rules ‘The Biomedical Waste Management (BMW) Rules, 2016’.
Second most hazardous waste
The United Nation Basel convention has described healthcare waste as the second most hazardous waste after the radioactive waste. Inadequate and inappropriate handling of healthcare waste may have serious public health consequences and a significant impact on the environment. Thus, sound management of healthcare waste is a crucial component of environmental health protection. In both, the short term and the long term, the actions involved in implementing effective healthcare waste management programmes require multisectoral cooperation and interaction at all levels.
Policies should be generated and coordinated globally, with the management practices implemented locally. Establishment of a national policy and a legal framework, training of personnel, and raising public awareness are essential elements of successful healthcare waste management. Improved public awareness of the problem is vital in encouraging community participation in generating and implementing policies and programmes. Management of healthcare waste should thus be put into a systematic, multifaceted framework, and should become an integral feature of healthcare services.
Recently in 2014, the World Health Organisation has come out with the second edition of ‘Safe management of wastes from healthcare activities’, more popularly known as the Blue Book.
It is the global reference book for framing national and international guidelines for heath care waste management. This handbook is intended to be comprehensive, yet concise, ‘user-friendly’ and oriented towards practical management of healthcare waste in local facilities. It provides guidelines for responsible national and local administrators, and is the first publication to offer globally relevant advice on the management of healthcare waste. The guidelines complement and supplement those produced in different regions in the past.
WHO strongly encourages the widespread implementation of these guidelines and is ready to assist users in adapting them to national settings.
In many countries and particularly in India, the knowledge about the potential for harm from healthcare wastes has now become more prominent to governments, medical practitioners and civil society. Increasingly, managers and medical staff are expected to take more responsibility for the wastes they produce from their medical care and related activities.
The indiscriminate and erratic handling and disposal of waste within healthcare facilities is now widely recognized as a source of avoidable infection, and is synonymous with public perception of poor standards of healthcare. Coming back to the BMW Rules, 2016, some of the salient features of the rules are:
The ambit of the rules has been expanded to include vaccination camps, blood donation camps, surgical camps or any other healthcare activity; Phase-out the use of chlorinated plastic bags, gloves and blood bags within two years;
Pre-treatment of the laboratory waste, microbiological waste, blood samples and blood bags throughdisinfection orsterilisation onsite in the manner as prescribed by WHO or NACO; Provide training to all its health care workers and immunise all health workers regularly;
Establish a Bar-Code System for bags or containers containing bio-medical waste for disposal; Report major accidents;
Existing incinerators to achieve the standards for retention time in secondary chamber and dioxin and furans within two years;
Bio-medical waste has been classified in to 4 categories instead 10 to improve the segregation of waste at source; (i) Procedure to get authorisation simplified. Automatic authorisation for bedded hospitals. The validity of authorization synchronised with validity of consent orders for Bedded HCFs. One time Authorisation for Non-bedded HCFs.
Exclusion from new rules
Following categories / types of waste have been excluded in the new rules
Radioactive wastes as covered under the provisions of the Atomic Energy Act, 1962(33 of 1962) and the rules made there under;
Hazardous chemicals covered under the Manufacture, Storage and Import of Hazardous Chemicals Rules, 1989 made under the Act;
Solid wastes covered under the Municipal Solid Waste (Management and Handling) Rules, 2000 made under the Act;
The lead acid batteries covered under the Batteries (Management and Handling) Rules, 2001 made under the Act;
Hazardous wastes covered under the Hazardous Wastes (Management, Handling and Transboundary Movement) Rules, 2008 made under the Act;
Waste covered under the e-Waste (Management and Handling) Rules, 2011 made under the Act; and Hazardous microorganisms, genetically engineered microorganisms and cells covered under the Manufacture, Use, Import, Export and Storage of Hazardous Microorganisms, Genetically Engineered Microorganisms or Cells Rules, 1989 made under the Act.
Gaps still exist
However, there are many gaps and weak links in the implementation and monitoring of these rules and the healthcare waste management in general. Still, large number of healthcare facilities, laboratories and clinics are not practicing the safe management of health care waste from their sites.
There is a perceptible deficiencies in the level of knowledge and skills in this area. This is posing serious health hazardous and infections, not only in hospital employees but also to the community at large. The environment degradation on account of toxic emissions from incinerators, landfills, recycling of plastics among others, has become a serious public health hazard. Notification as the rule is one thing but addressing these challenges on the ground is more important and needs urgent attention from one and all.
(The author is the President of Indian Society of Hospital Waste Management)
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