Health care waste a burning issue

As the Indian health sector grows and modernises, awareness about the safe disposal of the country’s growing mountain of medical waste must grow, driven by public health concerns and demands for better environmental protection.

Since medical waste is classified as more dangerous than ordinary garbage, successful hospital by-product management in India must involve strict maintenance policies to avoid the spread of disease and prevent the leaching of hazardous chemicals into ground water.

To address these concerns, the Indian government, both at the Centre and the State, and healthcare organisations must establish efficient hospital and medical waste management policies and systems.

The scale of the problem is significant; it is estimated that generation of medical wastes in India varies from an average of 3-5 kg per bed per day. The disposal of these items requires a precise and integrated national plan for waste management - from audit, collection, separation, storage and transfer to final treatment.

Sadly, there is no such hazardous waste management plan in India. Conversely, European laws require countries to separate collection and storage of solid hospital waste. A look at these good management practices.

Categorisation of Hospital Waste

The European laws require classification of waste based on the definitions in the European hazardous waste directive. These include two main categories - municipal waste and special hospital waste. Municipal waste includes all solid waste without infectious, chemical, or radioactive waste. The special hospital waste consists of several different sub-categories including infectious discarded materials from health-care activities on humans or animals which have the potential of transmitting infectious agents to humans.

Regulation and control system

The health-care waste producer is responsible for safe packaging and adequate labeling of waste to be transported off-site and for authorization of its destination. Packaging and labeling should comply with safe management of wastes from health-care activities.

Waste Separation

The key to minimisation and effective management of health-care waste in Europe is segregation and identification of the waste. Appropriate handling, treatment, and disposal of waste by type reduces costs and does much to protect public health. Segregation is always the responsibility of the waste producer and takes place close to where the waste is generated and is maintained in storage areas and during transport.

Effective waste segregation is the obligation of hospital staff. The most common way of identifying the categories of health-care waste in Europe is by sorting them into impermeable colour-coded plastic bags or containers in addition to the colour coding of waste containers.

Separation of waste in European hospitals occurs almost immediately - at the time the waste is produced, for example, when an injection is given, or when packaging is removed from supplies and equipment. Each hospital is obliged to designate a person responsible for waste management. Costs for safe treatment and disposal of hazardous health-care waste are typically more than 10 times higher than those for general waste.

When a disposable syringe is used, for example, the packaging should be placed in the general waste bin and the used syringe in the expensive sharps container.

Collection

Nursing and other clinical staff in European hospitals ensure that waste bags are tightly closed or sealed when they are about three-quarters full. A routine programme for their collection is established in each European country, as part of the hospital’s waste management plan.

Incineration

Proper incineration is the high technological approach in Europe adequately treats all types of special hospital waste and is the preferred option for cytotoxins and other pharmaceuticals.

Autoclaving

Autoclaving is also an efficient wet thermal disinfection process, practiced in European hospitals. Special hospital waste is heated with steam in an enclosed container, constructed of thick-walled steel, at high pressure. Waste management autoclaves generate a wastewater stream and European law requires a boiler with stack emissions. Also, wastewater and emissions need to be controlled.

Microwave irradiation

Application of high energy electromagnetic fields result in the oscillation and rapid heat up of liquids contained in the waste to include the liquid cell material of micro-organisms and eventually cause the destruction of all infectious components of the waste. This too, is common in Europe.

Chemical disinfection

Chemicals (mostly strong oxidants such as chlorine compounds, ammonium salts, aldehydes and phenolic compounds) are added to the waste to kill or inactivate pathogens.

Liquid wastes such as blood, urine, stools or hospital sewage are chemically treated, whereas solids and highly hazardous hospital waste such as microbiological cultures undergo a complex and expensive preparative process of separation, shredding and milling prior to the application of the mentioned chemicals. In all of Europe, chemical disinfection requires special treatment of a hazardous wastewater stream, which cannot simply be released to the public sewer canal system.

It should be stressed that the non-destructive technologies such as chemical disinfection, autoclaving, microwave or radiowave irradiation are not allowed for special hospital waste such as organs, tissues or amputated body parts. Thus, incineration or burial are the only accepted techniques for the treatment of such special type of HW.

Training

It is mandatory in Europe that training and instruction in waste separation is imparted to all employees, particularly the new ones. There are ongoing refresher courses for employees’ to update their level of knowledge at regular intervals, to discuss newly emerging problems and to look for the best solutions for the workplace.

Waste avoidance

According to the European waste legislation and in practice, the first priority of waste management is waste avoidance or reduction. In Germany, careful segregation ensures that 95 per cent of clinical waste is hazardous material, and each hospital bed is expected to take a year to fill an 18-kg bin with it.

In a swiftly growing Indian economy, the emergent health service practices are increasing perilous waste creation. This, combined with a flaccid, limp and un-regulated hazardous waste management regime in India, seems like a perfect recipe for pandemonium and spread of the deadly disease.