Improper procedures of medical waste management have been reported from many places. At the global level, up to 64 per cent of healthcare institutions are reported to have unsatisfactory biomedical waste management (BMWM) facilities. Expansion of healthcare facilities and the recent trend of using disposables have led to an unprecedented burden of healthcare-related wastes. Since the last decade, unregulated handling of biomedical wastes is emerging as a serious threat to human health and safety.
The International Labour Organisation (ILO) observes the World Day for Safety and Health at Work on April 28 to promote prevention of occupational accidents and diseases. April 28 is also the day on which the world’s trade union movement holds its international Commemoration Day for Dead and Injured Workers in memory of the victims of occupational accidents and diseases.
Biomedical wastes are generated in the diagnosis and treatment of human and animal diseases. Hospitals, clinics and laboratories produce huge quantities of biomedical wastes, which pose occupational health risks to those who generate or come in contact with them. According to the WHO, almost 80 per cent of medical wastes are benign and comparable to domestic wastes. The remaining 20 per cent is considered hazardous.
In many cities, collection, segregation, transportation, and disposal of solid wastes has been done in a very unscientific way. Segregation of wastes has not been done before disposal. Solid wastes contain biomedical waste and sometimes other toxic and hazardous wastes.
The wastes from hospitals, nursing homes, clinics, etc., are apparently infectious unless treated carefully. These wastes include blood-soaked bandages, culture dishes and other glassware, discarded surgical gloves, discarded surgical instruments, discarded needles, etc. All activities in medical waste management from collection to disposal involve risk either to the worker directly involved or to nearby residents.
Occupational health and safety now has an impact on every worker in every workplace. Employers have a duty to prevent occupational diseases by taking preventive and protective measures through assessment and control of risks at work. Poor management of healthcare wastes potentially exposes health workers, waste handlers, patients and the community at large to infection, toxic effects and injuries. Prospective workers should be educated about the biohazards to which they may be occupationally exposed, the types of exposures that place their health at risk, the nature and significance of such risks as well as the appropriate first aid and follow-up for potential exposures.
The Constitution of India has detailed provisions for the rights of citizens and also lays down the Directive Principles of State Policy which set an aim to which the activities of the state are to be guided. On the basis of these Directive Principles, the Government is committed to regulate all economic activities for management of safety and health risks at workplaces and to provide measures to ensure safe and healthy working conditions for every working man and woman. The Biomedical Waste (Management and Handling) Rule 1998, prescribed by the Union Ministry of Environment and Forests, came into force on July 20, 1998.
Hospital wastes can be categorised and segregated on the basis constituents. Such as infectious materials containing dangerous concentrations of waste, if exposed, can cause diseases are included in this category. It includes wastes from surgery on patients with infectious diseases; sharp disposable needles, syringes, blades, broken glasses or any other items that can cause injury; pharmaceuticals like drugs and chemicals that are returned from wards, spilled, expired, contaminated or exposed for longer period are included in this category. There are also radioactive like solids, liquids and gaseous wastes contaminated with radioactive substances used in diagnosis and treatment of diseases.
Whether the method of disposal is on-site or off-site, biomedical wastes must be segregated from the general waste stream. If biomedical wastes are mixed with general refuse, the total waste stream would require special treatment and handling. Waste segregation relies on the waste being segregated at its point of generation and placed into appropriate waste containers. Segregation permits facilities to effectively divert those materials that are recyclable, require special handling or disposal. Used syringes need to be disposed of in an environmentally safe manner. Syringes and needles must be damaged before they are put in containers.
There is a need of proper management of biomedical wastes. In this regard, public awareness will play an important role in addressing the issue at local level. Various types of awareness programmes are being organised to spread awareness for management of this problem. Policies and procedures should be made available and include methods of segregating, packaging, labeling, moving, storing, treating and transporting the various waste types and a list of all regulations and legislations concerning biomedical wastes and provision for regular, ongoing staff instruction about proper handling and potential hazards of biomedical waste.
Workers and their organisations have a right to be involved at all levels in formulating, supervising and implementing prevention policies and programmes for occupational safety and health and prevention of occupational diseases.
It has been felt that the solid waste management in Bhubaneswar is not in tune with the rapid development of the city. The indiscriminate disposal of biomedical wastes poses a great risk to human health and environment in the city. The hazardous and infectious wastes from hospital and nursing homes are at present disposed of in a manner which is not environmentally sound. Within the Bhubaneswar Municipal Corporation areas there are five Government hospitals, two private hospitals, 17 Government Dispensaries, about 20 nursing homes which generate a total of one tonne of biomedical wastes every day. The wastes are currently dumped along with municipal solid wastes. This poses high risks to the city.
There are no demarcated dump yards for biomedical waste disposal in Bhubaneswar. Many open areas in the city have been converted into dumping yards. Medical wastes are simply dumped with other solid wastes in different locations. These sites are visually unpleasant without any visual barriers. Besides, open dumping often leads to a number of problems like air, water and ground pollution, spread of diseases, etc. People involved in the disposal process can suffer from needle stick injuries. This can happen during the disposal of the used syringe or even after disposal to those involved in recovering them. Of all the potential sources of infection transmission from biomedical wastes, needle sticks are of prime concern to the health staff and the community at large.
The management of solid wastes including biomedical waste should, therefore, be a priority for the city of Bhubaneswar. Protection against personal injury is essential for all workers who are at risk. The individuals responsible for management of healthcare wastes should ensure that all risks are identified and suitable protection from those risks is provided. It is essential that all medical waste materials are segregated at the point of generation, appropriately treated and disposed of safely.