Biomedical waste, an elephant in the room

The Council of Scientific and Industrial Research National Institute for Interdisciplinary Science and Technology (CSIR-NIIST) at Thiruvananthapuram is developing a technology for converting biomedical waste (BMW) into soil additives in a significant scientific advancement in BMW management in India. The technology can be a game changer in BMW management, provided the compliance of Bio-Medical Waste Management (BMWM) Rules, 2016 by all healthcare establishments does not remain mere annual statistics compiled by the state and the central pollution control board. Ironically, while the generation of BMW poses health and environmental hazards, poor enforcement of the legal provisions in various states, including Assam, indicates that it continues to be an elephant in the room. Improper disposal of BMW leading to the mixing of hazardous BMW with solid and liquid municipal waste can increase health and environmental hazards manifold. Persisting wide gap between the BMW waste generation and treatment capacity in Assam is due to poor enforcement of BMWM rules and the state lagging behind in creating treatment facilities. The installation of an automated biomedical waste conversion rig at the All India Institute of Medical Sciences, Delhi, that uses the new technology has raised hopes for bridging the gap in states like Assam. According to an official release, the rig can spontaneously disinfect and immobilise pathogenic biomedical waste such as blood, urine, sputum, laboratory disposables, etc., apart from imparting a pleasant natural fragrance to otherwise foul-smelling BMW. Simultaneously, the laboratory disposables could be disinfected and prepared for direct recycling. With its potential to transform treated waste into value-added soil additives with minimal human intervention, the developed technology provides a safer solution for healthcare facilities, avoids the risk of spills and occupational exposure, and assists in preventing the uncontrolled spread of infectious microbes, it adds. The technology can be implemented at any healthcare facility where pathogenic biomedical waste is generated, requires only a 3-phase electrical connection and an air compressor line, can be installed at point-of-care, and can be scaled up if needed. A significant increase in the number of healthcare facilities is a key indicator of improvement in healthcare service delivery in a state, making it more accessible to people. An increase in the number of healthcare facilities for tertiary care reduces out-of-pocket expenditure incurred by a patient’s household in availing similar diagnostics and treatment facilities outside the state for which they require to travel long distances and seek accommodation in hotels or lodges. BMWM Rules require every bedded and non-bedded healthcare facility to obtain authorisation from the state pollution control board so that the board can ensure that no healthcare facility functions without a proper BMW management system in place. Central Pollution Control Board data shows that more than 40% of healthcare facilities in the state are operating without authorisation from the Pollution Control Board, Assam. This is a serious gap, and an inordinate delay in bridging this gap can prove costly as BMW handling and disposal in many healthcare facilities continue to be carried out without a proper oversight mechanism. The state currently has two Common Biomedical Waste Treatment Facilities (CBWTF), and the establishment of more such facilities needs to be prioritised to ensure safe collection, transportation, storage, treatment, and disposal of BMW. The BMWM Rules stipulate that no healthcare facility should establish a captive treatment facility if it is located within a radius of 75 km of CBWTF. The CBTWF involving private investment in waste management and optimal capacity utilisation is crucial for its commercial viability in the long run. Besides, state PCBs lacking adequate human resources to carry out more frequent inspections of healthcare facilities for ensuring regulatory measures for compliance with BMWM Rules, the establishment of more CBWTF can reduce the pressure on SPCBs by reducing inspection to common waste disposal facilities. For healthcare facilities, the establishment of CBWTF can significantly bring down capital expenditure in creating the captive treatment facilities and recurring expenditure incurred in recruiting trained professionals to manage such treatment facilities. Revised Guidelines for Common Bio-medical Waste Treatment Facilities issued by CPCB mandate the SPCBs to conduct a gap analysis regarding the coverage area of the bio-medical waste generation and project over a period of the next ten years, the adequacy of the existing treatment capacity of the CBWTF in each coverage area with a radius of 75 km. In the absence of an expression of interest by any proponent, then SPCB shall insist that healthcare facilities form an association and develop their own CBWTF in line with these guidelines or have captive treatment facilities, the guidelines state. The functional CBWTF operating at a profit is crucial to attracting more private investment for the establishment of more such facilities in the state. The cost of using CBWTF services being economical to healthcare facilities is essential to make the transition from compliance to voluntary requisitioning common in BMW management service. Bridging the gap between BMW generation and treatment needs fine balancing between regulatory measures for addressing health hazards and healthcare services delivery.