Not Handled With Care, survey report by Centre for Science and Environment (CSE) is an effort to understand the state of bio-medical waste management in two of the biggest cities of Jharkhand, the gaps that exist and the path towards harnessing the opportunities
CSE urges Jharkhand for proper segregation and handling of bio-medical waste management at healthcare facilities and eventually, its scientific disposal
Ranchi, March 20, 2017: Hospitals and nursing homes in Jharkhand could be blatantly flouting India’s bio-medical waste laws by dumping hundreds of tonnes of such wastes without treatment – says a latest sample survey and study done in the state by Centre for Science and Environment (CSE), the New Delhi-based public policy advocacy organisation. Not Handled With Care, CSE’s first such study on biomedical waste management, was released at a workshop here today.
The study, which collected waste management infor¬mation from 19 hospitals in Ranchi and Dhanbad districts with a combined bed capacity of 3,486, highlights how the hospitals are flouting the Bio-Medical Waste (Management and Handling) Rules, 1998 and the Bio-Medical Waste Management Rules, 2016, at every stage.
“Every day, healthcare facilities in Jharkhand dump 2,201 kg of biomedical waste without even basic treatment,” said Chandra Bhusan, deputy director general, CSE. This is over 40 per cent of the total bio-med¬ical waste generated in the state; the India average is close to 7 per cent.
Problem at source
The Rules state that waste should be segregated in four containers: a yellow container for infected body parts, blood soaked cotton, gauges and bandages; a red container for intravenous tubing, saline bottles, catheter, syringes and gloves; a puncture-proof container for sharp wastes; and a cardboard box for glassware and metallic body implants. The reason for segregation is that 15-20 per cent of waste generated in hospitals is toxic and needs to be treated; mixing it with the remaining 80 per cent increases the pool of infected waste and the chances of infection.
The CSE study finds that 42 per cent hospitals do not follow even this basic segregation guideline. In fact, just 52 per cent of the hospitals have their yellow containers distinctly marked as containing bio-hazard waste. Most hospitals (79 per cent) transport their waste in open containers, which increases the risk of spreading infection.
Bio-medical waste, being organic in nature, must not be kept within the premises of any healthcare facility beyond 48 hours. In reality, just three of the 19 hospitals follow this guideline. Two of the hospitals admit that they clear their waste only twice a week.
Every healthcare facility should maintain records of generation, collection, storage, transportation, treatment, disposal and any other form of handling of bio-medical waste undertaken over five years. The 1998 Rules state that the records should be shared with the State Pollution Control Board (SPCB) every year. In reality, most facilities do not maintain the records – they depend on the information gathered from the bills furnished by Common Bio-medical Waste Treatment Facility (CBWTF) operators. They also use CBWTF estimates for their annual reports to the SPCB, which means untreated bio-medical waste goes unaccounted for.
As per the 2016 Rules, healthcare facilities should also have an accident re¬porting system to check any mishaps during the handling of bio-medical wastes. But 14 of the 19 hospitals are not following this guideline. Officials at all the 19 hospitals were not even aware that they need to prepare a report about the remedial steps taken as a response to every accident/mishap within 24 hours.
Hospitals generate two kinds of wastewater: sanitary wastewater from kitchens, toilets, washing and cleaning activities and non-sanitary wastewater generated from laboratories, blood banks and treatment areas. The sanitary wastewater is similar to domestic sewage, but at times carries infectious body fluids of the patients. The nonsanitary wastewater is full of pathogens and bacteria and should be treated before being released into the sewer drains. But none of the hospitals CSE visited have separate pipes to carry the non-sanitary wastewater. Only three in Ranchi have onsite sewage treatment plants to treat mixed wastewater before it is discharged into sewer drains.
The CSE report also highlights how the hospitals, which consume considerable quantities of water, do not practice water conservation methods such as rainwater harvesting. This could be responsible for the depleting water table in the two districts. RIMS Ranchi, which has 1,500 beds and a medical college, consumes 0.4 million litres of water a day, half of which is pumped out of the ground. In fact, none of the healthcare facilities have water metres. “Earlier, tube wells 91 metres deep were sufficient to draw out the water. Now we have to dig the tube wells to 240 metres,” says a worker at Govindpur community health centre.
Only Ispat Hospital in the state capital practices rainwater harvesting and groundwater recharging. “We have estimated the whole potential of groundwater recharging through rainwater harvesting and accordingly dug wells within the campus of MECON Limited (which runs Ispat Hospital),” says Sanjay Xalco, chief engineer, town administration and construction department of MECON Limited.
Infection at your doorstep
Plastic parts of used syringes are either dumped or burnt in the location where vaccination is being administered, or are sold to local scrap dealers. Hospital solid plastic waste has huge recyclable potential as this is made up of virgin plastic, which has high market value. This is the reason why both the earlier and the new Rules refer to disinfection and shredding of infected plastic waste before selling to recyclers. Instead, hospitals sell the infected plastic waste directly to scrap dealers,
The Act accords the health department the responsibility of keeping a record of all the clinical establishments within the state. But neither the state health department nor the SPCB have such a list. While the health department only has information related to government health centres, the SPCB has data for those health institutions which submitted authorisation ap-plications till 2014.
The way ahead
“Healthcare facilities and regulatory authorities have to take slew of measures in order to ensure that status of bio-medical waste management improves in the states,” said Bhushan.
Inventorisation of the total number of healthcare facilities and the amount of waste generated is a big grey area that needs to be addressed. Without proper inventorisation, it is difficult to create the most relevant design for the new CBWTFs, or to decide how many are needed.
Legal action against defaulting healthcare facilities and the ill-operated CBWTFs needed.
Coming up with a self-regulatory mechanism for monitoring and implementation of waste management.
Regular and ongoing training and capacity building of healthcare workers on biomedical waste management and handling.
For more on this and access to the CSE study report, please contact Souparno Banerjee (firstname.lastname@example.org / 9910864339) of The CSE Media Resource Centre.