Effective waste management:Are hospitals having the right methods and utilities?

With the growing healthcare sector and increasing number of patients, the amount of waste generated by hospitals is also increasing. The question that arises in such a demanding situation is, are the hospitals in India adhering to proper medical waste disposal guidelines and having the right equipment to do so? Experts from the field of manufacturers of waste equipment and hospitals analyse the scenario.

Titash Roy Choudhury      

Biomedical waste refers to all waste, biologic or non-biologic that is generated during the diagnosis, treatment or immunisation of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals. Now the biomedical waste generated by hospitals need to be properly collected, segregated and disposed. For all these procedures the right equipment are necessary especially for the segregation and disposal part as any slack in these methods lead to bad repercussions. Some of the reasons for segregation of medical waste are to prevent cross infection or outbreak of disease through improper handling of hospital waste, in and out of the hospital premises, to minimise the exposure to infection for the healthcare workers and waste handlers and to provide safe and hygienic environment in the hospital. Thus, care should be taken to integrate the proper waste disposal equipment in the hospitals, but are the Indian hospitals and clinics abiding the guidelines?

Monish Bhandari

Director – Marketing, SS Medical Systems (I) Pvt Ltd, Lucknow

Surveys carried out by various agencies show that the healthcare establishments in India are not giving due attention to waste management. After the notification of the Bio-medical Waste (Handling and Management) Rules, 1998, these establishments are slowly streamlining the process of waste segregation, collection, treatment and disposal. Core competency of any hospital is to treat and manage the patient; biomedical waste management thus has a low strategic value in terms of its business model hence investment is minimal in equipment and trained personnel. This fact is evident as all big and small hospitals, pathologies, etc have availed our services in states of Uttar Pradesh and Bihar.

We at SS Medicals and others step in to fill that gap as outsourced strategic partners of such large hospitals or pathologies and providing competitively priced and affordable services.

Dr Namita Jaggi

Consultant Microbiologist, Director, Labs & Infection Control, Artemis Health Institute, Gurgaon

Proper handling, treatment and disposal of biomedical waste are the important elements of healthcare infection control programme. Correct procedure will help to protect the healthcare workers, patients and the local community. Artemis Hospital is authorised by Haryana Pollution Control Board for the management and handling of bio-medical waste. It follows the rules laid down by the Haryana State Pollution Control Board under the Biomedical Waste (Ministry of Environment and Forests) rules of 1998. In India, when we go into the remote areas and smaller cities we see rampant misuse of medical waste and this scenario needs to change. The problem starts from segregation part, most of the smaller hospitals do not even carry out proper segregation of the waste according to rules leave alone having the right equipment like trolleys, and waste paper bags and others. The responsibility of the segregation is with the generator of biomedical waste – doctors, nurses and technicians and this is one step that should be given more attention. And if we look into the equipment section, most of the basic waste disposal equipment are not present in most of the local or public hospitals and this scenario can be changed by both voluntary and enforcing methods. While the government should conduct more checks and make it necessary for all healthcare units to follow the rules and guidelines of waste disposal.

Neeraj Garg

Managing Director, Nishika Enterprise, New Delhi

In general if we speak of the condition of hospitals in waste management it is poor. Most of the hospitals do not have the right equipment for proper waste disposal and one of the main reasons behind this sad situation is lack of awareness. Awareness plays an important role in making any new concept or technology popular and consequently used more often. It is because of lack of awareness that the right equipment are not purchased or not used properly. It is the lack of awareness regarding the innovations that are happening in this field that is also restricting the purchasing of the latest equipment. All of them are aware of the notifications of Ministry of Environment and Forest regarding biomedical waste management but proper adhering to such rules does not happen. They are all informed about the regulations but when it comes to implementing it at the ground level we see no efforts; there is a gap on implementation level. In metro cities the condition is still better but the more we move into the interiors and remote areas the situation worsens.

Another factor is that in big government hospitals there is a separate allocation for biomedical waste but in private hospitals that is not done. And most of the time the private hospitals are reluctant to shell out extra money for waste purposes thus not paying proper attention to it. Again even if the hospitals have the equipment there is also the problem of maintenance that comes to the forefront. There is no proper maintenance of them because of which the waste management of the hospital is adversely affected.

N K Venkataramana

Vice Chairman and Chief Neurosurgeon, BGS Global Hospitals, Bengaluru

Everyday hospitals generate disposables including sharp and non sharp objects, medical and non-medical materials. These materials have the potential risk of spreading infections if not handled appropriately. It is essential to have a process of collection, segregation, storage, disinfection and proper disposal. This involves various steps right from the hospital all the way up to the septic tanks and further disposal into ecologically compatible system. Internationally guidelines are now available for identification, isolation, segregation and disinfection. The management has the responsibility to adopt these guidelines, implement and train staff adequately to see that it is enforced effectively. There are a lot of challenges involved in this, like the challenge to train people at all levels who work in a hospital apart from providing infrastructural support. The second challenge is to properly disinfect with an effective method to isolate into various packs without contaminating the environment. Third challenge is to transport these materials in appropriate containers and properly concealed vehicles. Lastly, it is a challenge to create a place which caters to the multiple hospitals in a city like Bengaluru. The Government should provide a suitable area away from the inhabited areas and enforce a system for the final disposal without any compromise.

With the accreditation like NABH and JCI in our country a sort of enforcement is apparent in many of the major hospitals.

Dr P K Dave

Chairman, Advisory Board & Head Of Department, Orthopaedics, Rockland Hospital, New Delhi

In 1990, the world health assembly passed a resolution on hazardous waste management urging the member countries to strategise for the sound management of hazardous waste. Use of newer technologies in diagnosis and management results in the production of different kinds of waste like plastics, sharp material like needles and knife blades. Some of these items are non-biodegradable causing hazards for the environment. There are also other hazardous toxic biomedical wastes.

The technology used for waste management should be environment friendly and should confirm to the norms laid down by the Central Pollution Control Board. The awareness among the hospitals and health administration has increased but a lot still remains to be done. Management of waste requires segregation, collection, safe transportation and its ultimate disposal require definite hospital specific remedies.

Segregation of waste should be done at its source of its generation. For example, wards, operation theatres, laboratories and labour rooms. Toxic and hazardous waste should be treated before disposal. All the waste material should be segregated in different coloured plastic bags.

Treatment of waste material requires special equipment, training of personnel for segregation and making them aware for its needs.

The hospital management has to ensure authorisation from civic authorities and should be responsible for formulating a hospital plan for supervision, periodic monitoring and implementation.

Sarabjit Singh

Director, ARVS Equipments Pvt Ltd, New Delhi

The management of hospital waste poses to be a major problem in most of the countries, especially developing countries. In recent years, medical waste disposal has posed even more difficulties with the growing volume and increasing types of waste materials.

Most countries have guidelines and regulations stipulating proper waste management practices at all healthcare facilities. Therefore, it is important for any healthcare facility to have a proper waste segregation system and proper disposal products that are well-suited for the different kinds of biowaste produced in their facilities.

Segregation means the separation of the entire waste generated in a hospital in defined, different waste groups according to the specific treatment and disposal requirements. Only a segregation system can ensure that the waste will be treated according to the hazards of the waste and that the correct disposal routes are taken and that the correct waste management products will be used.

Various specialised products for medical waste handling are now-a-days available in Indian market, such as waste segregation systems, disposable safety sharp containers, disposable contaminated waste containers, biodegradable disposal bags, waste sterilisers, etc. Usage of such products & equipment can guarantee effective medical waste management.

We believe most of the hospitals in India are not well equipped with the waste handling & disposal products and equipment partly due to the lack of availability at reasonable cost and partly due to serious intentions to implement the system. All the managers of the hospitals and institutions need to see beyond the legal requirement angle and implement the system as a necessity towards infection & environment control and as a duty towards mankind.

Shashi Bhushan

Head-Marketing, Taxus Meditech, Gurgaon

I do not think hospitals are well equipped with the proper equipment needed for waste disposal in India. We at Taxus Meditech mainly work with government hospitals in providing them with the required waste disposal equipment and apart from the big government hospitals there is not much awareness regarding this fact. The district level and state level hospitals lack all the basic knowledge required for proper waste management, leave alone having the equipment. Our basic need for the moment is to spread awareness on this issue and to make them more conscious of the need of having proper waste disposal equipment. And once we establish the fact that it is their health which is also at risk if they neglect it, it may have a deeper impact. Funds allocation is also another reason behind lack of proper waste management facilities in India. Most of the time the hospitals are not aware of the new equipment that are being launched in the market and consequently do not upgrade them. Proper propagation of this concept is the need of the hour.