Bio-Medical Waste Disposal During and Post Pandemic: Challenges Faced and Ways to Overcome Them

Sukrit Dhingra, 3rd Year Law Student, University School of Law and Legal Studies, GGSIPU

  1. INTRODUCTION TO BIO-MEDICAL WASTE

Bio-Medical waste or BMW means any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps, including human anatomical waste, animal anatomical waste, metal waste, glass waste etc. [1] As is evident from a plain reading of this definition, the ambit of Bio- Medical Wastes is humongous and covers everything from waste generated by first aid kids at home, research laboratories to waste generated by clinics and hospitals. A research team at WHO found out that as much as 15% of the total amount of waste generated by health care activities is hazardous in nature and can be infectious, toxic or in some cases, radioactive. [2] This means that a good chunk of Bio-Medical waste can prove to be very deleterious and harmful for patients in a hospital, researchers in a laboratory and the general public at large.

It is a well-documented fact that exposure to perilous bio-medical waste can become the genesis of multitude of problems and ailments. This hazardous nature of biomedical waste stems out from various factors such as presence of infectious agents, existence of harmful toxins and genotoxins, radioactive materials as well as sharp.[3]The statistics in India suggest that our country generates approximately generates 2kg of Bio-Medical wastes per occupied hospital bed per day.[4] This in turn is only one source of the total bio-medical waste generated in India and that too during pre- COVID times. As explained before, there are multiple sources of bio-medical wastes and they can cause a myriad of deadly infections in humans such as extreme immune deficiency and hepatitis infections.

This makes it clear that Bio-Medical waste is like a bomb on the verge of exploding staring that has somehow gone unnoticed for quite a while. It is imperative that we start giving the requisite attention to BMW and take the necessary steps to manage its disposal in a way that does not harm our ecological balance.

  1. MANAGEMENT RULES IN EFFECT

As discussed above, around 15% of the waste generated by hospitals and similar institutions is deemed hazardous in nature. Our lawmakers took note of this fact and came up with Bio-Medical Waste (Management and Handling) Rules, 1998 which was published by the erstwhile Ministry of Environment and Forests. These rules aimed to provide a regulatory framework for the bio-medical waste that the country generates. In this, two categories were created, one of the “occupier”, that is the institution that generates bio-medical waste and another of the “authorized person” which was the operator designated to handle the generated bio-medical waste. An Occupier was mandated to strictly follow the procedure prescribed by the 1998 BMW rules while collecting the bio-medical waste generated in the institute and various standards were prescribed by the abovementioned rules for Authorized Persons to meet when receiving, storing , dealing, transporting and disposing off the BMW generated by Occupiers. However this was not all encompassing as the rues were applicable on only those  Occupiers who provided services for more than 1000 patients per month. This meant that the standards were not adhered to religiously and various disease outbreaks occurred because of that. In 2009, approximately 240 people in the state of Gujarat contracted hepatitis B because of reuse of syringes and unsterilization of syringes.[5]

Realizing the negative ratifications of the caveat imposed in the rules, the Ministry of Environment and Forests proposed the draft of “ Bio-Medical Waste (Management and Handling Rules 2011” and stipulated that the standards mentioned in the BMW rules shall be adhered by all Occupiers irrespective of the patients they deal with in a month. However, this amendment could never sport the hat of law due to various political reasons.

However, the Ministry of Environment, Forest and Climate Change brought in a much needed update in the BMW rules in form of the Bio- Medical Waste Management Rules, 2016.[6] These rules are currently in effect in India and the scope of BMW rules has been expanded significantly to include entries which were hitherto outside the scope of the abovementioned rules. They include health camps like vaccination camps, blood sample collection camps, blood donation camps, surgical camps etc. The new rules also expand on the duties of the Occupiers. They now include-

  1. Mandatory pre-treatment of onsite equipment and paraphernalia in accordance with the methods stipulated by NACO or WHO.
  2. Gradual phasing out of plastic bags, gloves, blood bags, etc.
  3. Training and immunization of all staff at health care facilities.
  4. Liquid waste to be separated and pretreated before any confluence with other liquid waste.
  5. All BMW to be registered with barcodes before sending out.
  6. All major accidental occurrences including accidents caused by fire outbreaks, blasts, ill handling or mis management of BMW and all remedial and preventive actions taken up by the prescribed authority must be reported.
  7. Mandatory updating the incinerators in accordance with the new standards.
  8. A register regarding bio-medical waste to be maintained on a daily basis and it should be updated on the website every month. [7]

Similarly, the duties of the operator of CBMWTF ( Common Biomedical Waste Treatment and Disposal Facility) has also been increased and they are now statutorily obligated to assist the health care facility’s staff and also materialize a GPS system for the handling of BMW. They now also have to maintain their records of incineration, hydroclavings and autoclavings for 5 years.

In the current system, BMW is classified into four categories based on factors such as type of waste and the modus of treating it. To curb the menace produced by anatomical waste, the rules put a bar of only 48 hours on the storage of untreated human anatomical waste, animal anatomical waste as well as waste that is generated as a byproduct of various biotechnological activities. For the same reasons, there is an embargo on health care facilities to establish BMW treatment facilities on the same site, given that a CBMWTF is present in a   range of 75 kilometers.  To insure implementation of these guidelines, the ministry of Environment, Forest and Climate Change will monitor the activities of occupiers and BMW treatment plants yearly by setting up district level committees in every state. Also, this committee shall submit its findings every 6 months to the respective State Pollution Control Board.

  1. EXACERBATION BY COVID-19

With the percolation and spreading of SARS-CoV-2 and the disease of COVID-19, there has been an exponential increase in the number of bio-medical supplies being used. With the safety guidelines in place, everyone is using a face mask and people in the workplace are using the surgical face masks coupled with nitrile gloves, both of which are a use and throw supple, almost on a daily basis. All medical professionals and frontline workers are wearing Personal Protective Equipment (PPE) kits or coveralls/ gowns and show covers and  most of them are single use. Not only this, with the increase in testing capacities and large scale production of COVID-19 testing kits, various categories of biomedical waste is produced in huge quantities daily. The quantity of bio-medical waste generated has increased significantly also by the vaccine trials that are going on around the world at a blazing pace. The research and development and the final production and delivery of the vaccine for consumers brings with it a lump load of bio-medica waste that needs to be disposed of very prudently and safely.

It is pertinent to mention herein that the BMW generated in battling the pandemic has to be treated as a new category and should be handled with extra care because any amount of brazenness could cause to become a great global concern to public health and environmental sustainability. According to the World Health Organization and Indian Council of Medical Research, COVID-19 waste acts as a vector for spreading the disease as SARS-CoV-2 can survive for a week on COVID019 waste like face masks, face shields, gowns, other surfaces etc.[8] This is a major problem because before the pandemic, such equipment was only used in hospitals and similar institutions but now the global pandemic has brought these supplies into every household and necessitated their use by every individual. This is leading to a rapid accumulation of  waste that has the potential of being infectious. Therefore, it is imperative that in our fight against COVID-19, the world not only focuses on the stopping of the spreading of virus from human contacts but also by safely disposing all the COVID waste generated so that it cannot become the source of new infections.

The levels at which bio-medical waste is being generated in India is sky rocketing. According to the Central Pollution Control Board, India is now churning out almost 800 metric tonnes every day as opposed to the average of around 600 metric tonnes in the pre COVID-19 era.[9] Although institutes like hospitals take due care and adhere to guidelines to tackle COVID waste like keeping it separate for 72 hours before disposal, most houses are unaware about it and they throw up their COVID waste alongside municipal waste and this a cause of worry for the society.

  1. MECHANISMS IN PLACE AND THE ROAD AHEAD

As mentioned above, the 2016 BMW rules are the main legislative framework that deal with the collection, dealing, treating and disposing off of bio-medical waste in India. The Central Pollution and Control Board has published new guidelines in July, 2020 especially regarding COVID-19 waste and it is in addition to the 2016 rules.[10] It states that healthcare facilities that are treating COVID-19 patients or even isolation wards should  ensure that they have separate colour coded bins/bags/containers that are operated by foot  and segregated as per BMWM Rules,2016 and that two bags should be used instead of one. This will ensure that the waste can be disposed off safely and that it does not leak or burst out on the way. It has also been made mandatory to collect and store biomedical waste separately and use a collection bin marked as “COVID-19” and use it specifically to store COVID-19 waste in a temporary storage room before it is handed out to the staff of  Common Bio-Medical Waste Treatment and Disposable Facility (CBWTF). The guidelines also mentions that even the trolleys for carrying COVID-19 waste should be separate and that any and everything that comes in contact with COVID-19 waste should be sanitized by spraying with 1% sodium hypochlorite solution daily.

Other than that, the CPCB, in line with the digital India campaign of the government, has also started a new mobile application called “COVID19BWM”. Herein institutes can register their details and update the data relating to the COVID-19 biomedical waste generation from their premises. Although it’s a good initiative, the data received by it is not accurate at a central level because only 15 states and Union Territories have implemented the functioning of this app at the tie of writing this paper.[11] Not only this, the absence of general awareness in people about these rules adds to the worry of ill management and disposal of biomedical waste. In India, most of the COVID-19 patients are in home isolation and they aren’t aware of the disposal techniques that need to be followed when they have to throw away their waste like shredding and wrapping a mask/glove in paper for 72 hours before throwing it away by mixing it with general waste. Although the new rules make it imperative for Urban Local Bodies to provide for colour coded yellow bags for hazardous COVID waste to people living in quarantine, it has been noted that there is a general lack of segregation etiquette followed in Indian Households. This could potentially mean that the waste can metamorphize as a source of infection. It is therefore imperative that CPCB tweaks its guidelines and labels all COVID waste like gloves, masks etc. as bio-medical waste and not only those that are received from the house of a COVID-19 patient. This is also imperative because the majority of COVID-19 patients are asymptomatic carriers and has possibly unaware that they have contracted the infection. Collecting their general waste can put the sanitization workers at risk of contracting the virus themselves and this can in turn start a new chain of infections.

It should be noted here that the author does not suggest that the CPCB should bear all burden of waste management in India. It is the need of the hour that we emphasize on the 2Rs of waste management- Reduce and Reuse. Due to the widespread scare of the virus, a lot of people are seen taking extreme measures to protect themselves that are in their lifestyle unwarranted. For example, the people of non-healthcare sectors do need to wear PPE kits or hazmat suits to work and they absolutely not need to throw them away after one use. Also, non- quarantined people should be urged to wear reusable masks so that the waste that is generated daily can be reused. If steps like these are implemented and people are informed of their obligations towards the environment and how these measures can significantly reduce the burden of the country, we can cut down on a lot of bio-medical waste generation.

The above mentioned ways deal with how the quantity of bio-medical waste generated can be diminished by cutting down on using unnecessary equipment and reusing things like masks after disinfecting them and also how a proper segregation of COVID waste can be done by efforts of CPCB and ULB in tandem and educating the public about it. However, that is not everything we can do to tackle the problem of bio-Medical waste in India. Scientists are coming with ingenious ways of safely disposing of the COVID waste that does not harm the environment.Indian scientists from the University of Petroleum and Energy Studies have come up with a method in which the plastic that has been used in PPE kits can be converted into renewable liquid fuels using a process called pyrolysis.[12] The method that we are using now has been incinerating the COVID-19 waste and if this method is implemented, it would not only take down the burden from our over burdened incinerators but also help the environment by converting harmful plastic to useful biofuel. The process of doing that is quite feasible as it only requires a heating of the plastic for one hour at high temperatures between 300 to 400 degree Celsius without oxygen. Not only this, there are other viable methods of disinfection like using the microwave technique, dry heat techniques are also available which can be created on site where the waste is generated.[13]Until this is implemented, to cope with the burden of overwhelming bio-medical waste, the author suggests that we continue with the practice of incineration but streamline it more on the lines of how Spain handled it.[14] The authorities therein have formulated a plan based on the available resources by prioritizing the incineration of COVID-19 waste by municipal incinerators under a highly automated environment and minimum involvement of manpower.

  • CONCLUSIONS

The outbreak of SARS-CoV-2 has thrusted the entire planet and its people into uncertain, unprecedented and somber times. Although containing the spread of the virus through human contact remains our first and foremost priority, the author observes that we see that as an end in itself and miss out on various other contours of the pandemic, like the bio-medical waste that is generated in battling it and our level of knowledge and preparedness to deal with it. The paper has dealt in detail about the ill effects on public health and ecological balance this waste can have if it is not properly managed and has also suggested some measures that can be taken by the government and citizens alike to stop that from happening. It should be stressed that this waste can also become a new source of infection, so it has been recommended that the government should tweak its guidelines and consider all pandemic related waste like masks, gloves etc. as COVID-19 waste whether it comes from an isolated COVID-19 patient or not. This has been suggested because of the large number of asymptomatic carriers of the virus that are not caught by the government’s radar.

It has also been suggested that if the CPCB zealously continues to do its work in tandem with urban local bodies and keeps on edifying Indian citizens on the guidelines regarding segregation of waste, the mammoth task of managing this new surge of bio-medical waste can become possible. We have also discussed alternative efficient ways of disinfecting and disposing off COVID-19 bio waste using novel techniques that not only have reduced emissions than the industry standard incinerations but also convert the waste into bio-fuel like the Pyrolysis technique. Other techniques that ease up the burden on municipal incinerators such as microwave technique have also been suggested because of an easy and mobile set up of its required technology on waste producing sites.

Lastly, it has been strongly asserted that it is imperative upon India as well as the rest of the world that we take on the challenge of bio-medical waste in these times head on while we can still manage it effectively and sustainably and not let this problem wallow on until it gets out of control. If we don’t take steps to curb this menace right now, we’ll have to deal with a COVID-19 scale problem even after even after we have overcome the pandemic. This battle may be a long and arduous one but it is one that we cannot shy away from and must face it head on as one.


[1] Section 3f, Bio-Medical Waste Management Rules, 2016.

[2]HealthImpactsofHealthCareWaste,WorldHealthOrganizationhttp://www.who.int/water_sanitation_health/medicalwaste/020to030.pdf.

[3]S.R. Kumar et al.,Bio-medical waste disposal in India: From paper to practice, what has been effected, 3Indian J Health Sci Biomed Res202, 207-209 (2019).

[4]A.D. Patil et al,  Health-care waste management in India, 6 J Environ Manage 211, 203 (2001).

[5]S. Seetharam, Hepatitis B outbreak in Gujarat: A wake-up call, 6 Indian J Med Ethics 120, 120-121 (2009).

[6]Bio-medical_Waste_Management_Rules_2016.pdf (dhr.gov.in)

[7]P. Datta et al, Biomedical waste management in India: Critical Appraisal, 10 J Lab Physicians 6,11 (2018).

[8]S. Ilyas et al,Disinfection technology and strategies for COVID-19 hospital and bio-medical waste management, 749 Science of The Total Environment 1416, 1426-1432 (2020).

[9]SimrinSirur, Where do used Covid masks, gloves end up? Infection surge creates waste problem for India, THE PRINT (Oct. 02, 2020, 12:06 PM), https://theprint.in/health/where-do-used-covid-masks-gloves-end-up-infection-surge-creates-waste-problem-for-india/513717/.

[10]https://cpcb.nic.in/uploads/Projects/Bio-Medical-Waste/BMW-GUIDELINES-COVID_1.pdf

[11]https://greentribunal.gov.in/sites/default/files/news_updates/Complaince%20Status%20Report%20by%20CPCB%20%20in%20OA%2072%20of%202020%20(In%20Re%20Scientific%20Disposal%20of%20BioMedical%20Waste%20arising%20out%20of%20COVID-19%20treatment-%20Compliance%20of%20BMW%20Rules,%202016).pdf

[12]Press Trust of India, COVID-19: Disposed Personal Protective Equipment Could Be Turned Into Biofuel, Say Indian Scientists, NDTV (Aug. 05, 2020, 07:52 PM), https://swachhindia.ndtv.com/covid-19-disposed-personal-protective-equipment-could-be-turned-into-biofuel-say-indian-scientists-2-47976

[13]S. Ilyas, Supra note 9, at 1440.

[14]D. Barcelo, An environmental and health perspective for COVID-19 outbreak: meteorology and air quality influence, sewage epidemiology indicator, hospitals disinfection, drug therapies and recommendations, 8 Journal of Env Chem Engineering 1016, 1187-1190 (2020).

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