Biomedical waste – status as per CPCB
report of situation analysis and some suggestions
Author- Prof.
Dr. Niraj Pandit, Professor, Department of Community Medicine, SBKS Medical
Institute & Research Center and Deputy Director Research Cell, Sumandeep
Vidyapeeth, Piparia, Vadodara, Gujarat – email- drniraj74@gmail.com
Even
though it is known fact that biomedical waste is potential dangerous to community
and after more than 17 years of implementation of BMW rules, still biomedical
waste management and disposal is problematic area. The regulators are trying
hard to make sufficient implementation. There are various actions taken place
to make it proper implementation. As per the rule, each hospital or nursing
home has to register with the authority state level and they have to submit
report to state authority every year by 31 January. The compiled report of all
HCF (Health care facilities) needs to submit to Central Pollution Control Board
(CPCB) by 31 March of year. The CPCP is providing compiled report on the web
page http://www.cpcb.nic.in/Bio_medical.php,
which was accessed in first week of July 2015 and author prepared the situation
analysis.
Table-1
Basic information
|
Key area / Year
|
2013
|
2012
|
2011
|
2010
|
|
No. of HCF
|
1,68,869
|
1,59,838
|
1,51,222
|
1,39,594
|
|
No. of beds
|
17,13,742
|
16,12,600
|
14,59,286
|
14,20,563
|
|
No of CBWTFs in operation
|
198
|
190
|
179
|
188
|
|
No of CBWTFs under installation
|
28
|
29
|
22
|
17
|
|
No of HCF using CBWTFs
|
1,31,837 (78%)
|
1,21,279
(76%) |
1,12,187
(74%) |
98,764
(71%) |
|
No. of HCF using own Rx & disposal
facilities
|
22,245 (13%)
|
21,870 (14%)
|
23,361 (15%)
|
20228 (14%)
|
|
Gap in own facility and CBWTFs use
|
9%
|
10%
|
11%
|
15%
|
|
BMW generated kg per/day
|
4,84,000
|
4,16,000
|
4,07,773
|
3,50,325
|
|
BMW generated bed per day
|
0.28 kg/day/ bed
|
0.25 kg/day/ bed
|
0.27 kg/day/ bed
|
0.24 kg/day/ bed
|
|
HCF violating rules
|
7,894 (4.6%)
|
12,990 (8.1%)
|
5472 (3.6%)
|
6653 (4.8%)
|
|
Notice issued
|
4,391 (55.6%)
|
11,583 (89.1%)
|
3585 (65.5%)
|
5829 (87.6%)
|
The
above table is showing interesting information. As per World Bank report[i],
India has 0.7 beds per 1000 population. But this record shows that the bed
strength of country rose to 1.4 beds per 1000 population in 2013, which is
almost double. In last four years the number of CBWTFs increased from 188 in
2010 to 198 in 2013. There is observed gap in the use of CBWTF and using own
BMW treatment & disposal facilities. But the positive aspect is that the
gap reduced from 15% in 2010 to 9% in 2013. The waste generated per bed per day
is almost near constant 0.24 kg/day/bed in 2010 and 0.27 kg/day/bed in 2013.
There are almost around 5% of registered health care facilities who are
violating rules and pollution control board is issuing notice.
I
enjoyed to analyze these reports. While analysis these reports I personally
found some missing information in the reports. If CPCB starts to collect the
missing information, they can monitor the waste management in better way. As
per my personal opinion, the points which need to incorporate in report are-
1. The
number of HCF is divided to three category primary HCF, secondary and tertiary
HCF. In report if type of HCF is collected, it will help to understand the
distribution of beds in secondary and tertiary hospitals. The primary care
centers and nursing homes may not have indoor facilities. Thus it will help to understand
the bed distribution and waste production pattern.
2. In
this report it is not clear the category of waste. If the waste per bed per day
if we calculate it is coming to 0.28 kg/day per bed. It looks like that the
reported data is for infectious waste only. As it matches with 10-15% of infectious
waste from total waste generated per bed per day. But plastic waste and
non-infectious waste details can be collected.
3. The
report did not have anything on radioactive and cytotoxic waste. They are
potential dangerous for community in different way. If authority plan to
collect data on same will be helpful to track such hospitals.
4. There
is no clarity on liquid waste. Also report also does not ask anything on liquid
waste. But it was found in last committee meeting the CPCB has made committee
on liquid waste disposal.
5. Many
hospitals are doing training and capacity building workshops. If they report in
yearly reporting system, it will help to monitor hospital’s involvement in
capacity building of staff.
6. As
per BMW rules, each hospital needs to report accident or injury to authority.
There is no discussion or report found in yearly report. This is a key to
understand the needle stick injury pattern and incidence in a year. Also if
hospital reports accidents like spillage blood on floor in ward or operation
theater, leakage of BMW bags and similar other accidents to authority, it will
help to understand the dangerous aspect of wastage management.
7. One
more suggestion to monitor the Hepatitis-B vaccination programme. All hospital
staff should receive Hepatitis-B vaccine as per prescribe interval. If
authority monitor, it will be great help to hospital staff and thus community.
In
addition to this state pollution control board should spare some 5% to 10% of
fees collected from health care facilities registration for the purpose of
research and generation of evidence. There
are lots of gaps in available evidences in biomedical waste and require to
generate. This research fund will be helpful to generate new knowledge and new
technology in context to our country need. Every year pollution control board
can invite applications form all health care people and medical – paramedical
students or research associates. Team of expert will evaluate the proposal and
best 10 proposals can be awarded with adequate funds.
