We explore biomedical waste management in India-from current practice and challenges to solutions including environmentally-friendly alternatives to traditional methods of disposal.

India generates significant biomedical waste due to its large population and burgeoning healthcare sector. This waste can pose severe environmental and public health risks if not managed properly. The COVID-19 pandemic has further exacerbated the problem recently, highlighting the urgent need for effective biomedical waste management solutions.

According to an Indian Express report, the National Green Tribunal (NGT) highlighted substantial gaps in compliance with the Biomedical Waste Management Rules across India in January this year. The NGT had called for remedial action to be planned and executed to protect public health and the environment.

Hospitals, including AIIMS Delhi, generate significant amounts of waste from their medical activities. As an example, in 2018 alone, AIIMS Delhi produced a substantial quantity of waste - including 24,000 kilograms of yellow waste, 23,500 kilograms of plastic and rubber waste, 500 kilograms of sharp waste, and 26,200 kilograms of glass waste - totalling a massive 74,500 kilograms per month, or close to 2,500 kilograms each day. This illustrates the scale of biomedical waste production in hospitals and the urgent need for proper waste management practices in the healthcare sector.

Impact of Biomedical Waste on Environment and Public Health

Improper disposal of biomedical waste can spread infectious diseases, contaminate soil and water resources, and harm wildlife. The release of harmful chemicals and toxins into the environment can cause air and water pollution, posing a threat to public health and ecosystems.

Biomedical Waste Management Rules in India

In the quest to safeguard both public health and the environment, the Ministry of Environment and Forests made a bold move: they issued the Bio-Medical Waste (Management and Handling) Rules, 1998 under the aegis of the Environment (Protection) Act, 1986 (29 of 1986), followed by the notification of the Bio-medical Waste Management Rules, 2016.

As if that weren't enough, the ministry drafted comprehensive guidelines that would empower each hospital to institute a waste management system that accounted for every facet of the waste management process - from segregation to collection to transportation, treatment and disposal.

To put it plainly, biomedical waste management pertains to any waste that arises during the diagnosis, treatment or immunisation of human beings or animals and research activities.

Major Challenges

Some key challenges in biomedical waste management in India include the lack of proper segregation, inadequate treatment facilities, insufficient monitoring and enforcement, and improper disposal methods. The COVID-19 pandemic has compounded these challenges by generating a surge in biomedical waste, mainly from using personal protective equipment (PPE).

Dr Vishesh Kasliwal, founder of Medyseva, notes that biomedical waste management is critical to India’s public health and environmental management. The improper management of biomedical waste can spread infectious diseases and environmental pollution and harm public health. He adds that one of the significant challenges in India’s biomedical waste management system is inadequate infrastructure. “There is a lack of proper facilities for the segregation, collection, transportation, treatment, and disposal of biomedical waste,” he explains. He adds that India has a comprehensive legal framework for biomedical waste management, but its implementation needs improvement. The regulations are only sometimes strictly enforced, leading to non-compliance by healthcare facilities.

“Another major challenge is the low awareness among healthcare workers and the general public regarding the importance of proper biomedical waste management. This results in inadequate segregation and disposal practices and poses a significant risk to public health and the environment. The lack of sufficient funding for biomedical waste management infrastructure, training, and awareness campaigns is a significant challenge. This leads to the inadequacy of resources to manage biomedical waste effectively. Healthcare workers need proper training to handle biomedical waste safely and effectively. The lack of such training results in inadequate handling and disposal practices. The involvement of the informal sector in the disposal of biomedical waste poses a significant challenge. The informal sector often uses unsafe and unhygienic methods to dispose of biomedical waste, leading to environmental pollution and health hazards. The need for more research and innovation in biomedical waste management is a challenge in India. Developing new technologies and processes for the safe and effective management of biomedical waste is necessary,” he concludes.

Impact of COVID on Biomedical Waste Management

The COVID-19 pandemic has sharply increased biomedical waste, particularly from PPE and disposable testing kits. This has put additional strain on waste management systems and highlighted the need for innovative solutions and increased capacity. Both public and private sectors have a significant role in biomedical waste management. The public sector creates and enforces regulations, provides funding and infrastructure, and promotes research and development. On the other hand, the private sector can contribute by offering innovative solutions, investing in waste management facilities, and ensuring responsible waste disposal practices in healthcare settings.

Roles of Government and Local Agencies

The government and local agencies can play a crucial role in addressing these challenges by investing in waste management infrastructure, promoting research and innovation, and raising public awareness. They can also facilitate public-private partnerships to improve waste management services.

Prof. Ashok K Agarwal, President of the Indian Society of Hospital Waste Management, said, "The government introduced rules for biomedical waste management back in 1998, which were later revised in 2016. During the COVID-19 pandemic, numerous guidelines were issued for managing biomedical waste. The rules are comprehensive and well-designed, leaving no gaps in the framework. Regulatory bodies are in place to ensure these rules are implemented effectively."

He further explains, "Hospitals, clinics, dental clinics, and diagnostic centres are required to segregate biomedical waste and hand it over to central biomedical waste treatment facilities (CBWTF)s. These facilities then take the waste to central waste management facilities for proper disposal. However, there are gaps in implementing these rules, and they are often not observed in letter and spirit. In many small district hospitals, biomedical waste is mixed with non-hazardous waste, which is against the regulations.” However, there is an acute shortage of CBWTFs in the country. Prof. Agarwal highlighted the importance of segregation, stating, "Around 80-85% of medical waste is non-hazardous, and only 15% is hazardous. But if proper segregation is not practised, it can turn the entire waste into hazardous material. Unfortunately, this practice is not followed consistently at many places in the country, resulting in challenges for effective biomedical waste management.”

In addition to these challenges, Prof. Agarwal mentions a few other areas of concern:

Barcoding of biomedical waste has been mandated since 2016, but most hospitals struggle to implement it due to system constraints.
Hospital liquid waste management is a weak link, with many hospitals failing to install the mandated Effluent Treatment Plans.
Pre-treatment of hospital laboratory waste is another weak link in the waste management chain.

Prof. Agarwal emphasises the financial challenges many hospitals face, stating, "The availability of consumables and disposables is limited due to inadequate budget allocations by state governments. Some companies, such as Ramkey, collect biomedical waste from hospitals and transport it to treatment facilities authorised by state pollution control boards. These CBWTFs are equipped with incinerators, microwaves, autoclaves, deep burial pits, sanitary landfills, etc."

He further explains, "These waste management companies charge hospitals per bed for their services. However, many government hospitals struggle to afford these services due to a lack of budget allocation. To address this issue, funds must be provided under a separate budget head specifically for biomedical waste management.”

Prof. Agarwal stressed the challenges faced in capacity building and awareness within hospitals, stating, "There is a lack of proper training for the people responsible for segregating and transporting biomedical waste. Awareness of proper waste management practices is insufficient in many places. Monitoring and supervision present additional challenges."

He continued, "Every hospital is required to obtain a license from the state Pollution Control Board, which has the authority to penalise non-compliant hospitals. However, gaps exist in the monitoring conducted by these boards, possibly due to staff shortages or the priority given to other tasks."

Agarwal also highlights the issue of sharps, such as needles and plastic syringes, which carry the potential to spread Hepatitis and HIV. He explained, "Needle cutters in hospitals often go out of order and can take considerable time to be replaced or repaired, which poses a significant problem."

Prof. Agarwal suggests exploring environmentally friendly alternatives, stating, "We should promote non-burn technologies, such as autoclaving, microwaving, and deep pits for biomedical waste management. One innovation I observed during a trip to Germany, specifically in Dresden, involved converting tons of plastic waste into diesel, which is then sold. This process is carried out in an environmentally sound manner."

He continues, "Even in India, at the Petroleum Institute in Dehradun, plastic is converted into gases that can be utilised in furnaces. Another method involves incorporating plastic waste into road construction by mixing it with bitumen. Experiments are underway in several locations to explore the potential of this approach in road-making."

Overall, the challenges in the current landscape of biomedical waste management in India are complex and require a coordinated effort from the government, healthcare facilities, and the general public to overcome them.

Lessons in Biomedical Waste Management in India