Disposal of medical waste:
Hospitals limp towards deadline
From Ruchika Mohindra

LUDHIANA, Dec 4 — Less than a month is left for various medical and health care institutions in the city to comply with the Bio-medical Waste (management and handling) Rules, 1998.

But survey by this correspondent in two city hospitals with the capacity of more than 500 beds — Dayanand Medical College and Hospital (DMC) and Christian Medical College and Hospital (which are required to have an efficient system of waste disposal either through incineration, autoclaving or microvawing in place by December 31, 1999) and other healthcare institutions, found that the institutions were still relying on the municipal corporation dump. There is no segregation of waste and in some institutions waste is stored for more than 48 hours — both are in violation of the above mentioned rules.

On condition of anonymity, a senior district Health Department official observed that no systematic approach was in place for management of the thousands of kilograms of health care waste generated in the city.

These views were corroborated by Dr S.C. Gupta, Prof and Head, Department of Health Education and Family Welfare, CMC, who has done extensive research on the subject and was the organising secretary of the first conference on medical waste management in Ludhiana held at CMC earlier this year.

He says, "in most institutions general non-hazardous waste is mixed with infectious waste and disposed off without segregation or treatment. Wastes like body parts, foetuses and placenta are either buried or sent on the MC dump. Rarely are body fluids like blood, semen, urine and other waste from pathology labs treated with Sodium Hypochlorite solution. Instead these are washed down the sink."

While both DMC and CMC have at least begun the exercise to have an efficient disposal system in place by the December 31 deadline. (Being the only institutions in the city which fall under the purview of these rules as their capacity is more than 500 beds). The majority of the 200-odd nursing homes that have mushroomed around the city, have neither a system nor the urgency to adopt one. Thus blood-soaked bandages, cotton swabs and used disposable needles can often be found in the garbage containers in the proximity of these nursing homes.

Safai karamcharis and rag-pickers, who manually lift this garbage, are potential victims for the badly viruses and bacteria present inside the waste. "Contact with such waste can cause diseases of the gastrointestinal tract, respiratory tract, HIV, Hepatitis B and C etc," says Dr Gupta.

When contacted the proprietor of one of the oldest nursing homes in the city said though he was taking precautions about disinfecting waste before its disposal, installing of an incinerator/ microwave/ autoclave etc was not only too expensive but also required more land than he had. He said the government should come to the medical industries aid by providing a common incinerator.

A 20-member committee of doctors, officials of the Pollution Control Board, Punjab Health Systems Corporation, Department of Science and Technology and municipal corporation had been formed two months ago to find ways to establish a common system for disposal of bio-medical waste.

Subsequently, the municipal corporation was approached by the committee for providing a site outside the MC limits for installing incinerators. Currently the proposal is being worked on and each hospital will have to contribute for the incinerator according to its capacity. The community incinerator will be managed by a private committee with members from all hospitals/nursing homes using it.

Dayanand Medical College and Hospital, an 1100-bed hospital, which generates 2300 kg of biomedical waste on an average each day, is planning to instal an autoclave so that all waste generated can be autoclaved and then disposed off.

Col T.S. Kanwar, Chief Operations Officer, DMC says, "In addition, we have needle destroyers — one each at the garbage collection centre and laboratory to segregate the needle from the syringe before being disposed off. Most sharps are first treated in a solution of bleaching powder for disinfection and four trolleys continuously do the rounds of the hospital to maintain proper sanitation".

However, after the waste reaches the hospital dump, it is collected by a private contractor to be thrown in the MC dump at Jainpur.

The incinerator installed in DMC in 1996 is likely to be modified to the specifications of the pollution control board. The district administration had ordered against the operation of the incinerator as it was found to pollute the environment.

Christian Medical College and Hospital, with a capacity of 740 beds, generates 500-600 kg of waste per day. Officials point out that of this only 70-80 kg of waste is contaminated.

Says Mr N.S. Chahal, Chief Operations Officer, "Segregation of all waste is done at the sources of generation (wards operation theatre etc) and after disinfection it is collected in different coloured bags — as prescribed in the bio-medical waste (management and handling) rules. We have also earmarked a separate fund for buying a microwave system and an autoclave to treat waste". The hospital authorities are considering a proposal to instal an incinerator in the hospital itself, he adds.