Growing medical technologies and contemporary hospital facilities for better healthcare have resulted in an increase in the amount of trash produced by health care institutions. All wastes from any medical operation in healthcare facilities, research centers, and laboratories are referred to as “Health Care Waste” or “Bio-Medical Waste” (WHO, 2017). Bio-Medical Waste (BMW) is generated by operations in healthcare, research, and diagnostic institutions that include one or more of the following: diagnosis, treatment, immunization of humans and animals, and the synthesis or testing of biological materials. Biomedical waste also covers waste generated during any home healthcare activities. The contents’ categories and characteristics determine the waste’s hazard level. Infectious compounds, radioactivity, sharps, genotoxic, cytotoxic, other toxic compounds, and biologically aggressive medications are used to classify them (WHO, 2017). The inappropriate management of BMW has resulted in a number of issues, including the development of infectious diseases and many sorts of environmental contamination.
For years, proper biomedical waste (BMW) management in line with the rules has been one of the most neglected parts of health care, particularly in developing nations like India. Since the Government of India’s (GoI) Ministry of Environment, Forest, and Climate Change introduced revisions in 2016 by prescribing simple categories (color-coded) for segregation of distinct BMWs, an amendment in 2018 came into effect with the goal of improving rule compliance. Nonetheless, with an annual increase rate of 7% and a predicted estimate of 775.5 tonnes/d by 2022, adequate segregation, handling, and disposal remained a critical concern for health care facilities across India.
As indicated by some early experiences, the situation has increase amid the coronavirus disease 2019 (COVID-19) pandemic, with heaps of personal protective equipment (PPE) accumulating in hospitals. Despite the World Health Organization and Ministry of Health and Family Welfare, Government of India instructions on the rational use of personal protective equipment (PPE) for COVID-19, health care settings are seeing increased demand for PPE from all strata of health care workers due to fear of infection.
The fear often leads to the overuse of PPE, exacerbating the problem by causing a large number of BMWs to be produced, which are difficult to store and move with the limited resources and manpower available during a crisis. The indiscriminate usage and disposal of single-use surgical masks (at times N95 respirators) even in the community adds to the threat. Their disposal is frequently mixed with non-infectious kitchen/general waste from households and residential settings where color-coded BMW containers are hard to come by. It’s worth noting that the indiscriminate disposal of BMWs in the general garbage allows easy access to the primarily susceptible populace for the new severe acute respiratory syndrome coronavirus 2 (SARS CoV2) with fomite-borne transmission and a yet-to-be-determined duration of viability on fomites.
In response to the COVID-19 pandemic in India, the Ministry of Environment, Forest & Climate’s Central Pollution Control Board (CPCB) has issued rules for handling waste created during COVID-19 patient treatment, diagnosis, and quarantine. In addition to the recommendation to follow existing standards of BMW Management Rules, 2016, these instructions recommended for the use of double-layered bags (using two bags), required marking of bags and containers as “COVID-19 waste,” frequent disinfection of dedicated trolleys, and separate record-keeping of waste generated from COVID-19 isolation wards. Although the CPCB is the primary institution in India for any BMW-related recommendations, various government bodies have produced guidelines for handling COVID-19 trash. While the latter guidelines must follow the CPCB’s recommendations, there have been significant discrepancies in the segregation rules of the existing BMW Management Rules, 2016, in which the goods are separated based on the final mode of treatment. This rapid shift in the category of certain BMWs could lead to inadvertent final treatment.
In the impending CPCB guidelines, spill management from BMW bags or containers, recommendation of optimum PPE for persons handling BMW, and provision of health check-ups for those individuals may be considered. Other government bodies should make it explicit in their own guidelines that the CPCB’s standards for BMW management should be followed, with a link to the CPCB’s recommendations. Monitoring the application of the prescribed policies for BMW management should be prioritized and preserve uniformity in the standards. Due to an increase in the volume of waste, hospitals and institutions should strengthen their capacity to transport and store BMWs. An electronic communication method should be in place to identify the exact amount of “COVID-19 trash” in various categories and any breaches during transit and treatment that should be reported to the nodal agency. BMW management should be trained regularly by the institution’s infection prevention and control team, which should also monitor the practices. When combined with rigorous respect to the rules, these actions will ensure that the oncoming crisis is handled more effectively.
Basic infection control methods are the only methods for containment, as evidenced by the current pandemic crisis. The proper disposal of waste is an essential aspect of these management strategies.