Community engagement in Biomedical Waste Management
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While India has had a biomedical waste management rule since 1998, which was modified for ease in 2019, household biomedical waste has been neglected. The emergence of epidemics or pandemics, increased/better access to healthcare, early hospital discharge, increased lifespan, rise of non-communicable diseases and home management of chronic illnesses could all play a role in the rise in biomedical waste generation at home. The situation could get worse considering India’s aging population and dependence on doorstep healthcare services. This poses serious challenges to a frail public health system. This growing problem needs to be tackled by acknowledging it, introducing guidelines, and decentralizing solutions, including facilitating recycling.
The market analysis for healthcare at home is predicted to expand from its current value of $179 million in 2022 to $295 million in 2030 at a compound annual growth rate (CAGR) of 6.40%. Environmental Research and Education Foundation (EREF) has revealed that between 2001 and 2011, the number of needles and sharps in household waste tripled.
Biomedical waste (BMW) is any waste produced during the diagnosis, treatment, or immunization of humans or during animal research activities or that produced in health camps. The above definition is often focused on the waste generated at hospitals, health institutions, research and training establishments, slaughterhouses, laboratories and biotechnology institutions while overlooking BMW generated at our homes.
Household biomedical waste (henceforth HBMW) usually gets mixed with other household waste in India, ending up in posing numerous public health hazards.
The clinical waste generated in households includes unused or expired medicines, used adult/baby diapers, soiled sanitary napkins, injected needles, bloodstained cotton buds, used condoms, spilt mercury, used band-aid, used X-ray films, pregnancy and blood sugar test strips, expired hand sanitizers and discarded insulin pens to name a few.
Wastes like these require sophisticated chemical processing plants, incinerators and disassembly centers for proper disposal. Unfortunately, conventional waste management infrastructure in developing countries is not efficient enough to handle or treat household biomedical waste. For example, when expired medicines are disposed of in sewage, our existing treatment plants cannot process them since they are not designed to break down pharmaceutical drugs. This eventually gives rise to superbugs and antimicrobial resistance.
Biomedical waste is hazardous and infectious. It has an impact on all biological life, not just people. The chemicals from the waste can pollute the air, water, and land. Needles, sharps, and lancets in household waste put municipal waste handlers at risk. If these needles or sharps are infected, a prick from them can cause blood-borne infections (HIV, Hepatitis C, and Hepatitis B).
One Health is an approach that recognizes and studies the interconnections between humans, animals, plants, and their shared environment. From the One Health standpoint, it is clear that biomedical waste has an impact beyond just humans.
How can community contribute in HBMW Management:
1) Community awareness & education:
It’s been observed in various studies that people are not aware about the hazards & management of Biomedical waste at home.Initiative can be taken to educate the patient attenders especially of bedridden patients & suffering from chronic illness who are responsible for generating HBMW in more quantities.
Community awareness can be in the form of short videos, pamphlets attached with patients discharge summaries or patients OPD Files or Short counseling session can be arranged for the attenders at the discharge time. On a larger platform, Hospitals can arrange a small outreach programs in public places to educate community or via social media.
2) Providing information on management of HBMW
Information regarding management of HBMW can be simplified & explained as per the waste generated as per the patient as follows:
Sharps: Lancets, insulin injection needles, and other sharp objects that can pierce the skin are called “sharps”. People who take injections on a regular basis should have a sharps container in the house which is hard, thick plastic, and are constructed to be difficult to open (child and pet safe). Throw away syringes, with needles attached, into a sharps container immediately after use. Do not try to remove or bend the needle. Keep the sharps containers away from children. If sharps are produced regularly, it is worth buying a container or can make one from an old plastic bottle, or a metal container. Label it “SHARPS”. Do not use a cardboard carton or a container of thinner plastic, and try not to use a transparent container.
When the sharps container is full, put it in the regular trash. Put the sealed container into the center of a full, preferably dark trash bag and throw it out with the regular trash. Never put any type of sharp container in the recycle bin.
You might also have a hospital, clinic, or doctor’s clinic nearby willing to take sharps waste for final disposal along with their BMW.
Cloth/ Disposable Items: Used cotton, gauze, gloves, diapers, sanitary pads and bandages may have blood, excreta, or other body fluids on them and hence be classified as infectious waste. Put them into plastic bags that can be sealed/knotted. When the bag is full or it is trash pickup day, seal the bag (to protect sanitation workers) and put it in the regular garbage pickup barrels.
Medicines: Prescription medicines should be used only by patients they are prescribed for. If you have leftover medicine you don’t need, do not give it to someone else. Throw it away. DON’T FLUSH MEDICINES DOWN THE TOILET. Sewage treatment systems cannot typically break down drugs. For this reason, most drugs should be put in the regular trash barrel so your local authority picks it up for disposal in a landfill. The drugs are less likely to negatively impact the environment if they are in a landfill.
Radioactive/Chemotherapy waste:
Patients receiving radiation/chemotherapy such as brachytherapy and iodine treatment for thyroid disease can produce low-level radioactive waste. Their urine and feces may be considered radioactive. Follow your healthcare provider’s instructions for cases like this. You might be advised to keep bodily wastes in a container for a while until the radioactive material decays.
3) Role of Hospitlals & Pharmacies:
Hospitals/clinics where the patient is getting treated can give a facility of taking the BMW generated from the patients after proper counseling on its proper segregation & management. Healthcare providers who offer homecare and outreach services should be directed to take back any biomedical waste that was generated during the service delivery.
4) ) Legislation and accountability
Since the effects of biomedical waste are multifaceted, the state governments should liaise with other important departments such as public health, pollution control board, urban local bodies, and other non-governmental organizations to streamline the management of household biomedical waste & issue proper guidelines for the same.Municipal waste handlers risk could be reduced by ensuring that they are provided with prick-proof gloves and boots, as well as Hepatitis B vaccination.
Australia, the United Kingdom (UK), and the United States of America (USA) are just a few countries that have begun sensitizing their citizens about ways to manage biomedical waste. The governments in India also should make efforts to disseminate scientific awareness materials to guide the public to take informed actions regarding Household biomedical waste disposal.
