Infection Control and Environmental impact in Waste Management
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Any waste created during human or animal diagnosis, treatment, or immunization is called biomedical waste (BMW). It contains syringes, needles, scalpels, blood, body parts, toxic chemicals, pharmaceuticals, medical devices, radioactive substances, and other potentially infectious objects. Every day, relatively large amount of potentially infectious and hazardous waste are generated in the health care hospitals and facilities around the world. These substances pose a great threat to the environment and can pollute the air, water and land if not properly disposed. In 2015, a joint WHO/UNICEF assessment found that just over half (58%) of sampled facilities from 24 countries had adequate systems in place for the safe disposal of health-care waste.
Biomedical waste generated can be general, infectious, sharps, radioactive and genotoxic, chemical and pharmaceutical. Between 75% and 90% of the waste produced by health-care providers is comparable to domestic waste and usually called “non-hazardous” or “general health-care waste. The remaining 10%–25% of health-care waste is regarded as “hazardous” out of which 10% are infectious and around 5% are chemical/radioactive. However, if the hazardous waste are not properly segregated at source, the entire general waste can become hazardous .
Infectious waste may contain any of a great variety of pathogenic microorganisms. Pathogens in infectious waste may enter the human body by a number of routes: through a puncture, abrasion, or cut in the skin; through the mucous membranes; by inhalation; by ingestion and can cause both local and systemic infections.
Some examples of infections are Salmonella, Shigella, Mycobacterium tuberculosis, Streptococcus pneumonia, acquired immunodeficiency syndrome (AIDS), hepatitis A, B, and C, and helminthic infections. The existence of bacteria resistant to antibiotics and chemical disinfectants in effluent treatment plants may also contribute to the hazards created by poorly managed health-care waste and can spread antimicrobial resistance to the community.
Sharps on the other hand are equally dangerous. Worldwide, an estimated 16 billion injections are administered every year. Not all needles and syringes are disposed of safely, creating a risk of injury and infection and opportunities for reuse. A person who experiences one needle-stick injury from a needle used on an infected source patient has risks of 30%, 1.8%, and 0.3%, respectively, of becoming infected with HBV, HCV, and HIV.
Chemical, cytotoxic and radioactive waste are toxic, carcinogenic and genotoxic and causes severe imbalance to the existing ecosystem.
In the Indian subcontinent, the Central Pollution Control Board (CPCB) has established standards to guarantee proper BMW disposal. It is a statutory organization under the Ministry of Environment, Forest and Climate Change (MoEFCC) of India, established in 1974 under the Water (Prevention and Control of Pollution) Act. To ensure proper and optimized BMW management, CPCB established guidelines and rules to be followed by the medical facilities as well as the common BMW treatment facilities (CBWTFs) which has been amended from time to time.
In July 2020, the fourth revision of the guidelines was published, which included updates and modifications for separating general solid waste and BMW from quarantine canters, home care facilities, and hospitals treating COVID-19 patients, as well as recommendations for the disposal of PPE. Under the Act, healthcare facilities bear the responsibility of effective BMW management to ensure public health and environmental safety. This involves the segregation, proper collection, transportation, treatment, and disposal of BMW.
Existing Challenges and Concerns
Lack of awareness and training among health care workers and waste handlers with inadequate monitoring and inspection in health care facilities, inadequate infrastructure with lack of dedicated waste disposal units, insufficient waste collection systems, and limited treatment facilities, costs of supplies and materials used for collection, transport, storage, treatment, disposal, decontamination and cleaning and cost of training and contract services are major challenges faced in implementing good BMW disposal practices.
Solutions and Strategies for better management of BMW
- Establishment of a Biomedical waste management and Infection Control team at Health care facilities.
Healthcare facilities should have a designated team for the proper management and disposal of BMW. The team should consist of a Infection control officer, Hospital project manager, Head Nurse, Clinical Pharmacist and Laboratory in charge.
The infection-control officer’s duties include: Identifying training requirements according to staff grade and occupation organizing and supervising staff training courses on the infection risks from poor waste management liaising with the department heads, the matron, and the hospital manager to coordinate training activities and conducting regular inspection of BMW treatment and disposal practices. Clinical Pharmacist needs to monitor procedures for the treatment and disposal of pharmaceutical waste ensuring that personnel involved in pharmaceutical waste handling, treatment, and disposal receive adequate training. The pharmacist should remain up to date with the proper treatment and safe disposal of expired, damaged, and unusable pharmaceuticals, pharmaceutical packaging, and equipment. The Hospital manager should ensure stocks of consumables (bags, receptacles and containers, personal protective equipment, etc.) are permanently available. Head Nurse should ensure proper training to health care staff in waste management (paying special attention to new staff members) and monitor sorting, collection, storage and transport procedures in the various wards. A quarterly meeting should be conducted to discuss existing practices and issues related to Biomedical waste management.
- Use Modern Techniques in waste treatment : Modern techniques like high-temperature hydrothermal carbonization and autoclave pressure technology can be used to carbonize BMW. Different methods of disinfection such as hydrogen peroxide steam, washing, ultraviolet (UV) disinfection lamps, humidifiers, gamma radiation, alcohol solutions of 75%, and ethylene oxides can be considered
- Integrated Solid Waste Management Hierarchy (3Rs approach):Integrated Solid Waste Management Hierarchy, based on the concept of 3Rswhich includes prevention and reduction in the production of waste and minimize the quantity entering the waste system, re use and recycle waste after processing and recover waste items to generate fuel for electricity and direct heating, treat waste which cannot be recovered and finally dispose to landfill if no other option is available.
- Community engagement : A public awareness program and a media campaign must be launched to raise awareness of the environmental impact of accidental discharges and poor governance of plastic waste (PW) and BMW.
Conclusion
BMW disposal is pivotal for public health and environmental preservation. Adapting good infection control practices in the health care facility with continued compliance to best practices and government regulations in BMW treatment and disposal will ensure a sustainable future with minimized environmental and public health risks.
References
- Safe management of wastes from health-care activities. World Health Organization (WHO), Geneva, Switzerland; 2014.
- Bhalla GS, Bandyopadhyay K, Sahai K: Keeping in pace with the new biomedical waste management rules: what we need to know!. Med J Armed Forces India. 2019, 75:240-5. 10.1016/j.mjafi.2018.12.003
- Jibril Dan Azimi Jibril, Ibrahim Bin Sipan, Maimunah Sapri, Suleiman Aliyu Shika, Mona Isa, Shahabudin Abdullah,3R s Critical Success Factor in Solid Waste Management System for Higher Educational Institutions,Procedia – Social and Behavioral Sciences,Volume 65,2012,Pages 626-631
- Bansod H S, Deshmukh P (February 03, 2023) Biomedical Waste Management and Its Importance: A Systematic Review. Cureus 15(2): e34589. doi:10.7759/cureus.34589
- Gupta P P, Bankar N J, Mishra V H, et al. (October 19, 2023) The Efficient Disposal of Biomedical Waste Is Critical to Public Health: Insights from the Central Pollution Control Board Guidelines in India. Cureus 15(10): e47303. doi:10.7759/cureus.47303
- Khurshid Mattoo, Vishwadeepak Singh, Rishabh Garg. Are Dental Training Programs Heading towards Ecological Disaster – Results from a Survey. Journal of Atmospheric Pollution. 2014; 2(1):17-21. doi: 10.12691/jap-2-1-4.
