INTRODUCTION

Medical care is vital for our life, health and well being.  But the waste generated from medical activities can be hazardous, toxic and even lethal because of their high potential for diseases transmission. The  hazardous and toxic parts of waste from health care establishments comprising infectious, bio-medical and radio-active  material as well as sharps (hypodermic needles, knives, scalpels etc.) constitute a grave risk, if these are not properly treated/disposed or is allowed to get mixed with other municipal waste.   Its propensity to encourage growth of various pathogen and vectors and its ability to contaminate other nonhazardous/non-toxic municipal waste jeopardises the efforts undertaken for overal l municipal waste management. The rag pickers and waste workers are often worst affected, because unknowingly or unwittingly, they rummage through all kinds of poisonous material while trying to salvage items which they can sell for reuse. At the same time, this kind of illegal and unethical reuse can be extremely dangerous and even fatal. Diseases like cholera, plague, tuberculosis, hepatitis (especially HBV), AIDS (HIV), diphtheria etc. in either epidemic or even endemic form, pose grave public health risks.Unfortunately, in the absence of reliable and extensive data, it is difficult to quantify the dimension of the problem or even the extent and variety of the risk involved.With a judicious planning and management, however, the risk can be considerably reduced.  Studies have shown that about three fourth of the total waste generated in health care establishments is non-hazardous and non-toxic. Some estimates put the infectious waste at 15% and other hazardous waste at 5%. Therefore with a rigorous regime of segregation at source, the problem can be reduced proportionately.  Similarly, with better planning and management, not only the waste generation is reduced, but overall expenditure on waste management can be controlled. Institutional/Organisational set up, training and motivation are given great importance these days.  Proper training of health care establishment personnel at all levels coupled with sustained motivation can improve the situation considerably.

The rules framed by the Ministry of Environment and Forests (MoEF),Govt. of India, known as ‘Bio-medical Waste (Management and Handling) Rules, 1998,’ notified on 20th July 1998, provides uniform guidelines and code of practice for the whole nation. It is clearly mentioned in this rule that the ‘occupier’ (a person who has control over the concerned institution / premises) of an institution generating bio-medical waste (e.g., hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank etc.)  shall be responsible for taking necessary steps to ensure that such waste is handled without any adverse effect to human health and the environment.

Definition :  ‘Bio-medical waste’ means any solid and/or liquid waste including its container and any intermediate product, which is generated during the diagnosis, treatment or immunisation of human beings or animals or in research pertaining thereto or in the production or testing thereof. The physico-chemical and biological nature of these components, their  toxicity and potential hazard are different, necessitating different methods / options for their treatment / disposal. In Schedule I of the Bio-medical Waste (Management and Handling) Rules, 1998 (Annexure II), therefore, the waste originating from different kinds of such establishments, has been categorised into 10 different categories (as mentioned in the box below) and their treatment and disposal options have been indicated.

Components of Bio-medical waste

(i) human anatomical waste (tissues, organs, body parts etc.), 

(ii) animal waste (as above, generated during research/experimentation, from veterinary hospitals etc.), 

(iii) microbiology  and  biotechnology  waste,  such  as,    laboratory   cultures, micro-organisms, 

human and animal cell cultures, toxins etc.,

(iv) waste sharps, such as, hypodermic needles, syringes, scalpels, broken glass etc.,

(v) discarded medicines and cyto-toxic drugs

(vi) soiled waste, such as dressing, bandages, plaster casts, material contaminated with blood etc.,

(vii) solid waste (disposable items like tubes, catheters etc. excluding sharps),

(viii) liquid waste generated from any of the infected areas,

(ix) incineration ash,

(x) chemical waste.