MANAGING MUNICIPAL SOLID WASTE: SPECIAL FOCUS ON BIO-MEDICAL WASTE MANAGEMENT – A CASE STUDY

Authors

Abstract

    Garbage mounds rotting in street corners, sewage drains overflowing and sometimes choking with plastic carry bags certainly trigger an overall unhygienic lifestyle for a city’s inhabitants resulting in the spread of deadly diseases. These conditions also indicate the fact that the city is growing. The gravity of the problem is increasing rapidly in all the Indian cities in general and in the metropolitan cities in particular. The main reason is massive migration of population from rural to urban regions. According to a UN report of 1995, India would have more than 400 million people i.e. almost 40 per cent of its population clustered in the cities within the next thirty years. On this background, urban India is on the brink of a massive waste disposal crisis. Even though stringent rules and regulations have been made by the government (MSW Management Rule, 2000, implemented in January, 2004) these are barely enough even to maintain a linear system of collection and disposal creating health and environmental hazards. The most important aspect of MSW management is community participation. Generators of the MSW are the common people who need to be made aware of health hazards generated due to mismanagement of MSW.

    Enviro-Vigil, an environmental NGO from Thane city in Maharashtra is working in this area for the past few years. We, at Enviro-Vigil have been organising campaigns on a large scale to seek community participation with practical input. Apart from general MSW management, bio-medical waste management has been our major activity for the past four years. Bio-medical waste encompasses a wide variety of waste products generated as a result of human activities in the hospitals, pathology labs, animal houses in pharmaceutical and other related industries, abattoirs or slaughter houses, diagnostic centres and even at the household level. However, this kind of waste is being mistreated and mismanaged causing serious health hazards not only to the healthcare personnel, but also to the community. Management of BMW has now attracted wide attention of social activists, environmentalists, health policy makers, medical professionals and administrators. In managing bio-medical waste, community participation plays a significant role. People from medical fraternity such as healthcare workers, sweepers, ward boys, nurses and even the doctors are always at high risk due to continuous exposure to disease causing microorganisms. The deadly viruses like Hepatitis-B, HIV, etc. and a variety of other dreadful viruses and bacteria always seem to hover around these people. This certainly has long-term effects on the society in general. It is the need of the hour to create awareness among these people to handle and manage the BMW with utmost care. For this, Enviro-Vigil has been imparting on site training to these healthcare professionals.

    At the government level, Ministry of Environment and Forests (MoEF), Govt. of India along with Central Pollution Control Board (CPCB) have formulated and published rules entitled Bio-Medical Waste (Handling and management) Rules, 1998. Enviro-Vigil has set up a ‘Common Bio-Medical Waste Treatment Facility’ for treatment and safe disposal of BMW. Here we present our experience in seeking community participation in the field of Solid Waste Management, with special emphasis on bio-medical waste management and working of our common BMW treatment facility.

Introduction

     “Garbage Garbage Everywhere, Not A Street To Walk!” This punch line perfectly describes the present scenario in the Indian cities. Ever-increasing population due to mass migration from rural to urban areas, changing lifestyles, extensive use of disposable articles in day to day life, lack of awareness, lack of infrastructural facilities for proper treatment and disposal of garbage etc. are some of the major problems the Indian cities are facing. Accumulation of garbage and littered public places are a few manifestations of indifferent attitude and lack of sensitivity of the people in general and the municipal bodies in particular, towards environmental issues. The quantity of the waste being generated in the cities poses serious threat to the quality of environment and also to the human health. The municipal corporations allot huge amount of funds for solid waste disposal and management. However, there are no serious efforts taken by the concerned people right from the top ranking officials to the workers in the lowermost cadre. Solid waste management is still considered as an inferior service and is generally overlooked by the municipal bodies. Added to this, is the lack of awareness and of active participation of the general public in the management of solid waste. Civic bodies are finding it more and more difficult to locate suitable dumping grounds, which are hardly available these days. Apart from municipal bodies or civic authorities, common man is also equally responsible for letting the problem become more and more serious day by day. As per the Municipal Solid Waste (Management and Handling) Rules, 2000, municipal bodies will be responsible for providing necessary infrastructure and manpower for segregation, transportation, storage, processing and disposal of municipal solid waste. However, NIMBY (Not In My Backyard) attitude of common man has made the task of the municipal bodies more difficult with respect to waste storage. Several studies conducted by environmental and technical institutions like NEERI indicate that over 100,000 metric tonnes of garbage are generated in the Indian cities per day. Only about 50%-80% of this waste gets collected for disposal on the dumping grounds. The remaining waste is left on the streets which eventually enters the drains, gutters, etc. These studies have also indicated that municipal solid waste is likely to reach 125,000 MT per day by the year 2030 considering the changing urban consumption pattern and increase in per capita income. Such studies have also linked per capita garbage generation with per capita income. For example, Srishti, a Delhi based NGO and TERI (Tata Energy Research Institute) have conducted a survey, according to which, people with lower income bracket earning Rs. 2000/- per month generated about 200 gm waste per day, while people in the higher income bracket with an average monthly income of Rs.8000/- generated about 700 gm of waste per day. Considering such amount of garbage generated by the citizens, and projected scenario of the future, it is certainly not possible for municipal bodies to handle this problem alone. Public participation is equally essential. Without public initiative, problems of solid waste management will worsen day by day. Seeking public participation is tedious, time consuming and many a times a thankless job. Nevertheless, it is very essential. By increasing people’s participation, the costs of waste management can be greatly reduced. Public participation is also necessary to bring about changes in waste management with respect to segregation at source, recovery of reusable and recyclable articles form the household waste, and proper storage prior to collection. There are several NGOs working hard in the Indian cities to seek community participation in the activities related to solid waste management. Due to sincere efforts being taken by these NGOs, common man is slowly awakening and is shedding his indifferent attitude towards solid waste issues at least at personal level. The results are encouraging. People have started believing that their participation in solid waste management programmes has become a compelling necessity. Enviro-Vigil is one such NGO working in Thane, Maharashtra for the past eight years. In order to obtain people’s participation in the area of solid waste management and other environmental issues, this NGO has initiated several environmental projects involving people in general and the school and college students in particular. Our initial step was to motivate the college students for door-to-door campaign for convincing people to understand the importance of segregation of waste at the source of its generation. We organised a workshop of the college students to motivate them and to provide a proper training to them for this campaign. More than 300 students from NCC, NSS and others participated in this campaign. They eventually visited nearly 30,000 households to explain the methodology of domestic waste management. This campaign was a grand success and people started taking initiative to manage their own waste. However, their enthusiasm disappeared gradually, although there are a handful of the residential societies in Thane where people are still segregating their waste and managing it on their own. As already mentioned earlier, the main problem is ever increasing population. It is difficult for anyone, be it the civic authorities or the NGOs or the government organisation, to handle this aspect of environmental management.

     While dealing with solid waste management, we decided to handle the issue of bio-medical or the hospital waste management, even before the rules came into existence. With our earlier experience of community participation, we first decided to seek participation of the community of healthcare workers and the professionals such as doctors, nurses, etc. We visited several government, semi-government and private hospitals to study the practices of waste management there and to encourage the concerned people to participate in the waste management programme. The response was rather discouraging. People simply did not bother about such issues. Fortunately for us and for the environment, first, the Bio-Medical Waste (Management and Handling) Rules, 1998 and then civic authorities at Thane Municipal Corporation came to our rescue. With a strong support form the Thane Municipal Corporation, we decided to go ahead with providing a common facility to take care of hospital waste. Here we present an overview of the bio-medical waste, segregation at source, treatment and safe disposal of the waste, etc. This paper also highlights the functioning of common BMW treatment facility of Enviro-Vigil.

WHAT IS BIO-MEDICAL WASTE?

    Bio-Medical waste is an extremely hazardous type of waste and if not managed properly, it can lead to serious health and environment problems. “Bio-medical waste is any type of waste generated during the diagnosis, treatment or immunisation of human beings or animals or in research activities pertaining to the production of drugs in pharmaceutical companies, animal waste generated in the veterinary hospitals and also in the slaughter houses, etc.”--- Bio-Medical Waste (Management and Handling) Rules, 1998. Although not included in the standard definition, bio-medical waste is also generated at the domestic level in the form of sanitary pads, diapers, cotton swabs and gauges, disposable razors, etc. In many cases, the patient is given treatment in his or her own house when the hospitalisation is not possible due to some or the other reason. Such “domestic BMW” has not been given any consideration so far. Although, BMW includes the waste produced by the living organisms because of human activities, more attention and emphasis is being given on the management of the BMW generated in the healthcare centres or hospitals. This hospital waste will be discussed at length in this article.

Sources of Generation of Hospital Waste:

    Hospital is a place, where an individual is examined by the doctors, diagnosis is made and an appropriate treatment plan is worked out. Depending upon the extent or the intensity of illness, the patients are either treated in out patient department (OPD) or are admitted in the hospital for treatment and follow up. In both the cases, greater amount of waste is generated during this procedure. The quantum of waste thus generated varies according to the site and the nature of treatment. For example, in the minor operation theatres (OT), the amount of waste would be less than that of the major OT. Similarly, the amount of infectious waste is more in the maternity hospitals than in a general hospital. In orthopedic specialties, this amount is much less. Thus, the amount of waste will vary depending upon the nature of treatment. At individual ward level also, waste is generated. However, this is generally non-infectious, domestic type. Apart from the hospitals, BMW is also generated in the clinics and dispensaries belonging to the general practitioners and the dentists.

   Hospital waste is different from domestic waste and must be segregated, collected and disposed off using scientific technology. If segregation is not done properly at source, it can get mixed with municipal solid waste resulting in possible exposure of the entire community to the microorganisms, which are responsible for highly infectious and dreadful diseases like HIV, hepatitis A, B and C, tuberculosis, and other skin and respiratory ailments. In many hospitals, unscientific technologies, like burning of the waste are used for disposal of the hospital waste. This can lead to dangerous levels of emission of gases like dioxins and furans in the environment, which contain cancer causing agents. Residual ash, if not disposed off in secured landfills, can also pollute the underground water and contaminate the soil. The waste generated in the hospitals in particular can be categorised as follows:

General Waste: This makes about 80-85% of the total waste generated in a hospital. This is non-infectious and can be easily managed if it is segregated at source properly. General waste includes items like paper, cardboard boxes, plastic packaging, metal boxes, etc. which is non biodegradable Another category of general waste includes kitchen waste which consists of left over food, vegetable and fruit peels, meat, fish, tea bags or used tea powder, coconut shells, flowers or bouquets brought in by patient's visitors, etc. which is biodegradable.

Infectious Waste: This accounts for only a small fraction comprising about 10-15% of the total volume of waste generated in a hospital. However, this small fraction is of the biggest concern as it poses direct threat to the health and hygiene of the human beings by transmitting viral, bacterial fungal or parasitic diseases. This type of waste includes:

a) Pathological Waste: Human anatomical wastes, like organs, body parts, tumours, glands, etc. that are removed during surgery or biopsy or any other medical procedure, amputated parts and also tissues, placentas, aborted foetuses, blood and other body fluids, etc., animal carcasses and tissues from laboratories, dressings, cotton swabs soaked in blood/body fluids, hospital gowns, aprons and other similar materials which have been in contact with a patient's body,

b) Infectious Plastic: Disposable items like syringes, IV sets, blood bags, catheters, gloves, endotracheal tubes, canulas, dialysis sets, etc.

c) Sharps: These are the most dangerous contents of the hospital waste especially for the healthcare staff handling these. Sharps include broken glass articles or metal articles such as needles, blades, scalpels, saws, nails, etc.

Non-Infectious, but Hazardous Waste: This type of waste does not contain any infectious, i.e. disease causing component and comprise about 5-10% of the total volume of waste generated in a hospital. However, it can cause serious health hazards like burns, corrosions, genotoxicity, chromosomal aberrations, toxicity, carcinogenic effects, etc. These include:

a) Chemical Waste: Chemicals like disinfectants, fumigants, other solid, liquid or gaseous substances, etc. These can be hazardous, if these possess corrosive, inflammable or reactive genotoxic properties, or these can be non-hazardous, if these do not possess these properties. These include inorganic salts, buffer chemicals, sugars, amino acids, etc.

b) Radioactive Waste: Solids, liquids and gases from in vitro analysis of tissues and body fluids, X-rays, chemical dyes and isotopes of various radioactive elements frequently used in diagnosis and /or treatment of diseases, etc.

c) Cytotoxic Waste: This type of waste is generated form diagnosis and treatment of diseases like cancer. This type of waste can be found in small quantities in human excreta, I.V. solutions and containers from laboratories.

BIO-MEDICAL WASTE: How to Manage?

   It is essential to manage the hospital waste in a proper way. The following hints may be useful:

# Use a ‘mantra' of three R's, i.e., Reduce, Reuse and Recycle!

# Segregate at source for safe and proper disposal.

Segregation of waste at source for safe and proper disposal :Basic and the most important step in managing the hospital waste.

     General Waste and Infectious as well as hazardous waste generated from different activities of the hospital should be properly separated. Even if a small amount of infectious waste gets mixed with general waste, it can contaminate the entire waste collected. Segregation at source means separation of the waste materials from each other at the place of its generation. For example, the quantity of the infectious waste generated in OTs, ICUs is proportionately greater than the non-infectious waste. If the waste is segregated there itself, then the risk of infection can be greatly reduced.

Segregation in a hospital results in:

* Waste minimisation

* Effective waste management

* Decrease in expenses incurred in managing waste

* Reduce the risk of infection ensuring better healthcare

* Prevent infection to communities living in the vicinity of the hospital that may be exposed to the infectious hospital waste.

    Segregation should be done as per specific treatment and disposal requirements. Segregated waste must be stored in coloured containers as per the colour coding system prescribed by the Ministry of Environment and Forests, Govt. of India, under Bio-Medical Waste (Management and Handling), 1998 rules

    The ideal system would be to use different coloured garbage bags or liners in waste storage bins. There are four major colour codes as per the notification:

Black Bag: Used for collecting general waste i.e., paper, non-infectious plastics, cardboard boxes, and other dry waste generated in hospital office or in the wards. For kitchen waste, a separate, preferably a green coloured container is highly recommended.

What is the current practice and why it is harmful?

The current practice is to collect and throw the entire waste in common municipal refuse collector. This ultimately results in the creation of large volume of garbage ultimately causing overburdening of the landfills.

Where should this waste go?

However, when segregated in this way, the ‘dry', non-infectious waste can be reused after recycling it at a recycling facility. The ‘wet', non-infectious and bio-degradable waste from the hospital kitchens can be used for making good quality compost within the hospital premises only and can be effectively used for a healthy garden of the hospitals.

Red Bag: To be used for segregated plastics collected from OTs, ICUs and from the wards. You have to be very careful and strict about proper segregation of this waste component.

What is the current practice and why it is harmful?

The current practice is to mix this waste with general waste after improper disinfection or even in some places, disinfection is not carried at all. This thus enters a common municipal refuse collection bins. The rag pickers segregate these and sell these for a small price. These plastics are then repackaged imitating the original and resold thus causing serious health problems to the concerned people.

Where should this waste go?

This waste should be disinfected by applying an authorised, scientific methodology. The best way to disinfect is to autoclave this waste. After autoclaving, all the plastic should be shredded or mutilated to avoid unauthorised use. Such plastic can be then recycled and reused for good cause for the community.

Yellow Bag: Used for highly infectious items like pathological waste, human anatomical waste such as body parts, amputated parts/ organs, tumours, placentas, aborted or otherwise abnormal or dead foetuses, etc. In addition to this, it also includes blood soaked cotton bandages, animal tissues, organs, carcasses and other wastes.

What is the current practice and why it is harmful?

The current practice is to mix this waste with general waste and thus throw this in a common municipal garbage collection. The hazards of such mixing are already discussed earlier. In many hospitals, most of the human anatomical wastes are buried in the soil. However, this practice is dangerous and causes serious social and environmental problems.

Where should this waste go?

As per the Central Pollution Control Board regulation, deep burial of this type of waste is not acceptable for towns or cities above a population of 5 lakhs.

The best solution that is available these days is to incinerate this type of waste. In this technology, the contents of the yellow bag are burned in an incinerator at extremely high temperature (800 0 C-1100 0 C). The contents of the yellow bag are thus turned completely into residual ash, which can be safely buried in the soil. The alternative technologies that are available include use of microwaves, hydroclaves, plasma pyrolysis, etc.

Blue or White, Opaque Bag: This bag is used for collecting the segregated metal and /or glass sharps such as needles, blades, saws, scalpels and all such similar type of waste.

These bags must be puncture proof as the sharp metal or broken glass wastes are to be collected in these.
It is, however strongly recommend to the hospital staff that even metal sharps and broken glass articles are to be segregated. Ideally, a metal box should be used for collecting the metal sharps and glass sharps should be collected in blue/ white bags.

Lead Containers: These are to be used, if necessary, for radioactive wastes which are to be disposed as per the guidelines provided by Bhabha Atomic Research Centre (BARC), Mumbai. Radioactive wastes, especially cobalt needles used for Brachy treatment must be returned to BARC. Cytotoxic waste can be stored in sturdy cardboard boxes, which can be incinerated later.

Disinfection : It is a process of destruction or removal of pathogen which gives rise of infection. Hospital Medical Waste in category of “Infectious Waste” should be disinfected before final disposal as it contains pathological microorganisms responsible for diseases.

     Disinfection should be used even if sterilisation facilities are available. Infectious waste should be disinfected before it is disposed off. Instruments and equipments that come in contact with contaminated floor, surfaces like trolley tops, table tops, clothes, bedding, beds, utensils and other articles like bed pan etc. should be regularly disinfected.

Disinfectant :

    Any chemical substance used for disinfection.

Methods of Disinfection:

# Thermal

# Chemical (Formaldehyde, Ethylene Oxide, etc.)

# Irradiation and ultraviolet

# Microwave

# Filtration

Managing Chemical waste:

a) Chemotherapy and antineoplastc chemicals :

•  Reducing the volume to be used.
•  Optimising the size of the drug container while purchasing
•  Returning the outdated drugs to the manufacturer
•  Centralising chemotherapy compounding location
•  Providing spill clean ups
•  Segregating the wastes.

b) Formaldehyde:

•  Minimise the strength of formaldehyde solutions.
•  Minimise the waste from cleaning dialysis machines and RO units.
•  Use reverse osmosis water treatment to reduce dialysis-cleaning demand.
•  Capture waste formaldehyde
•  Investigate the possibility of reuse in pathology, autopsy labs, etc.

c)  Photographic chemicals:

•  Return of spec developer to the manufacturer.
•  Cover developer and fixes cans to reduce evaporation.
•  Recover silver efficiency.
•  Recycle waste film and paper.
•  Segregate and label properly the radioactive wastes and store short-lived wastes in isolation until decay permits disposal in trash.
•  Substitute less hazardous cleaning agents, methods for solvent cleaners, etc.

d)  Solvents:

•  Reduce the volume requirement.
•  Use premixed kits for tests involving solvent fixation.
•  Use calibrated solvent dispensers for routine tests.
•  Segregate solvent wastes.
•  Recover used solvents through distillation.

e)  Mercury:

•  Substitute electronic sensing devices for mercury containing devices.
•  Make provisions for mercury spill clean up kits and proper training to the concerned personnel.
•  Recycle uncontaminated mercury waste using proper safety controls.

f)  Waste Anesthetic gases:

•  Purchase low leakage equipments and maintain these properly,

g)  Toxic corrosives and Miscellaneous chemicals:

•  Inspect and maintain ethylene oxide sterilisers.
•  Use less toxic compounds, cleaning agents, etc.
•  Return the containers for reuse and make use of recyclable containers.
•  Neutralise the acidic waste by mixing with basic wastes.
•  Avoid spills; make use of mechanical handling aids.
•  Use automated system for laundry equipments.
•  As far as possible, use physical cleaning methods.

Common Bio-Medical Waste Treatment and Disposal Facility (CBMWTDF) run by Enviro-Vigil, a Thane based NGO: An Ideal project, set by NGO.

     Enviro-Vigil is a NGO working hard to tackle various environmental issues in and around Thane city, for the past six years. As a NGO, it has set up a common facility for collection, transportation, treatment and disposal of BMW generated in the healthcare facilities since past three and a half years. This facility has been set up for Thane Municipal Corporation. All the private and government hospitals in the jurisdiction of TMC have joined this facility. In addition, private and govt. hospitals from Vasai, Nalasopara, Bhayander, Mira Road, Virar, etc. have joined this facility. Waste is also collected from the pathology labs, diagnostic centres, etc. Enviro-vigil provides on site training to the hospital staff, in which the details regarding handling and management of BMW are explained. The nurses and class four employees are made aware about the colour coding system and significance of segregation at source. About 500 to 600 kg waste is received per day at the facility, out of which, almost 400 kg is “incinerable” waste. The plastic waste is disinfected by autoclaving, shredded and sent for recycling. The volume of metal sharps and disposable glass articles is comparatively less. These are also disinfected at the facility, and then sent out for recycling. The residual ash is disposed of as per the norms provided in the rules.

    Enviro-vigil has a pyrolytic incinerator with a burning capacity of 50 kg of incinerable waste per hour. It is manufactured by Thermax (India) Pvt. ltd., Pune, Mharashtra. It is a dual chambered incinerator with Venturi scrubber. Enviro-Vigil has also set up an effluent treatment plant (ETP) as per the requirement. It has obtained all the necessary authorisations and permits from MPCB. Transportation is carried out in its own vehicles, which have been designed as per the specifications provided by the MPCB and are totally dedicated for this cause only. Enviro-Vigil has its own staff that are committed and dedicated to run this facility for a social cause. This facility is located in the campus of Thane Municipal Corporation’s Chhatrapati Shivaji Maharaj Hospital (CHM Hospital) and Rajeev Gandhi Medical College, at Thane-Belapur road, Kalwa, Thane. As this facility is being run by a NGO, it is receiving good response and appreciation from various sectors of the society. Barring a few shortfalls, even the authorities at higher levels in CPCB and MPCB have identified this facility as a role model, which is unique of its kind. A mass campaign has been initiated by Enviro-Vigil now to involve general practitioners, dentists, etc. to join this facility. It has also started collecting waste from the research laboratories, pharmaceutical companies, etc. A campaign is being worked out to involve the common people for managing their domestic BMW. So far no emphasis is being given on the issue of BMW generated at the slaughterhouses. However, in near future, Enviro-Vigil plans to consider managing the animal waste form the slaughter houses also

     The NGO is aiming towards ‘Zero Bio-Medical Waste’ in the city. As a proud moment for us at Enviro-Vigil, this bio-medical waste treatment facility has been awarded ISO 9001-2000 Certificate from DNV of Netherlands in December, 2005. Following are the highlights of this facility. All the employees mentioned above are coming from lower middle class of the society. Some of these have been the rag pickers. The work they are doing is very good in large perspective. But, while working such type of work, they have to take care of themselves e.g. cleanliness, wearing PPEs (personal protective equipments), etc. We have provided all the necessary facilities to these workers to maintain health and hygiene. They have been provided the necessary vaccination and they have to undergo routine medical check up once in three months under normal conditions. These workers have also been covered under Medi-Claim Insurance policy.

The number of health care units that are attached to our facility is as follows:

CONCLUSION:

    Management of household waste and hospital waste are of extreme importance.

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