Biomedical Waste – Health beyond Healthcare

Abstract

Healthcare encompasses the trinity of teaching, research, and patient care that necessitates the proper management of biomedical waste (BMW) generated during these activities. In recent years, with the rise in public and private healthcare establishments, India is likely to generate about 775.5 tons of medical waste per day by 2022. A joint study conducted by industry body The Associated Chambers of Commerce and Industry of India and Velocity suggests that medical waste is expected to grow at a compounded annual growth rate of about 7%. The seemingly endless stream of BMW has become a topic of global concern and implications. It is not only the subject of humanitarian concern but it has far-reaching effects on the environment also. BMW is a potential health hazard to the healthcare workers, public, and flora and fauna of the area. The Environment Protection Act 1986, the BMW (Management and Handling) Rules in July 1998, subsequently revised in 2011, and now the “BMW Management Rules, 2016” are an attestation to the commitment of the Government of India to ensure safe and proper disposal of allopathy and nonallopathy (Ayurveda, Siddha, Unani, or Homeopathy) BMW. The present BMW guidelines are based on the guiding principles of the World Health Organization, The Basel Convention on Hazardous Waste (1989), The Bamako Convention (1991), The Stockholm Convention on Persistent Organic Pollutants (2001), and The Minamata Convention on Mercury (2013). Despite our two-decade-old history of implementing BMW management guidelines, there have been innumerable incidents of mismanagement of BMW. The Hepatitis Outbreak in Modassa, Gujarat (India), 2009 is one of the major episodes that drew attention to the issue of unsatisfactory BMW management in the country. “Safe and effective management of waste is not only a legal necessity but also a social responsibility. Lack of awareness, commitment, concern, and cost factor are some of the reasons for unsatisfactory management of BMW.” By definition, waste generated during dental care is a subset of hazardous BMW, thus making dental institutions and dentists liable for the management of the waste generated. It includes infectious wastes and noninfectious toxic wastes (mercury, silver amalgam, heavy metal scraps, X-ray processing waste, acrylic resin scraps, wasted metal alloys, metal dust, porcelain, plaster of Paris, gypsum, and other chemical wastes). All of these wastes if not handled properly can pose a serious threat to humans as well as environment. Thus, there is an equally overarching need for the management of dental waste from dental care establishments. Considering the Indian scenario, major issue related to the current BMW management is lack of satisfactory implementation of BMW management guidelines. Data from the Government of India site indicate that the total BMW generated in the country is 484 tons per day (TPD) from 168,869 HCFs. Unfortunately, only 447 TPD is treated, and 37 TPD is left untreated, necessitating an urgent need to take action for strengthening the existing system capacity, increase the funding and commitment toward safe disposal of BMW. In recent years, the monitoring bodies, viz., State Pollution Control Board and Central Pollution Control Board, have formed monitoring bodies to plan out a strategy to manage the quantum of BMW generated all over the country. A country like India that has strode in expansion of health sector in recent decades, attention should be drawn to BMW management strategies that are affordable, sustainable, and adaptable to local conditions so that the wastes generated should not harm the healthy.