1350: Round Table - Expert Group on Environment Zoom Meeting on “Issues and Challenges in implementation of Bio-medical Waste Management Rules"

31^st January, 2020, 12 noon-1pm

Participants: Dr KK Aggarwal, Dr SK Tyagi, Dr Ajeeta Aggarwal, Dr M Dwarkanath, Mr Pankaj Kapil, Mr Pradeep Khandelwal, Mr Neeraj Tyagi, Mr Vikas, Dr Suresh Mittal, Dr Anil Kumar, Ms Ira Gupta, Dr S Sharma

The meeting was chaired by Mr Pankaj Kapil.

Key points from the discussion

• Bio-medical Waste Management Rules, 2016 (BMW Rules) were framed under the Environment (Protection) Act, 1986 and notified in 2016.The Rules lay down the duties of all stakeholders and have defined the standards of treatment and disposal of biomedical waste.
• These rules were amended in 2018 and new guidelines were also issued during the COVID pandemic.
• Unscientific disposal of bio-medical waste has potential of spread of serious diseases such as gastrointestinal infection, respiratory infection, eye infection, skin infection, anthrax, meningitis, AIDS, hemorrhagic fevers, septicemia, viral hepatitis, etc. 
• Environmental pollution also results from unscientific disposal leading to unpleasant smell, growth and multiplication of vectors, like insects, rodents and transmission of diseases.
• The rules have defined the duties of an “Occupier” who is a person having administrative control over the institution and the premises generating bio-medical waste. They have to ensure safe handling of BMW and the first step in safe handling is segregation at source to be stored at safe, ventilated and secured location in colored bags or containers.
• Certain types of waste need to be pretreated and then handed over to the CBMWTF (common BMW treatment facility). On site disposal is not allowed now. Every bag handed over is to be bar coded.
• Treated bio-medical waste should not be disposed with municipal solid waste.
• ≥100-bed hospitals should put in a sewage treatment plant to treat waste water generated from the hospital.
• Healthcare workers and others, involved in handling of BMW, have to be trained regarding proper segregation, color coding of bins, etc. Their health checkup should be done; immunization and occupational safety to be ensured.
• The operator of a CBMWTF has to take all necessary steps to ensure that the BMW collected from the occupier is transported, handled, stored, treated and disposed of. Ensure timely collection of bio-medical waste from the occupier and use bar coding and global positioning system for handling of BMW.
• 202 CBWTFs are functioning in the country and 36 are under installation.
• About 615 metric tonnes of BMW is generated per day and 541 metric tonnes of BMW is treated per day.
• 28,816 healthcare facilities violated BMW Rules in 2019.                          
• Handling of COVID-19 waste generated from persons in home quarantine has been defined in CPCB guidelines. It is being taken care of by urban local bodies to a centralized point and then collected by CBWTF operators and then disposed of in a scientific manner.
• Hazardous waste is now being collected separately.
• However, while rules have been formulated and are in place, there are no SOPs; there is a gap between formulation and implementation. There is not enough awareness about the rules.
• Awareness needs to be created that unless BMW is disposed of scientifically, it will be a health hazard.
• MCDs need to have some material recovery centers; either they should pick up segregated hazardous material from the homes or if this is not available, then they should have some material recovery centers where the domestic hazardous waste can be segregated and handed over to CBWTF.
• Almost 33,000 metric tonnes of BMW due to COVID has been generated in the country, as per latest CPCB report (data from 198 CBWTFs over 7 months). 6000 tonnes is only due to COVID BMW in terms of PPEs from individual hospitals, which has gone to common treatment facilities.
• Guidelines need to be repeatedly emphasized.
• Local bodies should take responsibility. RWAs need to be made accountable.
• It should be made mandatory that all pharmaceuticals unused should be returned to the chemist shops. However, chemists are not ready to take back the left over and expired medicines.
• Local bodies should collect such waste, at least once a week, from those houses or RWAs should identify some collecting bins/containers in each colony especially for disposal of BMW. It is their responsibility to get this waste collected.
• Children should be educated in school about disposal of expired medicines at home.
• Incentive should be given to each household for proper disposal of BMW, e.g., some relief in house tax.
• Segregation of waste is best done at homes. However, self-discipline is also very important.
• BMW waste management rules do not cover radioactive waste as per Rule 2 a. It comes under AERB (Atomic Energy Regulatory Board) guidelines.
• Medical radioactive waste includes waste generated by nuclear medicine, radiation oncology and PET scans. All needles should be placed into a sharps container for disposal.
• At present, we do not have an inventory of healthcare facilities. There should be mandatory registration of clinics. This is required for monitoring. Also, there is not enough staff to cover the entire state.
• Every state should be given a marking system based on 12 key performance indicators, which includes inventorization, action taken, rate of disposal, etc.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA