With input from Dr Monica Vasudev

1378: Round Table - Expert Group on Environment Zoom Meeting on “Issues and Challenges in implementation of Biomedical Waste Management Rules – Part 2"

7^th February, 2020, 1-2 pm

Participants: Dr KK Aggarwal, Dr Anil Kumar, Dr Dipankar Saha, Dr M Dwarkanath, Mr Pankaj Kapil, Mr Pradeep Khandelwal, Mr Neeraj Tyagi, Dr Shyam Gupta, Dr Suresh Mittal, Dr Meenakshi Soni, Ms Ira Gupta, Dr S Sharma

The meeting was chaired by Dr M Dwarkanath and co-chaired by Mr Pradeep Khandelwal.

Key points from the discussion

• COVID-19 has increased the volume of biomedical waste (BMW) generated. With patients in home care, this subject has become very important and needs attention because hazardous waste is being disposed of mixed with domestic waste.
• Expired medicines, broken mercury thermometers, used batteries, used needles and syringes, contaminated gauze, etc., generated in home care of patients are covered under solid waste management rules, 2016 as “domestic hazardous waste” and not under BMW management.
• CPCB should come out with SOPs about domestic hazardous waste. Awareness should be there so that it is properly handled and disposed.
• There are three types of waste in household: Wet waste, dry waste and domestic hazardous waste.
• NDMC, SDMC have started collecting the domestic hazardous waste. EDMC has started work on this. Indore has done a lot of work on this.
• Domestic hazardous waste includes paints and varnishes, expired medicines, sanitary pads, batteries. These are collected separately and segregated at MRF facilities.
• Indore model can be adopted and a separate system for domestic hazardous waste collection can be established.
• Big chemist stores or stockists should keep a box where the expired and left over medicines can be put under EPR by a pharmaceutical company. They can be then collected and transported for safe disposal.
• Special e-waste collection bins had been put to collect electronic waste. Along similar lines, DPCC can tie up with market trader/drug stockist associations and put collection bins at various places for domestic hazardous waste, at least for expired medicines.
• For synchronization of segregation and collection system, it is important to have education and awareness for all. Education should start at the school level itself; there should be regular programs and courses round the year.
• People should know where the waste should be disposed.
• RWAs should be asked to keep collection bins for domestic hazardous waste, especially with many patients in home care/quarantine.
• Implementation is poor because chain is incomplete. All things should move parallel to each other to achieve sustainability.
• Even if segregation is done, people do not know where it should go. Domestic hazardous waste has to go to Hazardous Waste Treatment, Storage and Disposal Facilities (TSDFs).  Delhi does not have a TSDF.
• A suggestion was given to write to CPCB/Central government/Delhi government to undertake a survey for lifecycle analysis of e-vehicle batteries.
• Lack of space for landfills; hence, lot of waste is dumped in the open. Awareness needs to be generated about domestic hazardous waste and not just limited to penalisation.
• Monitoring of autoclaving and steam disinfection should be done.
• A BMW nodal officer should be appointed in each hospital. However, most hospitals (≥50 beds) already have a BMW management committee including a nodal officer (at doctor level); there are advisory committees at district level and multi-departmental teams are there for inspection.
• COVID waste needs to be segregated (in double bags) with proper labelling, treated and disposed of expeditiously, within 24 hours, as per latest revision of CPCB guidelines (31^stJuly, 2020).
• The generation of BMW must be reduced. This should be our first emphasis. For example, to reduce discarded medicine waste, medicines should be dispensed in the quantity that has been prescribed by the doctor.
• EPR should be implemented; chemists must be regulated to take back discarded medicines.
• Write to IRDA that when reimbursing for home care, there should be a written assurance that they have followed BMW & other waste management guidelines. Doctors should also prescribe these guidelines – how to handle the home generated BMW. Adherence to these guidelines should be mandated.
• DPCC/CPCB should write to the National Medical Commission in this regard.
• Can masks be washed, disinfected and reused? A procedure should be prescribed and can be standardised and should be included in CPCB guidelines. Fabric masks can be washed with detergent and re-used. N95 masks are single use masks. The masks can be discarded in domestic waste after 72 hours of keeping in a paper bag.
• For collection boxes (for discarded medicines etc.), along with EPR, all hospitals, medical associations, nursing homes, schools and colleges should be included.
• Wherever first aid is provided, there should be a collection facility either in the form of a box or room.
• Time for collection should be fixed; there should be helpline numbers.
• MCD vehicles that collect waste should be compartmentalized to avoid mixing of different kinds of waste. The compartments should be of appropriate volume and size.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA