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  Table of Contents  
CORRESPONDENCE
Year : 2017  |  Volume : 35  |  Issue : 4  |  Page : 623-625
 

Implementation challenges in bio-medical waste management rules, 2016


1 Department of Microbiology, Biomedical Waste Unit, VMMC and Safdarjung Hospital, New Delhi, India
2 Department of Radiotherapy, Biomedical Waste Unit, VMMC and Safdarjung Hospital, New Delhi, India

Date of Web Publication1-Feb-2018

Correspondence Address:
Malini R Capoor
Department of Microbiology, Biomedical Waste Unit, VMMC and Safdarjung Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmm.IJMM_17_416

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How to cite this article:
Capoor MR, Bhowmik KT. Implementation challenges in bio-medical waste management rules, 2016. Indian J Med Microbiol 2017;35:623-5

How to cite this URL:
Capoor MR, Bhowmik KT. Implementation challenges in bio-medical waste management rules, 2016. Indian J Med Microbiol [serial online] 2017 [cited 2019 Aug 26];35:623-5. Available from: http://www.ijmm.org/text.asp?2017/35/4/623/224439


Dear Editor,

As India was signatory to Aarhus convention and Stockholm convention, it became crucial to phase out the then existing Bio-Medical Waste (Management and Handling) rules, 1998 to the current bio-medical waste management (BMWM) rules, 2016. As the BMWM rules, 2016 got notified on March 28, 2016, most of the health-care facilities (HCFs) started implementing the new rules.[1],[2],[3] In the process of implementing the new rules, the occupiers faced implementation challenges, and there were certain grey areas in the rules.[4] Improper and inefficient disposal of BMW can lead to infectious hazards, malignancies, malformations, air, land and water pollution for environment and community at large for not only this generation but also for generations to come. Furthermore, it can also lead to hazardous chemicals, infectious agents, antimicrobial residues getting discharged in hospital wastewater, groundwater and surface water.[3],[5] These antimicrobial residues pass through current treatment technologies such as ozonation, ultraviolet radiation, reverse osmosis and effluent treatment plants. The country has very few units of photocatalysis units that hold promise for disinfection of bacteria and decontamination of antibiotics.[6] As per the BMWM rules, 2016, BMW is not to be mixed with solid waste. The bulk of health-care waste generated is solid waste (80%–85%), and its collection needs to be settled at the level of municipalities as part of the solid waste, rules 2016.

As per the mandate of the BMWM rules, 2016, only pre-treatment (few articles) and segregation (all kinds of BMW) is required at the HCF level, and the final disposal and recycling (Government authorised recyclers) is mandated at common bio-medical waste treatment facility (CBMWTF) level. As per the BMWM rules 2016, there are 4 colour coded categories of yellow, red, white and blue. To curtail the Pilferage of sharps (needles), a mutilation preferably with a needle cutter is required on site, before transportation to central common waste site and final disposal by CBMWTF. [Table 1] depicts the colour categories of waste and grey areas, i.e. articles not documented or ambiguous in the Schedule I, of BMWM rules, 2016.
Table 1: Colour categories of bio-medical waste and grey areas, i.e., articles not documented or ambigous**** in the Schedule I, of bio-medical waste management rules, 2016

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Use of non-chlorinated blood bags and 10% sodium hypochlorite: non-chlorinated (polyvinyl chloride [PVC] free) blood bags are undergoing Phase III trials in the European Union by the company, as from studies on such trial documents their disadvantage of decreasing the shelf life of blood cells (www.pvcfreebloodbags.eu). The use of 10% sodium hypochlorite for routine BMWM as per the available scientific literature shows it to be a slurry, costly, hazardous and therefore may have non-compliance issues from HCWs. The rollback of 10% sodium hypochlorite may be delved on as per the recommendations of existing literature.[7],[8],[9] Further, large-scale studies are warranted on its use, and its substitutes may be initiated to support or refute the claim.

Ideally in future with ever-expanding field of medical disposables, the manufacturers should document on the label of the product the recommended disposal method. With the notification of the BMWM rules, 2016, urgent interventions are required in terms of systems capacity, greater resources and processes. As per the BMWM rules 2016 records of yearly BMWM training, health checkup, immunisation, equipments, etc., need to be maintained for 5 years. The pre-treatment of laboratory waste, microbiology waste, blood bags by sterilisation is recommended by autoclave, microwave or hydroclave. The definite shortcomings include the non-availability of PVC free blood bags. The inability of the most of available effluent treatment technologies in removing antimicrobial residues needs to be addressed. For barcoding, the draft guidelines by the Central Pollution Control Board (CPCB) are available since September 2017 (http://cpcb.nic.in/Bio_medical.php). The grey areas or novel waste which is generated but not documented in rules should have a buyback policy or should be treated as per recommended guidelines of Centers for Disease Control and Prevention or the World Health Organization. The challenges in the BMWM rules 2016 will be gradually overcome with the guidelines and handbooks released from state pollution control committee, CPCB, MoEF and CC from time to time (http://cpcb.nic.in/Bio_medical.php; www.dpcc.delhigovt.nic.in). It has become obligatory on all the stakeholders HCF, CBMWTF, inspecting agencies, the pharmaceutical industry, households, civil societies involved in BMWM to delve into the scientific aspect of BMWM and come up with definitive, targeted and practical ways under the existing rules of the country to save the environment from hazards. Furthermore, sustainable development goal 12.4 states that by 2020 countries should achieve the environmentally sound management of waste throughout their life cycle, in accordance with agreed frameworks (https://sustainabledevelopment.un.org). This correspondence provides information coupled with the scope of BMWM vis-à-vis the implementation challenge and their troubleshoot that surrounds the concept as a whole and second, to bring to light, the best definitive and focussed solution to the grey areas aiming at achieving the efficient BMWM through the dynamic spirit of BMWM rules, 2016. These rules bring the most welcome addition of segregation of waste at the source and accountability on the key stakeholders.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
 ~ References Top

1.
Secretariat of the Stockholm Convention. Revised Draft Guidelines on Best Available Techniques and Provisional Guidance on Best Environmental Practices of the Stockholm Convention on Persistent Organic Pollutants. Geneva: Secretariat of the Stockholm Convention; 2006.  Back to cited text no. 1
    
2.
Bio-Medical Waste Management Rules. Published in the Gazette of India, Extraordinary, Part II, Section 3, Sub-Section (i). Government of India Ministry of Environment, Forest and Climate Change, Notification. New Delhi; 28th March, 2016.  Back to cited text no. 2
    
3.
Chartier Y, Emmanuel J, Pieper U, Prüss A, Rushbrook P, Stringer R, et al., editors. Safe Management of Wastes from Health-Care Activities. 2nd ed. Geneva, Switzerland: WHO Blue Book; 2014.  Back to cited text no. 3
    
4.
Capoor MR, Bhowmik KT. Current perspectives on biomedical waste management: Rules, conventions and treatment technologies. Indian J Med Microbiol 2017;35:157-64.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Singhal L, Tuli AK, Gautam V. Biomedical waste management guidelines 2016: What's done and what needs to be done. Indian J Med Microbiol 2017;35:194-8.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Lundborg CS, Tamhankar AJ. Antibiotic residues in the environment of South East Asia. BMJ 2017;358:j2440.  Back to cited text no. 6
    
7.
Widmer AF, Frei R. Decontamination, disinfection, sterilization. In: Versalovic J, Carroll KC, Funke G, Jorgensen JH, Landry ML, Warnock DW, editors. Manual of Clinical Microbiology. 10th ed. Wahington DC, USA: ASM Press; 2011. p. 143-73.  Back to cited text no. 7
    
8.
Rutala WA, Weber DJ; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guideline for Disinfection and Sterilization in Healthcare Facilities. Atlanta: Centres for Disease Control; 2008.  Back to cited text no. 8
    
9.
Rutala WA, Weber DJ. Uses of inorganic hypochlorite (bleach) in health-care facilities. Clin Microbiol Rev 1997;10:597-610.  Back to cited text no. 9
    



 
 
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