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Monday, April 16, 2012

80% city hospitals flout bio-waste disposal norm

After Masina shocker, biomedical waste disposal agency raises giant red flag
Hazardous waste, that's so dangerous it needs to be incinerated at 900 degrees Celsius, is not segregated at source 
Disposal agency official says they hardly receive used syringes and saline bottles, raises fears that these are recycled in the market

A week after Mirror reported how medical waste from a hospital ended up on a Byculla footpath, the nodal agency for collecting hazardous materials has revealed that the problem of improper disposal pervades nearly the entire hospital system. BMC-appointed SMS Envoclean claims 80 per cent of Mumbai's hospitals (public and private) don't segregate their refuse - from syringes, blood-soaked gauze pieces to intravenous drips - seriously compromising efforts to keep infections away from the city's streets and citizens. Waste from clinics and hospitals, where infections and drug-resistant bacteria are becoming increasingly common, poses serious health risks. Unlike regular garbage, it has to be segregated and stored in colour-coded bags depending on its hazardous nature, and incinerated at more than 900 degrees Celsius. (See box on the disposal method mandated by the government.) 
    On April 5, heaps of medical throwaways from Masina Hospital were found scattered on a footpath of a busy street in Byculla. Rag-pickers rummaged through the waste, unmindful of the diseases it may have been carrying. 
    "Eighty per cent of government and private hospitals do not segregate medical waste at source. To raise awareness, we regularly send posters on the right disposal method to all healthcare units," the director, SMS Envoclean, Chetan Bora, told Mirror. "The bio-degradable bags we sell also carry information about how used medical items can be separated. All these efforts have proved to be futile." 
    The city administration has tasked the agency with collecting bio-medical refuse from all hospitals. Its 95 vans collect 12 to 14 tonnes of medical waste every day from 12,000 healthcare units, including nursing homes and dispensaries. Bora said that staff at some hospitals stuffed hazardous waste in regular trash bags, and not colour-coded ones. 
    "It may seem to be a minor lapse, but what happens is that BMC workers mistake the garbage for regular trash and collect it. This way dangerous items enter the city's disposal system," he said. BMC workers are not allowed to collect or dispose medical items. 
    On Masina Hospital's indication that the agency left waste on the footpath, he said: "We have records to prove that our vehicle collected waste from all health units in Byculla," he said. 
    Another pressing concern for health officials is the sale of used medical items. "We hardly get used syringes and saline bottles. We suspect hospitals send these items for recycling without carrying out a proper disinfection process," said an employee of Envoclean. 
    According to BioMedical Waste Rules, 1998, hospitals cannot discard non bio-degradable items in chlorinated bags, which, when burnt, cause harm to environment. "Many hospitals use these types of bags, which also cause damage to our disposal machines. We have raised the issue with the Maharashtra Pollution Control Board (MPCB)," the employee said. 
    When Mirror contacted MPCB sub-regional officer A S Nandavate, he said that the board conducts periodic checks at hospitals and clinics. "Whenever we get a complaint from the agency, we order an inspection," he said. Nandavate contradicted the agency's claim that 80 per cent of hospitals were flouting disposal norms. 
    The medical fraternity, meanwhile, blamed the agency for sidestepping norms. "Envoclean employees are supposed to collect waste from our premises every alternate day, but they come here only once a week. We cannot dispose of the garbage on our own," said Physician Krishnakant Dhebri, who runs a clinic at Girgaum.
    He added that small healthcare units that don't generate high amount of garbage should be allowed to dispose it of in regular trash bags. "Unlike hospitals, such clinics do not generate hazardous waste," he said. 
    Another doctor, who didn't want to be named, said that the agency demanded steep charges for collecting medical refuse from hospitals and clinics. Bora, however, said that rates were reasonable. "They are calculated on the basis of the number of beds in a hospital. We offer discounted rates to municipal and government hospitals," he said. 
BIO-MED WASTE DISPOSAL 
As per the Bio-Medical Waste (Management and Handling) Rules, 1998, it is mandatory for hospitals in the city to dispose bio-medical waste through a prescribed method. They could either hand over the refuse to collection agents, authorised by the civic body, or treat it on their own. 
    However, since the latter requires health facilities to install expensive machinery, most of them opt for the common treatment and disposal facility – SMS Envocare in Mumbai. 
SEGREGATION 
The BMW rules require hospitals to segregate the hazardous waste and put it into different colour-coded bags – yellow, red and blue/white – before handing it over to Envocare staffers for disposal. 
THE DISPOSAL 
YELLOW BAGS They contain infectious bandages, gauzes, cotton or any other thing that comes in contact with body fluids, human body parts, blood bags and blood sample tubes TREATMENT They are reduced to ash in an incinerator at 1200 degrees Celsius. The toxic fumes generated through the process are burnt at 1500 degrees Celsius. RED Plastic wastes such injection syringes, ampules, plastic intravenous bottles, catheters, plastic and rubber hand gloves TREATMENT: Autoclaving – disinfecting with the help of steam and chemical treatment. The items are then crushed and sent to authorised reprocessor or plastic manufacturers BLUE/WHITE (puncture-proof bags): All types of glass bottles, scalpels, metal articles TREATMENT: After autoclaving, the items are buried in areas known as sharp pits


Hazardous waste lying on a footpath in Byculla and (right) the treatment plant at Deonar where all medical waste is disinfected, buried or incinerated




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