Cautious Approach

Managing biomedical waste in times of COVID-19

The COVID-19 pandemic in the country remains alarming with the rapidly rising number of cases. The pandemic has been accompanied by several other grave challenges as well, including those pertaining to the management of biomedical waste. In the coming months, the quantity of medical waste generated in the country is expected to witness a substantial increase. The scenario is worsened by the fact that the country has a poor track record of medical waste disposal with weak enforcement of government rules, mixing of medical and general waste, and illegal dumping. Besides, as of 2017, around seven states had no medical waste treatment facilities.

Therefore, developing a strategy to handle and monitor the proliferating quantities of medical waste amidst the COVID-19 pandemic has become an imperative. In this regard, the Central Pollution Control Board (CPCB) issued guidelines in March 2020 for the safe handling and disposal of waste generated during the diagnosis, treatment and quarantine of COVID-19 patients. The guidelines are in addition to the already existing Biomedical Waste Management Rules, 2016. They underpin the necessity of enforcing strict measures in order to prevent any secondary transmission through infectious waste streams.

CPCB guidelines for COVID-19 waste

The guidelines issued by the CPCB direct all medical establishments, isolation wards, quarantine centres, sample collection centres, laboratories, urban local bodies (ULBs) and operators of common biomedical waste treatment facilities (CBWTFs) to follow stringent handling practices for COVID-19-related waste. As per the guidelines, all hospitals and healthcare facilities that have isolation wards for COVID-19 patients need to keep separate colour-coded bins, bags or containers for collection and segregation of biomedical waste. Further, double-layered bags are to be used for waste collection to avoid leakages. The labelling of such bags and containers as “COVID-19 waste” has been made mandatory. The CPCB has also written to state pollution control boards (SPCBs) and pollution control committees to consider the operation of CBWTFs and their associated staff as an essential part of their health infrastructure.

Moreover, the medical waste generated from isolation facilities is to be stored separately in a temporary storage room prior to handing it over to the CBWTFs. Alternatively, waste from such wards can be picked up directly from the ward and taken to CBWTF collection vans. A separate record for waste generated from COVID-19 wards needs to be maintained. Besides, only dedicated trolleys and collection bins with proper labelling are to be used in such wards. The inner and outer surfaces of such containers and trolleys need to be disinfected every day with a 1 per cent sodium hypochlorite solution. The healthcare facilities are also to depute dedicated sanitation workers for separate collection of COVID-19 related waste and general solid waste to ensure timely transfer of medical waste to the temporary storage area.

Biomedical waste generated from quarantine camps as well as homes where suspected cases or contacts of suspected or confirmed cases have been directed to stay by hospitals or local authorities should be collected separately in yellow coloured bags. CBWTF operators need to be contacted to collect the biomedical waste as and when it gets generated. The contact details of such operators have been made available with the local authorities. The general solid waste from quarantine centres is to be handed over to the waste collector identified by the respective ULBs or as per the prevailing local method of waste disposal.

The guidelines have, however, been revised thrice since they were issued to incorporate developments arising from an increase in cases and quarantined areas in major cities. According to the revisions, used personal protective equipment (PPE) such as goggles, face shields and plastic coverall hazmat suits from COVID-19 facilities need to be collected in red bags. The healthcare facilities have also been directed to disinfect the sewage discharged at each establishment. They have been advised to avoid the utilisation of treated wastewater. Besides, operators of sewage and effluent treatment plants attached to healthcare facilities need to adopt basic hygiene precautions and wear PPEs to avoid the risk of coronavirus transmission. Further, the guidelines recommend that used masks and gloves generated from home quarantine or other households be kept in a paper bag for a minimum of 72 hours prior to their disposal as general waste. Cutting of masks before disposal has also been advised to prevent reuse.

The CPCB has created a digital tracking system to monitor the life cycle of COVID-19 waste after the National Green Tribunal raised concerns about the improper disposal of medical waste and directed the board to incorporate best practices through continuous supervision. The digital app can monitor waste collection, segregation, transportation and incineration by geotagging each process and submitting details on a common platform. All waste generators and transporters will be asked to register on the app. While waste generators such as hospitals and quarantine camps will have to provide details regarding the quantity of waste handed over, transporters will have to confirm the amount of waste lifted. The details will be monitored and checked for discrepancies by the SPCBs.

Key issues and challenges

The volume of biomedical waste in the country is expected to rise further with the possibility of a surge in COVID-19 cases. According to several reports, the coronavirus epicentre Wuhan witnessed a sixfold increase in biomedical waste at the peak of its outbreak. A new medical waste plant and 46 mobile treatment facilities had to be constructed in the Chinese province to deal with the excess waste. A big challenge for India would then also be to deal with such huge quantities of medical waste, considering that the country has only 198 CBWTFs and 225 captive incinerators at present.

Further, waste segregation has been an issue till date in most Indian cities and the problem has been exacerbated further with the coronavirus outbreak. Several common treatment facilities in cities such as Delhi and Mumbai are receiving mixed waste in yellow bags from quarantined homes. In certain areas, PPE has also been dumped or burnt openly posing a serious threat to public health.

The way forward

The safe disposal of biomedical waste is of utmost importance for maintaining community sanitation amidst the coronavirus outbreak and for avoiding a larger health crisis. While the guidelines issued by the CPCB aim to address the challenges posed by improper handling of medical waste, it is essential for ULBs to ensure that they are strictly adhered to. Besides, regular monitoring also needs to be undertaken.

The perennial issue of lack of waste segregation also needs to be resolved. While over the past few years due to a push from government initiatives such as the Swachh Bharat Mission, several cities have mandated source segregation into wet and dry waste, the emergence of the coronavirus has made it necessary to further segregate infectious and hazardous waste in domestic waste streams. Thus, there is an urgent need for states to spread awareness and sensitise citizens about protected disposal of household waste. Moreover, front line sanitation workers who are at risk from handling unmarked waste such as discarded masks and gloves need to be provided with adequate protective gear.

Possible solutions such as decentralising incineration, using thermal technologies for biomedical waste treatment, setting up of new facilities and ramping up capacity at existing facilities need to be looked at. Other innovative practices such as the deployment of reusable PPE kits can also play a crucial role in reducing waste volumes. Going forward, our waste management processes will require greater mechanisation and automation to reduce human contact.

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