Biomedical waste management rule and changes in the policy

INTRODUCTION

The Healthcare industry in India is delivered mainly either by public or private providers. The healthcare industry in India comprises of Hospitals, medical centers, clinical trails, telemedicine, clinics, medical tourism, and health insurance.

The public healthcare focuses on delivering primary healthcare through community-level health programmes mainly focusing on reducing mortality and morbidity caused by various communicable and non-communicable diseases. Biomedical waste (BMW) is defined as any waste which is generated during the diagnosis, treatment, or vaccination of human beings or animals or in research or in the use of biological or in health camps.¹

The healthcare industry is growing at a tremendous pace to reach $372 Billion by 2022 from $45.0 billion in 2008 owing to its strengthening coverage, services and increasing expenditure by public as well as private players.² In terms of employment and revenue, healthcare has been one of the largest sectors and is growing at a vigorous pace.

The basic principle of good BMW practice is based on the concept of Rs. 3, namely reduce, recycle and reuse. It follows the cradle to grave approach which is characterization, quantification, segregation, storage, transport, and treatment of BMW.

The best BMW management (BMWM) methods aim at avoiding generation of waste or recovering as much as waste as possible, rather than disposing. Therefore, the various methods of BMW disposal, according to their desirability, are prevent, reduce, reuse, recycle, recover, treat, and lastly dispose. Hence, the waste should be tackled at source rather than ‘end of pipe approach’.³

Poor management of HCW exposes health-care workers, waste handlers and the community to infections, toxic effects and injuries. On an average, the hospital waste generation rate ranges from 0.5 to 2.0 kg/bed/day which amounts to about 0.33 million tons annually.⁴

The most common problems associated with the healthcare workers with biomedical waste management handling is lack of awareness about segregation, health hazards, insufficient financial allocation and manpower for proper management. They need well updated information about rule and skill and practices in managing this waste besides reducing hospital acquired infections to protect their own health.

On 20^th July 1998, first BMW (management and handling) rules were notified by Government of India, by the erstwhile Ministry of Environment and forest (MoEF), Government of India under Environment (Protection) Act, 1986 (29 of 1986). The BMW 1998 rules were modified and amendments in the following years- (a) 1^st amendment dated 06/03/2000- BMW (management and handling) (amendment) rules, 2000; (b) 2^nd amendment dated 17/09/2003; (c) 3^rd BMW (management and handling) Rules, 2011; (d) 4^th- BMWM Rules, 2016; (e) 5^th- BMWM rules, 2016. The word ‘management’ includes handling; (f) 6^th- BMWM rules, 2018. Amendment dated 16/03/2018

The MoE, F and CC has notified the new BMW (M) rules, 2016 on 28^th March, under the Environment (Protection) Act, 1986 to replace the earlier rules (1998) and the amendments thereof Published in the Gazette of India, extraordinary, part Ⅱ, section 3, sub-section (i) the draft of BMW rules 2011 remained as draft and did not get notified because of lack of consensus on categorization and standards. Now Ministry of Environment, Forest and Climate change in March 2016 (Gazetted on 28^th March, 2016) and amended Rules, 2018 the BMWM rules.

These new rules have increased the coverage, simplified the categorization and authorization while improving the segregation, transportation and disposal methods to decrease environmental pollution. It has four schedule, five forms and eighteen rules.

The BMW 1998 rules were modified in the following years- 2000, 2003, 2011 and 2016.

The draft of BMW rules 2011 remained as draft and did not notifies because of lack of consensus on categories and standards. Now Ministry of Environment, Forest and Climate change in March 2016 have amended the BMWM rules (999).⁵

Definitions and abbreviations

Biomedical waste

Waste generated during the diagnosis, treatment or immunisation of human beings or animals or research activities pertaining thereto or in the production or testing of biological or in health camps.

BMW Rules, 1998

The Biomedical Waste (Management and Handling) Rules, 1998.

BMW Rules, 2016

The Biomedical Waste Management Rules, 2016.

Occupier

A person having administrative control over the institution and the premises generating biomedical waste including hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank, health care facility and clinical establishment.

Operator

A person who owns or controls a common biomedical waste treatment facility for the collection, reception, storage, transport, treatment, disposal or any other form of handling of biomedical waste.

Prescribed authority

The State Pollution Control Board in respect of a State and Pollution Control Committee in respect of a Union territory.

Treatment and disposal facility

Facility wherein treatment, disposal of biomedical waste or processes incidental to such treatment and disposal is carried out, and includes common bio-medical waste treatment facilities.

REVIEW

The Biomedical Waste Management Rules, 2016 brings more clarity in the application, duties of occupier and operator, reduce use of number of colour code bins and categories of waste. The Rules apply to hospitals, nursing homes, clinics, dispensaries, veterinary institutions, animal houses, pathological laboratories, blood banks, ayush hospitals, clinical establishments, research or educational institutions, health camps, medical or surgical camps, vaccination camps, blood donation camps, first aid rooms of schools, forensic laboratories and research labs.

It has been clarified that the BMW rules, 2016 do not apply to radioactive wastes, hazardous chemicals, hazardous wastes, municipal solid wastes, lead acid batteries, e-wastes, hazardous microorganisms, genetically engineered microorganisms and cells, which are governed by the other respective rules.

Comparison and differences of Biomedical Waste (Management and Handling) Rules, 1998 and Bio-Medical Waste Management Rules, 2016 is given in Table 1.

CONCLUSION

Biomedical Waste Management Rules, 2016 clarify various responsibilities of occupier, operator and regulatory authorities. The number of forms and reduced and categories of waste to 4 only. Continuous awareness, training programs and regular monitoring and audits must be done by the healthcare facilities for implementation of the rule. The rules, 2016 would improve the implementation in healthcare facilities of the MBW rules.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

1. 1. Capoor MR, Bhowmik KT. Current perspectives on biomedical waste management: Rules, conventions and treatment technologies. Indian J Med Microbiol. 2017;35(2):157-64.
2. 2. Statista. 2. Size of the healthcare market in India from 2008 to 2017, with estimates until 2022, 2022. Available at: https://www.statista.com/statistics/701556/healthcare-sector-size-india/. Accessed on 21 August 2022.
3. 3. Chartier Y, Emmanuel J, Pieper U, Prüss A, Rushbrook P, Stringer R. Safe Management of Wastes from Health-Care Activities. 2nd ed. Geneva, Switzerland: WHO Press; 2014: 1-146.
4. 4. Patil AD, Shekdar AV. Health-care waste management in India. J Environ Manage. 2001;63(2):211-20.
5. 5. Government of India, Ministry of Environment and Forests. Bio-Medical Waste (Management and Handling) Rules. Gazette of India, 1998. The Gazette of India Biomedical Wastes (Management and Handling) Rules. India: Ministry of Environment and Forests, Government of India; 1998.