To cater to the needs of the expanding population, the last century witnessed rapid mushrooming of healthcare establishments in both government and in private sector.19,30 With the advent, acceptance and increasing demand of “disposable items”, the present hospitals generate of healthcare wastes in substantial amount.19 The absence of proper waste management, lack of awareness about the associated health hazards, human resources, insufficient financial and poor control of waste disposal are the main contentious issues connected with healthcare wastes.63,100
Thus inadequate, inappropriate and improper waste management leads to foul odor, environmental pollution, multiplication of disease carrying organisms like insects, rodents and worms and hence the transmission of diseases like typhoid, cholera, hepatitis A, B, C and AIDS through contact with infected waste and in particular through accidental injuries from used sharps.19 Owing to unsafe healthcare practices, half a million people all over the world die every year due to infections like hepatitis B, and C, HIV and hepatocellular carcinoma.7,97 Apart from these health risks, inappropriate management of healthcare wastes also has a negative impact on environment by adding toxic pollutants to water, air and soil. This environmental pollution can potentially damage our flora, fauna and the ecosystem.19
Not only are the healthcare workers at risk of acquiring infection through improper handling hospital wastes, but also general public is exposed to avoidable risks. The risk to the public increases many folds as disposable items are picked up by rag pickers in India and recirculated into the market without any sterilization.19,96 In an assessment report of WHO of 2002, covering 22 developing countries, it is stated that 18 to 64 percent2 of healthcare facilities do not use proper waste disposal methods ranges.99
According to World Health Organization, 85 percent of hospital wastes are nonhazardous, whereas 15 percent are hazardous wastes, subcategorized as 10 percent being infectious and 5 percent are non-infectious.70 Developed countries generate approximately 1 to 5 kg of hospital waste/bed/day, whereas developing countries add 1 to 2 kg/bed/day.69 In developed countries like US and Canada, annual waste production in over 1 million hospital beds is about 2 tonnes per hospital bed, or about 2,000,000 tonnes in total.71
In India, the estimated figure is 2.0 kg/bed/day and out of this, 10 to 15 percent is found to biomedical waste.19 India, the highest generator of biomedical waste in the world, contributes 0.33 million tonnes per year.77
Biomedical waste means any waste, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biologicals, and including categories listed in Schedule I.83
The biomedical waste and their appropriate disposal has come up as a challenge and hence have become an issue of increasing concern. Public has become more aware and conscious about the production of hazardous wastes and subsequent methods employed for its disposal. This has prompted hospital administration experts to find new ways of scientific, safe and cost-effective management of the biomedical waste.19 To address these public concerns and acting upon the directives of honorable Supreme Court of India, Biomedical Waste (Management and Handling) or BMW Rules, 1998 were drafted in exercise of powers conferred by Section 6, 8 and 25 of the Environment (Protection) Act, 1986 that was published in The Gazette of India Extraordinary, Part-II, Section 3-Subsection (ii) New Delhi, July 27, 1998.6
As per the Biomedical Waste (Management and Handling) rules, 1998, it is the responsibility of every occupier of an institution generating biomedical waste (which includes hospitals, nursing homes, clinics, dispensaries, veterinary institutions, animal houses,3 pathological laboratories, blood banks, etc.), that all necessary steps are taken for handling such wastes without any adverse effect to human health and environment.56 The healthcare establishments would also follow strict segregation, packaging, labeling and disposal as per the BMW Rules, 1998.79
In India particularly many institutions lack appropriate systems because of nonavailability of appropriate technologies, lack of professional training and adequate financial resources and above all lack of commitment at each level.63 However, many NGOs and media personnel are actively working in this field and trying to bring this issue to the fore.