Healthcare LESS & Hands that heal hands that Harm

The study in 2001 suggested that the city of Chennai with 200 or more healthcare institutions and a total bed strength of around 28,000. In the process of offering one of the best healthcare facilities in the country, these institutions generate as much as 20 tonnes of hospital waste every day – most of which finds its way into the community. The Bio-medical Waste (Management and Handling) Rules set deadlines for streamlining waste management in hospitals.

The Central Government brought out the Bio-medical Waste (Management and Handling) Rules in 1998 in order to streamline the management of hospital waste. The Government also issued a deadline of 31-12-1999 for cities like Chennai with a population of more than 30 lakhs, to comply with the Rules and by an amendment extended it to 30-06-2000.
               
Keeping this in mind Srishti and CAG, assisted by Toxics Link Chennai initiated a study in Chennai in July 2000 to estimate the status of bio-medical waste management in the city. The study, which covered 25 healthcare institutions, including laboratories, analyses various aspects of the subject such as, waste segregation, sharps management, worker safety, the practice of incineration and other disposal methods.

The Rules have clearly laid down the methods to be adopted for safe management and disposal of waste. But hospitals have, by and large, not adopted any of these practices and have been found wanting in many of the above mentioned parameters. Hospital waste essentially comprises 85% general waste including packaging and food waste. Only the remaining 15% comprise used cotton, bandages, pathological tissues, needles and disposable plastics like syringes. It is this 15% of waste that needs special treatment for disposal – including incineration, autoclaving, microwaving and chemical disinfection.

In the present study - of 25 healthcare institutions covered, 15 units were found to have single chamber incinerators and one unit, a double chambered incinerator. None of these comply with the standards.

Despite this currently all the waste, unsegregated, is incinerated. This is not safe since they often result in the emission of toxic substances. However, incineration may be a good method of disposal for non-plastic waste as it kills all sources of infection. The ash produced is also environmentally inert. The problem starts when plastics, especially chlorinated ones (which is a major contributor of plastic waste in hospitals), are subjected to incineration. Dioxin and furans, which are persistent organic pollutants and proven carcinogens, are released when chlorinated plastics are incinerated. Incineration has been phased out in the West and unfortunately, India is still in the process of adopting and procuring variants of this technology. Knowing the drawbacks of this process, it becomes imperative that we look at more environmentally viable options such as hydroclaving and microwaving and restrict incineration to treat non-plastic and pathological waste.

This Report by CAG and Srishti is an attempt to situate Chennai’s healthcare service providers on the global map of bio-medical waste management strategies. The study shows how far we are from having safe healthcare and calls upon both the service providers and the government to take steps towards making the cities healthcare providers cleaner and safer – for themselves, for their employees and for the public at large.