Campaign to curb environmental pollution in Kerala was mostly limited to some couplets from poets against cutting trees. An occasional action by the Pollution Control Board used to get the headlines. Visibly smoggy skies and murky streams caught the eyes of a few. But not hazardous wastes; they remained, though not out of sight, out of mind.
Relatively slow pace of industrialization has mercifully insulated Kerala against the most common source of pollution, barring pockets like Cochin-Alwaye belt. However no state, not even Kerala enjoying a high sense of cleanliness and hygiene, was protected against a potential mass killer, hazardous wastes from the guardians of health – the hospitals.
Categories of Hospital Waste
Hospitals generate wastes which can be broadly categorized into:
• Wastes which are supposedly harmless
• Wastes which can transmit infection
The first category of wastes is mainly packing materials, kitchen wastes, garbage and other domestic types of wastes. These wastes can safely go into the municipal waste system; care should, however, be taken to transport them quickly and carefully to the municipal disposal sites.
The second one consists of the following:
1. Pathological wastes, including tissues, and body parts that are removed during surgery or autopsy.
2. Cultures and stocks of infectious agents and associate biological including cultures from medical and pathological laboratories, vaccines etc.
3. Waste human blood and products of blood including serum, plasma, and other blood components.
4. Sharps that have been used in patient care including hypodermic needles, syringes, pipettes, broken glass, and scalpel blades, blood vials, needles with attached tubing.
5. Wastes from autopsy that were in contact with infectious agents, including soiled dressing, sponges, drapes, tubes, drainage sets, under pads, and surgical gloves.
6. Laboratory wastes from medical or pathological research, such as slides, disposable gloves, laboratory coats and aprons.
7. Dialysis wastes that were in contact with the blood of patients undergoing hemodialysis, including contaminated disposable equipment and supplies such as tubing filters, disposable sheets and towels.
8. Discarded medical equipment and parts that were in contact with infectious agents.
9. Biological waste and discarded materials contaminated with blood, excretion, exudates or secretion from human beings.
Hazards from Hospital wastes
Probable health hazards from these wastes and their improper disposal can be the transmission of the following diseases like, AIDS, hepatitis B, most common bacterial infections including cholera, dysentery and typhoid, plague, tuberculosis and many parasitic infections.
Magnitude of the Hospital waste in Kerala
On the basis of the number of hospitals and available beds, a tentative estimate of the quantum of wastes generated is arrived at 1, 30,000 the total number of beds.
The quantity of infectious wastes produced per bed, per day is reckoned at 2kg. Thus, the hospitals in the state generated more than 260 tonnes of infectious wastes every day or 95,000 tonnes annually.
The Present Scenario
If there is anything more deadly than the potential danger caused by infectious hospital wastes, it was the lack of concern about the danger. The clinical wastes were being fed into the municipal wastes system by almost all the government and private hospitals, doctor’s consulting rooms, clinics and laboratories till 2003. Waste disposal systems were woefully inadequate or non-existent in most hospitals. The dangerous wastes dumped into landfills next to the hospitals resulted in land and ground water pollution.
The workers handling these wastes were themselves blissfully unaware of the danger of these hazardous body wastes. The health care workers in the hospitals were often inadequately protected because of the lack of appropriate protective clothing and equipment.
Again, there are the people who run ‘informal’ recycling service and thereby, exposing themselves to the hazards. They rummage through the wastes for plastic, cardboard and tin.
There are also instances when the discarded disposable syringes and needles came back to the shops packed as new.
An Agenda for action
It would be safer to incinerate every bit of waste. It is an ideal goal. But to provide incinerators to each and every hospital is unrealistic both economically and ecologically.
A practical disposal strategy, to minimize risks, can be operated in a sustainable way that do not present long term hazards. The general strategy can be:
1. Permanently minimizing contact with waste by patients and their relatives, other personnel and population potentially affected; for this purpose, plastic bags and bins should be provided to all the wards in the hospitals. The workers handling these wastes must be provided with protective garments such as coats and gloves.
2. Awareness and education programmes for medical and lay persons to apprise them of the possible dangers posed by the inappropriate and careless handling of medical waste. This must include orientation and continuing education programmes and training for all health care workers.
3. To instil the importance of tracking and disposal of infectious wastes in hospitals not only in the minds of the medical personnel but hospital administrators and the government.
4. Thus the project “IMAGE” was initiated by Indian Medical Association, Kerala.
IMAGE – IMA Goes Eco-friendly
The project “IMAGE” – IMA Goes Eco-friendly was initiated in 2000 to assist Government and Private Hospitals in Kerala to manage and dispose the hazardous wastes produced in their premises. An office was set up in the Headquarters of IMA in Trivandrum. Continuous correspondence with the managements of all hospitals in Kerala was initiated. Meetings were organized all over Kerala by IMA through which the need for proper waste management was promoted. The support of the Kerala State Pollution Control Board (KSPCB was very helpful. Member Secretary Indulal, Engineer, Vijayabhas and others helped in initiating this process.
The plan was to start five Central Waste Management Plants in Kerala – two acres of lands for each with an incinerator, autoclave, shredder, and an effluent treatment plant. A plot was purchased in Parippally near Kollam and the proposal was approved by Kerala State PCB. But due to the opposition from local people, it had to be shelved. The same happened to the plans in Kannur.
Finally, the present site was located near Kanjikode, Palakkad. With the approval of the Pollution Control Board, Municipal Corporation etc., the Plant was started with one incinerator, one autoclave, shredder, ETP, etc.
Training programs for Hospitals in Waste Segregation was started. Colour Bags and Bins were supplied to all hospitals with necessary instructions, posters etc. Suppliers for all these items were contacted. Hospitals were requested to provide needle destroyers in all necessary locations.
A private organization, GJ Multiclave was selected for collection of wastes and the operation of the Plant.
This was planned as a common facility for the entire State and a Co-operative Project where the hospitals will have to pay an Affiliation Fee and a per bed per day fee for waste collection and disposal.
The estimate for such a Project was `1 crore to start with including the cost of the land, building, Incinerator, Autoclave, Shredder, ETP etc. This was to cater to >10,000 beds. Thus the Affiliation fee was decided as `1000 per bed and the treatment charges at `3.50 per bed per day.
Soon with the initiative of the IMA and the PCB, several hospitals were made to join the project. Of course, there were objections from many fronts. Environmentalists bringing experts from as far as USA against incineration, enemy organizations advising ‘better’ treatment plants, etc. But IMAGE survived and is making a huge net profit for IMA apart from undertaking a useful activity.
Meanwhile, a study was conducted to find out the wastes created by the hospitals, clinics, dental clinics, diagnostic centers in the entire Kollam district.
From the present data available from IMAGE reports, it shows that only about 60% of the hospitals, etc. are affiliated to IMAGE. Only a couple of hospitals have their own waste treatment plants.
While IMAGE has been a success to the extent to which it has been implemented, there is need to take it further, to spread awareness about the need for bio-medical waste management and extend the facility for all hospitals in Kerala.
V.S.S. Nair Biomedical Engineer-Consultant, Kerala Paper presented at the International Conference on Waste, Wealth and Health organized by IIWM.