WASTE: an asset or liability?
The problem of waste often surpasses terrorism or corruption. Like terrorism or corruption, scientific social engineering during planning and/ or administration can reduce the problem to a great extend. A motivation to compromise or desire to grab an instant political or monetary gain often prepares ground for pollution. Waste was never a social threat in the traditional life where there was an inbuilt harmony among man, animal and nature. Excavations of Mohan-je-Dora and Harappa show that Dravidians, in 5000 BC pioneered scientific waste management. Immaculate disposal of solid and liquid wastes in sewerages was in place with equal consideration to the health of Man, animal and nature. This can be likened with the modern concept of “one health”, a collaborative effort of multiple disciplines- working locally, nationally, and globally – to attain optimal health for people, animals and the environment.
What is waste?
“Wastes” are substances or objects which are disposed of or are intended to be disposed of or are required to be disposed of by the provisions of national law. Wastes can be Organic waste, Glass, Paper Metals, Plastics and Hazardous Wastes like chemicals, drugs, batteries etc. Many of the wastes can be recycled or processed; if a relatively small portion is hazardous it is to be treated and rendered harmless.
1.0 Segregation means the separation of the various types of wastes to ensure that each group is processed as per the level of hazards involved. Segregation reduces risk of injury and incidents and is cost effective as it collects waste in a pure form. Waste without effective segregation is hazardous making its disposal cumbersome and costly; it increases risk & cost. Organic wastes need Daily removal.
The legal responsibility of segregation is with waste generators, irrespective of their position or status in society (ie. duty of care principle). In case of un-segregated waste the precautionary principle must be followed ie. consider the entire material as high risk waste. Producer must segregate wastes close to their place of generation. eg:- in schools, the students & staff must segregate wastes (from canteens or laboratories) and throw food, paper cups, plastic bottles, metallic waste in separate bag/ bin. Segregation is maintained from the point of generation to point of final disposal.
1.1 The principles of segregation:
As per rules every place must have the necessary equipments like bags, bag holder, container, etc. for the types of wastes generated. The correct segregation is achieved through rigorous training of all involved ie.. in schools staff and students (includes parents & visitors). Segregation done first, under the “polluter pay” principle and second, under the “precautionary” principle. Follow the precautionary principle in all unclear situations (ie. consider entire un-segregated waste as hazardous and treat it accordingly)
1.2 Basic facts to be considered for segregation are,-
a) Places where different kinds of waste are generated?
b) Identify who generates (can generate) the waste?
c) Kinds of wastes generated in each room, area or department
d) Find out which kinds of bags/ containers needed/ to be used
e) Fix the segregation points as near to the point of generation.
f) identify the type and quantum of waste generated
g) Calculate the needed size and quantity of bags and container/ holder.
h) Find peak times of generation; supply and place bags to suit / contain the peak times.
i) Collection frequency (only food and organic wastes demand daily clearance)
NOTE: The quality of the segregation determines quality of waste management
1.3 Colour coding of waste
Color coding is done so that even a low-skilled worker with reading problems can identify and handle waste types and do segregation, collection, storage, transport and disposal. Generally the following color code is chosen.
i) For hazardous waste (Red, yellow, orange)
ii) Positive colors for recycling (Blue, green, etc.)
iii) Neutral colors for normal waste (Black, etc.)
(unfortunately, there appears to be no uniform global Color code)
In India at domestic and industrial levels we use the following colour codes
Organic waste (green).
1.6 The labeling of the segregated waste
The labeling of the waste is necessary, to identify, monitor and record waste groups all along treatment. Waste bags or containers are labeled with the following information -,
1) Name of the Producer and if applicable, department
2) Waste classification, date of production
3) Special remarks
4) Waste volume-
5) waste destination
Glass (yellow).
Paper (white).
Metal (grey).
Plastic (blue).
Hazardous (bulb, batteries etc.) (red).
COMPULSIONS TOWARDS MANAGEMENT OF BIO-MEDICAL WASTE?
(a) (Statutory) Legal Obligation: In accordance with the provisions of the Bio-Medical Waste (Management and Handling) Rules 1998, deadline was 31st December’ 1999, by which the rules must be conformed with, failing which legal action can be initiated.
(b) Health hazards associated with improper hospital waste management: A number of hazards and risks are associated with this viz.
* Injuries from sharps to all categories of hospital personnel and waste handlers.
* Nosocomial infections in patients from poor infection control and poor waste management.
* Risks of infections outside hospitals through waste handlers, animals, rag pickers, scavengers to the general public.
* Risks associated with hazardous chemicals, drugs, for persons handling wastes at all levels.
c) Environmental hazards: Improper hospital waste management also results in air, water and soil pollution, especially due to imperfect treatment and faulty disposal methods.
2.3. DEFINITIONS: Definition is important to have a clear understanding of the subsequent steps of waste management in each case. Bio-Medical Waste, Medical Waste, Clinical Waste, Hospital Waste, Pathological Waste, Infectious Waste, Hazardous Waste, Radioactive Waste, Pressurized Waste, General Waste and Recyclable Waste are terms used to describe various hospital wastes.
2.4. CATEGORISATION OF BIO-MEDICAL WASTES: Bio-Medical waste have been categorized into ten categories like Human anatomical, animal wastes, Microbiology & biotechnology waste, sharps, discarded medicines, solid waste (like dressings, plaster, disposables), liquid waste, incineration ash, Chemical wastes (Pl. see details in annexure II)
2.5. HOSPITAL WASTE MANAGEMENT COMMITTEE: A Hospital Waste Management Committee is established to improve and streamline Hospital Waste Management and for proper implementation of rules. The committee has representative from administration, clinical wings, pharmacology, VPH, pathology and microbiology departments. It has powers to take decisions on matters related to Bio-Medical Waste Management. The responsibilities of staff involved in generation, collection, transportation, collection, treatment and disposal of wastes is formulated and monitored by this committee.
2.6. OPERATIONAL ASPECTS: The practical operational aspects include all steps starting with the generation and ending with final disposal of wastes ie. Generation of Wastes, Type of Generation, Disposal by, Quantum of Wastes, Segregation of Wastes (Pl. see annexure III)
2.7. SITE CONTAINER RESPONSIBILITY: Assigns the responsibility to persons involved in generating wastes in wards, labs., Operation theatre (OT), office, waiting shed etc. (Pl. see annexure IV)
2.8 This is followed by spelling out what goes where: A guide table with colour coding and type of container for disposal including collection of Waste, Operational Aspects, Storage of Waste and Transportation both Intramural (internal) transport and Extramural (external) transport: (Pl. see annexure V); role identification
3. Treatment and Disposal of Hospital Waste:
3.1 Civic Authorities: Non toxic and non infectious materials like paper, left over feed, food articles, peels of fruits, disposables, card boards boxes, outer cover or wrapping of disposable items like syringes, needles sets etc. generated in the hospital is similar to one generated in houses and offices. They being general wastes can be collected by the local municipal authorities for disposal daily. However, the hospital must ensure that they are disposed in pure form and that stray animals or rag pickers do handle the dumps.
3.2 Incineration: The waste collected in bins is transported to the site of incineration. The functioning of the incinerator and the number of cycles operated per day need be documented in a log book. Regular monitoring should be carried out by the technician as per Pollution Control Board (PCB) and feed back provided to officer in charge. The ash produced by incineration can be used for secure land filling.
3.3 Autoclaving and Shredding: If the autoclave facility is in place, the waste collected will be transported to the site of autoclaving and shredding for treatment. The process of deposition of the waste for autoclaving and shredding will also be defined and a register maintained to record the functioning of the autoclave as per PCB norms.
3.4 Radioactive Waste: Radioactive wastes generated during the process of body/ organ imaging, tumour localization or researches include vials, syringes, absorbent paper, protective clothing etc. They are stored under strict supervision in a large drum/ containers till they decay. The radioactive in liquid form (including excreted urine) are generally diluted and dispersed in the sewers. Gaseous radioactive waste too can be diluted through dispersal in the outside atmosphere. Normally urine and faeces can be handled as non-radioactive waste if the area is being routinely monitored for radioactive contamination.
3.5 Liquid and Chemical Wastes: These wastes should be chemically treated (or neutralized) and discharged into drains/ sewers where it is taken care of by the principle of dilution and dispersal by sanitation supervisor in case of weekly “gang” cleaning and by the nursing staff in case of routine cleaning. Responsibility of chemical waste should be with the persons/ staff using the chemicals and generating the waste.
4.1. IDENTIFYING THE ROLE OF PERSONNEL INVOLVED IN WASTE MANAGEMENT
The outline on the roles and responsibilities of the various personnel must be in confirmation to the Bio-Medical Waste Management (management and handling) Rules 1998. An example may be seen in annexure VII [doer, monitor, supervisor manager etc.]
4.2 TRAINING ON HOSPITAL WASTE MANAGEMENT (normally)
In order to be able to comprehend and implement the Bio-Medical Waste (Management and Handling) Rules’ 1998, it is mandatory to provide training to all categories of staff i.e. resident doctors, nurses, paramedical staff, hospital and sanitation attendants, patient and their attendants, canteen staff, operation of Bio-Medical Waste treatment facilities. Before the training is carried out the training needs to be identified content varied accordingly. It should be interactive and should include awareness sessions, demonstrations and behavioural science inputs. It should definitely include the following,-
(i) Awareness of different categories of waste and potential hazard
(ii) Waste minimization, reuse or reduction in use of disposables
(iii) Segregation policy
(iv) Proper and safe handling of sharps
(v) Use of protective gear
(vi) Color coding of containers
(vii) Appropriate treatment of waste
(viii) Management of spills and accidents
(ix) Occupational health.
5. USE OF ANIMALS in waste management: Waste results from use of materials beyond human need. Changing life style often prompts man to shift his “need” to ‘want’ or to the level of ‘greed’. Animals are an important link of the ecosystem that holds the balance between man and nature. As per an eminent veterinarian Dr.C.K. Rao “Animals in India are factories that convert crop residues and common property resources into milk, meat, wool and other utilities”. ”Domestic animals, free living animals and wild animals have, for each, a specific role to sustain the ecosystem (Dr.C.M.Singh). That is why animals became the cultural element, essentially maintaining the traditional life. In the changing life-style animal resources can be effective in Waste minimization, reuse of waste or recycling and for reducing the cost of waste management considerably.
Reasons for poor waste management are Economic, Social and Environmental. Age old “mind set” and social attitude that “all is well and NEED no more” is one reason. Statistical facts reveal that only 60% to 80% of urban garbage of our metropolitan cities is cleared by designated agencies, the rest being scavenged (salvaged?) by animals like straying Pigs, stray dogs, stray cattle. GLOBALLY, 86% OF URBAN POPULATION AND 38% OF RURAL POPULATION has access to some level of sanitation (together it is 60%). In Asia only 78% of urbanites and 31% of rural people has some access to sanitation. On the average 52% people still have no access to proper sanitary service like the flush system or septic tank.
In flush system, an average of 15,000 litres of treated, safe, drinking water is being used to flush 35 kilograms of feces and 500 litres of urine annually. In developing countries 90 percent of this sewage is discharged into surface waters, polluting rivers, lakes and coastal areas. This can spread of disease and lower the oxygen content of the water bodies, leading to increased algae growth and eutrophication. [Eutrophication is a condition in an aquatic ecosystem where high nutrient concentrations suffocates the fauna]
Pit latrines, although use much less water than flush system, does not suit densely populated areas or where the groundwater get contaminated from seepage and/ or during floods. Organics like nitrogen, phosphorous and potassium that are plenty in urine and feces and which conditions the soil and provides carbon are not recycled.
Ecoogical sanitation that treats and recycles waste to recover water and nutrients from human exceta and return them into productive systems, though safe, is prohibitively costly. China use pigs in community toilets for sanitation and waste utilisation. In India the system is used only in small pockets. Ample scope exists through scientific veterinary intervention to use food wastes as animal feed and do sustainable animal waste management. Limited (0.3% & 0.1%) use of manure gas (Gobar gas) though is an eco-friendly method need be improved to suit each region and reintroduced. But there is an urgent need to re-look into amending pollution laws of PCB .
Use of ducks and geese for wetland management though is fast declining is an example of sustainable sanitation and waste utilization.
Organic/ food wastes, methods in use, can be used, irrelevant to us, cost effectiveness,
Recycling waste Indian cattle and buffaloes produce (by a modest estimate) more than 800 MT (million tons) of fiber rich dung every year. Of this around 300 MT is burned as dung cakes for cooking energy and the rest is used as manure. Nearly 90% of cooking energy of India’s rural areas are from crop residues and cow dung cake (78%+11.5%). Manure gas plant especially the cow dung gas plants though low in water consumption, has not caught up due to operational problems. (human waste can be added) These difficulties vary from region to region and season to season.
Reclaiming / reusing waste. use of biomass: crop residues are animal feed/ fodder Animal waste (biomass) reduces the soil abuse caused through overuse of chemical fertilisers and retains precious water needed to sustain crops. Manure is a major source of energy for cooking. In rural India where, 90% of households use crop residues and cow dung cakes for cooking.
By -Dr Prof. Rama kumar V.
Founder Secretary, VCI.(Rtd)
