Keywords
biomedical waste - CAGR - CBWTF - infectious waste - plastic waste
Introduction
Over the years, there has been immense growth and advancement in health care facilities.
As a consequence of this betterment and expansion, production of health care waste
has seen an exponential upward trend. Waste generated by a health care facility can
be infectious or noninfectious. The infectious waste is hazardous and poses serious
threat to patients, health care workers, public health, and the environment. As per
the World Health Organization (WHO), approximately 75 to 90% of the total health care
waste generated by the health facilities is nonhazardous. The remaining 10 to 25%
waste is dangerous, infectious, toxic, or with radioactive components.[1]
Waste generation from individual health care facilities can vary based on the type
or level of health care facility and location of health care facilities, rural or
urban. It may reflect upon the differences in the services provided, scale, organizational
complexity, availability of resources, and the number of medical and other staff.
Quantification of waste generation can be used to establish baseline data on the rates
of production in different medical areas. It also helps in planning, budgeting, calculating
revenues from recycling, optimizing waste-management systems, and assessing environmental
impact. We have attempted to analyze the amount of biomedical waste (BMW) generated
by a tertiary care hospital in New Delhi.
Materials and Methods
This is a retrospective study conducted in a tertiary care hospital in New Delhi from
2005 to 2019. The BMW generated and collected from various parts of the hospital was
quantified and analyzed further. The waste generated before the Biomedical Waste Management
Rules 2016 was segregated according to the provisions of Biomedical Waste Management
and Handling Rules 1998. After the notification of the new rules in 2016, the hospital
started complying with the requirements of the revised rules.
For the ease of description, waste is classified under three categories: incinerable
waste, recyclable plastic waste, and sharp and glass waste. Quantification is done
in terms of the total amount of waste generated annually, the amount of waste generated
per bed per day, and compound annual growth rate (CAGR) for total BMW and for all
three types of waste categories.
Results
The total amount of BMW generated in 2005 was 65,658 kg, which substantially increased
to 374,712 kg in 2019, with a CAGR of 12.5% ([Table 1]). CAGR was calculated to be 8.4, 16.4, and 15.4% for incinerable waste, plastic
waste, and sharp and glass waste, respectively. The overall estimated plastic waste
was 31% of the total BMW in 2005 and increased to 53% in 2019. The total number of
beds in the hospital increased from 1,000 in 2005 to 1,447 in 2019. Waste generated
per bed per day in different categories is depicted in [Fig. 1], and overall it was 0.179 kg in 2005, which has increased fourfold to reach 0.709
kg in 2019. CAGR for per bed per day waste has been calculated to be 5.7% for incinerable
waste, 13.6% for plastic, 12.6% for sharp and glass waste, and 9.8% for total waste.
Table 1
BMW generated in the hospital from 2005 to 2019
|
Year
|
Incinerable waste (kg)
|
Plastic waste (kg)
|
Sharps and glass waste (kg)
|
Total BMW (kg)
|
|
Abbreviation: BMW, biomedical waste.
|
|
2005
|
37,937
|
20,400
|
5,683
|
65,658
|
|
2006
|
40,136
|
25,460
|
7,146
|
73,785
|
|
2007
|
41,909
|
26,874
|
5,434
|
75,242
|
|
2008
|
45,689
|
25,633
|
3,619
|
76,085
|
|
2009
|
50,380
|
27,452
|
3,911
|
83,365
|
|
2010
|
46,145
|
33,620
|
4,582
|
85,940
|
|
2011
|
49,976
|
35,033
|
9,299
|
95,571
|
|
2012
|
54,907
|
60,680
|
13,768
|
131,154
|
|
2013
|
65,058
|
99,320
|
28,493
|
192,871
|
|
2014
|
75,514
|
122,345
|
35,127
|
232,986
|
|
2015
|
78,802
|
140,992
|
34,395
|
254,248
|
|
2016
|
98,962
|
163,959
|
38,616
|
301,597
|
|
2017
|
107,166
|
168,799
|
45,283
|
321,248
|
|
2018
|
117,547
|
197,653
|
45,995
|
361,195
|
|
2019
|
127,113
|
198,766
|
48,833
|
374,712
|
Fig. 1 Line diagram of different categories of BMW generated per bed per day (in kilograms).
BMW, biomedical waste.
Discussion
According to a joint study conducted by ASSOCHAM (Associated Chambers of Commerce
and Industry of India) - Velocity, various health sectors in India were generating
approximately 550 tonnes of BMW per day in 2018. It is expected to be 780 tonnes per
day by 2022, with an estimated CAGR of 9.13%.[2] The total BMW generated in our hospital from 2005 to 2019 has recorded an increase
of 470.7%, with a CAGR of 12.5%. As per the WHO estimates, average hazardous waste
production by a country varies from 0.2 to 0.5 kg/bed/day based on their per capita
income.[3] A study from a tertiary care hospital in India reported an average of 0.341 kg/bed/per
day of infectious waste.[4] Another study from Nigeria reported medical waste generation ranged from 0.116 to
0.561 kg/bed/day in seven hospitals, with an average generation of approximately 0.181
kg/bed/day.[5] Our hospital was producing an average BMW of 0.179 kg/bed/day in 2005, which has
increased four times in 2019 to reach 0.709 kg/bed/day. This continued increase reflects
advances in the delivery of health care provided by our hospital over the years, and
being a public hospital, its bed strength has always been fully occupied.
As of July 2018, there were 1,478 bedded and 3,916 nonbedded health care facilities
in Delhi, which produced 24,667.05 kg of BMW every day. However, there are only two
common biomedical waste treatment facilities (CBWTFs) to cater to these health care
facilities.[6] The way BMW is growing as seen in our hospital, the number of CBWTFs is grossly
inadequate to handle the current quantum of waste, and this capital city of Delhi
would need to address this issue on the immediate priority of strengthening the number
of these facilities.
The infectious plastic waste generated by our hospital from 2005 to 2019 has increased
by 874.34%, with a CAGR of 16.4%. In comparison to incinerable waste, the quantity
of plastic waste has significantly increased over these years. The CAGR for plastic
waste has been 16.4%, which is almost double the CAGR for incinerable waste (8.4%).
The plastic waste has also increased at a greater rate of 4% annually as compared
with the total BMW and constituted 31% of the total BMW in 2005, but the figure reached
to 53% in 2019.
Single-use items such as disposable syringes, needles, catheters, and body fluid collection
bags, have become an integral part of the health care delivery and play a significant
role in the control of hospital-associated infections. But over the years, single-use
variations of some medical devices have been made available, replacing the previous
models that were sterilized and reused repeatedly. This replacement of reusable materials
with single-use disposables has resulted in a logarithmic expansion in the generation
of plastic waste as is evident by the increase in quantities of plastic waste in our
hospital.
The majority of plastic waste produced by health care facilities, if properly segregated,
is likely to be recycled as per the Biomedical Waste Management Rules 2016. Only blood
bags and waste contaminated by cytotoxic drugs is supposed to be incinerated. Improper
management of plastic waste may result in adverse health and environmental effects.
Combustion of plastics, especially chlorinated ones, may cause a generation of various
hazardous substances such as smoke, carbon monoxide, dioxins, furans, and free radicals
such as benzene. Some of these substances have negative effects on human and animal
health, mainly affecting the endocrine and reproductive systems. Some of these are
also well-known carcinogens. Plastic is estimated to be persisting in the environment
for hundreds of thousands of years, but it is likely to be far longer in deep sea
and nonsurface polar environments. Plastic debris poses a considerable threat by choking
and starving wildlife.[7]
[8]
[9]
This creates a sad juxtaposition, in which we are contributing to the negative health
effects created by the manufacture and disposal of plastics while delivering care
to our patients.
With the advancement in sterilization techniques, we should consider giving a serious
thought about reverting back to the use of instruments that can be easily sterilized
and reused or exploring the possibilities of biodegradable/compostable plastics in
health care.[7]
[9]
[10] As the demand for plastic in health care continues to grow, it is highly imperative
that manufacturers of medical supplies are encouraged to produce and supply products
that have minimal impact on the environment. In addition, medical scientists need
to explore the possibilities of treatment modalities that result in reduced generation
of plastic and other BMW.
Conclusion
This analysis of BMW data over a period of 15 years provides baseline information
for policy development at individual hospitals as well as the national level. Generation
of BMW is likely to see significant upward trends unless diligent deliberations are
held between different stakeholders in regard to the reintroduction of reusable materials
and waste reduction strategies. Health care waste management would require strengthening
of capacity in areas of manpower and infrastructure development. It would also require
intersectoral cooperation and coordination between different organizations.
