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Bulletin of Occupational & Environmental Health

Workshop on Bio Medical Waste Management-13.4.04

Author(s): (Inaugural speech of the Principal Secretary of H&FW)

Vol. 1, No. 1 (2004-01 - 2004-06)

Medical waste is now recognized as a major public health hazard. According to World Health Organization, each year half a million people globally die due to infections such as Hepatitis B, and C, HIV and hepatocellular cancer transmitted through unsafe healthcare practices. There is no information as to what component of this figure comprises healthcare workers. There are also alarming disclosures about used medical devices and other items getting recycled and repacked by unscrupulous traders in countries such as ours. This happens when the hospitals do not take adequate steps to disinfect and mutilate the medical waste as required under the law. Most of you would recall the big cache of used medical devices that were seized by police in Delhi last year. This was meant for reuse. I am sure all hospitals in Delhi and particularly those under Delhi govt. are making sure that no medical waste falls in wrong hands. It is the duty of one and all that no medical waste ends up in Municipal dhalos or other waste dumps for the reasons mentioned above.

You are aware that after a spate of Public Interest litigations, bio medical waste (management and handling) rules were formulated and notified in July 1998. These were enforced in phased manner and are now applicable throughout the country. In Delhi these became applicable on 1 st July 2000. It is guesstimated that out of about 6000-7000 tons of solid waste generated in Delhi, about 1% is medical waste. This makes the amount of medical waste generated 60-70 metric tons/day. If proper segregation is done by healthcare personnel which the rules prescribe, then the bio medical waste generation in Delhi should not be more than 20-25 metric tons/day or even less. This amounts to great savings in financial terms.

The govt. of national capital territory of Delhi had made adequate arrangements for meeting any contingencies arising out of the handling, treatment and disposal of bio medical waste much before any other government any where. Funds were made available to the hospitals to procure incinerators, and state of the art autoclaves and shredders were imported so that the prescribed methods of medical waste treatment under the law could be met. The vacuum type of autoclaves procured by Delhi govt. are the best available anywhere. These are ideal to disinfect plastic, PVC and other categories of medical waste. Adequate funds have always been provided to all hospitals for purchasing accessories such as bags, trolleys and the disinfectants. So there should be no excuse for not properly disposing bio medical waste.

Delhi govt. had signed a MOU with the Government of Australia in 1998 to have experts visiting from that country and advising and assisting our hospitals to learn and understand a variety of issues related to bio medical waste management. This collaborative programme resulted in developing training modules, which have been made available to all. It is for you all to benefit from the training that COEH at Lok Nayak Hospital organizes regularly. We have to make sure that those trained pass on the information to their colleagues and other staff so that everyone segregates the waste at source.

There is much media focus on medical waste these days and if this is discovered in general waste or municipal waste it is immediately highlighted to the embarrassment of the department. Besides, inadequate and inept handling of such waste creates a risk to the health and safety of the health care workers. So proper management is in the interest of one and all. The idea of this workshop emerged when an internal assessment revealed that though most hospitals are able to do a reasonable job of medical waste management others, have still to go much further. I am sure all medical superintendents are regularly reviewing the gaps that exist in proper bio medical waste management. It is the duty of all of us to protect human health and the environment which is an obligation placed on us by the law.

I am sure besides taking care of the solid waste you are paying equal attention to liquid waste management and complying with all the provisions of the rules such as installation of Anti Pollution Control Devices (APCD), and spore testing of the autoclaves regularly. These must be sent to the DPCC from time to time. Consent should be obtained if there is a boiler and generator set in use and the annual returns should be filed. All this requires that training should be made available to all resident doctors and nurses who do most of the patient handling and in the process generate bulk of the waste. I look forward to the suggestions and recommendations of this workshop.

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