Desechos Biologicos

Hospital Waste

1

An Indian and International Perspective

Medical Waste Issues, Practices and Policy

by

Ravi Agarwal
Srishti

for the Seminar on Health and the Environment Centre for Science and Environment
July 6-9th, 1998, New Delhi

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CONTENTS
Section
1.0 2.0 2.1 2.2 3.0 3.1 3.2 3.3 4.0 4.1 4.2 5.0 5.1 15 5.2 5.3 6.0 6.1 19 6.2 22 7.0 8.0 29 8.1 8.28.3 8.4 8.5 9. 9.1 9.2 9.3

Topic
Background Defining Medical Waste Quantity of Medical Waste Nature of Medical Waste Risks associated with Medical Waste To the Community To the Worker Hazardous Waste Risks Problems with Medical Waste Incinerators Environmental and Health risks associated with medical waste incineration

Page No:
03 05 05 07 09 09 09 11 11 14 15

Dioxins Health Risks Posedby Dioxin and Dioxin-Like-Chemicals Exposure Routes Conclusion The Technology Debate Alternative Technologies to Incineration for medical waste Comparing Alternative Technologies

16 18 19

Effects of Regulation on Medical Waste Technology Markets 26 Overview and Issues of Medical Waste Disposal in India History Legislation and NGO Intervention Medical Waste Disposal Technology Markets 30National Cost Worker Safety Prevalent Practices of Medical Waste Disposal in India Delhi Mumbai Bangalore 29 29 30 31

32 33 34

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9.4 9.5 10.0 10.1 10.2 10.3 10.4 11.0 11.1

Calcutta Worker Safety Practices Sector Wise Responses The Government Response Other Institutional Responses Industry Responses NGO and People’s Responses Policy and other Initiatives needed Whatneeds to be done

35 35 37 37 37 38 39 40 40

List of technology manufactures in India List of Institutions working on Medcial waste Issues List of Publications in India List of WHO funded Model hospitals 12.0 References 46

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1.0

Background:

The evolution of a separate category of medial waste within the municipal waste stream dates back to the late 1970s, whenmedial wastes including syringes and bandages were washed up on US east coast beaches. The public outcry which followed led to the formulation of the US Medical Waste Tracking Act (MWTA) which finally came into force on November 1, 1988. Much of the outcry ignored the specifics of medical waste, its small quantities and its nature. (see section 2.0) The first solutions adopted to solve this problemwere to install on-site, small and unregulated medical waste incinerators in health care facilities. More than 6500 of these were installed in the US alone in less than a decade. In many ways this only aggravated the problem, since there was a belief that the problem was solved. Just burn it and it disappeared. But not quite. As later research showed, not only were these small burners created morepolluting, and in fact extremely toxic chemicals than the risks posed by medical waste itself, but they also provided a license to create more and more waste, much of it disposable plastic, since it could all be `easily burned (see section 4.0). Besides, the end - of -pipe solution did not even address itself to the crucial question of worker safety since nurses and wardboys continued to sufferneedle stick injuries, which using the sharp or disposing them improperly. (see section 3.0). Medical waste was put out of sight, but in many ways its dangers increased. Despite the Medical Waste Tracking Act, syringes continued to be washed up on US beaches, in fact in larger numbers. Incineration was suddenly not as magical as it had been posed to be. The community was crying for changing thepractice of medical waste disposal. In many senses new findings of dioxins (see section 5.0) catalysed this change. A 1994 report of the USEPA, published as a draft on dioxin reassessment, put medical waste incineration as the primarily source of dioxins in the US. Health concerns about this class of super toxins, which were increasingly found to be potent in extremely small, almost undetectable...