Perinthalmanna has an effective system for the management of biomedical waste with few areas for improvement

Waste management is a pressing concern for urban practitioners, government officials, as well as state and local governments. In Kerala, a majority of regions grapple with persistent waste management challenges, and the widespread reliance on landfill disposal exacerbates the issue.

Even though it is less discussed than plastic and electronic waste, biomedical waste also requires attention.

In light of recent incidents of careless handling of biomedical waste in healthcare facilities in Kerala, Kochi-based public policy think tank Centre for Public Policy Research conducted a study as part of the non-profit’s ‘Youth Leadership Fellowship’ programme.

The research titled Biomedical Waste Management in Perinthalmanna: Practices and Challenges chose Perinthalmanna municipality due to its accessibility and reputation as a “hospital city”.

The municipality houses 12 private hospitals, one government district hospital, 19 medical laboratories and 55 clinics. The research intended to assess the efficacy of biomedical waste management practices and identify any obstacles they may face.

According to the study, Perinthalmanna has an effective system for the management of biomedical waste with few areas for improvement.

Existing rules

In 2016, the Centre published a set of guidelines for the management of biomedical waste under the Biomedical Waste Management Rules.

According to the guidelines, biomedical waste is subdivided into four subcategories, each with a distinct colour code: Yellow, red, white and blue.

The yellow category of waste contains anatomical, chemical liquid, and clinical laboratory waste. The red category includes waste generated from disposable items. Sharp objects and metals fall under the category of white waste. Except for those containing cytotoxic wastes, wastes in the blue category consist of contaminated glass.

In addition, the Act prescribes six steps for the proper management of biomedical wastes, including separation, collection, pre-treatment, intramural transportation, storage, treatment, and disposal through a Common Biomedical Waste Treatment Facility or a captive facility. The first five steps are the exclusive responsibility of the healthcare facility.

The Perinthalmanna model

Healthcare facilities in Perinthalmanna segregate their waste at the time of generation itself. Colour-coded trash cans are used for this purpose. They purchase special containers and puncture-resistant bags from vendors and install them in various locations throughout the facility.

The staff members who are trained in biomedical waste segregation separate the waste. This is the primary step for all healthcare facilities. The size of the institution and the amount of waste generated are always proportional.

Compared to clinics and laboratories, hospitals in Perinthalmanna generate significantly more waste daily. Therefore, the bags quickly fill, and the cleaning / housekeeping staff label the filled bags, replace them with new bags / containers of the same colour and transport the filled bags to the central storage facility.

Each container has a QR code that is unique to each healthcare facility. So whenever the bags are filled, the healthcare facility scans the QR code and uploads the information into the mobile application of the agency authorised with waste management.

The agency is then notified and dispatched to the respective healthcare facility to collect, treat and dispose of the waste in accordance with the procedures. When the amount of waste is substantial and some are hazardous and requires immediate removal, the agency collects the waste as and when required.

In Perinthalmanna, an agency under the Indian Medical Association is responsible for the safe management of biomedical waste, which they treat at a facility in the Palakkad district of Kerala.

Way forward

Even though the municipality has an effective system for managing biomedical waste, healthcare facilities still face several obstacles. One relates to the separation of waste at the time of generation in the rooms of hospitalised patients.

Because most people in the inpatients’ room are unaware of the segregation techniques and colour-coded representation of biomedical wastes, they frequently place all wastes in one bin or in bins that are not intended for the waste category they have deposited. This can be avoided by displaying pictures with clear instructions on segregation techniques on the walls or doors of patients’ rooms as well as on the trash cans.

Currently, biomedical wastes in Perinthalmanna are treated at a plant in Palakkad. A multispecialty hospital in the sample with 1,100 employees, including trainees, and 0.26 million square feet of space generates 390 kilogrammes of biomedical waste per day. This indicates the combined biomedical waste generation of all 13 hospitals, 19 laboratories and 55 clinics in the municipality is much greater.

The agency collects waste from clinics and laboratories anywhere from twice per week to three times per month, depending on the amount of waste they produce. However, collecting waste three times per month is problematic as it causes a delay in biomedical waste management. This issue must, therefore, be addressed.

In addition, survey responses and informal conversations with hospital cleaning staff revealed that the practice of not wearing a PPE kit during waste collection is widespread. Failure to wear PPE kits during waste collection is a serious issue because some biomedical wastes are pathogenic and must be collected carefully.

Consequently, it is essential to implement stringent protection measures for waste collectors, and the frequency of collection must be carefully considered and implemented.

Overall, the municipality of Perinthalmanna has a well-established structure for managing biomedical waste in healthcare facilities, but it lacks a comparable structure for households. 

Households also generate biomedical wastes in the form of sanitary pads, diapers, discarded or expired medicines, etc. Creating awareness among people and training them on the importance of segregation at the time of waste generation using colour-coded waste bins is the first step in this regard. Ensure that each household has at least one yellow container, as yellow-category wastes are prevalent in homes. 

The same QR code scanning and uploading technique can be used for waste collection by municipal employees or self-help groups such as Haritha Karma Sena. Timely and proper management of waste, including biomedical waste, is necessary for public health, and negligence may lead to higher prices.

Bio-medical waste does not begin and end in healthcare facilities alone; rather, bio-medical waste generation in households is substantial. The success of Perinthalmanna in tackling the bio-medical waste of health centres is worth replicating at the household level with the aim of making Perinthalammanna a model municipality in bio-medical waste management.

(This article was first published on Down to Earth)

The author is a youth leadership fellow at CPPR

Views expressed by the author are personal and need not reflect or represent the views of the Centre for Public Policy Research.

Maneesha A

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