CHENNAI: Chennai and Mumbai are the only big Indian cities with an effective system to manage biomedical waste , whereas Delhi and other north Indian state capitals have a poor record, a study has found.

The survey by the International Clinical Epidemiology Network ( INCLEN ), published in the Indian Journal of Medical Research, covered 400 hospitals, both government and private, in 20 states. It found that around 82% of primary, 60% of secondary and 54% of tertiary health care facilities have no credible biomedical waste management system in place.Of the 10 cities it covered, seven including Delhi, Jaipur, Chandigarh and Lucknow received a ‘red’ rating to indicate that they fell short of the bare minimum required to ensure safe disposal of medical waste. One (Srinagar) was given a ‘yellow’ rating which meant it required ‘some additional effort’ to make the grade, while two (Mumbai and Chennai) were coded ‘green’.“These two cities topped the list as the waste management system was quite sound at the primary level,” said INCLEN executive director Dr N K Arora. “However, this doesn’t mean the two cities have everything in place. There’s still a lot more left to be done. We need more in terms of monitoring and bringing smaller hospitals into the loop.” Private hospitals in Chennai scored higher compared to institutions in Mumbai, while the latter scored higher in the public sector category.Incidentally, India was among the first countries in the late 1990s to initiate measures for safe disposal of bio-medical waste, but appears to have slowed down since then. The study found the enforcement regime to be lax despite a legislative framework being in place. The government notified the ‘Bio-medical Waste Management and Handling Rules’ in July 1998 (later amended in 2003 and 2011) under the Environment Protection Act, 1986, laying down rules for rules for segregation, packaging, transportation and storage of bio-medical waste.Biomedical waste, which includes discarded syringes, used bandages, anatomical waste, and amputated body parts, can be a major source of infection and diseases. It poses a direct risk to garbage collectors, ragpickers and others who come in contact with it, if not segregated and disposed of properly. According to data from the ministry of environment and forests, India produces 272.15 crore kg of medical waste every year, and this figure is expected to grow 8% annually.Investigators found many of the hospitals they surveyed did not have records on the amount of biomedical waste they generate. “The problem was more prevalent in the primary healthcare setting,” said Dr Manoj K Das of INCLEN.Under the survey, availability of trained personnel, suitable containers and bags, needle destroyers, protective gear, segregation of waste at point of generation and logbook maintenance were seen as parameters associated with better biomedical waste management.“Most tertiary care hospitals had the necessary resources. Some, like a few in Delhi, had the resources but didn’t use them. We found many hospital staffs were handling biomedical waste without gloves,” said Dr Das.Across the country, in tertiary and secondary hospitals, 82.6% and 64% had designated officials for management of biomedical waste, while in primary health centres (PHCs) only 40.8% had a designated official. Only 63.3% of staff in PHCs were provided protective gear compared to 87% and 95.5% in secondary and tertiary care centres.Experts say the expansion of healthcare facilities as well as the recent trend of using disposables have created an unprecedented burden of healthcare-related waste. Researchers observed four kinds of waste — sharp, infectious, recyclable and food waste. “Our survey was primarily on studying injection practices in the country. We discovered many of the hospitals had no mechanism in place to discard sharps and used syringes,” said Dr Manoj.Investigators also interviewed officers in charge of biomedical waste at health facilities. At the PHC level, between 34.3% and 48.9% were either not concerned or denied its existence, at tertiary (16.7%) and secondary (28%) such apathy was less.“India was among the first countries to implement biomedical waste management rules in 1998. There needs to be more coordination between hospitals, municipal officials and pollution control boards to check one of the biggest challenges in the health sector now,” said Dr Manoj.