technological advances in the modern era have revolutionised the concept of hospitals. But, sadly, in most Indian hospitals there is no proper system of waste management -- a process which deals with the collection and disposal of hospital waste. Pollution control laws also do not touch upon the environment hazards of hospital waste.
On March 1, 1997, the Supreme Court directed the government to ensure that every hospital and nursing home with more than 50 beds had an incinerator for disposal of hospital waste. The court made it mandatory for nursing homes that do not have incinerators to set up alternative waste disposal facilities. Unfortunately, the alternative methods have not been clearly defined.
At present, only a few hospitals in India have effective incinerators. A large number of smaller hospitals and nursing homes do not have any and hence may have to set up a joint incinerator or look for an alternative. Even in large hospitals, incinerators are not in proper working condition. Most of these incinerators emit highly-toxic dioxins, hydrochloric acid, metal and ash.
The World Health Organisation has classified medical waste into different categories. These are:
- infectious: material containing pathogens in sufficient concentrations or quantities that, if exposed, can cause diseases. This includes waste from surgery and autopsies on patients with infectious diseases;
- sharps: needles, syringes, scalpels, saws, blades, broken glasses, nails or any other item that could cause a cut;
- Pathological: tissues, organs, body parts, human flesh, foetuses, blood and body fluids;
- pharmaceuticals: drugs and chemicals which are returned from wards, spilled, outdated, contaminated or are no longer required;
- radioactive: solids, liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goitre; and
- others: kitchen wastes -- approximately 1kg per day per bed where patients are served diet by the hospital; gaseous waste -- gases from operation theatre, sterilisation department and air conditioning; and linen waste -- an average of about 1-2 kg per bed every day.
Besides radioactive wastes, all others can be managed by biological methods.
Under "Economic Viability of Non-milch Cows" project, R D Dixit, director of the Botanical Survey of India, Ajay K Kanaujia, project director and the author, among others, have been carrying out a biological method of hospital waste treatment for Kushul Orthopaedic Hospital and Research Centre ( kohrc ) in Allahabad. It has only 10 beds and mostly treats orthopaedic and gastroenterology patients. The waste comprises biological paper, infected cotton, gauze, blades, nails, plaster of Paris, amputated limbs and non-degradable intravenous fluid bottles, glass, syringes and needles.
The waste is collected in large buckets every day and then put in a ditch with a capacity of approximately 0.72 cubic metres (24 cubic feet). Every few days it is covered with a thin layer of cow dung and soil. The process is continued till the ditch is almost filled. Finally, it is covered with a thick layer of nearly 5 centimetre (cm) of cow dung and 3 cm of soil.
The digs are opened in the months of November and December (for winter crops), and in June and July (for summer crops). During this period of three to nine months, medicinal plants like castor oil, dhatura , aak, madar and ban-tulsi are grown in abundance. These medicinal plants have the capacity to absorb toxic agents present in the wastes, cleaning the manure of all toxic elements. The period of three to nine months is enough for the plants to soak the toxins and degrade the waste. The waste is then converted into manure with lots of calcium and phosphorus (from plaster of Paris).
The dug out material can be separated manually (with gloved hands) into two parts -- soil and non-degradable -- with the help of a sieve. The soil can be used as manure and the non-degradable part can be dumped in a landfill. So far none of the workers have suffered from Hepatitis or any other transmissible diseases.
The alternative treatment method can also be repeated for larger hospitals in collaboration with local gaushalas (cowsheds).
For the last two years, the kohrc has been experimenting with this kind of hospital waste treatment in a 6.5 acre agricultural land in Jhunsi, Allahabad. The land has a cowshed with 60-70 non-milch cows, biogas plant, tube well and grows two standard crops along with medicinal plants for use in ayurvedic preparations. The maintenance of the uneconomic herd has now become sustainable. Ayurvedic herbs under license from the Directorate of Health (Ayurvedic), Uttar Pradesh, are also grown.
There are a lot of advantages in treating biological waste in the manner kohrc is doing it. Top soil is used in the manufacture of bricks. This robs the land of its fertility. However, if the land is filled with composted hospital and municipal waste, it can be reclaimed in a few years for wild plantations, producing enough wood for energy and medicinal plants.
The biggest advantage of this procedure is that hospital waste is touched minimally by hands. Secondly, in this process, neither toxic gases (dioxin, for instance) nor incinerator ash is released into the environment. Regarding infectious material, it is known that human infecting agents, both anaerobic and aerobic, cannot survive for three to nine months in a highly anaerobic environment. For example, the aids virus survives only for few minutes.
The choice between incinerating hospital wastes or using an alternative bioremediation technique depends on the availability of natural resources, manpower and machines. For developed countries, where incinerator fuel is available in plenty, the cost of labour is high, the population is minimal and there is not much degraded land, incinerating wastes may be a good option. But for developing countries like India, where the conditions are just the opposite, biological method of hospital waste management is the ideal choice.
The author is the director and chief orthopaedic surgeon, Kushul Orthopaedic Hospital and Research Centre, Allahabad.
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