Representative image. The emergence of epidemics or pandemics, increased access to healthcare, early hospital discharge and home management of chronic illnesses could all play a role in the rise in biomedical waste generation at home. Photo by Touam (Hervé Agnoux)/Wikimedia Commons.
Solid waste management has become a global issue that impacts everyone. Population growth and rapid urbanisation have accelerated waste generation at an alarming rate — approximately 2 billion tonnes of waste is generated per annum. The World Bank group has predicted that solid waste generation will reach about 2.59 billion Mt per annum by the year 2030. In developing countries, up to 93% of their waste is estimated to being openly burned or dumped and a small percentage goes to landfills. Most countries continue to struggle with non-hazardous waste, and the real concern is how they will cope with hazardous biomedical waste.
Biomedical waste is the waste generated during the diagnosis, treatment, or immunization of human beings, animals, or research activities. It is generated at healthcare facilities like hospitals and nursing homes.
Since the majority of biomedical waste originates from healthcare facilities, both small and big, the comparatively smaller amount of biomedical waste generated from domestic or household sources is often ignored.
Waste segregation in hospitals. Photo by Ajay Kumar Chaurasiya/Wikimedia Commons.
The growing concern
Biomedical waste at home includes, among numerous other items, unused or expired medicines, cotton swabs covered with blood, used bandages, gauze, pregnancy and blood sugar test kits, insulin injection needles, dirty diapers, sanitary pads, used condoms, x-ray films, expired hand sanitisers and mercury thermometers that have been broken. The emergence of epidemics or pandemics, increased access to healthcare, early hospital discharge and home management of chronic illnesses could all play a role in the rise in biomedical waste generation at home. The situation could get worse considering India’s aging population and dependence on doorstep healthcare services.
The market analysis for healthcare at home is predicted to expand from its current value of $179 million in 2022 to $295 million in 2030 at a compound annual growth rate (CAGR) of 6.40%. Environmental Research and Education Foundation (EREF) has revealed that between 2001 and 2011, the number of needles and sharps in household waste tripled.
Wastes like these require sophisticated chemical processing plants, incinerators and disassembly centres for proper disposal. Unfortunately, conventional waste management infrastructure in developing countries is not efficient enough to handle or treat household biomedical waste. For example, when expired medicines are disposed of in sewage, our existing treatment plants cannot process them since they are not designed to break down pharmaceutical drugs. This eventually gives rise to superbugs and antimicrobial resistance.
When expired medicines are disposed of in sewage, our existing treatment plants cannot process them since they are not designed to break down pharmaceutical drugs. Photo by Pöllö/Wikimedia Commons.
Effects on people, animals, and the environment they share
Biomedical waste is hazardous and infectious. It has an impact on all biological life, not just people. The chemicals from the waste can pollute the air, water, and land. Needles, sharps, and lancets in household waste put municipal waste handlers at risk. If these needles or sharps are infected, a prick from them can cause blood-borne infections (HIV, Hepatitis C, and Hepatitis B). EREF has highlighted the growing worry regarding the presence of needles and the associated risk of needle stick injury during municipal waste handling.
One Health is an approach that recognises and studies the interconnections between humans, animals, plants, and their shared environment. From the One Health standpoint, it is clear that biomedical waste has an impact beyond just humans.
Reports have described the harmful consequences of biomedical waste on animals due to the toxic nature of waste. One study concluded the near extinction of vultures in Southeast Asia due to renal failure brought on by exposure to diclofenac (a non-steroidal anti-inflammatory drug). Another piece of evidence indicates that fish in European waterways have experienced disruptions in their sexual development due to exposure to ethinylestradiol (EE2), a component used in oral contraceptives. Researchers have assessed the negative effects of biomedical waste on water quality. A study on the migration of leachate (any contaminated liquid produced by water seeping through a waste disposal site) to groundwater discovered heavy metals that were exceeding drinking water standards. It was then considered as surface and groundwater contamination. Similar studies were carried out on the effects of biomedical waste on soil quality. The soil’s physical and chemical properties close to the dumping sites showed significant effects.
Segregation of biomedical waste in separate, prick-proof bags and tie-ups with biomedical waste treatment facilities can be helpful in separating hazardous biomedical waste from general garbage. Photo by Vinoth offl/Wikimedia Commons.
Legislation and accountability
Addressing household biomedical waste is inevitable. Biomedical waste management rules have been there in India since 1998 and were notified by the Ministry of Environment and Forests (MoEF) under the Environment (Protection) Act, of 1986 (4). The Biomedical waste management rules-2016 clearly say that the biomedical waste generated at home during healthcare activities should be segregated and handed over to municipal waste collectors in separate bags or containers. It also advises urban local bodies to tie up with the nearest biomedical waste treatment facility. These guidelines are phrased in such a manner that it’s not a mandate for the authorities to be followed. This gives authorities room to ignore the issue, which eventually leads to the hazardous waste being mixed with routine municipal solid waste. Since the effects of biomedical waste are multifaceted, the state governments should liaise with other important departments such as public health, pollution control board, urban local bodies, and other non-governmental organisations to streamline the management of household biomedical waste. Municipal waste handlers’ risk could be reduced by ensuring that they are provided with prick-proof gloves and boots, as well as Hepatitis B vaccination. Healthcare providers who offer homecare and outreach services should be directed to take back any biomedical waste that was generated during the service delivery. Since existing sewage plants are unable to degrade pharmaceutical drugs, provisions should be made to allow consumers to discard outdated medications at neighbouring pharmacies. Australia, the United Kingdom (UK), and the United States of America (USA) are just a few countries that have begun sensitising their citizens about ways to manage biomedical waste.
The governments in India also should make efforts to disseminate scientific awareness materials to guide the public to take informed actions regarding biomedical waste disposal. Addressing household biomedical waste is critical – yet it is being overlooked. The recent pandemic (COVID19) has contributed significantly to the wastes generated at home. The stress brought on by the inappropriate management of biomedical waste has already begun to affect animals and the ecosystem. If this neglect continues, humans, animals, and the ecosystem will all soon pay a larger price.
Irfan Shakeer is an epidemiologist and was a former Senior Research Associate (One Health) at the Ashoka Trust for Research in Ecology and Environment. Deepak Joseph is a project consultant at All India Institute of Ayurveda, New Delhi.
