BIO-MEDICAL WASTE INVERNTORY AND STATUS OF MANAGEMENT IN WEST BENGAL WEST BENGAL POLLUTION CONTROL BOARD PARIBESH BHAWAN, 10A, BLOCK LA SECTOR III, BIDHAN NAGAR, KOLKATA – 700098 INDIA www.wbpcb.gov.in SOCIETY FOR DIRECT INITIATIVE FOR SOCIAL & HEALTH ACTION (DISHA) 20/4 SIL LANE, KOLKATA 700015 INDIA www.dishaearth.org Acknowledgement This report is a result of the project scheme and guidelines formulated by the Central Pollution Control Board and the initiative of the West Bengal Pollution Control Board. Credit for the successful completion of the project goes entirely to the project team and others who have contributed directly or indirectly in the execution of the project and in the preparation of the project report. The West Bengal Pollution Control Board would like to gratefully acknowledge the efforts of Society for Direct Initiative for Social & Health Action (DISHA) , Kolkata in conducting the project: Bio-medical Waste : Inventory and Status of Management in West Bengal and for preparing the report. The State Board would also like to convey its gratitude to the concerned persons of the Government Hospitals / Health Centres, Private Nursing Homes / Healthcare establishments, various organizations and agencies who have extended their whole hearted cooperation and provided valuable inputs in making the project successful and meaningful. The immense contribution of Professor Shyamal Kanti Sanyal, Advisor of the State Board and Ex-Vice Chancellor of Jadavpur University by providing technical help and guidance in executing the project is also highly acknowledged. The project could never have been successfully executed without the untiring efforts of Dr. Dipak Chakraborty, Chief Scientist, Dr. T. K. Gupta, Chief Engineer, Shri Shyamal Kumar Adhikari, Senior Environmental Engineer (Waste Management Cell) and Shri Debasish Sarkar, Senior Environmental Engineer (Planning) of the State Board. Other Senior Engineers and colleagues of the Pollution Control Board also deserve appreciation for their assistance in all respects from the inception to the completion of the project. Contribution of the Accounts section of the State Board require a special mention for ensuring continuous fund support to the project. This acknowledgement would not be complete if the name of Shri Debal Ray, Chief Environmental Officer, Department of Environment, Government of West Bengal and the Ex-Member Secretary of the West Bengal Pollution Control Board is not mentioned here. West Bengal Pollution Control Board remains thankful to Shri Ray for his initiatives for the execution of the project during his tenure. Sandipan Mukherjee Member Secretary West Bengal Pollution Control Board Executive Summary 1 Executive Summary Overview: Biomedical waste (BMW) consists of solids, liquids, sharps, and laboratory waste that are potentially infectious or dangerous. Out of the total waste generated by health-care activities almost 80 – 85 % is general waste comparable to domestic waste. The remaining approximately 15 - 20% of waste is considered hazardous material that may be infectious, toxic or radioactive. When all the waste is mixed together, 100% of the health-care waste turns infectious and hazardous as well as become unmanageable. According to World Health Organization (WHO) “poor management of health care waste potentially exposes health care workers, waste handlers, patients and the community at large to infection, toxic effects and injuries, and risks polluting the environment. It is essential that all medical waste materials are segregated at the point of generation, appropriately treated and disposed of safely.” Background of the Study: Efforts towards safe and proper management of bio- medical waste in West Bengal date back to the 1990s, even prior to the introduction of the Bio-Medical Waste (Management and Handling) Rules, 1998. Dept. of Health & Family Welfare, Govt. of West Bengal took initiative towards this through several projects. With the introduction of the BMW Rules in 1998, WBPCB became the designated authority to approve and monitor BMW management in the state. After ten years of the introduction of BMW Rules, it is imperative to assess the achievements and the failures, the problems and the prospects of BMW management in the state. Thus the study “Bio-medical Waste : Inventory and Status of Management in West Bengal” was undertaken. Study Objectives: The study was conducted from November 2008 to March 2010. Objectives of the study was to (a) prepare an inventory of health care establishments, which are sources of BMW in West Bengal, (b) quantify amount of BMW generated to derive average generation in different categories of health care units, (c) make an assessment of treatment and disposal options, (d) assess availability and further requirement of common BMW treatment facilities (CBWTFs), (e) suggest options for BMW management in remote areas beyond reach of CBWTFs and (f) make assessment of compliance status in some selected Health Care Units (HCUs). Inventory of HCUs: West Bengal has a vast network of government HCUs in urban and rural areas. As per data available in December 2008 the Dept. of Health & Family Welfare has 11 tertiary (Medical College and Hospitals), 213 secondary (District, Sub-Divisional, State General and Rural Hospitals), 1168 Block Primary and Primary health centres in the state. Total number of hospitals run by different departments of state and central governments, urban local bodies and private organizations is 3780 and number of beds is 102949. Society for Direct Initiative for Social and Health Action Executive Summary 2 There are also 10356 government (rural) and 2100 urban sub-centres which perform mainly immunization activities. These sub-centres also conduct outreach sessions in remote villages. Numbers of municipal (urban) sub-centres and Extended Special Outdoor Patients Department (ESOPDs) are 1740 and 48 respectively. Number of diagnostic centres in the state is 3169 among which BMW is generated mainly by 2572 pathological centres. Quantification: Total BMW generated in the state from these facilities is around 12000 MT per year. With a rate of increase of 1% per year, the annual generation of BMW in the state has been estimated to be nearly 13500 MT in the year 2020. 45% of the BMW as a whole is made of recyclable materials. If the recyclable items can be properly segregated, decontaminated and then recycled, a good amount of resources can be saved in environment-friendly manner. But if these are salvaged through unscrupulous recyclable trade practices or incinerated or left in dumpsites, huge risk of environmental pollution and adverse health effect cannot be avoided. Treatment Facilities Available: At present 5 large Common BMW Treatment Facilities (CBWTFs), 2 small CBWTFs and 14 Stand-Alone Treatment Facilities are functioning in the state. But as a whole only 28% of BMW is being treated as most of the HCUs are yet to be incorporated in the management regime. The situation varies from region to region. It is to be noted that maximum proportion (42%) of BMW treatment is taking place in South Region (Kolkata, Howrah and South 24 Parganas) whereas lowest proportion (5%) of BMW is being treated in the adjacent South-West region (West and East Midnapore). Proportion of BMW treated in other regions is as in the following: 29% in Central (Murshidabad, Nadia, North 24 Parganas and Hoogly), 14% in West (Bankura, Burdwan, Birbhum and Purulia) and 14% in North (Coochbehar, Jalpaiguri, Darjeeling, Uttar Dinajpur, Dakhsin Dinajpur and Malda) regions. However it is hoped that situation will improve within a short period. As per decision of joint monitoring committee initiated by WBPCB, Dept. of H&FW made a budgetary provision for management of BMW and has issued circular (vide No. HF/O/MS/316/W-99/2008 dtd 28.5.09) conferring authority to respective heads of the Government HCUs to come in agreement with the CBWTFs. As the government HCUs have major number of beds and produce bulk of the BMW, in all probabilities there will be a marked improvement in the situation if the above order is implemented. Further Requirement of Treatment Facilities: BMW treatment capacity as a whole available in the state is 100% of its present generation. But that does not indicate that the capacity is enough in all the regions. CBWTF has to be made available within an optimum distance from the generation point of BMW. In South (Kolkata, South 24 Parganas and Howrah districts), Central (North 24 Parganas, Nadia, Murshidabad Society for Direct Initiative for Social and Health Action Executive Summary 3 and Hooghly districts) and North regions (Coochbihar, Jalpaiguri, Darjeeling, Uttar Dinajpur, Dakshin Dinajpur and Malda districts) capacity available for BMW treatment falls much short of requirement, whereas it is largely in excess in West (Bankura, Burdwan, Birbhum and Purulia districts) and South-West (East Midnapore and West Midnapore districts) regions. To cater to the requirement both by capacity and accessibility it is recommended that three more facilities should come up – 1 in South 24 Parganas (30000 bed capacity) for South region, 1 in Hooghly (15000 bed capacity) for Central region and 1 in Malda or Dakshin Dinajpur (15000 bed capacity) for North region. Options for HCUs beyond CBWTF Reach: There are many small non-bedded HCUs like govt. and municipal sub-centres, outreach sessions, which individually generate very small amount of BMW, but because of their huge number, together they generate around 8% of the total BMW. Again there are several HCUs, which are not so small but situated at remote and inaccessible places like hills and Sundarbans. CBWTF vehicles cannot visit these HCUs in regular frequency because of geographical or economical constraints. In the case of sub-centres, outreach sessions a BMW kit with safety box, syringe cutter, bleaching powder etc. should be used. BMW should be segregated at the point of generation. The kit should be used for carrying and transporting the BMW to the nearest treatment facility or storage for handing over to CBWTF. In case of other HCUs local arrangements for treatment and disposal should be opted for.