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Biomedical Waste and Solid Waste Management in the Time of COVID-19: a Comprehensive Review of the National and International Scenario and Guidelines

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Biomedical Waste and Solid Waste Management in the Time of COVID-19: a Comprehensive Review of the National and International Scenario and Guidelines Published online: 2021-06-28 THIEME Review Article 175 Biomedical Waste and Solid Waste Management in the Time of COVID-19: A Comprehensive Review of the National and International Scenario and Guidelines Malini R. Capoor1 Annapurna Parida1 1Department of Microbiology and Biomedical Waste Unit, Address for correspondence Malini R. Capoor, MD, Department of Vardhman Mahavir Medical College and Safdarjung Hospital Delhi, Microbiology, Vardhman Mahavir Medical College and Safdarjung New Delhi, India Hospital, New Delhi 110029, India (e-mail: [email protected]; [email protected]). J Lab Physicians 2021;13:175–182. Abstract Biomedical waste generated during the diagnosis, isolation, and treatment of coronavi- rus disease 2019 (COVID-19) patients can also be the source of new infections; hence, it needs special consideration. Previous guidelines for the management of biomed- ical waste need to be revisited as the majority of COVID-19 patients remain asymp- tomatic and reside in community. Personal protective equipment (PPE) like masks, hazmat suits, gloves, and visors are now being used by the public also. Thus, the gen- eral household waste and disposables now make an exponential increase in the waste that can be considered an environmental hazard. In this article, the authors have tried to present the problems arising from COVID-19 waste and the recommendations put forth by competent authorities both nationally and internationally on COVID-19 waste Keywords management. Furthermore, in all the guidelines, it is crucial that the COVID-19 waste ► COVID-19 waste management follows environmentally sound principles and practices of biomedical ► biomedical waste waste management, with safe work and infection-control practices. Segregation of ► solid waste COVID-19 waste at source, awareness, and precautions at all steps of the waste-cycle ► guidelines are the only way ahead in this crisis. Introduction preparedness to battle a pandemic but also loopholes in their waste management process. Basic waste management services were available in only Existing evidence points toward contact, droplet, and air- 27% of health-care facilities in the least developed countries borne as well as environmental spread from fomites and fecal– even before the coronavirus disease 2019 (COVID-19) pan- oral routes of transmission of COVID-19. Only 15% of the affected 1 demic hit the global population. By the time COVID-19 was have severe life-threatening pneumonia in COVID-19, while in declared a pandemic, cities around the world reported an the rest of the cases, the patient might be asymptomatic or may increase of nearly five times in medical waste generation.2 present with mild (common cold) or moderate forms of ill- This volume increase can be attributed to the increased use ness.3-5 Waste generated by patients in hospitals and the waste of personal protective equipment (PPE) globally. The out- from households with COVID-19–infected patients can all be break of the novel coronavirus has not only exposed the contaminated with blood, body fluids, or droplets. Sewage and poor health-care infrastructure in countries and the lack of waste water generated from these sources can also be considered published online DOI https://doi.org/ © 2021. The Indian Association of Laboratory Physicians. June 28, 2021 10.1055/s-0041-1729132 This is an open access article published by Thieme under the terms of the Creative ISSN 0974-2727 Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/). Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India 176 Biomedical Waste and Solid Waste Management during COVID-19 Capoor and Parida contaminated with the COVID-19 virus. To control the spread production ranged from 1 kg/day/bed to 10–11 kgs/day/bed of COVID-19, the use of masks and PPEs, disposables, sanitizing (2 kgs/bed/day infectious waste) depending on the average liquids, and disinfectants has also increased. All these methods income of a country. During COVID-19 pandemic, health-care of precaution lead to an increased waste production and, as we facilities across the world reported nearly five times increase all know, irresponsible waste management has led to disasters in the volume of waste produced.8-10,12 previously.6 As of the last week of December 2020, nearly 78 million What Is COVID-19 Waste? people worldwide were diagnosed with COVID-19 and more BMW is defined as the waste generated during the diagno- than 1,727,000 had died.7 The number of COVID-19 cases sis, treatment, or immunization of human beings or animals, is still on the rise; any further outbreaks due to improperly in research, or in the production or testing of biological or handled waste will just increase the problem. In this article, in health camps.13 Of the total amount generated, 85% is the authors have tried to present a comprehensive review of general waste and only 15% is considered hazardous waste, the national and international scenario and of all national including infective waste (10%), chemical, radioactive, cyto- and international guidelines on solid waste and biomedical toxic, or sharps (►Table 1).14 During this pandemic, the term waste (BMW) management during the COVID-19 pandemic. COVID-19 waste is now used for any waste generated during isolation, diagnosis, treatment, quarantine, and home care Magnitude of the Problem (National and International of COVID-19 patients. Solid waste is considered infectious Scenario) only if it is contaminated by the body fluids and secretions of With COVID-19, the fear of infection led to reduced effective COVID-19 patients; otherwise, uncontaminated solid waste segregation and, in some instance, even recycling of waste is handled as per the Solid Waste Management Rules, 2016. was prohibited. Furthermore, waste generated in homes increased and the chain of waste segregation and recycling COVID-19 Virus Survival in Environment was, in many instances, abandoned. According to the World The coronavirus SARS-CoV2 of the family Coronaviridae Health Organization (WHO), before COVID-19 just over half is responsible for COVID-19.15 This virus is similar to the pre- (58%) of the sampled facilities from 24 countries had ade- vious two viruses responsible for the severeacute respira- quate systems in place for proper BMW management.6 tory syndrome (SARS) outbreak in 2003 and the Middle East In low-income countries, proper segregation of hazardous respiratory syndrome (MERS) outbreak in 2012.16,17 WHO and nonhazardous waste is not complete, which increases has categorized COVID-19 into risk group 2 in bio-hazard the volume of hazardous waste. COVID-19 has increased the level.18 Kempf et al, in 2020, showed that the COVID-19 virus problem of BMW management manyfold. Wuhan province remains infectious for up to 72 hours on plastic and metal of China, where the COVID-19 virus was first detected, experi- surfaces, up to 24 hours on cardboard, and for 4 hours on enced a surge of BMW production from 50 tonne per day before to 247 tonne per day during the pandemic.8In April 2020, at Table 1 Categories of health-care waste as per the World least 14,500 tonne waste from health care was generated across Health Organization Bangladesh because of the COVID-19 pandemic, out of which Waste category Descriptions 206 tonne per day of medical waste was produced in Dhaka Hazardous waste alone.9Until the mid of July 2020, more than 2,600 tonne medi- Infectious waste Waste contaminated with cal waste was collected from 91 designated COVID-19 hospitals, blood, body fluid, or any other 8 residential centers, 24 temporary facilities, and self-quarantine material with the potential to households in south Korea that was disposed of by incineration carry bacteria, virus, fungi, or on a priority basis. The drastic increase in COVID-19 waste from parasites 5 million tonne per year to 2.5 million tonne per month in the Pathological waste Human anatomical tissue, United States is scary if not treated properly.10 fetuses, organs, body fluids According to a report filed by the Central Pollution Control Microbiological waste Bacterial and viral culture, Board (CPCB) in the National Green Tribunal in July, India stock, used media, quality control reagents, serological generates ~101 metric tonne (MT) of COVID-19–related BMW enzymes and equipment used per day. This quantity is in addition to the regular BMW gen- in microbiological laboratories eration of ~609 MT per day. The report clearly states that the Pharmaceutical waste Expired or unused drugs available capacity for incineration of COVID-19 BMW in the Cytotoxic waste Cytotoxic drugs country is ~840 MT against the total generation of ~710 MT Chemical waste Laboratory reagents, solvents, per day. New Delhi, the national capital of India, accounts cleaning agents for 11% of India’s daily COVID-19 BMW generation. New Delhi Radioactive waste Radioactive isotopes, urine has only two incinerators and 70% of their capacity is already and excreta of patients treated utilized. As BMW gets segregated, the load on the incineration with radioactive isotopes facilities gets reduced as more waste gets diverted to disin- Nonhazardous waste fection and recycling routes. It will not increase the capac- General waste Cardboards, plastic, and ity of incinerators but allow the BMW treatment facilities to thermocol packaging material, handle more waste.11 Pre-COVID-19 total health-care waste paper, kitchen waste Journal of Laboratory Physicians Vol. 13 No. 2/2021 © 2021. The Indian Association of Laboratory Physicians. Biomedical Waste and Solid Waste Management during COVID-19 Capoor and Parida 177 copper.19 The COVID-19 virus can remain suspended in aero- than adopting “end-of-pipe” approach.
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