While environmental pollutants affect health, the healthcare sector also impacts the environment. The waste generated from healthcare has a very high potential for carrying infections.
Interview: Dr Deepali Kadam, Associate Professor, Department of Community Medicine, K.J. Somaiya Medical College and Research Centre
Q: What are the various ways in which healthcare harms the environment?
Healthcare activities protect and restore health and save lives. Waste and the by-products generated during healthcare activities carry a higher potential for infection than any other type of waste. Inadequate and inappropriate handling of healthcare waste may have serious public health consequences and a significant impact on the environment.
Q: What is the rule for managing waste?
The Ministry of Environment and Forest formulated a biomedical waste rule in 1998. The central government notified these rules for the management and handling of biomedical waste generated from hospitals, clinics and other institutions of scientific management of biomedical waste.
Waste and by-products cover a diverse range of materials like infectious waste: blood and body fluids, laboratory waste, and waste from patients (bandages and disposable medical devices); Pharmaceutical waste: expired, unused drugs, vaccines; Cytotoxic waste: cytotoxic drugs used in cancer treatment; Radioactive waste: radioactive diagnostic material or radiotherapeutic materials.
15% of the total amount of waste generated by healthcare activities is hazardous, and 85% is general non-hazardous waste. Healthcare waste is potentially harmful to patients, health workers and the general public. Treatment and disposal of healthcare waste pose risks by the release of pathogens and toxic pollutants into the environment. The untreated healthcare waste contaminates drinking and groundwater. The risk of infection due to the reuse of syringes, needles, expired medicines and medical devices prevails if not disposed of appropriately thereby leading to potential propagation of infection within the common public.
Q: How well studied are these impacts in the Indian context?
There are publications on awareness of the hazards of biomedical waste among healthcare workers. Case studies are done to study the impact on the environment which highlights that the untreated/ undisposed waste finds its way into the dumps or water bodies and re-enters the system.
Q: Can you explain and give examples of some sustainable healthcare practices?
Creating awareness by training of healthcare personnel of all cadres along with repeated reinforcement, and implementation of stringent Hospital Infection Control Practices to monitor the effectiveness of training. Hospitals carry out periodic audits for the same.
Q: Is there any measure to quantify the intended and unintended consequences of non-sustainable healthcare practices on the environment?
The government has started a barcoding system for waste generated from various hospitals. This helps in the identification of non-compliance. There is a colour coding system followed to segregate and collect biomedical waste generated in the hospitals. The health care facilities ensure segregation, collection, disposal and transportation of the waste, which is done within 24-48 hours to the Common Biomedical Waste Treatment Facility(CBMWTF). The agency comes for collection of this waste once in 24 hours post that the area of storage of waste in the hospital is cleaned with bleaching powder/ hypochlorite solution to ensure a reduction in cross-contamination.
Q: How can healthcare practices be structured into a community’s way of living such that the way of life becomes sustainable and planet-friendly?
Accreditation by National and International regulatory bodies such as Quality Council of India - National Accreditation Board for Hospitals (NABH), National Accreditation Board for Laboratories and international bodies such as Joint Commission International (JCI) and College of American Pathologists (CAP) help in reinstating the execution of policies/ rules effectively. Recycling of plastic waste post disinfection is practised for an eco-friendly environment. Alternative technologies for biomedical waste disposal such as thermal, chemical, irradiative processes and biological processes are more promising. Most of the methods are still under research.
