Covid19 and Biomedical Waste It is about how the India disposed its biomedical waste during Covid19 pandemic and its outcomes

1. COVID 19 and Bio-Medical Waste
By:- Rahul gaur(B-09) and Rohit kumar panjwani(B-48)
Introduction
Proper biomedical waste (BMW) management in accordance to the stipulated rule was one of the
neglected aspects of health care for years, especially in developing countries like India. Since the
BMW Management Rules, 2016 by Government of India (GoI), Ministry of Environment,
Forest, and Climate Change initiated changes by prescribing simplified categories (color coded)
for segregation of different BMWs, an amendment in 2018 also came into force with the aim to
improve the compliance to the rules. Nonetheless, proper segregation, handling, and disposal
remained a serious concern for health care facilities across India with an annual growth rate of
7% with a projected estimate up to 775.5 tonnes/d by the year 2022.
Amidst the coronavirus disease 2019 (COVID-19) pandemic, the scenario might worsen as
evidenced by some initial experiences, with piles of personal protective equipment (PPE)
accumulating in the hospitals. In spite of the guidelines by World Health Organization and
Ministry of Health and Family Welfare, GoI regarding the rational use of PPE for COVID-19,
health care settings are experiencing high demand of PPE from all strata of health care workers
owing to the fear of infection. The apprehension is often resulting in the misuse of PPE on many
occasions aggravating the problem by generating huge quantity of BMWs which are difficult to
store and transport with limited resources and manpower available at the time of crisis. Added to
the menace, is the indiscriminate use and disposal of single-use surgical masks (at times N95
respirators) even in the community. Their disposal is often being carried on along with the
noninfectious kitchen/general waste from the household and residential areas where color-coded
BMW bins are difficult to be found. It is worth mentioning that for the new severe acute
respiratory syndrome coronavirus 2 (SARS CoV2) with fomite-borne transmission and yet to be
known period of viability on the fomites, the indiscriminate disposal of BMWs in the general
garbage provides an easy access to the largely susceptible community.
Indian Response to Covid19 Pandemic
In response to the COVID-19 pandemic in India, Central Pollution Control Board (CPCB),
Ministry of Environment, Forest & Climate has published guidelines for the management of
waste generated during treatment/diagnosis/quarantine of COVID-19 patients.These guidelines
have advocated use of double layered bags (using two bags), mandatory labeling of bags and
containers as “COVID-19 waste,” regular disinfection of dedicated trolleys, separate record
keeping of waste generated from COVID-19 isolation wards, in addition to the recommendation
for following existing practices of BMW Management Rules, 2016. Although the CPCB is the
nodal agency for making any recommendation pertaining to BMW in India, some guidelines
have also been published by other government agencies for the management of COVID-19
waste. While the latter guidelines must conform to the recommendations made by CPCB,

2. disparities have been noted in some with respect to the segregation norms of existing BMW
Management Rules, 2016 in which the segregation of the items is devised based on the final
mode of treatment. This abrupt change in the category of certain BMWs might result in
inappropriate final treatment.
BMWM in COVID-19 context: Challanges
 Training – Social distancing, MS Team, smallbatches, All
 Social distancing
 Collection of waste
 Barcoding
 Hand hygiene, Resp. etiquette
 GENERAL Population USING PPE: PPE in SW
 Health checkup/screening
 Immunization
 ETP/STP Plants
 CPCB Mobile App for COVID waste
Waste Management in COVID 19 Contexts
 Follow the national regulations / WHO WASH guidance on infectious waste treatment
1. Treat coronavirus waste as any infectious waste.
2. Segregate waste at source
3. Dispose in an infectious waste in foot operated bin, with a suitably color coded
liner.
4. Proper handling collection, transport and storage
5. Use PPE (mask, face shield, heavy duty gloves, long sleeve gown, boots) hand
hygiene
6. Use safe and environmentally sound treatment methods
7. Centralized treatment facility using autoclave, microwaves
8. Hybrid stream systems, microwaves, ecofriendly treatment methods
9. On-site Chemicals disinfection low resource settings bleach, pressure cooker a
highest setting (30 m), encapsulation and sanitary burial
 Cut masks and other PPE: reports that they are being illicitly resold
 Follow routine disinfection and cleaning protocols for waste bins.
Strategies for disinfection of COVID- waste
Classification of hospital waste is the first step for the management of COVID-waste. It is the
best practice that the waste is classified at its origin. This strategy is not only time-efficient but
also avoids the chances of infection spread to other handlers of the waste. The collection of
COVID-waste in separate bags/bins is directed to have a clear marking over the dedicated bins.

3. At the time of waste classification, the waste containing bags must be disinfected and sealed in
double-layered plastic bags (usually yellow color) prior to transportation from the originated
place/ward. Commonly, the BMW contains about 85% of general non-infectious waste, 10% of
infectious hazardous waste, and 5% of radioactive and/or, chemical waste.
All COVID-waste comes under the hazardous BMW. Once identified, the segregation becomes
an easy task for their separate storage from where the waste can be collected on a priority basis
and within the deadlines. While doing so, proper disinfection of the storage area and the
transporting vehicles carrying COVID-waste to common bio-medical waste treatment and
disposal facility (CBMWTF) becomes necessary. For the disinfection of COVID-waste, various
factors like the quantity and type of waste, costs, and maintenance are considered for selecting
the appropriate disinfection technology. It suggests that incineration at higher/lower temperature
can be adopted on the basis of waste volume to be treated and the investment capacity. Else if,
the operational scale of a hospital is smaller with limited investment that cannot afford the
installation and maintenance costs of incinerator, the chemical disinfectant (as front disinfection
technique) in combination with microwave and steam disinfection technique at the latter stage
and relatively a lower temperatures (between 93 and 540 °C) over incineration (usually at 800–
1200 °C) can be preferred.
Identification and isolation of COVID-waste for a safer treatment in India
Although no specific guideline was issued for handling COVID-waste up to mid of March 2020,
as COVID-19 spread in India, a proper COVID-waste management system was introduced. It
was imperative due to the fact that before this pandemic outbreak only 265 tons/day were
undergoing to the treatment facilities out of the generated volume of 463 tons/day BMW. The
first big step was to enact the Epidemic Disease Act, 1897; by which, the Central Government of
India could directly impose its directives to the state governments. Then, the Central Pollution
Control Board (CPCB) under the Ministry of Environment, Forest & Climate Change issued the
specific guidelines on 18 March 2020. The “Guidelines for handling, treatment, and disposal of
waste generated during treatment/diagnosis/quarantine of COVID-19 patients” was issued to deal
COVID-waste disposal at healthcare facilities including the quarantine camps, home-care,
sample collection centers, testing labs, state pollution control boards, and bio-waste treatment
facilities. Despite having the Biomedical Waste Management Rule 2016, the guidelines kept
specific to ensure COVID-waste disposal in a scientific manner. The guidelines suggest that the
commonly used facemasks and gloves by general people for preventive measures should be
enveloped for a minimum of 72 hours before disposal as the MSW. It is emphasized that
COVID-waste generated by the isolation wards must be kept in a double-layered dedicated
yellow bags to collect and store separately by marking “COVID-19 waste” for a priority
handling by the common bio-medical waste treatment facility, CBWTF.

4. The guidelines incorporate in Biomedical Waste Management Rules, 2016
1) Safesuard for sanitation workers
They addressed the safety of waste handlers and sanitation workers associated with such
healthcare facilities.The guidelines provide extracare to be taken in COVID-19 isolation wards.
Foot-operated lids bins must be introduced to avoid contact, according to the guidelines.
Ordinary solid waste like medicine wrappers and cartons, syringes, peels, empty bottles,
discarded paper and other items not used by the contaminated by patients’ secretions and body
fluids must be collected separately, according to Solid Waste Management Rules, 2016.Wet and
dry solid waste bags needed to be securely tied and handed over to waste collectors authorised by
ULBs daily. Non-disposable items should not be disposed of as much as possible and should,
instead, be cleaned and disinfected keeping hospital rules in mind.
2) Waste classification
The classification of waste material, biomedical waste treatment facility.Left-over food,
disposable plates, glasses, used masks, tissues, toiletries, etc used by COVID-19 patients were
classes as biomedical waste and should be put in yellow-coloured bags, while used gloves should
be put in red bags.This demarcates the type of COVID-19 waste that needs to be incinerated and
the kind that can be disinfected, autoclaved (a process that kills bacteria, viruses, etc) and
disposed. It provides in reducing the quantity of COVID-19 waste generated and reduces
unnecessary burden on CBWTFs for incineration as well.
3) Work of nodal officers
Identification and navigating the movement of COVID-19 needed to be carried out by all
quarantine centres though the CPCB’s biomedical waste-tracking mobile application called
COVID19BWM. The daily generation of COVID-19 waste must be updated by nodal officers of
quarantine centres every day.The same can also be used to enter data by CBWTF and SPCBs and
PCCs to develop a cross-checking mechanism at each stakeholder level to avoid data
discrepancies.The SPCBs and PCCs of Union territories are authorised to permit hazardous
waste incinerators at existing COVID19 centers. The same is done if the generation of yellow
colour-coded (incinerable) COVID-19 waste is beyond the capacity. Waste feeding for
incinerators, needs to be separate for COVID-19 and hazardous waste.

5. Disposal of PPE kits, during COVID-19 pandemic
As per Central Pollution Control Board guidelines, used PPE’s like face shields, goggles, hazmat
suits, plastic coverall, used masks, head cover, shoe cover etc, generated from COVID-19
isolation wards at Healthcare Facilities shall be segregated and sent to Common Facilities for
disposal as per Bio-medical Waste Management Rules, 2016 (BMWM Rules).
Already used PPEs like masks and gloves generated in Common Households, Commercial
Establishments, Institutions, etc., are required to store separately for a minimum 72 hours for
disposal along with solid waste after cutting or shredding.
Guidelines for handlings of BMW as laid down by Central Pollution Control Board
(CPCB)
India produces around 600 metric tons of biomedical waste daily, which is approximately 10%
more wastes, due to this pandemic situation of COVID-19. As per the guidelined a committed
container marked 'COVID-19', should have been kept in a different, brief extra space and should
just be taken care of by approved staff and separate arrangement of sanitation labourers in these
wards for biomedical waste administration was likewise suggested. These guidelines recommend
that those dealing with such wastes need to be provided with adequate training and PPE,
including three-layered masks, splash-proof aprons, gloves, gumboots and safety goggles.
Legal obligations of the hospital, if a Non-COVID patient contracts COVID while admitted
in the hospital
 National Consumer Dispute Redressal Commission in the matter of Apollo Emergency
Hospital vs Dr. Bommakanti Sai Krishna & Anr, held that“As already observed, the
infection occurred during the stay of the Complainant at the hospital. On the other hand,
there is nothing to show that the source of infection lay outside the hospital. Thus, there is
preponderance of possibilities of the infection having been acquired in the hospital itself.
We therefore, do not accept the contention that it was necessary for the Complainant to
produce expert evidence to prove negligence on the part of the concerned doctors in the
hospital.”
 The afore-stated judgement implies a presumption of liability on the hospital in cases
where the probability of acquiring the infection is much higher inside the hospital than
from other sources. However, the same may not apply in COVID cases in light of the
peculiar difficulty of tracing the source of acquiring the COVID-19 infection. Therefore,
the presumption rendered by the aforesaid judgement will not be ipso facto applicable to
cases of COVID patients.
BM Waste being treated and disposed of by hospitals in India during COVID-19

6. Under the 2016 Rules, while the hospitals are required to ensure that there is a secured location
within its premises for a spill/pilferage free storage of segregated BM Waste in labelled/coloured
bags or containers, the duty to transport the stored BM Waste from the hospital premises
onwards to the common BM Waste treatment and disposal facility is of an ‘operator’ as defined
in the Rules. Under the 2016 Rules, while the hospitals are required to ensure that there is a
secured location within its premises for a spill/pilferage free storage of segregated BM Waste in
labelled/coloured bags or containers, the duty to transport the stored BM Waste from the hospital
premises onwards to the common BM Waste treatment and disposal facility is of an ‘operator’ as
defined in the Rules.The Bombay High Court in a pending public interest litigation has, while
issuing notices to local municipal corporations and the State Pollution Control Board, also
directed the Maharashtra government to clarify whether it was ensuring that all COVID-19
related biomedical waste generated in the state was being disposed of in a safe manner.
Conclusion
It is recommended that COVID-19 waste should be disposed of immediately upon receipt at
facilities and emphasised that they should not allow “any worker showing symptoms of illness to
work at the facility. The Board directs that these guidelines need to be followed by all
stakeholders including isolation wards, quarantine centers, sample collection centers,
laboratories, urban local bodies, and the CBWTFs. Public participation in the separate and timely
collection of COVID-waste along with a priority disposal of the waste volume are the key factors
to the effective management of an emerged category of BMW. The practices discussed herein
will greatly help the strategy development for preventing/controlling the pandemic of similar
episodes in the future. The protection contemplations and a need to guarantee information
security can be a test, given the scale, human cost and monetary effect of COVID-19, this
exploration ought to continue with full dedication.
Biblography
 https://www.sciencedirect.com/science/article/pii/S266601642030027X
 https://www.downtoearth.org.in/news/waste/covid-19-revised-guidelines-show-how-
biomedical-waste-must-be-handled-71934
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7419320/
 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7467828/
 https://india.mongabay.com/2020/03/pollution-watchdog-releases-guidelines-to-handle-
covid-19-biomedical-waste/
 https://corporate.cyrilamarchandblogs.com/2020/07/bio-medical-waste-and-liability-of-
hospitals-in-wake-of-the-covid-19-pandemic/
 https://thefederal.com/news/covid-19-rise-in-biomedical-waste-generation-poses-fresh-
challenge/