March 2002
Return to March 2002 contents page
UPDATE
Reports from the sharp end
2: India: an environmentally sustainable solution
in a crowded country
AIR
MARSHAL LK Verma, director general of medical services for the Indian
Air Force, has taken on many challenges in his career and
medical waste disposal is just one of them. In a WHO pilot project
at the Command Hospital Air Force, Bangalore, Verma has developed
a "multi-option" approach that he believes is safe, appropriate
and environmentally sustainable. The pilot project, one of 11 in
India, was completed in 2000 and the approach is now being extended
to all Armed Forces hospitals around the country by mid-2002, supported
by the Indian Ministry of Defence.
Immunizations account for only a fraction of the
injections given in many health care facilities (see Immunization
Focus, March 2001),
but the overall healthcare waste management policy followed at this
hospital is nevertheless of interest to immunization programme managers,
since many immunization centres share disposal facilities at hospital
or district level.
Medical waste includes a broad range of components
in addition to injection equipment, such as chemicals, radioactive
wastes, used dressings, and large quantities of plastic. Instead
of relying on just one method of disposal for all these items
autoclave, microwave, incinerator or hydroclave Verma, a
medical doctor and administrator, believes that a hospital needs
to have all four to ensure waste is disposed of in the appropriate
way. The key is to ensure that waste is properly segregated: the
benefits outweigh the costs, says Verma, and hospital-related illness
is reduced.
Although incineration is widely regarded as the best
method for disposing of injection equipment, Verma has shown that
much plastic hospital waste can safely be disinfected with hypochlorite
solution or microwave, then shredded and sold for recycling. He
believes this is preferable to having poorly maintained and wrongly
used incinerators, which are already common in urban India, and
which may emit pollutants such as dioxins and furans. Burial of
injection equipment, plastics and human or animal tissue are not
options in urban areas, he says, given the sheer population density
in India and the competition for scarce land.
So the hospital in Bangalore, and the other Armed
Forces hospitals, use a relatively sophisticated system that is
suitable for their needs. After an injection is completed the used
syringe is placed in a destroyer. A mechanical cutter cuts off the
syringe at the nozzle. The needle is simply melted by passing an
electric current through it. The resulting waste is disinfected
and placed into an old water tank at underground level: the tank
will take 5-10 years to fill, Verma estimates. The remainder of
the plastic syringe is disinfected, shredded and the plastic is
recycled. Waste handlers wear protective gloves, masks and goggles.
Staff are trained not to recap needles or handle used syringes at
all after use.
For more information see www.medwasteind.org/verma.htm
and www.expresshealthcaremgmt.com/20010930/editorial2.htm
Phyllida Brown
Return to March 2002 contents
page
|