The cost of disposing Covid biomedical waste is adding significantly to the cost of treatment, and patients are being billed for it.
Since the pandemic broke out, the rates for disposal have gone up, hospital administrators say.
“Earlier it was about Rs 50 per kg, but the price has almost tripled. This puts a lot of pressure on hospitals and more often than not the costs are billed to the patients,” says Dr Masood Sharieff, physician, St Philomena’s Hospital.
Suneetha P Lasrado, auditor and quality and safety officer, National Accreditation Board for Hospitals and Healthcare Providers (NABH), says the first step a hospital should take is to get a pollution control licence.
“Then you can contact biomedical waste disposal companies such as Maridi or Medicare who ferry waste and dispose of it,” she explains.
The NABH has found that the cost is calculated in weight, and then assigned per bed.
“Smaller clinics don’t generate that much waste, but they end up paying an unnecessarily large sum to these companies,” she observes.
For Covid waste up to 100 kg, the disposal cost is Rs 11,500. “Any hospital that takes Covid patients generates so much waste in less than a week,” she says. That means a hospital with 150 Covid patients spends over a lakh a month on waste disposal.
Haphazard dumping
Both opine that this added cost might also be leading smaller hospitals and clinics dumping waste through improper channels. Such haphazard disposal can pose serious threats.
“The companies come once or twice a week. In three days, a Covid hospital can generate up to 300 kg of waste. There is a lack of storage space. Although there are fines for improper storage and disposal, it is tough to monitor hospitals,” Suneetha explains.
Risk of contact
Contact is the biggest risk. “In hospitals we have meticulous procedures for donning and doffing the PPE. So much so that we wear three layers of gloves and have separate donning and doffing rooms. Every kit after use is considered infected,” Shareiff says.
Coming in contact with any biomedical waste poses a risk of infection. “There are reports of stray dogs dragging around such waste into denser localities. And while dogs may not be at risk of Covid, they can be carriers of the virus,” he adds.
The combination of rains and biomedical litter can also increase the risk of the infection.
Not just hospitals
When lay people use medical-grade goods, they don’t know how to dispose of them. Private ambulances, NGOs and others using PPEs have no tie-ups with waste management centres. The only waste bins they have access to are regular dustbins.
This lack of waste segregation means that all kits, even when dumped in bins, are treated the same way as general waste.
“Some hospitals don’t have a proper segregated set up and they are a huge risk, not just for patients but also for healthcare workers,” adds Shareiff.
Suneetha agrees but says fixing that is not tough. “Putting up yellow bins and educating the public about disposing Covid waste in them is a simple step,” she says.
What happens to waste?
Each category of waste is treated differently. Yellow bag waste is incinerated, blue and white bag waste is sterilised using an autoclave or microwave and then shredded. Sharp objects such as needles are mutilated.
The water generated during this process is treated through a sewage treatment plant and the solid waste is buried.
“There is a protocol in place for how deep it must be buried. The land used for disposal is barren and cannot be used for other purposes because of the risk of infection,” says Suneetha P Lasrado, auditor for the National Accreditation Board for Hospitals.
Disposal is one part. Hospitals are also mandated to visit their assigned dumping yards once a year. “The ones generating the waste are also held responsible if it is dumped improperly,” she says.
What disposal companies do
Each company is allocated a zone within the city.
The hospitals have to collect their waste in separate, colour-coded bins. Some of it is disinfected on the spot and the rest kept ready for collection.
Hospitals handling Covid patients have to register separately with their biomedical waste vendors. Covid waste must be kept separately in double cover bags and be treated at the hospital before it is handed over to these vendors.
The driver of the vehicle who picks up this waste goes to one hospital at a time, and wears a full PPE.
Cut the straps
When you throw away your masks, cutting the straps is a good practice.
Since disposal is haphazard, they often get tangled on the feet of animals, especially birds. Cutting the straps is a simple way to prevent this from happening.