The waste generated in the course of the medical diagnosis, treatment, and research activities is considered Biomedical waste (BMW). The proper handling of these BMWs is critical and continues to remain a highly challenging problem over the past few decades. As per the World Health Organization (WHO), the total amount of general and non-hazardous waste generated by healthcare activities is about 85% while the remaining 15% includes clinical solid waste, expired vaccines, unlabelled products, medical instruments, and organic fluids which are considered as infectious, toxic and hazardous to humans and the environment (WHO, 2018). Due care and caution must therefore be taken to ensure that these wastes are properly handled and segregated safely. To manage the large portion of these wastes by healthcare institutions, numerous technologies are in practice all around the globe such as sewage, land disposal, gasification, incineration, etc. Best Available Technology (BAT) survey for identifying safe and sustainable biomedical waste treatment options and management methodologies was conducted for 24 countries of the Western Pacific area in 2012. It was found that Japan and the Republic of South Korea were the only two countries that effectively managed their biomedical wastes. The evaluation was done by assessing five major areas of management, i.e. training, policy and regulatory framework, technologies implemented, and financial resources (Datta et al., 2018). Canada is one of the pioneers in the field as it has centralized provincial facilities for BMW sterilization (Walkinshaw, 2011).
Several decades ago, not much importance was given to biomedical waste and Indian scavengers working in recycling stations were found to be unequipped with protective equipment. For instance, medical syringes were reused without proper sterilization until 2009 (Salkin, 2004). During this period, around 240 people in Gujarat were affected with Hepatitis B due to the reuse of unsterilized syringes (Seetharam, 2009). International clinical epidemiology imposed the existing BMW practices in 20 states of India during 2002-2004 based on detailed questionnaires used to sub-classify its standards. An earlier research study found that 82%, 60%, and 54.2% of primary, secondary, and tertiary healthcare centres, respectively, were in the red category indicating the critical need for immediate measures to stringently enforce an efficient BMW management system in the country to curb the spread of infections (Arora et al., 2014).
The generation of BMW has increased at an abnormal rate over the recent past due to the spread of the coronavirus disease “COVID-19”, an infectious virus whose origin has been traced to a localized seafood marketplace in Wuhan, China; it was later referred as “SARS-CoV-2” by WHO on January 12, 2020 (Dharmaraj et al., 2021). Due to the global transmission and worldwide impact of the coronavirus, WHO further declared this as a pandemic on March 11, 2020. As per the reports published till 16th September 2021, SARS-CoV-2 have spreading across 237 republics with 22,62,36,577 confirmed cases including 46,54,548 deaths as of the date (WHO, 2021b). The increasing rate of COVID-19 is greater than SARS and MERS with a short gestation time of 24 hours (Zhang et al., 2020). The primary source of transmission of COVID-19 is through inhalation of respiratory droplets from close contact with an infected person (Kitajima et al., 2020). Several research studies reveal that COVID-19 can also be transmitted in other ways, it is shed in the faces of infected patients displaying acute symptoms, it can be contracted from asymptomatic persons, and patients treated without any signs (Thakur et al., 2021).
This situation has resulted in many healthy people getting infected, needed medical treatment, and in certain severe cases requiring hospital admission. The essential protective equipment used by healthcare professionals for treating the sick and the mandatory precautionary safety measures like facial masks and hand gloves has led to a stupendous increase in the accumulation of BMW all around the world. In China, nearly 240 tons of medical waste were disposed of per day during the pandemic compared to a mere 40 tonnes on normal days (Hossain et al., 2020). In India, even before the pandemic, the generation of BMW had increased from 559 tonnes per day to 613 tonnes (CSE India, 2021) and in the course of battling the pandemic, the country currently generating BMW of around 850 tonnes/day (Chand et al., 2021). The major repercussion of this steadily increasing BMW generation is the effect on the environment. Thousands of sanitation workers, rag pickers, and waste segregation having no proper awareness of the need for personal protective systems leading to the loss of many precious human lives.
The generation of BMW at the end of COVID’s first and second waves was still on an increasing trend due to the careless disposal of surgical masks, gloves, personal protective equipment suits, etc., leading to many people getting affected by the SARS-Cov-2. The Indian government has recommended that all healthy people of age 18 and above must get their vaccination and as of 14th September 2021 5,63,45,33,040 people have been successfully vaccinated (WHO, 2021a). The syringes and the vials used in the course of the vaccination drive have added to the increasing pile of BMW. To manage the enormous amount of waste produced on a day-to-day basis during the pandemic, a proper BMW disposal method has to be adopted. Although the government of India has imposed stringent rules, regulations and specified guidelines for maintaining a clean ecosystem without the deployment of appropriate technological solutions these regulatory policies are largely ineffective in an available for safe disposal of BMW but a majority of Indian states have adopted the incineration technique due to the advantages of the requirement of less area, energy and cost.
In this context, to help society and to address the identified information gap, the key objective of this assessment study is to produce the current knowledge on approaches for treating BMW generated, to support further research needs, and resolve the obstructions to the enactment of various treatment technologies. The impact of the coronavirus on the BMW generation is deliberated in detail to existing a crystal pure image to the scientific society. Various remedial approaches for efficient BMW management are discussed along with their advantages and disadvantages. In the light of the increasing number of COVID-19 cases and the danger of an impending catastrophe of the third wave from new variants and mutations of the virus, the creation of greater awareness can help in drawing the attention of the scientific community and society to the critical need for effective BMW management in India.