Challenges and actions to the environmental management of Bio-Medical Waste during COVID-19 pandemic in India

Variability of the treated biomedical waste disposal behaviours during the COVID lockdowns

Literature review suggests that studies on biomedical waste generation and disposal behaviors in North America are limited. Given the infectious nature of the materials, effective biomedical waste management is vital to the public health and safety of the residents. This study explicitly examines seasonal variations of treated biomedical waste (TBMW) disposal rates in the City of Regina, Canada, from 2013 to 2022. Immediately before the onset of COVID-19, the City exhibited a steady pattern of TBMW disposal rate at about 6.6 kg∙capita-1∙year-1. However, the COVID-19 pandemic and its associated lockdowns brought about an abrupt and persistent decline in TBMW disposal rates. Inconsistent fluctuations in both magnitude and variability of the monthly TBMW load weights were also observed. The TBMW load weight became particularly variable in 2020, with an interquartile range 4 times higher than 2019. The average TBMW load weight was also the lowest (5.1 tonnes∙month-1∙truckload-1) in 2020, possibly due to an overall decline in non-COVID-19 medical emergencies, cancellation of elective surgeries, and availability of telehealth options to residents. In general, the TBMW disposal rates peaked during the summer and fall seasons. The day-to-day TBMW disposal contribution patterns between the pre-pandemic and post-pandemic are similar, with 97.5% of total TBMW being disposed of on fixed days. Results from this Canadian case study indicate that there were observable temporal changes in TBMW disposal behaviors during and after the COVID-19 lockdowns.

Does medical waste research during COVID-19 meet the challenge induced by the pandemic to waste management?

The COVID-19 pandemic has resulted in an unprecedented amount of medical waste, presenting significant challenges for the safe disposal of hazardous waste. A systematic review of existing research on COVID-19 and medical waste can help address these challenges by providing insights and recommendations for effective management of the massive medical waste generated during the pandemic. This study utilized bibliometric and text mining methods to survey the scientific outcomes related to COVID-19 and medical waste, drawing on data from the Scopus database. The results show that the spatial distribution of medical waste research is unbalanced. Surprisingly, developing countries rather than developed countries lead research in this area. Especially, China, a major contributor to the field, has the highest number of publications and citations, and is also a centre of international cooperation. The main study authors and research institutions are also mainly from China. And the research on medical waste is a multidisciplinary field. Text mining analysis shows that COVID-19 and medical waste research is mainly organized around four themes: (i) medical waste from personal protective equipment; (ii) research on medical waste in Wuhan, China; (iii) threats of medical waste to the environment and (iv) disposal and management of medical waste. This would serve to better understand the current state of medical waste research and to provide some implications for future research.

Deciphering the role of fungus in degradation of polypropylene from hospital waste

Health and environmental consequences are unavoidable when it comes to management of hospital waste (HW) disposables. In order to eradicate the HW, this study isolated a novel fungus SPF21 from a hospital dumping yard to degrade Polypropylene (PP). We measured the attributes of PP inoculated with fungus using mass loss, Fourier trans-form infrared (FTIR), contact angle (CA), and scanning electron microscopy (SEM). The weight of PP exposed to SPF21 was reduced by 25% in 90 days. The SEM images reveal that there are pores all over the sample surface; they alsocaused voids during the biodegradation of PP. FTIR analysis indicates that the spectra of treated mask pieces show the absence of peak at 1746 cm-1 and the appearance of a new peak at 1643 cm-1 . A period of 90-day exposure to the fungal isolate SPF21 reduced the CA of PP by 44.8% when compared to the nonexposed PP samples, suggesting that the surface of PP turned more hydrophilic after exposure. Moreover, our study on PP degradation by the fungus Ascotricha sinuosa SPF21 appears to be promising from the perspective of environmental, health, and economic hazards. Our results indicate that biodegradation greatly facilitates fungus deposition and changes PP film morphology and hydrophilicity.

Management of healthcare waste collection and segregation for developing countries

Healthcare waste (HCW) consists of hazardous material that may be radioactive, toxic or infectious. Inappropriate treatment and disposal of HCW may pose health risks to humans indirectly through the release of pathogens and toxic pollutants into the environment. The biggest problem in HCW management is its handling, which causes anxiety over sorting and categorizing the waste. Hence, the current study identifies and addresses the challenges towards sustainable environmental development by managing infectious HCW in developing countries. Fuzzy Delphi method is used in the present study to carefully examine the barrier drawn from the literature and experts' opinions. The number of barriers taken into consideration for study are 30, which are then grouped into four main categories, that is, social, environmental, technological and economic barriers. Additionally, a hybrid strategy based on the fuzzy decision-making trial and evaluation laboratory is developed in this work to examine the significance and interrelationships of the identified barrier. The research outcome is a hierarchy and classification model based on the relative importance of the barriers. The results of this study indicate that: 'Lack of segregation', 'Inconsistency in waste collection', 'Unregulated disposal site' and 'Inadequate programme for training and awareness' require quick action. The conclusions obtained through the study would facilitate the preparation of check sheets for documenting HCW management procedures by the healthcare administration and Pollution Control Boards. Understanding the priority cause-group barrier would improve the long-term protection of the hospital environment from the spread of infection caused by the HCW.

Assessing the challenges to medical waste management during the COVID-19 pandemic: Implications for the environmental sustainability in the emerging economies

Emerging economies are struggling with proper and efficient management of waste due to their constrained resources and weak management. In recent days, this crisis has worsened due to the outbreak of the highly contagious COVID-19 pandemic. To avoid building up stockpiles and contaminating communities with potentially contagious medical waste (MW), and to ensure sustainability in the current and post-COVID-19 era, it is a dire need to develop and implement a safe and efficient medical waste management (MWM) system. This research, thereby, aims to identify, assess, and prioritize the key challenges to efficient and sustainable MWM to mitigate the impacts of the disruptions caused by situations like the pandemic in emerging economies. An integrated approach consisting of the Best-Worst Method (BWM), Interpretive Structural Modeling (ISM), and Cross-Impact Matrix Multiplication Applied to Classification (MICMAC) has been proposed to achieve the objectives. Based on the literature review and expert feedback, a total of seventeen challenges were identified and later prioritized by using BWM. The top twelve challenges have been further analyzed using ISM-MICMAC to examine their interrelationships. This study reveals that lack of proper law enforcement and insufficient financial support from investors and the government are two crucial challenges for efficient MWM implementation. The research insights can assist healthcare facility administrators, practitioners, and city managers in identifying the associated challenges and shaping strategic decisions for establishing and managing efficient MWM systems to ensure sustainable development in the post-COVID-19 era.

Continuously-deformable and stiffness-tunable soft manipulator achieving unmanned COVID-19 pandemic sampling

In recent years, COVID-19 has spread across the whole world, and manpowered collection of pharyngeal samples undoubtedly increases the possibility of cross-infections. In this article, based on our previous fabricated soft manipulator (Cell Reports Physical Science, 2021, 2, 100600), we performed the COVID-19 sampling on real human volunteers by exploiting a pre-programmed unmanned system. The unmanned sampling system mainly includes a soft manipulator and a rigid motion platform, which are adjusted by pneumatic control box and the motor control modules, respectively. Drawn on the lead-through teaching method, the unmanned sampling of COVID-19 is realized by recording the applied pressure in soft manipulator and the feed motion of rigid platform. This research provides a potential approach for unmanned COVID-19 sampling, solving the risk of cross-infection during manual collection.

Understanding of environmental pollution and its anthropogenic impacts on biological resources during the COVID-19 period

The global outbreak of the COVID-19 pandemic has given rise to a significant health emergency to adverse impact on environment, and human society. The COVID-19 post-pandemic not only affects human beings but also creates pollution crisis in environment. The post-pandemic situation has shown a drastic change in nature due to biomedical waste load and other components. The inadequate segregation of untreated healthcare wastes, chemical disinfectants, and single-use plastics leads to contamination of the water, air, and agricultural fields. These materials allow the growth of disease-causing agents and transmission. Particularly, the COVID-19 outbreak has posed a severe environmental and health concern in many developing countries for infectious waste. In 2030, plastic enhances a transboundary menace to natural ecological communities and public health. This review provides a complete overview of the COVID-19 pandemic on environmental pollution and its anthropogenic impacts to public health and natural ecosystem considering short- and long-term scenarios. The review thoroughly assesses the impacts on ecosystem in the terrestrial, marine, and atmospheric realms. The information from this evaluation can be utilized to assess the short-term and long-term solutions for minimizing any unfavorable effects. Especially, this topic focuses on the excessive use of plastics and their products, subsequently with the involvement of the scientific community, and policymakers will develop the proper management plan for the upcoming generation. This article also provides crucial research gap knowledge to boost national disaster preparedness in future perspectives.

A dual hesitant q-rung orthopair enhanced MARCOS methodology under uncertainty to determine a used PPE kit disposal

Healthcare waste management is regarded as the most critical concern that the entire world is currently and will be confronted with in the near future. During the COVID-19 pandemic, the significant growth in medical waste frightened the globe, prompting it to investigate safe disposal methods. Plastics are developing as a severe environmental issue as a result of their increased use during the COVID-19 pandemic which has triggered a global catastrophe and prompted concerns about plastic waste management. One of the biggest challenges in this circumstance is the disposal of discarded PPE kits. The purpose of this research is to find a viable disposal treatment procedure for enhanced personal protective equipment (PPE) (facemasks, gloves, and other protective equipment) and other single-use plastic medical equipment waste in India during the COVID-19 crises, which will aid in effectively reducing their increasing quantity. To analyse the PPE waste disposal problem in India, we used the fuzzy Measurement Alternatives and Ranking according to the Compromise Solution (MARCOS) technique, which included the dual hesitant q-rung orthopair fuzzy set. The fuzzy Best Worst Method (BWM), which is compatible with the existing MCDM approaches, is used to establish the criteria weights. Sensitivity and comparative analyses are utilised to confirm the stability and validity of the proposed strategy.

Elucidating the role of environmental management of forests, air quality, solid waste and wastewater on the dissemination of SARS-CoV-2

The increasing frequency of zoonotic diseases is amongst several catastrophic repercussions of inadequate environmental management. Emergence, prevalence, and lethality of zoonotic diseases is intrinsically linked to environmental management which are currently at a destructive level globally. The effects of these links are complicated and interdependent, creating an urgent need of elucidating the role of environmental mismanagement to improve our resilience to future pandemics. This review focused on the pertinent role of forests, outdoor air, indoor air, solid waste and wastewater management in COVID-19 dissemination to analyze the opportunities prevailing to control infectious diseases considering relevant data from previous disease outbreaks. Global forest management is currently detrimental and hotspots of forest fragmentation have demonstrated to result in zoonotic disease emergences. Deforestation is reported to increase susceptibility to COVID-19 due to wildfire induced pollution and loss of forest ecosystem services. Detection of SARS-CoV-2 like viruses in multiple animal species also point to the impacts of biodiversity loss and forest fragmentation in relation to COVID-19. Available literature on air quality and COVID-19 have provided insights into the potential of air pollutants acting as plausible virus carrier and aggravating immune responses and expression of ACE2 receptors. SARS-CoV-2 is detected in outdoor air, indoor air, solid waste, wastewater and shown to prevail on solid surfaces and aerosols for prolonged hours. Furthermore, lack of protection measures and safe disposal options in waste management are evoking concerns especially in underdeveloped countries due to high infectivity of SARS-CoV-2. Inadequate legal framework and non-adherence to environmental regulations were observed to aggravate the postulated risks and vulnerability to future waves of pandemics. Our understanding underlines the urgent need to reinforce the fragile status of global environmental management systems through the development of strict legislative frameworks and enforcement by providing institutional, financial and technical supports.

Increased personal protective equipment consumption during the COVID-19 pandemic: An emerging concern on the urban waste management and strategies to reduce the environmental impact

Personal protective equipments (PPEs) are essential protective products for individuals exposed to microorganism, toxic substances, and pathogens. However, the advent of the coronavirus pandemic generated a heavy demand for PPE, which has led to a rapid accumulation of plastic waste related to potentially infectious PPE in the urban waste stream. Mismanagement of these wastes can lead to subsequent environmental problems. This study estimates the daily consumption of facemasks, gloves, and daily medical waste generation during the SARs-CoV-2 pandemic in the selected 33 countries worldwide. The results indicate that China used the highest daily facemasks and gloves among these selected countries, followed by India, the US, Brazil, Indonesia, and Japan. Moreover, India is the first one in medical waste production, followed by the USA, Brazil, the United Kingdom, France, and Spain. The article also provides viable strategies and discusses the pros and cons of strategies to address the unprecedented generation of plastic waste material during the pandemic. This manuscript also encourages scientific communities and policymakers to pay exceptional attention to the pandemic's plastic waste.

Overcoming challenges due to enhanced biomedical waste generation during COVID-19 pandemic

Biomedical wastes (BMWs) are potentially infectious to the environment and health. They are co-dependent and accumulative during the ongoing coronavirus disease-2019(COVID-19) pandemic. In India the standard treatment processes of BMWs are incineration, autoclaving, shredding, and deep burial; however, incineration and autoclaving are the leading techniques applied by many treatment providers. These conventional treatment methods have several drawbacks in terms of energy, cost, and emission. But the actual problem for the treatment providers is the huge and non-uniform flow of the BMWs during the pandemic. The existing treatment methods are lacking flexibility for the non-uniform flow. The Government of India has provisionally approved some new techniques like plasma pyrolysis, sharp/needle blaster, and PIWS-3000 technologies on a trial basis. But they are all found to be inadequate in the pandemic. Therefore, there is an absolute requirement to micromanage the BMWs based on certain parameters for the possible COVID-19 like pandemic in the future. Segregation is a major step of the BMW management. Its guideline may be shuffled as segregation at the entry points followed by collection instead of the existing system of the collection followed by segregation. Other steps like transportation, location of treatment facilities, upgradation of the existing treatment facilities, and new technologies can solve the challenges up to a certain extent. Technologies like microwave treatment, alkaline hydrolysis, steam sterilization, biological treatment, catalytic solar disinfection, and nanotechnology have a lot of scopes for the treatment of BMWs. Hi-tech approaches in handling and transportation are found to be fruitful in the initial steps of BMW management. End products of the treated BMWs can be potentially fabricated for the application in the built environment. Some policies need to be re-evaluated by the health care facilities or government administrations for efficient BMW management.

Challenges and measures during management of mounting biomedical waste in COVID-19 pandemic: an Indian approach

BACKGROUND

During coronavirus pandemic, an unpredictable pile of biomedical waste (BMW) gathers at the top. India produces 710 tonnes of biomedical waste daily. The contribution of COVID-19 related biomedical waste was 126 tonnes per day in first wave of the pandemic. BMW's rapid growth is putting a strain on current waste management facilities, especially in developing countries. A sudden boost in biomedical waste needs rapid and proper segregation and disposal methods to avoid future consequences.

MAIN BODY OF THE ABSTRACT

From literatures and statistical data available on Central Pollution Control Board (CPCB) it shows that India lags behind in large-scale sorting, collection, careful storage, transfer and disposal of bio waste. India has its own guidelines set by the CPCB to ensure the safe disposal of biomedical waste during diagnosis, treatment and quarantine of COVID-19 patients. Although there are strict guidelines for bio-waste management, many hospitals in the process of implementing them often dispose of waste in inappropriate, chaotic and indiscriminate ways due to negligence or laziness. Often, due to poor separation practices, hospital waste is mixed with general waste, resulting in harmful overall waste flow. Waste disposal handlers are not safe due to their exposure to various health risks and inadequate training in waste management. The present review sheds light on guidelines, measures, and challenges related to biomedical waste management.

SHORT CONCLUSION

Improper waste separation leads to improper waste disposal. Waste generation and management issues are causing daily problems as they have a profound impact on the dramatically changing global environment, including air, water and soil pollution. In addition, BMW's daily production and its processing are inversely proportional. This situation suggests that India will soon be drowning in its own garbage. The focus of this review is on the generation and disposal of biomedical waste. Based on a review of the literature, this evaluation provides a comparative picture of the current status of waste generation, national waste management strategies, and some measures to contribute to waste management and avoid future disasters.

Comparison of microwave and autoclave treatment for biomedical waste disinfection

As the world is facing a Covid-19 pandemic, this virus teaches a lesson about the importance of on-site disinfection. On-site disinfection/sterilization with real-time monitoring of biomedical waste generated from the medical facilities is mandatory to prevent hospital-acquired infection (HAI). In this study, the life cycle assessment of two technologies, i.e., microwave (radiation-based) and autoclave (steam-based) were performed to summarize the inside-out evaluation of both technologies in terms of efficiency, efficacy, and cost-effectiveness. The results of disinfection efficacy indicated a log 10 reduction (almost 100%) in the vegetative load of microorganisms compared to the control, showing a similar level of disinfection efficacy of both strategies. Additionally, both technologies were compared on several parameters, and it was discovered that the autoclave uses more time and resources than the microwave. The total cost of an autoclave to the government is approximately double that of a microwave, while the operational cost of an autoclave is more than double that of a microwave. The findings from this study indicate that MACS may be used as a dry technique of biomedical disinfection, and its portability, tunability, and compactness make it a suitable alternative for biomedical disinfection and sterilization.

Graphical abstract

A review on emergency disposal and management of medical waste during the COVID-19 pandemic in China

The surge of medical waste (MW) generated during the COVID-19 pandemic has exceeded the disposal capacity of existing facilities. The timely, safe, and efficient emergency disposal of MW is critical to prevent the epidemic spread. Therefore, this review presents the current status of MW generation and disposal in China and analyzes the characteristics and applicability of emergency disposal technologies. The results show that movable disposal facilities can dispose of infectious MW on site, even though most of their disposal capacity is at a low level (<5 t/day). Co-disposal facilities need to be reformed completely for emergency MW disposal, in which separate feeding systems should be taken seriously. Specifically, municipal solid waste (MSW) incineration facilities have great potential to improve emergency MW disposal capacities. For hazardous waste incineration facilities, compatibility of the wastes must be matched to the composition and calorific value of the waste. As for cement kiln, MW can only be used as an alternative fuel instead of a raw material for cement. Based on the environmental risk and technical adaptability, the six emergency MW disposal technologies are recommended to be prioritized as follows: movable microwave sterilization, movable steam sterilization, movable incineration, co-incineration with hazardous waste, co-incineration with MSW and co-disposal in cement kilns. Infectious MW, especially COVID-19 MW, should be prioritized for disposal by centralized and movable disposal facilities, while non-infectious MW can be disposed of using co-disposal facilities. All stakeholders should strengthen the delicacy management of the end-of-life stage of MW, including collection, classification, packaging identification, transportation, and disposal. Currently, it is necessary for centralized disposal enterprises to follow the emergency disposal operation flowchart. From a long-term strategic perspective, making full use of regional movable and co-disposal facilities in the megacities can effectively enhance the emergency MW disposal capacity.

Assessment of knowledge, attitude, and practice about biomedical waste management among healthcare workers during COVID-19 pandemic in a health district of West Bengal

Background

Efforts to combat Coronavirus disease (COVID-19) pandemic have significantly increased the quantity of bio-medical waste (BMW) generation.

Objectives

A cross-sectional study was performed to assess the knowledge, practice, and attitude and factors affecting knowledge on BMW management among Health Care Workers (HCWs) when taking care of patients with COVID-19.

Methods

This cross-sectional study was conducted among 384 HCWs, actively involved in caring of COVID-19 patients in Healthcare settings of North 24 Parganas Health District, West Bengal. Data were collected using a structured self-administered questionnaire (through Google Forms) and an observational checklist after selection criteria and having consent. The Questionnaire included four sections like the sociodemographic information, knowledge related to BMW management, observational questionnaire assessing the practice of HCWs on BMW management and rating scale related to attitudes towards BMW management.

Results

166 HCWs (43.2%) had an excellent knowledge with overall mean score 13.5 ± 3.6. A high mean score (14.4 ± 3.2) was obtained by doctors followed by nurses (13.6 ± 3.8). Regarding practice, the majority of HCWs (52.8%) followed the color-coding of BMW and 49.5% followed policies in separating the wastes according to hazard. Doctors (91%) and nurses (81%) had more favorable attitude than others. There was a statistically significant association found among knowledge level and educational qualification (P = 0.0001), gender (P = 0.001), and work experience (P = 0.05) and work area (P = 0.05).

Conclusion

Emphasis should be given to aware and train all HCWs regarding proper BMW management during this pandemic to prevent infection transmission.

Assessment of Knowledge, Practice and Attitude about Biomedical Waste Management among Healthcare Professionals during COVID-19 Crises in Al-Ahsa

Biomedical waste (BMW) management is an essential practice of healthcare professionals (HCPs) for preventing health and also environmental hazards. Coronavirus disease (COVID-19) has become a global pandemic, posing significant challenges for healthcare sectors. A cross-sectional study was performed to assess the knowledge, practice, and attitude on BMW management among HCPs when taking care of patients with COVID-19 and associated with demographic variables. From Al-Ahsa healthcare sectors, 256 HCPs were selected randomly, of which 105 (41%) had excellent knowledge, 87 (34%) had good knowledge, and 64 (25%) had poor knowledge with a mean score of 13.1 ± 3.6. A higher mean score was (14.4 ± 3.2) obtained by physicians, and (13.6 ± 3.8) nurses than the other HCPs. Regarding practice, 72 (28.1%) HCPs used and discarded PPE while handling biomedical wastes. Additionally, 88 (34.4%) followed proper hand hygiene before and after each procedure and whenever needed. Physicians, nurses, and respiratory therapists had a more favorable attitude than other HCPs. There was a statistically significant association found among knowledge level and educational qualification (p < 0.0001), gender (p < 0.001), and work experience (p < 0.05). Emphasis is needed to train all HCPs regarding proper BMW management during this pandemic to prevent infection transmission.