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Table of Contents
REVIEW ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 57-61

Biomedical waste management in Panchakarma practice: Present scenario and scope


Department of Panchakarma, AIIA, New Delhi, India

Date of Submission09-Apr-2021
Date of Decision26-Feb-2022
Date of Acceptance28-Feb-2022
Date of Web Publication31-Mar-2022

Correspondence Address:
Dr. Diksha N Kabra
Department of Panchakarma, AIIA, New Delhi 110076.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JISM.JISM_36_21

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  Abstract 

Ayurveda is a traditional medical system of India. In Ayurveda, Panchakarma (fivefold detoxification treatment) procedures are designed for internal purification and cleansing. As per the Indian government’s initiative (launched in September 2014), Ayurveda is part of wellness industry. There is a constant rise in the number of Ayurveda clinics, hospitals, wellness centers, and spas in India. The various Panchakarma procedures performed in these hospitals, clinics, wellness centers, and spas generate biomedical wastes (BMW). Metropolitan areas in India bring about 62 million tonnes of wastes annually, and this figure is predicted to rise to 165 million tonnes by 2030. Forty-three million tonnes of the municipal solid waste are collected every year, of which 31 million are disposed of in landfills and only 11.9 million are treated. Pharmaceutical wastes are one among them. Reports from the Indian medicinal plant industries indicate that presently more than 9000 plant industries are registered in India, which produces a huge amount of waste each year. This has created a need in the proper management of waste generated. Here is the description and discussion of categorization, classification, and treatment options for waste generated during Panchakarma procedures in Ayurveda hospitals. Effective and proper management of the BMW is necessary to maintain personal as well as environmental health. The current available techniques for the treatment of waste generated during Panchakarma procedure are sewage drainage, incineration, and landfill. Nothing turns around to be waste until it is being not used further with intelligence. The natural cycles of life taught us the same through science: utilizing of three Rs of ideal waste management. While further advancement can include the use of phytoremediation, composting, vermicomposting, biofiltration, bioaugmentation and use of solar energy in waste management.

Keywords: Ayurveda, biomedical waste, Panchakarma


How to cite this article:
Kabra DN, Bhatted SK, Dharmarajan P. Biomedical waste management in Panchakarma practice: Present scenario and scope. J Indian Sys Medicine 2022;10:57-61

How to cite this URL:
Kabra DN, Bhatted SK, Dharmarajan P. Biomedical waste management in Panchakarma practice: Present scenario and scope. J Indian Sys Medicine [serial online] 2022 [cited 2022 May 27];10:57-61. Available from: https://www.joinsysmed.com/text.asp?2022/10/1/57/342318




  Introduction Top


Any waste consisting of infectious material is termed as biomedical waste (BMW), which is of medical or laboratory origin.[1] It may be solid or liquid or infectious as well as non-infectious. Infectious waste includes discarded blood, sharps, human or animal tissue, used bandages, discarded gloves, and body fluids. Sharp waste includes contaminated needles, scalpel, or any devices that may penetrate skin. The BMW is distinct from normal waste because of its infectious origin, which can lead to toxic effects on human being and environment too. In Ayurveda, Panchakarma procedures can lead to the generation of different types of BMW such as human fluids, sharp instruments like needle, scalpel, blade, syringe, etc., cotton bandage, markin cloth, linen, sheets, gloves, plastic or fiber lids/bottle, various medicinal powders, leaves and food preparations, milk products, residual oils, which has significant environmental impact too. Many patients undergoing Panchakarma procedure are immunologically weak, having autoimmune diseases, diseases of chronic nature, so it is important to take care of such patients and to prevent hospital-borne infections with the proper management of BMW. As Ayurveda is a holistic science and intensely connected to the environment for healing process, it is necessary for Ayurvedic practitioners to work for the proper treatment and management of BMW generated during Panchakarma procedure. [Table 1] describes classification, category, and disposal options of BMW.[2][Table 2] describes BMW segregation.
Table 1: Classification, category, and disposal options of biomedical waste[3]

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Table 2: Biomedical waste segregation

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  Materials and Methods Top


The categorization, classification, and treatment options of BMW are compiled from various research articles.

Observations

The amount of waste that is generated annually is quite large and alarming. It is observed that there are mainly two types of wastes produced during Panchakarma procedures: one is herbal-based (herbal powders) waste, while another is residual oil, ghee. These two wastes have to be segregated and disposed differently. Some waste includes food preparations like Shasthika Shali Pinda Swedana (a type of sudation done with food preparations); this also has to be categorized and disposed differently. Waste is segregated into different categories such as yellow, red, etc., which is described in [Table 2]. There is a minimal involvement of blood-stained wastes in Panchakarma procedures; maximum waste is generated through herbal origin. Currently, sewer, incineration, and dumping are the techniques used for the treatment of BMW. Further advancement includes the use of techniques such as bioremediation, composting, biofiltration, and solar energy.


  Results Top


The currently used techniques such as incineration, dumping, and sewer are associated with several side effects, which need to be addressed. There is a need to develop reuse protocol for wastes generated through Panchakarma procedures. The three Rs of ideal waste management should be applied in day-to-day practice. There is a need of hour to adopt advanced techniques that are associated with lesser side effects and better outcome.


  Discussion Top


Waste is also not waste when used properly. Following are the various techniques that are used currently, and further scope is also discussed.

Waste Water Management in Panchakarma Procedures

Panchakarma procedures need a large amount of water for different purposes such as making decoction, hot water for Parisheka (pouring the stream of medicated decoction), preparation of Basti (enema), Jala Dhara (pouring stream of medicated water), Avagaha Swedana (tub bath sudation), cleaning of various equipments in Panchakarma theater, etc. This water should be recycled first, and later it can be drained into domestic sewage plant. Recycling process includes primary and secondary treatments. Water can be reused for gardening or replenishing surface water. The waste water from Panchakarma procedures mostly includes oil, powder, and human wastes. Therefore, proper treatment is needed before draining it into sewage plant. The bigger Panchakarma setup should include water treatment plants for its proper reuse. It ensures physical and chemical quality of water. Waste water treatment plants are of different types such as effluent treatment plant, sewage treatment plant, and combined effluent treatment plant. Sewage treatment plant is most preferable for waste water management in Panchakarma procedures.[2][Figure 1] depicts BMW flow.
Figure 1: Biomedical waste flow

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Current Disposal Techniques

Sewage plants/sewer

This is widely adopted and also non-expensive method for the disposal of liquid wastes such as products of Vamana (therapeutic emesis), Virechana (therapeutic purgation), residual of decoction required for preparation of Basti (enema), and Parisheka. Most of the waste does not cause any adverse effect, but if it is contaminated with human waste products and drained directly, then it causes adverse effect on public health. Therefore, waste containing human waste products should be treated first and later can be drained into domestic sewage plants. The major drawback is when water is contaminated with oil, or any other therapeutic medicines such as herbal powder cause clogging due to sedimentation, which can damage the useful bacterial flora.[3]

Incineration

This process is used for products that cannot be reused or recycled. It is useful for solid as well as dry herbal organic wastes such as used Kizhi or Pottali (bag filled with medicines), food preparation, Kalka (paste of drugs), choorna (powder of drugs), etc. The advantage of incineration is that it needs only small amount of landfill and also can be worked in any atmosphere and easy to adopt. Incineration results in the pathogen destruction and also reduces the weight and volume of waste, but leads to the formation of solid material known as “biomedical waste ash.” This ash residue is responsible for increasing concentrations of organometallic compounds and hydrocarbons in the environment.[4] The drawback of incineration is that it causes air pollution.

Dumping

The large quantity of soiled wastes is disposed with this technique. This is the subsequent step of disposing ash generated because of incineration. The disposal of BMW and poisonous waste in land causes contamination of ground water. Dumping the waste in land results in the formation of biggest anthropogenic emission source.[5] Openly dumping the waste leads to the risk of disease transmission and pollution as well as forms threat to animals and scavengers.[3] Different harmful gases generated via decaying wastes are released into air. Over dumping and no longer focusing at the organic remedy for the landfill will be the reasons to harm the ecosystem.

Three Rs of Ideal Waste Management

Reduce

It includes the process of reducing the production of waste during procedure, and the segregation of waste plays an important role in the reduction of waste. This approach causes the conservation of natural resources.

Reuse

Dry powder used during Rookshana (dehydrating therapy) procedure can be reused for fumigation purpose. The residual of Kalka (residue of paste of herbal drugs) of Sneha Kalpana, i.e., medicated oils and ghee, can be used for Snigdha Udvartana (powder massage).[6] Oil can be reused for Abhyanga (massage) or external procedures of the same person. The waste water containing oil can be treated with gravity oil separator; the separated oil from this may be reused for flaming other solid wastes and greasing manufactures, and the separated water can be used for farming, scenery, and flushing toilet. Dried powder that is used in the preparation of Basti (enema) can be reused for fumigation; residual Kashaya Dravya (decoction drugs) from Basti preparation can be reused to make decoction as it has the same potential, the only difference is in the concentration that it can be administered in large amount.[3]Kashaya Kalka (paste of drugs used for preparation of decoction) may also be used for the preparation of compost, which eventually leads to manure. Properly sterilized glycerine syringe, Basti Netra (instrument used to administer enema), can be reused for the same patient.

Recycle

It can be achieved by converting waste into energy. Some techniques can be developed to form biodiesel from waste oil. The residual of Kashaya and herbal waste can be used for biofuel production. Plastic and glass waste can be recycled.

Further Advancements

Bioremediation is another emerging branch, which should be focused for waste management. It involves the use of natural microbiomes to break down harmful materials into less harmful or harmless materials. This approach is significant as it does not make use of chemical compounds, as chemical compounds are very dangerous for plants and humans existence. Some research file that uses of Gomaya (cow dung) as an exquisite bioremediation approach.[3] Cow dung is cheap and easily available source of microflora. Different biological organisms found in Gomaya decrease the quantity of pollutants in the environment. Some strategies of bioremediation are described below.

Phytoremediation

Phytoremediation is one of the bioremediation processes that uses different types of plant for removal, transfer, stabilization, and/or destruction of contaminants in the soil and groundwater.[3] There are various ways of phytoremediation process. These are rhizosphere biodegradation, phytostabilization, phytoaccumulation, phytovolatilization, and phytodegradation. It can be adopted for metallic components, volatile organic compounds, and semivolatile organic compounds.

Composting

It is one of the cost-efficient methods of bioremediation. It can be adopted for the disposal of herbals waste. Significant evidence exists for the utilization of compost for efficient bioremediation of natural pollutant and soil pollutants.[7]

Vermicomposting

Organic waste can be disposed by using vermiculture by means of this technique; herbal waste is converted into vermicompost by adding vermi. There is significant evidence of the use of vermicomposting for the treatment of waste water, the sanitation of polluted soils, and the improvement of agricultural productivity.[8]

Biofiltration

Biofiltration is the process for removal of contaminants present in liquid or gaseous effluents by making the use of aerobic microorganism.[9] Pharmaceutical companies’ effluent is consisting of high concentration of phenolic compounds; if this is not treated properly, it can further lead to serious environmental issue. Biofiltration technique shows evidence in decreasing amount of phenolic residue, as well as it is available at low cost and low energy and requires less space.[9]

Bioaugmentation

Bioaugmentation is the process of adding archaea or bacterial cultures to improve the rate of degradation of waste although the organisms that are generated from waste may be able to break down the waste, but, in some cases, it is inefficient adding of microbes that can speed up the rate of degradation.

Application of oil-eating microbes

In Panchakarma procedures, oils are used in large quantity while conducting various therapies; thus, it generates a huge amount of waste oil. The application of oil eating microbes can be effective to break down the oil before draining it into sewage plants, which can be helpful to reduce further soil and water contamination.

Solar Energy in Waste Management

Solar energy is abundantly available everywhere which is a cost-effective way of sterilizing infectious medical waste. It can be used for both types of waste such as solid waste and liquid waste. With the use of solar energy, one can disinfect contaminated water, and solar distillation and solar photocatalytic degradation are some ways.


  Conclusion Top


For maintaining social and public health, it is a need of time to implement proper rules and regulation for segregation and treatment options of BMW. To maintain proper ecosystem, it is ethical and social responsibility of healthcare workers to do proper management of waste generated during procedures. At the same time, we need cost-effective, environment-friendly and user-friendly techniques for the management of waste; also there should be further advancement in the treatment options such as the use of bioremediation, composting and vermicomposting, and biofiltration. Better training of workers is needed to achieve this.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Wikipedia. Biomedical waste. 30 June 2021. Available from: https://en. wikipedia.org/w/index.php?title=Biomedical_waste&oldid= 989206782. Retrieved on 23 Nov 2021.  Back to cited text no. 1
    
2.
Sahu L, Kumar AM, Ba L Establishment of eco-friendly Panchakarma center: A review. Int J Res Ayurveda Pharm 2017; 8:18-21.  Back to cited text no. 2
    
3.
Rajan R, Robin DT, Vandanarani M Biomedical waste management in Ayurveda hospitals—Current practices and future prospectives. J Ayurveda Integr Med 2019;10:214-21.  Back to cited text no. 3
    
4.
Rajor A, Xaxa M, Mehta R, Kunal . An overview on characterization, utilization and leachate analysis of biomedical waste incinerator ash. J Environ Manage 2012;108:36-41.  Back to cited text no. 4
    
5.
Agnihotri AK Current scenario of Indian landfill and its solution through biotechnological approaches. 2nd International Congress on Green Urban Futures. [Google Scholar] Nov 3-7, 2014, Bangalore.  Back to cited text no. 5
    
6.
Randhawa GK, Kullar JS Bioremediation of pharmaceuticals, pesticides, and petrochemicals with Gomeya/cow dung. ISRN Pharmacol 2011;2011:362459.  Back to cited text no. 6
    
7.
Marin JA, Hernandez T, Garcia C Bioremediation of oil refinery sludge by landfarming in semiarid conditions: Influence on soil microbial activity. Environ Res 2005;98:185-95.  Back to cited text no. 7
    
8.
Sathwik MS, Banu W Review on “Management of herbal industrial waste through vermicompost.” Int Ayurvedic Med J 2019;7:1350-3.  Back to cited text no. 8
    
9.
Das Neves LCM, Miyamura TTMO, Moraes DA, Penna TCV, Converti A Biofiltration methods for the removal of phenolic residues. Appl Biochem Biotechnol 2006;129:130-52.  Back to cited text no. 9
    


    Figures

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    Tables

  [Table 1], [Table 2]



 

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