In June this year, tens of hospitals in the capital city New Delhi and in Bangalore were sent closure notices for flouting rules from fire safety to biomedical waste disposal. This didn’t come out of the blue but was in response to blatant refusal of these hospitals to bring their premises and operations up to code despite previous warnings.

In 2016, the Fire and Emergency Services Department issued an ultimatum to 770 hospitals in Bangalore to comply with fire safety measures. With many flammable objects like oxygen cylinders and chemicals, hospitals are major fire hazards, which is even more serious when one considers their immobile and convalescing occupants. Two years later, nothing had been done and as many as 81 hospitals in Karnataka were issued notices and might have criminal cases filed against them for non-compliance.

When fire alarm rings in hospitals

The National Accreditation Board for Hospitals & Healthcare Providers (NABH) audits compliance with the National Building Code of India – 2005, that covers construction, occupancy and protection features that are necessary to minimise danger to life and property from fire. Hospitals, which are categorised as Group C institutional buildings, come with specific requirements on top of general requirements common for all buildings.

The NABH list almost 50 measures that it checks for in hospitals, including:

1. Updated NOC from the state’s fire department with a formally appointed Fire Safety Officer-in-charge. A multidisciplinary safety committee, that meets at least once in three months, will review reports on regular mock drills and address issues that crop up during the same.
2. An approved Fire Safety Manual with plans for fire prevention and control, protocols for fire safety installations and codes for announcements of fire-related emergency, procedures and communication protocols. An Emergency Command Centre that becomes functional immediately when there is an emergency is recommended.
3. Well-defined and uncluttered fire exits that end on the ground floor or refuge area or any safe place decided by the hospital management. Fire signs in appropriate locations that glow in the dark and are bilingual (with one local language).
4. Fire Doors with appropriate fire rating which lead outside, are open at all times and preferably have panic bars. Open fire cabinets and appropriate number and type of fire extinguishers that are tested frequently. Access for fire brigade around the building and proper fire training imparted to staff.
5. Protocols in place governing the storing, use and disposal of flammable materials.

Reckless disposal of biomedical waste

Meanwhile in Delhi, DPCC (Delhi Pollution Control Committee) sent closure notices to 12 hospitals in June (later expanded to 32 hospitals) for flouting biomedical waste norms. According to the Central Pollution Control Board (CPCB) annual report of 2016, India generates approx. 517 tonnes of biomedical waste every day. By 2022, these figures are likely to increase close to 775.5 TPD. It is critical to implement, with extreme prejudice, the proper disposal of such dangerous waste.

Safe and effective management of waste is not only a legal necessity but also a social responsibility. Under the Environment Protection Act 1986, the Centre had included the section on the generation of bio-medical waste in hospitals, which was later revised to the Bio-Medical Waste Management Rules, 2016. According to these rules, health care facilities are required to

• Handle bio-medical waste without causing any adverse effect on human health and the environment and submit annual reports and accidents reports to the State Pollution Control Board
• Store segregated biomedical waste in a safe, ventilated and secured location
• Strictly monitor that there will be no secondary handling, pilferage of recyclables, scattering or spillage by animals
• Conduct pre-treatment of all the laboratory waste, microbiological waste, and blood samples before finally disposing of to CBMWTF
• Directly transport this waste to the common bio-medical waste treatment facility for the appropriate treatment/disposal

These norms were further amended in February this year, instructing all bedded hospitals (irrespective of their number of beds) must regularly update their Bio-medical Waste Management register.

The author, Sonali Desai is a Mumbai - based freelance writer and a member of 101Reporters.com, a pan-India network of grassroots reporters.