Total Environment Research Themes 7 (2023) 100062

Contents lists available at ScienceDirect

Total Environment Research Themes

journal homepage: www.elsevier.com/locate/totert

Chorographic assessment on the overburden of single-use plastics bio-

medical wastes risks and management during COVID-19 pandemic in India
K. Kathiravan a, A. Vidyasakar b,⇑, C. Pradeep c, Usha Natesan d, K. Ajith Kumar b, V. Arun Bharathi b,
G. Nantha Kumar b, S.D. Arun Prakash e
a
Environmental Expert, Corporate Centre (Environmental, Sustainable and Governance), Department of Power Transmission and Distribution IC, Larsen and Toubro Construction Ltd,
Chennai, India
b
Department of Geology, Periyar University Centre for Post Graduate and Research Studies, Dharamapuri, 635 205, India
c
Institute of Remote Sensing, Anna University, Chennai 600 025, India
d
Centre for Water Resources, Anna University, Chennai 600 025, India
e
Department of Orthopaedics and Emergency, Government Sub District Hospital, Harur, Dharmapuri, 636908, India

A R T I C L E I N F O A B S T R A C T

Keywords: Amid the rapid influx of SARS CoV 2 patients in various hospitals across India, the disposal of COVID‐19 bio‐
COVID‐19 medical wastes become a major challenging crisis in these days. As a consequence, the unexpected surge of uti-
Bio‐Medical Waste Management (BMWM) lizing Single‐Use Plastics (SUP) from Personal Protection Equipments (PPEs) in particular protective gloves,
Single‐Use Plastics (SUP) nose masks, body aprons. is common in day to day and estimated as minimum of 730 g of waste can be gen-
Health and Environmental Risk Assessment
erated per day/person in India. The research objectives on a national scale focuses that the document being
GIS
active belongings, communications and preparations associated with hospital desecrates care and the existing
facts on the physical condition and ecological risk on health care biomedical throw away which dropped during
the SARS CoV 2 virus disease pandemic. Based on number of confirmed COVID‐19 cases 5,78,578 and
3,92,1149 health care workers as of 1st July 2020 (includes active, recovered and deaths) in India is assessed
using GIS that an average 3150 tons per day of SUP waste generated only due to COVID‐19 even though the
hospitals make all safety measures to put away the clinical wastes. The States like Maharashtra (484.12tons/-
day), Tamil Nadu (337.76 tons/day), Andhra Pradesh (229.23 tons/day), Rajasthan (183.87 tons/day), Gujarat
(181.41 tons/day), Karnataka, Kerala and Uttar Pradesh are over loaded with 212.73, 244.36 and 176.86
tons/day respectively greater than their normal per day bio‐medical waste generated. This study finds the
space in handling of Bio‐Medical Waste Management of the pandemic COIVD‐19 outbreaks and its’ remedial
actions to improve the necessity in the future emergency in the developing countries like India.

1. Introduction
In the progress of inhabitant, urbanization, trade and industry
developments, all aggravate major threats in emerging waste segment
markets due to the present swift of waste generation during the out-
break of pandemic Coronavirus disease 2019 (COVID‐19) worldwide.
It results in serious health, safety and environmental impacts, in partic-
ular, the developing nations as of indisposed ravage care and control
where often burned or discarded in unregulated dumps. The develop-
ing nation like India which is profoundly populated, faces major diffi-
culties to deal with the danger during take care of and securing the
environment just as the general wellbeing from this COVID‐19 virulent
disease ailment. The environmental pollution related to hazardous
biomedical wastes specifically some carbon contained chemicals and
solutions able to absolve noxious substances towards insecure trans-
port and throwing away. Emissions from the incinerators in Bio‐
Medical Waste Treatment Facility Centres (BMWTFCs) consist of toxic
compounds like dioxins and furans, which are to be minimized and

Abbreviations: ANM and GNM, Auxiliary Nursing Midwifery and General Nursing and Midwifery; BMW, Bio‐Medical Waste; BMWTFC, Bio‐Medical Waste Treatment Facility
Centres; CBMWTFs, Common Biomedical Waste Treatment Facility; COVID‐19, Coronavirus disease 2019; CPCB, Central Pollution Control Board; EPI, Environmental Performance
Index; GIS, Geographic information system; HCFCs, Health Care Facility Centres; MBBS, Bachelor of Medicine, Bachelor of Surgery; PPE, Personal Protective Equipment; SARS‐CoV‐2,
severe acute respiratory syndrome coronavirus 2; SUP, Single‐Use Plastic; WHO, World Health Organization.
⇑ Corresponding author.
E-mail address: a.vidyasakar@gmail.com (A. Vidyasakar).

https://doi.org/10.1016/j.totert.2023.100062
Received 20 February 2023; Revised 25 May 2023; Accepted 16 June 2023

2772-8099/© 2023 The Authors. Published by Elsevier B.V.

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
K. Kathiravan et al. Total Environment Research Themes 7 (2023) 100062

managed. The jeopardize circumstances besides the process in excel- tective Equipment and Related IPC supplies (World Health
lence with the potentially infectious medical garbage increases the Organization ‐ WHO, 2020) per day per person in the health centres.
effect of ecological disorders (Zimmer and McKinley, 2008; The active Health Care Facility Centres (HCFCs), facilities with num-
Schuhmacher et al., 2014; Zhang et al., 2015; Ananth et al., 2010). ber of beds, testing centres, health care workers in the health centres,
The recommended defensive medical kit and tools against the health active registered cases, number of workers, list of number of active
care workforce and the persons who treat the infected patient brings treatment waste units’ state wise and their performance capacity
an end to biomedical wastes in daily basis. It increases potential pres- derived from available government portal and published reports. The
sure to the BMWTF centres for handling, treating and disposing which quantity of SUPs generated derived from the number of workers were
leads to health and environmentally hazardous to the nation using the PPEs state wise. The overall statistically consolidated data
(Nzediegwu and Chang, 2020). The progressive usage of Single‐Use interpreted using ArcGIS 10.
Plastics (SUPs) has seen a resurgence, largely driven by increased
use of plastic‐based PPEs such as gloves, masks, aprons and test kits
3. Medicaid Waste: Facts and data of WHO
and apparatus like vials, swabs, test apparatus, ventilators, and disin-
fectant bottles, as well as packaging materials (Sinha et al., 2020) in
A great deal of clinical fritter away incorporates overwhelming
this present scenario threatening massive challenges to the waste sec-
trashes, spiky objects, chemical stuffs, pathological ravages, nuclear
tors. Henceforth, these wastes are identified as hazardous biomedical
debris so as to accommodate profoundly with toxic materials force
wastes in the eradication of the COVID‐19 outbreak. From past dec-
very perilous situation to clinical staff, sick ‐beings moreover on the
ades, removal of plastics, management of microplastics, are major
whole populace (Mostafa et al., 2009). Given clinical wastes from
challenges for all the policy decision makers as well as for scientists
the COVID‐19 outbreak may incorporate needles and sharp materials
due to emerging plastic debris along with the existing microplastics
polluted with organic liquids like bandage, gloves or outfits; neurotic
crisis (Ma et al., 2021; Saliu et al., 2021; Shen et al., 2021; Wang
wastes; and pharmaceutical wastes. The administration of
et al., 2021). In addition to that, the overburden of PPEs made up
Bio‐Medical Waste (BMW) involves three primary exercises: (1) accu-
off SUPs waste generated during outbreak of COVID‐19 pandemic
mulation and detachment at the sources (2) transiting to particular
were transported either in the treated form nor in untreated form
provisions (3) right treatment and ejection (Ashworth et al., 2014).
entered the marine ecosystem by direct or indirect sources, impacts
The clinical wastes can be nursed by a few strategies, i.e., sterilization,
drastic load in addition with the plastic quantum in the existed condi-
replacement, absorption, ionizing radiation, transformation, disinfec-
tion, evidenced with recent studies stated the increased level of pollu-
tion, decontamination and sanitization (Board, 2017) amid burning
tion due to PPEs used against the COIVD‐19 discharged in
clinical wastes which is the most generally run through approach in
waterbodies, beach environment (Gunasekaran et al., 2022;
the present day (World Health Organization ‐ WHO, 2020). Neverthe-
Ammendolia et al., 2021; Aragaw, 2020; Ardusso et al., 2021;
less, the fly ash, in addition to other toxic wastes be the result of
Akhbarizadeh et al., 2021; Akhbarizadeh et al., 2021; Cordova et al.,
smouldering possibly will transport atmosphere effluence also an inapt
2021; Ben et al., 2021; De‐la‐Torre et al., 2022; De‐la‐Torre et al.,
locale of cremation subsequently put a noteworthy death‐defying
2021; Hassan et al., 2022; Patrício Silva et al., 2020; Rakib et al.,
exposure to the nearby dwellers (Hu et al., 2015; Yu et al., 2020). At
2021; Aragaw et al., 2022; Hatami et al., 2022; Mghili et al., 2022).
the worldwide level, 18% − 64% of medicinal services foundations
During the COVID‐19 pandemic outbreak, major rivers and watersheds
are accounted for having unacceptable hospital Bio‐Medical Waste
account for global riverine pandemic associated plastics discharge into
(BMW) disposal service, indicators incorporate absence of mindful-
the sea. The major contribution of rivers from Asia (73%), Europe
ness, lacking assets along with contemptible dump clearance system
(11%) and with minor contributions from other continents discharged
(Rutala and Mayhall, 1992; Mostafa et al., 2009; World Health
pandemic SUPs which is 87.4% of the excess waste was from hospitals
Organization ‐ WHO, 2013). Of the aggregate sum of waste created
where high density population, large runoff with high velocity flow
by medicinal services tasks are around 85% overall non‐hazardous
are the major reasons (Peng et al., 2021). The Yale Centre for Environ-
waste and the rest15% is viewed as an unsafe substance that would
mental Law and Policy established in 1994 which estimates the pre-
be irresistible, harmful or dangerous. The significant sources are from
sent time India and its’ 180th rank among globally in 2022, based
emergency clinics and other wellbeing offices, labs and centre of
on (Environmental Performance Index (EPI)) is the global environment
research, morgue and post‐mortem areas, animal studies and testing
matrices of the country Environmental Performance Index environ-
workshops, blood donation centres and assortment administrations,
mental policy challenges, performance on sustainable issues
convalescent homes for the old (World Health Organization ‐ WHO,
(Wendling et al., 2022). Considering the current population growth
2019). The open consuming and burning of human services wastes
and Biomedical Waste propagation rate in India, it is anticipated to
can under certain conditions, which bring about the outflow of diox-
generate more waste by the year 2050 at a growing rate of 1.45 times
ins, furans, and particulate issue. The course of action to guarantee
the existing trend. Therefore, it is a vital focus to create a proper
the safe and ecologically solid administration of human services squan-
scheme of collecting clinical discharges strategy to help out decreasing
ders can keep unfavourable wellbeing and natural effects from such
the potential risk on the environmental deterioration of BSW to secure
waste counting the casual arrival of synthetic or organic risks includ-
human health. This paper explores the lacuna and the requirement for
ing drug‐safe viruses into the earth in this manner securing the sound-
the improvement of anticipated pandemic disease COVID – 19 origi-
ness of patients, health care workers and the overall population.
nated SUPs episode. Besides, it shows the sound effects of the inherent
natural menaces of dealing with and removal of biomedical waste
administration in India. 3.1. Classification of biomedical Wastes:

Waste and side effects spread a various scope of materials as the

2. Methods and data sources
2.1. Data collection and analysis
The net weight of mandatory PPEs used to protect from COVID‐19
Pandemic was calculated by weighted average as per the recommenda-
tion prescribed in COVID‐19 Technical Specifications for Personal Pro-
accompanying rundown delineates according to the World Health
Organization (WHO) concern:
I. Infectious Waste: Waste polluted with lifeblood and natural liq-
uids (For Example: disposed of diagnostic samples), societies and sup-
plies of irresistible operators from research facility work (For Example:
waste from post‐mortems and contaminated creatures from research
facilities), or wastes from infected/sickly patients (For Example:

2
K. Kathiravan et al.
clinical rolls and wraps in the same way some expendable medical
gadgets).
II. Bio hazardous Waste: Bodily stuff, fluids, tissues, leftovers and
sullied appendage of living beings.
III. Sharps Waste: Hypes, needles, expendable surgical tools and
cutting edges, and so on.
IV. Chemical Waste: The solvents and testing agents which have
been utilized for research centre arrangements, antiseptics, preserva-
tives and overwhelming metals hold in clinical gadgets (For Example:
unused solutes, synthetic containers, storages, acids, broken glass
wares and temperature scale, asbestos‐containing bits and pieces.).
V. Pharmaceutical Waste: No longer needed polluted medications
besides immunizations.
VI. Non‐hazardous or General Waste: Junk which does not pose any
immediate destruction to particular organic, human and bionetwork.
4. Regulated healthcare devastation control in Indian Law
practices
Significantly, in the year 1998, the Indian Administration has for-
mulated the foremost BMW rules. The International Clinical Epidemi-
ology Network has been investigated utilizing current BMW practices
during 2002–2004, which opines that the arrangement and structure
in essential (82%), auxiliary (60%) furthermore the third level camp
(54%) out for ailment preventive must be in across 20 States in India,
which have no provisions for waste disposal framework across the
nation. India is the primary nation to set up all the initiatives of bio
hazardous dumping clearance in out of harm's way and at hand a dire
necessary implication which makes a move in favour of fortifying cur-
rent framework limit, increment the subsidizing and duty towards the
sheltered removal of BMW. Under further alteration of the BMW
(Singh et al., 2019) principles followed by 2000, 2003 and 2011, the
convinced altering rules in 2016 which streamlined the order and
approval while improving the isolation, transportation and removal
strategies for BMW to decrease dangers on expanding ecological con-
tamination (Ben et al., 2021). In India, out of2,38,259 Health Care
Facility Centres (HCFCs), 87,281 centres are bedded and 1,51,302cen-
tres functions without bed facilities Central Pollution Control Board
(CPCB), 2017). As mentioned by the Directorate General of State
Health Services 2018, 23,582 government emergency clinics are hav-
ing 7,10,761 beds accessible. In India, Uttar Pradesh states has pro-
gressively number of medical clinics (4635) furnished with
increasingly number of beds (76,260 beds) that contrasting with other
states (Fig. 1). The waste generation rate runs somewhere in the range
of 0.5 kg to 2 kg for per bed per day. Notably, every year appraisal in
particular India, the numbering scale of waste production is nearly
0.34 million tons. The biomedical waste from the clinics comprises
of bandages and materials of different contagious is almost in the
ranges from 30 to 35% which plastics contain 7–10%, throw away nee-
dles are < 1%, glass‐wares are from 3 to 5% and common disposals
incorporate nearing 50%. The research study and assessment from dif-
ferent parts of the country on unsafe handling of separate out and dis-
carding the multi hazardous clinical wastes from the hospital promotes
numerous and stern ecological threats facing the society (Ananth et al.,
2010).
In India, the following techniques and procedures such as crema-
tion, landfill, microwave, steam sanitization advances, and compound
sterilization have been employing for the removal of biomedical
wastes (Board, 2017). Having said that the Common Biomedical Waste
Treatment Facility (CBMWTF) under 24 activity developments set up,
9841 HCFCs possess attention on clinical sweepings and clearance ser-
vices that associated with healing as well as removal of disposal
around 500 – 560 tons every day. The hostage treatment office which
is introduced by HCFs is expected to expand up to 775 tons per day by
2020 from the present scenario in general condition (Ansari et al.,
3
Total Environment Research Themes 7 (2023) 100062
2019). The generation of biomedical waste has been assessed in State
wise in all over India for the year 2016––2018 is cited in Fig. 2.
The number of common biomedical waste treatment facilities in
India is has increased in size around 93 in 2008 to 198 in 2017. The
States like Maharashtra, Karnataka, Kerala and Tamil Nadu are as
the maximum biomedical waste generated in an average of more than
45 tons/day than others did comparatively. It may be the dynamic
population density in the mentioned States is the well‐founded
grounds for the leading hazardous waste construction. Around 78 %
of biomedical waste is treated in CBWTF by incinerating, autoclaving
or shredding and the waste left out is dealt with either hostage treat-
ment offices or being arranged off in profound internments. In India,
the number of different biomedical waste treatment unit operations
and their treatment capacity in CBWTFs in the State‐wise is illustrated
in Figs. 3a‐3d.
In total, 225waste treatment equipment are introduced to present
emanation norms under the rules of Bio‐medical Waste Management
(Bio‐Medical Waste, 1998) for the concern of hygiene and removing
the harmful substances in treated areas. The major infectious flotsam
and jetsam producing states are classified in percentage wise as fol-
lows: Bihar – 6.0%, Delhi − 4.4 %, Gujarat − 5.2 %, Karnataka
−12.0 %, Kerala − 7.4 %, Maharashtra − 11.1 %, Rajasthan − 4.0
%, Tamil Nadu − 8.4 %, Uttar Pradesh − 7.8 % and West Bengal
− 5.3 %. The other States those who haven’t the facilities for the
removal of biomedical waste are as follows: Andaman and Nicobar,
Arunachal Pradesh, Goa, Lakshadweep, Mizoram, and Nagaland and
Sikkim (Blahuskova et al., 2019). The Information regarding the
nation’s web forum demonstrates a complete data of clinical waste
production of the nation is 484 tonnes per day as of 1, 68,869 total
health care facilities centres. Shockingly, just 447 tonnes per day is
dealt with, but 37 tonnes per day is not treated well. In the whole of
Common Bio – medical Waste Treatment and Disposal Facility, only
20 to 30 out of 198 are less development. Moreover, the numbers of
HCF utilizing the Common Biomedical Waste Treatment and disposal
facility are 1, 31,837 and around 22,000 HCF having been a possession
of their individual health care services (Bio‐Medical Waste, 1998).
5. Environmental risk of COVID-19 SUPs biomedical waste
Under the urban nation‐states, the act of discarding excretion from
the health care centres are of meticulous care whereas comparing with
early nation‐states which are habitually destroy the garbage by using
fire in unsuitable vicinity and also they are not having applied proper
waste disposal systems which means the easily elevated point of dioxin
exposure in atmosphere. For this reason, the widespread attention is
the most urgent needed of protecting people living in close proximity
of waste disposal premises also to avoid the reverberating of ecological
jeopardy in the forth coming years in the developing countries
(Windfeld and Brooks, 2015). The treatment and removal of Single‐
Use Plastic (SUP) wastes may present wellbeing dangers in the vicinity
by emitting pathogens and poisonous toxins. The removal of untreated
human services squander in landfills can prompt the tainting of
absorbing and ground waters if those depots are not appropriately
developed. The burning of SUP wastes has been broadly rehearsed
however deficient cremation or the burning of inadmissible materials
lead to the entry of contaminations into the air and in the age of debris
escalation. On the other hand, the blazed substances are treated with
antiseptic releases toxic chemical compounds and acid gases being
cancer‐causing performers also enlarge the capacity on the unusual
effects of constructive well beings. However, the burning essential
alloy inclusive of heavy ions merely brings out the biosphere becomes
augment poisonous build‐up. Correspondingly, the current day incin-
erators working at 850–1100 °C which is shaped with uncommon
gas‐cleaning hardware can agree to the global outflow gauges for diox-
ins and furans. Furthermore, the options in contrast to burning, for
example, autoclaving, microwaving, steam treatment incorporates
K. Kathiravan et al.
Fig. 1. State wise Distribution of Total Health Care Facilities in India.
with inside combining, which curb the arrangement and entry of syn-
thetic substances or wild discharges concern to be given conviction in
settings where there are sufficient assets to work and remain up such
structures and arrange the used waste. Meanwhile, the act of recursion
in ambience and nature sustains life remains a mystery and impossible
in the alarming future centuries due to the overwhelming hazardous
waste treatment and indirect harming of the biosphere. The regular
dealing of dump clearance methods that are adopted in major parts
of the country (Table 1) and their sources of hazardous emissions have
been reviewed further (See Figure 4).
The huge volume of biomedical waste can be reduced by the incin-
eration methods up to 90% has a unique advantage (Bio‐Medical
4
Total Environment Research Themes 7 (2023) 100062
Waste Management Rules, 2016), since it requires minimum land uti-
lization contrast to erstwhile treatment of clearing the biomedical
waste (Efaq et al., 2017). Similarly, the foremost detrimental aspect
in making use of incinerators produce toxic smokes due to excessive
burning process, which keeps on in the environment for a long time,
leads to health and ecological problems (Ananth et al., 2010). The
emission of venomous gas and load up of substances from the
BMWTFCs mainly composite with SUPs are toxic chemicals that cause
a life‐threatening carcinogen, which can interrupt the immune system
and hormone regulation of human (McKay, 2002). However, the com-
position of homo‐polymers includes degradation synthetic products,
chemical additives and polycyclic aromatic hydrocarbons in incinera-
K. Kathiravan et al. Total Environment Research Themes 7 (2023) 100062

Fig. 2. State wise Biomedical Waste Generated in India for the year 2016, 2017 & 2018.

5
K. Kathiravan et al. Total Environment Research Themes 7 (2023) 100062

Fig. 3a. State Wise total availability of Incinerators in the CBMWTFCs and their per day treatment capacity.

Fig. 3b. State Wise total availability of Autoclave Units in the CBMWTFCs and their per day treatment capacity.

6
K. Kathiravan et al. Total Environment Research Themes 7 (2023) 100062

Fig. 3c. State Wise total availability of Shredder units in the CBMWTFCs and their per day treatment capacity.

Fig. 3d. State Wise total CBMWTFCs units and their per day treatment capacity.

7
K. Kathiravan et al.
Table 1
Sources of carcinogenicity of hazardous emissions during Biomedical Waste
Disposal methods.
Disposal Method Source
Incineration Dioxins and furans in the stack gas from Biomedical
Waste Incineration units
Mainly during quarantine period, isolation ward,
disposal of samples from laboratory, etc.,
Bottom or fly ashes from incinerators consist of
heavy metals s (Hg, Pb, Cd, Cr, and Ag), inorganic
salts, and organic compounds
Land filling Leachate from the Landfills or open dumps area can
release a high amount of pollutants into the ground
water resources as well as soil contamination.
Autoclaving, hydroclaving, stack gas, Bottom or fly aerosols and Leachate from
microwave the Landfills or open dumps area can release a high
amount of pollutants into the ground water
resources
Pyrolysis/gasification, pit Fly ashes and leachate consist of heavy metals s (Hg,
burial, vermiculture Pb, Cd, Cr, and Ag), inorganic salts, and organic
compounds
Liquid Sanitization Floor wash, Ward wash, body sanitization, etc.,
tors of all Biomedical Waste Treatment Facilities bring into being
relentless eco intimidation (Chartier, 2014). Those all have low water
solubility with high surface assimilative migrated through dust, runoff,
treated effluent discharge in to the solids of water, air and soil environ-
ment (Kim et al., 2013). In other words, the flue dust and soot blower
comes out of combustion in waste materials treatment contains high
concentrated ores, metallic substance, a load of ions, chemical compos-
ites and intense mineral bearing elements like hematite, hydrochloro-
Fig. 4. State wise Number of COVID-19 confirmed cases and the added quantum COVID-19 SUP Biomedical Waste Generated in India.
8
Total Environment Research Themes 7 (2023) 100062
borite, cristobalitechlormayenite, silicates, carbonates, tridymite. are
not destroyed but disperse directly to the environment (Allawzi
et al., 2018; Bio‐Medical Waste Management Rules, 2016; Ananth
et al., 2010).
Consequently, the dumping ground or junk pile of BMWs are well‐
thought‐out as the intimidation for prominent environmental assets
such as land and reservoir owing the requirement for large land area,
high residual volume of waste and most importantly the leach ate gen-
erates heavy toxic contaminants (Idowu et al., 2019). Despite the
shortage in debris clearance after shocking waste treatment systems
in the clinic, especially embryonic nations engender constant land fill-
ing which harms the natural environment into worsening cemetery
(Awodele et al., 2016). In fact the heavy chemical elements like cad-
mium, chromium, copper, iron, nickel, lead and zinc are commonly
found in the groundwater taken from unlined landfill site stuffed amid
BMW due to the impact of leach ate (Mor et al., 2006). The emission of
dioxins, furans and ashes due to incinerating of BMW, the microwave
is an alternative advanced treatment method that creates less contam-
ination. The minimum land requirement besides contemporary incli-
nation that increasing the ecological standards all over the globe
(Chartier, 2014) and it has been adopted in developed countries
although in developing countries have only limited attention because
of the complexity and high cost (De‐la‐Torre et al., 2021). Alterna-
tively, the techniques and procedures like heavy heat conduction,
which is used for free of detrimental germs and a mixture of pathogens
in the hospital fritter away is not practicable at all times. Although, the
process does not produce high noxious residues as well it cannot com-
pletely get rid of all possible microbes even it causes complex issues
and have an effect on bio ‐ substratum (Edlich et al., 2006). On that
account, the analysts give proposition for some complementary
method to destroy all resistant microorganisms under autoclave treat-
K. Kathiravan et al. Total Environment Research Themes 7 (2023) 100062

Table 2
State wise COVID19-SUPs contribution, generation and treatment capacity of CBMWTFs in India.

Sl. States Total Registered Micro Bio- Total Health Care workers Total COVID-19 COVID-19 SUP Treatment
No Doctors* Pharmacists Biologists chemists directly involved COVID-19 Confirmed Cases as Waste Generated Capacity of
diagnosis and treatment on 01.07.2020 (tons/day) CBMWTFs
tons/day

1 Andaman and 100 163 97 0.18 0

Nicobar Islands
2 Andhra 89,822 50,247 1566 980 312,872 14,595 229.23 56
Pradesh
3 Arunachal 868 279 120 4450 191 3.25 0
Pradesh
4 Assam 20,924 15,462 194 70 55,148 8227 44.36 12
5 Bihar 35,933 24,341 66 22 94,983 10,043 73.52 90
6 Chandigarh 150 4316 74 86 6751 440 5.03 3
7 Chhattisgarh 8448 9716 740 170 42,961 2860 32.07 7
8 Dadra, Nagar 150 673 213 0.62 17
Haveli and
Daman & Diu
9 Delhi 19,261 27,302 144 206 90,778 87,360 124.70 72
10 Goa 3410 3539 80 9576 1315 7.62 0
11 Gujarat 61,812 66,237 3342 824 226,604 32,557 181.41 127
12 Haryana 6369 32,744 600 226 71,905 14,548 60.52 93
13 Himachal 3439 9369 472 46 31,894 953 22.99 31
Pradesh
14 Jammu & 13,635 92 164 15,411 7497 16.04 7
Kashmir
15 Jharkhand 13,944 2337 12 10 32,411 2490 24.43 3
16 Karnataka 105,167 57,648 1656 1508 333,843 15,242 244.36 101
17 Kerala 49,927 64,223 898 560 299,457 4442 212.73 63
18 Ladakh 580 629 973 1.12 26
19 Lakshadweep 121 10 131 13,593 9.61 0
20 Madhya 35,236 54,181 1678 372 197,663 0 138.36 46
Pradesh
21 Maharashtra 154,298 233,322 4018 1400 516,835 174,761 484.12 93
22 Manipur 225 1273 184 46 10,107 1234 7.94 0
23 Meghalaya 50 899 70 42 5454 52 3.85 1
24 Mizoram 162 1313 10 10 4998 160 3.61 0
25 Nagaland 98 1553 4972 459 3.80 0
26 Odisha 20,694 32,386 310 12 125,949 7065 93.11 14
27 Puducherry 1430 1673 112 124 9190 714 6.93 15
28 Punjab 41,897 47,570 708 248 161,685 5568 117.08 62
29 Rajasthan 40,497 51,054 1182 410 244,657 18,014 183.87 27
30 Sikkim 1232 281 64 24 2664 89 1.93 0
31 Tamil Nadu 119,799 72,241 5674 3244 392,348 90,167 337.76 48
32 Telangana 8997 64,881 1106 492 100,384 16,339 81.71 42
33 Tripura 1670 4747 50 10,240 1388 8.14 3
34 Uttar Pradesh 71,511 84,300 2778 1220 249,776 2881 176.86 84
35 Uttarakhand 7814 16,148 998 294 33,425 23,492 39.84 2
36 West Bengal 64,279 89,630 1554 374 220,162 18,559 167.10 44
Total 1,003,828 1,125,222 30,552 13,184 3921149a 578578b 3149.81c 1189 d

Note:
* Govt. Allopathic Doctors in Medical Colleges/ Hospitals are included in MBBS doctors.
Source:
a –Organization Wise Covid Warriors Data, Govt. of India. https://covidwarriors.gov.in/.
b – Real time data from Ministry of Health & Family Welfare, Govt. of India. https://www.mohfw.gov.in/.
c – As per the interim guidance by WHO recommended PPEs, 2020. WHO/2019-nCoV/IPC PPE_use/2020.2.
d - State-wise status of Common Bio-medical Waste Treatment Facilities (CBWTFs) (As per the information provided by the SPCBs/PCCs for the Year 2008). dste.
puducherry.gov.in.

ment prior junk burial in the earth (Edlich et al., 2006; Hatami et al.,
2022) While comparing the ex‐situ BMW incinerators in connected ex‐
situ autoclave sterilizers which lessen atmospheric adulteration and
boosts well again ecological succession (Taghipour and Mosaferi,
2009).
6. Handling and disposal of COVID-19 SUPs bio-medical waste
and its’ management
The tonnage medical waste of Wuhan (the unique epicentre of pan-
demic SARS CoV 2) has been increasing six times as great close to 40
and 240 tonnes every day. Nevertheless, the rising patients count and
extreme pugnacious to deal with clinical disposals; it is a vital neces-
sity of 46 mobile treatment units and built a new plant with a capacity
of 30 tonnes in Wuhan City within 15 days (South China Morning Post
Reports, 2020). Conversely take America as instances for weighing and
ensuring Wuhan’s perceptive of medical waste disposal, the American
infirmaries bring into being about five million tons of waste a year
(Practice Green Health, 2020). While the measurement of 416.7 thou-
sand tonnes every month is nearly identical, the American hospitals
will continue to produce 2.5 million tonnes more as increasing
demand similar to Wuhan every month. In such a situation, America
may have to produce a year’s worth of medical refusals in just two
months due to an increase in spreading virus. Despite the fact that out-
standing one‐use of individual safety tools trim down the quantity of
clinical bio waste creation. As well as the decision‐makers are obliged

9
K. Kathiravan et al.
to hands‐on the difficulties in biohazard maintenance and afford some
crucial provisions and facilities for healthy and economic infrastruc-
ture over these pandemic days (Seth Cutler, 2020).
Though India already has regulations in BMW control, the Central
Pollution Control Board suggests strongly for maintaining waste breed
and segregate wastes of secluded wards and common domestic wastes.
Also a maximum number of sincere and devoted janitors are deputed
for collecting and transport the refuse lot at the right time and in the
right dumpsite. The pollution control committee keeps an eye on the
existing measures and arrangement for safe handling the transmittable
biomedical titbits also seek out the gathering sacks or trolleys are dou-
ble layered without any seepage and for managing security, mandatory
labelled ‘COVID‐190 which is permitting of CBWTFs to categorize bin
collection without difficulty from the hospital prior for treatment
and immediate disposal. In India, the amount of biomedical waste gen-
eration per day increased by 1.84 times from 288 tonnes in 2007 to
530 tonnes in 2018 (See Table 2).
The sudden incursion of severe acute respiratory syndrome
coronavirus‐2 (SARS CoV 2) patients across India, the disposal of
COVID‐19 bio‐medical waste from the hospital is such a venturesome
journey in the medical field. Therefore, the usage of SUPs from Per-
sonal Protection Equipment’s (PPEs) like testing kits, gloves, masks,
bags, goggles also increased, but at this point the problem ‐ produce
is how to dispose‐off the hospital refusals. Ever the COVID‐19 out-
break, the environmental activists have been demanding full compli-
ance of Biomedical Waste Management Rules in 2016 besides other
measures to minimise the impact on the environment. Since, there is
no data is available for the so far protection of biomedical waste man-
agement generated and treated due to the COVID‐19 outbreaks in
India, also very complex to forecast clinical remnants projection ‐ rate
in this critical period.
In India, there are 1056 testing centres (Government – 764 Nos.
and Private 292 Nos.) identified to combat the SARS CoV 2 (COVID‐
19) as of 1st July 2020 (Indian Council of Medical Research (ICMR),
2020). Currently, there are 3,92,1149 health care workers (Licensed
Practical Nurses, General Nursing Midwifery, Inventory Health–visi-
tors, Registered Health–guard, Final Year Auxiliary Nursing Midwifery
and General Nursing and Midwifery (ANM and GNM) Students, Bach-
elor of Medicine, Bachelor of Surgery (MBBS). doctors, Bachelor of
Medicine, Bachelor of Surgery (MBBS) Intern, Registered Pharmacists,
microbiologist and biotechnologist) are all actively involved in the
COVID‐19 extermination programme. It can be recommended that
WHO, the Personnel Protective Equipment (PPE) such as air purifier
masks, goggles or face shield, safety glasses, medical cap, gloves, med-
ical mask gown are being used in the Health Care centres by all the
staff including nurses and the patients (including for diagnosis, admit-
ted and isolated during the pandemic COVID‐19 outbreaks). In this
respect, the basic PPEs of the aforesaid health care workers in India
are being engaged and their used SUPs such as medical gloves, face-
masks, and aprons are only considered as biomedical wastes on daily
basis estimated on the minimum of 730 g of waste generated per
day/person. Based on the number of confirmed COVID‐19 cases
5,41,211 as of 1st July 2020 (includes active, recovered and deaths)
in India and the health care workers it is assessed that an average
2022.92 tonnes per day of SUP waste generated only due to COVID‐
19 which is an overburden for the handling of BMW management in
India. Except for a few States/UTs, all the other States of India are
overburdened with the COVID‐19 SUPs and their treatment and dis-
posal handling pathways. The States like Maharashtra (334 tonnes/-
day), Tamil Nadu (284 tonnes/day), Andhra Pradesh (172
tonnes/day), Rajasthan (157 tonnes/day), Kerala, Karnataka and West
Bengal are over loaded with 150, 143 and122 tons/day respectively
increasing the quantum of COIVD‐19 SUP wastes on daily basis
depending on the existing available CBWTFs to the safe treatment
and disposal.
10
Total Environment Research Themes 7 (2023) 100062
7. Conclusion, study limitation
Every nation has been potentially dealing with clinic discarded
heaps; on the other hand, it would be shaped utilizing pretty few traits
like formulating stratagem of accumulating, carrying, managing and
treating the sanatorium bio‐refusals. Subsequently, the data of the
hygiene process, disinfection measures and waste disposal system
are differing among nations and the policy management being a big
upheaval and extent practicable.
Accordingly, India’s COVID‐19 numbers representing an uphill and
concave yet circumstance persist startling also, the riskiness and hard-
ships relating excessive inoperative, infective and unsafe medical
belongings add to bothersome. The clinic refusal is measured as 530
tons per day and two union territories and six states in India haven’t
waste treatment facilities and anticipated as more in the present and
subsequent years significantly. Correspondingly, just about 93% of
biomedical despoil have pre‐treatment and sterilization facilities
before going garbage dump. On the other hand, the scraps and dumps
of residences, factories, and industries, administrative divisions, in col-
lective both degradable and non‐degradable are infested with bio med-
ical waste, which makes the sanitization work progression more
complicated. In recent scientific studies, the health experts suggest
the possible pathways of spreading contagious infect and in all proba-
bility the considerable tot up of non‐symptoms and pre symptoms peo-
ple are the actively greatest transmitter of an extensive amount of
virus. On the other hand, it triggers an added alarm for the sanitation
workforce. Considering the generalization of the problem under inves-
tigation, the stringent policy proposals have to frame for better
decision‐making in debris control. Notably, the positive cases and
death report moves up day to day around the world yet the upcoming
predilection of stopping the spread is still struggling one.
In particular, persons suspected with the infectious virus have been
extensively increasing all around the globe, predicted to be prolonged
period and also if there may be the same kind of pandemic outbreak
will exist, the country has to prepare for handling of the waste going
to generate in advance manner. The major focal point on overtaxing
of med bay trashes added with existing treatment methodology avail-
able in the BMWTFs based on the consideration with the minimum
PPEs based SUPs used during this pandemic outbreak by the patients
and the health care workers from the reported government hospitals
only, which exclude the BMW generate from the testing and research
laboratories, COIVD‐19 testing centres, professionals, health centres
administrative and other departments and the same PPEs being added
with the Municipal Solid Waste from the public.
7. Recommendations
It should be noted that the existing applications of sickbay throw
out management in the nation are rightly monitored also several chal-
lenging spots are acknowledged. It might seem that some dynamic
necessitates prevailing over the impediment routes in the disposal pro-
cess. Henceforth the things considered, the excerpt below is the recom-
mended suggestions for the various approaches of medical dump
clearance.
I. The number of Common Biomedical Waste Treatment Facility
(CBWTF) can be installed and operated in each State not only
for the emerging pandemic diseases outbreak, but also in every
simple practice and it is essential that the dispose of biomedical
waste cannot impose any risk to the environment.
II. Explore the advanced filtration and treatment systems in
wastewater treatment plants to remove microplastics effectively
by upgrading existing treatment infrastructure to minimize the
release of microplastics into ocean through water bodies.
K. Kathiravan et al.
III. During this COVID‐19 crisis, like developed countries which
needs adequate mobile waste treatment facility at the source
where an environmentally sensitive area concerning the quan-
tum of biomedical waste is being generated;
IV. It is unavoidable to reduce the use of SUPs during such a mas-
sive pandemic outbreak, since it is highly recommended to
incinerate these SUPs safely than to landfill or other methods.
However, these treatment operation units need to be fulfilling
the CPCBs guidelines because of setting the height of the stocks
and safe flue dust and sooty mould removal.
V. From a general environmental perspective, microwave heating
has been one of the finest techniques for treating contaminated
medical debris as it provides a reduced amount of environmen-
tal intimidation. This method gently inactivates the microor-
ganisms in the disposables also avoid generating lethal fumes
and irradiation (Soares et al., 2013; Voudrias, 2016).
VI. Steam sterilization technologies can be used as additional treat-
ing method which disinfects the litter in low heat thermal pro-
cess ahead of disposal. On the contrary BMW incinerators, it has
been suggested even for non‐hazardous and non‐producing
combustion gases (Taghipour and Mosaferi, 2009).
VII. To put it another way, the implementation of proper decontam-
ination methods for instance reprocess, steam, repurpose, sani-
tize, sterilize, asepsis, compost and refusal which are lacking the
issues in both biosphere and health of human. When the ruins
are properly cleared, it mitigates the pollution and conserves
the energy considerably. Accordingly, the advanced techniques
and well‐prepared schemes facilitate the waste control safe and
sound right the way through increasing pandemic days.
VIII. Scientific approaches like incorporated Geographic information
system (GIS)‐based mode of waste management practices would
be widened for identifying the locale of wreckage collection,
transport and to the final civic amenity point. This technique
can minimize the risk associated with transport, occupational
and transportation costs on the network could aid to develop
better routing schedule by the decision makers in terms of the
imposed risk of biomedical wastes.
IX. Awareness about the waste management practices to the public
in terms of disposal need to improve, especially to the schools
and educational institutions, involvement of NGOs is the practi-
cal effective action to reduce the SUPs and other plastic waste
get into the water bodies and ocean. Support and participate
in local and international beach clean‐up initiatives to remove
plastic waste, including COVID‐related microplastics, from
coastal areas and oceans. Invest in and support initiatives
focused on the removal of plastic waste, including microplas-
tics, from coastal areas and oceans. Encourage volunteer partic-
ipation and provide resources for clean‐up efforts.
X. Government departments should encourage value added aware-
ness programs by improving rules and regulations, strengthen
cooperation with external sectors, motivate and reward the
responsible citizens through publicity, not only benefit human
society but also contribute to sustainable development of the
environment.
XI. Improve waste management infrastructure, particularly in
coastal areas, to prevent PPE and plastic waste from reaching
the ocean. Increase the number of waste bins, implement recy-
cling programs, and ensure proper waste collection and
disposal.
XII. Adoptive collaboration among governments, scientific institu-
tions, industries, and environmental organizations to share
knowledge and best practices for mitigating microplastic pollu-
tion, monitoring programs to assess the potential risk and
threads of COVID‐related microplastics in the ocean. Encourage
adaptive research to mitigate the impacts on marine ecosys-
11
Total Environment Research Themes 7 (2023) 100062
tems. Invest in research and development of biodegradable or
compostable PPE materials that pose minimal harm to the
environment.
CRediT authorship contribution statement
K. Kathiravan: Conceptualization, Investigation, Methodology. A.
Vidyasakar: Conceptualization, Investigation, Writing – original draft.
C. Pradeep: Methodology, Software, Validation, Data curation. Usha
Natesan: Investigation, Validation, Data curation. K. Ajith Kumar:
Validation, Data curation. V. Arun Bharathi: Conceptualization,
Investigation. G. Nantha Kumar: Conceptualization, Investigation.
S.D. Arun Prakash: .
Data availability
Data will be made available on request.
Declaration of Competing Interest
The authors declare that they have no known competing financial
interests or personal relationships that could have appeared to influ-
ence the work reported in this paper.
Acknowledgements
The corresponding author is like to thank Prof. P. Mohanasun-
daram (Director) of Periyar University centre for Post Graduate and
Research studies encouraging us to publish research article and to con-
tribute something useful for the Society during this pandemic situa-
tion. And we would also like to extend our thank to Ms. D. Ashwini,
PhD scholar, Department of English Periyar University centre for post
graduate and Research studies, for correcting the grammar and
reviewing the language of the manuscript.
References
Akhbarizadeh, R., Dobaradaran, S., Nabipour, I., Tangestani, M., Abedi, D., Javanfekr,
F., Jeddi, F., Zendehboodi, A., 2021. Abandoned Covid-19 personal protective
equipment along the Bushehr shores, the Persian Gulf: an emerging source of
secondary microplastics in coastlines. Mar. Pollut. Bull., 168. https://doi.org/
10.1016/j.marpolbul.2021.112386.
Akhbarizadeh, R., Dobaradaran, S., AmoueiTorkmahalleh, M., Saeedi, R., Aibaghi, R.,
FarajiGhasemi, F., 2021. Suspended fine particulate matter (PM2.5), microplastics
(MPs), and polycyclic aromatic hydrocarbons (PAHs) in air: their possible
relationships and health implications. Environ. Res. 192, 110339.
Allawzi, M., Al-harahsheh, M., Allaboun, H., 2018. Characterization and leachability
propensity of bottom ash from medical waste incineration. Water Air Soil Pollut.
229. https://doi.org/10.1007/s11270-018-3810-5.
Ammendolia, J., Saturno, J., Brooks, A.L., Jacobs, S., Jambeck, J.R., 2021. An emerging
source of plastic pollution: environmental presence of plastic personal protective
equipment (PPE) debris related to COVID-19 in a metropolitan city. Environ. Pollut.,
269. https://doi.org/10.1016/j.envpol.2020.116160.
Ananth A.P., Prashanthini V., Visvanathan C. (2010). Healthcare waste management in
Asia Waste management (New York, N.Y.), 30, 154-161.
Ansari, M., Ehrampoush, M.H., Farzadkia, M., Ahmadi, E., 2019. Dynamic assessment of
economic and environmental performance index and generation, composition,
environmental and human health risks of hospital solid waste in developing
countries; A state of the art of review. Environ. Int. 132, 105073. https://doi.org/
10.1016/j.envint.2019.105073.
Aragaw, T.A., 2020. Surgical face masks as a potential source for microplastic pollution
in the COVID-19 scenario. Mar. Pollut. Bull., 159. https://doi.org/10.1016/
j.marpolbul.2020.111517.
Aragaw, T.A., De-la-Torre, G.E., Teshager, A.A., 2022. Personal protective equipment
(PPE) pollution driven by the COVID-19 pandemic along the shoreline of Lake Tana,
Bahir Dar, Ethiopia. Sci. Total Environ., 820. https://doi.org/10.1016/J.
SCITOTENV.2022.153261.
Ardusso, M., Forero-Lopez, A.D., Buzzi, N.S., Spetter, C.V., Fernandez-Severini, M.D.,
2021. COVID-19 pandemic repercussions on plastic and antiviral polymeric textile
causing pollution on beaches and coasts of South America. Sci. Total Environ., 763.
https://doi.org/10.1016/j.scitotenv.2020.144365.
Ashworth, D.C., Elliott, P., Toledano, M.B., 2014. Waste incineration and adverse birth
and neonatal outcomes: a systematic review. Environ. Int. 69, 120–132.
K. Kathiravan et al.
Awodele, O., Adewoye, A.A., Oparah, A.C., 2016. Assessment of medical waste
management in seven hospitals in Lagos, Nigeria. BMC Public Health 16, 269.
Ben, H.D.M., De-la-Torre, G.E., Abelouah, M.R., Hajji, S., Alla, A.A., 2021. Personal
protective equipment (PPE) pollution associated with the COVID-19 pandemic
along the coastline of Agadir, Morocco. Sci. Total Environ., 798. https://doi.org/
10.1016/J.SCITOTENV.2021.149282.
Bio-Medical Waste Management Rules. 2016 Published in the Gazette of India,
Extraordinary, Part II, Section 3, Sub-Section (i), Government of India Ministry of
Environment, Forest and Climate Change. Notification; New Delhi, the 28 March,
2016.
Bio-Medical Waste (Management and Handling, 1998) Rules. New Delhi: Government of
India Publications; 1998. Ministry of Environment and Forests Notification; pp.
276–84.
Blahuskova, V., Vlcek, J., Jancar, D., 2019. Study connective capabilities of solid
residues from the waste incineration. J. Environ. Manage. 231, 1048–1055. https://
doi.org/10.1016/j.jenvman.2018.10.112.
Central Pollution Control Board (CPCB), (2017), Annual Report on Biomedical Waste
Management as per Biomedical Waste Management Rules, 2016.
Chartier, Y. Safe Management of Wastes from Health-Care Activities; World Health
Organization: Geneva, Switzerland, 2014; Available online: https://books.google.
no/books?hl=en&lr=&id=S8a9HQc7xboC&oi=fnd&pg=PR11&dq=Safe
+management+of+wastes+from+healthcare+activities&ots=3fOaxvrr4v&
sig=Te1KfaDeFCOriGG38N8ussPxQ&redir_esc=y#v=onepage&q=Safe%
20management%20of%20wastes%20from%20health-care%20activities&f=false
(accessed on 22 February 2020).
Cordova, M.R., Nurhati, I.S., Riani, E., Nurhasanah, Iswari, M.Y., 2021. Unprecedented
plastic-made personal protective equipment (PPE) debris in river outlets into
Jakarta Bay during COVID-19 pandemic. Chemosphere 268,. https://doi.org/
10.1016/j.chemosphere.2020.129360 129360.
De-la-Torre, G.E., Rakib, M.R.J., Pizarro-Ortega, C.I., Dioses-Salinas, D.C., 2021.
Occurrence of personal protective equipment (PPE) associated with the COVID-19
pandemic along the coast of Lima, Peru. Sci. Total Environ., 744. https://doi.org/
10.1016/j.scitotenv.2021.145774.
De-la-Torre, G.E., Dioses-Salinas, D.C., Pizarro-Ortega, C.I., Fernández Severini, M.D.,
Forero López, A.D., Mansilla, R., Ayala, F., Jimenez Castillo, L.M., Castillo-Paico, E.,
Torres, D.A., Mendoza-Castilla, L.M., Meza-Chuquizuta, C., Vizcarra, J.K., Mejía, M.,
Valdivia De La Gala, J.J., SayraNinaja, E.A., Siles Calisaya, D.L., Flores-Miranda, W.
E., Eras Rosillo, J.L., Espinoza-Morriberón, D., Gonzales, K.N., Torres, F.G.,
Rimondino, G.N., Ben-Haddad, M., Dobaradaran, S., Aragaw, T.A., Santillán, L.,
2022. Binational survey of personal protective equipment (PPE) pollution driven by
the COVID-19 pandemic in coastal environments: abundance, distribution, and
analytical characterization. J. Hazard. Mater. 42 (6). https://doi.org/10.1016/j.
jhazmat.2021.128070.
Edlich, R.F., Borel, L., Jensen, H.G., Winters, K.L., Long III, W.B., Gubler, K.D.,
Buschbacher, R.M., Becker, D.G., Chang, D.E., Korngold, J., Chitwood Jr, W.R., Lin,
K.Y., Nichter, L.S., Berenson, S., Britt, L.D., Tafel, J.A., 2006. Revolutionary
advances in medical waste management. The Sanitec system. J. Long Term Eff. Med.
Implant. 16, 9–18. https://doi.org/10.1615/JLongTermEffMedImplants.v16.i1.20.
Efaq, A.N., Ab. Rahman, N.N.N., Nagao, H., Al-Gheethi, A.A., Ab. Kadir, M.O., 2017.
Inactivation of Aspergillus spores in clinical wastes by supercritical carbon dioxide.
Arab. J. Sci. Eng. 42, 39–51. https://doi.org/10.1007/s13369-016-2087-5.
Gunasekaran, K., Mghili, B., Saravanakumar, A., 2022. Personal protective equipment
(PPE) pollution driven by the COVID-19 pandemic in coastal environment,
Southeast Coast of India. Marine Pollut. Bull. 180, 113769.
Hassan, I.A., Younis, A., Al Ghamdi, M.A., Almazroui, M., Basahi, J.M., El-Sheekh, M.M.,
Abouelkhair, E.K., Haiba, N.S., Alhussaini, M.S., Hajjar, D., Abdel Wahab, M.M., El
Maghraby, D.M., 2022. Contamination of the marine environment in Egypt and
Saudi Arabia with personal protective equipment during COVID-19 pandemic: a
short focus. Sci. Total Environ. 810, 152046. https://doi.org/10.1016/j.
scitotenv.2021.152046.
Hatami, T., Rakib, M.R.J., Madadi, R., De-la-Torre, G.E., Idris, A.M., 2022. Personal
protective equipment (PPE) pollution in the Caspian Sea, the largest enclosed inland
water body in the world. Sci. Total Environ. 824, 153771.
Hu, H., Li, X., Nguyen, A.D., Kavan, P. A critical evaluation of waste incineration plants
in Wuhan (China) based on site selection, environmental influence, public health
and public participation. Int. J. Environ. Res. Public Health 2015, 12, 7593–7614.
[Google Scholar] [CrossRef].
Idowu, I.A., Atherton, W., Hashim, K., Kot, P., Alkhaddar, R., Alo, B.I., Shaw, A., 2019.
An analyses of the status of landfill classification systems in developing countries:
sub Saharan Africa landfill experiences. Waste Manage. 87, 761–771. https://doi.
org/10.1016/j.wasman.2019.03.011.
Indian Council of Medical Research (ICMR), Department of Health Research, Ministry of
Health and Family Welfare (MoHFW), Government of India (2020).
Kim, K.H., Jahan, S.A., Kabir, E., Brown, R.J.C., 2013. A review of airborne polycyclic
aromatic hydrocarbons (PAHs) and their human health effects. Environ. Int. 60,
71–80. https://doi.org/10.1016/j.envint.2013.07.019.
Ma, J., Chen, F., Xu, H., Jiang, H., Liu, J., Li, P., Chen, C.C., Pan, K., 2021. Face masks as
a source of nanoplastics and microplastics in the environment: quantification,
characterization, and potential for bioaccumulation. Environ. Pollut. 288,. https://
doi.org/10.1016/J.ENVPOL.2021.117748 117748.
McKay, G., 2002. Dioxin characterisation, formation and minimisation during municipal
solid waste (MSW) incineration: review Chem. Eng. J. 86, 343–368. https://doi.
org/10.1016/S1385-8947(01)00228-5.
12
Total Environment Research Themes 7 (2023) 100062
Mghili, B., Analla, M., Aksissou, M., 2022. Face masks relate d to COVID -19 in the
beaches of the Moroccan Mediterranean: An emerging source of plastic pollution.
Mar. Pollut. Bull. 174,. https://doi.org/10.1016/J.MARPOLBUL.2021.113181
113181.
Mor, S., Ravindra, K., Dahiya, R.P., Chandra, A., 2006. Leachate characterization and
assessment of groundwater pollution near municipal solid waste landfill site.
Environ. Monit. Assess. 118, 435–456. https://doi.org/10.1007/s10661-006-1505-
7.
Mostafa, G.M.A., Shazly, M.M., Sherief, W.I., 2009. Development of a waste
management protocol based on assessment of knowledge and practice of
healthcare personnel in surgical departments. Waste Manage. 29 (1), 430–439
[PubMed] [Google Scholar].
Nzediegwu, C., Chang, S.X., 2020. Improper solid waste management increases potential
for COVID-19 spread in developing countries. Resour. Conserv. Recycl. 161,
104947.
Patrício Silva, A.L., Prata, J.C., Walker, T.R., Campos, D., Duarte, A.C., Soares, A.M.V.M.,
Barcelo, D., Rocha-Santos, T., 2020. Rethinking and optimizing plastic waste
management under COVID-19 pandemic: policy solutions based on redesign and
reduction of single-use plastics and personal protective equipment. Sci. Total
Environ. 742. https://doi.org/10.1016/j.scitotenv.2020.140565.
Peng, Y., Wu, P., Schartup, A.T., Zhang, Y., 2021. Plastic waste release caused by COVID-
19 and its fate in the global ocean. Proc. Natl. Acad. Sci. 118, (47). https://doi.org/
10.1073/pnas.2111530118 e2111530118.
Rakib, M.R.J., De-la-Torre, G.E., Pizarro-Ortega, C.I., Dioses-Salinas, D.C., Al-Nahian, S.,
2021. Personal protective equipment (PPE) pollution driven by the COVID-19
pandemic in Cox's bazar, the longest natural beach in the world. Mar. Pollut. Bull.
169,. https://doi.org/10.1016/j.marpolbul.2021.112497 112497.
Rutala, W.A., Mayhall, C.G., 1992. SHEA position paper (Society of Hospital
Epidemiology of America). Infect. Control. Hosp. Epidemiol. 13 (1), 38–48
[PubMed] [Google Scholar].
Saliu, F., Veronelli, M., Raguso, C., Barana, D., Galli, P., Lasagni, M., 2021. The release
process of microfibers: from surgical face masks into the marine environment.
Environ. Adv. 4,. https://doi.org/10.1016/j.envadv.2021.100042 100042.
Schuhmacher, M., Fàbrega, F., Kumar, V., García, F., Nadal, M., Domingo, J.L., 2014. A
PBPK model to estimate PCDD/Flevels in adipose tissue: comparison with
experimental values of residents near a hazardous waste incinerator. Environ. Int.
73, 150–157.
Seth Cutler, 2020. Mounting Medical Waste from COVID-19 Emphasizes the Need for a
Sustainable Waste Management Strategy, https://ww2.frost.com/frost-
perspectives/managing-the-growing-threat-of-covid-19-generated-medical-waste/.
Shen, M., Zeng, Z., Song, B., Yi, H., Hu, T., Zhang, Y., Zeng, G., Xiao, R., 2021. Neglected
microplastics pollution in global COVID-19: disposable surgical masks. Sci. Total
Environ. 790, 148130.
Singh, A., Unikrishnan, S., Samriddhi, D., 2019. Biomedical waste management in India:
Awareness and novel approaches. Biomed. J. Sci. Technol. Res. 13 (4).
Sinha, R., Michelsen, J.D., Akcura, E., Njie, L., 2020. COVID-19’s Impact on the
WasteSector. International Finance Corporation. www.ifc.org/wps/wcm/connect/
industry_ext_content/ifc_external_corporate_site/infrastructure/resources/covid-19-
and-waste-sector.
Soares, S.R., Finotti, A.R., Prudêncio da Silva, V., Alvarenga, R.A.F., 2013. Applications
of life cycle assessment and cost analysis in health care waste management. Waste
Manag. 33, 175–183. https://doi.org/10.1016/j.wasman.2012.09.021.
Taghipour, H., Mosaferi, M., 2009. The challenge of medical waste management: a case
study in northwest Iran-Tabriz. Waste Manag.Res. 27, 328–335. https://doi.org/
10.1177/0734242X09104132.
Voudrias, E.A., 2016. Technology selection for infectious medical waste treatment using
the analytic hierarchy process. J. Air Waste Manag. Assoc. 66, 663–672. https://doi.
org/10.1080/10962247.2016.1162226.
Wang, Z., An, C., Chen, X., Lee, K., Zhang, B., Feng, Q.i., 2021. Disposable masks release
microplastics to the aqueous environment with exacerbation by natural weathering.
J. Hazard. Mater. 417,. https://doi.org/10.1016/j.jhazmat.2021.126036 126036.
Wendling, Z.A., Emerson, J.W., de Sherbinin, A., Esty, D.C., et al, 2022. 2022
Environmental Performance Index. Yale Center for Environmental Law and
Policy. epi.yale.edu, New Haven, CT.
Windfeld, E.S., Brooks, M.S.-L., 2015. Medical waste management—A review. J.
Environ. Manag. 163, 98–108 [Google Scholar] [CrossRef].
World Health Organization - WHO (2013). Wastes from health-care activities. Factsheet
No. 25, http://www.who.int/mediacentre /factsheets/fs253/en.
World Health Organization - WHO (2019). Overview of technologies for the treatment
of infectious and sharp waste from health care facilities. Geneva: Licence: CC BY-
NC-SA 3.0 IGO. https://apps.who.int/iris.
World Health Organization - WHO (2020). Health-Care Waste. Available online: https://
www.who.int/news-room/factsheets/detail/health-care-waste.
Yu, H., Sun, X.u., Solvang, W.D., Zhao, X.u., 2020. Reverse logistics network design for
effective management of medical waste in epidemic outbreaks: Insights from the
coronavirus disease 2019 (COVID-19) Outbreak in Wuhan (China). Int. J. Environ.
Res. Public Health 17, 1770. https://doi.org/10.3390/ijerph17051770.
Zhang, Q.Q., Ying, G.G., Pan, C.G., Liu, Y.S., Zhao, J.L., 2015. Comprehensive evaluation
of antibiotics emission and fate in the river basins of China: source analysis, multi-
media modelling, and linkage to bacterial resistance. Environ. Sci. Technol. 49,
6772–6782.
Zimmer, C., McKinley, D., 2008. New approaches to pollution prevention in the
healthcare industry. J. Clean. Prod. 16 (6), 734–742.