Hospital Waste Factsheet

Hospital Waste Management means the management of waste produced by hospitals using such techniques that will help to check the spread of diseases through it.

The story so far:
The management of waste poses to be a major problem in most of the countries, especially hospital waste. It is an ongoing problem for many countries. In recent years, medical waste disposal has posed even more difficulties with the appearance of disposable needles, syringes, and other similar items. Pakistan is also facing this problem. Around 250,000 tonnes of medical waste is annually produced from all sorts of health care facilities in the country. This type of waste has a bad affect on the environment by contaminating the land, air and water resources.
According to a report, 15 tonnes of waste is produced daily in Punjab. The rate of generation is 1.8 kilograms per day per bed. The province houses 250 hospitals with a total capacity of 41,000 beds.

Hospital wastes are categorised according to their weight, density and constituents. The World Health Organisation (WHO) has classified medical waste into different categories. These are:
Infectious: material-containing pathogens in sufficient concentrations or quantities that, if exposed, can cause diseases. This includes waste from surgery and autopsies on patients with infectious diseases;
Sharps: disposable needles, syringes, saws, blades, broken glasses, nails or any other item that could cause a cut;
Pathological: tissues, organs, body parts, human flesh, fetuses, blood and body fluids;
Pharmaceuticals: drugs and chemicals that are returned from wards, spilled, outdated, contaminated, or are no longer required;
Radioactive: solids, liquids and gaseous waste contaminated with radioactive substances used in diagnosis and treatment of diseases like toxic goiter; and
Others: waste from the offices, kitchens, rooms, including bed linen, utensils, paper, etc.

There are Guidelines for Hospital Waste Management In Pakistan since 1998 prepared by the Environmental Health Unit, of the Ministry of Health, Government of Pakistan, giving detailed information and covering all aspects of safe hospital waste management in the country, including the risk associated with the waste, formation of a waste management team in hospitals, their responsibilities, plan, collection, segregation, transportation, storage, disposal methods, containers, and their color coding, waste minimisation techniques, protective clothing, etc.
A project was implemented in January, 2000 in the biggest hospital in every province by the Ministry of Health in Islamabad, in collaboration with WHO.

Hospitals and public health care units are supposed to safeguard the health of the community. However, the waste produced by the medical care centers if disposed off improperly, can pose an even greater threat than the original diseases themselves.
Pakistan is also facing such problems. There are no systematic approaches to medical waste disposal. Hospital wastes are simply mixed with the municipal waste in collecting bins at roadsides and disposed off similarly. Some waste is simply buried without any appropriate measure. The reality is that while all the equipment necessary to ensure the proper management of hospital waste probably exists, the main problem is that the staff fails to prepare and implement an effective disposable policy.
In Lahore, like most of the cities in Pakistan, there are no proper measures taken for the management of hospital waste. The standard practice of hospital waste disposal is dumping it in the M.C.L. container wherever situated.
Disposable syringes and needles are also not disposed off properly. Some patients, who routinely use syringes at home, do not know how to dispose them off properly. They just throw them in a dustbin or other similar places, because they think that these practices are
inexpensive, safe, and easy solution to dispose off a potentially dangerous waste item.

If hospital waste is not managed properly it proves to be harmful to the environment. It not only poses a threat to the employees working in the hospital, but also to the people surrounding that area.
Infectious waste can cause diseases like Hepatitis A & B, AIDS, Typhoid, Boils, etc.
A common practice in Pakistan is the reuse of disposable syringes. People pick up used syringes from the hospital waste and sell them. Many drug addicts also reuse the syringes that can cause AIDS and other dangerous and contagious diseases. If a syringe, previously used by an AIDS patient, is reused, it can affect the person using it. So, the hospital staff should dispose off the syringes properly, by cutting the needles of the syringes with the help of a cutter, so that the needle ca not be reused.
When waste containing plastics are burnt, Dioxin is produced, which can cause Cancer, birth defects, decreased psychomotor ability, hearing defects, cognitive defects and behavioral alternations in infants.
Flies also sit on the uncovered piles of rotting garbage. This promotes mechanical transmissions of fatal diseases like Diarrhea, Dysentery, Typhoid, Hepatitis and Cholera. Under moist conditions, mosquitoes transmit many types of infections, like Malaria and Yellow fever. Similarly, dogs, cats and rats also transmit a variety of diseases, including Plague and Flea born fever, as they mostly live in and around the refuse. A high tendency of contracting intestinal, parasitic and skin diseases is found in workers engaged in collecting refuse.

Some steps should be taken for the minimisation of hospital waste. Before any clear improvement can be made in medical waste management, consistent and scientifically based definitions must be established as to what is meant by medical waste and its components, and what the goals are. Plans and policies should be laid down for this purpose. Then the waste should be segregated. Imposing segregated practices within hospitals to separate biological and chemical hazardous waste will result in a clean solid waste stream, which can be recycled easily. If proper segregation is achieved through training, clear standards, and tough enforcement, then resources can be turned to the management of the small portion of the waste stream needing special treatment.
New emphasis should be put on the reduction of waste, workers' safety should be ensured through education, training and proper personal protective equipment.

Incineration has been the treatment method of choice for medical waste for two important reasons. First, incineration has always been thought to be the best method of eliminating any infectious organisms that are present in medical waste. Second, incineration has been economical for hospitals because it substantially reduces the volume to be disposed of in a landfill. Waste disposal costs have historically been based on the volume to be disposed. Both of these assumptions behind medical waste incineration are no longer able to support objective scrutiny. Waste is burnt at very high temperatures, that produce emissions full of acidic gases, heavy metals, toxic organisms and dioxins. There is a lot of ash produced by an incinerator as well.
Incinerators for medical and municipal waste have been linked to severe public health threats and pollution. The combination of intense public opposition to incineration and increasingly strict environmental pollution regulation has forced the closure or cancellation of many incinerators in industrialised countries.
Incinerators are fast becoming an obsolete technology in many developed countries as they are moving towards safer and more economical alternative approaches to medical and municipal waste management.
As a result, many incinerator companies are targeting overseas markets where people are not yet aware of the serious health and environmental threats associated with incineration or the many advantages of alternatives. Incinerator companies are now targeting Asia, Africa, and Latin America to sell their toxic technology. Researchers came to the conclusion that Dioxin, as well as mercury and other toxic substances, are emitted when waste is burnt in an incinerator. Dioxin and related chlorinated organic compounds are extremely potent toxic substances that produce a remarkable variety of adverse effects in human and animals at extremely low doses.
Mercury is also bio-accumulative and is toxic to the kidneys and nervous system. Readily converted to its organic form in the environment, mercury interferes with normal brain development.

Various alternative technologies for incineration are available at hospitals in many developed countries. As these techniques are either too complicated or very expensive, they are not being used in Pakistan. Though, these techniques should also be applied here,, for proper waste disposal.

Steam Autoclaving is the most widely used and most efficient alternative medical-waste-treatment technology. Most available autoclaves are designed to handle both biohazard and normal hospital wastes simultaneously. However, they cannot treat pathological animal wastes, chemotherapy wastes, and low level radioactive wastes. These wastes have to be treated separately.
Medical waste autoclaves usually jointly operate with a shredder, and a compactor(to minimise the waste volume).
In autoclaves, the effects of heat from saturated steam and increased pressure decontaminate medical waste by inactivating and destroying microorganisms.
There are two types of autoclaves, gravity displacement and pre-vacuum. Those designed for medical waste are mostly pre-vacuum.

In chemical treatment systems, an anti-microbial chemical, such as sodium hypochlorite, chlorine dioxide, or peracetic acid, decontaminates the medical waste. Most chemical treatment systems, currently in use, operate at ambient temperature.

In Microwave Radiation, medical waste enters the system by batch or continuous mode, where it is wetted with steam or water and heated by microwave radiation at de-contaminating temperatures.

Some systems use a combination of infrared radiation and forced hot-air convection to treat the waste. The waste then is compacted, preparing it for landfill. Other systems use gamma radiation to heat the waste to disinfecting temperatures. A portion of the solid residue obtained is recycled, while the remainder is disposed. Several other thermal systems currently under development use steam, oil, electricity or some form of radiation as their source of heat.

As mentioned above, Pathological waste (body parts, research animals, etc.) cannot be disposed off by autoclaving. For disposal of such waste, either Crematoria (burning of the body) or burial should be performed.

The hospital staff should be trained in such a manner that they help in disposing off the waste properly.

WWF advocates for safer waste disposal techniques and wishes to educate the broader public about dioxin, mercury and other endocrine disrupting chemicals. WWF is ready to join a campaign that makes explicit links between environmental contamination and public health. WWF also advocates for safe waste disposal methods like waste reduction, then waste segregation, which is crucial to reduce the volume and toxicity of the medical waste stream. Then stress is laid on the assessment and recycling of hospital waste. Waste assessment will give hospital staff a clear idea of how their waste is managed on a daily basis. Recycling reduces pollution from resource extraction and manufacturing products, and pollution associated with incineration, landfills and other waste disposal methods.
WWF-P questions the policy followed by the developed world as they export their incinerators to developing countries. Despite being fully aware of the unmanageable pollution problems caused by waste-burners.
WWF-P urges the general public to demand a 'Right to Know' basis about the kinds of waste management technologies proposed to be adopted by the Government.

For further information regarding hospital waste management, please visit the following web sites,

www.healthcarewasre.org
www.noharm.org
www.medwastecontest.org
www.cleanmed.org
www.cdc.gov/exposurereport
www.telmedpak.com.waste_disposal

Compiled and edited by Environmental Pollution Unit, WWF- Pakistan