Professional Documents
Culture Documents
HealthCareActivities
UNEPIETCOsaka,Japan
19July2012
SusanWilburn,TechnicalOfficer
PublicHealthandEnvironment
1|
KeyPoints
Ofthetotalamountofwastegeneratedbyhealthcare
activities,about80%isgeneralwaste.
Theremaining20%isconsideredhazardousmaterialthat
maybeinfectious,toxicorradioactive.
Everyyearanestimated16000millioninjectionsare
administeredworldwide,butnotalloftheneedlesand
syringesareproperlydisposedofafterwards.
Healthcarewastecontainspotentiallyharmful
microorganismswhichcaninfecthospitalpatients,health
careworkersandthegeneralpublic.
2|
Whatishealthcarewaste?
Healthcarewasteincludesallthewastegeneratedbyhealth
careestablishments,researchfacilities,andlaboratories.In
addition,itincludesthewasteoriginatingfromminoror
scatteredsourcessuchasthatproducedinthecourseofhealth
careundertakeninthehome(dialysis,insulininjections,etc.).
3|
Categoriesofhealthcarewaste
Sharps:Usedorunusedsharps
e.g.hypodermic,intravenousorotherneedles;autodisablesyringes;
syringeswithattachedneedles;infusionsets;scalpels;pipettes;knives;
blades;brokenglass
Infectious:Infectiouswasteismaterialsuspectedtocontainpathogens
(bacteria,viruses,parasitesorfungi)insufficientconcentrationorquantityto
causediseaseinsusceptiblehosts.Thiscategoryincludes:wastecontaminated
withbloodorotherbodyfluids,culturesandstocksofinfectiousagentsfrom
laboratorywork,wastefrominfectedpatientsinisolationwards;dressings,bandages
andothermaterialcontaminatedwithbloodorotherbodyfluids
Pathological:Humantissues,organsorfluids;bodyparts;fetuses;
unusedbloodproducts
4|
Categoriesofwaste(cont)
Pharmaceutical:Pharmaceuticalsthatareexpiredornolonger
needed;itemscontaminatedbyorcontainingpharmaceuticals;Cytotoxic
wastecontainingsubstanceswithgenotoxicpropertieswastecontaining
cytostaticdrugs(oftenusedincancertherapy)genotoxicchemicals)
Chemical:Wastecontainingchemicalsubstances
(e.g.laboratoryreagents;filmdeveloper;disinfectantsthatareexpiredorno
longerneeded;solvents;wastewithhighcontentofheavymetals,e.g.
batteries;brokenthermometersandbloodpressuregauges)
Radioactive:Wastecontainingradioactivesubstances
(e.g.unusedliquidsfromradiotherapyorlaboratoryresearch;contaminated
glassware,packages,orabsorbentpaper;urineandexcretafrompatients
treatedortestedwithunsealedradionuclides;sealedsources)
5|
Generaldefinitionand
characteristics
6|
Childrenwhomaycomeintocontactwithcontaminatedwaste
DozenofchildreninSadrCity,largestsuburbofBaghdad,havebeen
admittedtohospitalswithsymptomsofinfectiousdiseasesduetocontact
withwaste(IntegratedRegionalInformationNetworks,2007).
Communitieslivingnearlandfillandwastesitesorneartreatmentfacilities
Lowincomehouseholdsaremorelikelytoliveclosetowastesites
resultinginmoredirectcontactwithhealthcarewaste(AppletonandAli,
2000)
Localpopulationsaffectedbytheutilizationofproductsrecycledfrom
healthcarewasteandthereuseofuntreatedmedicalequipment
InIndiamorethan30%oftheinjectionsadministeredeachyearwere
carriedoutusingreusedorinadequatelysterilizedmedicalequipmentand
thatnationally,10%ofhealthcarefacilitiessoldusedsyringestowaste
pickers(IndiaCLEN2004).
pickers(IndiaCLEN2004).
Communitiesimpactedbypollutionfrompoorlyoperatedincinerators
Researchsuggeststhatpopulationlivingwithin3kmofoldincinerators
sawanincreaseof3.5%intheriskofcontractingcancer(Portaetal,2009)
9|
ProcessofHCWastemanagement
10 |
Wasteclassification
Wastesegregation
Wasteminimization
Containerization
Colorcoding
Labelingandsignage
Handling
Transport
Storage
Treatment
Finaldisposalof
waste.
Wastemanagementhierarchy
Most preferable
Prevent
Reduce
Reuse
Recycle
Recover
Treat
Dispose
Least preferable
11 |
Wastesegregationiskey
Carefulsegregationandseparate
collectionofhospitalwasteisthekey
tosafe,soundmanagementofhealth
carewaste.
Segregationcansubstantiallyreduce
thequantityofhealthcarewastethat
requiresspecializedtreatment.
12 |
Segregationofhealthcarewaste
(continued)
Inanyareathatproduces
hazardouswastehospitalwards,
treatmentrooms,operating
theatres,laboratories,etc.
binsplusseparate
sharpscontainerwillbeneeded.
13 |
Segregationofhealthcarewaste
14 |
Sharpswaste
Sharpsareitemsthatcancause
cutsorpuncturewounds,
including:
15 |
needles,
hypodermicneedles,
scalpelandotherblades,
knives,
infusionsets,
saws,
brokenglass,
andpipettes
Sharpwastemanagement
SharpsHandlingRecommendations
Donotrecapneedles
Neverpassusedsharpsfromone
persontoanother
Locateneedledestroyerand
containernearthepointof
generationtohavegoodvisibility
Sharpsshouldbedisposedofin
punctureresistantsharps
containers
16 |
Highlyhazardoushealthcarewaste
Highly hazardous healthcare wastes, which should be given special
attention, includes
highly infectious non-sharp waste such as laboratory supplies,
highly infectious physiological fluids, pathological and anatomical
waste, stools from cholera patients,
and sputum and blood of patients with highly infectious diseases such
as TB and HIV/AIDS.
They also include large quantities of expired or unwanted
pharmaceuticals and hazardous chemicals,
as well as all radioactive or genotoxic wastes.
17 |
Subcategoriesofhazardouswaste:Infectious
wasteandhighlyinfectiouswaste
Infectiouswasteincludes:
culturesandstocksofinfectiousagentsfrom
laboratorywork;
wastefromsurgeryandautopsiesonpatients
withinfectiousdiseases;
wastefrominfectedpatientsinisolationwards;
wastethathasbeenincontactwithinfected
patientsundergoinghaemodialysis;
infectedanimalsfromlaboratories;
anyotherinstrumentsormaterialsthathave
beenincontactwithinfectedpersonsoranimals.
18 |
Infectiouswastemanagement
Infectiouswasteshouldgointo
yellowleakproofplasticbagsor
containers.
Bagsandcontainersfor
infectiouswasteshouldbe
markedwiththeinternational
infectioussubstancesymbol
19 |
Subcategoriesofhazardouswaste:
Chemicalwasteandpharmaceutical
waste
Chemicalwasteconsistsof
discardedsolid,liquid,and
gaseouschemicals,for
examplefromdiagnosticand
experimentalworkandfrom
cleaning,housekeeping,and
disinfectingprocedures.
Pharmaceuticalwasteincludes
expired,unused,spilt,and
contaminatedpharmaceutical
products,drugs,vaccines,and
serathatarenolongerrequired
andneedtobedisposedof
appropriately.
20 |
Chemicalandpharmaceuticalwaste
management
Smallamountsofchemicalor
pharmaceuticalwastemaybe
collectedtogetherwithinfectious
waste.
Largequantitiesofchemical
wasteshouldbepackedin
chemicalresistantcontainers.
21 |
Theidentityofthechemicals
shouldbeclearlymarkedonthe
containers:hazardouschemical
wastesofdifferenttypesshould
neverbemixed.
Radioactivewaste
Thewasteproducedbyhealthcareandresearchactivities
involvingradionuclides,andrelatedactivitiessuchas
equipmentmaintenance,storage,etc.,canbeclassifiedas
follows:
sealedsources;
spentradionuclidegenerators;
lowlevelsolidwaste,e.g.absorbentpaper,swabs,glassware,syringes,vials;
residuesfromshipmentsofradioactivematerialandunwantedsolutionsofradionuclides
intendedfordiagnosticortherapeuticuse;
liquidimmisciblewithwater,suchasliquidscintillationcountingresiduesusedin
radioimmunoassay,andcontaminatedpumpoil;
wastefromspillsandfromdecontaminationofradioactivespills;
excretafrompatientstreatedortestedwithunsealedradionuclides;
lowlevelliquidwaste,e.g.fromwashingapparatus;
gasesandexhaustsfromstoresandfumecupboards.
22 |
Generalhealthcarewaste
General healthcare
waste, similar or
identical to domestic
waste, including
materials such as
packaging or unwanted
paper. 7590% of waste
generated by healthcare
facilities falls into this
category.
23 |
Generalwastemanagement
This waste is generally
harmless and needs no
special handling; and
General health-care waste
should join the stream of
domestic refuse for disposal.
Bags and containers for
general healthcare waste are
black.
24 |
Wasterecycling
Only15%ofthehospitalwastestreamisclassified
regulatedorpotentiallyinfectious,andmustbe
handledassuch.
Themajorityofhospitalwasteissimilartothatfoundin
anofficebuildingorhotelmostlypaper,cardboard,
metalandfoodwaste.
Muchofthiswastecanbedivertedfromlandfillsandcan
reducewastedisposalcoststhroughwasterecycling.
25 |
Examplesof
Reuse,Recycle
ofWaste,Water
ThailandGREEN&
CLEANHospitals
Biogasfromfoodwasteusedfor
hospitalcooking
RecyclingplasticIVbottles
IndiaBhopal
SambhavnaTrustClinic
26 |
Harvestsrainwaterforhospitaluse
Solarwaterheatersandpassive
ventilationreduceenergyuse
Tropicalgardens,irrigatedby
recycledwater,providefreshfruits
andvegetablesforstaffandpatients
Public health and environment
Greeninghealthsector:cobenefitsfor
patients,healthworkersandclimate
mitigation
Chemicalhazards:
"Riskingtheirhealthwhile
Captureandreuse
caringforothers:
ofwasteanesthetic Reproductivehealth
gases:reproductive hazardsofgermkillers"
hazardsandpotent NIOSH,HarvardSchoolofPublic
HealthandBrigham&Women's
Hospitalsurveyedof7,000women
GHGases*
nursesandfoundnumerouspotential
*Estimatedtohaveaglobal
occupationalchemicalexposuresthat
warmingpotentialof500
3700XCO2
Ryan,SM,NielsenCJ.Globalwarmingpotentialof
inhaledanaesthetics:applicationtoclinicaluse.
InternationalAnesthesiaResearchSociety,July2010,
111(1).
27 | Public health and environment
doubledortripledmiscarriagerisk.
LawsonCetal.AmJObstetGynecol.2011Dec30
...Examplesofmercuryelimination
NewDelhi,India:thecityspublichealth
systemissubstitutingmercuryinits
hospitals.Todate12hospitalsarein
theprocessofsubstitution.(Poster
fromcampaignonright)
SaoPaulo,Brazil:morethan100private
hospitalsand34publichospitalshave
gonemercuryfree
MexicoCity,Mexico:Thehealth
secretariatannouncedinSeptember
2009thatitssystemof28hospitalsand
morethan200healthclinicswouldjoin
theWHOHCWHInitiativeandphase
outmercurybasedmedicaldevices.
28 |
29 |
SpecialRapporteuronhazardouswaste,
Theimproper
managementand
disposalofmedical
wastehasan
adverseimpacton
theenjoymentof
humanrightsin
manycountries.
30 |
ReferstotheStockholm
ConventiononPOPs
Sourcewiththepotential
forcomparativelyhigh
formationofdioxins&
furans:MedicalWaste
Incinerators
40,000timeshigherthan
emissionlimitssetforth.
Sept2011A/HRC/18/31
31 |
32 |
Supply Chain
Lookforsolutionstoreducewastetocontributetoimproving
someofthehealthcarewastemanagementproblemcountries
face
Ultimately,thewastemanagementproblemmustbeaddressedat
alllevels,fromupstreamtechnologydevelopmenttodownstream
wasteminimizationandmanagement,toensurethathealthcare
canbedeliveredwithoutsideeffectsonhealthcareworkers,
communities,ortheenvironment
Improvementsmadebycountriesbyadoptingpurchasepolicies
thatconsiderthewastestream
33 |
Healthwastemanagement
Some25%ofhealthwasteishazardousdevelopingcountriesaremost
atriskduetopoorwastemanagementpractices.
Energybenefitsofenergywastesystemsareclearbutmayinvolveahealth
penalty(e.g.emissionsofdioxins,pollutants)
Environmentalbenefitsofmechanical/thermaltreatment(e.g.
microwaving/autoclaving)arealsoclearenergyaspectsneedsmore
exploration.
OpenhealthwasteincinerationpitHaiti
34 |
Hydroclave:forhealthwastesteamsterilizationand
griding/volumereductionGuyana
Safe health-care
waste management
POLICY PAPER
1 - Unsafe health-care waste management leads to death and disability
Health-care activities lead to the production of waste that may lead to adverse health effects. Most of this waste
is not more dangerous than regular household waste. However, some types of health-care waste represent a
higher risk to health. These include infectious waste (15% to 25% of total health-care waste) among which are
sharps waste (1%), body part waste (1%), chemical or pharmaceutical waste (3%), and radioactive and
cytotoxic waste or broken thermometers (less than 1%).
Sharps waste, although produced in small quantities, is highly infectious. Poorly managed, they expose healthcare workers, waste handlers and the community to infections. Contaminated needles and syringes represent a
particular threat and may be scavenged from waste areas and dump sites and be reused. WHO has estimated
that, in 2000, injections with contaminated syringes caused:
two million hepatitis C virus (HCV) infections (40% of all new infections);
Standards: 0.1 ng TEQ/m (Toxicity Equivalence) in Europe to 0.1 ng to 5 ng TEQ/m in Japan according to
incinerator capacity.
RapidAssessment
Toole.Monitoring
Tool
Mercury in
Health Care
WORLD HEALTH ORGANIZATION
POLICY PAPER
1 - Background
Mercury is a naturally occurring heavy metal. At ambient temperature and pressure, mercury is a silvery-white
liquid that readily vaporizes and may stay in the atmosphere for up to a year. When released to the air, mercury
is transported and deposited globally. Mercury ultimately accumulates in lake bottom sediments, where it is
transformed into its more toxic organic form, methyl mercury, which accumulates in fish tissue.
WHOcoreprinciples
Mercury is highly toxic, especially when metabolized into methyl mercury. It may be fatal if inhaled and harmful if
absorbed through the skin. Around 80% of the inhaled mercury vapour is absorbed in the blood through the
lungs. It may cause harmful effects to the nervous, digestive, respiratory, immune systems and to the kidneys,
besides causing lung damage. Adverse health effects from mercury exposure can be: tremors, impaired vision
and hearing, paralysis, insomnia, emotional instability, developmental deficits during fetal development, and
attention deficit and developmental delays during childhood. Recent studies suggest that mercury may have no
threshold below which some adverse effects do not occur.
forachievingsafeand
sustainable
management
ofhealthcarewaste
35 | Public health and environment
http://www.healthcarewaste.org
"WaterandSanitationisoneoftheprimarydriversofpublic
health.IoftenrefertoitasHealth101,whichmeansthatoncewe
cansecureaccesstocleanwaterandtoadequatesanitationfacilities
forallpeople,irrespectiveofthedifferenceintheirlivingconditions,
ahugebattleagainstallkindsofdiseaseswillbewon."
DrLEEJongwook,DirectorGeneral,WorldHealthOrganization.
YvesCHARTIER
http://www.who.int/water_sanitation_health
36 |
http://www.healthcarewaste.org
Public
health and environment