4.4 Health Care Waste Management

4.4 Health Care Waste Management


Welcome back. In this module, we’ll be covering the very important aspect
of health care waste management. Hopefully after this module, you’ll be able to
distinguish the health care waste categories,
and their respective risks. You should also know how to improve
health care waste management, especially regarding segregation,
storage and treatment. This module is quite short, so we’ll also give indication where you can
obtain more information and further training. First and above all, you have to realize that
health care waste comes from many sources, including major sources
such as hospital, clinics and laboratories, but also minor sources such as doctor offices,
dental clinics and convalescent homes. If we look at health care waste amounts and composition, what is most important to know is that only
15 to 25 percent of the health care waste, only this fraction, is actually hazardous. The rest is actually like municipal solid waste, and can be treated as normal
municipal solid waste is treated. So what is most important is to segregate
this hazardous fraction from the rest, because it is this part that needs special treatment. Here is a list of categories
of hazardous health care waste. For instance, sharps. That’s needles and syringes,
but also blades. Then, there is infectious waste: blood, body fluids
or infectious cultures. Pathological waste, which includes
human tissue, organs or body parts. Pharmaceutical waste,
which obviously are pharmaceuticals. Then there is chemical waste: reagents, disinfectants, solvents,
but also batteries or thermometers containing mercury. And finally, radioactive waste
from radiotherapy or from laboratories. Implementing a comprehensive segregation system
involves knowing how to distinguish these various fractions, and then setting up a system,
to be able to store these separately. Here is one example of color coding on bins and
containers for these different health care waste categories. You see the infectious and the sharps
typically color-coded with yellow, and the normal waste with black. This is also shown in this table by WHO, where recommendations for color coding and types
of containers for the different categories are given. Let us take one look at a specific case: of sharps. Sharps is one fraction with a high risk, mostly for health care workers, waste workers or
sometimes even users of recycled injection equipment. Here are some examples of sharps containers. They must be closable, puncture-resistant
and leak-proof on the sides and on the bottom; they should be accessible, always maintained upright
and not allowed to overfill; also, they should be labeled or color-coded,
labeled even with a bio-hazardous symbol. In one example, you even see a container that is
suitable for direct treatment in, for instance, an autoclave. Now, let’s look at health care waste treatment. Health care waste treatment systems
are commercially available today. The choice of technology depends on the
characteristics of the waste of the health care facility, the capabilities and the requirements of the technology, environment and safety factors
as well as cost. A good overview is given in this document from UNEP
on technologies for treatment and destruction of
health care waste. The most common types of treatment technologies are
autoclaves, hybrid steam-based treatment systems
or microwave treatment technologies. Then, there is also dry heat treatment technologies,
where waste is heated up by conduction
or thermal radiation. This requires higher temperature and longer exposure times
than steam-based processes. They are commonly used to treat small volumes. Then finally,
there is of course also incineration, there is chemical treatment or
options for special landfilling and disposal. Here is an example of an autoclave system in Senegal or here another example from Tanzania. In this case,
this shows a gas-powered autoclave. Then, there is also incineration. One simple incineration system is
the De Montfort Incinerator, as a cheap but effective incinerator
which can be built in almost any developing country. It reaches the criteria of a temperature above 800°C
with a residence time of over one second. Despite that they’ve been designed to be
simple and affordable, we still have to think of appropriate location,
and using the right materials for construction. Guidelines on how to construct, use and maintain
such an incineration unit can be found online. The incinerator should be built at a convenient distance away
from buildings, so that any smoke or gas does not enter the buildings. 150 meters is the suggested minimum. So now, how do we go about to set up a system,
for instance at a hospital? First of all, we need to take into account the legislative framework. We also need to assign responsibilities and duties,
find financial arrangements – but also, we need to start by knowing our situation
through monitoring and an assessment. Based on that, we can then develop a waste management plan
and implement this through appropriate infrastructure, and of course with an intense development of
awareness through respective campaigns. On the other hand, if you are active on a city level,
your concern will not be at the facility itself, but how to organize and coordinate a system inside the city
which is able to manage health care wastes
from different sources. The aspects of segregation will happen
at the health care center itself, but then how to organize transport and treatment
might take different pathways. For instance, if the health care facility is large, like a central
hospital, then treatment can happen at this same location. On the other hand, for small centers which are distributed
all throughout the city, it will probably make more sense to set up a
collection and transport system, and then
have a semi-central treatment at one larger facility or even a central treatment
at one specific location in the city. So to summarize, in this module, we have looked at
health care waste, its different categories and risks. We have discussed aspects of segregation at source,
specifically also the site storage requirements. Then, we looked at some examples of treatment options, and then concluded by describing some elements of
planning for health care waste management – at the facility itself, but also taking an overall perspective
on how to plan for a city-wide solution. If I have been able to excite you about
health care waste management, and you feel now disappointed that this module
just gave you a small glimpse of the issues, then I can recommend the following documents
for further reading. As you can see from the website links,
it is WHO, the World Health Organization, that has quite a number of very exciting documents
that make for an interesting read. Also this webpage by WHO is a resource hub for very many
different issues related to health care waste management. We have links to basics, there are aspects of country issues, and then there’s a link to resources, to many documents
giving more information on health care waste management. You might even be interested to get
more training and education on health care waste. WHO has a series of training modules. They are structured as PDF files,
which you can download, In addition,
I would also recommend two modules of the MOOC course
Introduction to public health engineering
in humanitarian contexts”, which focus on health care waste. Thanks for watching.

Daniel Yohans

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