Waste Management In Healthcare

What is Waste Management?

Waste management is the process of collecting, segregating, disposing or recycling, and monitoring of waste materials. Waste materials or chemicals are often a result of human activity and are inherent to civilization. These materials can be of solid, liquid, gaseous or radioactive nature that can pose as a threat to both the environment and those living in the environment.

Around the world waste generation has been on a steady rise. Solid waste generation in 2012 in the world cities was 1.3 billion tonnes/year; this amounts to 1.2kg/person/year. With the ongoing urbanization and rapid population growth, it is estimated that by 2025 waste generation will rise to 2.2 billion tonnes. Low and middle-income countries are found to be more affected by the waste disposal as unsustainable practices like burning and open dumping of waste can severely affect the health of the populations.

India is presently facing challenges with rapid urbanization. Urban estimates reveal that there are 377 million people living in 7935 town and cities who generate 62 million tonnes in a year. Of this only 43 million tonnes (or metric tons / MT) are collected, 11.9 MT treated, and 31.1 MT are dumped in landfill sites. Solid waste management is one of the essential services of municipal authorities but it is managed in a haphazard manner resulting in adverse health effects.

What is the Importance of Healthcare Waste Management?

Healthcare waste management refers to waste generated from health care facilities, hospitals, laboratories and other diagnostic facilities. Health care institutions play an important role in safeguarding health but the waste generated also need to be accounted for. Of the waste generated, 85% are non-hazardous while the rest 15% are infectious, toxic or radioactive.

Worldwide, 16 billion injections are administered but not all of the syringes and needles were properly disposed. Proper management of health care waste is important as infectious material present in the wastes can infect the health care workers, patients and hospital staff. Incineration of health care waste in an improper manner and can result in producing dioxins, furans and other air pollutants. In India it is estimated that 0.5 kg to 2 kg of hospital waste is produced per bed per day.

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What are the Types of Medical Waste?

The types of medical wastes are:

• Infectious wastes: These are materials contaminated by water and body fluids, cultures and stocks of infectious organisms, and patient wastes from isolation wards
• Pathological waste: These include tissue material of humans, organs, fluids, and animal carcass
• Sharps waste: These include used needles, syringes, disposable scalpels and blades
• Chemical waste: Materials like heavy metals in devices, solvents in laboratory reagents and detergents
• Pharmaceutical waste: Waste materials that include unused, contaminated, expired drugs and vaccines
• Genotoxic waste: Hazardous, mutagenic, carcinogenic and cytotoxic drugs in cancer treatment and metabolites
• Radioactive waste: Products including radioactive diagnostic and therapeutic materials
• Non-hazardous waste: Materials that are not biological, chemical or radioactive hazards

What are the Major Sources of Health-Care Waste?

The major sources of health care waste are:

• Hospitals, nursing homes and health care facilities

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• Diagnostic research and laboratory centers
• Autopsy and mortuary centers
• Animal research centers
• Pain, palliative and rehabilitative centers
• Blood bank and pathology centers

What are the Health Impacts of Health Care Waste?

There has been an alarming increase in the amount of health care waste with the increase in the number of hospitals and dispensaries that the local government is unable to deal with or clear. With the exception of a few large hospitals, many health care institutions are facing the problem of disposal of waste generated. The health risks associated with the waste include:

• Exposure to toxic chemicals like mercury, xylene and formalin can result in chemical injuries among health personnel and patients in contact.
• Microorganisms can come into contact with health care personnel and patient bystanders due to exposure to surfaces that are soiled with infected body fluids. In 2010 it was found that unsafe injection use was responsible for 1.7 million Hepatitis B infections, 315000 Hepatitis C infections and 33800 Human immunodeficiency virus infections.
• Improper disposal and lack of properly designed landfills result in contamination of water and exposure to toxic wastes.
• Inadequate incineration can result in toxic air pollution; the failure to use proper filters adds to the release of such pollutants into the air. Incineration of chlorine containing waste produces dioxins that are carcinogens.
• Lack of segregation of the biomedical wastes can risk an exposure to sharps among the workers of waste disposal and treatment. Even one needle stick injury from an infected source patient can result in 30% risk of Hepatitis B virus, 1.8% risk of Hepatitis C virus and 0.3% risk of Human immunodeficiency virus.
• Open waste dumping results in piling up of the waste which attracts insects; these dumps during the rains become breeding areas for the insects and as sources for vectors which spread infectious disease.
• Pouring of the antibiotics into the drain results in the killing of required microbes and altering the environment that helps in the breakdown of biological matter in septic tanks.

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Why do Waste Management Practices Fail?

Management of waste requires diligent knowledge and practice. Though there are laws available and implemented, there still exists a failure in proper waste disposal. Some of the concerns that require to be addressed are:

• Lack of awareness of health hazards related to health care waste
• Lack of training on proper waste disposal practices
• Absence of available constructed waste disposal systems
• A low priority level even after knowing the harmful effects of improper waste disposal
• A lack of funds and resources towards constructing waste disposal systems
• Occupational risks to health care waste exist but have not been efficiently addressed

What is E-Waste Management?

E-waste or electronic waste management is the collection and disposal of electrical and electronic equipments. It requires formal disposal methods. The main sources of E-waste in healthcare include:

• Information and communication technology equipment used in hospitals
• Patient monitors such as heart rate, breathing rate and blood pressure monitors
• Sterilizer, Surgical light and Defibrillator
• Electrocardiogram and digital sphygmomanometer

In India, close to 1, 46,000 tons of electronic and electrical waste is produced per year as per the report of the Confederation of Indian Industries (2006). The guidelines for management and handling of electronic waste in India are given by the E-waste (Management and Handling) Rules, 2010.

What is Waste Recycling?

Waste recycling is a method of collecting and processing waste materials that would otherwise be thrown away and turning them into new products. The perceived advantages are the reduction in waste disposed, lower chances of pollution and creating employment.