- Country level
- HC facilities
- Country level
- HC facilities
Healthcare activities lead to the production of waste that can have adverse health effects. Although most of this waste is not more dangerous than regular household waste, some types of healthcare waste represent a higher risk to health [read more…]
These include infectious waste (15% to 25% of total healthcare 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:
Epidemiological studies indicate that a person who experiences one needle-stick injury from a needle used on an infected source patient has risks of 30%, 1.8%, and 0.3% respectively to become infected with HBV, HCV and HIV. In 2002, the results of a WHO assessment conducted in 22 developing countries showed that the proportion of healthcare facilities that do not use proper waste disposal methods ranges from 18% to 64%.
HCWM options may themselves lead to risks to health and no perfect readily achievable solution to manage HCW exists. Healthcare waste, whether generated at smaller rural clinics or larger facilities, can be managed where adequate well-operated infrastructures exist [read more…]
However, the volumes of waste generated within large facilities and targeted public efforts (e.g., immunization campaigns) are more challenging, particularly in developing countries where resources may be limited.
In these difficult situations for which waste disposal options are limited, small-scale incinerators have been used and are still used as an interim solution. However, small-scale incinerators often operate at temperatures below 800 degrees Celsius. This may lead to the production of dioxins, furans or other toxic pollutants as emissions and/or in bottom/fly ash.
Transport to centralised disposal facilities may also produce hazards to healthcare handlers, if not safely managed.
In addition to risks to health from infectious agents, long-term low-level exposure of humans to dioxins and furans may lead to impairment of the immune system, and impaired development of the nervous system, the endocrine system and the reproductive functions. Short-term high level exposure may result in skin lesions and altered liver function [read more…]
The International Agency for Research on Cancer (IARC) classifies dioxins as a “known human carcinogen”. However, most of the evidence documenting the toxicity of dioxins and furans is based upon studies of populations that have been exposed to high concentrations of dioxins either occupationally or through industrial accidents. There is little evidence to determine whether chronic low-level exposure to dioxins and furans causes cancer in humans. Overall, it is not possible to estimate the global burden of diseases from exposure to dioxins and furans because of large areas of uncertainty.
In the last 10 years, the enforcement of stricter emission standards for dioxins and furans by many countries significantly reduced the release of these substances into the environment.
In several Western European countries where tight emissions restrictions were adopted in the late 1980s, dioxin and furan concentrations in many types of food (including breast milk) have decreased sharply.
WHO has established tolerable intake limits for dioxins and furans, but not for emissions. The latter must be set within the national context.
In view of the challenge represented by healthcare waste and its management, WHO activities are oriented by the following guiding principles [read more…]
To better understand the problem of healthcare waste management, WHO guidance recommends that countries conduct assessments prior to any decision as to which healthcare management methods be chosen. Tools are available to assist with the assessment and decision-making process so that appropriate policies lead to the choice of adapted technologies. WHO proposes to work in collaboration with countries through the following strategies:
Until countries in transition and developing countries have access to HCWM options that are safer to the environment and health, incineration may be an acceptable response when used appropriately.
Key elements of appropriate operation of incinerators include effective waste reduction and waste segregation, placing incinerators away from populated areas, satisfactory engineered design, construction following appropriate dimensional plans, proper operation, periodic maintenance, and staff training and management.