Clear rules applicable to all

It is the responsibility of governments to set up the necessary legal framework for the safe management of healthcare waste and to ensure that HCF managers take their share of responsibility to manage wastes safely and comply with national regulations.

Legal provisions

National legislation is the basis for improving healthcare waste practices in any country. It establishes legal controls and permits the national agency responsible for the disposal of healthcare waste, in most cases the ministry of health, to apply pressure for their implementation. The ministry of environment or national environmental protection agency may also be involved; there should be a clear designation of responsibilities before the law is enacted.

The law should be complemented by a policy document, and by technical guidelines developed for implementation of the law [read more…]

This legal «package» should specify regulations on treatment for different waste categories, segregation, collection, storage, handling, disposal, and transport of waste, responsibilities, and training requirements. It should take into account the resources and facilities available in the country concerned and any cultural aspects linked to waste-handling.

A national law on healthcare waste management may stand alone or be part of more comprehensive legislation such as the following:

  • law on management of hazardous wastes: application to healthcare waste should be explicitly stated;
  • law on hospital hygiene and infection control: a specific chapter or article should be devoted to healthcare waste.

The law should include the following:

  • a clear definition of hazardous  healthcare waste and of its various categories;
  • a precise indication of the legal obligations of the healthcare waste producer regarding safe handling and disposal;
  • specifications for record-keeping and reporting;
  • specifications for an inspection system to ensure enforcement of the law, and for penalties to be imposed for contravention;
  • designation of courts responsible for handling disputes arising from enforcement of or non-compliance with the law.

Gradual implementation of the law is recommended in preference to any attempt to introduce all measures simultaneously, particularly where existing practices are inadequate.

Policy & Strategy document(s)

The policy document should outline the rationale for the legislation, plus national goals and the key steps essential to the achievement of these goals. It may contain the following: [read more…]

  • descriptions of the health and safety risks resulting from mismanagement of HCW;
  • reasons for sound and safe HCWM practices in HCFs;
  • listing of approved methods of treatment and disposal for each waste category;
  • warning against unsafe practices, such as disposing of hazardous HCW in municipal landfills;
  • management responsibilities within and outside healthcare establishments;
  • assessment of the costs of HCWM;
  • key steps of HCWM: minimization, segregation and containerization, transport, storage, treatment and final disposal of waste. Technical specifications for the implementation of each step should be described in separate technical guidelines;
  • record-keeping and documentation;
  • training requirements;
  • rules governing the protection of workers’ health and safety.

Technical guidelines

These guidelines associated with the legislation should be practical and directly applicable [read more…]

They should include the following specifications, with sufficient detail to ensure that safe practices are observed and appropriate standards achieved:

  • legal framework covering safe management of HCW, hospital hygiene, and occupational health and safety (limits of emission of atmospheric pollutants and measures for protection of water resources may be addressed here or in the other national guidelines);
  • the responsibilities of public health authorities, of the national environmental protection body, of the heads of HCFs, of the scattered and smaller producers of HCW; and of the heads of any private or public waste-disposal agencies involved;
  • safe practices for waste minimization;
  • segregation, handling, storage, and transport of healthcare waste;
  • recommended treatment and disposal methods for each category of HCW and for wastewater.

For ease of application, the definitions of HCW categories included in the law should be repeated in the technical guidelines.