Dangers of hospital waste

ENVIRONMENT

By GODFRIED ANGI
THERE is a high risk of infections and injuries to human health and the potential to cause environmental harm from the generation and disposal of biomedical or hospital wastes.
These wastes of a high risk nature have not been fully considered by authorities concerned. The dangers of these wastes are very real and it calls for appropriate actions to be taken to address these life threatening issue. The issues to be considered are government policy, legislation and administrative procedure in addressing this waste stream.
What is the current situation and trend in the generation and disposal of these wastes in Papua New Guinea? Although there are some efforts by the Government in addressing these issues, more needs to be done to contain and manage the threats these wastes pose to human health and the environment. Generation of these wastes at the different health care facilities lacks proper collection, storage, transportation and disposal.
Inevitable increase in waste generation
More and more government and private healthcare facilities are being established in PNG. This leads to the inevitable increase in the generation of these wastes and the problems in managing them. The provisions in PNG in terms of legislation, regulation, policy and administrative frameworks are well below acceptable standards.
Medical waste is a term that refers to wastes that are generated at hospitals, physicians’ offices, dental clinics, blood banks, and veterinary hospitals/clinics, as well as medical research facilities and laboratories.
Biomedical waste or hospital waste contains materials that have the potential to cause infection. This may also include any material that comes into contact with the generation of biomedical waste that appears to be of medical or laboratory origin such as packaging, unused bandages and infusion kits etc, as well as research laboratory waste containing biomolecules or organisms that are mainly restricted from environmental release.
Discarded sharps are considered biomedical waste whether they are contaminated or not, due to the possibility of being contaminated with blood and their potential to cause injury when not properly contained and disposed. Biomedical waste may be solid or liquid. Examples of infectious waste include discarded blood, sharps, unwanted microbiological cultures and stocks, identifiable body parts that result from amputation, other human or animal tissue, used bandages and dressings, discarded gloves, other medical supplies that may have been in contact with blood and body fluids, and laboratory waste that exhibits the characteristics described above.
Waste sharps include potentially contaminated used (and unused discarded) needles, scalpels, lancets and other devices capable of penetrating skin.
Biological and medical sources
Biomedical waste is generated from biological and medical sources and activities, such as the diagnosis, prevention, or treatment of diseases. Common generators (or producers) of biomedical waste include hospitals, health clinics, nursing homes, emergency medical services, medical research laboratories, offices of physicians, dentists, veterinarians, home health care and morgues or funeral homes. In healthcare facilities (hospitals, clinics, doctor’s offices, veterinary hospitals and clinical laboratories), waste with these characteristics may alternatively be called medical or clinical waste.
Biomedical waste is distinct from general waste, and differs from other types of hazardous waste, such as chemical, radioactive, universal or industrial waste. Medical facilities generate waste hazardous chemicals and radioactive materials. While such wastes are normally not infectious, they require proper disposal. Some wastes are considered multi-hazardous, such as tissue samples preserved in formalin.
Effects on humans
Disposal of these waste is an environmental concern, as many medical wastes are classified as infectious or biohazardous and could potentially lead to the spread of infectious disease. The most common danger for humans is the infection which also affects other living organisms in the region. Daily exposure to the wastes (landfills) leads to accumulation of harmful substances or microbes in a person’s body.
Some research and studies concluded that the general public is not likely to be adversely affected by biomedical waste generated in the traditional healthcare setting but found that biomedical waste from those settings may pose injury and exposure risks via occupational contact with medical waste for doctors, nurses, and janitorial, laundry and refuse workers.
Further, there are opportunities for the public to come into contact with medical waste, such as needles used illicitly outside healthcare settings, or biomedical waste generated via home health care.

Management
Biomedical waste must be properly managed and disposed of to protect the environment, the public and workers, especially healthcare and sanitation workers who are at risk of exposure to biomedical waste as an occupational hazard. Steps in the management of biomedical waste include generation, accumulation, handling, storage, treatment, transport and disposal.
Specific policy framework
The development and implementation of an appropriate and a relevant legislation and policy such as the national waste management policy can improve biomedical waste management in health facilities in Papua New Guinea. The management of these wastes should not be included in the National Health Act but should have a specific legislation and policy framework to deal with these wastes streams.
Disposal occurs off-site, at a location that is different from the site of generation. Treatment may occur on-site or off-site. On-site treatment of large quantities of biomedical waste usually requires the use of relatively expensive equipment, and is generally only cost -effective for very large hospitals and major universities who have the space, labour and budget to operate such equipment. Off-site treatment and disposal involves hiring of a biomedical waste disposal service (also called a truck service) whose employees are trained to collect and haul away biomedical waste in special containers (usually cardboard boxes, or reusable plastic bins) for treatment at a facility designed to handle biomedical waste.
Generation and accumulation
Biomedical waste should be collected in containers that are leak-proof and sufficiently strong to prevent breakage during handling. Containers of biomedical waste are marked with a biohazard symbol. The container, marking, and labels are often red.
Specialised equipment is required to meet standards of safety. Minimal recommended equipment includes a fume hood and primary and secondary waste containers to capture potential overflow.
Even beneath the fume hood, containers containing chemical contaminants should remain closed when not in use. An open funnel placed in the mouth of a waste container has been shown to allow significant evaporation of chemicals into the surrounding atmosphere, which are then inhaled by laboratory personnel. To protect the health and safety of laboratory staff as well as neighboring civilians and the environment, proper waste management equipment should be utilised in any department which deals with chemical waste.
Storage and handling
Storage refers to keeping the waste until it is treated on-site or transported off-site for treatment or disposal. There are many options and containers for storage. Regulatory agencies may limit the time for which waste can remain in storage. Handling is the act of moving biomedical waste between the point of generation, accumulation areas, storage locations and on-site treatment facilities. Workers who handle biomedical waste must observe standard precautions.
Treatment
The goals of biomedical waste treatment are to reduce or eliminate the waste’s hazards, and usually to make the waste unrecognisable. Treatment should render the waste safe for subsequent handling and disposal. There are several treatment methods that can accomplish these goals. Biomedical waste is often incinerated. An efficient incinerator will destroy pathogens and sharps. Source materials are not recognisable in the resulting ash. Alternative thermal treatment can also include technologies such as gasification and pyrolysis including energy recovery with similar waste volume reductions and pathogen destruction.
An autoclave may also be used to treat biomedical waste. An autoclave uses steam and pressure to sterilise the waste or reduce its microbiological load to a level at which it may be safely disposed of.
Many healthcare facilities routinely use an autoclave to sterilise medical supplies. If the same autoclave is used to sterilise supplies and treat biomedical waste, administrative controls must be used to prevent the waste operations from contaminating the supplies. Effective administrative controls include operator training, strict procedures, and separate times and space for processing biomedical waste.
Microwave disinfection can also be employed for treatment of biomedical wastes. Microwave irradiation is a type of non-contact heating technology for disinfection. Microwave chemistry is based on efficient heating of materials by microwave dielectric heating effects.
When exposed to microwave frequencies, the dipoles of the water molecules present in cells re-align with the applied electric field. As the field oscillates, the dipoles attempts to realign itself with the alternating electric field and in this process, energy is lost in the form of heat through molecular friction and dielectric loss.
Microwave disinfection is a recently developed technology which provides an advantage over old existing technologies of autoclaves as microwave based disinfection has less cycle time, power consumption and it requires minimal usage of water and consumables as compared to autoclaves.
For liquids and small quantities, a 1–10 per cent solution of bleach can be used to disinfect biomedical waste. Solutions of sodium hydroxide and other chemical disinfectants may also be used, depending on the waste’s characteristics. Other treatment methods include heat, alkaline digesters and the use of microwaves.
For autoclaves and microwave systems, a shredder may be used as a final treatment step to render the waste unrecognizable. Some autoclaves have built in shredders.
If body fluids are present, the material needs to be incinerated or put into an autoclave. Although this is the proper method, most medical facilities fail to follow the regulations. It is often found that biomedical waste is dumped into the ocean, where it eventually washes up on shore, or in landfills due to improper sorting or negligence when in the medical facility. Improper disposal can lead to many diseases in animals as well as humans. Large number of unregistered clinics and institutions also generate bio-medical waste which is not controlled.
Syringe tide environmental disaster
The syringe tide environmental disaster of 1987–1988 raised awareness about medical waste as medical syringes washed ashore in Connecticut, New Jersey, and New York. A similar situation occurred in 2013 at Island Beach State Park in New Jersey, and brought about the Floatables Action Plan. The syringes endangered marine species and posed a threat to humans who visited the beach. The crises spurred scientists and lawmakers to create mechanisms, policies, and laws so that health care providers would process their bio-waste in an environmentally friendly way.
Effects of medical waste on the environment
Improper management of health care waste can have both direct and indirect health consequences for health personnel, community members and on the environment. Indirect consequences in the form of toxic emissions from inadequate burning of medical waste, or the production of millions of used syringes in a period of three to four weeks from an insufficiently well planned mass immunisation campaign.
Plastic
Biomedical waste is not limited to medical instruments; it includes medicine, waste stored in red biohazard bags, and materials used for patient care, such as cotton and band aids. The most serious effect that biomedical waste has on our seas is the discharge of poisons into the waters that could then be consumed by ocean life creatures. Toxins would interject into the food chain and eventually reach humans who consume sea creatures. Human exposure to such toxins can stunt human growth development and cause birth defects.
The high volume of plastic use in the medical field also poses a dangerous threat to the environment. According to North and Halden, 85 per cent of disposable plastic materials make up all medical equipment.
Our current reliance on plastic materials is rooted in their unique capabilities to be lightweight, cost-effective, and durable while preserving the sterility of medical equipment.

• Godfried Angi is the principal scientist at Yeyue Environmental Services