Biomedical waste is dangerous

Dr. Satyawan Saurabh *

About 85% of the total waste generated by healthcare activities is normal, non-hazardous waste. The remaining 15% is considered hazardous material that may be infectious, toxic, carcinogenic, flammable, corrosive, reactive, explosive, or radioactive. An estimated 16 billion injections are performed worldwide each year, but not all needles and syringes are disposed of properly. Open burning and low-temperature incineration of healthcare waste can, in some circumstances, emit dioxins, furans, and particulate matter.

Healthcare activities protect and restore health and save lives. But what about the waste and by-products they generate? About 85% of the total waste generated by healthcare activities is normal, non-hazardous waste comparable to household waste. The remaining 15% is considered hazardous material that may be infectious, chemical, or radioactive.

Measures to ensure safe and environmentally sound management of healthcare waste can prevent adverse health and environmental effects from such waste, including unintended release of chemical or biological hazards. Healthcare waste contains potentially harmful microorganisms that can infect hospital patients, healthcare workers, and the general public.

Other potential hazards may include drug-resistant microorganisms that spread from healthcare facilities to the environment. Adverse health outcomes associated with healthcare waste and by-products also include injuries from sharp objects;
exposure to pharmaceutical products, particularly antibiotics and cytotoxic drugs and substances such as mercury or dioxins, released into the surrounding environment during the handling or incineration of healthcare waste;
chemical burns arising in the context of disinfection, sterilization or waste treatment activities;
air pollution resulting from the release of particulate matter during medical waste incineration; thermal injuries associated with open burning and the operation of medical waste incinerators;
radiation burns; and the spread of antimicrobial resistance through unsafe storage, treatment and disposal of pharmaceutical waste.

Several reasons exist for inadequate healthcare waste services. These include limited legal frameworks (e.g., policies, regulation, guidelines), lack of awareness of the health hazards associated with healthcare waste, inadequate training in proper waste management, absence of waste management and disposal systems, inadequate financial and human resources, and low priority. Many countries either do not have proper regulations or do not monitor and enforce them.

Worldwide, an estimated 16 billion injections are performed each year. Not all needles and syringes are disposed of safely, creating risks of injury and infection and opportunities for reuse. Injecting with contaminated needles and syringes has decreased significantly in low- and middle-income countries in recent years, partly due to efforts to reduce the reuse of injection equipment.

Despite this progress, unsafe injections were still responsible for 33,800 new HIV infections, 1.7 million hepatitis B infections, and 315,000 hepatitis C infections. A person who experiences a needlestick injury from a needle used on an infected source patient has a 30%, 1.8%, and 0.3% risk of becoming infected with HBV, HCV, and HIV, respectively.

Additional hazards arise during cleanup at waste disposal sites and during the handling and manual sorting of hazardous waste from healthcare facilities. These practices are common in many regions of the world, especially in low- and middle-income countries.

Waste handlers face an immediate risk of needlestick injuries and exposure to toxic or infectious substances. The treatment and disposal of healthcare waste can also pose indirect health risks through the release of pathogens and toxic pollutants into the environment.

Disposal of untreated healthcare waste in landfills can lead to contamination of drinking, surface, and ground water if those landfills are not properly constructed. Minimizing healthcare waste should be a priority. This will significantly reduce the amount of waste that needs to be handled and treated.

Waste minimization actions include green purchasing and selecting products where shipping is minimized and have less and ecological packaging, switching to reusable products when safe and feasible, ordering/receiving pharmaceuticals only based on documented need, and recycling common items including plastics, paper, and cardboard.

Treatment of healthcare waste with chemical disinfectants can result in chemical substances being released into the environment if those substances are not handled, stored, and disposed of in an environmentally friendly manner.

Managing healthcare waste requires greater attention and diligence to avoid the adverse health outcomes associated with poor practice, including exposure to infectious agents and toxins.

Key elements to improving healthcare waste management are to promote practices that reduce the amount of waste generated and ensure proper waste segregation;
develop strategies and systems, along with strong monitoring and regulation,
to progressively improve waste segregation, destruction,
and disposal practices with the ultimate aim of meeting national and international standards;
favor safe and environmentally friendly treatment of hazardous healthcare waste
(e.g., autoclaving, microwaving, integrated steam treatment with internal mixing, and chemical treatment) over medical waste incineration, where possible;
create a comprehensive system, responsibilities, resource allocation,
and select safe and environmentally friendly management options to protect people from hazards when collecting, handling, storing, transporting, treating, or disposing of waste.

Universal, long-term reform requires government commitment and support, although immediate action can be taken at the local level.