Health care activities protect and restore health, saving lives. But what about the waste and by-products they generate?
Poor management of health care waste potentially exposes healthcare workers, waste handlers, patients and the community at large to infection, toxic effects and injuries, risking pollution of the environment. It is essential that all medical waste materials be segregated at the point of generation for appropriate treatment and safe disposal.
The most common reasons for improper waste treatment are:
Incineration and burial in landfills was for many years the traditional solution for medical waste.
Treatment and disposal of healthcare waste may pose health risks indirectly through the release of pathogens and toxic pollutants into the environment.
· Landfills can contaminate drinking water if they are not properly constructed. Occupational risks exist at disposal facilities that are not well designed, managed, or maintained.
· Incineration of waste has been widely practiced, but inadequate incineration or the incineration of unsuitable materials results in the release of pollutants into the air and of ash residue. Incinerated materials containing chlorine can generate dioxins and furans, which are human carcinogens and have been associated with a range of adverse health effects. Incineration of heavy metals or materials with high metal content, in particular lead, mercury and cadmium, can lead to the release of toxic metals into the environment.
· Only modern high-temp incinerators fitted with special gas-cleaning equipment are able to comply with the international emission standards for dioxins and furans. This solution is expensive.
On-site solutions as alternatives to off-site (remote incineration and landfills) are recommended and are now available.
In developed countries, Hygimed on-site solution can save the user up to 50%.
UN Special Rapporteur urges the replacement of incineration
Calin Georgescu claims in his report to the Human Rights Council (2011) that while industrialized countries are phasing out incinerators as the preferred means for disposing of medical waste because of health and environmental concerns, in developing countries combustion is the favored option.
Incineration of medical waste at low temperatures releases toxic emissions which may contain heavy metals and dioxins. The residual ash also may contaminate food and sources of drinking water. The report quotes a study which analyzed free-range chicken eggs collected near a small-scale medical waste incinerator and found they had levels of dioxins – known carcinogens – sometimes 5.5 times higher than the upper limit set by the European Union. In his report Georgescu calls for the development of a comprehensive, international, legal framework to protect human health and the environment from the adverse effects of improper management and disposal of hazardous waste. The Special Rapporteur also urges the replacement of incineration as a method of eliminating dangerous medical refuse and the use instead of more effective and environmentally friendly methods. (UN Human Rights Council).
Require the use of the best available techniques (BAT)
Under the Stockholm Convention , countries are obliged to require the use of the best available techniques for new waste treatment facilities and to promote best available techniques and environmental practices for all new and existing sources of persistent organic pollutants (POP’s).
Annex C of the Stockholm Convention (2004) states that when parties are considering proposals to construct new facilities using processes that release unintentional POP’s (e.g., incineration), "priority consideration should be given to alternative processes, techniques or practices that have similar usefulness but which avoid the formation and release of such chemicals."
In most cases, the incinerators used in developing countries unintentionally release significant quantities of POP’s and other hazardous pollutants into the environment through gaseous emissions, ash and, occasionally, through wastewater. A medical waste incinerator releases such pollutants as particulate matter, heavy metals such as arsenic, cadmium, mercury, lead, etc., acid gases like hydrogen chloride and nitrogen oxides, carbon monoxide and toxic organic compounds like benzene, chlorophenols, polycyclic aromatic hydrocarbons and dioxins.