MANAGEMENT OF HEALTHCARE WASTE

2020·0.83 MB·

by  Da Silva, Isis Arend

I. A. Silva, L. P. Sant’Ana

Management of healthcare waste
Isis Arend da Silva¹, Luís Paulo Sant’Ana²

2Endereço para correspondência: Universidade Federal dos Vales do Jequitinhonha e Mucuri (UFVJM).
Departamento de Ciências Biológicas, FCBS. Campus JK - Rodovia MGT 367 – Km 583, nº 5000 Alto da
Jacuba CEP: 39100-000 Diamantina/MG Telefone: (38) 99244991 E-mail: [email protected]

ABSTRACT
Due to risks to health and environment that improperly management and disposal of waste
can lead, in the last years has been an international mobilization for implementation of waste
management systems. The World Health Organization published in 2014 a document on safe
healthcare waste management that offers a guide for elaboration of healthcare waste
management systems. According to World Health Organization a healthcare waste
management systems consist of 5 steps: segregation, storage, transport, treatment and
disposal. With the global pressure the trend is the development of policies around the world
and the improvement of management systems. This report covers three main aspects of
healthcare waste management that are in featured in the recent literature: First, the structure of
the current healthcare waste management system. Second, poor healthcare waste management
systems in developing countries. Finally, the importance of National Policy on Solid Waste
management for the implementation of healthcare management systems.
Keywords: Solid waste, waste generation, developing countries, healthcare waste

Manejo de resíduo hospitalar
RESUMO
Devido aos riscos para a saúde e o meio ambiente que gestão inadequada e eliminação dos
resíduos podem ocasionar, nos últimos anos tem-se observado uma mobilização internacional
para a implementação de sistemas de gestão de resíduos. A Organização Mundial de Saúde
publicou em 2014 um documento sobre a gestão segura de resíduos hospitalares que oferece
um guia para a elaboração de sistemas de gestão para resíduos hospitalares. De acordo com a
Organização Mundial de Saúde um sistema de gestão de resíduos hospitalares é composto por
5 etapas: segregação, armazenamento, transporte, tratamento e disposição final. Com a
pressão global a tendência é o desenvolvimento de políticas em todo o mundo para a melhoria
dos sistemas de gestão. Este trabalho abrange três aspectos principais da gestão de resíduos
hospitalares que estão em destaque recentemente na literatura: Primeiro, a estrutura do atual
sistema de gestão de resíduos hospitalares. Segundo, os sistemas precários de gestão de
resíduos hospitalares em países em desenvolvimento. Finalmente, a importância da Política
Nacional de Gestão de Resíduos Sólidos para a implementação de sistemas de gestão
hospitalar. .
Palavras-chave: Resíduo sólido, geração de resíduos, países em desenvolvimento, resíduo
hospitalar
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I. A. Silva, L. P. Sant’Ana

INTRODUCTION because is cheaper prevent than remediate
(5).

This work will cover three main
The current pattern of life is leading
aspects of HCW management that are in
to an enormous generation of different
featured in the recent literature. First, the
types of waste. Due to risks to health and
structure of the current HCW management
environment that improperly management
system. Second, poor healthcare waste
and disposal of waste can lead, in the last
management systems (HCWMS) in
years has been an international
developing countries. Finally, the
mobilization for implementation of waste
importance of National Policy on Solid
management systems (1,2,3). For example,
Waste management for the implementation
the Basel Convention deals with
of HCW management systems.
transboundary movements of hazardous,
but also requires of its parties an
HEALTHCARE WASTE
appropriate national or domestic legislation
MANAGEMENT SYSTEMS
(4).

The Healthcare waste (HCW) can
The World Health Organization
be characterized by the presence of both
(WHO) published in 2014 a document on
general waste and hazardous waste which
safe healthcare waste management that
represent serious risks to health if
offers a guide for elaboration of healthcare
mismanaged (5). According to WHO (5)
waste management systems (HCWMS).
there are five types of hazardous in the
According to WHO (5) a HCWMS consist
HCW: presence of infectious agents;
of 5 basic steps: segregation, storage,
genotoxic or cytotoxic chemical
transport, treatment and disposal, each step
composition; presence of toxic of
is briefly described below. The author
hazardous chemicals or biologically
describes each step and the most safety
aggressive pharmaceuticals; presence of
procedures for each one, it is also
radioactivity; and presence of used sharps.
recommended adaptations of the steps
These can transmit infectious agents that
based on the local legislation or available
can include HIV and hepatitis viruses B
proceeds. If there is no legislation, is
and C (5,6). Besides, improperly HCW
recommended the use of the patterns
management can spread resistant bacteria
suggested by the WHO (5). Furthermore,
throughout the hospital or even the city
this system follows a waste management
(5,7). Furthermore, chemicals and
hierarchy: first waste minimization, reuse
pharmaceutical waste can cause
and then recycling.
intoxication through acute, chronic
exposure or physical injuries (5). Many of Segregation
the possibilities of health damage due to
HCW can lead to death, a properly HCW
management save lives (5). However, The objective of waste segregation
according to WHO (5) it is not just the is to separate the general waste of the
about the risks, it is also an opportunity to infectious/hazardous waste which need
the health care facility save money. It is special treatment (5). For safety reasons
because just 20% of the waste of a the hazardous waste is usually separated
healthcare facility need to receive special into two categories: used sharps and
attention and management and also potentially infectious items. It is called
“three-bin system”, it is a basic system of
segregation. It needs to have a system of
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I. A. Silva, L. P. Sant’Ana

colour, preferably a national system, if international transport for treatment,
there is not a national system to guide this, regulated by the Basel Convention (4).
the WHO has a system of colours for that. Whereas there are none of these
Furthermore, the waste needs to be stored regulations can be find, international
in proper containers and labelled (5). All authorities may give guidance for transport
these procedures will facilitate the disposal of hazardous, which can be found in UN
and also how handling each type of waste, (4).
which ensure the safety of the workers.
Treatment
Collection

The treatment of waste aims
The WHO (5) points out that the neutralizes or reduces the dangerous of
collection of waste needs to be very well waste for safety disposal, protecting human
coordinated. It should happen daily, but the health and environment (5). According to
hazards cannot be collected together with WHO (5) the waste treatment choice
the general waste for avoiding depends on many factors, the most
contamination (5). All waste should be important are: “waste characteristics,
market with hour and local of collection technology capabilities and requirements,
for facilitate the management control and environmental and safety factors, and costs
the weight should be measured. It can help – many of which depend on local
to find failures with the management (5). conditions” (5).
Storage Disposal

According to WHO (5) the storage Most part of the waste after
of waste for short-term need to be done in treatment can be disposal in a controlled or
a way that the waste is out of reach for sanitary landfill. Uncontrolled landfills are
patients and in properly containers to avoid environmental damaged, thus gases and
leaking of undesirable substances. The best other toxic component that can release to
way of do that is storage it in utility rooms. the atmosphere or reach groundwater when
If it is not possible it should be storage in a the material start to decompose or react in
location near of the medical facility, but contact with a different materials (5). Other
away from patients and public access (5). types of healthcare waste cannot be
disposal in landfill due to its harm
Transport
characteristics, such as products which

contain heavy metals or radioactive
compounds (5).
According to WHO (5) the
transport is separated in two phases: onsite
POOR MANAGEMENT OF HCW
and offsite transport. The onsite transport

needs to be based on the health care
facility design and the routes and timing
There are few journals in this area,
should be planned to ensure non
but with the increased concern about
contamination of workers and patients (5).
hazardous waste management the focus of
The WHO (5) also describes basic
the most recent studies is the poor
procedures for transport offsite. However,
management of health care waste in
WHO outlines that offsite transportation
developing countries. These cases can lead
may be regulated by local, regional or
to situations where workers, patients and
national regulations, even by international
even citizens are in a position of risk of
regulations and agreements in case of
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I. A. Silva, L. P. Sant’Ana

contamination as in the studies presented the WHO standards; all countries give
below. some kind of treatment to the HCW;
Cambodia, China, Indonesia, Mongolia
Longe & Adenuga (3) presented a
and Myanmar do not follow the standards
study with twenty healthcare facilities in
and LAO follow partially.
Nigeria, Lagos state. The major finds were
inappropriate handling, disposal, storage, Those countries that do not follow
treatment and no-segregation (3). The the WHO standards for the transport of
professionals involved in the healthcare HCW are transporting risk HCW at the
waste collection have no instructions of same vehicle that transport general waste,
management or cleaning of infectious exposing the general waste to hazardous
material before disposal which put their waste (10). About the treatment of HCW in
life in risk and also other professionals, Asia, such as in Nigeria, the most common
patients and relatives (3). Relative to treatment is incineration, most open
disposal and treatment Longe & Adenuga incineration (10). As reported by Ananth,
(3) reported that part of the waste does not Prashanthini & Visvanathan (10), in
receive any treatment before disposal, 70% countries economically vulnerable, where
practice uncontrolled open burning and the hospitals cannot afford pay for an
10% semi-controlled and the final disposal incinerator which follow the criteria for
is done in open dumps mixed with general combating secondary pollution, the waste
waste. Furthermore, according to Longe & is burnt using makeshift combustion
Adenuga (3) there is no system of chambers, releasing toxic compounds to
segregation that enhances great the air. Furthermore, this practice usually
management practice and reduce happens at the hospital facilities in the
occupational health and safety risks. This external areas (10).
study also showed that the current method
of storage is in pits mixed with general THE ROLE OF A NATIONAL
waste, it has a high risk of reach water POLICY ON SOLID WASTE
resources and contaminate groundwater
and surface water (3). The practice of
Longe & Adenuga (8), Ananth,
waste incineration is extremely dangerous,
Prashanthini & Visvanathan (10) Sant’ana
it lead to intoxication by toxic air
(14) and WHO (5) agree that a National
pollutants, and the incineration does not
Policy on Solid Waste is the key for
mean neutralization of the compounds in
countries achieve a minimum safe pattern
the waste (2,5,8,9).
in HCW management. Longe & Adenuga
A study about HCWMS in Asia (3), Ananth, Prashanthini & Visvanathan
showed similar results, mainly for (10), reported that the reason behind the
developing countries. Ananth, Prashanthini poor management in the hospitals is the
& Visvanathan (1) analysed twelve lack of National or Local legislation to
countries, these just four countries comply guide the healthcare facilities. A HCW
with all requirements of the World Health management system is the integration of
Organization (WHO) about HCW internal and external management. The
management. According to Ananth, external transport and disposal are
Prashanthini & Visvanathan (1) China, indispensable parts of a HCW management
Indonesia an LAO do not have properly system, and if the country has not
systems of waste segregation; Indonesia regulations for these steps of the process, it
and Myanmar do not follow the WHO will put the public in risk independent of
standards for storage and LAO, Mongolia the internal management. WHO (5)
and Thailand follow partially; Cambodia, showed some alternatives in case of a
Indonesia, LAO, Myanmar do not follow country there is no safe external
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I. A. Silva, L. P. Sant’Ana

regulations for transport and disposal, but Ministry of Health. only this way is
they are just provisory measures. In many possible achieve an adequate and
cases the hazardous waste need to be send sustainable management (13).
to specialized facilities that are not even in
the same country and a National Policy CONCLUSION
ensuring the compliance with safe
management is the first step for
In conclusion, the current system of
international cooperation (4,5).
HCW management is focused on security
A study in Brazil shows the harder than sustainability even considering
importance of a National Policy on Solid principles of minimization, reutilization
Waste: Guimarães, Sabagh & Fialho (11) and recycling. This system follow five
studied the HCWMS of The National basic steps, the compliance with the five
Institute of Quality Control in Health steps is essential for neutralizing the risks
(INCQS). They have a computerized for health and environment. Furthermore,
system that allows them track down the the studies in the developing countries
waste, register the time that the waste showed clearly that the most medical
remain at the institutions, date, quantity facilities are not complying with the first
generated, and it also allows them make step that is segregation. It creates a chain
comparative surveys and improve the reaction, since each step depend upon the
quality of their management system (11). good development of the previous step.
Guimarães, Sabagh & Fialho (11) reported
Besides, the success of HCW
that the segregation of waste has been
management systems is related with the
successful, the INCQS follow the national
presence of laws and regulations. The role
standards and regulations, a system of
of a national policy on solid waste is to
colours is present and there is a properly
protect the people and environment,
system of labelling and symbology.
providing control and increasing awareness
Guimarães, Sabagh & Fialho (11) also
about the risks people are being submitted
found the safety handling and transport are
in places where the standards are not being
also following the national standards.
followed. Moreover, the World Health
Furthermore, the waste is receiving
Organization has been performing a clearly
treatment before final disposal, sterilization
role in the incentive to the creation of
or incineration. Guimarães, Sabagh &
national laws and regulations, to the
Fialho (11) reported that the incineration
assistance to medical facilities to improve
process is being undertaken following
or to implement safety measures regard to
safety standards by the Environment
HCW management systems and rising
Agency, the toxic gases from the
international awareness as well.
incineration process may undergo
filtration. As for the final step, that is
Finally, HCW management
disposal, the waste has been deposited in
systems depend upon national laws and
landfills (11).
regulations and however, some developing
countries are facing difficult in the
A similar situation was reported in
implementation for lack of national
Mongolia, where a National System has
regulation the WHO provide guidance and
been improving the HCWM in the country
provisory options to comply with the
and facilitating the shift to environmentally
safety patterns. With the global pressure
friendly technology like non- incinerating
the trend is the development of national
technology (12). A study in Bolivia also
policies around the world and the
highlights the improvement in the
improvement of HCW management
healthcare waste management after the
systems.
introduction of an Integral system by the
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I. A. Silva, L. P. Sant’Ana

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