Interview with Keith Alverson, Director of the United Nations Environment Programme (UNEP) International Environmental Technology Centre in Osaka, Japan. The Centre has produced a Compendium of Technologies for Treatment/Destruction of Healthcare Waste, a scientific and practical publication covering all aspects of medical waste—a topic that is highly relevant to the current novel coronavirus COVID-19 pandemic.
Please describe the document and how it can help in this current pandemic?
The compendium is intended to assist national and local governments, health organizations and countries in assessing and selecting appropriate technologies for the destruction of healthcare waste. It can help those with responsibility for planning and managing the significant increase in medical waste as a result of this global pandemic.
What is healthcare waste?
Healthcare waste is all the waste generated by healthcare facilities, medical laboratories and biomedical research facilities, as well as waste from minor or scattered sources. Although hospitals produce the bulk of healthcare waste by volume, they are a small fraction of the total number of sources.
Improper treatment and disposal of healthcare waste poses serious hazards of secondary disease transmission due to exposures to infectious agents among waste pickers, waste workers, health workers, patients, and the community in general where waste is improperly disposed.
Open burning and incineration without adequate pollution control exposes waste workers and the surrounding community to toxic contaminants in air emissions and ash.
How much medical waste does an average hospital produce?
An assessment of waste generation rate data from around the world shows that about 0.5 kg per bed per day is produced in hospitals. However, this figure, and the underlying composition of the waste, varies enormously depending on local context, with higher-income countries generating far higher levels of waste and plastic, for example, often making up more than half of all medical waste. Because of this huge diversity, there is no single best solution to dealing with medical waste.
The compendium provides a robust methodology for analysing local healthcare waste generation, composition and disposal needs and selecting appropriate technologies as part of a local waste management system.
Which kind of medical waste is most risky in terms of spreading infectious diseases?
Healthcare waste can be categorized according to the following general classifications: sharps waste, pathological waste, other infectious wastes, pharmaceutical waste including cytotoxic waste, hazardous chemical waste, radioactive waste, and general (non-risk) waste.
In general, between 75 and 90 per cent of the waste produced by healthcare facilities is non-risk (non-infectious, non-hazardous) general waste, comparable to domestic waste. Infectious waste is waste that is suspected to contain pathogens (disease-causing bacteria, viruses, parasites, or fungi) in sufficient concentration or quantity to cause disease in susceptible hosts.
The Compendium talks about segregation of medical waste. What does this segregation mean?
Segregation is an important element in efficient healthcare waste management. By separating hazardous from non-hazardous waste one can dramatically reduce the volume of waste that requires specialized treatment. Other elements of healthcare waste management include waste classification, waste minimization, containerization, colour coding, labelling, signage, handling, transport, storage, treatment and final disposal. And, of course, to maintain such a system requires continuous training, planning, budgeting, monitoring, evaluation, documentation and record-keeping.
What should countries do to implement a waste management policy for medical waste?
The process of institutionalization of a good healthcare waste management system is complex. It entails a waste assessment and evaluation of existing practices, evaluation of waste management options, development of a waste management plan, promulgation of institutional policies and guidelines, establishment of a waste management organization, allocation of human and financial resources, implementation of plans according to a set timelines, as well as a programme of periodic training, monitoring, evaluation and continuous improvement.
How can this compendium inform coronavirus waste management for hospitals?
Countries, cities and institutions that have used this compendium, or other similar tools, and developed an operating waste management system, are far better able to cope with surges in medical waste associated with disasters, including the ongoing pandemic. The best medical waste management systems include contingency plans for natural disasters, including pandemics.
The compendium is, however, a risk reduction tool, very useful and relevant to the pandemic response over a medium- to longer-term timescale from months to years, but must be complemented with rapid response guidelines for emergency operations in real time.
What are the basic processes involved in the treatment of healthcare waste?
There are four basic processes involved in the treatment of healthcare waste: thermal, chemical, irradiative and biological processes.
The unfortunate reality worldwide is, however, that an enormous amount of healthcare waste, including waste generated as a result of our pandemic responses, is either mistreated with improperly maintained technologies, or not treated at all.
For more information, please contact Keith Alverson: Keith.Alverson@un.org