1. WHO Health Care Waste Management Protection of the Human Environment (PHE) Richard M. Carr

2. WHO Health Care Waste Management Protection of the Human Environment (PHE) Content of Presentation Health Risks Manage m ent of HCWM Technology Options WHO HCWM Resources

3. WHO Health Care Waste Management Protection of the Human Environment (PHE) Health Risks Injections with non-sterile syringes cause: 22.5 million hepatitis B infections/year (35% of new cases /year), 2.7 million hepatitis C infections/year (55% of new cases/year), 98 000 HIV infections per year (2% of new infections /year) and Approximately 1.3 million deaths per year

4. WHO Health Care Waste Management Protection of the Human Environment (PHE) Health Risks

5. WHO Health Care Waste Management Protection of the Human Environment (PHE) Relative Health Risks Reuse of needles and syringes pose the greatest health risks to patients, staff and the community Risks to health-care workers and the community can still be significant even without reuse Burning HCW at low temperatures produces dioxins: persistent toxins which effect human health and the environment Burning HCW can release mercury and other heavy metals which effect human health and the environment Risks from dioxin and mercury due to burning HCW are unknown

6. WHO Health Care Waste Management Protection of the Human Environment (PHE) Risk: Reuse Staff & Community Dioxin Mercury Relative Health Risks Strategies for reducing risk: AD syringes, Over-supply needles and syringes, Good management and disposal, Hepatitis B vaccination of staff and children Sharps boxes, protective clothing, training, Community awareness programmes, good management and disposal Hepatitis B vaccination of staff and children Non-incineration disposal options, high temperature Incineration, procurement Waste segregation, non-incineration disposal options, procurement

7. WHO Health Care Waste Management Protection of the Human Environment (PHE) Policy for Safe HCWM Designation of responsible authority Regulatory framework and guidelines Assessment Integration into overall waste management plan Monitoring and evaluation Comprehensive system of HCWM Assignment of waste management responsibilities Allocation of resources Minimization of waste Segregation of waste Safe collection, handling and storage Safe treatment and disposal Comprehensive system of HCWM Assignment of waste management responsibilities Allocation of resources Minimization of waste Segregation of waste Safe collection, handling and storage Safe treatment and disposal Awareness and Training Waste management in training curricula Regional or country-level training Train the trainers programme Education on health risks Education on safe practices Selection of HCWM options Review of available options Safety and environment friendliness Ensure worker’s safety Sustainability Acceptability Monitoring of safety and efficiency

8. WHO Health Care Waste Management Protection of the Human Environment (PHE) Managing Waste No one-size-fits-all solution Solutions do exist for many situations “non-availability” of technologies is often a “wrong problem” - or not a technical one Allocated resources ? Regulatory compliance ? Social acceptance ? Environmental concerns, pressure groups, Kyoto, bans on burning in some countries “polluter pays” principle ---

9. WHO Health Care Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Safety boxes - first line of defence Bundled with vaccines Work well in vaccination campaigns and for some routine programme needs Reusable plastic sharps boxes can be used for routine needs Disposable boxes require frequent re-supply

10. WHO Health Care Waste Management Protection of the Human Environment (PHE) Safety boxes - first line of defence

11. WHO Health Care Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Needle Cutters and Destroyers Reduce risks by removing the sharp before disposal Prevent reuse and community exposure Reduce most dangerous waste significantly Manual needle cutters may still pose health risks from splashing Requires further disposal step e.g. burial or autoclave for syringe

12. WHO Health Care Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Needle Cutters and Destroyers – Needle popper

13. WHO Health Care Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Waste Burial Pit Suitable for small clinics Easy to build, operate and maintain Requires space on-site Proper segregation of sharps can increase life May not be suitable for areas with high water tables

14. WHO Health Care Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Waste Burial Pit

15. WHO Health Care Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Burning – Low temperature Open pit Brick enclosures and open brick incinerators “Drum” incinerators Low costs Create maximum pollution Incomplete combustion does not destroy all sharps Least desirable option

16. WHO Health Care Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Burning – High temperature Locally built brick incinerators e.g. “De Montford” Small factory built pre-fabricated steel incinerator Other industrial incinerators

17. WHO Health Care Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Burning – High temperature Appropriate for medium to large facilities – better for less densely populated areas Reduce harmful emissions by high temperature incineration Complete combustion of all sharps Moderately expensive to build US$ 1500 – 5000 May require fuel to operate Requires training to operate and maintain Requires waste segregation – heavy metals

18. WHO Health Care Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Burning – High temperature De Montford Locally built brick Incinerator US $1500 Installed

19. WHO Health Care Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Steam Sterilizers e.g. “Hydroclave” Appropriate for medium to large facilities Essentially no emissions Good for densely populated areas Complete destruction of all sharps Requires training to operate and maintain Requires waste segregation – heavy metals

20. WHO Health Care Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Other Options Encapsulation Melting ovens Professional recovery and recycling

21. WHO Health Care Waste Management Protection of the Human Environment (PHE) Technical Options for Managing Waste Waste Minimization Reduce injection overuse New delivery systems Biodegradable syringes and needles Reduce packaging Eliminate use of toxic components

22. WHO Health Care Waste Management Protection of the Human Environment (PHE) Tools/Resources Aide-Memoire Safe health-care waste management WHO Rapid Assessment Tool (RAT) Safe management of wastes from health-care activities Teacher’s guide for safe HCWM Websites: www.healthcarewaste.org www.safeinjection.orgwww.healthcarewaste.orgwww.safeinjection.org Technical option database on website