Whether you run a hospital, a general practitioner surgery, a pharmacy or a laboratory, you have to deal with healthcare waste.
This includes expired pharmaceuticals, bags and vials containing traces of toxic drugs, spilled liquids and contaminated body tissues or fluids. In addition, healthcare waste can include the waste produced in the course of healthcare procedures undertaken by patients at home (dialysis, insulin injections, etc.).
Healthcare waste can be classified in:
• Infectious waste. Any waste that is suspected to contain pathogens (bacteria, viruses, parasites, or fungi) in sufficient concentration or quantity to cause disease, such as cultures and stocks of infectious agents from laboratory work, waste from surgery and autopsies on patients with infectious diseases, waste from infected patients in isolation wards and infected animals from laboratories.
• Pathological waste. It consists of tissues, organs, body parts, human foetuses and animal carcasses, blood, and body fluids. Within this category, recognizable human or animal body parts are also called anatomical waste.
• Sharps. These are items that could cause cuts or puncture wounds, including needles, hypodermic needles, scalpel and other blades, knives, infusion sets, saws, broken glass, and nails. Whether or not they are infected, such items are usually considered as highly hazardous waste.
• Pharmaceutical waste. This includes expired, unused, spilt, and/or contaminated medicines, drugs and vaccines that are no longer required and need to be disposed of appropriately. The category also includes discarded items used in the handling of pharmaceuticals, such as bottles or boxes with residues, gloves, masks, connecting tubing, and drug vials.
• Genotoxic waste. This type of waste is highly hazardous and may have mutagenic or carcinogenic properties. It raises serious safety problems, both inside hospitals or practices and also after disposal. Genotoxic waste may include certain drugs used in chemotherapy or body fluids containing chemicals and radioactive residues.
• Chemical waste. Waste in this category consists of discarded solid, liquid, and gaseous chemicals, for example from diagnostic and experimental work and from cleaning, housekeeping, and disinfecting procedures. Chemical waste is considered to be hazardous if it is toxic, corrosive, flammable or reactive in any way.
• Radioactive waste. This includes solid, liquid, and gaseous materials contaminated with radionuclides. It is produced as a result of procedures such as in-vitro analysis of body tissue and fluid, in-vivo organ imaging and tumour localization, and various investigative and therapeutic practices.
It is important that all healthcare waste is safely disposed of to avoid any possible negative impact on the environment and on the public safety.
One of the biggest challenges of managing healthcare waste is that this type of waste contains potentially harmful microorganisms that can infect hospital patients, health workers and the general public.
Other potential hazards may include drug-resistant microorganisms which spread from health facilities into the environment. The disposal of untreated healthcare wastes in landfills can lead to the contamination of drinking, surface and ground waters.
For all these reasons, management of healthcare waste requires special attention and diligence.
These are the most important steps to follow:
1. Reduce the volume of wastes generated and ensure proper hazardous waste segregation. Waste can be minimised by careful stock keeping. For example, you can keep a record of the amount of each pharmaceutical product that is needed and avoid ordering too much. Establish a “first in first out” system, so that the packages which are going to expire first are used first. Wherever possible, try to negotiate take-back agreements with suppliers, whereby the suppliers accept and dispose of pharmaceuticals that you cannot use. The key to effective management of healthcare waste is segregation (separation) and identification of the waste. Appropriate handling, treatment, and disposal of hazardous waste by type reduces costs and helps protect public health. Segregation should always be the responsibility of the waste producer, it should take place as close as possible to where the waste is generated, and it should be maintained in storage areas and during transport.
2. Ensure proper hazardous waste transportation Before transportation of the waste, dispatch documents should be completed, all arrangements should be made between the waste producer, carrier and treatment facility. Vehicles or containers used for the transportation of healthcare waste should not be used for the transportation of any other material. They should be kept locked at all times, except when loading and unloading. Articulated or demountable trailers (temperature-controlled if required) are particularly suitable, as they can easily be left at the site of waste production. Other systems may be used, such as specially designed large containers or skips; however, open-topped skips or containers should never be used for transporting health-care waste.
3. Choose a safe and environmentally compatible treatment of hazardous healthcare waste In recent years, many waste brokering companies have sprung up subcontracting their customers waste to the cheapest bidder, often with no idea if in fact these contractors are licensed to handle such materials. If in doubt please do contact the Environment Agency who will be able to tell you if the company has the correct licensing. As well as the obvious dangers to human health, as the producer of the waste, it is your legal responsibility to ensure correct disposal and avoid prosecution.
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