Health-care activities - for instance, immunizations, diagnostic tests, medical treatments, and laboratory examinations - protect and restore health and save lives. But what about the wastes and by-products they generate?
From the total of wastes generated by health-care activities, almost 80% are general waste comparable to domestic waste. The remaining approximate 20% of wastes are considered hazardous materials that may be infectious, toxic or radioactive. The wastes and by-products cover a diverse range of materials, as the following list illustrates (percentages are approximate values):
Infectious and anatomic wastes together represent the majority of the hazardous waste, up to 15% of the total waste from health-care activities.
Sharps represent about 1% of the total waste from health-care activities.
Chemicals and pharmaceuticals amount to about 3% of waste from health-care activities.
Genotoxic waste, radioactive matter and heavy metal content represent about 1% of the total waste from health-care activities.
The major sources of health-care waste are hospitals and other health-care establishments, laboratories and research centres, mortuary and autopsy centres, animal research and testing laboratories, blood banks and collection services, and nursing homes for the elderly.
High-income countries can generate up to 6 kg of hazardous waste per person per year. In the majority of low-income countries, health-care waste is usually not separated into hazardous or non-hazardous waste. In these countries, the total health-care waste per person per year is anywhere from 0.5 to 3 kg.
Health-care waste is a reservoir of potentially harmful micro-organisms which can infect hospital patients, health-care workers and the general public. Other potential infectious risks include the spread of, sometimes resistant, micro-organisms from health-care establishments into the environment. These risks have so far been only poorly investigated. Wastes and by-products can also cause injuries, for example radiation burns or sharps-inflicted injuries; poisoning and pollution, whether through the release of pharmaceutical products, in particular, antibiotics and cytotoxic drugs, through the waste water or by toxic elements or compounds such as mercury or dioxins.
Throughout the world every year an estimated 12 000 million injections are administered. And not all needles and syringes are properly disposed of, generating a considerable risk for injury and infection and opportunities for re-use.
In June 2000, six children were diagnosed with a mild form of smallpox (vaccinia virus) after having played with glass ampoules containing expired smallpox vaccine at a garbage dump in Vladivostok (Russia). Although the infections were not life-threatening, the vaccine ampoules should have been treated before being discarded.
The use of radiation sources in medical and other applications is widespread throughout the world. Occasionally, the public is exposed to radioactive waste, usually originating from radiotherapy treatments, that has not been properly disposed of. Serious accidents have been documented in Goiania, Brazil in 1988 in which four people died from acute radiation syndrome and 28 suffered serious radiation burns. Similar accidents happened in Mexico City in 1962, Algeria in 1978, Morocco in 1983 and Ciudad Juarez in Mexico in 1983.
Risks associated with other fractions of health-care wastes, in particular blood waste and chemicals, have been relatively poorly assessed, and need to be strengthened. In the meantime, precautionary measures need to be taken.
Although treatment and disposal of health-care wastes aim at reducing risks, indirect health risks may occur through the release of toxic pollutants into the environment through treatment or disposal.
In addition, perceived risks related to health-care waste management may be significant. In most cultures, disposal of health-care wastes is a sensitive issue and also has ethical dimensions.
The absence of waste management, lack of awareness about the health hazards, insufficient financial and human resources and poor control of waste disposal are the most common problems connected with health-care wastes. Many countries do not have appropriate regulations, or do not enforce them. An essential issue is the clear attribution of responsibility of appropriate handling and disposal of waste. According to the 'polluter pays' principle, this responsibility lies with the waste producer, usually being the health-care provider, or the establishment involved in related activities.
Improvements in health-care waste management rely on the following key elements:
Government commitment and support is needed to reach an overall and long-term improvement of the situation, although immediate action can be taken locally.
Health-care waste management is an integral part of health-care, and creating harm through inadequate waste management reduces the overall benefits of health-care.
The first global and comprehensive guidance document, Safe Management of Wastes from Health-Care Activities, released by WHO in 1999, addresses aspects such as regulatory framework, planning issues, waste minimization and recycling, handling, storage and transportation, treatment and disposal options, and training.
It is aimed at managers of hospitals and other health-care establishments, policy makers, public health professionals and managers involved in waste management. It is accompanied by a Teacher's Guide, which contains material for a three-day workshop aimed at the same audience.
The Interagency Guidelines for the Safe Disposal of Unwanted Pharmaceuticals in and after Emergencies provide practical guidance on the disposal of drugs in difficult situations in or after emergencies are also available.
The full text of these publications is available on the WHO water, sanitation and health web site
Planned WHO products and activities include: