- Of the total amount of waste generated by health-care activities, about 85% is general, non-hazardous waste.
- The remaining 15% is considered hazardous material that may be infectious, toxic or radioactive.
- Every year an estimated 16 billion injections are administered worldwide, but not all of the needles and syringes are properly disposed of afterwards.
- Health-care waste contains potentially harmful microorganisms, which can infect hospital patients, health workers and the general public.
- Health-care waste in some circumstances is incinerated, and dioxins, furans and other toxic air pollutants may be produced as emissions.
Health-care activities protect and restore health and save lives. But what about the waste and by-products they generate?
Of the total amount of waste generated by health-care activities, about 85% is general, non-hazardous waste comparable to domestic waste. The remaining 15% is considered hazardous material that may be infectious, toxic or radioactive.
Types of waste
Waste and by-products cover a diverse range of materials, as the following list illustrates:
- infectious waste: waste contaminated with blood and other bodily fluids (e.g. from discarded diagnostic samples),cultures and stocks of infectious agents from laboratory work (e.g. waste from autopsies and infected animals from laboratories), or waste from patients in isolation wardsand equipment (e.g. swabs, bandages and disposable medical devices);
- pathological waste: human tissues, organs or fluids, body parts and contaminated animal carcasses;
- sharps: syringes, needles, disposable scalpels and blades, etc.;
- chemicals: for example solvents used for laboratory preparations, disinfectants, and heavy metals contained in medical devices (e.g. mercury in broken thermometers) and batteries;
- pharmaceuticals: expired, unused and contaminated drugs and vaccines;
- genotoxicwaste: highly hazardous, mutagenic, teratogenic1 or carcinogenic, such as cytotoxic drugs used in cancer treatment and their metabolites;
- radioactive waste: such as products contaminated by radionuclides including radioactive diagnostic material or radiotherapeutic materials; and
- non-hazardous or general waste: waste that does not pose any particular biological, chemical, radioactive or physical hazard.
The major sources of health-care waste are:
- hospitals and other health facilities
- laboratories and research centres
- mortuary and autopsy centres
- animal research and testing laboratories
- blood banks and collection services
- nursing homes for the elderly
High-income countries generate on average up to 0.5 kg of hazardous waste per bed per day; while low-income countries generate on average 0.2 kg. However, health-care waste is often not separated into hazardous or non-hazardous wastes in low-income countries making the real quantity of hazardous waste much higher.
Health-care waste contains potentially harmful microorganisms which can infect hospital patients, health workers and the general public. Other potential infectious risks may include the spread of drug-resistant microorganisms from health facilities into the environment.
Health risks associated with waste and by-productsalso include:
- radiation burns;
- sharps-inflicted injuries;
- poisoning and pollution through the release of pharmaceutical products, in particular, antibiotics and cytotoxic drugs; and
- poisoning and pollution through waste water; andby toxic elements or compounds such as mercury or dioxins that are released during incineration.
Worldwide, an estimated 16 billion injections are administered every year. Not all needles and syringes are disposed of safely, creating a risk of injury and infection and opportunities for reuse.
Injections with contaminated needles and syringes in low- and middle-income countries have reduced substantially in recent years, partly due to efforts to reduce reuse of injection devices. Despite this progress, in 2010, unsafe injections were still responsible for as many as 33 800 new HIV infections, 1.7 million hepatitis B infections and 315 000 hepatitis C infections
A person who experiences one needle stick injury from a needle used on an infected source patient has risks of 30%, 1.8%, and 0.3% respectively of becoming infected with HBV, HCV and HIV.
Additional hazards occur from scavenging at waste disposal sites and during the manual sorting of hazardous waste from health-care facilities. These practices are common in many regions of the world, especially in low- and middle-income countries. The waste handlers are at immediate risk of needle-stick injuries and exposure to toxic or infectious materials.
In 2015, a joint WHO/UNICEF assessment found that just over half (58%) of sampled facilities from 24 countries had adequate systems in place for the safe disposal of health care waste.
Treatment and disposal of healthcare waste may pose health risks indirectly through the release of pathogens and toxic pollutants into the environment.
- Landfills can contaminate drinking-water if they are not properly constructed. Occupational risks exist at disposal facilities that are not well designed, run, or maintained.
- Incineration of waste has been widely practised, but inadequate incineration or the incineration of unsuitable materials results in the release of pollutants into the air andof ash residue. Incinerated materials containing chlorine can generate dioxins and furans, which are human carcinogens and have been associated with a range of adverse health effects. Incineration of heavy metals or materials with high metal content (in particular lead, mercury and cadmium) can lead to the spread of toxic metals in the environment.
- Only modern incinerators operating at 850-1100 °C and fitted with special gas-cleaning equipment are able to comply with the international emission standards for dioxins and furans.
Alternatives to incineration are now available, such as autoclaving, microwaving, steam treatment integrated with internal mixing, and chemical treatment.
Waste management: reasons for failure
Lack of awareness about the health hazards related to health-care waste, inadequate training in proper waste management, absence of waste management and disposal systems, insufficient financial and human resources and the low priority given to the topic are the most common problems connected with health-care waste. Many countries either do not have appropriate regulations, or do not enforce them.
The way forward
The management of health-care waste requires increased attention and diligence to avoid the substantial disease burden associated with poor practice, including exposure to infectious agents and toxic substances.
Key elements in improving health-care waste management are:
- building a comprehensive system, addressing responsibilities, resource allocation, handling and disposal. This is a long-term process, sustained by gradual improvements;
- raising awareness of the risks related to health-care waste, and of safe practices; and
- selecting safe and environmentally-friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing of waste.
Government commitment and support is needed for universal, long-term improvement, although immediate action can be taken locally.
WHO developed the first global and comprehensive guidance document, “Safe management of wastes from health-care activities”, now in its second edition.It addresses aspects such as regulatory framework, planning issues, waste minimization and recycling, handling, storage and transportation, treatment and disposal options, and training. The document is aimed at managers of hospitals and other health-care facilities, policy makers, public health professionals and managers involved in waste management.
In collaboration with other partners, WHO also developed a series of training modules on good practices in health-care waste management covering all aspects of waste management activities from identification and classification of wastes to considerations guiding their safe disposal using both non-incineration or incineration strategies.
WHO guidance documents on health-care waste are also available including:
- a monitoring tool;
- a cost assessment tool;
- a rapid assessment tool;
- a policy paper;
- guidance to develop national plans;
- management of waste from injection activities;
- management of waste at primary health care centres;
- management of waste from mass immunization activities; and
- management of waste in emergencies.
In addition, WHO and UNICEF together with partners in 2015 launched a global initiative to ensure that all health care facilities have adequate water, sanitation and hygiene services. This includes addressing health care waste.
1Pépin J, Abou Chakra CN, Pépin E, Nault V, Valiquette L. Evolution of the global burden of viral infections from unsafe medical injections, 2000-2010.PLoSOne. 2014 Jun 9;9(6):e99677.
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3Bell DM. Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview. Am J Med 1997;102(suppl 5B):9–15.
4Mitsui T, Iwano K, Masuko K, et al. Hepatitis C virus infection in medical personnel after needlestick accident. Hepatology 1992;16:1109–14.
5WHO/UNICEF, 2015. Water, sanitation and hygiene in health care facilities: status in low- and middle-income countries. World Health Organization, Geneva.