Medical wastes in emergencies
Special care must be taken with refuse from a field hospital or health centre. The main categories of waste of concern are: infectious waste; pathological waste; sharps; pharmaceutical waste; genotoxic waste; chemical waste; waste with high heavy metal content; pressurized containers; and radioactive waste. Each type of waste requires specific measures for handling, storage, collection, treatment and final disposal and destruction. In the case of simple health centres, particularly in rural areas, well-managed on-site burial may be appropriate. In larger centres producing a significant quantity of sharps and infected waste, high level technology may be required. When health facilities operate diagnostic laboratory services, radiological diagnosis and treatment facilities, pharmacies, etc., waste management is a specialized activity requiring trained and well-equipped staff.
Waste management during triage and classification of victims
Triage and classification of victims generate potentially infectious waste. Since this is a rapid response activity, it is highly recommended that all wastes generated during this stage, without exception, are stored in containers, preferably in red bags, that are properly labelled as "bio-contaminated waste". Direct contact with such wastes must be avoided.
Waste management during routine medical activities
Management will be similar for permanent (existing hospitals and health centres) and provisional (field hospitals) health facilities.
Wastes should be segregated at the point of generation according to their type:
- Infectious, bio-contaminated wastes (including sharp materials);
- chemical wastes (drugs, chemical solutions, etc.);
- non infectious, common wastes (paper, cardboard, glass, or the like; empty chemical product containers should be treated as chemical wastes).
Only puncture proof, hermetic plastic containers of 2–5 litre capacity or opaque glass bottles should be used to store sharp objects
For each hospital room, washable and easily disinfected PVC containers with a capacity of 40–50 litres should be used. Waste should be disposed of in coloured bags according to national codification. Usually they are:
- red bags for bio-contaminated wastes;
- yellow bags for chemical wastes;
- black bags for common wastes.
These wastes should then be collected separately at latest 12–24 hours. Small carts, preferably with lids, should be adapted to this end. The personnel assigned to handle medical waste should be properly trained and should wear protective gear such as with aprons, masks, boots and gloves.
Treatment should be done according to the type of waste. Sharp materials disposed in puncture proof containers should then buried in a protected sharp pit. Existing functioning nearby waste treatment facilities should be used but only if safe means of transport can be ensured.
Burial area should be isolated and protected to avoid illegal recycling. However, this may not be possible in permanent health facilities, due to lack of space. In such cases, protected areas should be used at landfill sites to receive treated wastes. Common wastes may be managed by the municipal waste-collection service, as long as they are not mixed and do not contain hazardous materials.
In the acute emergency phase, if no better options exist to treat infectious waste, a basic temporary incinerator for medical waste can be used. However, it is of outmost importance to be aware of the fact that though it may help reduce the volume of waste to be buried, it will produce toxic smoke, only partially reducing the health risks posed by the waste. The use of incinerators, as opposed to direct burial, besides exposing the operators to highly hazardous fumes, also creates an additional step in the disposal process, increasing the chances of waste escaping into the environment.
For the rehabilitation and reconstruction phases after the emergency, only long term environmentally friendly options should be selected. Non burn technologies such as autoclaving should always be preferred to incineration techniques.