MANAGEMENT IN DEVELOPING
This brief gives an overview on healthcare waste treatment options, focussing on
incineration, one of the options most used for the treatment of healthcare waste. It
highlights advantages and drawbacks of the use of incineration in comparison to other
treatment options, as well as discussing the different kinds of incineration that can be found
in low and middle income countries. It also describes ‘De Montfort’ incinerators, built in
order to represent a cheap but effective treatment option. Their application in several
developing countries is also discussed and contrasting opinions are reported.
Healthcare waste (HCW) includes all the waste generated by hospitals, healthcare centres,
research facilities and laboratories. In addition, it includes the waste originating from “minor” or
“scattered” sources, such as that produced in the course of healthcare undertaken in the home
(dialysis, insulin injections, etc.) (WHO, 1999). According to The World Health Organization
(WHO), health care waste can be classified into eight main categories briefly presented in Table
1 (Ahmed, 1997).
Improper disposal of health-care wastes, syringes and needles that are scavenged and reused
may lead to significant numbers of hepatitis B, hepatitis C, HIV and possibly other infections –
such as, gastric, lung or eye infections - in the developing world (Batterman, 2004). WHO
(2011) estimates that in 2000 injections with contaminated syringes caused 21 million
hepatitis B virus infections (32% of all new infections); 2 million hepatitis C virus infections
(40% of all new infections); and 260,000 HIV infections (5% of all new infections). In some
countries (e.g., India and Pakistan), contaminated disposable needles are often scavenged,
repackaged, sold and reused without sterilization. Inappropriate disposal of chemical and
pharmaceutical waste causes poisoning and injuries – mainly burns.
Several groups of people are most at risk from poorly managed health-care waste:
• Health workers.
• Patients & visitors to healthcare waste establishments.
• Waste handlers.
• Scavengers retrieving items from dumpsites or uncontrolled collection points.
• Children who may come into contact with contaminated waste and play with used
needles and syringes, e.g., if waste is dumped in areas without restricted access.
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