How dangerous is waste produced by healthcare facilities? What are the health and socio-economic impacts of healthcare waste? A lack of information on the actual risks may result in the establishment of inappropriate standards and the unnecessary use of expensive technology. What alternative low-cost measures are available for dealing with this waste?

A study by the UK Water Engineering and Development Centre investigates the management and disposal of healthcare waste and its effect on the urban poor. It uses field studies in Pakistan and Bangladesh to identify risks posed by healthcare waste and methods for reducing these hazards.

Hospitals, healthcare establishments, research facilities and laboratories produce a lot of waste. Up to a quarter of this is classified as hazardous clinical waste, including: infectious materials; sharps such as needles; pathological waste containing human tissues, body fluids and viral cultures; pharmaceuticals; gas canisters and other chemical and radioactive materials. However, hazardous waste only poses a risk when its disposal is not effectively managed.

People can be exposed to hazardous waste directly or through pollution of the air, water supply or environment. It can also be carried by other humans or animals. The potential consequences of contact with hazardous waste include: infections; cuts, burns and skin irritation; cancers; injuries from explosion; ineffective medical care and pollution.

It is difficult to quantify the level of actual rather than perceived risk. For example, it is hard to distinguish the adverse effects of "waste-picking" from the effects of poor living conditions. However, the study found that:

• The urban poor are at greatest risk from healthcare waste, although the degree of risk depends on the level of contact.
• Waste-pickers are the highest risk labour group and may have no alternative sources of income.
• Other high-risk employment groups are those working in the recycling industry, and healthcare and municipal waste workers. Hospital waste workers are exposed to slightly lower levels of risk.
• Anyone in the local community may be at risk if they live near or on a waste site. Drug addicts, children and the most poor are the highest risk groups; middle-income groups face the lowest level of risk.

Health planners involved in improving local healthcare facilities can tackle the issue of healthcare waste by:

• addressing risks at all stages of the waste stream
• ensuring the separation of hazardous waste at the source
• developing procedures for the storage, handling, transfer and disposal of waste
• improving waste containment and providing protective equipment
• establishing a distinct management function for waste with a dedicated budget line
• providing training for waste handlers
• protecting the population through strategies such as immunisation.

Source(s):
'Healthcare or health risks? Risks from healthcare waste to the poor' by J. Appleton and M. Ali, WELL Study 326 (2000)

Funded by: UK Department for International Development

id21 Research Highlight: 1 June 2001

Further Information:
Mansoor Ali
Water Engineering and Development Centre (WEDC)
Loughborough University
Leicestershire LE11 3TU
UK

Tel: +44 (0)1509 222885
Fax: +44 (0)1509 211079
Contact the contributor: S.M.Ali@lboro.ac.uk

Water, Engineering and Development Centre (WEDC), University of Loughborough, UK

Sue Sherry
London School of Hygiene and Tropical Medicine
Keppel Street
London WCIE 7HT
UK

Tel: +44 171 927 2214
Fax: +44 171 636 7843
Contact the contributor: well@lshtm.ac.uk

London School of Hygiene and Tropical Medicine, UK

Other related links:
The WHO has several publications on the disposal of healthcare waste.

See the ILO site for resources on occupational health.