Healthcare facilities are in place to offer diagnostic and curative medical attention to people, yet these facilities fail to fully provide a safe and sanitary environment. In 2015, the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) conducted a joint global review of healthcare facilities and found nineteen percent of facilities lack adequate sanitation. Additionally, thirty-five percent of facilities lack soap and water for hand washing and thirty-eight percent lack a water source. Remarkably, only fifty-eight percent of tested facilities have satisfactory biomedical waste management systems (“Health Care Facilities and Waste”). When biomedical waste is not properly managed, it harms anyone from employees to citizens of surrounding communities. The environment is also at risk and lacking proper management can lead to water, air, and land pollution. Biomedical waste is an environmental concern because improper handling and disposal of hazardous waste harm the health and well-being of both humans and the environment.
Biomedical waste is defined as “all waste materials generated at healthcare institutions as well as medical research facilities and laboratories” (Chen and Tsai 593). Of all biomedical waste generated, around ten to twenty-five percent is hazardous waste that poses a threat to both humans and the environment (Capoor and Bhowmik). Biomedical waste is hazardous if it contains infectious agents, sharps, and hazardous chemicals or pharmaceuticals or if it is radioactive or genotoxic. Employees of healthcare facilities or medical research centers and laboratories, waste handlers, and the public are all high-risk groups to the harmful effects of hazardous biomedical waste (“The Basis for Healthcare Waste Management”).
The global expansion of healthcare facilities is leading to the production of an unprecedented amount of hazardous biomedical waste (Capoor and Bhowmik). In high-income countries, facilities are producing an average of 0.5 kilograms of waste per hospital bed per day. Low-income countries are generating an average of 0.2 kilograms of waste per hospital bed per day, but this figure is considerably inaccurate due to the lack of separation of hazardous and nonhazardous biomedical waste. The actual amount of hazardous waste would be much greater than this statistic with the implementation of proper management procedures (“Health-care Waste”). On a global level, the healthcare industry is still in its beginning stages of biomedical waste management (Mor et al. 468).
Hazardous biomedical waste includes pathological waste, pharmaceutical waste, and chemical waste. Sharps, highly infectious waste, radioactive waste, and genotoxic or cytotoxic waste are highly hazardous and require extra caution when disposing of. Any tissues, organs, body parts, blood, or bodily fluid from surgical procedures or autopsies are categorized as pathological wastes. Pharmaceutical waste includes pharmaceutical products, drugs, or vaccines that are expired, unused, spilt, or contaminated.
Chemicals from diagnostic work or cleaning and disinfecting that are toxic, corrosive, flammable, reactive, or oxidizing classify as chemical waste. Chemical wastes may intoxicate a person if they are inhaled, ingested, or absorbed through the skin or mucous membranes. Contact with chemical waste may also cause physical injuries, especially chemical burns. The skin, eyes, or mucous membranes of the airways are more susceptible to injuries related to chemical waste (Chartier et al. 5-6, 28).
Sharps waste includes needles, scalpels, broken glass, or any other object capable of creating cuts or puncture wounds to the skin. This waste is hazardous whether it actually contains infectious material, and it must always be treated as if it is infectious. Infectious waste is any waste containing pathogens, for instance, waste with blood or bodily fluids, cultures or infectious agents from laboratories, or waste from infected patients in isolation wards of hospitals. Pathogens of sharps and infectious wastes may infect a person by entering through punctures in the skin, absorption through mucous membranes, or through inhalation or ingestion. These pathogens cause both local and systemic infections, including infections of the gastrointestinal system, respiratory system, skin, or eyes (Chartier et al. 4, 26-27).
Globally, sixteen billion injections are administered annually, but not all syringes are properly disposed of. Although this is an improving issue, injections with contaminated needles frequently occur in low- and middle-income countries. In 2010, these unsanitary injections resulted in as many as 38,000 new cases of human immunodeficiency virus (HIV) infections, 315,000 hepatitis C infections, and 1.7 million hepatitis B infections, all of which could have been avoided. One needle stick injury from a needle used on an infected patient increases the risk of HIV by 0.3 percent, hepatitis C by 1.8 percent, and hepatitis B by thirty percent. Needle-stick injuries are an immediate threat to persons involved in the handling and manual sorting of biomedical waste, which is common in low- and middle-income countries (“Health-care Waste”).
Any waste produced from radioactive procedures, including imaging, therapeutic, or diagnostic procedures, is classified as radioactive waste. The adverse effects associated with this waste are headaches, dizziness, and vomiting and can become more serious with increased duration of exposure.
Cytotoxic and genotoxic waste are both highly hazardous if it comes into contact with humans. Genotoxic waste may be mutagenic or carcinogenic and includes any excretory substances from patients treated with drugs, chemicals, or radioactive material that is cytostatic, or inhibiting to cell growth and reproduction. Cytotoxic waste also derives from cytostatic drugs. Aside from the threat these wastes impose on living cells, they may also cause dizziness, nausea, headaches, and dermatitis (Chartier et al. 5, 8, 29-30). It is estimated approximately half of the world population is at risk of the hazards of biomedical waste due to lack of proper management methods (Capoor and Bhowmik).
Disposal of biomedical waste is a major threat to the environment and results in pollution of the air, water, and land. Incineration of waste is a common disposal method, but it emits toxic air pollutants and ash residues (Gautam et al.). Additionally, biomedical waste pollutes the air when it is transported without pretreatment or when it is dumped in open areas. Liquid biomedical waste contaminates water supplies when it is not properly treated (Mor et al. 469). Untreated waste discarded in landfills may also find its way into drinking water, surface water, and groundwater (“Health-care Waste”). Wastes containing contagious pathogens, chemicals, discarded medications, or ashes are all culprits of land pollution. This biomedical waste can contain substances like cadmium, lead, or mercury that may be taken up by plants and enter the food chain (Mor et al. 469). Some of these metals, including mercury and cadmium, are known to cause damage to the immune system, neurological system, lungs, and kidneys (Chartier et al. 30).
The United States Environmental Protection Agency reported biomedical waste as the third largest known source of dioxins in the environment. This toxic chemical is linked to cancer, immune system disorders, and birth defects (Gautam et al.). A recent news report stated some hospital incinerators produce dioxin levels more than one hundred times higher than those permitted by law and burn around four million pounds of waste annually. Illinois Environmental Protection Agency director Renee Cipriano commented, “…we’re having a tough time persuading lawmakers these remaining incinerators should be shut down the protect the public. The bottom line is there are safer alternatives” (Hawthorne).
Biomedical waste is managed in a series of four phases: classification, disposal, storage, and collection and transportation. The problem stems from the segregation phase when hazardous and nonhazardous wastes are not appropriately separated. This results in hazardous waste not being properly treated before disposal (Chen and Tsai 594). Unsatisfactory biomedical waste management is a result of a lack of employee awareness, insufficient resources for management, and poor disposal mechanisms (Capoor and Bhowmik). Developing countries generally dump waste in unsanitary manners, and new healthcare facilities are unaware of the proper methods for handling and managing biomedical waste (Mor et al. 468). Proper training in biomedical waste management and awareness of its harmful effects may minimize this dilemma.
The most effective method of biomedical waste management is to limit the generation of waste or to preserve as much waste as possible as opposed to discarding it. Currently, there are two primary international agreements regarding biomedical waste management. First, the Basel Convention on Hazardous Waste is a highly inclusive environmental treaty that serves to protect both human health and the environment from hazardous biomedical wastes. Its objectives are to minimize the generation of hazardous wastes, reduce the movement of hazardous wastes, and dispose of wastes close to the source of generation. The Basel Convention serves to implement “environmentally sound management” through an “integrated life-cycle approach.” This means issuing strong controls in each step of the biomedical waste management cycle, starting with the generation of waste and ending with the final disposal of it (“The Basis for Healthcare Waste Management”).
Secondly, the Stockholm Convention on Persistent Organic Pollutants (POPs) intends to protect human health and the environment from POPs. These toxic chemicals accumulate in the fatty tissue of living organisms and are toxic to both humans and wildlife. POPs are formed by biomedical waste incinerators or other methods of disposal that involve combustion and become widely distributed once they are emitted. The Stockholm Convention urges governments to take legal action to eliminate or reduce the emission of POPs (“The Basis for Healthcare Waste Management”).
There is an international agreement on four principles to govern the management of biomedical waste, and it is encouraged that these principles are implemented by healthcare facilities. First, the duty of care principle states that any organization that generates biomedical waste has a duty to safely dispose of that waste. Next is the polluter pays principle, which affirms all waste producers are legally and financially responsible for the safe handling and environmentally sound disposal of the waste they produce. This includes any accidental pollution, and the waste producer is liable for any cleanup costs. The purpose of this principle is to serve as an incentive to produce less waste and to manage it well. Third is the precautionary principle that one must always assume waste is hazardous until proven otherwise. All waste must be handled with caution and treated properly in order to prevent harm to human health and the environment. Lastly, the proximity principle encourages treatment and disposal of biomedical waste to occur at the closest possible location to the source of generation. This minimizes the harmful risks in transporting hazardous wastes (“The Basis for Healthcare Waste Management”).