Whether in India, Tanzania, the United Kingdom, or the United States, countries around the world are coping with the proper disposal of medical waste. Developed countries face challenges with the sheer volume of waste from the use of disposable items. On the other hand, developing countries, whose supplies are limited, are dealing with challenges of sorting and disposing of all types of medical waste in a sanitary manner.
This is no small problem considering that medical waste is the third largest source of waste in the United States, with hospitals discarding more than two million tons of waste annually.1 For developing countries, the unsanitary disposal of waste has put millions of lives at risk because dumping sites are often visited by people scavenging for goods. Developing countries face a myriad of health problems arising from the burning of the waste. Incinerators are still the main vehicle used to dispose of medical waste in much of the developing world, especially in sub-Saharan Africa.
On an international level, the UN Stockholm Convention is the main treaty for addressing the disposal of Persistent Organic Pollutants (POPs). Parties to the Stockholm Convention are required to use the best available technologies for Medical Waste Incinerators. Unfortunately, the costs of such technologies are out-of-reach for most medical institutions in sub-Saharan Africa.2
This news analysis will compare and contrast medical waste problems in the developed and developing world and will outline potential solutions for both.
Medical Waste in the Developed World
In the United States, the medical waste problem is linked to the expanded use of disposable items, which became popular in the 1990’s with the AIDS outbreak. Operating rooms provide the most medical waste, about 20-30 percent of all hospital waste.3 Often items in surgical kits are thrown out unused because the kit was opened, thus making it unsterilized. Streamlining these kits can save hospitals a lot of money and reduce the amount of waste.
Many hospitals are starting to look into recycling or donating leftovers that are still usable to developing countries, many of whom are in desperate need for these supplies. At least half of U.S. hospitals send some of their single-use items to re-processors, who sterilize the items and resell them back to hospitals at a fraction of the cost. Since 2000, the FDA has required that re processors meet the same stringent standards as the original makers. A 2008 study by the U.S. Government Accountability Office (GAO) has revealed that there are no additional health risks from the reprocessed items.4
Scientists are now starting to look at another form of medical waste, inhaled anesthetics, whose presence in the atmosphere might be linked to global warming. The three major inhaled anesthetics (sevoflurane, isoflurane, and desflurane) undergo very little change once exhaled by patients. These three gases are considered greenhouse gases and most hospitals vent them out of the building as waste gases. According to a study published in Anesthesia & Analgesia, a busy hospital could emit annually as much gas as 100 -1,200 cars (depending on the type of anesthetic used). Reducing the use nitrous oxide, decreasing the anesthetic flow rate, and recapturing the anesthetic gases for reuse would reduce the greenhouse gas emissions.5
Medical Waste in the Developing World
Medical waste problems in the developing world are associated poor funding and the lack of national regulations for the sanitary disposal of waste (and/or lack of oversight).
In India, the government passed the Biomedical Waste Management and Handling Rules, 1998, which outlines how hospitals should collect, transport and dispose of waste. Despite this legislation, most of the medical waste in India is dumped in the open and collected with the general waste.6 Unfortunately, the Indian press often reports cases in which hospitals are shut down or are not following regulations for waste disposal. A case study from King George Hospital (KGH) in Visakhapatnam, India highlights typical problems with medical waste management:
- staff were exposed to potential infections from poor quality equipment used for handling the medical waste (such as repeated use of single-use gloves)
- laboratories did not segregate waste according to the required color-coded system, but put all types of waste in one bag (including sharp items)
- waste storage areas were not secure (flies, rodents and dogs could access the area).7
Since the hospital studied was in a relatively well-off state, Andhra Pradesh, the biomedical waste treatment facility for this hospital had state-of-the-art pollution controls. This is not necessarily the case throughout India or in other developing countries.8
The United Nations Development Program’s (UNDP) Global Healthcare Waste Project is researching ways to help sub-Saharan Africa better dispose of medical waste. Most of the countries surveyed lacked legal policy for medical waste management and lacked proper sanitary landfills. For example, Eritrea, Lesotho, and Ghana have no legislation for health care waste management, while Kenya, Nigeria, and Gambia are signatories to the Stockholm Convention and have some relevant laws on the books.9
The lack of sanitary landfills has lead to the increased used of incinerators. Gambia, Ghana, Lesotho, Nigeria, Senegal, Tanzania have no sanitary landfills; while Kenya and Zambia only have crude dump sites. It is estimated that there are more than 1,000 incinerators in Africa; many of which have been reported to be inoperative or operating below standards.10
One of the biggest risks for African healthcare facilities is the disposal of sharps (needles, scalpel blades, blood vials, glassware, etc) that are in contact with infectious germs. The high cost of safety boxes for proper disposal of sharps limits the use of these boxes. Asian countries have started to produce these boxes locally, bringing down the cost, but African countries are still buying them from outside vendors. Nonetheless, all the countries surveyed by the UNDP did not allow sharp waste to be disposed of at the dump sites and some hospitals had separate sharp pits.11
While additional funding would certainly help developing countries better dispose of medical waste, relevant legislation is also needed to insure that waste is disposed of properly.
While governments and hospitals are looking for solutions to handle waste management problems, there are many individuals and NGOs that are stepping in as middle-men to provide much-needed services to help hospitals recycle and provide equipment to hospitals in need.
Intervol, a New York-based NGO, collects unused (and used, but functioning) medical equipment and distributes them locally, nationally, and internationally. All of these supplies would have otherwise been thrown out or incinerated.12
Another NGO, Medshare, offers similar services. According to their website, Medshare has, “Gathered more than $70 million worth of life-saving medical supplies and equipment,” “Collected over 10,000 pieces of equipment,” “Shipped more than 550 forty-foot containers to 80 countries,” “Saved in excess of 1 million cubic feet from area landfills,” and “Provided medical supplies for over 1,000 medical mission teams.”13
Organizations, such as these, can provide much needed support until longer term solutions are found.
1 Everson, Michelle. “Resolving Global Medical Waste.” Earth911. August 24, 2010.
2 “TANZANIA: THE TECHNOLOGY DEVELOPMENT COMPONENT.” UNDP Global Healthcare Waste Project.
3 Chen, Ingfei. “In a World of Throwaways, Making a Dent in Medical Waste.” New York Times. July 5, 2010.
5 “Anesthetics Could Add to Global Warming.” Business Week. July 8, 2010.
6 Goddu, Vijaya Kumar and Kavita Duvvuri and Vidya Kaumudini Bakki. “A Critical Analysis of Healthcare Waste Management in Developed and Developing Countries: Case Studies from India and England.” International Conference on Sustainable Solid Waste Management,5 – 7 September 2007, Chennai, India.
9 “Needs Assessment for Hospitals in African Countries in Relation to Infectious Waste Treatment Final Report.” UNDP. May 2009.
12 Intervol. http://www.intervol.org/index.php
13 Medshare. http://www.medshare.org/about-us