Healthcare Risk Waste

Unique identifier / Notation

TL0042

Synonyms

Terminology varies across stakeholders:

medical waste,

clinical waste,

regulated medical waste,

hospital waste (Rutala and Mayhall 1992).

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Healthcare waste includes waste generated within healthcare facilities, research centres and laboratories related to medical procedures and medical equipment. It also includes waste originating from minor and scattered healthcare sources, including waste produced in the course of emergency medical treatment or health care undertaken in the home (e.g., home dialysis, self-administration of insulin, recuperative care) (WHO, 2014).

Primary reference(s)

WHO, 2014. Safe management of wastes from health-care activities, 2nd Edition. World Health Organization (WHO). Accessed 15 November 2019.

Additional scientific description

The main sources of medical waste are hospitals, clinics, laboratories, blood banks and mortuaries. Whereas physician’s offices, dental clinics, pharmacies, home-based health care and so on, generate healthcare waste but in smaller amounts (UNGA, 2011).

Metrics and numeric limits

Classification of healthcare waste (HCW) that can inform the metrics is shown below (Basel Convention and WHO, 2005):

Healthcare waste for the purpose of transboundary movements under the Basel Convention can be classified with the codes Y1 (Clinical wastes from medical care in hospitals, medical centres and clinics) or Y2 (Wastes from the production and preparation of pharmaceutical products, or Y3 (Wastes pharmaceuticals, drugs and medicines), among others.

Approximately 15% of healthcare waste is estimated to be hazardous and has a potential to cause disease or injury. About 85% of healthcare waste is general waste, and is non-hazardous and includes items such as paper, glass, plastic packaging material, and food that have not been in contact with patients. It is similar to domestic/household waste (WHO, 2018).

Key relevant UN convention / multilateral treaty

Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and their Disposal (1989). At the time of writing, there were 187 parties to the Basel Convention (UN Treaty Collection, 2019).

Examples of drivers, outcomes and risk management

Drivers of this hazard include lack of awareness about the health hazards related to healthcare waste; inadequate training in proper waste management; absence of waste management and disposal systems; insufficient financial and human resources; and the low priority given to healthcare waste. Many countries either do not have appropriate regulations, or do not enforce them (WHO, 2018). Healthcare waste may result in the following outcomes (WHO, 2018):

Potentially harmful microorganisms can infect hospital patients, health workers and the general public.
Release of drug-resistant microorganisms from healthcare facilities into the environment.
Needle stick injury (e.g., a person who experiences one needle stick injury from a needle used on an infected source patient has risks of 30%, 1.8%, and 0.3% respectively of becoming infected with HBV, HCV and HIV).
Radiation burns.
Toxic exposure to pharmaceutical products, especially antibiotics and cytotoxic drugs released into the surrounding environment, and to substances such as mercury or dioxins, during the handling or incineration of healthcare wastes.
Chemical burns arising in the context of disinfection, sterilisation or waste treatment activities.
Air pollution arising from the release of particulate matter during medical waste incineration.
Thermal injuries occurring in conjunction with open burning and the operation of medical waste incinerators.
Indirect health risks (environmental impact) due to the release of pathogens and toxic pollutants into the environment.
Inadequate incineration or the incineration of unsuitable health waste materials can result in the release of pollutants into the air and in the generation of ash residue. Incinerated materials containing or treated with chlorine can generate dioxins and furans, which are human carcinogens and have been associated with a range of adverse health effects. Incineration of heavy metals or materials with high metal content (especially lead, mercury and cadmium) can lead to the spread of toxic metals in the environment.
Treatment of healthcare wastes with chemical disinfectants can result in the release of chemical substances into the environment if those substances are not handled, stored and disposed of in an environmentally sound manner.
Disposal of untreated healthcare wastes in landfills can lead to the contamination of drinking water, surface waters, and groundwaters if the landfills are not properly constructed.