Health care is the prevention, treatment and management of illness and the preservation of mental and physical well-being through services offered by the medical and allied health professions (Dictionary.com 2005). Health care covers disease management, emergency preparedness, emergency department overcrowding, pain management, and patient safety (Jayco 2005). These health care activities encompass immunizations, diagnostic tests, medical treatments, and laboratory examinations in protecting and restoring health and saving lives. But the by-products and wastes generated by these activities have not be adequately addressed.
Studies and records show that from the total wastes generated by these health care activities, almost 80% are general wastes, comparable to domestic wastes and the remaining 20% are considered hazardous materials, which can be infectious, toxic or radioactive (WHO 2005). Infectious wastes are made up of cultures and stocks of infectious agents, wastes from infected patients, wastes contaminated with blood and blood derivatives, discarded diagnostic samples, infected animals used in laboratories, and contaminated materials, such as swabs and bandages, and disposable medical devices and anatomic wastes, such as recognizable body parts and animal carcasses. These infectious and anatomic wastes combined represent the majority of hazardous wastes, which account for up to 15% of the total wastes proceeding from health care activities. Sharps, chemicals and pharmaceuticals contribute to the bulk of wastes. Examples of sharps are syringes, disposable scalpels and blades and these sharps represent 1% of the total waste from health care activities. Examples of chemical wastes are solvents and disinfectants. On the other hand, examples of pharmaceutical wastes are expired, unused, and contaminated drugs or their metabolites, vaccines and sera. These chemical and pharmaceutical wastes account for approximately 3% of wastes from health care activities. Genotoxic wastes are highly dangerous mutagenic, teratogenic1 or carcinogenic wastes, for example, from cytotoxic drugs of cancer treatment and their matabolites, and radioactive matter, emitting from glassware contaminated with radioactive diagnostic material or radio-therapeutic materials. These genotoxic wastes, radioactive matter and heavy metal content account for approximately 1% of the total waste volume produced by health-care activities.
The main sources of these health care wastes are hospitals and other health care establishments, laboratories and research institutions or centers, mortuary and autopsy centers, animal research and testing laboratories, blood banks and collection services, and nursing homes for the elderly (WHO 2005). High-income countries produce up to 6 kilogram of hazardous waste per person a year. Such wastes generated by many low-income countries are usually not differentiated into hazardous and non-hazardous and build up anywhere from 0.5 to 3 kilograms of health care wastes per person per year. These wastes are a source of potentially harmful micro-organisms to hospital patients, health-care workers and the general public. Potential infection risks include the spread of sometimes resistant, micro-organisms from health-care centers and establishments into the environment itself. These wastes and by-products can cause injuries, like radiation burns, sharps-inflicted injuries, poisoning and pollution, through the release of pharmaceutical products -- such as antibiotics and cytotoxic drugs - or the waste water or by toxic elements or compounds, such as mercury or dioxins. Throughout the world, approximately 12 billion injections are administered where not all needles and syringes are properly disposed of. This creates a considerable risk of injury and infection and opportunities for re-use. Throughout the world, 8 to 16 million hepatitis B cases, 2.3 to 4.7 million hepatitis C cases and 80,000 to 160,000 HIV infections proceed from the re-use of syringe needles without sterilization. Disposable syringes and needles are re-used for injections, commonly in certain African, Asian and Central and Eastern European countries. In these countries, additional hazards occur because of scavenging on waste disposal sites and the manual sorting of waste from the backdoor of health-care establishments (WHO). Waste handlers are exposed to needle-stick injuries and other ways of getting exposed to toxic or infectious materials. Further risks that can result from the disposal of these health-care wastes occur through treatment or disposal. Occupational risks include inadequate incineration or incineration of materials unsuitable for incineration that can release pollutants into the air. Incinerated materials containing chlorine produce dioxins and furans, considered as possible human carcinogens and associated with an entire range of adverse effects. The incineration of heavy metals or materials with high metal contents can spread heavy metals in the environment. Only modern incinerators can function between 800 and 1000 degrees Centigrade and possess special emission-cleaning features that ensure that no dioxins and furans are produced.
Waste management of health care activities has been admitted to be a failure due to a lack of waste management, a prevailing lack of awareness about health hazards, a shortage in financial and human resources and poor control of waste disposals (WHO 2005). Many countries also do not have appropriate regulations or do not enforce these regulations on the pro-per handling and disposal of waste. Medical waste incinerators are considered the top sources of dioxin and anthropogenic mercury emissions in the U.S. These contaminants can travel long distances and easily transferred between air, land and water. Estimates state that from the early 1990s, medical waste has been produced at a rate of 3.5 million tons a year and magnified by the increasing prevalence of home health care, which in turn has been generating about 50,000 tons of waste per year. Roughly 15% of hospital waste is considered infections.
The American Hospital Association and the U.S. Environmental Protection Agency have joined ranks through a memorandum of agreement in addressing the condition and in reducing the volume and toxicity of wastes by 2010 and the virtual elimination of mercury from health care by the year 2005 (Kaiser et al. 2001). The alliance utilizes a web of relationships and decisions covering or affecting product suppliers, health care workers and hospital waste treatment decisions. The two organizations recognized the link between harmful pollutants to human health and health care waste, two of these being mercury and dioxin, which have been identified in significant amounts in the air and ash emissions of medical waste incinerators. It applies life cycle considerations in evaluating the environmental impact of medical products and services during the manufacture, distribution, use and end-of-life or disposal and not just the costs directly related to waste disposal. These costs are associated with collection, transport, treatment and waste disposal. Health care professionals within the organizations review their waste disposal methods and develop criteria for the environmental screening of products. The personnel in charge of procuring health care products and services, such as materials managers and purchasing agents, are screened according to their qualifications and many of them have working experience within the health care spheres, such as nursing or another technical skills area.
The overall health care supply chain management process has been revised to incorporate other criteria directly linking product selection, product use, product disposal and environmental and community health impacts. Product acquisition also includes evaluating upstream life cycle steps in resource use, energy demands and global impact.
The alliance likewise integrates environmental into the education of their health care professionals in matching the changing trends in disease and illness and in increasing their consciousness on the appropriate use and disposal of resources (Kaiser et al. 2001). It has also made a commitment out of employing full-time environmental or waste managers. Its adoption of life cycle thinking from a design and purchasing standpoint promises a decrease in environmental risks and costs. It employs upstream tactics that can also reduce the environmental impacts of products and services it uses as well as downstream tactics of waste management. Some of the facilities have undertaken recycling programs, segregation of waste streams for optimal end use, such as by recycling and materials recovery. Other facilities within the two organizations have instituted upstream programs in preventing pollution, such as focusing on reducing mercury use. One way of reducing…