Medical or health care waste (HCW) from health care facilities are biological products that can no longer be used. They are a byproduct from the diagnosis, treatment, or immunizations of humans or animals; as part of research; or in the production/testing of biological products. These waste products usually fall into four categories:
general or non-infectious
infectious (including sharps)
chemical or hazardous
radioactive.
Non-infectious waste includes paper and packaging, bottle/cans, glass, and food. Infectious waste includes used gauze/dressing, blood/IV lines, gloves, anatomical waste, and pharmaceutical waste; and sharps that include used needles, infusion sets, scalpels, blades, and broken glass.
Health care waste management (HCWM) is a major health and environmental concern. Sharps waste is highly infectious and, if it is not handled and disposed of correctly, poses a serious threat to both service providers and the general public. Other infectious waste also poses serious risks to human health and the general environment. It is, therefore, important to segregate infectious waste (e.g., sharps and blood-soaked bandages) from other general, non-infectious waste, and then use standard practices to dispose of the waste.
Under ideal circumstances, HCW is segregated according to non-infectious, infectious, chemical/hazardous, and radioactive, as required. Sharps are collected immediately after use in safety boxes, or for needles cut with a needle cutter, in a needle receptacle. The infectious waste and sharps should be disposed of using deep burial. If deep burial is not available, infectious HCW is usually incinerated using an incinerator with a controlled combustion process that completely oxidizes waste and destroys microorganisms under high temperature, while controlling emissions of toxic pollutants. Plastic wastes, which cannot be incinerated, are usually sterilized using an autoclave and then shredded if a shredder is available.
The situation in many developing countries is not ideal because of the lack of financial and human resources, meaning that—
data is often not available to estimate need
HCW is not always segregated according to World Health Organization (WHO) standards
sharps are not always collected and disposed of correctly
waste handlers cannot be adequately protected
waste cannot be collected and/or disposed of on time or correctly.
This situation makes the logistics of HCW management very challenging.
The USAID | DELIVER PROJECT advocates realistic approaches to solve logistical problems related to HCW management. Our approaches, explained below, are based on actual experience in developing countries.
Quantification
Quantification of HCW management commodities is complicated by the lack of reliable consumption information. The project has developed methods using the information gathered by personnel directly involved with waste and/or use available proxy data to estimate need. The methods can be used as required.
Procurement
The project has assembled a complete list of specifications for HCW commodities; we encourage the use of in-country suppliers that can meet these specifications. In cases where this is not possible, the project has assembled a list of qualified sources and the list can be referenced.
On-site Storage
First and most important, usable commodities must be carefully separated from waste. The two should never be stored together, even temporarily.
For many reasons, it is not always possible to dispose of infectious or sharps waste according to regulations. If the waste is not large (e.g., sharps), one option is to defer the final disposition of the commodity until a later date by storing it semi-permanently. If an appropriate storage facility can be constructed on-site underground, it is also possible to store sharps waste in permanent storage. The project has specifications for both storage/construction options available.
Waste Collection and Transport
Waste collection and transport to a disposal site (sometimes called reverse logistics) is possibly the most vexing logistics problem in HCW management. It is important to identify solutions that are both cost effective and safe. Network optimization tools can be used to determine the most cost-effective system for collecting and moving waste to a disposal site. Other strategies can also be employed to maximize resources and protect waste handlers.
Disposal
Waste collection strategies should not be developed without considering the final disposal. Disposal sites (either burial or incineration) should be optimally located to minimize costs and maximize safety.
Though it is not exactly a logistics issue, the final treatment and disposal of HCW (either through burial or incineration) is an important part of HCW management. The project can help you identify and evaluate options.
The appropriate handling, movement, and disposal of HCW are, in many ways, as important as the procurement, storage, and distribution of health care commodities. If not managed properly, HCW can result in serious injury to waste handlers and the public in general. Although the logistics of HCW can sometimes seem daunting in developing country settings, the project has started taking steps to address this important activity. If you would like to learn more about the logistics of health care waste management in developing countries, contact the project’s supply chain management team.
