Introduction:

Safe health care waste management, including segregation, collection, transport, treatment and waste disposal, is fundamental to wider efforts to provide safe and quality health care. Safe health care waste management practices also support a number of the UN Sustainable Development Goals (SDGs), including Goal 3 on health, Goal 6 on safely managed water and sanitation, Goal 7 on climate change and Goal 12 on sustainable consumption and production. 

According to new global data released by WHO/UNICEF in 2019, there is no or very limited safe management of health care waste in a large proportion of facilities. The data, representing over 

560 000 facilities from 125 countries, indicate that 40% of health care facilities do not segregate waste. In least developed countries, the situation is far worse with only 27% of countries having basic (segregation and safe waste destruction) services.

In parallel, WHO/UNICEF have published global guidance on the practical steps that need to be taken to solve the crisis. These steps include developing national roadmaps, setting targets and regular monitoring, improving infrastructure and maintenance, developing the health workforce and engaging communities.2 Case studies are used to illustrate these steps, including examples of waste recycling schemes and use of non-incineration technology. 

The purpose of this document is two-fold. The first is to provide criteria for selecting technologies to facilitate decision making for improved health care waste management in health care facilities. 

The second is to provide an overview of specific health care waste technologies for the treatment of solid infectious and sharp waste for health care facility administrators and planners, WASH and 

infection prevention control staff, national planners, donors and partners. For each technology, details on its operation, effects on the environment and health, requirements for installation, capacities for treating waste, examples of consumables and advantages and disadvantages are described.

Infectious waste: Waste that contains pathogens and poses a risk of disease transmission e.g., waste contaminated with blood and other body fluids; laboratory cultures and microbiological stocks; waste including excreta and other materials that have been in contact with patients infected with highly infectious diseases, particularly those in isolation wards. 

Sharp waste: Items that could cause cuts or puncture wounds e.g., hypodermic, intravenous or other needles; auto-disable syringes; syringes with attached needles; infusion sets; scalpels; pipettes; knives; blades; broken glass. 

Source: WHO 2014

This document is particularly focused on resource-limited settings of low and middle-income countries. The document describes environmentally friendly technologies which advance climate 

mitigation strategies and help to meet commitments enshrined in global environmental conventions.

The waste-management hierarchy 

• The preferred approach is to avoid generating waste and thus minimize the quantity entering the waste stream. 

• Where practicable and safe, those waste items that can be recovered for secondary use is the next most preferable method. 

• Waste that cannot be recovered must then be dealt with by the least harmful options, such as treatment or land disposal to reduce their health and environmental impacts.

Stockholm Convention 

The Stockholm Convention recommends that priority consideration should be given to alternative processes, techniques or practices that have similar usefulness, but which avoid the formation and release of dioxins and furans (UNEP 2007). Non-incineration waste treatment technologies should always be implemented wherever possible. 

WHO calls on all stakeholders to uphold the Stockholm Convention and work towards incrementally improving safe health care waste management practices to protect health and reduce harm to the environment (WHO 2007). To this end WHO recommends that: 

Governments should: 

• Allocate a budget to cover the costs of establishment and maintenance of sound health care waste management systems 

• Request donors, partners and other sources of external financing to include an adequate contribution towards the management of waste associated with their interventions 

• Implement and monitor sound health care waste management systems, support capacity building, and ensure worker and community health. 

Donors and partners should: 

• Include a provision in their health program assistance to cover the costs of sound health care waste management systems. 

All concerned institutions and organizations should: 

• Promote sound health care waste management 

• Develop innovative solutions to reduce the volume and toxicity of the waste they produce which is associated with their products 

• Ensure that global health strategies and programs take into account health care waste management.

2. Priority considerations 

To ensure sustainability, technologies should be selected according to the economic, environmental and social context. To choose the most appropriate technology, benchmarking, expert opinions and participatory assessment by relevant stakeholders should be considered (UNEP 2012b). The following steps can be used to select the best technology: 

1. Baseline data collection 

• Legal requirements (national and international) 

• Volume of waste generated 

• Availability of resources water, electricity, fuel) 

• Available space and security for the treatment technology 

• Availability of collection and safe disposal of treated waste 

• Budget for capital, operation and maintenance costs 

• Use of decentralised or centralised waste treatment 

2. Calculation of treatment capacity required 

3. Mapping and screening of eligible technology options 

4. Submission of bidding documentation and evaluation criteria 

(in cases of public bidding), including: 

• Experiences in the country/region, technical certificates, use of local or regional services, process for procuring spare parts, technical training, maintenance contracts, technical drawings, housing requirements, availability of documents in local language, costs (including equipment, transport to the site, installation and commissioning, operation), delivery time and proven experience in installing and maintaining the technology in a similar context 

5. Decision making (evaluation of bids) 

Table 1 provides a comparison of types of technologies available on the market which comply with the Stockholm and Basel Conventions. Table 2 compares interim treatment technologies which do not meet the two conventions. Tables 1 and 2 rate available technologies according to environmental impact, capital capital and operational costs2. 

(pastedGraphic.png = low, pastedGraphic_1.png=medium, pastedGraphic_2.png= high, = pastedGraphic_3.pngvery high). Table 1 covers those technologies which comply with the Stockholm and Basel Conventions, while those listed in Table 2 do not meet these requirements and are considered interim solutions.

Table 1. Comparison of infectious and sharp waste treatment technologies which comply with the Stockholm and Basel Conventions

 

Table 2. Comparison of interim waste treatment technologies used in lowresource settings 

 

Above all, the steam autoclave and microwave have advantage of low environmental impact, low capital costs and low operating costs.