Concern over disposal of medical waste

Anonymous writes: The management and treatment of medical waste (MW) are of great concern owing to its potential hazard to human health and the environment. A United Nations human rights expert noted that medical waste is becoming an increasing problem. The Cayman Islands have three fully-equipped hospitals (and a fourth is going to be built), over 200 registered healthcare facilities (including pharmacies, laboratories, physician practices and therapy clinics, alternative medicine clinics), over 500 registered practitioners, and numerous private specialists.

A new healthcare facility is set to open in Bodden Town in 2021. A Minimally Invasive Glaucoma Surgery and a sleep laboratory are in the works. Cayman also has a forensic laboratory that performs toxicology testing, advanced radiology services, computerised tomography, MRI machine, ultrasounds, echocardiography, and GI endoscopy. MW is also generated from animal husbandries, veterinary hospitals, mortuary centres and home-based treatment of patients.

Examples of medical wastes:

• Formaldehyde (Haemodialysis)
• Photographic fixing and developing solutions (X-ray Department)
• Solvents and fixatives (Pathology or Histology Labs)
• Engine or vacuum pump oils, solvents, degreasers (Facility Engineering)
• Disinfectants, pesticides, rodenticides (Housekeeping)
• Acids, alkalis or reducing agents (Laboratory)
• Mercury (thermometers), cadmium (batteries), lead (Radiology)
• Gases stored under high pressure, in cans or cylinders (Surgical Theater)
• Ethylene oxide gas (Central Sterile Supply)
• Expired drugs, cytotoxic drugs (Pharmacy, Chemotherapy Ward)
• Pathological waste. Tissues, organs, body parts, and body fluids removed during surgery and autopsy.
• Human blood and blood products. Waste blood, serum, plasma and blood products.
• Cultures and stocks of infectious agents (microbiological waste). Specimens from medical and pathology laboratories. Includes culture dishes and devices used to transfer, inoculate, and mix. Also includes discarded live and attenuated vaccines.
• Contaminated sharps. Contaminated hypodermic needles, syringes, scalpel blades, Pasteur pipettes, and broken glass.
• Isolation waste. Generated by hospitalized patients isolated to protect others from communicable disease.

According to WHO, high-income countries generate on average up to 0.5 kg of hazardous waste per hospital bed per day.

• How does the territory deal with the MW?
• How MW is transported on-site?
• How is it stored?
• How it is transported off-site?
• Where it is transported to?
• Where it is being detoxified and neutralized before proceeding to the disposal sites, specific for each type of waste?
• Do disposal sites exist?
• Do workers know about the hazards of chemicals they are working with?
• Are they (staff) provided chemical hazard information?

The answer is: Nobody knows, because there are no comprehensive regulations regarding the on-site, off-site, transportation management of MW.

Since MW is not regulated, I assume

• it is not segregated from general waste at its point of origin (not required by law);
• transportation of MW within a healthcare facility has no guidelines and rules;
• packaging/labeling to safely contain the waste during storage and transport and to alert employees and the public to the potential hazard is not being done;
• there are no specific guidelines regarding MW storage areas and time limits.

Regulated MW must be treated before it can be disposed of. Healthcare facilities could be allowed to treat regulated medical waste on-site when an approved method of treatment is used. This would require permits or operating plans for the treatment units.

All employees involved with the on-site management of regulated medical waste (packaging, labeling, storage, or treatment) must be trained in accordance with the requirements of Labor law and regulations (Exposure to Bloodborne Pathogens).

A tracking document is prepared before regulated MW is shipped off-site and that the document accompanies the waste to the treatment/disposal site. Incinerator facility must maintain records of the quantity of regulated MW generated, and the disposition of those wastes. Transporters of regulated MW must have a MW transporter permit in order to pick-up, transport, or deliver regulated MW.

Regulated MW must be treated to render it non-infectious before it can be disposed of. Such treatment can be performed on-site or at a permitted treatment facility. Permitted facilities have stringent standards that must be met.

Pharmaceuticals – Hazardous Waste: Some pharmaceuticals must be extremely toxic in order to function. Antineoplastic agents (the type of drug most often used in chemotherapy), for example, are designed to kill dividing cells. Some radioactive compounds are used for the same purpose. Many drugs have other properties, unrelated to their intended action, that makes them hazardous.

Pharmaceuticals in the waste stream pose several different types of risk: Ignitability, Corrosivity (corrosive hazardous wastes), Reactivity (liable to explode, or to react violently or release toxic gases if it comes in contact with water), Toxicity.

I hope you are aware now of the other side of healthcare system: medical waste, which, if not properly regulated, could cause extensive harm to health and environment.

Now let see how and by whom it is regulated in the US for example:

• The Resource Conservation and Recovery Act. Provides “cradle-to-grave” control of solid and hazardous waste by establishing management requirements on generators and transporters of hazardous waste and on owners and operators of hazardous waste treatment, storage, and disposal facilities.
• The Clean Air Act. An air inspector will primarily be interested in five areas of a hospital: air conditioning and refrigeration, boilers, medical waste incinerators, asbesto, ethylene oxide sterilizers, generators.
• The Clean Water Act. A typical healthcare facility has a wide variety of wastewater sources, such as: lavatories, sinks, and showers, laboratories, photo processing labs, washing machines and dish washers, boilers, maintenance shops.
• The Toxic Substances Control Act. This is self-explanatory.
• The Insecticide, Fungicide and Rodenticide Act.
• Medical Waste Tracking Act. Requires management standards for segregation, packaging, labeling and marking, and storage of the medical waste.

In my opinion, The Cayman Islands has failed to practice appropriate healthcare waste management. It simply doesn’t exist.

Regulations, legislation and policies are 20 years outdated and have no provisions for MW. Since there is no waste management system, management training programmes don’t exist. Ignorance among staff and handlers leads to unsafe waste handling and causes health risks.

Outdated incinerators need to be replaced with autoclaving, steam sterilisation, and comparatively reasonable new practice of pyrolysis to avoid the emission of toxic gases.

The significance of proper healthcare WM cannot be ignored any longer in order to protect the environment and human health from serious risks.

The vast (and growing) number of medical/health-care establishments and pharmacies on the tiny 22×4 rock presents a unique “concentration” risk for its inhabitants- human, animals, flora and fauna and marine life.

I recommend you read this Ask Auntie piece to se the dismal state of waste management in the Cayman Islands. See here.

Now ask your candidates about this problem.

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