Concern over disposal of medical waste

| 23/02/2021 | 17 Comments

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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Category: Health, health and safety, Viewpoint

Comments (17)

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  1. Anonymous says:

    You would think that as a “hospital” they would not need anyone to tell them the dangers of their medical waste and they wouldn’t have to be told how to dispose of it!!

    Who’s running our hospitals that don’t know any better?
    That’s the REAL danger…

  2. Anonymous says:

    What is mind boggling, everyone on this rock seems to be petrified of COVID, yet drawing in the sea of extremely toxic waste that is in the air, water, soil, grass, foliage, beach water etc, doesn’t seem to bother people.

  3. Anonymous says:

    Obviously no research. really sad.

  4. Anonymous says:

    Wow! Only 10 responses after 2 days! Fellow Caymanians and Residents wake up!!

  5. Anonymous says:

    In most cases I would agree. However, this is not a problem in the Cayman Islands. It all burns up in the Dump, often before it even gets there.

    • Anonymous says:

      Not true. Only Health City incinerates it’s waste with no oversight over emissions.

      Do you know that One hospital bed can generate anywhere between 13 and 23 pounds of medical waste per day. That’s over 6,000 pounds per bed per year.

      Do you know that It’s estimated that one hospital bed per year generates approximately 145,000 gallons of wastewater. Even the most effective water treatment plants or sewage collection treatments are unable to remove all contaminants such as microbes or pharmaceuticals from wastewater, leaving traces levels of chemicals behind with the potential to be released into the environment.

      Do you know that a dental practice produces some similar types of medical waste as a doctor’s office or surgical center. Regularly guidelines exist in the developed word specific to dental office waste.

      Do you still believe it is not a problem in Cayman?

      Legislation, staggering fines and penalties, as well as greater awareness of the human and environmental risk of dumping medical waste or improper medical waste disposal has improved in the developed word, but NOT in Cayman. In Cayman it doesn’t exist.

      .

  6. Anonymous says:

    Great observations and commentary! Oh that the “powers” would read it and follow through!

    Alternately, hope that some political hopeful will latch on and ride the subject through election season. Anyway if it creates attention to the issue……….

  7. Anonymous says:

    Lol its called an incinerator

    • Anonymous says:

      Yeah right. That is why most people die from cancer on this rock.

      My late coworker, an expat, died from an aggressive brain tumor. She won’t be in Cayman cancer statistics though. Died in the US hospice.
      She lived on Jennifer drive for 3 years.

      And if you believe an incinerator is the answer to Cayman ever growing medical waste problem, you have stone age mentality.

      The rest of the developed world has laws, stringent rules, regulations and guidelines, monitoring and enforcement.

      • Anonymous says:

        Sorry to hear about your neighbor. I know of five people (between 30-50 yrs old) who have died from aggressive brain tumors while living in Cayman and no doubt there have been countless others. That’s extremely worrying.

        • Anonymous says:

          Expats leave the island once diagnosed with life threatening diseases, therefore cancer statistics in Cayman will never be accurate.

  8. Anonymous says:

    Wait WHAT no law, regulations? But first on the list of legislative updates was how to limit malpractice liability. Sounds about right.

  9. Anonymous says:

    Would this be the planning responsibility of John Seymour who is Minister of Health ?

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