Welcome back. In this module, we'll be covering the very important aspect of health care waste management. Hopefully after this module, you'll be able to distinguish the health care waste categories, and their respective risks. You should also know how to improve health care waste management, especially regarding segregation, storage and treatment. This module is quite short, so we'll also give indication where you can obtain more information and further training. First and above all, you have to realize that health care waste comes from many sources, including major sources such as hospital, clinics and laboratories, but also minor sources such as doctor offices, dental clinics and convalescent homes. If we look at health care waste amounts and composition, what is most important to know is that only 15 to 25 percent of the health care waste, only this fraction, is actually hazardous. The rest is actually like municipal solid waste, and can be treated as normal municipal solid waste is treated. So what is most important is to segregate this hazardous fraction from the rest, because it is this part that needs special treatment. Here is a list of categories of hazardous health care waste. For instance, sharps. That's needles and syringes, but also blades. Then, there is infectious waste: blood, body fluids or infectious cultures. Pathological waste, which includes human tissue, organs or body parts. Pharmaceutical waste, which obviously are pharmaceuticals. Then there is chemical waste: reagents, disinfectants, solvents, but also batteries or thermometers containing mercury. And finally, radioactive waste from radiotherapy or from laboratories. Implementing a comprehensive segregation system involves knowing how to distinguish these various fractions, and then setting up a system, to be able to store these separately. Here is one example of color coding on bins and containers for these different health care waste categories. You see the infectious and the sharps typically color-coded with yellow, and the normal waste with black. This is also shown in this table by WHO, where recommendations for color coding and types of containers for the different categories are given. Let us take one look at a specific case: of sharps. Sharps is one fraction with a high risk, mostly for health care workers, waste workers or sometimes even users of recycled injection equipment. Here are some examples of sharps containers. They must be closable, puncture-resistant and leak-proof on the sides and on the bottom; they should be accessible, always maintained upright and not allowed to overfill; also, they should be labeled or color-coded, labeled even with a bio-hazardous symbol. In one example, you even see a container that is suitable for direct treatment in, for instance, an autoclave. Now, let's look at health care waste treatment. Health care waste treatment systems are commercially available today. The choice of technology depends on the characteristics of the waste of the health care facility, the capabilities and the requirements of the technology, environment and safety factors as well as cost. A good overview is given in this document from UNEP on technologies for treatment and destruction of health care waste. The most common types of treatment technologies are autoclaves, hybrid steam-based treatment systems or microwave treatment technologies. Then, there is also dry heat treatment technologies, where waste is heated up by conduction or thermal radiation. This requires higher temperature and longer exposure times than steam-based processes. They are commonly used to treat small volumes. Then finally, there is of course also incineration, there is chemical treatment or options for special landfilling and disposal. Here is an example of an autoclave system in Senegal or here another example from Tanzania. In this case, this shows a gas-powered autoclave. Then, there is also incineration. One simple incineration system is the De Montfort Incinerator, as a cheap but effective incinerator which can be built in almost any developing country. It reaches the criteria of a temperature above 800°C with a residence time of over one second. Despite that they've been designed to be simple and affordable, we still have to think of appropriate location, and using the right materials for construction. Guidelines on how to construct, use and maintain such an incineration unit can be found online. The incinerator should be built at a convenient distance away from buildings, so that any smoke or gas does not enter the buildings. 150 meters is the suggested minimum. So now, how do we go about to set up a system, for instance at a hospital? First of all, we need to take into account the legislative framework. We also need to assign responsibilities and duties, find financial arrangements - but also, we need to start by knowing our situation through monitoring and an assessment. Based on that, we can then develop a waste management plan and implement this through appropriate infrastructure, and of course with an intense development of awareness through respective campaigns. On the other hand, if you are active on a city level, your concern will not be at the facility itself, but how to organize and coordinate a system inside the city which is able to manage health care wastes from different sources. The aspects of segregation will happen at the health care center itself, but then how to organize transport and treatment might take different pathways. For instance, if the health care facility is large, like a central hospital, then treatment can happen at this same location. On the other hand, for small centers which are distributed all throughout the city, it will probably make more sense to set up a collection and transport system, and then have a semi-central treatment at one larger facility or even a central treatment at one specific location in the city. So to summarize, in this module, we have looked at health care waste, its different categories and risks. We have discussed aspects of segregation at source, specifically also the site storage requirements. Then, we looked at some examples of treatment options, and then concluded by describing some elements of planning for health care waste management - at the facility itself, but also taking an overall perspective on how to plan for a city-wide solution. If I have been able to excite you about health care waste management, and you feel now disappointed that this module just gave you a small glimpse of the issues, then I can recommend the following documents for further reading. As you can see from the website links, it is WHO, the World Health Organization, that has quite a number of very exciting documents that make for an interesting read. Also this webpage by WHO is a resource hub for very many different issues related to health care waste management. We have links to basics, there are aspects of country issues, and then there's a link to resources, to many documents giving more information on health care waste management. You might even be interested to get more training and education on health care waste. WHO has a series of training modules. They are structured as PDF files, which you can download, In addition, I would also recommend two modules of the MOOC course "Introduction to public health engineering
in humanitarian contexts", which focus on health care waste. Thanks for watching.
