Understanding Medical Waste Management to Curb the Transmission of COVID-19

The Outbreak in Wuhan and The Surging Amount of Medical Waste 

Wuhan is a city located in Hubei province, China, which becomes ground zero for the COVID-19 virus. With a population of 11 million people, 75% of fatality cases of the Novel Coronavirus are concentrated in Wuhan. In China itself there are more than 80.000 positive cases and more than 3.000 cases that result in death.

What’s even worse is that since December last year, Wuhan does not only struggles with the ongoing health crisis and the stagnant economic activity due to the lockdown but also with the mountain of medical waste that resulted from the epidemic.

Even though specific numbers on the amount of medical waste cannot be pinpoint, mainland China’s media Southern Metropolis Daily reported that the volume of medical waste in Wihan surged 4 times into more than 200 tons on 24th February alone. This is a drastic increase when taking into consideration that five days prior, the amount of medical waste was 109 tons. According to a statement by the officials from China’s Environment Ministry, this amount exceeds the capacity of medical waste management in Wuhan, which can only manage around 50 tons per day.

China is struggling to cope with the mountains of medical waste caused by the coronavirus epidemic. Photo: ReutersOfficials managing a mountain of waste due to the Coronavirus epidemic in China. Photo courtesy: Reuters

The massive production of medical waste aligns with the increasing demand for medical masks in the midst of the Coronavirus, which has been declared as a pandemic by the World Health Organization (WHO). According to China’s National Development and Reformation Commission, as many as 116 million of medical masks are manufactured every day, 12 times higher than the previous month.

Workers are busy on the face mask production line at the GAC Component workshop in Guangzhou in February. Photo: XinhuaA worker is busy doing his part in the production line of medical masks at the GAC Component workshop in Guangzhou last February. Photo courtesy: Xinhua

Moreover, the surging amount of disposable medical masks, as well as other self-protection equipment, mostly come from hospitals in Wuhan. News portal The Paper reported that as many as 3 tons of medical waste are generated in just 4 days from Puren Hospital. This trend is also evident from the data regarding 365 tons of medical waste that were managed to be collected in the Hubei province on 24th February, 60% of which is generated from hospitals.

People in Wuhan frequently reuse their face masks to reduce waste. Photo: XinhuaA waste officer is transporting waste from an isolation area in Du’an Yao Autonomous County. Photo courtesy: Xinhua/Cao Yiming

Meanwhile, Wuhan Economic Development Zone (an area where more than 400.000 people live and work) stated that they collected around 200 to 300 kilograms of disposable medical masks from approximately 200 trash bins.

Limitations in Medical Waste Management

Medical masks and other protective equipment are indeed crucial to protect the people who are directly involved in treating patients that have been infected by the Coronavirus. In addition, the use of medical masks is also necessary for any person having the symptoms of the COVID-19 in order to minimize the transmission of the virus to healthy people.

This becomes all the more reason why medical waste should be handled seriously since it is different from domestic/household and thus needs special treatment. Medical waste that has been contaminated with saliva from COVID-19 patients, for example, can be a potential source of transmission for the Coronavirus for, say, waste operators that are assigned to handle such waste.

Medical waste at the west campus of Wuhan Union Hospital. Photo: XinhuaThe huge amount of medical waste at the West campus of the Wuhan Union Hospital. Photo courtesy: Xinhua

Ideally, medical waste like disposable masks that are used by health workers and people infected with the Coronavirus should be sterilized and incinerated in designated facilities.

Unfortunately, based on a statement by the Ministry of Ecology and Environment, most of the medical waste treatment facilities in China, which were built 17 years ago in response to the SERS outbreak, were all nearing the end of their operation.

Disposable medical masks also face a dilemma in a way because these masks can be categorized into three types: those that are worn by patient and health workers, those that are worn by healthy people, and those that are in between: they are used by people having symptoms of the COVID-19 and have resort to self-quarantine at home.

Masker medis sekali pakai. Sumber: Noah/Unsplash
Disposable medical masks. Photo courtesy: Noah/Unsplash

The medical masks that are used in hospitals or other health care facilities will be treated as medical waste and thus be managed accordingly. Meanwhile, medical masks that are used by healthy people can be managed together with other domestic waste. What’s problematic is regarding the disposable masks that are worn by people who have symptoms of COVID-19 but were treated in neither hospitals nor health care facilities.

The treatment of such disposable masks tend to be confusing because it’s a grey area, in a sense that it is not under the jurisdiction of health institutions, on the other hand, masks that have been used by sick people are considered as contaminated and thus will need to handled with medical waste treatment standardization.

Types of Medical Waste and The Risks that It Poses 

Medical Waste is defined as a type of waste that contains infectious material (or has the potential to be infectious). This definition includes waste that is usually generated from health facilities such as hospitals, dental clinics, laboratories, health research facilities, as well as veterinarians. Medical waste might also contain bodily fluids such as blood, saliva, etc.

According to the 1988 Medical Waste Tracking Act, medical waste is also defined as waste that resulted from health research activities, health tests, diagnosis, immunization process, as well as those that resulted from the treatment of both humans and animals.

Examples of discarded syringes as one type of medical waste. Photo courtesy: waste360.com

The World Health Organization (WHO) categorized medical waste into several types, which are:

  1. Infectious waste: waste that is contaminated with blood and other bodily fluids, stocks of infectious agents from laboratory work such as waste from autopsies and infected animals from laboratories, or waste from patients with infections like bandages and disposable medical devices
  2. Pathological waste: includes human tissues, organs or fluids, body parts, and contaminated animal carcasses;
  3. Sharps waste: syringes, needles, disposable scalpels and blades
  4. Chemical waste: such as solvents and reagents used for laboratory preparations, disinfectants, sterilants, and heavy metals contained in medical devices (for instance, mercury in broken thermometers) and batteries;
  5. Pharmaceutical waste: expired, unused and contaminated drugs
  6. Cytotoxic waste: waste containing substances with genotoxic properties (hazardous substances that are mutagenic, teratogenic or carcinogenic), such as cytotoxic drugs used in cancer treatment
  7. Radioactive waste: products contaminated by radionuclides including radioactive diagnostic material or radiotherapeutic materials
  8. Non-hazardous or general waste: waste that does not pose any particular biological, chemical, radioactive or physical hazard.
Red is the color code for medical waste. Source: usbioclean.com

The Danger of Medical Waste for Our Health and the Environment 

Health Risks

From the various types of medical waste that is explained above, it can be seen that without proper treatment, medical waste can be dangerous for patients, health workers, and even the general public. Other danger includes drug-resistant microorganism that can become infectious and spread from inside health facilities into the open environment.  

Other health risks that might are from mistreatment of medical waste includes:

  • injury from sharps waste such as syringes
  • toxic exposure to pharmaceutical drugs such as antibiotics and cytotoxic drugs as well as substances like mercury or dioxins, during the handling or incineration of medical waste
  • chemical burns that resulted from disinfection, sterilization or waste treatment activities
  • air pollution arising as a result of medical waste incineration
  • thermal injuries occurring in conjunction with open burning and the operation of medical waste incinerator
  • burns due to radiation.
Medical waste that are discarded carelessly could be very harmful to waste management operator. Source: medsharps.com

It is equally important to be reminded how these medical waste could pose some serious risks for scavengers and unregulated waste operators when discarded without the right procedure in landfills or waste disposal sites, and also during the manual waste-sorting and treatment process in health facilities. Such practices are still found in low and middle-income countries whose medical waste facilities are still inadequate.

Petugas dari Kementerian Lingkungan Hidup dan Kehutanan tengah memeriksa sampah medis yang dibuang secara ilegal di Karawang, Jawa Barat. Sumber: KLHK via JakartaPost
Officials from the Ministry of Environment and Forestry were checking up on the medical waste that was illegally dumped in Karawang, West Java. Photo Courtesy: KLHK via JakartaPost

Waste management operators such as scavengers and waste-pickers are especially vulnerable because they work with very limited safety equipment, and some of them do not even wear shoes or footwear. Imagine the risks of being exposed to medical waste that was mismanaged and end up being discarded without a special container or label.

Environmental Risks

Besides health risks, medical waste that is discarded carelessly into the environment might cause severe consequences. One of which is it might pollute the source of drinking water, freshwater, surface water, and groundwater.

In addition, the burning of medical waste without adequate or standard equipment can release hazardous materials such as dioxin that is carcinogenic or substances from heavy metals like mercury.

The Importance of Proper Treatment of Medical Waste 

How to Dispose of Medical Waste

An example of how to properly discard medical waste, i.e using protective gloves, putting the waste into a red container. Source:danielshealth.com

Amidst the COVID-19 pandemic, medical masks became one of the most-sought things, either by health workers and even the general public who are not healthy and show symptoms of the Coronavirus.

This phenomenon has certainly caused the volume of disposable medical masks skyrocketed in many places around the globe, including in Indonesia, especially in Jabodetabek. Furthermore, with the social distancing now implemented, it is better and advisable for us to know the basics of disposing and treating the medical waste that we produced in order to minimize the transmission of the Coronavirus. Here are the steps:

  1. Separate based on categories: If there is more than one type of medical waste, then the waste needs to be segregated according to the category that has been agreed or set by the medical waste management company.

2. Provide specific containers: Medical waste that are sharp, like syringe and scalpel, need to be put into a special container to prevent it from hurting the waste operators that will transport our waste.

 medical waste disposal binA special container for infectious waste. Source: success.ada.org

3. Give Label: After the medical waste has been placed in a sealed container, do not forget to label the medical waste according to its name or category. This will come into handy for the waste operators the kind of waste that they are dealing with, as well as to prevent the operators/officers from opening the container and touch the medical waste.

A special container for sharps medical waste such as syringe. Source: www.inciner8.com

The Types and Method of Medical Waste Management

Types of medical waste treatment are generally divided into two categories: on-site treatment and off-site treatment. The on-site treatment of medical waste is generally limited to large, well-monied hospitals and facilities. That’s because the required equipment is expensive to buy, expensive to maintain, and expensive to manage and run.

The second one is the off-site treatment, which is far more cost-effective for most small and mid-sized medical practices and facilities. Third-party vendors whose main business is medical waste management will manage the medical waste.

Moreover, the methods for managing medical waste are:

Incinerator: This is a waste management method by incineration or burning the waste. Incinerator is still the only method used on pathological waste, for example, body parts and recognizable tissues

Autoclaving: This method uses steam sterilization to make biohazardous waste non-infectious. After it’s been sterilized, the waste can be disposed of normally in solid waste landfills.

Medical waste management using the autoclaving method. Source: blog.veolianorthamerica.com

Microwaving: Another way to make hazardous medical waste non-hazardous is to microwave it with high-powered equipment. As with autoclaving, this method will enable the medical waste to be discarded into normal landfill disposal afterward.

Chemical: Certain kinds of chemical waste may be neutralized by applying reactive chemicals that render it inert.

Biological/Biologi: This method is still under development and is rarely used in practice. Theoretically, this method treats biomedical waste by using enzymes to neutralize hazardous, infectious organisms.

The More You Know, The More Responsible You Should Be

Before the COVID-19, we might become oblivious in regard to medical waste, of how dangerous it can be compared to the usual waste, of how it needs special treatment at specific facilities, and so on.

Medical waste rarely comes into our radar because apart from those who work in the healthcare sector, medical waste does not directly intertwine with our daily lives. However, during times like this, disposable medical masks also fall under medical waste, and at the very least we should know how to properly discard them.

And remember, do not ever try to manage medical waste on your own. Even companies who specialize in medical waste management need specific training and license in order to perform their job. So just do your job to dispose of the medical waste correctly, and let them do their job to manage the medical waste.

In the meantime, stay healthy, stay at home, keep your house and environment clean, and do not forget to segregate your waste at home. The segregated waste can, later on, be given to either waste banks or Waste4Change after all of this is over.

References:

https://www.scmp.com/news/china/society/article/3065049/coronavirus-china-struggling-deal-mountain-medical-waste-created

https://www.inciner8.com/blog/medical-incineration/different-types-of-medical-waste/

What is Medical Waste? Definition, Types, Examples & More

https://www.who.int/news-room/fact-sheets/detail/health-care-waste

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