Urgent need to improve healthcare waste management practices: report

Tens of thousands of tonnes of extra medical waste from the response to the pandemic has put tremendous strain on healthcare waste management systems around the world, threatening human and environmental health and exposing a dire need to improve waste management practices, according to a new WHO report.

The WHO Global analysis of healthcare waste in the context of COVID-19 bases its estimates on the approximately 87,000 tonnes of personal protective equipment (PPE) that was procured between March 2020 and November 2021 and shipped to support countries’ urgent pandemic response needs through a joint UN emergency initiative. Most of this equipment is expected to have ended up as waste.

The authors point out that over 140 million test kits, with the potential to generate 2600 tonnes of non-infectious waste (mainly plastic) and 731,000 litres of chemical waste, have been shipped, while over 8 billion doses of vaccine have been administered globally producing 144,000 tonnes of additional waste in the form of syringes, needles and safety boxes.

As the UN and countries grappled with the immediate task of securing and quality-assuring supplies of PPE, less attention and resources were devoted to the safe and sustainable management of COVID-19-related healthcare waste.

“It is absolutely vital to provide health workers with the right PPE,” said Dr Michael Ryan, Executive Director, WHO Health Emergencies Programme. “But it is also vital to ensure that it can be used safely without impacting on the surrounding environment.”

This means having effective management systems in place, including guidance for health workers on what to do with PPE and health commodities after they have been used.

Today, 30% of healthcare facilities (60% in the least developed countries) are not equipped to handle existing waste loads, let alone the additional COVID-19 load. This potentially exposes health workers to needle stick injuries, burns and pathogenic microorganisms, while also impacting communities living near poorly managed landfills and waste disposal sites through contaminated air from burning waste, poor water quality or disease-carrying pests.

“COVID-19 has forced the world to reckon with the gaps and neglected aspects of the waste stream and how we produce, use and discard our healthcare resources, from cradle to grave,” said Dr Maria Neira, Director, Environment, Climate Change and Health at WHO.

“Significant change at all levels, from the global to the hospital floor, in how we manage the healthcare waste stream is a basic requirement of climate-smart healthcare systems, which many countries committed to at the recent UN Climate Change Conference, and, of course, a healthy recovery from COVID-19 and preparedness for other health emergencies in the future.”

The report lays out a set of recommendations for integrating better, safer and more environmentally sustainable waste practices into the current COVID-19 response and future pandemic preparedness efforts and highlights stories from countries and organisations that have put into practice the spirit of “building back better”.

Recommendations include using eco-friendly packaging and shipping, safe and reusable PPE (eg, gloves and medical masks), recyclable or biodegradable materials; investment in non-burn waste treatment technologies, such as autoclaves; reverse logistics to support centralised treatment and investments in the recycling sector to ensure materials, like plastics, can have a second life.

The COVID-19 waste challenge and increasing urgency to address environmental sustainability offer an opportunity to strengthen systems to safely and sustainably reduce and manage healthcare waste. This can be through strong national policies and regulations, regular monitoring and reporting and increased accountability, behaviour change support and workforce development, and increased budgets and financing.

“A systemic change in how health care manages its waste would include greater and systematic scrutiny and better procurement practices,” said Dr Anne Woolridge, Chair of the Health Care Waste Working Group, International Solid Waste Association (ISWA).

“There is growing appreciation that health investments must consider environmental and climate implications, as well as a greater awareness of co-benefits of action. For example, safe and rational use of PPE will not only reduce environmental harm from waste, it will also save money, reduce potential supply shortages and further support infection prevention by changing behaviours.”

Image credit: ©stock.adobe.com/au/Kat Ka