Month: November 2021

The content of this article:

1.0 Facts of clinical waste Malaysia

2.0 What is clinical waste

3.0 Clinical waste management in Malaysia

4.0 Ways to handle clinical waste

According to the World Health Organisation, an estimated 16 billion injections are administered worldwide every year, but not all of the needles and syringes are properly disposed of afterwards. All these health-care activities protect and restore health and save lives. But what about the waste and by-products they generate?

Covid-19 has affected the waste management industry in terms of the disposal of clinical waste. It has become increasingly challenging as the pandemic peaked across the globe since March 2020.

What is clinical waste?

Clinical waste is the waste originating from healthcare facilities and other related facilities such as laboratories, autopsy or mortuaries and the hundreds of quarantine centers scattered throughout the country during the pandemic.

Following the Covid-19 outbreak, there has been a 27% increase in clinical waste given the increased generation of swabs, syringes, needles, blood or body fluid, excretions, mixed waste, laboratory waste, material or equipment contaminated with the virus, masks, disposable gloves and personal protective equipment. ²

About 85% of the total amount of these waste generated by health-care activities are non-hazardous waste while the remaining 15% is considered hazardous material that may be infectious, chemical or radioactive. Another term for Hazardous Waste is Scheduled Waste. According to the Department of Statistics Malaysia, scheduled wastes were recorded at 4 million tonnes as of November 2020.¹

Clinical waste management services are managed by private consortiums under the supervision of the government according to the Environmental Quality (Scheduled Wastes) Regulations 2005 and regulated by the Department of Environment (DoE) Malaysia. The DoE regulates all aspects of clinical waste management from collection, transportation, treatment and disposal, and uses an electronic scheduled waste management system (eSWIS) to monitor compliance.

Generators of scheduled waste need to notify the DOE of any scheduled wastes generated and keep an up-to-date inventory of scheduled waste generated, treated and disposed as per regulation.

Types of disposal methods for Clinical Waste

Disposal of clinical waste is performed by separating, labelling and disposing clinical waste from generated waste into proper containers and bags. Blue plastic bags are used for wastes to be autoclaved, yellow is for wastes that are to be incinerated and black is for general wastes. ³

After these clinical waste has been separated into its respective disposal bag, it will be sent to dispose using various methods. These methods are Incineration, Landfilling, Autoclaving, Recycle and Recovery.

Incineration

In Malaysia, incineration is a popular treatment method for managing clinical and pharmaceutical waste, infectious and hazardous waste. This disposal method turns clinical waste into ash which must be disposed of at an approved landfill site.

The benefits include eliminating pathogen and anatomic wastes, reduced bulk volume of waste and energy recovery. However, the potential of producing secondary toxic gases and pollutants remains the primary disadvantage of incineration as this contributes to air pollution and poses risks to human health.

Landfilling

Fly ash is the by-product of the incineration process and needs to be disposed of in landfill sites. Leachate and gas generated from these landfills may lead to soil and groundwater contamination, can cause unpleasant odours and increase atmosphere temperature.

Landfilling is not a sustainable and long-term solution because of the toxic leachate and greenhouse gas emission. Due to the risks associated with landfilling and limited space available in the future, alternative technology for clinical waste treatment is needed.

Autoclaving

Autoclaving or steam sterilization is also used for treating clinical waste in Malaysia but is not actively implemented. This method applies especially for highly infectious clinical waste such as lab cultures which effectively inactivates the pathogenic microbes. However, pathogenic bacteria can re-grow a few days after being autoclaved.

Recycle and recovery

This method works for non-infectious clinical waste. Recyclable materials from clinical waste are high because of the high plastic content of the medical waste stream. The recycle-reuse approach not only reduces the clinical waste generation but also saves the cost of purchasing new equipment and costs of disposal.

Reducing the amount of clinical waste will reduce the volume of waste for incineration, thus reducing the emission of pollutants that cause detrimental public health risks.Nevertheless, a cost-effective and reliable treatment method to disinfect and sterilise recycled clinical waste is needed – one that is successful and sustainable in the long-term.⁴

The challenge of clinical waste management in Malaysia includes searching for sustainable and long-term waste treatment methods. In addition to promoting the reduction of waste generated and ensuring proper waste segregation, we need to develop strategies with strong oversight and regulation to improve the destruction and disposal practices with an aim to meet international standards.

The Covid-19 outbreak has affected an urgent need to raise awareness on the risks related to hazardous health-care waste and application of safe practices and environmentally sound treatment of health care waste over the current method of medical waste incineration.

 

Management hierarchy in recognition that no single waste management approach is suitable for managing all increasing populations per capita in major cities, limited space for landfills and rising costs of proper disposal services has led to an urgent need to tackle waste management and reduce our impact on the environment. Rapidly developing countries like Malaysia are facing numerous challenges in sustainably managing wastes.

How are these wastes being managed?

The United States Environmental Protection Agency (EPA) developed the non-hazardous materials and waste management hierarchy in recognition that no single waste management approach is suitable for managing all materials and waste streams in all circumstances.

According to the Malaysia Investment Development Agency (MIDA), the waste generated in Malaysia in 2005 was 19,000 tons per day at a recycling rate of 5%. The quantity rose to 38,000 tons per day in 2018, despite the increased recycling rate of 17.5%. This is alarming as the rate has exceeded the Japan International Cooperation Agency (JICA) study’s proposed rate of 30,000 tons per day in the year 2020.³ Thus, the implementation of the 5-Steps of Waste Management is a must.

The waste management hierarchy is a simple ranking system used for the different waste management options according to which is the best for the environment. Presented in the form of an inverted pyramid diagram, the standard hierarchy of waste management involves five crucial steps; prevention, reuse, recycling, recovery and disposal. This hierarchy aims for waste generators to extract the maximum practical benefits from products and to generate the minimum amount of waste – emphasising on reducing, reusing, and recycling as key activities of sustainable materials management.

First off, let’s look into the disposal. In 2021, the most predominantly employed application in the country is disposal. Landfills are the most common method of waste disposaland are primarily regulated by state and federal regulations.Thus, there is an urgent need to shift to more integrated and sustainable waste management practices on all levels to prevent further environmental degradation.

With that, we move on to the next step – Recovery. Most commonly known as Energy Recovery. Energy recovery from waste is the conversion of non-recyclable waste materials into heat, electricity or fuel through a variety of processes, often referred to as waste-to-energy (WTE). This produces renewable energy sources such as biofuels which reduce carbon emissions in the long-run by replacing energy generated by fossil fuel sources. The beauty of this method is that it helps to reduce the volume and toxicity of waste.

Now let’s move on to recycling. Recycling is a series of activities that include collecting used, reused, or unused items that are considered waste and processing them into raw materials for new products. It’s the third step of the waste management hierarchy due to the extra energy and resources that go into producing a new product as the end product.

Besides recycling, there is another step which is much better, Re-use. This step is very precise and direct to understand from the word itself. Such step is the best approach to waste management by preparing materials to be re-used in their original form. Aside from creating new waste, reusing waste also benefits your business by spending more on resources and paying external sources to dispose of waste for you.

Last but not least from the hierarchy is prevention. It means reducing or totally prevent waste at the source and is the most environmentally preferred strategy. This includes reducing packaging, redesigning products and reducing toxicity, especially important in manufacturing. Use products made from environmentally friendly materials such as bamboo and organic cotton.

In order to ensure proper application of the waste hierarchy across industries, private companies and households, there must be a coherent strategy with effective horizontal cooperation locally and vertical cooperation between the local, regional, state councils and the national level. Effective implementation and success of waste management policies require financial investments, information and technical expertise.

Malaysia has taken a stepwise approach to privatise and centralise its solid waste management in recent years. The Malaysian Government continues to promote effective waste management by encouraging the reuse and reduce method. This contributes huge benefits to the global environment – from prevention of greenhouse gases emissions, reduced pollution, energy savings, conservation of natural resources to the creation of new jobs – which then stimulates the development of green technologies in the long-term.²

1. ^{https://www.epa.gov/smm/sustainable-materials-management-non-hazardous-materials-and-waste-management-hierarchy}
2. ^{https://en.wikipedia.org/wiki/Waste_hierarchy}
3. ^{https://www.mida.gov.my/sustainable-waste-management-in-malaysia-opportunities-and-challenges/}