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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.
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.
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 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.