Hazardous waste management solutions in South Africa still a challenge

OPINION

PEER REVIEWED

 

KE Jansen1, DJ Kocks2, H Roberts3

 

1 Department of Agriculture and Environmental Sciences, Central University of Technology, Free State, South Africa

2 Department of Occupational Medicine; School of Medicine, Faculty of Health Sciences Sefako Makgatho Health Sciences University, South Africa

3 Department of Agriculture and Environmental Sciences, Central University of Technology, Free State, South Africa

 

Correspondence: Prof. Daniel Jacobus Kocks, Professor and Head, Department of Occupational Medicine, School of Medicine, Faculty of Health Sciences, Sefako Makgatho Health Sciences University, Molotlegi Street; Ga-Rankuwa, 0208, South Africa. e-mail: kocks@wol.co.za

 

Prof. Kocks is the Chairperson of The South African Society of Occupational Medicine (SASOM)

 

Keywords: healthcare risk waste, medical waste, placenta, alternative technologies

 

INTRODUCTION

The generation of pathological waste creates risk waste management problems for healthcare workers (HCWs) at healthcare facilities. The solution lies with both treatment and management of the waste. HCWs are able to recommend solutions that will comply with standard legal frameworks in South Africa. Alternative waste treatment technologies should be investigated to determine efficacy, reliability, cost-effectiveness and applicability.

Daily, HCWs are exposed to biological hazards that pose health risks. Biological waste, known as healthcare risk waste (HCRW), is generated at healthcare facilities such as hospitals, clinics, community health centres, laboratories, research institutions, dental facilities, emergency services, ports of entry, veterinarian practices, old age homes, and forensic pathology services. HCRW comprises anatomical and pathological waste, genotoxic or cytotoxic waste, infectious waste, sharps waste, sanitary waste, nappy waste, chemical waste, low-level radioactive waste, and pharmaceutical waste. The risks and preventive measures, in addition to legal requirements, are well documented.1,2 The management of all HCRW as a problem or concern in South Africa defines the need for this paper, to illustrate the shortfall of compliance with national and provincial legal requirements.3-7

 

MANAGEMENT PRIORITIES

Different categories of HCRW, excluding low-level radioactive waste, comprise different inherent bacterial contaminants which pose a risk to the immediate surrounding environment at health facilities, communities and, especially, environments where HCRW is dumped or mismanaged.8-13 Enhanced handling and disposal techniques are therefore necessary.

Statistics South Africa reported that there were 969 415 births in 2016.14 The mean weight of a placenta is 637 g.15 Using the population figure for 2016, it is estimated that pathological waste originating from births was around 618 tons.

Waste in primary healthcare centres consists of approximately 80% non-infectious waste, 15% pathological and infectious waste, 1% sharps waste, 3% chemical or pharmaceutical waste, and less than 1% of other waste, such as pressurised cylinders and broken thermometers.16 In 2008, it was reported that the total waste stream at two hospitals in Limpopo province of South Africa consisted of 60.7% general waste, 30.3% medical waste, and 8.9% sharps. It was estimated that each patient generated 0.60 kg of waste per day.17

The management of HCRW in developing countries is problematic due to differences in terminology, socio-economic conditions, governance structures, policies for HCRW management, and definitions of best practice at local-national and international levels. Education, resources, treatment technologies, capacity, improved practice at local level and legislative frameworks are required to address problems and concerns in South Africa.5,15,17-19

 

LEGISLATION FOR HEALTHCARE WORKERS AND BIOLOGICAL RISK MANAGEMENT IN SOUTH AFRICA

South African environmental legislation includes the National Environmental Management Waste Act, No. 59 of 2008,20 the Environmental Conservation Act No.73 of 1986,21 the Gauteng Health Care Waste Regulation of 2004,6 and the Regulations for Hazardous Biological Agents of 2001 of the Occupational Health and Safety Act no. 85 of 1993.22

The legislation stipulates that all pathological waste must be treated by incineration. Certain practices are of concern, such as the traditional practice by some population groups in southern Africa of taking the pathological waste home for burial. This means that pathological waste can be taken by public transport to an individual’s home to be buried in a shallow grave or a hole in the ground. Although the ceremonial handling of pathological waste is practiced by many cultures around the world, in most developed countries, the human placenta, as an example, is regarded as nothing more than human waste. Traditional ways of handling the pathological waste vary from burial, covering it with grass, burial in dirt floors of the family house, wrapping in blankets and burial near a tree, and burial by the father. These rituals are practised in Nigeria, Mali, Arabia, North and South America and New Zealand. 4-7,23,24

Ownership of human tissue is a contentious issue in South Africa. 
Chapter 8 of the National Health Act No. 61 of 2003 addresses the legal regulation of human tissues. The safeguarding of healthcare workers at clinics and laboratories (including the transport of human tissue and fluid), other healthcare service employees, families partaking in this practice in the home environment, as well as the public exposed to the potentially infectious waste, should be considered.23,24 For example, studies have confirmed heavy metal (lead and cadmium) contamination in human placentae. Other environmentally-associated pathogens, such as Escherichia coli and Listeria motocytogenes have also been identified during pathology investigations of placentae after birth.25-28

 

HEALTHCARE RISK WASTE TREATMENT AND TECHNOLOGIES

The global general practice is treatment through incineration for specific pathological waste.29 In line with this; the Gauteng Health Care Waste Regulations of 20046 prohibit the treatment of pathological waste except through incineration. Currently, the economic limitations (financial viability of treatment) in terms of treatment availability are proximity and distance between generation and treatment of these waste products, in both rural and urban areas.30

Although non-incinerator technologies exist, several factors need to be considered before they are introduced. These include throughput capacity, types of waste treated, microbial inactivation efficacy, environmental emissions, waste residues, regulatory acceptance, space requirements, reduction of waste volume, reduced mass, occupational health and safety, noise and odour, automation, reliability, level of commercialisation, technology manufacturer, cost, and cultural and staff acceptance. 4,7,29

Alternative treatment technologies are classified as follows: 31

• Thermal – autoclaving, incineration, heat, micro- or macro-waving, pyrolysis, gasification or friction heat treatment

• Chemical – chlorine or chlorine derivatives, ozone, enzymes, sodium hydroxide treatment

• Irradiation – ultraviolet, Cobalt 60, electron beam treatment

Other types of technologies, such as gas or vapour sterilisation treatment, are designed for specific medical waste categories.

However, not all these alternative treatment technologies are deemed effective and/or suitable for the treatment of all categories of healthcare risk waste. The degree of thickness or smoothness of a mixture, temperature, and penetration ability create problems in terms of effective inactivation of pathogens. In the United States an alternative treatment method, microwave technology, is used to treat HCRW but it is dependent on specialised knowledge, and large infrastructure and capital investments.29,30

 

CONCLUSION AND RECOMMENDATIONS

Due to the challenges associated with the incineration of HCRW, it may be time to explore cheaper and more efficient methods of pathological waste treatment technologies. Healthcare management staff is able to investigate, evaluate and recommend healthcare waste treatment technologies that can comply with legal standards, as alternatives to incineration.

It is recommended that healthcare waste workers be aware that:

     a) Healthcare risk waste is a risk for healthcare workers;

     b) Legal requirements for the management of HCRW need to be considered;

     c) HCRW volumes are creating an environmental hygiene problem;

     d) Incineration is not the only solution for the management of healthcare risk products;

     e) There are different management categories and technologies for effective treatment of HCRW.

 

DECLARATION

We declare that this paper contains no section copied in whole or in part from any other source unless explicitly identified in quotation marks and with detailed, complete and accurate referencing. No external sources of funding were received. No conflicts of interest exist.

 

REFERENCES

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