Hazardous Health Care Materials: Health Impact and Waste Minimization - Research Paper Example

Hazardous Health Care Materials: Health Impact and Waste Minimization Introduction Hazardous materials have been attributed to the majority of the health problems in the society. The increase in the amount of hazardous material has resulted in an increase in the health cost and burden due to diseases. This is because hazardous materials have both direct and indirect effects on human life. They are also associated with the pollution of the environment. A hazardous material is defined as a substance that threatens to harm the environment or the public health. In the US, the treatment, disposal and storage of hazardous material is governed by the Resource Conservation, Recovery Act (RCRA). Hazardous material may take the form of gases, liquids or solids. Hazardous materials are known to be corrosive, toxic, reactive and inflammable. This paper will focus health care hazardous health care material. It will focus on the source, impact and prevention of hazardous material. Hazardous health care waste is produced as a result of diagnosis, treatment, research and immunization of human beings. They are classified as general and hazardous material generated in the health care facilities and institutions (Upton, 2003). It is produced during administrative procedures in the health care facilities. The hazardous materials include pathological, infectious material, sharps, genotoxic material, pharmaceutical waste, chemical waste and radioactive materials. The source of the material determines the composition of the waste. These wastes are also generated from the mortuary, drug manufacturers, laboratory and research centres as well as health care facilities and institutions. Infectious material contains pathogens, for example, bacteria, virus and fungi in sufficient concentration to cause a disease or harm in a susceptible host. Pathological materials consist of tissues, organs, body parts, blood and other body fluids which are considered to be infectious. Genotoxic wastes include cytostatic drugs, urine, feces and vomit from a patient who has been treated using radioactive, cytostatic drugs and chemicals (Upton, 2003). Pharmaceutical materials include expired, spilt or contaminated drugs and vaccines. Radioactive material includes liquids and gases containing radioactive material as well as the excretion products of a patient treated with radioactive substances. 2. Impact of hazardous health care wastes 2.1 Impact on health Health care hazardous waste exposure can lead to disease or injury. The hazardous attributes of the health waste may be due to several characteristics. These include genotoxic characteristics, radioactivity, containing infectious agents, containing sharps, containing hazardous or toxic pharmaceuticals or chemicals. The impact of the hazardous health care waste depends on the risk level. Every person with an exposure to hazardous wastes in the health care is at a potential risk. This includes those within the health care facility and also those outside. Those on the outside may be at risk if the health care facility practices careless waste management (De Rosa et al. 2006). Those at an increased risk include the patients within the facility or under home care. Workers in the hospital have an increased chance of exposure to the hazardous waste. This includes the nurses, doctors and the maintenance personnel. Others such as those who do the laundries are also at an increased risk. Visitors are also not spared the risk of exposure. Those who transport the waste to their disposal site are also not spared. It is worth noting that the general public near the facility is also at a higher risk level. 2.1.1 Hazards from sharps and infectious wastes Infectious waste has microbiologic and macro biologic pathogens. There are several ways through which these pathogens can gain access to the host/human. The first route of entry is through the skin. Here, pathogens can pass through abrasion, or even intact skin (Such as treponema bacteria that causes syphilis). The mucus membrane is also another route of access into the body. Other pathogens can gain access through inhalation, and finally, via ingestion (De Rosa et al. 2006). Sharps posses the greatest danger from infectious pathogens. Pathogens are at high concentrations in the sharps such as needles. They present the most acute health hazard. They posses a double risk of injury. They can cause physical injuries such as cuts, lacerations and abrasions. They can also cause infections through the cuts created, if they possess pathogens. There are pathogens that are of greater concern when it comes to infectious wastes. Viral blood infections are usually given top most concern. This is because of their pathogenesis, which tends to be erratic, and in some cases uncontrollable. A virus such as the Human Immunodeficiency Virus is incurable. Hepatitis B virus is very lethal and highly infectious. It kills within hours of active infection. A report by the USEPAC (US Environmental Protection Agency of Congress) estimates that Hepatitis B virus infections from sharps are roughly 300 annually (Ozonoff et al. 1987). Hypodermic needles containing a patient’s blood are the particularly notorious for such infection transmission. Incinerators may cause various heart diseases and cancer types, thought to be due to virus transmission. 2.1.2 Hazards from Pharmaceutical and Chemical waste It is worth noting that this subgroup of hazardous hospital waste is only found in small quantities. However, they are highly hazardous, with various adverse effects. They may lead to intoxication, due to chronic or acute exposure. They may also lead to physical injuries. Intoxication will result when a chemical or pharmaceutical agent is absorbed into the body. This may happen through mucous membranes, skin or ingestion or inhalation. Contact with corrosive, reactive and flammable chemicals may lead to damage of eyes, skin, mucus membrane or bronchial airway. Formaldehyde is and example of a chemical with these deleterious effects (Lee, 1988). Disinfectants are imperative in this group. Sodium hypochlorite and other and chlorinated compounds are corrosive. They may also form highly reactive and toxic compounds on mixing. Such chemicals may carry with them possibility of fires. The most common injuries caused by chemicals are burns. Acids and strong alkalis may lead to severe burns. Alkalis cause protein emulsification and can result in highly penetrative burns, especially when swallowed. Anesthetics gases are another source of chronic intoxication. Theatre staff may inhale cumulative doses of such anesthetic gases, which may cause cumulative toxicity. An anesthetic gas such as halothane, have been shown to cause hepatitis (Lee, 1988). 2.1.3 Hazards from Genotoxic Waste There are several major routes that genotoxic waste can gain entry into the body. Skin absorption, dust inhalation or ingestion of contaminated food are the major ways. The cytotoxic contaminants may be chemicals, drugs and other wastes. The severity of the impact of genotoxic waste depends on the mode of exposure. Hospital workers may be exposed to such agents when mixing chemotherapeutic drugs or in contact with secretions and bodily fluids (Benhamou, 1986). The cytotoxic drugs have numerous adverse effects on the body. Most of these agents are myelosuppressive. This means that they impair the formation of blood cells from the bone marrow. Therefore, they may cause a reduction in white blood cells, which are the body’s defensive cells (Benhamou, 1986). In addition, red blood cells may decrease; hence, anemia. Platelets will also be impaired leading to bleeding disorders. The cytotoxic drugs are also irritating to eyes and skin. They can cause headaches, dizziness, dermatitis or nausea. Research has proven that some anticancer drugs are mutagenic and carcinogenic. In other words, they have the possibility of inducing mutations and cancers. Genotoxic agents may also cause spontaneous abortion and fetal malformations in those who are pregnant. 2.1.4 Hazards from Radioactive Waste Those in the radiology/imaging department are at the highest risk of radioactive wastes. There are various health effects that can be attributed to radioactive wastes. Like genotoxic drugs, they are also myelosuppressive. Another health effect commonly observed is nausea and vomiting. Reddening of the skin is a common reaction to radioactive wastes (Babich, 1985). A more serious effect is damage to the DNA. These may lead to gene defects. These gene defects may be future generations, hence mutations and other genetic disorders. Sources of high radioactivity include radiation sources for cancers. Contaminated working environment is another source. Some radioactive materials may cause tissue destruction and necrosis, leading to body parts amputation. 2.2 Impact on public Health and Environment Significant impacts of hazardous health care waste are pollution of water, air and soil. There has been increasing pollution emanating from the hazardous health care waste. This has been attributed to poor waste segregation techniques. Water pollution by radioactive materials causes deleterious effects to the aquatic environment (Babich, 1985). Environmental pollution may constitute an imperative risk to the public. The uncontrollable sewage discharge from the hospitals that are managing cholera patients may cause cholera epidemic to the public. Urine and feces from patients that are in isolation wards may cause outbreaks of diseases to the public. Chemicals used in the health facilities are can lead to water pollution via the sewer system. Health incinerators have an impact in terms of air pollution. They cause the emission of gases that might possess injurious stimuli to the health of those nearby. There are various harmful products that are released into the air during incineration activities. They include polychlorinated dibenzo-p-furans, polychlorinated dibenzo-p-dioxins and other carcinogenic agents such as aromatic polycyclic hydrocarbons. Long term exposure to these products lead to cardiovascular and lung cancer. Short term effects include cardiac and respiratory depression and increased asthma severity (Floret et al. 2003). 3.0 Hazardous waste minimization Hazardous material management and prevention consists of a hierarchy of steps involving the reduction at the source, treatment, recycling and residue disposal (Upton, 2003). In hazardous waste management, minimization of hazardous health care materials utilizes both reduction at source and recycling. This helps reduce the cost of purchase of new material. The implementation of a waste minimization program depends on the health care establishment, resources, procedures and operations. It is important to establish the organization’s waste generation data before implementation of a health care program. This is aimed at identifying the department that generates the largest amounts of hazardous waste. Minimization strategies are then implemented in these departments. Hazardous waste minimization principles are centered on both the elimination and reduction of health care waste stream (Lee, 1988). The reduction strategies that can be implemented at the source include measures that can completely eliminate the use of the substance. These include the use on non toxic chemicals where applicable. In other cases involves the improvement of the procedures and operation so as to reduce the waste produces by the department. An example includes improving the cleaning services in the hospital so as to eliminate the use of air fresheners that produce toxic waste and mask the smell. Reduction of waste at the source also includes the purchase of materials that are less hazardous and wasteful. This involves the management of hazardous material purchases ensuring that their use and flow in the health institution is monitored. It also involves the implementation of stock management policies to ensure that the institution maintains only the necessary stock of hazardous material. Recycling involves the collection of the waste and processing it to a new product. In the health care set up, various items can be recycled. These include paper, plastics, metals and glass which can be easily recycled. On the other hand, re-use of the product involves the application of a used product for another function (McRae & Gusky, 1996). It also entails the application of reusable products instead of disposable materials. Implementation of reusing strategies also involves the employment of reliable sterilization and disinfection procedures. This ensures that infections are not spread from one individual to another. Other strategies that can be implemented in waste minimization include segregation of hazardous material as well as compositing of other materials. Segregation involves the separation of material based on their level of toxicity (WHO, 1999). The separation of waste materials generates a solid waste stream that can be safely, cost-effectively and easily managed through compositing and recycling. It also reduces the amount of hazardous material disposed in the environment by separating the hazardous materials from the general waste. This method also enables that the assessment of the composition and quantity of the different waste streams produced by the different units. On the other hand, compositing involves the use of the waste products to generate composite that can be used for farming activities. This involves the use of free land far from the patient and public access. Compositing technologies involve the use of simple un-aerated static piles and aerated windows as well as vermi-compositing. Materials such as food, yard waste and kitchen waste have been successfully applied in compositing. In other countries, human placentas have also been used to produce composite. 4.0 Treatment and Disposal of Hazardous Material Various modalities can be applied for the treatment and disposal of hazardous material generated in the health care facilities. These methods depend on the material as well as the toxicity levels of the material. They include incineration, safe burying, open air burning, autoclaving and encapsulation. In developed countries, the use of microwave radiation, sanitary landfills and wet thermal treatment methods are applied. Incineration is applied in pathological waste, infectious material and sharps. This method is effective as it destroys about 99% of the micro-organism found in the hazardous material (WHO, 1999). It is also has low investment and operation costs. Safe burying of hazardous waste involves the burying of waste in a pit whose access is limited. The pit is covered with clay so as to extend the useful life of the pit to be used for hazardous materials. Each time materials are disposed the waste layer is covered with a thick layer of clay soil. This method has been successfully used for infectious and pathological materials, sharps and small amounts of pharmaceutical waste materials. This method is effective as it provides both environmental and human protection. In addition, organic materials are degradable and useful as composite in the soil. Open air burning involves the burning of waste material at the disposal site. It should not be used as a permanent method or where toxic materials are used. There is a need to add a fuel, for example, kerosene, so as to maintain the combustion. This method can be used for sharp and infectious material. However, burning of the hazardous material may be incomplete leaving infectious materials at the site. This method is also hazardous to the people that burn the waste. The incomplete combustion leaves materials that attract waste-pickers, scavengers and other animals that may be used as vectors in spreading the infection. Furthermore, this method is not appropriate for a majority of chemicals and pharmaceutical wastes (WHO, 1999). Autoclaving involves the use of high pressure and heat so as to sterilize the materials. It is used for the sterilization of reusable materials. It is effective in disinfecting materials without environmental pollution. It requires relatively low cost to invest and operate. However, it requires qualified personnel to use the autoclave machine. Autoclaves have a limited sterilization capacity of the equipments used in hospitals. Encapsulation involves the use of cement mortar, sand and plastics to surround the hazardous materials. When the hazardous material is dry they are buried in the landfills. This method is used for sharps, pharmaceutical and chemical wastes. It is safe as well as requires low investment and cost to operate. However, it is not effective in non-sharp waste materials (McRae & Gusky, 1996). Wet thermal treatment is similar to autoclaving where the waste is subjected to heat and pressure. Microwave irradiation involves the shredding, humidification and irradiation of the hazardous material using microwaves. These heat waves are effective in the destruction of the micro-organisms. These two methods are effective in the treatment and disposal of waste. They are also environmental friendly. However, they are expensive to initiate and run. They also require qualified stuff to operate the machines involved. They cannot be used for pathological materials, chemical and pharmaceutical waster. Sanitary landfills involve the package of waste to minimize exposure. The waste is then buried in a hollow dug below the working space and covered with a 2m thick layer of mature waste (WHO, 1999). This method is effective in the disposal of sharps, infectious waste as well as small amounts of pharmaceutical and chemical waste. However, this method requires access to large sanitary landfills for the disposal of waste. In addition, transportation of the materials to the site creates an opportunity for exposure to the micro-organisms. It may be difficult to keep away the scavenging animals and insects. These animals act as vectors in spreading the micro-organisms. Various waste materials require different treatment and disposal methods. It is thus necessary to create a written waste management plan that clearly describes the handling, treating, storing and disposal of both hazardous and non hazardous material. It should also elaborate on the staff responsible for the management of waste products generated in the health care facility. It is imperative to consider the nature, composition and quantity of waste materials generated by the health care before selecting a method of handling the hazardous material. 5.0 Conclusion Hazardous health care waste has numerous deleterious impacts on the health and environment. Sharps and infectious waste are a common cause of severe infections such as HIV and Hepatitis. There are also chemicals that may lead to burns, and genotoxic agents leading to genome damage. The environment may be polluted by these hazardous materials from the hospital. Reference List Benhamou, S et al. (1986). Mutagenicity in urine from nurses handling cytostatic agents. European journal of cancer and clinical oncology, 22, 1489-1493. Babich, H. (1985). Reproductive and carcinogenic health risks to hospital personnel from chemical exposure: A literature review. Environmental health, 48(2), 52-56. De Rosa, C., Johnson, B., Fay, M., Hansen, H., & Mumtaz, M. (2006). Public health implications of hazardous waste sites: findings, assessment and research. Food Chemical Toxicology, 34 (11-12), 1131–1138. Floret, N., Mauny, F., Challier, B., Arveux, P., Cahn, Y., & Viel, J. (2003). Dioxin emissions from a solid waste incinerator and risk of non-Hodgkin lymphoma. Epidemiology, 14 (4), 392-398. Lee, M. (1988). The environmental risks associated with the use and disposal of pharmaceuticals in hospitals. Proceedings of 3rd European Conference. Risk assessment of chemicals in the environment, 491-504. McRae, G., & Gusky, S. (1996). Guidebook for Hospital Waste Reduction Planning and Program Implementation. Chicago: American Hospital Association. Ozonoff, T., Dresner, M., & Colton, T. (1987). Health problems reported by residents of a neighborhood contaminated by a hazardous waste facility. American Journal of Industrial Med, 11 (5), 581–597. Upton, A. (2003). Public health aspects of toxic chemical disposal sites. Annu Rev Public Health, 10, 1–25. WHO. (1999). Safe management of Wastes from Health care activities. World Health Organization, Geneva, 1999. Read More