Clinical waste: Act responsibly to protect us and environment from health hazards

Haya Arva

In early 2020, a youth-driven initiative to keep the environment clean was launched only to end abruptly due to the outbreak of the Covid-19 pandemic.

However, with the pandemic came a new and more serious environmental threat in the form of clinical waste.

According to the Central Environmental Authority (CEA), although Sri Lanka had issues with clinical waste management, they had been more or less resolved by 2018. To support their claim, the authorities cite the UNDP and UNICEF reports. But the reality is that clinical waste management is still a major issue.

A few years ago, the detection in the Colombo Port of containers full of clinical waste sent from a European nation caused a major uproar in the country. It prompted questions about whether attempts were being made to turn Sri Lanka into the garbage dump of the world.

The World Health Organisation has said that thousands of tons of pandemic-era clinical waste pose a serious threat to human health and the environment in many countries, including Sri Lanka. Clinical waste includes used syringes, test kits, and vaccines. 

The problem is aggravated when the Covid-19 virus survives on clinical waste and poses a health risk to workers who remove and incinerate the waste. Also, groundwater can be contaminated due to reckless dumping of clinical waste.

In November 2021, a WHO report said personal protective equipment distributed by the United Nations throughout the world alone amounted to nearly 87,000 tons, equivalent to the weight of hundreds of whales, and most of this remains as clinical waste. Also, it is estimated that about 140 million used test kits could generate about 2,600 tons of plastic waste. 

Moreover, nearly 8 billion Covid-19 vaccines have been administered globally, producing 144,000 tons of clinical waste containing largely glass vials and protective containers, according to the WHO report. It said that one-third of the clinical waste cannot be treated, and noted that the increase in clinical waste due to the pandemic will be extremely harmful to human health and the environment.

In Sri Lanka, the impact of the pandemic was so intense that around 700,000 people were infected with the Covid-19 virus and about 17,000 people lost their lives. To control the pandemic, more than 40 million vaccines were administered to people in two, three, or four doses. The figures enable us to visualize the gravity of the problem.

The economic crisis that erupted almost with the lifting of Covid restrictions has only made the problem more acute. During the early days of the economic crisis when gas and fuel were in short supply, proper disposal of clinical waste did not take place. This is all the more the reason why it is so hard to believe the CEA’s claims.

Clinical waste is the waste generated after treating patients in the hospital. This includes used syringes, vaccines, blades, human tissues, tubes, contaminated cotton wool, bandages, gloves, and sometimes even surgically removed body parts, microbes, and expired medicine. Even blood stored in blood banks becomes clinical waste after a few days.

There is no argument that clinical waste poses a major health hazard to people and, therefore, it should be properly and swiftly disposed of.

The problem is aggravated by the poor implementation of laws and regulations. As a result, incinerators operate below the standard temperature, the issue of inadequate storage facilities remains unaddressed and delays in the disposal of waste are commonplace. Also, a major concern is the cleaning staff’s lack of knowledge of hygienic waste disposal practices.

Hazardous clinical waste is not properly disposed of in many hospitals and is dumped in public places, in water bodies, outdoors, and in warehouses, it is reported. Clinical waste contains disease-carrying germs and if dumped recklessly in such places, it can cause serious health issues. Clinical waste generated by curing one patient can lead to diseases in many others. Given the poor implementation of the rules and regulations, some profit-driven private hospitals can be causing more harm than government hospitals, it is alleged.

Vehicles loaded with clinical waste move out of private hospitals stealthily at night to dump it in illegal garbage grounds out of human sight. 

This is why clinical waste has become one of the biggest challenges faced by humans today.

About 40 tons of clinical waste is generated daily in hospitals, healthcare facilities, laboratories, and other health institutions in Sri Lanka. These are required to be separated by hospital staff into ten major types such as microbial waste and sharp waste in accordance with a color-coded system and later incinerated in safe locations. It is reported that an average of 250 grams of clinical waste is generated per hospital bed. This should be disposed of within 48 hours. But the reality is that more than half of the clinical waste generated in hospitals is not properly disposed of or destroyed, it is learnt.

Although improper disposal of clinical waste has been gazetted by the CEA as a punishable offence, little or no action is taken against hospitals for non-compliance.

If we dig up the garbage dumps in Sri Lanka, we can see not only clinical waste but also human body parts, environmentalists say. For example, a few years ago, an English newspaper published an article with evidence about the discovery of clinical waste and human body parts at the Meethotamulla garbage dump.

It is common practice in Sri Lanka to burn, bury or dispose of clinical waste in designated areas. However, the WHO and the Stockholm Convention have warned of the potential negative impacts of disposing of clinical waste by these methods.

Incineration of clinical waste releases toxic chemicals such as carbon monoxide, pathogens, and dioxins into the air and they can pose a risk to the environment and the public. Therefore, the WHO has advised Sri Lanka to use alternative methods.

Disposing of clinical waste into public landfills and grounds and water bodies leads to the rapid spread of disease. Inhalation of fumes from open burning or incineration of clinical waste can cause respiratory problems and even cancer.

Clinical waste generated by patients receiving treatment from their homes is usually mixed with domestic waste. This is a dangerous situation. Birds and animals are also affected by clinical waste. Eating polythene and plastic found in garbage dumps can clog the alimentary canal of animals and even cause death. The addition of clinical sharps and clinical waste to general waste poses a high risk of injury and disease among the people handling this type of waste. 

So in terms of clinical waste management, we must keep in mind that each of us has a role to play in protecting ourselves, our society, our future generations, and our environment. Especially if private hospitals and clinics understand their collective responsibility and act accordingly, it will not be a difficult task to protect us and the environment from the danger of clinical waste.

The views and opinions expressed in this publication are those of the authors. They do not purport to reflect the opinions or views of the Sri Lanka Press Institute.

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