By Jayne Pilot
Healthcare facilities are in business to protect patients and to reduce health problems. But, at the same time, healthcare waste contains harmful microorganisms that can be dangerous to public health when disposed of in landfills.
Managing and controlling waste is crucial for public health, whether it is hospital infectious waste or municipal garbage. The World Health Organization is quoted as saying: “Healthcare waste contains potentially harmful microorganisms which can infect hospital patients, healthcare workers and the general public. Other potential infectious risks may include the spread of drug-resistant microorganisms from healthcare establishments.”
Infectious disease is a never-ending threat. The Chief Public Health Officer’s Report on the State of Public Health in Canada 2013 showed a 1000% increase in the Staphylococcus aureus infection rate between 1995 and 2009. S.aureus is one of the ten pathogens that create the biggest health burden for Ontarians.
Infectious diseases – epidemic
One in every 25 patients has an infection, according to the National Centre for Emerging and Zoonotic Infectious Diseases. A study by the Ontario Agency for Health Protection and Promotion and the Institute for Clinical Evaluative Sciences found that nearly 5,000 Ontarians die every year from infectious diseases.
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Biomedical waste in Ontario is managed under MOECC Guideline C-4. Having set up the disposal of biomedical waste in Canada in the early 1990s with Browning Ferris Industries, I was shocked to read the statistics in “The Green Hospital Scorecard (GHS)”, which is a benchmarking and recognition program reflecting hospitals’ environmental performance. The GHS 2013 reporting data suggests that the average composition of Ontario hospital waste is: 7% biomedical waste; 34% diverted wastes (recycle, reuse and compost); and 59% general (non-hazardous) which goes to landfill.
Infection control practices in hospitals have been designed to protect the patient and healthcare workers, but what about the public?
View an in-depth presentation on this topic and learn more about a petition the author has started.
How do hospital staff, or the outsourced maintenance or housekeeping staff, know if the healthcare waste contains potentially infectious material? This waste (incontinence, disposable bed liners, diapers, paper towels, absorbent material) will be going to landfills.
Public Health Ontario has been doing excellent work in providing scientific and technical advice and support on infectious diseases, prevention and control, as well as environmental and occupational health support.
The area of cleaning and disposal of blood/body fluid spill is one I would question though. In one video about cleaning blood/body fluids viewers are advised to: “Dispose of the materials by placing them into regular waste receptacle. If soiled materials are so wet that blood can be squeezed out of them, then they must be disposed of into the biomedical waste container, which is a yellow bag.”
Plastic bags – environment for bacteria growth
So, blood/body fluids on the healthcare paper towels or absorbent material are disposed of in regular garbage. This potentially infectious waste contained in a black bag now has the darkness, warmth, dampness and the food (blood/urine/feces) which are ideal for bacterial growth. The vectors (insects/birds/animals) at the landfills help to spread disease.
We are seeing an increase in viruses: Zika, West Nile, Ebola, flesh-eating disease, Group A streptococcal blood infection, to name a few. When the risk from the Ebola virus came out in April 2015, the Chief Medical Officer of Health issued Directive #4 regarding waste management. Hospitals were notified, but what about waste management companies, funeral homes, and municipal governments responsible for waste? When I enquired in these areas, no one knew of the Directive. Communication in handling these risks is lacking.
Government regulations need to be updated
Infectious hospital waste represents only a small part of total healthcare waste; however, it can have a huge impact on the spread of disease at a landfill.
Where the waste comes from, and what possible or probable risk and impact the waste can have, is where we need to start to set policy and purchasing decisions for waste disposal methods. A Canadian system needs to be in place for consistency in managing this waste.
Funeral homes are still putting blood and embalming fluids into our sanitary sewers. Patients are no longer staying for long periods in hospitals. They are being treated and recover at home. So, a patient’s waste that was classified as medical waste in a hospital is now municipal garbage.
Many cities and regional governments have allowed diapers and incontinence products to be included as compost. What they failed to consider is that AIDS/hepatitis patients, as an example, use these incontinence products in their homes.
Healthcare regulations can make a difference by reducing risks. The solution is total destruction of infectious waste and total diversion of healthcare waste from landfills.
Jayne Pilot is President of Pilot Performance Resources Management Inc. and was the District Manager for Browning Ferris Industries, establishing medical waste disposal in Canada in the late 1980s and early 1990s.