By Digoy Fernandez
THE mention of waste segregation and the decision not to use incinerators for getting rid of trash just made me think of something unusual: Medical Waste.
Many years ago, I used to go to daily mass in one of the country’s better hospitals because it was very near my office then. Until I bumped into a friend who also went to daily mass, sometimes in the same hospital chapel I would go to. My friend is in the insurance industry and is known as one of the more honest adjusters around, giving accurate assessments of fire and other damage in behalf of insurance companies. He asked me if I also had the habit of bringing my son to said hospital, knowing full well that this particular son was practically my shadow and companion in many an adventure and activity. When I answered in the negative, he said simply: "Good." And then, he explained why he thought bringing children to hospitals is not such a good idea.
According to him, hospitals, by their nature and business, tend to provide safe havens for many dangerous microbes that, over time, have began to develop strong resistance to antiseptics and other cleaning agents. And, he stressed further, the worst places were most possibly the ICU units! Yikes! That soured me on ever visiting ICU units again, even for close relatives.
I also remembered a proposal given to me by one of my foreign partners years ago touting mini-incinerators designed to get rid of what hospitals refer to as "Red Bag" waste. These are those used swabs, disposable linens, among others, that one tends to throw away after regular use in a hospital. The brochures stated that Red Bag waste tended to end up with other regular waste in landfills and wherever else waste is dumped. In our local milieu, that would mean that, aside from the filth and bacteria that a rag-picker would be exposed to, those who make a living from sifting through garbage would then be subjected to materials that could have come into contact with people with infectious diseases. Yikes, again!
Unfortunately, the Clean Air Act and proof that incineration causes the production of poisonous dioxins scuttled any move in that direction. But I still wonder to this day if our local hospitals follow any specific protocol in the disposal of their Red Bag waste. I Googled this subject and found many ways recommended in the task of disposing of said waste. Thus, there is no shortage or remedies. One of them is to simply subject said Red Bag waste to an antiseptic bath (until I remembered the thought that many bacterial and viral strains may have developed resistance to such cleansing!), to the use of superheated steam to cleanse infected materials.
In the US, the burning of some medical waste, especially body parts, is mandated by law. Here, we have no alternative but to use less controversial alternatives. Some quarters suggest that hospitals look into the possibility of examining their materials use and go for those that do not contain any possible toxic ingredients (e.g. mercury in thermometers since alternatives exist) or those that would turn into poisons when they begin to break down in landfills or dumps.
This reminds me to check out my local hospital on their Red Bag waste disposal policy!
Thinking aloud about medical waste
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I was thinking on the same line when I read, a few weeks ago, about our hospitals' decision to discontinue use of instruments containing mercury. My next question was: how will they dispose of those old instruments??? I hope the DOH and DENR have regulations about proper medical waste disposal.
I currently live in a 1st world country here in Europe. Months ago, we heard on the news evacuation of ICU patients of certain hospitals because of resistant microbes residing in those units. Cleaning up the ICUs takes months. In worst cases, the military had to help in putting up make-shift ICUs outside the hospital building where patients can be confined. It shocks me that these things happen in what I thought was an "antiseptec" environment.
I want to believe that even if we are a 3rd world country, we can do as well if not better than developed countries - if only we are aware...
Here in our country we refer to the infectious wastes generated by the hospitals "YELLOW BAGS". You're right, some microbes and viruses may already have developed some resistance to clorox/zonrox) and lysol which is commonly used for the disinfection of these infectious hospital wastes-- and chemical disinfection could just be "psychological disinfection", unless you use the right disinfecting solution-- and what about spores? -- Its not unfortunate that the clean air act has been passed. It makes the Philippines a pioneering country in the region to eliminate the burning of waste-- thus rendering the country dioxin and toxin free as results of non incinerating of regulated wastes-- meaning less sources of diseases such as different types of cancers.
For mercury free health care, again the Philippines again has pioneered in gradually phasing out mercury in all health care facilities in the region. Trivia: one gram of mercury (about the volume of what is inside a mercury thermometer) can already poison a small lake-- it also bio accumulative, meaning it sets in the body fats-- tuna bellies? you can bet that there's mercury in it, inside our bodies? You can bet on it. Hopefully the DENR will be able to strategically formulate some plans on what to do with all mercury containing devices left after the shift to non mercury devices. Unfortunately, there is no technology yet to finally dispose mercury safely, although it can be stored safely until such time that it can be collected by the local government.
Yes, Joyce, we only need to be aware and be responsible for our environment and our fellowmen.
There is a group here in the Philippines I have been following for quite some time. their website is www.noharm.org. i think the local office is based in Quezon City.
I am a medical technologist and used to work in a hospital. I'm now working in the academe, teaching microbiology.
Actually, health institutions can do a lot to minimize the harm caused by hospital waste or our yellow bags. It all boils down to how much a particular institution is willing to spend for proper waste treatment.
Autoclaving(steam under high pressure) is routinely employed to sterilize hospital equipment and to some degree is also used by many hospitals to treat infectious waste materials before they are disposed. Autoclaving is the most effective means of sterilization that does not use any chemical solvent nor produce any emission that may harm the environment.
If every health care institution can autoclave their waste, then the only problem left, in so far as infectious wastes are concerned, is how to dispose of what remains after--- usually non-biodegradable materials.
All I know is that before any clear improvement can be made in medical waste management, consistent and scientifically based definitions must be established as to what is meant by medical waste and its components, and what the goals are for how it is managed. If the primary goal of "managing" waste from medical facilities is to prevent the accidental spread of disease, then it must first be acknowledged that there is only a small percentage of the waste stream that is contaminated in a manner that renders it capable of transmitting disease, and that the only documented transmission of disease from medical waste has been from contaminated sharps (syringes, etc.).
Based on observations at a number of health care facilities in non-US countries it has been documented that the average hospital waste stream contains less than 10% of materials that could be considered "potentially infectious waste" if properly segregated. The problem is that it is running above 15% currently. I think this would be a great starting point.
James Monroe
Good stuff, bookmarked for further reading.
Good stuff, bookmarked for further reading.