The Importance of Medical Waste Disposal During a Pandemic

Medical waste disposal in a healthcare setting is of paramount importance as it minimizes microbial load and potential harm posed by the waste. Hospitals normally produce hazardous waste and non-hazardous waste. According to World Health Organization, hazardous healthcare wastes are broadly categorized as: infectious waste, chemical waste, sharps waste, radioactive waste, pathological waste, and pharmaceutical waste. The sharps waste includes used and unused sharps, i.e. syringes, infusion sets, intravenous needles, and scalpels.

The pharmaceutical waste mostly constitutes contaminated medical devices as well as expired and unneeded pharmaceutical products. Infectious wastes are a category of hazardous healthcare waste containing disease-causing pathogens, i.e. microbiological waste, laboratory cultures and blood and wastes contaminated by body fluid. According to the International Committee of the Red Cross (ICRC), the risks associated with hazardous medical waste are broad and include the risk of trauma, infection, radioactivity, fire and explosion and chemical risk.

The risk of trauma and infection is usually high where healthcare waste is poorly handled. The main exposure routes for trauma and infection include contact with the mucous membrane or skin of the affected person through ingestion or inhalation. The other route is injury via pricking or cutting. Some of the infections that may spread as a result of contact with contaminated hazardous medical waste include: gastrointestinal infections, eye infections, meningitis, skin infections, eye infections, HIV/AIDS, Avian influenza and wide-ranging respiratory infections.

The respiratory infections include SARs virus, measles virus, Mycobacterium Tuberculosis and the recent outbreak of the Coronavirus. Medical waste can also be contaminated with virulent infectious agents that are resistant to drugs such as pseudomonas aeruginosa, extended-spectrum beta-lactamase (ESBL) and MRSA or methicillin-resistant staphylococcus aureus, among others. It is important to acknowledge that exposure to harmful medical waste has the potential to hurt people working and living inside and away from the hospital setting.

Inside the hospital, the care staff, logistical personnel, scientific and technical staff stand a high risk of contracting an infection. The care staff includes doctors, nurses and support staff. Outside the hospital setting, off-site transportation personnel and the general populace can get infected. The non-hazardous health-care waste doesn’t pose any specific chemical, biological and physical harm to health practitioners, patients or the surrounding community. This category of waste constitutes up to 90% of all waste produced in the average health-care facility.

CDC Medical Waste Disposal Guidelines

Waste management should be completed in line with stipulated health provisions. According to Infectious Disease Advisor, US health facilities produce about 4 million tons of waste annually. The cost of disposing the waste gobbles up to 20% of the health facilities annual operating budget. Most of this waste is handled within the hospital premises by health practitioners and other staff. Non-hazardous waste can be disposed of in the same manner as municipal waste. Poorly handling of waste often increases the risk of contracting infection.

According to the Centers for Disease Control (CDC), medical waste must be disposed of carefully using effective containment strategies, starting from the point of collection to final treatment. The waste disposal measures designed to protect healthcare workers are clearly outlined under the stringent OSHA regulations. For starters, more than one sturdy, leak-resistant biohazard bag should be used to contain regulated medical waste. The design on the disposal bag should make it easy for the hospital staff to dispose-off the waste without contaminating the exterior surface.

Secondly, puncture-resistant containers such as sharps containers should be safely placed and secured on the point of usage. The containers should only be used to discard items like needles, syringes, slides and tubes with blood tracings. Health practitioners are strongly advised to avoid recapping, bending or hand breaking needles and contaminated sharps to prevent needlestick injuries. The CDC medical waste disposal guide also highlights the precautions to observe to prevent the production of potentially harmful aerosols in the hospital environment.

The CDC guide covers the handling of items that may be carrying blood-borne diseases like Ebola virus and the Lassa fever. The storage and transportation of regulated medical waste, on and off the site are normally outlined under various state and federal regulations. One of the instructions is avoiding the accumulation of medical waste. Before disposing of waste, it must be clearly labeled and placed inside leakproof, puncture-resistant containment. The waste should be kept in a well-ventilated area to contain foul smells and away from rodents.

Case Study: The H1N1 Pandemic of 2009

In 2009, an influenza-like viral illness, H1N1, caused a serious health scare in the US and around the world. Health authorities, health practitioners and the general populace facing new waves of infections such as Covid19 can learn a lot from how the 2009 H1N1 was handled. According to the Environmental Protection Agency (EPA), flu pandemics usually take place when newly-fangled influenza A virus appears. The flu then spreads from person to person, especially if the target population has little or no immunity to overcome the incapacitating illness. 

According to researchers, the following methods aided the transmission of the 2009 H1N1 virus:

• Droplet exposure – this happens when the virus gets into contact with the mucosal surfaces, namely, the eyes, nose, and mouth through the respiratory tract secretions. The virulent virus then spreads to another party or parties when the infected individual coughs, sneezes or touches an object.
• Contact – this phase involves contact through a handshake or other hand contacts with the affected persons followed by a virus self-inoculation into the mucosal surface (eyes, mouth, and nose).
• Minute aerosol particle – this phase of contact involves getting in touch with the minute particle aerosol from the individuals suffering from influenza.

Infectious influenza can also spread through respiratory fluids, bodily fluids, and air. Although the infection can spread through the air over long distances, this is generally a rare method of transfer.

When developing waste management procedures for the 2009 H1N1 virus, the hospitals were asked to plan for proper management, treatment, and disposal of waste generated when caring for patients. To kill the flu virus, contaminated surfaces must be disinfected as soon as possible. Routine fumigation of contaminated surfaces should go beyond the hospital setting to include the community and surrounding neighborhoods. The following guide informs how waste disposal must be handled to prevent the 2009 H1N1 from spreading:

Guidelines Targeting Healthcare Facilities

• Staff must apply standard precautions when disposing of 2009 H1N1 contaminated solid waste. This should be done in isolation, far away from the patients.
• Staff must use personal protective equipment as prescribed by the state-regulated waste disposal procedures. For instance, hospital marked gloves should be worn when using open waste containers.
• Medical waste should be handled and treated following the state and federal medical waste regulations.
• As part of standard procedure, treated medical waste should be disposed-off, safely alongside municipal waste landfills.

Guidelines for Homes, Business and Schools

• Masks and other disposable tissues used when coughing, sneezing or removing nasal discharges should be put on waste receptacles.
• Masks and other disposable tissues collected as part of routine solid waste should be sent to the municipal waste landfill before treatment commences, unless specified otherwise.
• People should be encouraged to wash their hands and maintain proper hygiene at all times.