Annotation2

= Health-care waste management =

World Health Organization (2011)[]

This article states that if medical waste is not incinerated at the proper temperature, toxins are released into the air. Then it tells you how this can affect the human body. Finally makes suggestions on how to most safely incinerate medical waste.

A few quotes from the article are:

“…when wastes are incinerated at low temperatures or when plastics that contain polyvinyl chloride (PVC) are incinerated, dioxins and furans and other toxic air pollutants may be produced as emissions…”

“Long-term, low-level exposure of humans to dioxins and furans may lead to the impairment of the immune system, the impairment of the development of the nervous system, the endocrine system and the reproductive functions.”

Plastics containing PVCs that are incinerated at too low temperatures can produce toxic air pollutants (PCBs) in the form of gas or ashes. “… PCBs are persistent substances that do not readily break down in the environment and that bio-accumulate in the food chain.”

Human exposure to these toxins can cause various health problems including skin lesions, altered liver function, the impairment of the immune system, the impairment of the development of the nervous system, the endocrine system and the reproductive functions.

Examples of current recommendations for safe incineration include:
 * For the short term, good practices in incinerator design, construction, operation (e.g., pre-heating and not overloading the incinerator, incinerating only at temperatures above 800°C), maintenance and lowest emissions


 * For the mid term, Further efforts to eliminate unnecessary injections to reduce the amount of hazardous health-care waste that needs to be treated


 * For the long term, Support of countries in the development of national guidance manuals for the sound management of health-care waste;

This document shows how medical waste is disposed of. It also states how this affects the environment and human body. Further more, it states ways to help keep the disposal system as safe as possible.

Some things that I might use in my report include:

- most evidence documenting the toxicity of dioxins and furans is based on studies of populations that have been exposed to high concentrations of dioxins either occupationally or through industrial accidents. insufficient evidence to prove that chronic low-level exposures to dioxins and furans causes cancer in humans.

- It has not yet been possible to estimate the worldwide burden of mortality and morbidity from exposure to dioxins and furans: the exposure and risk assessment has many uncertainties; data gaps are very large

- Additionally, the types of health effects that may result (e.g. cancer, impaired immune function) would only show up after long exposure periods and would be difficult to measure

- WHO has established tolerable intake limits for dioxins and furans, but not for emissions. The latter must be set within the national context

- In several European countries where tight emissions restrictions were adopted in the late 1980s, dioxin and furan concentrations in many types of food (including mother's milk) have decreased sharply

- In 2001, during a measles mass immunization campaign in West Africa (covering all or part of six countries), 17 million children were vaccinated, resulting in the generation of nearly 300 metric tonnes of injection waste. Without adequate waste disposal options at both local and regional levels, this volume of waste would have been difficult to eliminate safely.

- unsafe disposal of health-care waste (for example, contaminated syringes and needles) poses public health risks. Contaminated needles and syringes represent a particular threat as the failure to dispose of them safely may lead to dangerous recycling and repackaging which lead to unsafe reuse. Contaminated injection equipment may be scavenged from waste areas and dumpsites and either be reused or sold to be used again. WHO estimated that, in 2000, contaminated injections with contaminated syringes caused:
 * 21 million hepatitis B virus (HBV) infections (32% of all new infections);
 * two million hepatitis C virus (HCV) infections (40% of all new infections); and
 * at least 260 000 HIV infections (5% of all new infections).

- occupational hazards to health workers, waste handlers and scavengers. Where waste is dumped into areas without restricted access, children may come into contact with contaminated waste

- best practices" for incineration must be promoted, and must include the following elements:
 * 1) Effective waste reduction and waste segregation, ensuring that only appropriate wastes are incinerated;
 * 2) Sitting incinerators away from populated areas or areas where food is grown, thus minimizing exposures and thereby risks;
 * 3) A properly engineered design, ensuring that combustion conditions are appropriate, e.g., sufficient residence time and temperatures to minimize products of incomplete combustion;
 * 4) Construction following detailed dimensional plans, thus avoiding flaws that can lead to incomplete destruction of waste, higher emissions, and premature failure of the incinerator;
 * 5) Proper operation, critical to achieving the desired combustion conditions and emissions. In summary, operation must: utilize appropriate start-up and cool-down procedures; achieve (and maintain) a minimum temperature before waste is burned; use appropriate loading/charging rates (both fuel and waste) to maintain appropriate temperatures; ensure proper disposal of ash; and ensure use of protective equipment to safeguard workers;
 * 6) Periodic maintenance to replace or repair defective components, including inspection, spare parts inventory, record keeping, and so forth;
 * 7) Enhanced training and management, possibly promoted by certification and inspection programmes for operators, the availability of an operating and maintenance manual, management oversight, and maintenance programmes.