healthcare waste management in lebanon
DESCRIPTION
Healthcare Waste Management in Lebanon. Samar Khalil. 6 June, 2012. Outline. AGENDA. Sub headline. Types of Healthcare Wastes Impact of Mismanagement of Healthcare Waste Healthcare waste management in Lebanon Legal Framework. Types of Healthcare Wastes. AGENDA. Sub headline. - PowerPoint PPT PresentationTRANSCRIPT
Healthcare Waste Management in Lebanon
Samar Khalil
6 June, 2012
Sub headlineAGENDAOutline
• Types of Healthcare Wastes
• Impact of Mismanagement of Healthcare Waste
• Healthcare waste management in Lebanon
•Legal Framework
Sub headlineAGENDATypes of Healthcare Wastes
• Used X-ray fixer solution• Amalgam (containing
silver and mercury)• X-ray developer• Lead foils, shields and
aprons• Cleaners for X-ray
developer systems• Chemiclave/Chemical
sterilant solutions• Disinfectants, cleaners
and other chemicals
Example text
Hazardous Non-Infectious Waste
•Sharps (needles)• Waste
contaminated with blood and body fluids
Hazardous Infectious Waste
•Paper•Food•Packaging•Plastics•Glass
Non- Hazardous Waste1 2 3
Sub headlineAGENDATypes of Healthcare Wastes
Example text
•Sharps (needles)• Waste contaminated
with blood and body fluids
Radioactive Waste
• Expired Pharmaceuticals
• Pathological waste• Cytotoxic waste
Wastes that need special treatment
4 5
Impact of Mismanagement of Healthcare WasteOccupational & Public Health Risks
• AIDS; • Gastroenteric infections; • Respiratory infections;• Ocular infection;• Genital infections; • Skin infections; • Anthrax; • Meningitis;• Haemorrhagic fevers; • Septicaemia; • Bacteraemia; • Candidaemia; • Viral hepatitis A, B and C
Exposure to hazardous infectious waste
Occupational & Public Health Risks
Impact of Mismanagement of Healthcare WasteOccupational & Public Health Risks
Source: Safe management of wastes from health-care activities/ Chapter 3: Health Impacts of Health-care waste – WHO Geneva 1999.
Occupational & Public Health Risks
• Intoxication; • Burns; • Injuries to the skin, the
eyes, or the mucous membranes of the airways;
• Mercury waste: Inhalation of mercury vapor leads to damage in the central and peripheral nervous systems, lungs, kidneys, skin and eyes. It also affects the immune system and is mutagenic.
Exposure to hazardous non-infectious waste
Exposure to Mercury vapors
Impact of Mismanagement of Healthcare WasteOccupational & Public Health RisksOccupational & Public Health Risks
75%
25%
Mercury level below 5 µg/g
Mercury level above 5 µg/g
• Among ninety-nine dentists in Beirut, 25.25% had a mercury level above the safe baseline of 5 µg/g.
• Of those, 7.07% had a concentration approximately 10 µg/g.
Example text
Mercury level in dentists’ hair
Impact of Mismanagement of Healthcare WasteOccupational & Public Health Risks
Harakeh, S., Sabra, N., Kassak, K., & Doughan, B. (2002). Factors Influencing Total Mercury Levels Among Lebanese Dentists. The Science of Total Environment .
Impact of Mismanagement of Healthcare WasteOccupational & Public Health RisksOccupational & Public Health Risks
Sub headlineAGENDAImpact of Mismanagement of Healthcare Waste
Surface water contamination due to:•Runoff from
indiscriminate dumping.•Direct discharge of
untreated waste water.
Ground water contamination due to:• Leakage from
inadequate disposal sites.
Example text
Water Pollution
•Open burning of healthcare waste especially that containing plastics (PVC) release of carcinogens such as Dioxins and Furans.
Air Pollution
Leakage of contaminants into the soil as a result of:• Inappropriate
disposal of mixed Healthcare and Municipal waste.
• Indiscriminate dumping of incinerator ash containing toxic heavy metals such as Mercury.
Soil Pollution1 2 3
Indirect Risks Via the Environment
Healthcare Waste Management
• The quantity of infectious healthcare waste generated per day is estimated at 8,200 kg/day.
• The quantity of infectious healthcare waste generated per bed per day is estimated at 1 kg.
•Cost of transportation and treatment of infectious healthcare waste in Lebanon ranges between 0.55- 0.75 USD/Kg.
Current Situation
47%53%
Private Hospitals (Short Stay)
No. of beds with treated infectious wasteNo. of beds without treated infectious waste
49%51%
Public Hospitals
No. of beds with treated infectious waste
No. of beds without treated infectious waste
Lebanon
Sub headlineAGENDALegal FrameworkLaws
Law 64/1988: Conservation of the environment against pollution from hazardous waste and hazardous materials
Law 387/1994: Ratification of Basel Convention on the Control of Trans-boundary Movements of Hazardous Wastes and their Disposal• The law punishes crimes related
to breaching of the terms of the various stages of management of hazardous waste. • Sanctions include responsible and
people who know about the crime and refrain from reporting it to concerned authorities.• Sanctions range from payment of
fines to death penalty.
• Controls trans-boundary movements of hazardous waste (including hazardous healthcare waste).• The only legitimate trans-
boundary shipments of hazardous waste are exports from countries without facilities, or expertise to dispose safely of certain wastes, to countries which have both facilities and expertise.
12
Law 432/2002: Ratification of Stockholm Convention on Persistent Organic Pollutants
• Eliminate dangerous POPs, starting with the 12 worst.• Support the transition to safer
alternatives.• Target additional POPs for action.• Cleanup old stockpiles and
equipment containing POPs.• Work together for a POPs-free
future.
3 • The precautionary principle.• The principle of preventive action.• The polluter pays principle.• The principle of avoiding
degradation of natural resources.
4
Sub headlineAGENDALegal FrameworkLaws
Law 444/2002: Protection of the environment
Sub headlineAGENDALegal FrameworkDecrees, Decisions & Circulars
Decree 13389/2004: Determining the types of waste from healthcare facilities and their disposal
Decision 52/1/1996: Standards and Limits for the Prevention of Air Water and Soil Pollution
•Defines the types of HCW;•Requires proper waste
segregation and waste minimization;• Sets some guidelines for the
collection, storage, treatment and disposal of the different types of wastes;•Requires an EIA study for
licensing HCWT facilities.•Gave HCF 120 days for
compliance with the decree.
1
2 • Standards for water.• Standards for wastewater.• Standards for air emissions.
•Unifies the trimestrial reports submitted by HCWT facilities to the Ministry of Environment.
4
Decision 8/1/2001: Standards for air emissions, liquid effluents, and waste water treatment plants
• Standards for wastewater.• Standards for air emissions.
3
Circular 11/1/2011: Trimestrial Report for Infectious Healthcare Waste Treatment
Sub headlineAGENDADemonstrating Best Techniques & Practices for Reducing HCW to Avoid Releases of Dioxins and Mercury
• Introduction to the Project
• Pilot Facilities
Intro to the Project
India
Tanzania
PhilippinesVietnam
Lebanon
Senegal
Latvia
Argentina
Introduce and Evaluate the Use of
Mercury-Free Devices
ObjectiveTo demonstrate and promote best practices and techniques for health-care waste management in order to minimize or eliminate releases of persistent organic pollutants and mercury to the environment
Evaluate Available Non-Incineration
Treatment Technologies
Establish Model Facilities
Update Policies
Develop Training
Material & disseminate information
Baseline Assessment• Onsite survey conducted at both
model facilities
Model Facilities
1
Mercury Phaseout3
• Comparative Evaluation of Mercury Free Thermometers
• Policies and Procedures• Replacement of thermometers
Policies and Procedures UpdateWaste Management Program• Organizational structure and
resources’ allocation• Policies & Procedures• Waste Handling• Capacity Building
2
Sub headlineAGENDAChallenges for the Management of Healthcare Waste in Lebanon
1OpportunitiesChallenges
• Replication at the national level
• Setting legal framework for compliance with HCWM guidelines, and standards.
• Coordination with different stakeholders (ie.: MoPH: accreditation & licensing )
• Certification of HCWM personnel
• Coordination with the academic sector (i.e.: integration of a HCWM module in the curricula)
• Lack of national expertise in HCWM
• Lack of infrastructure for disposal of some types of HCW (cytotoxics, chemicals, etc...)
• Low level of legal enforcement (though improving)
• Lack of national strategies and plans for the management of chemical and hazardous wastes.
• Lack of national capacity for the testing and laboratory analysis of dioxins.
• Lack of national standards in relation to dioxins emission limit values in residues and air.
