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The many perils of offsite health care waste treatment and disposal
Burdening hospital and health care facility administrators and personnel with only the minimum responsibility, offsite and contracted medical waste management solutions remain the most preferred and prevalent health care waste (HCW) practice across the Philippine public health sector. But with documented reports of possibly infectious medical waste illegally disposed or spilling out of waste transport vehicles and discarded along roads and waterways, public health authorities need to rethink their options and seriously consider onsite treatment.
Below are FOUR PERILS OF OFFSITE MEDICAL WASTE MANAGEMENT that health care facility administrators need to be mindful of when determining their HCW management strategy
1. Government surveillance over HCW transport routes between the facility and the treatment/end-disposal site is weak and has blindspots.
While there are existing laws and implementing rules and regulations governing the licensing as well as the transport routes – including vehicle manifests – of HCW haulers, documented cases of illegally or irregularly discarded medical wastes in various locations across the country point to blindspots in actual enforcement particularly in terms of monitoring and surveillance.
With authorized disposal sites few and far in between, there is a wide space and time between collection and treatment or disposal during which HCW haulers are likely to engage in undocumented and unaccounted for activities, including disposing possibly untreated HCW along roads and waterways.
2. REGULATION AND SURVEILLANCE OF DISPOSAL FACILITIES IS ALSO WEAK
A key principle in HCW management which is also mandated by existing laws and regulations is that untreated HCW cannot be mixed with and disposed alongside any other type of waste as combining them can lead to cross-contamination and infect all the other types of waste which are handled by unprotected personnel. And while landfills and other waste disposal sites have to be ideally secured from populations, it is well known that across the Philippines, foraging in waste disposal sites is a common practice and a source of livelihood for some people, including children.
Infectious HCW mixed with non-HCW can further contaminate unadapted landfills and dump sites including ground water, contributing further to water pollution.
3. OFFSITE TREATMENT MEANS UNTREATED HEALTH CARE WASTE STAYS IN THE STORAGE OF HEALTH CARE FACILITIES FOR A TIME BEFORE BEING COLLECTED
As most HCW transporters follow a schedule which includes considering the viable volume of waste to be transported relative to attendant costs, the collection of HCW in facilities can at times take a while. The longer untreated HCW, albeit sorted and segregated, remains within a health care facility, the more people can be exposed including increased possibilities for leakages. With most facilities having only a limited space for storage and with daily waste being produced, unscrupulous and ill-managed health care facilities may simply opt to dispose their untreated infectious waste without waiting for the contracted transporter or hauler.
4. OFFSITE TREATMENT IS COSTLIER IN THE LONG-TERM
While onsite treatment of infectious HCW may require a considerable amount of public investment and capital, including capacity building and training, offsite treatment is in the long run more expensive with HCW hauling expenses reaching up to PHP750,000.00 per month in tertiary hospitals. Moreover, despite these expenses, health care facilities can never be fully certain that their infectious wastes are properly treated and disposed.
Treating HCW at the Source is the Emerging Norm
Around the world, most health care facilities are adopting onsite treatment as the new normal in managing infection HCW. Onsite treatment supervised by established waste management committees in health care facilities effectively minimizes the risk of untreated infectious waste being mixed with forms in the health and broader municipal or community waste stream and prevents unsuspecting publics from risks of infection.