Submission by Mr J.D. Seconna: Waste Management Specialist : Peninsula Technikon

Madame Chair
I thank you for the opportunity granted to me by this committee. I must admit that it is long over due.

I have been trained as an Environmental Health Officer, called Health Inspectors during 1969 and 1970. Ever since then I attended health conference, meetings and workshops on which Health Care Waste Management was always a matter of concern.

My submission here today is the lack of appropriate action that was taken the past 30 years since I qualified, by the officials and legislators dealing with waste. The past 30 years with the situation worsening the past 5 years and especially in the Western Cape, where this legislative organ is the supreme authority, this issue must be addressed with all ernesty and commitment.

Students from the Peninsula Technikon studying Waste Management IV for the B.Tech Degree in Environmental Health conducted Medical Waste surveys in the Eastern Cape, Western Cape and Namibia.

The students revealed that Health Care Waste from pharmaceutical companies, veterinary clinics, home care facilities and doctors in rural areas find their way into landfill sites, via the domestic refuse or the unscrupulous practices of waste transporters.

These are only some of the Health Care Waste streams that causes exposure, threatening the life of the inhabitants of this country. The dumping and burial of these wastes on illegal sites is escalating due to the perceived cost of disposal and blatant negligence on the side of the medical faternity and other health care workers.

The aim is provide recommendations for the development of actions on the measures and procedures necessary to control the risks to human health and harm to the environment caused by healthcare waste management. The basic concept is to minimise resources used without prejudicing healthcare itself. The mail focus is to apply a "cradle to grave" perspective on the product since it is only such a policy that will lead to "sustainable development". Wherever possible, it is necessary to look for environmentally acceptable solutions with groups that directly influence the production and consumption patterns ahead of the waste stage.

The field of waste management is characterised by the "ladder principle", a broad hierarchy of waste management options. Highest priority is given to prevention, followed by recovery (re-use, recycling, combustion with energy recovery), incineration and, finally, landfills of waste. A new form of working called the "strategic discussion" method should be employed, involving open discussion and allowing active involvement on the part of those who have not hitherto had a sufficient role in the early development of strategic solutions.
Healthcare waste (HCW) refers to all waste arising from healthcare practices. Only a small proportion of this waste poses any greater risk than normal household, or municipal waste. Segregation of and disposal is, therefore, a key issue for this project.

1.1Definitions of Health Care Waste
Healthcare: Medical activities such as diagnosis, monitoring, treatment, and prevention of disease or alleviation of handicap in humans or animals, including related research performed under the supervision of a medical practitioner or veterinary surgeon.

Healthcare Waste: The solid or liquid waste arising from healthcare.

Healthcare Risk Waste:
· Biological (recognisable anatomical waste)
· Infectious
· Chemical, toxic or pharmaceutical including cytotoxins
· Sharps (eg. Needles, scalpels)
· Radioactive

2. S.A. International Commitments
We have signed several global accords, protocols, agreements and conventions related to Waste Management, which include several principles. Some mentioned may be newly introduced, and their effect must still be tested. Although if we take up this global challenge seriously, we could just benefit from these actions.

- UNCED 1992 – Agenda 21
- Basel Convention
- Polluter Pays Principle
- Pre-cautionary Principle
- Responsible Care Principle
- Duty of Care Principle
- Proximity Principle
- Cradle to Grave Principle
- Dust to Dust Principle

3. Current Status
It is clear the on a national, provincial/regional and local level the management of Health Care Waste needs all the attention it can get. There appears to be "no management strategies" in place that would satisfy any interests of affected party in this country. The real status should be established by investigating the present state of the Health Waste Care Industry.
- National
- Provincial
- Local

4. Health Care Waste Management Strategy
4.1General Strategies
Strategy: Prevention is to be encouraged. Prevention must not present a barrier to technological innovation, or to high standards of healthcare.
Strategy: If a suitable market exists then healthcare and healthcare waste personnel should be encouraged to recycle suitable fractions of waste as a matter of course, providing that recycling does not compromise healthcare standards.
Strategy: Re-use of used products should be encouraged, but guidance must be provided on those products suitable for re-use and those that are not. Re-use of products must not compromise healthcare standards.
Education and Training/Health and Safety at Work
Strategy: Compulsory education and training for healthcare and healthcare waste management staff, linked to the risk involved for all aspects of healthcare waste management should be introduced, together with a system of assessment of competence.
Public Perception
Strategy: The public perception of risks should be actively addressed to promote the reality of the situation. Relevant and correct information should be promoted in order to achieve an improvement in understanding.
Research Policy
Strategy: Research projects should be promoted, but selected on the basis of the priorities set out in the strategy statements for healthcare waste.
Waste Management Plans
Strategy:Waste Management Plans should detail the provisions to be made for healthcare waste management and disposal.

5. Healthcare Practices
Selection of Product
Strategy: Medical product selection should be based on healthcare performance, with consideration of the environmental effect of the waste produced.
Strategy: Healthcare risk waste should be strictly segregated at source and the appropriate disposal route taken in accordance with the Producers’ Waste Management Plan.
Strategy: The controls on the packaging of healthcare risk waste should be enforced and guidance produced for other waste types.
Transport and Storage
Strategy: Guidance should be developed for storage on site, transport to the point of treatment and disposal and storage prior to treatment or disposal taking legislation into account.
Strategy: Validated methods of pre-treatment should be encouraged if a decrease in the risk of harm to health or pollution or a reduction in costs will result.
Strategy: A system of record keeping specifically for healthcare waste should be developed.
Strategy: Responsibilities for all aspects of healthcare waste management should be defined and enforced by legislation.

5.1Treatment and Disposal
Choice of Methods
Strategy: The choice of method or methods of pre-treating and disposing of healthcare risk waste should be left to the institution providing that minimum performance standards are met.
Standards for Pre-Treatment
Strategy: Harmonised performance standards for pre-treatment of healthcare risk waste should be developed and enforced where they do not exist.
Disposal of non-risk waste via the municipal waste stream
Strategy: Disposal of healthcare waste that is not risk waste via the municipal waste stream is acceptable if suitable quality assurance is in place.
Disposal of Human Tissue via the Whole Body Disposal Route
Strategy: When disposal of recognisable human organs or tissues (not including blood) takes place via the whole body disposal route, it must conform to national law and be under the responsibility of medical, environmental and ethical authorities.
Disposal of Risk Waste via Municipal Waste Incinerator
Strategy: The use of specifically designed Municipal Waste Incinerators should be encouraged for the disposal of healthcare risk waste but mandatory conditions must be applied and specific approval given.
Energy Recovery
Strategy: Assessment of the potential for energy recovery and use form healthcare waste should be encouraged, with consideration of the overall costs and benefits.
Proximity Principle
Strategy: Guidance should be developed for the implementation of the Proximity Principle in relation to the treatment and disposal of healthcare risk waste.

6.Action Plan for a National Programme
Formulation of objectives and planning for their achievement are important for improving health-care waste management at the national, regional and local level. Planning requires the definition of a strategy that will facilitate careful implementation of the necessary measures and the appropriate allocation of resources according to the identified priorities. This is important for the motivation of authorities, health-care workers, and the public, and for defining further actions that may be needed. Surveys on the generation of waste will be the basis for identifying opportunities and setting targets for waste minimization, re-use and recycling, and cost reduction.

The United Nations Conference on the Environment and Development (UNCED) in 1992 led to the adoption of Agenda 21, which recommends a set of measures for waste management. The recommendations may be summarised as follows:
· Prevent and minimize waste production
· Re-use or recycle the waste to the extent possible
· Treats waste by safe and environmentally sound methods
· Dispose of the final residues by landfill in confined and carefully designed sites

Agenda 21 also stresses that any waste producer is responsible for the treatment and final disposal of its own waste; where possible, each community should dispose of its waste within its own boundaries.
- Establish Policy Commitment and Responsibility
- Conduct a National Survey
- Develop National Guidelines
- Training of Trainers

7.Questionnaire design for Health Care Waste Generator
The questionnaire of the WHO and our locally developed ones for current practice surveys, will be discussed with stakeholders and modified to suite the Southern Africa situation

8.Training Manual for Health Care Workers
- Policy Statement
- Current Status
- Source Management
- Handling, Storage(Packaging) and Collection
- Segregation
- Risk Management Practice
- Labeling
- Transportation
- Security Precautions
- Incinerator-Operation Maintenance
- Emergency Response
- Record Keeping
- State of the Art Reporting

9. Information Sharing Session
A request is being made based on the short notice we received for the submissions to allow me to make a verbal presentation to the Departments Strategic Discussion Group. It will have direct bearing on the guidelines for the safe management of medical waste, which will be developed and implemented by, DEAT by December 2001. The guidelines, which will address such issues as the separation of infectious waste from other waste, generated at clinics and hospitals.

The public awareness and education campaign, focusing on the hazards of medical waste and the legal responsibilities of medical waste generators, which will be developed by DEAT by December 2000 and implemented from 2001, could be facilitated on a contract bases. Planning for a system of medical waste treatment plants which will be completed by DEAT by 2002 can be assisted and the additional medical waste treatment facilities will be established and operated thereafter, in accordance with this plan.

Issues for discussion
· Strategic framework

· Action Plan and
· Training