Four ways to manage healthcare waste sustainably

The syringes, needles, expired pills that are used in healthcare must be disposed in a way that is both responsible and environmentally friendly. Health Care Without Harm Asia’s Pats Oliva outlines four considerations for the healthcare industry.

Doctor's tools
Instruments and items used in healthcare must be properly disposed of to protect the environment and public health. Image:, CC BY 2.0

The progress of modern medicine in the recent years has been astounding. A wearable pancreas is already increasingly common, continuously monitoring blood sugar levels and dispensing insulin as needed. Soon, we may even be able to finely edit our DNA, using molecular scissors to snip out genetic defects. But as global healthcare charges forward, it leaves behind a waste crisis waiting to explode.

For instance, the World Health Organization estimates 16 billion injections are administered worldwide every year without proper disposal, while an average of 0.5kg of hazardous waste per hospital bed per day is generated in high-income countries like the US. For the record, Phnom Penh in Cambodia produced 342.54kg of healthcare waste from 3,114 hospital beds, according to a 2003 Cambodia Environmental Association survey, and Japan creates 285,000 tonnes in infectious waste and 945,000 tonnes of non-infectious also in 2003. What makes the quantity of healthcare waste worse is that it’s not separated into hazardous and non-hazardous waste streams.

Hospitals produce very unique waste items. There are sharp objects, such as used needles and syringes; pharmaceutical waste, like expired and contaminated drugs; and infectious waste, including soiled dressings, blood and bacterial cultures.

Either directly or indirectly, these medical wastes pose large-scale health risks through release of pathogens and toxic pollutants. Improper management of medical wastes can lead to bigger health and environmental impacts such as radiation burns, sharps-inflicted injuries, toxic exposure to pharmaceutical products—especially antibiotics and cytotoxic drugs—as well as mercury and dioxin leaks that could eventually seep into the ground and pollute our water, agricultural land and even the air through the incineration of medical waste in waste-to-energy facilities.

In many developing countries, strong national legislation and regulation policies focusing on hospital waste are in place. However, in the face of tight resource constraints, implementation remains a critical problem. Indeed, many countries in Asia Pacific like the Philippines, Cambodia, China, Fiji, Laos, Malaysia and Palau still have no functioning waste management systems specifically for healthcare waste. Meanwhile the rest of the waste is dumped or burned through waste-to-energy incineration facilities that harms the people and the planet

In particular, according to the United States Environmental Protection Agency, medical waste incineration produces emissions that contain significant air pollutants including particulate matter, metals, acid gases, nitrogen oxides, and carbon monoxide to name a few. These substances can cause higher incidence of cancer and respiratory symptoms as well as possible congenital abnormalities and hormonal defects.

Efforts on healthcare waste are essential not only to provide a safe and sustainable environment for the public but also in passing on available solutions and best practices to other hospitals on healthcare waste management.

For that reason, here is a rundown of recommendations for hospitals and health centres on how to realise sustainable healthcare waste management, from the recently launched Sustainability in Action: Best Practices of Global Green and Healthy Hospitals Asia Members and other Countries:

  1. Plan. Every sound management scheme (whether of waste items or not) starts with a solid plan. At this stage, hospitals will lay out their waste management strategy, as well as the roles and responsibilities of each member. Typically, this includes the creation of a waste management committee and the designation of a waste management officer who oversees the day-to-day handling and monitoring of waste. It is equally important for the hospital to know how much and what types of waste it generates, and to what degree it fluctuates.
  2. Minimise.The worst way to deal with waste items is to dispose of them. That is, the most effective waste management solution is to not produce waste in the first place. This is an impossible standard, and in cases where waste is unavoidable hospitals should consider waste minimisation through the reuse of materials as long as patient safety is not compromised. To this end, hospitals should also be smarter with their procurement, opting instead for greener alternatives, such as non-mercury thermometers and recyclable plastic containers.
  3. Segregate. Proper handling and segregation of waste is vital in keeping the hospital environment clean and restful. The immediate responsibility of proper healthcare waste segregation is on the person who produces the waste. At each point of waste generation, there should be separate, properly labelled and colour-coded containers appropriate for the specified type of waste.

    Efforts on healthcare waste are essential not only to provide a safe and sustainable environment for the public but also in passing on available solutions and best practices to other hospitals on healthcare waste management.

  4. Dispose. Prior to disposal, waste items should undergo a variety of treatment processes, to simultaneously minimise potential public health threats and reduce the damage to the environment. While the choice of treatment depends largely on the waste characteristics, immediate environment of the disposal facility and its impact on public and planetary health, the most common ones include: mechanical treatment, such as shredding and grinding; chemical treatment, which involves the use of disinfectants; and steam sterilisation such as using autoclaves in order to destroy pathogens.

On that account, advancement of global healthcare takes not just modern technologies and top-of-the-line medications, but also requires the realisation of a truly sustainable and safe health care systems that understands the link between the sector’s landmark operations and the possible impacts it can create on the environment and people’s health.

Pats Oliva is Communications Campaigner at Health Care Without Harm Asia.

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