International Council of Nurses [Fact Sheet - Immunisation Safety: Safe Waste Disposal Practices Save Lives]

Immunisation Safety: Safe Waste Disposal Practices Save Lives

Best infection control practices for intradermal, subcutaneous, and intramuscular needle injections [pdf file, 568 KB]
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Waste generated by health facilities includes sharps, non-sharps, blood, body parts, chemicals, pharmaceuticals, medical devices and other materials. ⁱ In many countries, the disposal of used injection equipment and reuse of contaminated syringes and needles pose a significant public health threat. Therefore, a comprehensive health care waste management system is an integral part of good immunisation safety practices.

The disease burden caused by poor management of health care waste is prompting a commitment and behaviour change among health care professionals, the public and others involved in the health care waste management. An effective health care waste management system ensures the safe collection, disposal and destruction of used injection equipment, protecting the public from injury and exposure to hazardous waste products. ICN believes that nurses have a duty to reduce or eliminate the harmful effects of waste disposal practices. ⁱⁱ

Hazards of Unsafe Health Care Waste Management

Unsafe health care waste practices expose health care professionals, waste handlers and the community to infections and injuries. ⁱⁱⁱ Needle stick injuries, reuse and resale of contaminated syringes and needles are great risks to human health and the cause of infectious disease worldwide. Poor waste management is also an environmental hazard that can result in the release of toxic compounds into the air, soil and water. To reduce these risks, potentially infectious waste should be separated from non-harmful waste, treated and disposed. Systematic monitoring and evaluation of health care waste technology and good waste management practices are vital to improving public health initiatives.

Health Care Waste Technology and Procedures

There is no perfect “environment friendly” strategy for eliminating health care waste. ^iv However, when selecting health care waste technology and treatment, risks and benefits should be carefully weighed to ensure best practice and minimise risks to health care workers and the community. A variety of waste technology and treatments are currently available and should be chosen to suit the needs of a health care facility and community

The use of auto-disable syringes and safety boxes/containers ensures safe injection practices. An appropriate amount of puncture-proof sharp containers and/or safety boxes should be available in all immunisation settings. When sharp containers/boxes are no more than three quarters full, they should be sealed tightly and disposed in a plastic bag . ^v When plastic bags are three quarters full, they should be labelled or colour coded as potentially infectious waste, sealed and sent for disposal. All potentially infectious non-sharps, such as gauze and vaccine vials, should be disposed in a labelled waste container and closed when three quarters full.

Waste disposal routes can vary according to health care facility policy. In many situations, plastic bags are placed in a central storage area or in a temporary storage container and sent to be processed as potentially infectious waste. Non-harmful waste should, at all times, be stored separately from all potentially infectious waste. As much as possible, waste bags should not be hand-carried for long distances as this increases the risk of injury or spillage. Storage areas should be kept tidy and restricted to authorised personnel only. When handling waste, all health personnel should wear appropriate protective gears such as gloves, boots, trousers or aprons, and maintain good hand washing and infection control practices at all times.

To facilitate the safe collection and disposal of contaminated syringes and needles, devices such as portable needle pullers can be used for the removal of sharps. In some facilities, used needles can be melted by electric currents. Liquid waste is disinfected and placed into an underground tank that takes 5 to 10 years to fill . ^vi Large quantities of plastic are often generated from most immunisation practices. Used syringes and other plastics can be steam sterilised or chemically disinfected, shredded and recycled. Equipment such as autoclaves, microwaves, hydroclaves or dry heat systems can ensure the disinfection of highly infected waste prior to its disposal or recycling.

In resource-poor settings, adequate methods for disinfecting and pre-treating waste products may not be available. Instead, waste is often taken directly to an on-site incinerator and burnt immediately. The World Health Organization (WHO) does not advocate incineration as a final solution. ^vii Poorly maintained and wrongly used incinerators can emit pollutants such as trace metals, dioxins and others. Such emissions may lead to various illnesses in exposed populations.

In some countries, incineration is currently the only option available to eliminating re-use and re-sale of contaminated injection equipment. In addition, burial pits and landfills are not always safe alternatives in areas of high population density and insufficient land. The identification of appropriate options in all health facilities and communities is essential to in order to achieve safe, environment-friendly management of health care waste.

Policy and Planning for Safe Health Care Waste Management

All health facilities that generate health care waste require a waste management policy and a comprehensive system of best practices and safety standards. Strong political and economic support with sufficient human and financial resources is required to create a health care waste management system. An understanding of current legislation related to environmental protection is also important to the proper assessment and implementation of waste management and infection control practices. An effective waste management framework can best be achieved through coordinated efforts of health care professionals, municipalities and regional administrators, Ministries of Health, environmental agencies and other key partners.

Health care professionals at all levels should have waste management training and education. The public should also be educated and become aware of the risks associated with poor health care waste management. Advocacy campaigns that target policy-makers, health organisations, the media and the public can help ensure a shared responsibility for safe disposal of health care waste. Within health care establishments, occupational health nurses, nurse managers and others should participate in the surveillance of infection control and waste management practices. Poor waste management practices need to be identified and addressed to reduce risks and establish guidelines for infection control. Because nurses are directly involved in providing immunisation services, they must be involved at all levels of health care waste management policy.

For further information please contact:

i	World Health Organization. Aide-Memoire. For a national strategy for health-care waste management. September, 2000. WHO. www.healthcarewaste.org/.
ii	ICN Position Statement (1998), Medical Waste: Role of Nurses and Nursing.
iii	World Health Organization. Safe Injection Global Network (SIGN). Annual Meeting Report. 30-31 August, 2001. Injection and Waste Management Technology Day. 29 August, 2001. WHO.
iv	The Global Alliance For Vaccines & Immunization (GAVI). Gavi and the Vaccine fund Support to Improve the Safety of Immunization Programs. Fifth Gavi Board Meeting. 21-22 June, 2001, London, England. June 2001. www.Vaccine-Alliance.org.
v	World Health Organization. Regional Office for Europe. (2000). Copenhagen. Starting Health Care Waste Management in Medical Institutions. A Practical Approach. Health Care Waste Practical Information Series. No. 1. WHO.
vi	Global Alliance for Vaccines and Immunization (GAVI). Immunization Focus. March 2002. www.Vaccine-Alliance.org.
vii	Expanded Programme On Immunization (EPI). New developments in safe immunization. December 2001. http://www.wpro.who.int/pdf/rcm53/rd/01_EPI_5.pdf.