Comparison of infectious waste management in European hospitals

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Abstract

A research project sponsored by the EC-LIFE programme was conducted to compare waste management in five different European hospitals. A comparison of the regulations governing current waste management revealed different strategies for defining infectious hospital waste. The differences in the infrastructure were examined and the consequences for waste segregation and disposal were discussed under economic and ecological aspects. In this context the definition of infectious waste is very important.

Introduction

Waste is more than just rubbish to be disposed of and forgotten about. This fact is reflected in the increasing number of different waste disposal regulations1., 2., 3., 4., 5., 6., 7. and in the continuous development of waste segregation and treatment systems.8., 9., 10., 11.

Although there are still pronounced differences in the practical design of disposal systems, in most countries there is a growing awareness that the enormous volumes of waste generated not only result in huge disposal costs, but also that there is still a great deal of energy and re-usable material in waste which should not be carelessly discarded and ignored.

In the assessment of hospital waste, the focus lies mainly on the biological hazards caused by bacteria.12., 13., 14., 15., 16. In particular, the fact that biological systems are capable of reproducing themselves is considered to be very unpleasant. So far, the question of the extent to which hospital waste represents a suitable medium for the reproduction of bacteria has not been answered conclusively. However, studies on the bacterial content of hospital waste appear to indicate that it is not a very good culture medium for pathogens and disease transmission; so far, it has not been possible to provide a conclusive answer to the question as to whether, or at what point, any existing pathogens are transmitted from waste to humans. Empirical data show that it is mainly in intermediate animal hosts where pathogens, if allowed to multiply, can cause problems. But whether there are any differences in this respect between hospital waste and other waste remains unclear.

Modern disposal technology, whether properly managed landfills or incinerator units, provide a great deal of protection.

Section snippets

Methods

The project described here investigated waste management policies in five hospitals in five different European countries. The project, which was funded by the EU Commission LIFE 96 programme (LIFE96/ENV/D/10) examined disposal practices, the applicable regulations, available infrastructure, climate conditions and the organization of waste collection and disposal in the hospitals. Regulations and guidance documents, relevant to waste management, were collected and compared. The results were

Classification of medical wastes from hospitals

Rules and regulations pertaining to the current practice for the definition and disposal of healthcare waste vary widely in the countries surveyed. Specific legislation on hospital waste is only in place and enforced in Catalonia. With the exception of Italy, in all other countries classification and disposal of hospital waste is regulated by ordinances. In Italy, no specific rules exist, and the general law covering waste management provides only a very rough definition of hospital waste.

Definitions of infectious waste

A central issue concerning hospital waste disposal is the assessment of the real and potential risks emanating from waste with the focus on the risk of infection. This is reflected in the different definitions developed by the individual countries. In general, two strategies are applied for definition of infectious waste: Catalonia (Spain) and Germany largely apply a narrow pathogen-related definition of waste management. In the other countries, waste is classified in terms of its source and

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