Burn baby, burn!

Healthcare waste is often incinerated and dioxins, furans and other toxic air pollutants may be produced as emissions. CLAIRE RENCKEN investigates.

Over the last few years, there has been growing controversy over the incineration of healthcare waste. In some instances – including when wastes are incinerated at low temperatures, or when plastics that contain polyvinyl chloride (PVC) are incinerated – dioxins, furans and co-planar polychlorinated biphenyls (PCBs) may be produced as emissions and/or in ash. Exposure to these substances can sometimes lead to adverse health effects.

Among the different dioxins and furans, not all have the same toxicity; some are even harmless. Dioxins, furans and co-planar PCBs are persistent substances that do not readily break down in the environment and that bio-accumulate in the food chain.

Long-term, low-level exposure of humans to dioxins and furans may lead to impairment of the immune system, as well as impairment of the development of the nervous system, the endocrine system and the reproductive functions.

Short-term, high-level exposure may result in skin lesions and altered liver function. Exposure of animals to dioxins has resulted in several types of cancer.

The International Agency for Research on Cancer (IARC) classifies dioxins as a “known human carcinogen”. However, most of the evidence documenting the toxicity of dioxins and furans is based on studies of populations that have been exposed to high concentrations of dioxins, either occupationally or through industrial accidents. There is currently insufficient evidence to prove that chronic, low-level exposures to dioxins and furans cause cancer in humans.

The safe disposal of healthcare waste generated at smaller rural clinics, or larger facilities where adequate, well-operated infrastructure exists, is feasible. However, the volume of waste generated within large facilities where resources are limited, or during immunisation campaigns, may be difficult to dispose of safely.

To reduce exposure to toxic pollutants associated with the combustion process, best practices for incineration must be promoted and should include:

• Effective waste reduction and waste segregation, ensuring that only appropriate wastes are incinerated;

• Situating incinerators away from areas that are populated, or where food is grown, thus minimising exposure;

• A properly engineered design, ensuring that combustion conditions are appropriate, for example, sufficient residence time and temperatures to minimise products of incomplete combustion;

• Construction of disposal units that follow detailed dimensional plans, thus avoiding flaws that can lead to incomplete destruction of waste, higher emissions and premature failure of the incinerator;

• Proper operation of incinerators, which is critical to achieving the desired combustion conditions and reducing emissions;

• Periodic maintenance to replace or repair defective components, including inspection, spare parts inventory and record keeping;

• Enhanced training and management – possibly promoted by certification and inspection programmes for operators; and

• the availability of an operating and maintenance manual and maintenance programmes.

The World Health Organisation (WHO) aims to promote effective non-burn technologies for the final disposal of medical wastes, to avoid both the disease burden from unsafe healthcare waste management, and the potential risks from dioxins, furans and co-planar PCBs. The WHO has committed to:

• Prevent the health risks associated with exposure to healthcare waste for both health workers and the public, by promoting environmentally sound management policies for healthcare waste;

• Support global efforts to reduce the amount of noxious emissions released into the atmosphere, to reduce disease and defer the onset of global climate change;

• Support the Stockholm Convention on persistent organic pollutants (POPs);

• Support the Basel Convention (1989) on hazardous wastes and other wastes;

• Reduce the exposure to toxic pollutants associated with the combustion process through
the promotion of appropriate practices for high temperature incineration.

Gloves in a bottle

Working in an environment where you are constantly coming into contact with moisture-depleting irritants can result in dry, cracked, red, itchy or flaky skin.

Gloves in a bottle (GIAB) Shielding Lotion from Medloyd Healthcare, has been scientifically tested to be more effective than conventional moisturisers, most of which do not penetrate beneath the second major layer of skin. GIAB does not wash off through conventional washing. A single application provides deep rooted skincare that lasts between four and 12 hours.

GIAB works by locking in the natural moisture and oils of the skin.