Biomedical waste: Why bio-medical waste poses challenges to Ukraine's healthcare system?

Author : Oleh Titamir

Source : 112 Ukraine

The problem of handling medical waste, which is one of the most dangerous for the environment and the health of our citizens, has become especially urgent in connection with the coronavirus pandemic
16:00, 27 October 2021

Unfortunately, Ukraine cannot boast of a well-established system of the utilization of medical "trash" - due to the traditional lack of budgetary funds, lack of the latest technologies and managerial insolvency and negligence of specialized officials, banal excess of the executor. Hence the increased risks of infection of citizens with coronavirus and other dangerous diseases. But are there options to change the situation for the better in this area?

Medical waste: a disastrous state of affairs

First of all, it should be noted that medical waste, according to the current Ukrainian legislation, is classified as hazardous. Thus, according to the UN definition, such wastes include "infectious waste, sharps, anatomical and pathological waste, old or obsolete chemical products, pharmaceuticals, and radioactive materials." Today, medical waste associated with Covid-19 has been added to this array, which must be reliably disinfected and isolated in special containers. In addition, the standards for reliable protection of personnel of medical institutions with special means must be carefully observed.

Of course, it is categorically unacceptable for toxic medical waste to end up in the general massif - in containers for solid household waste - and then taken to landfills or spontaneous dumps without appropriate packaging and disposal. After all, such barbaric ways of behavior, together with the incineration of medical waste without the use of modern technologies, lead to extremely dangerous consequences - black smog, air pollution, the ingress of these caustic residues into sewage and soils, and their poisoning. If 1 g of household waste contains from 0.1 to 1 billion microorganisms, then in medical waste this amount increases to 200-300 billion!

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In accordance with current legislation, funding for the collection, removal, and disposal of medical waste falls on institutions and enterprises that produce or import medical and pharmaceutical products and provide medical services. First of all, specific medical institutions are responsible for the correct handling of such waste, which, in fact, produce this hazardous waste. It is the hospitals that must ensure the disinfection, proper sorting, and packaging of this toxicologically and epidemiologically dangerous "trash" and transfer it to specially licensed companies for disposal.

By law, these structures must destroy hazardous medical waste without harm to the environment and people. Such companies, by the way, receive licenses from the Ministry of Environmental Protection and Natural Resources of Ukraine. They must have the appropriate infrastructure, equipment, technologies, and reliable filtration systems for oxygen-free combustion in special furnaces (pyrolysis method) or for other methods of disposal (autoclaving, microwave treatment, steam-heat treatment in combination with internal stirring, chemical treatment, etc).

But are all established standards and algorithms observed in practice in Ukraine? What problems do medical institutions and the domestic communal system as a whole face? And are there enough specialized companies in our country that are able to properly dispose of medical waste, and not just throw it into landfills? Let's outline the main problems in this important segment.

Firstly, in Ukraine, according to the international charitable organization "Ecology - Right - Man", about 380-400 thousand tons of medical waste are accumulated annually. Of these, 100-120,000 tons are extremely dangerous. According to another study from the Lviv Polytechnic National University, Ukraine today has accumulated 5 billion cubic meters of toxic and highly toxic waste, of which 20% are extremely hazardous to the environment. Toxic substances contained in them can cause some forms of cancer, AIDS, viral hepatitis, other diseases, and now the coronavirus. According to environmentalists, the lion's share (70-90%) of medical waste is not properly collected, packaged, or disposed of - they end up in the general garbage array at landfills and spontaneous dumps!

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At the same time, there is still no clear mechanism in Ukraine that would regulate the adequate handling of medical waste. There is practically no comprehensive control of medical institutions and specialized companies by the State Ecological Inspectorate, the Ministry of Health, and local authorities on compliance with standards and legislative norms governing the handling of medical waste! And what are the just ridiculous fines in the amount of 30 USD, which the SEI can impose on violators of the law in this area?!

By the way, today, during the pandemic, neither the central nor the local authorities have introduced an extensive network of special containers and reception points - to collect medical masks and gloves from the population! But what can we say about this, if even in Kyiv, most apartment buildings are still not provided with bins for separate waste collection!

Secondly, most healthcare facilities dispose of the medical residues they produce in solid household waste containers! Unfortunately, an effective system of interaction between medical institutions and utilizers has not yet been established. At the same time, most state and municipal clinics do not adhere to the basic standard of medical waste management, which implies the availability of appropriate safe containers for their storage and transportation!

As you know, hospitals in Ukraine have simply beggar budgets - medical equipment is outdated in some places, patients buy most of the medicines at their own expense. The underfunding of hospitals has become even more noticeable during the transitional period of medical reform: hospitals and other institutions no longer receive funds in the form of medical subventions, they are centrally distributed by the National Health Service of Ukraine. But even in the conditions of an alleged increase in funds from the state budget for the treatment of those infected with coronavirus, for example, the Lviv Center for Lung Health lacks a million hryvnia per month. And there are many such examples in Ukraine!

Are the heads of state or communal medical institutions capable of ensuring adequate treatment of medical waste in these circumstances, if patients cannot be treated with quality due to the lack of modern, high-tech equipment? Moreover, the financing of hospitals under the article of correct collection, packaging, and proper storage of medical waste traditionally occurs in Ukraine on a leftover basis. If they stand out, then they are mere pennies. Some clinics receive compensation of several thousand hryvnias per month, producing 500-600 kg of such waste! At the same time, with an average cost of disposal of 1 kg of 2-3 USD, the real costs are 2-4 times more! The funds received from the budget are often not enough to even for the purchase of appropriate containers, let alone for transportation! That is why, in most cases, hazardous waste in domestic medical institutions is thrown into the general "boiler" of the VHF. At the same time, many hospitals sign deals with fictitious companies for minimal money and throw their waste into ordinary landfills or even spontaneous landfills!

Today, the same situation maybe even worse due to an increase in the number of infectious patients and an array of medical waste in the form of disposable protective equipment for hospital personnel (masks, gloves, special gowns, etc.). Unfortunately, even with the beginning of the pandemic, there were many "cases" of the really shameful treatment of medical waste, caused by the banal poverty of the state and the irresponsibility of officials.

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So, in the city of Monastyrsk, Ternopil region (which in the spring of 2020 was one of the epicenters of the coronavirus), in the summer of the same year, journalists recorded that hazardous waste was thrown into a common trash can in the district hospital on its territory, and then burned on the banks of the Koropets River! The worst thing is that you won't surprise anyone with such "practice" in Ukraine, these barbaric methods are widespread throughout the state (which for some reason seeks to join the European Union). And the main thing is that the heads of medical institutions themselves can easily find supposedly rational excuses!

In my opinion, a systemic and critical mistake of state management is the transfer of financial responsibility for preparation for the disposal of medical waste to medical institutions. Isn't this segment an integral part of both national and municipal waste management systems? After all, the main function of medical institutions is the high-quality treatment of Ukrainians (for which state funds are spent). So why do clinics still have to pay money, which is already sorely lacking even for the provision of basic medical services?

And are the budgets of hospitals able to "stretch" an additional item of expenditure, if, for example, the price of a modern plant for chemical treatment of medical waste starts from 50 thousand euros? Is it not a public matter to provide every Ukrainian hospital with this expensive, but effective equipment?

- proper control should be established by the State Environmental Inspection (inspections of medical institutions and licensed companies 1-2 times a month), and especially - it is necessary to strengthen responsibility for non-compliance with legislation on the disposal of medical waste. Fines should start from at least 800 USD for minor violations and end with criminal liability if negligent handling of hazardous waste entailed serious harm to the environment and society;

- it is necessary to introduce the best world and European standards of international associations for the quality of medical services, the World Health Organization, the European Union, by introducing a waste management system. Moreover, in every Ukrainian city (as, for example, in neighboring Poland) there should be a pyrolysis waste incineration station. Ideally, every Ukrainian hospital should be provided with a facility for the chemical treatment of medical waste.

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By the way, it is worth borrowing, say, NATO algorithms and standards (Essential field sanitary requirements) for the packaging and storage of hazardous waste. According to these requirements, special containers made of durable and reliable insulating material are used for sharp objects (such as syringes, worn-out medical instruments); special red bags (containers) or other containers resistant to punctures and leakage of liquid of a certain color are used for storing medical waste; neutralize medical waste using autoclaves, steam sterilizers, mobile or stationary incinerators, etc. At the same time, today, during the fight against coronavirus, municipalities should deploy wide networks of points for the separate collection of protective masks and gloves from the population, as has been introduced since the beginning of the pandemic by China and the United States in particular.

Until this is done, Ukraine will continue to drown in the garbage, including toxic, like medical waste. The authorities should sound the alarm today, and not blindly ignore this dangerous problem, only from time to time formally reporting on unsystematic, single control measures.

At the end of last year, the head of the State Environmental Inspectorate, Andrei Malevanny, announced an unscheduled inspection of companies in the field of medical waste management. After all, as he then noted, in 2020 about 100 thousand tons of medical waste was formed in Ukraine, but only 50,000 were taken by carriers, and the amount of recycled waste is generally unknown. And in April this year, the State Environmental Inspection checked "as many" as 20 enterprises working with medical waste. 5 of them were canceled licenses to carry out activities, and 7 SEI enterprises filed claims to the court to terminate their activities due to numerous environmental violations. But, unfortunately, these are only isolated cases of control over the handling of hazardous medical waste. However, for this work to be systematic, it is necessary that the authorities do not close their eyes to literally every negative case.

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