Among the various waste-generating sectors, the health care sector differs from the others in that it requires specific management. In particular, the emergency caused by the spread of the Covid-19 pandemic has given rise to a number of problems in the waste sector relating to the protection of public health and the protection of the environment.
What is meant by “medical waste”?
The World Health Organisation (WHO) defines “healthcare waste” (HR) as waste generated by facilities providing health services (hospitals, emergency departments, medical offices, research laboratories, etc. ).
In Italy, on the other hand, the management of healthcare waste is regulated by DPR 15. 07. 2003, which defines RS as waste that derives from public and private facilities carrying out medical and veterinary activities of prevention, diagnosis, treatment, rehabilitation, and research. In essence, therefore, all waste is generated by healthcare activities, regardless of the nature of the waste.
Medical waste is divided into:
-non-hazardous (including urban ones);
-dangerous not infectious;
-dangerous to infectious risk (i. e. waste from infectious isolation environments where there is a risk of aerial biological transmission.
The Regulation also regulates waste from exhumations and other cemetery activities. It also identifies different management methods depending on the type of waste.
Non-hazardous waste is disposed of in the wrong line of municipal waste (e. g. food waste from health facilities, disposable bed linen which does not come from the rooms of patients suffering from infectious diseases, etc. ).
Conversely, hazardous waste with an infectious risk should only be disposed of in hazardous waste incineration plants, taking care to avoid direct handling of the waste during the loading of the waste into the furnace. However, there is also the possibility of disposing of infectious waste in the same way as non-hazardous waste, provided that it is sterilized first so as to reduce bacterial load.
The impact of the pandemic on waste management
While hospital wards at risk of infection are limited at normal times, the number of beds dedicated to patients with Covid-19 and intensive care has increased since the beginning of the pandemic. The result has therefore been a sharp increase in the number of products to be treated with special processes as regards waste. According to Valeria Frittelloni, in charge of the National Center of the waste and the circular economy of Ispra (Higher Institute for Protection and Environmental Research), “Making a close estimate of the number of beds, we can expect at least a doubling, especially considering that, for precautionary reasons, the Ministry of Health has now classified all waste generated by health facilities as infectious. We are talking about a production that, under ordinary conditions, is around 200 thousand tons per year throughout the national territory. This is a fairly small size compared to the size of special waste, which amounts to 150 million tonnes a year. But we expect, when the data comes, a significant increase. ”
The biggest problem, however, is not waste from healthcare facilities, but the management of highly infectious materials produced outside the healthcare system. The Higher Institute of Health (ISS) intervened directly on this issue. According to Valeria Frittelloni, “For domestic users with a quarantined subject or a Covid patient, the ISS has recommended treating waste in the same way as waste from healthcare facilities. He therefore called for a halt to separate collection for those users and recommended that citizens use double or triple bags for collection. At the same time it gave instructions on the training of operators, who must be equipped with all personal protective equipment to protect themselves from the risk of contagion. ” However, operators cannot always know who is in quarantine and which users are highly infectious. In addition, each region has chosen different management methods. Tuscany, for example, has planned a dedicated collection with specialized operators for quarantine subjects. Liguria, on the other hand, has classified all municipal waste as infectious. Lombardi, especially in the first period of the health emergency, stopped the separate collection and all the waste was sent to incineration.
Another issue concerns the elasticity of the waste system. Proper waste management is even more important in an emergency phase. However, the Italian system is still very rigid. “We need the system to become more flexible, so that we can respond resiliently to any crisis”, are the words used by Valeria Frittelloni.