Medical waste-management practices vary across Canada How does Canada stack up?
Medical waste-management practices vary across
Canada
November 17, 2011 - Condoms and syringes mixed
with household waste and then exported from the United Kingdom to
Brazil for recycling. Scalpels and other sharps left in heaps
outside of hospitals. Effluents from health facilities "discharged
directly in rivers and other water streams." Hazardous materials
incinerated at inadequate temperatures. Deaths in Brazil, Algeria,
Morocco and Mexico caused by improper disposal of radiotherapy
materials.
As disturbing as the litany of unsound world practices in the
disposal of medical waste was United Nations Special Rapporteur
Calin Georgescu's conclusion that "only a limited number of
countries has developed, or is in the process of developing, a
national regulatory framework" to handle the mountain of medical
waste now being produced by the world's health facilities (www2.ohchr.org/english/bodies/hrcouncil/docs/18session/A-HRC-18-31_en.pdf).
How does Canada stack up?
Well, medical waste disposal certainly doesn't fall under the
rubric of a national regulatory framework, but that's in part a
product of proverbial Canadian jurisdictional splits on matters of
health.
And while not all provinces have regulations governing the
handling and disposal of medical waste, environmental experts say
most jurisdictions do a reasonable job of disposal and aren't party
to the sort of egregious abuses witnessed in some other
nations.
For the most part, Canada doesn't take as heavy a regulatory
approach toward hazardous medical waste as the United States, says
Colin Rasmussen, a cell biologist and patent attorney with legal
practices in both Saskatchwan and California. "Canada I don't think
has really been jumping on the bandwagon of regulation because I
suspect typically things get regulated when there's this perception
that it needs to be regulated and I don't think there's been this
perception that it's been a big problem."
The majority of provinces rely on umbrella legislation governing
all waste material to regulate the handling the medical waste. Only
Quebec appears to have biomedical waste-specific legislation (www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=3&file=/Q_2/Q2R12_A.htm).
Some provinces, though, have guidelines and targets for the
management of biomedical waste. In whatever form, regulations or
guidelines, most provinces also appear to aim their approach at
achieving minimum national standards for handling biomedical waste
that were developed by the Canadian Council of Ministers of the
Environment in 1992 (www.ccme.ca/assets/pdf/pn_1060_e.pdf).
Whatever the legal foundation used to regulate medical waste, it
has generally resulted in some manner of requirement that hazardous
medical waste be sterilized prior to disposal at a landfill. That's
the case in Ontario, says Kate Jordan, a spokesperson for the
Ontario Ministry of the Environment. She adds that sharps, such as
needles and syringes, have to be put into containers and treated by
either autoclaving or hydroclaving.
"Once they've been treated they're no longer considered
biomedical waste because they've been properly sanitized so they
don't pose any health risk," Jordan says. But the biomedical waste
must nevertheless be segregated from domestic waste and buried
separately, "as a general best management practice," she adds.
For the most part, Canada's hospitals appear to moving away from
on-site incinerators toward centralized provincial facilities for
the actual sterilization of biomedical waste.
In British Columbia, Alberta, New Brunswick and Nova Scotia, all
hazardous biomedical waste is taken to a third-party vendor or
disposed of at a centralized facility.
That's part of a nation-wide trend to take incineration out of
the hands of hospitals, Environment Canada spokesperson Henry Lau
writes in an email. "In their place, commercial medical waste
incineration facilities have been established to handle the medical
waste generated over a larger geographic area."
Lau adds that it is up to each province to implement standards
recommended by the Canadian Council of Ministers of the
Environment, which indicate that landfills should only accept waste
that has been decontaminated; that facilities should prearrange
required volumes with landfill operators; that facilities should
provide evidence of treatment of their waste before sending it to
landfills; that decontaminated waste should be buried immediately
or in compliance with a designated schedule; and that the waste
should be covered with earth or other waste to prevent direct
contact with landfill equipment.
But it's unclear how often governments inspect practices,
incineration facilities or landfills. Kathleen Range, spokesperson
for Alberta Health and Wellness says the "collection and
segregation of biomedical wastes at the place of generation
are carried out in accordance with waste-management procedures
outlined in regional infection control procedures developed by
institutions or Alberta Health Services."
Some suggest that medical waste disposal in Canada may rely too
heavily on goodwill rather than strict regulation, and that there
is a need for a more national approach.
"To me it's a continuum," says Rachel Bard, chief executive
officer for the Canadian Nurses Association. The federal government
has a leadership role to set benchmarks, the provinces must enact
legislation to achieve those targets, and health care facilities
must have the processes in place to ensure implementation and
compliance, she says. "It's a multi-prong approach. I think there's
responsibility at all levels."
Georgescu's report to the UN recommended that all countries
develop comprehensive waste-management strategies, including
specific definitions of what constitutes waste, clearly defined
duties and responsibilities for each player in the waste-management
process, the identification of a "national authority responsible
for overseeing the implementation of the law and its enforcement,"
and specific penalties for contravention.
He also urged:
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"Measures to raise awareness of the problems, especially among
policymakers and communities living in the vicinity of sites where
medical waste is incinerated or landfilled. Non-governmental
organizations working in the field of public health or
environmental protection should include the promotion of sound
health-care waste management in their advocacy and conduct
programmes and activities that contribute to sound health-care
waste management."
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The adoption of strict occupational health and safety frameworks
within hospitals to protect health care works, complete with
"adequate human, technical and financial resources to national
authorities responsible for its enforcement," as well as proper
training of staff who must handle medical waste, and proper
protection for workers, such as vaccinations and the provision of
appropriate equipment.
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That governments allocate "adequate financial resources to all
public and private institutions and bodies responsible for the safe
and environmentally sound management of health-care waste."
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That countries develop and adopt comprehensive health care
waste-management plans, including policies to separate hazardous
waste at source and policies for the proper handling,
transportation, storage and disposal of medical waste.
Editor's note: First of a two-part series