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Exposure to hazardous health-care waste can result in disease or injury.

The hazardous nature of health-care waste may be due to one or more of the following characteristics:

• It contains infectious agents;

• It is genotoxic;

• It contains toxic or hazardous chemicals or pharmaceuticals;

• It is radioactive;

• It contains sharps.

The term health-care waste includes all the waste generated within health-care facilities, research centers, and laboratories related to medical procedures. In addition, it includes the same types of waste originating from minor and scattered sources, including waste produced in the course of health-care undertaken in the home (e.g., home dialysis, self-administration of insulin, recuperative care).

Between 75% and 90% of the waste produced by health-care providers is comparable to domestic waste and usually called “nonhazardous” or “general health-care waste.” It comes mostly from the administrative, kitchen, and housekeeping functions at health-care facilities and may also include packaging waste and waste generated during maintenance of health-care buildings. The remaining 10%–25% of health-care waste is regarded as “hazardous” and may pose a variety of environmental and health risks.

Infectious waste may contain any of a great variety of pathogenic microorganisms. Pathogens in infectious waste may enter the human body by a number of routes: through a puncture, abrasion, or cut in the skin; through the mucous membranes; by inhalation; by ingestion. The body fluids are the usual vehicles of transmission.

There is particular concern about infection with human immunodeficiency virus (HIV) and hepatitis viruses B and C, for which there is strong evidence of transmission via health-care waste. These viruses are generally transmitted through injuries from syringe needles contaminated by human blood.

The existence in health-care establishments of bacteria resistant to antibiotics and chemical disinfectants may also contribute to the hazards created by poorly managed health-care waste. It has been demonstrated, for example, that plasmids from laboratory strains contained in health-care waste were transferred to indigenous bacteria via the waste disposal system. Moreover, antibiotic-resistant Escherichia coli have been shown to survive in an activated sludge plant, although there does not seem to be significant transfer of this organism under normal conditions of wastewater disposal and treatment.

All personnel dealing with health-care waste should be familiar with the main categories of health-care waste as set out in either national or local regulations on waste classification. As a minimum, managers responsible for health-care waste should conduct a walk-through of the facility to identify the medical areas that produce waste, to obtain an initial estimate of the types and quantities of waste generated, and to understand how the waste is handled and disposed of. A rapid assessment, combining observations with interviews and survey questionnaires, should provide sufficient data to identify problems and begin the process of addressing them.

All individuals exposed to hazardous health-care waste are potentially at risk, including those within health-care establishments that generate hazardous waste, and those outside these sources who either handle such waste or are exposed to it as a consequence of careless management. The main groups at risk are the following: medical doctors, nurses, health-care auxiliaries, and hospital maintenance personnel; patients in health-care establishments or receiving home care; visitors to health-care establishments; workers in support services allied to health-care establishments, such as laundries, waste handling, and transportation; workers in waste disposal facilities (such as incinerators), including scavengers.

The hazards associated with scattered, small sources of health-care waste should not be overlooked; waste from these sources includes that generated by home-based health-care, such as dialysis, and that generated by illicit drug use (usually intravenous).