Countries: Sierra Leone, Zimbabwe Source: Médecins Sans Frontières What happens after patients receive care is also vitally important to environmental health. In Sierra Leone, primary health care units often struggle to manage medical waste. Incinerators crack and rust. Waste pits fill up quickly. Under typical conditions, medical facilities can generate up to 3 pounds of medical waste per bed per day. In extreme conditions, like conflict or disease outbreaks, this figure increases. If not properly handled and disposed of, medical waste becomes a significant health risk to patients, staff, and nearby communities. Here, Doctors Without Borders/Médecins Sans Frontières (MSF) environmental health team leader in Sierra Leone Iginations Takavada discusses how MSF ensures proper waste management across its medical activities. Why is medical waste management important for health care? Medical waste management is an essential aspect of infection prevention and control, safe and sustainable health care, and environmental health. It is an integral part of MSF operations and ensures that treatment activities do not cause further harm to patients, staff, or the surrounding community. In Sierra Leone, we incorporate medical waste management into health care through emphasizing proper waste segregation at the point of generation. To achieve this, we use specific color-coded bins — yellow for clinical infectious waste and white for autoclaving [high-pressure, high-temperature sterilization] — as well as puncture-proof safety boxes for sharps to prevent injuries and infection transmission. The amount of medical waste generated per day in a clinic or hospital varies significantly based on the number of patients, staff, and services provided. At the MSF-supported Government Maternity and Children’s Hospital in Hangha, Kenema district, where we provide health care for pregnant and lactating women and children under 5, we estimate the quantity of medical waste generated daily at to be between 0. 5 and 3 pounds per bed under typical conditions. We also provide critical waste management support to community health centers across the district to enhance their capacity for proper waste management. MSF also focuses on reducing waste at the source by choosing products with less packaging and opting for reusable equipment such as reusable polyvinyl chloride (PVC) sharps containers [for used needles] which can be cleaned and disinfected. Also, reusable personal protective equipment (PPE) such as gowns, coveralls, aprons, etc. Types of medical waste Sharps: used needles and syringes, scalpels, and glass vials. Soft waste: wound dressings, used gauze, bandages, IV bags, and more. Biological waste: blood and placentas (in maternities), damaged or expired medicines, laboratory reagents, and consumables for biomedical devices. Operational waste: food waste, packaging, used chlorine bleach and other cleaning agents and disinfectants, broken electrical and information and communications technology (ICT) equipment, and used batteries. The challenges and risks of medical waste management are magnified during outbreaks of infectious disease, such as the 2014 Ebola outbreak across west Africa and the 2024 cholera outbreak in Zimbabwe. Working with MSF as part of an outbreak response is difficult, but these experiences have been the most memorable and rewarding for me. The impact of MSF’s work is so apparent. Not only is the waste itself higher risk because it has been in contact with infected patients and body fluids, but the quantity of waste increases significantly due to the requirement for staff treating patients to wear additional personal protective equipment, some of which is single use. How does medical waste impact water and sanitation? If not properly treated and disposed of, medical waste becomes a significant health risk to patients, staff, and nearby communities. When waste is not stored in a dedicated and controlled location before treatment and disposal, children or animals can easily come into contact with it, harming themselves and spreading infectious diseases into the broader environment. Heavy rains can also carry uncontrolled medical waste into water sources, leading to contaminated drinking water and agricultural fields. Why is proper incineration necessary for waste management? Incineration remains one of the most common and effective methods to manage medical waste. It not only destroys infectious pathogens but also greatly reduces the volume of waste by turning it into ash. However, if a high enough temperature is not reached during the burning of waste, there are significant environmental and health risks. Low-temperature burns produce heavy smoke and fine soot. These tiny particles can be inhaled into the lungs, causing respiratory and cardiovascular diseases. Highly toxic, persistent organic pollutants are also created when plastics containing chlorine (like PVC) are burned at low temperatures. They are carcinogenic and can interfere with hormones and reproduction. Toxic ash left behind after a low-temperature burn can leach heavy metals and chemicals into groundwater and nearby soil. Toxins like dioxins and mercury settle on vegetation and in water bodies. They bioaccumulate, meaning their concentration increases as they move up the food chain (e. g. , from grass to livestock to human consumers). MSF frequently uses on-site, low-cost technologies suitable for emergency contexts, including incinerators for soft waste and incineration of safety boxes using box reducers [mini-incinerators that are used to burn cardboard sharps containers, reducing them to ashes and sterilized needles. ] What do you wish people knew about your work? Delivering high quality health care requires so much beyond the medical components, particularly in the challenging contexts where MSF works. Medical waste management is but one such component. There are water systems, toilets, showers, lights, vaccine refrigerators, generators, and ambulances that all need to be running every day. Medicines, medical supplies, food, and equipment need to be bought and transported to the health care facility continuously. It takes a lot of work and a full team, but the results can be impressive.
Sierra Leone: Why medical waste management is an essential part of health care
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