Vol. 22, No. 2
Books and Publications
Publication from the World Health Organization
Safe Management of Wastes from Health Care Activities.
Edited by A. Prüss, E. Giroult, and P. Rushbrook
1999, xiv + 230 pages + 4 color plates (available in English; French
and Spanish in preparation), ISBN 92-4- 154525-9, CHF 72.-/USD 64.80;
In developing countries: CHF 50.40, Order No. 1150453.
This handbook provides the first comprehensive guide to the safe and
efficient handling, treatment, and disposal of all categories of hazardous
waste generated by health care activities. Although the major emphasis
is on waste generated by hospitals, guidelines and advice are also relevant
to wastes produced in health centers, research facilities, and laboratories,
or associated with home care or treatment in doctors' and dentists'
In publishing this handbook, WHO aims not only to promote a sound managerial
approach and the use of appropriate technologies, but also to inform
countries about the health risks that result from inadequate management
of health care waste. With these goals in mind, the book provides both
an alert to documented public health and environmental hazards and a
catalog of the technical, managerial, and legislative options available
for reducing these risks. All components of a waste management policyówhether
at the national or institutional levelóare considered in detail.
Although recommended policies and procedures have universal relevance,
the handbook gives particular attention to conditions in developing
countries, where methods for the safe treatment and disposal of hazardous
waste may be limited. With these conditions in mind, the handbook includes
approaches for gradual improvements together with a catalog of options
for waste management that include both simple and highly sophisticated
technologies. Throughout, photographs, line drawings, checklists, tables,
and step-by-step procedures are used to enhance the practical value
of the wealth of guidance provided.
The book opens with a definition and characterization of hazardous
health care wastes categorized as infectious waste, pathological waste,
sharps, pharmaceutical waste, genotoxic waste, chemical waste, waste
with high content of heavy metals, pressurized containers, and radioactive
waste. The health consequences of exposure to each category of waste
are described in the next chapter, which considers the nature and severity
of associated health hazards, factors influencing the likelihood of
exposure, persons at risk, and significance for public health. Concentrated
cultures of pathogens and contaminated sharps are identified as the
waste items that represent the most acute potential hazards to health.
Other chapters consider legislative, regulatory, and policy issues,
and offer a step-by-step guide to the planning of waste management,
including use of a detailed model survey questionnaire for gathering
data on waste generation and management practices in hospitals.
Against this background, five chapters offer guidance in a range of
specific practices and procedures for safe waste management. Chapters
cover strategies for waste minimization, recycling, and reuse; good
practices in the handling, segregation, packaging, storage, and transportation
of wastes; a wide range of treatment and disposal technologies appropriate
for specific categories of waste; and the collection and safe disposal
of hazardous wastewater. The remaining chapters discuss costs, health
and safety practices for health care personnel and waste workers, the
management of spillage and other emergencies, basic principles of hospital
hygiene and infection control, and training needs. The final chapter
sets out a minimum program of essential waste management practices considered
suitable for smaller rural health care establishments and field hospitals
in refugee camps and other temporary situations.