Healthcare waste management in developing countries
Drum or brick
- Drastic reduction of
weight and volume of the
- Very low investment and
- Destroys only 99% of
- No destruction of many
- Massive emission of
black smoke, fly ash,
toxic flue gas, and
- General healthcare
- Infectious waste
BUT it should be used
only in case of emergency
Table 2: Types of incinerator commonly available in low-income countries (WHO, 1999;
Criteria for decision making
Various factors should be considered before implementing an incinerator and in order to choose
a technology that is appropriate to the context. The following ones are some of the questions
decision makers should try to answer:
What is the available space?
Where is the incinerator going to be located?
How much HCW is generated?
What is the waste composition?
Is the waste separated?
What is the system of HCW management in place?
What are the options available for the final disposal of waste?
Who is going to be in charge of the incinerator?
What are the investment and operation costs likely to be?
How will the ashes be dealt with?
How will needles be dealt with?
Are the materials to build the incinerator locally available?
Are the technical skills for operation and maintenance of the incinerator locally
Are there specific regulations concerning HCW?
What is the opinion of local community and staff on the system to be adopted?
A variety of non-incineration treatment technologies, including several low cost options are
available or under development. Common processes in low-income countries include autoclaving,
chemical processes and containment processes (WHO, 2005).
Autoclaving is an efficient wet thermal disinfection process. Typically, autoclaves are used in
hospitals for the sterilization of reusable medical equipment. They allow for the treatment of only
limited quantities of waste and are therefore commonly used only for highly infectious waste,
such as microbial cultures or sharps. Research has shown that effective inactivation of all
vegetative microorganisms and most bacterial spores in a small amount of waste (about 5– 8 kg)
requires a 60-minute cycle at 121°C (minimum) and 1 bar (100 kPa); this allows for full steam
penetration of the waste material.
Chemical disinfection is an efficient process, but it is usually costly because the prices of
disinfectants are high. For safe operation it requires trained technicians provided with adequate
protective equipment and is therefore not recommended for treating all infectious healthcare
waste. However, the process can be useful in specific cases, such as disinfection of recyclable
sharps or disinfection of stools from cholera patients.
Containment processes deal with waste disposal phase and can be characterized by different
levels of complexity. When waste are to be landfilled in municipal disposal sites, the presence of
an established system for rational and organized disposal of waste, engineering works completed
to prepare the site to retain its wastes more effectively and rapid burial of healthcare waste are