Alternatives to Incineration
Alongside waste minimisation and segregation, the other key issue in medical waste management is how best to treat the unavoidable waste.
In the past, incineration was the technology of choice but it inevitably produces dioxin, one of the most toxic and persistent pollutants known to science — and most industrialised countries insist on complex and costly control measures to capture it. The resulting waste, such as fly ash, then must be disposed of as hazardous waste.
The scale of the problem is amply illustrated by the fact that, in 1994, the US Environmental Protection Agency announced that medical waste incinerators were responsible for 40% of the entire country's air dioxin pollution.
Most incinerators in the Global South have few or no pollution control devices, and so will release large quantities of dioxin, which can then enter the food chain. In rural areas where the smallest and most polluting incinerators are often found, it's not uncommon to see chickens scratching in the dust where the ash has been dumped — with the result that dioxin ends up transferred to their eggs. Dairy products are also particularly vulnerable to contamination of this type.
Part of the problem is that medical waste often contains a lot of PVC, and the chlorine in it is a vital ingredient in dioxin. Because of this, the World Health Organisation recommends that PVC waste not be incinerated; and Indian legislation rules it out entirely. For more information, see our PVC section.
The Stockholm Convention, which has been signed by over 150 countries, requires that best environmental practices and best available technologies are used to reduce the amount of dioxin from incineration.
There is ample proof that this can be done. In the last 20 years, the US has closed 99% of its medical waste incinerators, going from over 6,000 in 1988 to fewer than 60 at the end of 2008.
The Philippines demonstrates that is possible to eliminate incineration totally. In the cities, infectious waste is dealt with by centralised facilities running autoclaves or microwaves; and in 2004, HCWH helped the Philippines Department of Health prove that it was possible to manage the waste from a country-wide vaccination program without resorting to open burning or incineration.
Several cities across Argentina have also banned or restricted incineration.
- 2006: the municipality of General Pueyrredón in Buenos Aires Province and Villa Regina, in Rio Negro Province both banned incineration.
- 2005: the cities of Rio Grande, Ushuaia and Tolhuin in the Tierra del Fuego province banned the construction of new incineration plants. In the same year, the city of Rosario in Santa Fe province prohibited the incineration of pathological waste and the contracting out of the treatment of these wastes to other jurisdictions.
- 2004: The city of Esquel in Chubut province prohibited the incineration of all types of waste and Villa Allende, Marcos Juarez, both in Córdoba province banned incineration.
- 2002: Buenos Aires banned medical waste incineration.
HCWH first published a guide to non-incineration technologies and how they work in 2001. It was updated in 2004 (pdf). The most widely used technologies are autoclaves and microwaves which use heat to kill microbes in waste, after which it can be disposed of with ordinary municipal waste.
The alternative technology report was followed by an inventory of alternative medical waste technology suppliers around the world: For Proper Disposal (pdf). We identified 113 companies supplying to sixty countries. We will continue to update this inventory periodically. Manufacturers wanting to have their products included should email rstringer AT hcwh.org.
On top of the environmental benefits, alternative technologies are usually more economical than incineration. The World Health Organisation has developed an Expanded Costing Analysis Tools (ECAT) to help decision makers working at the facility, district or national level compare the capital and operating costs of the various options.
- Best Environmental Practices and Alternative Technologies for Medical Waste Management (pdf)
Discusses impacts of medical waste incineration and alternatives for the developing world
- Best Practices in Health Care Waste Management: Examples from Four Philippine Hospitals (pdf)
- Case Study - Nepal: Validating Autoclaves for Medical Waste Disinfection (pdf) Presentation by Ruth Stringer, HCWH's International Science and Policy Coordinator at SIGN Meeting, Dubai, Nov 2010
- Contamination of Chicken Eggs near Indian Hospital by Dioxins, PCBs and Hexachlorobenzene (pdf)
- For Proper Disposal: A Global Inventory of Alternative Medical Waste Treatment Technologies (pdf)
- GEF/UNDP Project: Demonstrating and Promoting Best Techniques and Practices for Reducing Healthcare Waste to Avoid Environmental Releases of Dioxins and Mercury (pdf)
- Global Alliance for Incinerator Alternatives (GAIA) website
- Health Effects of Waste Incinerators (pdf)
British Society for Ecological Medicine report
- Incineration and Human Health: State of Knowledge of the Impacts of Waste Incinerators on Human Health (pdf)
- Non-Incineration Medical Waste Treatment Pilot Project at Bagamoyo District Hospital, Tanzania (pdf)
- Non-Incineration Medical Waste Treatment Technologies in Europe (pdf)
(2004 version, pdf)
- Stockholm Convention on Persistent Organic Pollutants (POPs) website
- Tanzania's project to replace an incinerator with a safer, non-burn waste treatment system (pdf)
- Testing a Waste Treament Autoclave at a Hospital in Tanzania: A Technical Brief (pdf)
- WHO: Assessment of Small-Scale Incinerators for Health Care Waste (pdf)
- WHO: Core Principles for Achieving Safe and Sustainable Management of Health-Care Waste (pdf)
- WHO: Expanded Costing Analysis Tools (ECAT) (pdf)
for Health Care Waste Management
- WHO: Safe Health-Care Waste Management Policy Paper (pdf)
- WHO: Safe Management of Wastes from Healthcare Activities (pdf)