Reports & Publication

Managing Pharmaceutical Waste: A 10 step Blueprint for Health Care Facilities in the United States

2006 | Hospitals for a Healthy Environment

The discovery of a variety of pharmaceuticals in surface, ground, and drinking waters around the country is raising concerns about the potentially adverse environmental consequences of these contaminants.  Minute concentrations of chemicals known as endocrine disruptors, some of which are pharmaceuticals, are having detrimental effects on aquatic species and possibly on human health and development. The consistent increase in the use of potent pharmaceuticals, driven by both drug development and our aging population, is creating a corresponding increase in the amount of pharmaceutical waste generated.   Pharmaceutical waste is not one single waste stream, but many distinct waste streams that reflect the complexity and diversity of the chemicals that comprise pharmaceuticals. Pharmaceutical waste is potentially generated through a wide variety of activities in a health care facility, including but not limited to intravenous (IV) preparation, general compounding, spills/breakage, partially used vials, syringes, and IVs, discontinued, unused preparations, unused unit dose repacks, patients’ personal medications and outdated pharmaceuticals. In hospitals, pharmaceutical waste is generally discarded down the drain or landfilled, except chemotherapy agents, which are often sent to a regulated medical waste incinerator. These practices were developed at a time when knowledge was not available about the potential adverse effects of introducing waste pharmaceuticals into the environment. 2006 version: https://noharm-global.org/sites/default/files/documents-files/73/Managing_Pharma_Waste_H2E.pdf 2008 revision:  http://www.hercenter.org/hazmat/tenstepblueprint.pdf

Understanding and simplifying bio-medical waste management

2005 | Health Care Without Harm

The issue of medical waste management was first taken up in India around 1995.A lot has changed since then in the way medical waste is handled, stored, treated and disposed. An important catalyst to this change have been the Bio-medical Waste (Management &Handling) Rules 1998. Framing the rules was one important aspect of waste management, but implementing the rules required that the medical fraternity understood the rules and adopted them into their professional environments. This was possible only through large-scale training of medical staff. Considering the geographical spread of India, and the size of its medical sec-tor, this has been, and continues to be, a challenging task. Srishti, a programme of Toxics Link, has played its part in training healthcare professionals regarding medical waste management and the implementation of management systems in hospitals and other medical institutions. Srishti emphasises the importance of managerial interventions and staff dedication to bring about efficient waste management practices. It works towards dispelling the belief that technology is the only solution for medical waste management. As our work with various hospitals has progressed, the training needs have also increased. As a result, training has gradually become one of our focal areas. We have learnt from each training session; every hospital has its unique problems and challenges. As we attempted to resolve particular problems, and respond to the queries of the hospital staff, we enhanced our understanding of the practical problems and the unique needs of healthcare institutions. This helped us evolve our training methodology as well as its content. Apart from training hospital staff, we have also conducted various Training of Trainers(ToT) programmes all around the country, in association with various hospitals and Pollution Control Boards/ Committees. These programmes create a brigade of trainers who act as ambassadors and take the message of waste management forward. By the end of such sessions, trainees are exposed to a lot of information, but they do not have enough time to assimilate everything. Once they return to their workplaces, they have ex-pressed the need for a comprehensive resource on training. This manual has been compiled to fulfill their requirement. The main aim of the manual is to ensure that every healthcare worker and other stakeholders are aware of the hazards associated with improper bio-medical waste management. The manual has been produced to provide a convenient, up-to-date training resource that will allow interested people and trainers to increase awareness on waste management and related issues at every level in their organisation. The Training manual has six sections and each section has slides on a particular topic. Most of the points in the slides are self explanatory, but some of them, which may need explanations, have descriptive notes. This manual would keep evolving to address newer issues as experience in this field grows. Your suggestions and comments on the manual would therefore be highly appreciated.

Strategic Plan on Management of Mercury in Artisanal and Small Scale Gold Mining in Combodia 2012-2016

2011 | UNEP

The Strategic Plan on Management of Mercury  in Artisanal and Small Scale Gold Mining (SPASGM) was prepared by the Department of Environmental Pollution Control (DEPC), the Ministry of Environment (MOE), with support from the United Nations Environment Program (UNEP). This strategic plan was developed in response to various concerns on safe use and sound management regarding intentional mercury use in Artisanal and Small Scale Gold Mining (ASGM).  This SPASGM is also developed and implemented to support existing legal frameworks, national strategies, action plans and many other relevant technical papers. Technical support for this development was administered by the UNEP Chemicals Branch through the Artisanal and Small Scale Gold Mining (ASGM) Project with in-kind contributions from the Royal Government of Cambodia.  This Strategic Plan is published in Khmer and English versions by the Department of Environmental Pollution Control (DEPC), the Ministry of Environment (MOE) of  the Royal Government of Cambodia. This is to provide a practical framework on sound management of chemicals, including mercury and mercury containing wastes in Cambodia, with full participation from all levels of Government and civil societies in implementing it. 

Cambodia Mercury Inventory Report

2008 | Ministry of Environment, Cambodia

All over history, mercury has been known and used for gold and silver processing. In many parts of the world, mercury has been used in batteries, chlor-alkali production, dental amalgam, fluorescent lights, switches, and thermometers. Much of the mercury contained in these end-of-use products can be recycled; however, only a small amount of the mercury used is recycled. Mercury is a liquid metal, occurs naturally in a number of geologic environments, may be obtained as a by-product from precious metals mining, and is found in trace amounts in coal. Much of this mercury may be used and recycled; however, mercury used for gold production and mercury released from coal-fired power-plants, broken fluorescent lamps, battery production, and other sources is not recovered to any high degree and becomes a global environmental and human health concern. Minamata disease is an excellence example of mercury impact to the environment and human health in Japan, which brought a global concern of its release to the environment and seeking cooperation among countries for sound management of its release. In 2007, Cambodia got assistance from the United Nations Environmental Program (UNEP) to study the mercury releases from all identified sources. In 2007, UNEP-Chemicals provided the workshop training to the inventory team from the Ministry of Environment (MOE), Cambodia, by indicating a specific need data and information for gathering related to mercury releases. After training, the inventory team initiated and identified hotspot areas of possibly mercury releases sources based on local knowledge and current activities (as compared with activities mentioned in the UNEP Toolkit for identification and quantification of mercury releases, November 2005). Based on this material, the inventory team decided to select 12 provinces (including municipalities) out of 24 provinces and municipalities through the country. The inventory stage was conducted from August to November 2007 and then by December 2007 was the period of data entry and analysis.  

Mercury Contamination Along the Mekong River, Cambodia

2005 | Resource Development International

One of ten dolphins that died in the Mekong River had a presumed lethal concentration of mercury (67 ppm) in its liver.   The mercury content of fish at Kratie was on average 102 ng/g (n=137) but in some species it was up to six fold higher.  Hair in people collected in the drainage basin with gold mines (Ratanakirri) had significantly more mercury in their hair (4.4 ppm) than those living along the northern portion of the Mekong River (3.4 ppm).  Males had significantly more mercury than woman (5.2 vs 3.1 ppm, respectively). Individuals had as much as 22 ppm of mercury in their hair.  The concentration of mercury in a few percent of Khmers exceeds that in areas where mercury is associated with mercury poisoning.  Gold mines in Cambodia are likely the major source of mercury but tree cores indicated a major flux of mercury associated with deforestation.  Further analysis is required to determine what sources of mercury are manageable in Cambodia.       

National Profile on Chemicals Management in Cambodia

2004 | Ministry of Envrionment, Cambodia

In order to promote social development Cambodia, as well as other developing countries, has significant sectoral economic improvement including agriculture, industry and health. These sectors development activities have demanded high volume of chemicals uses, particularly in the last 10 years. All chemical substances imported have been distributed to different places and different sectoral users. Therefore, the import of chemicals, and the data and information concerning its use, have been maintained at different institutions.  Cambodia has no centralized source for chemicals data and information, and currently lacks a national document. The lack of information and data collection has created problems for chemical management in Cambodia, particularly in ensuring technical management to protect public health and maintain a safe environment.  After Cambodia’s signing of the Stockholm Convention on POPs in May 23, 2001 the country affirmed its full commitment to cooperation with the international community in reducing, eliminating and managing POPs as regulated by the provisions of the convention based on the capacity of the country. Since Cambodia is a least developed country, the Royal Government of Cambodia has received financial assistance from the Global Environment Facility (GEF) through the United Nation Environmental Program (UNEP) for the preparation of the national plan for implementation of the Stockholm Convention, which will be undertaken from 2003 through 2005. The United Nations Environmental Programme suggested that Cambodia should pay attention to chemicals data collection (including POPs) in order to support chemicals management actions for safe public health and environment in the preparation of their national action plan. Cambodia currently has no National Profile on Chemicals Management.  In response to the reccomendations of UNEP, the Ministry of Environment, with the support from main line ministries have prepared this national profile under supervision from the National Consultant and technical consultation provided by the United Nations Institute for Training and Research (UNITAR).  This action is considered part of the project preparation towards a national plan to implement the Stockholm Convention. 

Status of Used Lead Acid Battery Management in Kingdom of Cambodia

2004 | Department of Environmental Pollution Control; Ministry of Environment

In the Kingdom of Cambodia, used lead acid batteries (ULAB) are not normally managed in an environmentally sound manner and there is no specific government institution responsible for ULAB management1. Detailed legislation specifically targeting the management of ULAB does not exist, except for some related statutory instruments such as the Law on Environmental Protection and Natural Resources Management; the Sub-Decree on Water Pollution Control; and the Sub-Decree on Solid Waste Management. Unsound ULAB management has caused concern for the environment and population health in Cambodia and there is an urgent need to improve the management mechanisms based on sound environmental practices, otherwise, harmful and irreparable consequences will occur in the future. The adverse health effects are a particular concern because they become another obstacle in the application of the Poverty Alleviation Program, which is the main policy of the present Royal Government of Cambodia.   The main environmental and health threats arising from current practices are the release of hazardous materials from ULAB and flammable and obnoxious gas emissions. The materials released into the environment include lead oxides, lead sulfates and dilute sulfuric acid. These materials are released during various stages in the life cycle of the lead acid battery (LAB), including recharging, ineffective and inefficient ULAB recycling and residue disposal. These “unfriendly” activities are all contributors to the pollution of the soil, aquatic ecosystems, and sometimes, domestic air quality as well.  Besides the LAB recharging and ULAB recycling, the storage of ULAB in homes, workplaces and children’s playground areas has resulted in large amounts of lead and acidic substances accumulating in places readily accessible to young children and worker’s families. These small stockpiles might be a risk to them and the local communities.  

Toxic Justice: Human Rights, Justice, and Toxic Waste in Cambodia

1999 | UNHCR

In November 1998, nearly 3,000 tons of Taiwanese toxic waste were dumped in a field in the southern port of Sihanoukville. At the time, there was no law banning such dumping, but Minister of Environment Mok Mareth said publicly and repeatedly that toxic waste imports were prohibited in Cambodia and a national policy to that effect was in force. Dumped in an open field, the waste was scavenged by poor villagers, many of whom later complained of sickness; one quickly died. The Cambodian leadership, expressing outrage, promised a thorough investigation. Local people panicked: thousands fled the city. Others in Sihanoukville exercised their constitutional rights and in December held two days of public demonstrations, blaming government corruption for the presence of the toxic material. Even some local officials told Human Rights Watch they believed that demonstrations were warranted, provided they were lawful and peaceful. More details, pls visit the site.

Report of the Special Rapporteur on the adverse effects of the movement and dumping of toxic and dangerous products and wastes

| UN

Human Rights CouncilEighteenth sessionAgenda item 3Promotion and protection of all human rights, civil,political, economic, social and cultural rights,including the right to development In the present report, the Special Rapporteur focuses on the adverse effects that the unsound management and disposal of medical waste may have on the enjoyment of human rights. While approximately 75 to 80 per cent of the total waste generated by health-care establishments does not pose any particular risk to human health or the environment, the remaining waste is regarded as hazardous and may create a variety of health risks if not managed and disposed of in an appropriate manner. Hazardous health-care waste includes infectious waste, sharps, anatomical and pathological waste, obsolete or expired chemical products and pharmaceuticals, and radioactive materials. In many countries, significant challenges persist with regard to the proper management and disposal of health-care waste. The amount of waste generated by health-care facilities in developing countries is increasing owing to the expansion of health-care systems and services, a situation exacerbated by the lack of adequate technological and financial resources to ensure that health-care waste is managed and disposed of in a manner that is safe for human health and the environment.  Medical waste is often mixed with general household waste, and either disposed of in municipal waste facilities or dumped illegally. In health-care establishments where hazardous medical waste is incinerated, open burning and widespread deficiencies in the operation and management of small-scale medical waste incinerators result in incomplete waste destruction, inappropriate ash disposal and dioxins emissions, which can be even 40,000 times higher than emission limits set forth in the Stockholm Convention.  Contaminated sharps is the category of medical waste that attracts the most attention. Needle-stick injuries and reuse of infected sharps expose health-care workers and the community as a whole to blood-borne pathogens, including hepatitis B virus, hepatitis C virus and Human immunodeficiency virus (HIV). However, each type of hazardous medical waste presents hazards that jeopardise the enjoyment of human rights. The present report contains several examples of the adverse impact that the improper management and disposal of medical waste continue to have on the enjoyment of human rights in many countries. Nevertheless, the international community has to date paid little attention to this issue, despite the fact that a significant number of people – including medical staff, patients, workers in support services linked to health-care facilities, workers in waste disposal facilities, recyclers, scavengers and the general public – are potentially at risk of injury and/or contamination through accidental exposure to health-care waste. 

The effect of aeration position on the spatial distribution and reduction of pollutants in the landfill stabilization process

2013 | Sage

Three pilot-scale simulators with different aeration systems were constructed to explore the effects of aeration position on the reduction of pollutants. The simulator with a bottom aeration system successfully distributed oxygen and efficiently inhibited methane production. A close relationship was found between the oxygen distribution and the removal of pollutants, especially that of nitrogen. The transition between nitrification and denitrification in the longitude direction of the simulator with a bottom aeration system contributed to nitrogen removal in aerobic conditions. This process can be defined as a new path for nitrogen removal in addition to simultaneous nitrification and denitrification. The concentration of NH4 -N, total nitrogen and total organic carbon dropped to 3, 78 and 204 mg, respectively, after 312 days of bottom aeration and to 514, 659 and 828 mg, respectively, after 312 days of top aeration. These results indicate that the bottom aeration system was more efficient for reducing pollutants than the top aeration system.