**Abstract**

Proper management of waste in healthcare emergencies is key to preventing spread of infections within an emergency. The risks of poor waste management are varied with the risks of spreading infectious diseases being the most important to consider. Chemical pollution should also be considered as water sources can easily be polluted. Careful thought and planning including a risk assessment should be carried out and the results should be publicized to create a common understanding of the problem at hand. This will also inform the methods to be used for the management of waste. Training of healthcare workers is key to creating common understanding of the problem at hand. The different types of waste to be generated should be well understood and methods to manage it should be well thought out before implementation. The decision on the different methods used to manage waste should be informed by the risk assessment and the available resources. However effectiveness to deal with the waste produced should be considered above all factors. Proper healthcare waste management is imperative to preventing further infections that might not be part of the original healthcare emergency. Planning to manage waste is a process that requires information before implementation.

**Keywords:** Waste management, Risk Assessment, healthcare emergency, infections, chemical pollution

#### **1. Introduction**

Correct disposal of waste is critical in public health and even more critical in healthcare emergencies to improve safety. Existing collection and disposal systems can also be disrupted when there are unexpected volumes of certain types of health care waste as a result of healthcare emergencies. In some cases like, non-healthcare settings (quarantine centers, holding areas, designated hotels, households and refugee camps for displaced people) there might not be any provisions for managing healthcare waste. If healthcare waste is not dealt with quickly and appropriately enough it has the potential to worsen the situation. Waste from healthcare settings can be varied and includes used needles, syringes, soiled dressings, body parts, dead bodies, pharmaceuticals, medical devices, and laboratory related waste.

In order to better manage healthcare waste strict segregation is key as the bulk of the waste is non-infectious waste that can be managed by simpler methods. Poor segregation might lead to an increase in the volume of infectious waste as once mixed you cannot separate the waste and all the waste will now be treated as infectious. In general non-infectious waste constitute 75–90% of all healthcare waste while only 10–25% of the waste is clinical waste. The focus is on the 10–25% of the

waste produced that is infectious. Depending on the type and cause of health care emergency the clinical waste can be sharps, chemicals, radioactive waste, genotoxic waste, pathological waste, pharmaceutical waste and dead bodies.

Healthcare emergencies as a result of an infectious diseases outbreak can lead to increased amount of infectious waste. In the event of a disease that is of a respiratory nature (like TB and COVID-19) surgical masks will be needed to reduce human to human transmissions in everyday life as well as to reduce infections from patients to healthcare workers. The disposal of the face masks in non-healthcare settings requires a different perspective as the waste is now being generated even at household level. Use of latex or plastic gloves can also be encouraged in cases where diseases are spread by contact. This also significantly rises the amount of waste produced outside of healthcare settings. How this waste is managed needs special attention and strong policies. In order to better manage this level of waste production it is important to make sure that new lines of waste management are also opened beyond the usual hospital set up.

In non-emergency situations, the amount of waste produced is stable and easily managed with usual routes and methods. The integrated management of healthcare waste that comprises segregation, collection, storage, transportation and treatment should be significantly enhanced when there is a healthcare emergency. The entire chain should be adequately monitored in order to secure the waste at all stages. In order to better manage the waste introduction of mobile treatment facilities use of microwaves, steam disinfection can be used as innovations. The best available waste treatment technologies should be selected together with transitional methods that can be used to manage healthcare waste on an interim basis. However incinerations remains one of the most important ways of managing waste.

#### **1.1 Risks of poor waste management**

In emergency situations the major issues are generation of high volumes of healthcare waste in healthcare settings or generation of health waste in nonhealthcare settings. This can overwhelm the existing settings leading to improper management of waste.

The immediate effects of improper healthcare waste management is visual nuisance and serious smells. Healthcare waste is known to be a source of contamination and forms a part of the transmission routes of certain diseases through


It is important to avoid creation of another healthcare crisis as a result of poor management of waste. Some of the diseases like cholera, plague and Lassa fever have epidermic potential making it important to prioritize healthcare waste management. This chapter explores available methods of managing healthcare waste in healthcare emergencies. The efficacy of the different methods of managing waste are described fully.
