**2. Preparing to manage waste**

In order to protect the environment the waste management hierarchy is a useful tool in guiding how waste is managed. In healthcare emergencies however, it is not always possible to follow this hierarchy. Disposal becomes a common way of dealing with health care waste in healthcare emergencies as either the waste is produced in non-healthcare settings or the amount of waste overwhelms the usual healthcare settings (**Figure 1**).

The modern methods of medicine are such that it is not possible to completely prevent the generation of waste. It is very important that the generation of waste be minimized to the lowest possible level. The types of waste generated most healthcare settings are described below.

#### **2.1 Categories of waste**

Waste can be categorized as follows:

Management of waste is highly dependent on knowing the type of waste that is being generated. It is important that facilities take time to evaluate the type of waste that is being generated and to create the necessary awareness about the waste being produced.

The advent of a healthcare emergency should call for a comprehensive risk assessment that Is all encompassing. This needs to be carried out by competent health and safety professional together with other health care professionals.

#### **2.2 Risk assessment**

Healthcare emergencies present with risks of exposures to different types of health hazards. It is recommended that a full risk assessment be carried out and all possible exposure scenarios assessed and controlled. The exposure analysis should focus on healthcare workers, waste handlers, the public and the environment. All types of healthcare waste should be assessed (refer to **Table 1** above) and best ways of handling it described. In some cases a waste needs assessment might be useful [3].

#### **Figure 1.**

*Waste management hierarchy [2].*

The results of the risk assessment should be publicized. If big gaps are identified, waste handling policies and procedures need be updated to adequately address the risks identified. Risks assessments are an important part of anticipating dangers and preventing any accidents and exposures before they happen. Risks assessments are key in elevating awareness and ownership of the waste management procedures in health care emergencies. In most cases the existing policies and procedures might not be able to cover all the types of waste that come with emergencies.

A risk assessment typically involves risk identification, risk quantification, control, implementation and verification. It is recommended to carry out a risk assessment whenever conditions change in facilities and this can cover increased waste production, outbreaks, new procedures and new personnel.

Data to inform the risk assessment can be collected through:

• Interviewing key informants in the healthcare emergency: this helps to get relevant information about the existing healthcare waste management processes and procedures

