See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/344602182

Hazardous waste management solutions in South Africa -still a challenge

Article  in  The Journal of the Society of Occupational Medicine · October 2020

CITATIONS READS

0 16

3 authors, including:

Kathie Jansen Hester Roberts

University of the Free State Central University of Technology
5 PUBLICATIONS   27 CITATIONS    9 PUBLICATIONS   62 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Health Care Waste and Occupational Medicine View project

Medial Waste View project

All content following this page was uploaded by Kathie Jansen on 12 October 2020.

The user has requested enhancement of the downloaded file.

 OPINION PEER REVIEWED

Hazardous waste management solutions in

South Africa – still a challenge
KE Jansen1, DJ Kocks2, H Roberts3
1
Department of Agriculture and Environmental Sciences, Central University of Technology, Free State, South Africa
2
Department of Occupational Medicine; School of Medicine, Faculty of Health Sciences Sefako Makgatho Health Sciences University, South Africa
3
Department of Agriculture and Environmental Sciences, Central University of Technology, Free State, South Africa

Correspondence: Prof. Daniel Jacobus Kocks, Professor and Head, Department of Occupational Medicine, School of Medicine, Faculty of Health
Sciences, Sefako Makgatho Health Sciences University, Molotlegi Street; Ga-Rankuwa, 0208, South Africa. e-mail: kocks@wol.co.za

Prof. Kocks is the Chairperson of The South African Society of Occupational Medicine (SASOM)

Keywords: healthcare risk waste, medical waste, placenta, alternative technologies

INTRODUCTION and international levels. Education, resources, treatment technologies, capacity,

The generation of pathological waste creates risk waste management problems for
healthcare workers (HCWs), at healthcare facilities. The solution lies with both treat-
ment and management of the waste by the HCW. HCWs are able to recommend
solutions that will comply with standard legal frameworks in South Africa. Alternative
waste treatment technologies should be investigated to determine efficacy, reliability,
cost-effectiveness and applicability.
Daily, HCWs are exposed to biological hazards that pose health risks. Biological
waste, known as healthcare risk waste (HCRW), is generated at healthcare facilities
such as hospitals, clinics, community health centres, laboratories, research institu-
tions, dental facilities, emergency services, ports of entry, veterinarian practices, old
age homes, and forensic pathology services. HCRW comprises anatomical and
pathological waste in laboratories, genotoxic or cytotoxic waste, infectious waste,
sharps waste, sanitary waste, nappy waste, chemical waste, low-level radioactive
waste, and pharmaceutical waste. The risks and preventive measures, in addition
to legal requirements, are well documented.1,2 The management of all HCRW as a
problem or concern in South Africa defines the need for this paper, to illustrate the
shortfall of compliance with national and provincial legal requirements.3-7
MANAGEMENT PRIORITIES
Different categories of HCRW, excluding low-level radioactive waste, comprise differ-
ent inherent bacterial contaminants which pose a risk to the immediate surrounding
environment at health facilities, communities and, especially, environments where
HCRW is dumped or mismanaged.8-13 Enhanced handling and disposal techniques
are therefore necessary.
Statistics South Africa reported that there were 969 415 births in 2016.14 The
mean weight of a placenta is 637 g.15 Using the population figure for 2016, it is
estimated that pathological waste originating from births was around 618 tons.
Waste in primary healthcare centres consists of approximately 80% non-infectious
waste, 15% pathological and infectious waste, 1% sharps waste, 3% chemical
or pharmaceutical waste, and less than 1% of other waste, such as pressurised
cylinders and broken thermometers.16 In 2008, it was reported that the total waste
stream at two hospitals in Limpopo province of South Africa consisted of 60.7%
general waste, 30.3% medical waste, and 8.9% sharps. It was estimated that each
patient generated 0.60 kg of waste per day.17
The management of HCRW in developing countries is problematic due to
differences in terminology, socio-economic conditions, governance structures,
policies for HCRW management, and definitions of best practice at local-national
improved practice at local level and legislative frameworks are required to address
problems and concerns in South Africa.5,15,17-19
LEGISLATION FOR HEALTHCARE WORKERS
AND BIOLOGICAL RISK MANAGEMENT IN SOUTH AFRICA
South African environmental legislation includes the National Environmental
Management Waste Act, No. 59 of 2008,20 the Environmental Conservation Act
No.73 of 1986,21 the Gauteng Health Care Waste Regulation of 2004,6 and the
Regulations for Hazardous Biological Agents of 2001 of the Occupational Health
and Safety Act no. 85 of 1993.22
The legislation stipulates that all pathological waste must be treated by incin-
eration. Certain practices are of concern, such as the traditional practice by some
population groups in southern Africa of taking the pathological waste home for
burial. This means that pathological waste can be taken by public transport to an
individual’s home to be buried in a shallow grave or a hole in the ground. Although
the ceremonial handling of pathological waste is practiced by many cultures around
the world, in most developed countries, the human placenta, as an example, is
regarded as nothing more than human waste. Traditional ways of handling the
pathological waste vary from burial, covering it with grass, burial in dirt floors of the
family house, wrapping in blankets and burial near a tree, and burial by the father.
These rituals are practised in Nigeria, Mali, Arabia, North and South America and
New Zealand. 4-7,23,24
Ownership of human tissue is a contentious issue in South Africa.
Chapter 8 of the National Health Act No. 61 of 2003 addresses the legal regulation
of human tissues. The safeguarding of healthcare workers at clinics and labora-
tories (including the transport of human tissue and fluid), other healthcare service
employees, families partaking in this practice in the home environment, as well as
the public exposed to the potentially infectious waste, should be considered.23,24
For example, studies have confirmed heavy metal (lead and cadmium) contami-
nation in human placentae. Other environmentally-associated pathogens, such
as Escherichia coli and Listeria motocytogenes have also been identified during
pathology investigations of placentae after birth.25-28
HEALTHCARE RISK WASTE TREATMENT
AND TECHNOLOGIES
The global general practice is treatment through incineration for specific pathologi-
cal waste.29 In line with this; the Gauteng Health Care Waste Regulations of 20046

4 Vol 24 No 4   July/August 2018 Occupational Health Southern Africa www.occhealth.co.za

prohibit the treatment of pathological waste except through incineration. Currently,
the economic limitations (financial viability of treatment) in terms of treatment
availability are proximity and distance between generation and treatment of these
waste products, in both rural and urban areas.30
Although non-incinerator technologies exist, several factors need to be con-
sidered before they are introduced. These include throughput capacity, types of
waste treated, microbial inactivation efficacy, environmental emissions, waste
residues, regulatory acceptance, space requirements, reduction of waste volume,
reduced mass, occupational health and safety, noise and odour, automation,
reliability, level of commercialisation, technology manufacturer, cost, and cultural
and staff acceptance. 4,7,29
Alternative treatment technologies are classified as follows: 31
• Thermal – autoclaving, incineration, heat, micro- or macro-waving, pyrolysis,
gasification or friction heat treatment
• Chemical – chlorine or chlorine derivatives, ozone, enzymes, sodium hydroxide
treatment
• Irradiation – ultraviolet, Cobalt 60, electron beam treatment
Other types of technologies, such as gas or vapour sterilization treatment, are
designed for specific medical waste categories.
However, not all these alternative treatment technologies are deemed effective
and/or suitable for the treatment of all categories of healthcare risk waste. The
degree of thickness or smoothness of a mixture, temperature, and penetration
ability create problems in terms of effective inactivation of pathogens. In the United
States an alternative treatment method, microwave technology, is used to treat
HCRW but it is dependent on specialised knowledge and large infrastructure and
capital investments.29,30
CONCLUSION AND RECOMMENDATIONS
Due to the challenges associated with the incineration of HCRW, it may be time
to explore cheaper and more efficient methods of pathological waste treatment
technologies. Healthcare management staff is able to investigate, evaluate and
recommend healthcare waste treatment technologies that can comply with legal
standards, as alternatives to incineration.
It is recommended that healthcare waste workers be aware that:
a) Healthcare risk waste is a risk for healthcare workers;
b) Legal requirements for the management of HCRW need to be considered;
c) HCRW volumes are creating an environmental hygiene problem;
d) Incineration is not the only solution for the management of healthcare risk
products;
e) There are different management categories and technologies for effective
treatment of HCRW.
DECLARATION
We declare that this article contains no section copied in whole or in part from
any other source unless explicitly identified in quotation marks and with detailed,
complete and accurate referencing. No external sources of funding were received.
No conflicts of interest or affiliation of funding exist.
REFERENCES
1. Republic of South Africa. Occupational Health and Safety Act, 1993 (Act No. 85 of 1993).
Regulations for Hazardous Biological Agents. 2001. Available from: http://www.labour.gov.
za/DOL/downloads/legislation/regulations/occupational-health-and-safety/Regulation%20
-%201390%20-%20OHS%20-%20Hazardous%20Biological%20agents.pdf (accessed 12
Jul 2016).
2. Singh TS, Matuka O. Work-related infections Part 1. Risks of exposure to infectious agents
in the workplace. Occup Health Southern Afr. 2013; 19(2):4-12. Available from: http://www.
Occupational Health Southern Africa www.occhealth.co.za
View publication stats
occhealth.co.za/?/viewArticle/1414 (accessed 12 Jul 2016).
3. World Health Organization. Management of solid health-care waste at primary health-care
centres. Geneva: WHO; 2005. Available from: http://www.who.int/water_sanitation_health/
medicalwaste/decisionmguide_rev_oct06.pdf (accessed 24 Jun 2016).
4. National Waste Management Strategy. Department of Environmental Affairs; 2011. Available
from: https://www.environment.gov.za/sites/default/files/docs/nationalwaste_management_strat-
egy.pdf (accessed 23 Feb 2016).
5. Integrated strategy and action plans for sustainable health care risk waste management in
Gauteng. Department of Environmental Affairs. 2004. Available from: http://sawic.environment.
gov.za/documents/230.PDF (accessed 22 Mar 2016).
6. Gauteng Health Care Waste Management Regulations, 2004 [Internet]. Gauteng Department
of Agriculture and Rural Development. Available from: http://www.gdard.gpg.gov.za/Services1/
CertifiedHCWMRegulationsSTAMPED.pdf (accessed 30 Jun 2016).
7. Republic of South Africa. National Environmental Management Act, 2008 (Act No. 59 of
2008). Department of Environmental Affairs. 2008. Available from: https://www.environment.
gov.za/sites/default/files/legislations/nema_amendment_act59.pdf (accessed 12 Mar 2016).
8. Shareefdeen Z. Medical waste management and control. J Environ Prot. 2012; 3(12):
1625-1628.
9. Benmour E. Medical waste presents special challenges. American City Business J.
1993; 10(11):3.
10. Stevens WK. Medical waste is piling up, generating new concerns. New York Times. 27 June
1989. Available from: https://www.nytimes.com/1989/06/27/science/medical-waste-is-piling-up-
generating-new-concerns.html (accessed 10 May 2018).
11. Miller B. Firm to pay $1.5 million for pollution violations; medical waste ran into district sewers.
The Washington Post. 2 June 1998. Available from: https://www.highbeam.com/publications/
the-washington-post-p5554/jun-2-1998. (accessed 10 May 2018).
12. Harris J. 4 steps to medical waste management for non-healthcare facilities. Industrial Safety
and Hygiene News. 2006; 40(8);32.
13. Sharma P, Jais M, Gupta P, Randhawa V. Adequacy of awareness regarding biomedical
waste management among health care workers in a tertiary care hospital in Delhi. J Patient Saf
Infect Control . 2015; 3(2):27-117.
14. Statistics South Africa. Recorded live births, 2016; 2017. Available from: http://www.statssa.
gov.za/?p=10524 (accessed 18 Apr 2018).
15. Wang N, Tikellis G, Sun C, Pezic A, Wang L, Wells JCK, et al. The effect of maternal pre-
natal smoking and alcohol consumption on the placenta-to-birth weight ratio. Placenta. 2014;
35(7):437-441.
16. WHO. Safe management of wastes from health-care activities. 2014 [Internet]. 2nd edition,
Available from: http://apps.who.int/iris/bitstream/handle/10665/85349/9789241548564_eng.pdf;j
sessionid=E64D8E4491AF546F1E927618C1C4A430?sequence=1 (Accessed: 18 April 2018).
17. Nemathaga F, Maringa S, Chimuka L. Hospital solid waste management prac-
tices in Limpopo Province, South Africa: A case study of two hospitals. Waste Manag.
2008; 28(7):1236-1245.
18. University of Minnesota Duluth. Biohazardous and pathological waste manage-
ment plan. 2017. Available from: http://www.dehs.umn.edu/PDFs/infectwaste-plan.pdf
(accessed 18 Apr 2018).
19. Caniato M, Tudor T, Vaccari M. International governance structures for health-care waste
management: a systematic review of scientific literature. J Environ Manag. 2015;153:93-107.
20. Republic of South Africa. Environmental Conservation Act, 1989 (Act No. 73 of 1989). 2016
[Internet]. Available from: https://www.environment.gov.za/sites/default/files/legislations/environ-
ment_conservation_act73of1989.pdf (accessed 30 Jun 2016).
21. Republic of South Africa. National Environmental Management Act, 2008 (Act No. 59 of
2008). Department of Environmental Affairs. 2008. Available from: https://www.environment.
gov.za/sites/default/files/legislations/nema_amendment_act59.pdf (accessed 12 Mar 2016).
22. Republic of South Africa. Occupational Health and Safety Act, 1993 (Act No. 85 of 1993).
Department of Labour. 1993. Available from: http://www.labour.gov.za/DOL/downloads/legislation/
acts/occupational-health-and-safety/amendments/Amended%20Act%20-%20Occupational%20
Health%20and%20Safety.pdf (accessed 11 Jul 2016).
23. Mahomed S, Nöthling-Slabbert M, Pepper M. The legal position on the classification of
human tissue in South Africa: Can tissues be owned? S Afr J BL. 2013 ;6(1):14.
24. Bradley L. Placenta Traditions. Birth to earth. 2014. Available from: http://birth2earth.
myshopify.com/blogs/resources (accessed 23 Feb 2016).
25. Xu L, Ge J, Huo X, Zhang Y, Lau A, Xu X. Differential proteomic expression of human
placenta and fetal development following e-waste lead and cadmium exposure in utero. Sci
Total Environ. 2016; 550:1163-1170.
26. Grant K, Goldizen F, Sly P, Brune M, Neira M, Van den Berg M et al. Health consequences
of exposure to e-waste: a systematic review. Lancet Glob Health. 2013; 1(6):e350-e361.
27.Thornburg KL, Marshall N. The placenta is the center of the chronic disease universe. Am J
Obstet Gynecol. 2015; 213(4):S14-S20.
28. Benirschke K, Burton GJ, Baergen RN. Pathology of the Human Placenta. 6th ed. 2012:41-
53. Springer, Berlin, Heidelberg [Internet]. Available from: http://link.springer.com/book/10.1007
%2F978-3-642-23941-0 (accessed 12 Jul 2016).
29. Non-incineration medical waste treatment technologies in Europe. Health Care Without
Harm; 2004. Available from: https://noharm-europe.org/sites/default/files/documents-files/2063/
Non-Incineration_Technologies_Europe.pdf (accessed 18 Apr 2018).
30. Pepper M, Slabbert M. Human tissue legislation in South Africa: Focus on stem cell research
and therapy. S Afr J BL. 2015; 8(2):1-56.
31. US Department of Energy. Environment/health/safety/security (EHSS); 2012 Oct 23. Available
from: http://www2.lbl.gov/ehs/waste/wm_pub_3095_ch4.shtml (accessed 12 Jul 2016).
Vol 24 No 4   July/August 2018 5