1. Healthcare Waste Management in Lebanon
Samar Khalil
6 June, 2012

2. Outline Types of Healthcare Wastes
AGENDA
Sub headline
Types of Healthcare Wastes
Impact of Mismanagement of Healthcare Waste
Healthcare waste management in Lebanon
Legal Framework

3. Hazardous Infectious Waste Hazardous Non- Infectious Waste
Types of Healthcare Wastes
AGENDA
Sub headline 1 2
Hazardous Infectious Waste 3
Hazardous Non- Infectious Waste
Non- Hazardous Waste
Paper
Food
Packaging
Plastics
Glass
Sharps (needles)
Waste contaminated with blood and body fluids
Used X-ray fixer solution
Amalgam (containing silver and mercury)
X-ray developer
Lead foils, shields and aprons
Cleaners for X-ray developer systems
Chemiclave/Chemical sterilant solutions
Disinfectants, cleaners and other chemicals
Example text

4. Wastes that need special treatment
Types of Healthcare Wastes
AGENDA
Sub headline 4 5
Wastes that need special treatment
Radioactive Waste
Expired Pharmaceuticals
Pathological waste
Cytotoxic waste
Sharps (needles)
Waste contaminated with blood and body fluids
Example text

5. Exposure to hazardous infectious waste
Impact of Mismanagement of Healthcare Waste
Occupational & Public Health Risks
Occupational & Public Health Risks
Exposure to hazardous infectious waste
AIDS;
Gastroenteric infections;
Respiratory infections;
Ocular infection;
Genital infections;
Skin infections;
Anthrax;
Meningitis;
Haemorrhagic fevers;
Septicaemia;
Bacteraemia;
Candidaemia;
Viral hepatitis A, B and C

6. Impact of Mismanagement of Healthcare Waste
Occupational & Public Health Risks
Occupational & Public Health Risks
Source: Safe management of wastes from health-care activities/ Chapter 3: Health Impacts of Health-care waste – WHO Geneva 1999.

7. Exposure to hazardous non- infectious waste Exposure to Mercury vapors
Impact of Mismanagement of Healthcare Waste
Occupational & Public Health Risks
Occupational & Public Health Risks
Exposure to hazardous non- infectious waste
Intoxication;
Burns;
Injuries to the skin, the eyes, or the mucous membranes of the airways;
Mercury waste: Inhalation of mercury vapor leads to damage in the central and peripheral nervous systems, lungs, kidneys, skin and eyes. It also affects the immune system and is mutagenic.
Exposure to Mercury vapors

8. Mercury level in dentists’ hair
Impact of Mismanagement of Healthcare Waste
Impact of Mismanagement of Healthcare Waste
Occupational & Public Health Risks
Occupational & Public Health Risks
Occupational & Public Health Risks
Mercury level in dentists’ hair
Among ninety-nine dentists in Beirut, 25.25% had a mercury level above the safe baseline of 5 µg/g.
Of those, 7.07% had a concentration approximately 10 µg/g.
Example text
Harakeh, S., Sabra, N., Kassak, K., & Doughan, B. (2002). Factors Influencing Total Mercury Levels Among Lebanese Dentists. The Science of Total Environment .

9. Impact of Mismanagement of Healthcare Waste
AGENDA
Sub headline
Indirect Risks Via the Environment 1 2 3
Soil Pollution
Air Pollution
Water Pollution
Leakage of contaminants into the soil as a result of:
Inappropriate disposal of mixed Healthcare and Municipal waste.
Indiscriminate dumping of incinerator ash containing toxic heavy metals such as Mercury.
Open burning of healthcare waste especially that containing plastics (PVC) release of carcinogens such as Dioxins and Furans.
Surface water contamination due to:
Runoff from indiscriminate dumping.
Direct discharge of untreated waste water.
Ground water contamination due to:
Leakage from inadequate disposal sites.
Example text

10. Healthcare Waste Management
Lebanon
Current Situation
The quantity of infectious healthcare waste generated per day is estimated at 8,200 kg/day.
The quantity of infectious healthcare waste generated per bed per day is estimated at 1 kg.
Cost of transportation and treatment of infectious healthcare waste in Lebanon ranges between USD/Kg.

11. Legal Framework
AGENDA
Sub headline
Laws
Law 64/1988: Conservation of the environment against pollution from hazardous waste and hazardous materials
Law 387/1994: Ratification of Basel Convention on the Control of Trans- boundary Movements of Hazardous Wastes and their Disposal 1
The law punishes crimes related to breaching of the terms of the various stages of management of hazardous waste.
Sanctions include responsible and people who know about the crime and refrain from reporting it to concerned authorities.
Sanctions range from payment of fines to death penalty. 2
Controls trans-boundary movements of hazardous waste (including hazardous healthcare waste).
The only legitimate trans-boundary shipments of hazardous waste are exports from countries without facilities, or expertise to dispose safely of certain wastes, to countries which have both facilities and expertise.

12. Legal Framework
AGENDA
Sub headline
Laws
Law 432/2002: Ratification of Stockholm Convention on Persistent Organic Pollutants
Law 444/2002: Protection of the environment 3
Eliminate dangerous POPs, starting with the 12 worst.
Support the transition to safer alternatives.
Target additional POPs for action.
Cleanup old stockpiles and equipment containing POPs.
Work together for a POPs-free future. 4
The precautionary principle.
The principle of preventive action.
The polluter pays principle.
The principle of avoiding degradation of natural resources.

13. Legal Framework Decrees, Decisions & Circulars
AGENDA
Sub headline
Decrees, Decisions & Circulars
Decree 13389/2004: Determining the types of waste from healthcare facilities and their disposal
Decision 52/1/1996: Standards and Limits for the Prevention of Air Water and Soil Pollution
Standards for water.
Standards for wastewater.
Standards for air emissions. 2 1
Defines the types of HCW;
Requires proper waste segregation and waste minimization;
Sets some guidelines for the collection, storage, treatment and disposal of the different types of wastes;
Requires an EIA study for licensing HCWT facilities.
Gave HCF 120 days for compliance with the decree.
Decision 8/1/2001: Standards for air emissions, liquid effluents, and waste water treatment plants 3
Standards for wastewater.
Standards for air emissions.
Circular 11/1/2011: Trimestrial Report for Infectious Healthcare Waste Treatment
Unifies the trimestrial reports submitted by HCWT facilities to the Ministry of Environment. 4

14. THANK YOU! For further information: www.gefmedwaste.org
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15. Introduction to the Project Pilot Facilities
Demonstrating Best Techniques & Practices for Reducing HCW to Avoid Releases of Dioxins and Mercury
AGENDA
Sub headline
Introduction to the Project
Pilot Facilities

16. Intro to the Project
Introduce and Evaluate the Use of Mercury-Free Devices
India
Tanzania
Philippines
Vietnam
Lebanon
Senegal
Latvia
Argentina
Update Policies
Develop Training Material & disseminate information
Establish Model Facilities
Objective
To demonstrate and promote best practices and techniques for health-care waste management in order to minimize or eliminate releases of persistent organic pollutants and mercury to the environment
Evaluate Available Non-Incineration Treatment Technologies

17. Model Facilities Baseline Assessment Policies and Procedures Update
Onsite survey conducted at both model facilities 1
Policies and Procedures Update
Waste Management Program
Organizational structure and resources’ allocation
Policies & Procedures
Waste Handling
Capacity Building 2
Mercury Phaseout
Comparative Evaluation of Mercury Free Thermometers
Policies and Procedures
Replacement of thermometers 3

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19. 1 Challenges Opportunities
Challenges for the Management of Healthcare Waste in Lebanon
AGENDA
Sub headline
Challenges
Opportunities 1
Lack of national expertise in HCWM
Lack of infrastructure for disposal of some types of HCW (cytotoxics, chemicals, etc...)
Low level of legal enforcement (though improving)
Lack of national strategies and plans for the management of chemical and hazardous wastes.
Lack of national capacity for the testing and laboratory analysis of dioxins.
Lack of national standards in relation to dioxins emission limit values in residues and air.
Replication at the national level
Setting legal framework for compliance with HCWM guidelines, and standards.
Coordination with different stakeholders (ie.: MoPH: accreditation & licensing )
Certification of HCWM personnel
Coordination with the academic sector (i.e.: integration of a HCWM module in the curricula)

20. THANK YOU! For further information: www.gefmedwaste.org
Contact: