Burial pits and encapsulation are suitable in locations without shallow groundwater and for small volumes of waste.

Burial pits: The bottom of the pit should be 1.5 m above the groundwater level, 3-5 m deep, and lined with a substance of low permeability, such as clay. Surround the opening with a mound to keep run-off water from entering the hole, and build a fence around the area. Periodically, cover waste layers with 10-15 cm of soil.

Encapsulation: Cement-lined pits or high-density plastic containers or drums are filled to 75% capacity with health care waste. The container is then filled with plastic foam, sand, cement, or clay to immobilize the waste. The encapsulated waste is then disposed of in a landfill or left in place if the container is constructed in the ground.

Incineration: Medium- and high-temperature incineration devices require a capital investment and an operations and maintenance budget. They operate on fuel, wood, or other combustible material and produce solid ashes and gases. Pollutants are emitted to varying degrees. The ash is toxic and must be buried in a protected pit. Combustible waste is reduced to incombustible waste with a decreased volume. The high temperatures kill microorganisms.

Medium-temperature incinerators, commonly a double- chamber design or pyrolytic incinerator, operate at a medium-temperature combustion process (800°-1,000°C).

High-temperature incinerators, recommended by WHO, treat health care waste at a temperature >1,000°C.

When operated by staff trained in correct use and maintenance, incineration in a device like this one-

completely destroys needles and syringes
kills microorganisms
reduces the volume of waste
generates less air pollution than low- temperature burning.

Note: Incinerate pharmaceuticals only if absolutely necessary.

Low-temperature burning: Burning devices not exceeding 400°C include single-chamber brick hearths, drum burners, and burning pits. They burn incompletely and do not fully destroy waste. They may not kill microorganisms. Given these shortcomings, low-temperature burning should be used only as a short-term solution.

Burn and bury: Pit burning is a low-cost but relatively ineffective means of waste disposal. A fence should surround the pit to prevent children, animals, and others from coming into contact with the waste. The pit location should avoid walking paths (high-traffic areas). The fire, usually started with a petroleum-based fuel and allowed to burn, should be supervised by designated staff and located down-wind of the facility and residential areas. The low-temperature fire emits pollutants, and the ash and remaining material should be covered with 10-15 cm of dirt.

Other methods: In addition to the common methods, other methods are used in some settings, including needle removal/ needle destruction, melting syringes, steam sterilization (autoclaving and hydroclaving), and microwaving (with shredding).

Managing health care waste is a comprehensive program that requires support at all levels of the health care system. Staff involved in health care waste management must be given training and support.

Pharmaceutical Disposal

It is very important to dispose of pharmaceuticals properly because there can be very negative consequences to improper disposal. Improper disposal can result in-

contaminated water supplies
the diversion and resale of expired or inactive medicines
improperly incinerated products, which can release toxic pollutants into the air.

Always follow your facility’s procedures for handling damaged or expired medicines. In most cases, this will mean that you should send the products back to the facility that provides you with your supplies.

The disposal methods for various catagories of pharmaceuticals are indentified in the following table.

Source: WHO. 1999. Guidelines for Safe Disposal of Unwanted Pharmaceuticals In and After Emergencies. Geneva: World Health Organization. Available at http://www.who.int/medicines/library/par/who-edm-par-99-2/who-edm-par-99-2.htm

Particular attention must be given to disposal of the following catagories of pharmaceuticals-

controlled substances, such as narcotics and psychotropic medicines
anti-infective drugs
antineoplastics
cytotoxic anti-cancer drugs, toxic drugs
antiseptics and disinfectants.

Safety boxes

Safety boxes or sharps containers are puncture- and water-resistant, impermeable containers. When used correctly, they reduce the risk of skin-puncture injuries that may spread disease.

Do not recap syringes before disposal.
Place the syringe and needle in the sharps box immediately after use.
Keep the sharps box where the injections are given.
Do not overfill the sharps containers (about ¾ full).
When ¾ full, close box tab completely to cover the opening and tape it shut.
Store the box in a safe and secure location until ready for final disposal.
Do not empty and refill sharps boxes. Fill once and discard immediately.

See annex 2 for more information about waste disposal.