Safe management of wastes from health-care activities

This is the second edition of a World Health Organization (WHO) handbook, commonly known as "the Blue Book", which is designed to be a source of impartial health-care information and guidance on safe waste-management practices. The audience for the book was originally limited to those directly involved in the creation and handling of health-care wastes: medical staff, health-care facility directors, ancillary health workers, infection-control officers and waste workers. This has now been expanded to include regulators, policy-makers, development organizations, voluntary groups, environmental bodies, environmental health practitioners, advisers, researchers and students.

Chapters 2 and 3 explain the various types of waste produced from health-care facilities, their typical characteristics and the hazards these wastes pose to patients, staff and the general environment. Chapters 4 and 5 introduce the guiding regulatory principles for developing local or national approaches to tackling health-care waste management and transposing these into practical plans for regions and individual health-care facilities. Specific methods and technologies are described for waste minimisation, segregation and treatment of health-care wastes in Chapters 6, 7 and 8. These chapters introduce the basic features of each technology and the operational and environmental characteristics required to be achieved, followed by information on the potential advantages and disadvantages of each system.

To reflect concerns about the difficulties of handling health-care wastewaters, Chapter 9 is an expanded hapter with new guidance on the various sources of wastewater and wastewater treatment options for places not connected to central sewerage systems. Further chapters address issues on economics (Chapter 10), occupational safety (Chapter 11), hygiene and infection control (Chapter 12), and staff training and public awareness (Chapter 13). A wider range of information has been incorporated into this edition of the Blue Book, with the addition of two new chapters on health-care waste management in emergencies (Chapter 14) and an overview of the emerging issues of pandemics, drug-resistant pathogens, climate change and technology advances in medical techniques that will have to be accommodated by health-care waste systems in the future (Chapter 15). (editors' abstract).

The annexes include:

• an example training programmes in health-care waste management
• chemical destruction methods for cytostatic drugs
• clearance levels for radioactive waste
• accidental contamination by mutagenic and carcinogenic products
• disposal of pathological waste