医疗废物对健康造成严重危害（WHO最新报告）
本帖最后由 mickeypank 于 2011-11-9 10:39 编辑Medical waste poses an important threat to health 医疗废物对健康造成严重危害8 November 2011 -- Some 20% of all medical waste is considered hazardous material that may be infectious, toxic or radioactive. This updated fact sheet shows health-care waste contains potentially harmful microorganisms which can infect hospital patients, health-care workers and the general public.2011年11月8日——所有医疗废物中有20%被视为具有感染性、毒性和放射性的危险物质。这篇刚更新的情况报告显示医疗照护活动所产生的废物含有潜在的有害微生物，能造成医院住院患者、医疗机构工作人员和公共感染。 Waste from health-care activities来自医疗照护活动的废物Fact sheet N°253
November 2011
Key facts重要的事实
[*]Of the total amount of waste generated by health-care activities, about 80% is general waste.
[*]医疗照护活动产生的废物中约80%是普通废物。
[*]The remaining 20% is considered hazardous material that may be infectious, toxic or radioactive.
[*]剩余的20%被视为具有感染性、毒性和放射性的有害物质。
[*]Every year an estimated one billion injections are administered worldwide, but not all of the needles and syringes are properly disposed of afterwards.
[*]每年全球估计有10亿次注射，但是并不是所有的针尖和注射器在使用后都得到了适当的处置。
[*]Health-care waste contains potentially harmful microorganisms which can infect hospital patients, health-care workers and the general public.
[*]医疗照护活动产生的废物含有潜在的有害微生物，能造成住院患者、医疗机构工作人员和公众感染。
Health-care activities, protect and restore health and save lives. But what about the wastes and by-products they generate?Of the total amount of waste generated by health-care activities, about 80% is general waste comparable to domestic waste. The remaining 20% is considered hazardous material that may be infectious, toxic or radioactive. Types of waste废物的种类Waste and by-products cover a diverse range of materials, as the following list illustrates (percentages are approximate values):
[*]infectious waste感染性废物: waste contaminated with blood and its by-products, cultures and stocks of infectious agents, waste from patients in isolation wards, discarded diagnostic samples containing blood and body fluids, infected animals from laboratories, and contaminated materials (swabs, bandages) and equipment (such as disposable medical devices);
[*]pathological waste病理性废物: recognizable body parts and contaminated animal carcasses;
[*]sharps锐器: syringes, needles, disposable scalpels and blades, etc.;
[*]chemicals化学制品: for example mercury, solvents and disinfectants;
[*]pharmaceuticals药物: expired, unused, and contaminated drugs; vaccines and sera;
[*]genotoxic waste基因毒性废物: highly hazardous, mutagenic, teratogenic1 or carcinogenic, such as cytotoxic drugs used in cancer treatment and their metabolites;
[*]radioactive waste放射性废物: such as glassware contaminated with radioactive diagnostic material or radiotherapeutic materials;
[*]heavy metals waste重金属废物: such as broken mercury thermometers.
Infectious and anatomic wastes together represent the majority of the hazardous waste, up to 15% of the total waste from health-care activities. Sharps represent about 1% of the total waste but they are a major source of disease transmission if not properly managed. Chemicals and pharmaceuticals account for about 3% of waste from health-care activities while genotoxic waste, radioactive matter and heavy metal content account for around 1% of the total health-care waste. The major sources of health-care waste are:医疗照护活动产生的废物其主要来源有：
[*]hospitals and other health-care establishments
[*]医院和其他与医疗照护相关的公司
[*]laboratories and research centres
[*]实验室和研究中心
[*]mortuary and autopsy centres
[*]停尸房和尸体解剖中心
[*]animal research and testing laboratories
[*]动物研究及测试实验室
[*]blood banks and collection services
[*]血库和清收服务公司
[*]nursing homes for the elderly.
[*]疗养院（老人院）
High-income countries generate on average up to 0.5 kg of hazardous waste per bed per day; while low-income countries generate on average 0.2 kg of hazardous waste per hospital bed per day. However, health-care waste is often not separated into hazardous or non-hazardous wastes in low-income countries making the real quantity of hazardous waste much higher. Health impact对健康的影响Health-care waste contains potentially harmful micro-organisms which can infect hospital patients, health-care workers and the general public. Other potential infectious risks may include the spread of drug-resistant micro-organisms from health-care establishments into the environment. Waste and by-products can also cause injuries, for example:
[*]radiation burns;
[*]放射性灼伤
[*]sharps-inflicted injuries;
[*]锐器损伤
[*]poisoning and pollution through the release of pharmaceutical products, in particular, antibiotics and cytotoxic drugs;
[*]药品的释放造成的中毒和污染，特别是抗生素和细胞毒素药物
[*]poisoning and pollution through waste water; and
[*]废水中毒和污染
[*]poisoning and pollution by toxic elements or compounds, such as mercury or dioxins that are released during incineration.
[*]毒性元素或混合物造成的中毒和污染，如焚烧过程中释放的汞或二噁英。
Sharps锐器Throughout the world an estimated one billion injections are administered every year. Not all needles and syringes are properly disposed of, creating a risk of injury and infection and opportunities for re-use.
[*]WHO estimates that, in 2000, injections with contaminated syringes caused 21 million hepatitis B virus (HBV) infections, two million hepatitis C virus infections and 260 000 HIV infections worldwide. Many of these infections were avoidable if the syringes had been disposed of safely. The re-use of disposable syringes and needles for injections is particularly common in certain African, Asian and Central and Eastern European countries.
[*]In developing countries, additional hazards occur from scavenging at waste disposal sites and the manual sorting of hazardous waste from health-care establishments. These practices are common in many regions of the world. The waste handlers are at immediate risk of needle-stick injuries and exposure to toxic or infectious materials.
Vaccine waste盛装疫苗的废物物In June 2000 six children were diagnosed with a mild form of smallpox (vaccinia virus) after having played with glass ampoules containing expired smallpox vaccine at a garbage dump in Vladivostok (Russia). Although the infections were not life-threatening, the vaccine ampoules should have been treated before being discarded.2000年6月俄罗斯Vladivostok地区有6个孩子玩了盛装过期天花病毒疫苗的玻璃安瓿后被诊断为天花样轻微症状，这些玻璃瓶被丢弃在垃圾场里。 Radioactive waste放射性废物The use of radiation sources in medical and other applications is widespread throughout the world. Occasionally, the public is exposed to radioactive waste, which originates from radiotherapy treatment, that has not been disposed of properly. Serious accidents have been documented in Brazil in 1988 (where four people died and 28 had serious radiation burns), Mexico and Morocco in 1983, Algeria in 1978 and Mexico in 1962.Risks associated with other types of health-care waste, in particular blood waste and chemicals, may be significant but have not been fully assessed. More work needs to be done. In the meantime, precautionary measures should be taken. Risks associated with waste disposal与废物处置相关的风险Although treatment and disposal of health-care waste reduces risks, indirect health risks may occur through the release of toxic pollutants into the environment through treatment or disposal.
[*]Landfills can contaminate drinking-water if they not properly constructed. Occupational risks exist at disposal facilities that are not well designed, run, or maintained.
[*]Incineration of waste has been widely practised but inadequate incineration or the incineration of unsuitable materials results in the release of pollutants into the air and of ash residue. Incinerated materials containing chlorine can generate dioxins and furans2, which are human carcinogens and have been associated with a range of adverse health effects. Incineration of heavy metals or materials with high metal content (in particular lead, mercury and cadmium) can lead to the spread of toxic metals in the environment. Dioxins, furans and metals are persistent and bio-accumulate in the environment. Materials containing chlorine or metal should therefore not be incinerated.
[*]Only modern incinerators operating at 850-1100 °C and fitted with special gas-cleaning equipment are able to comply with the international emission standards for dioxins and furans.
Alternatives to incineration are now available, such as autoclaving, microwaving, steam treatment integrated with internal mixing, and chemical treatment. Waste management: reasons for failure废物管理失败的一些原因Lack of awareness about the health hazards related to health-care waste, inadequate training in proper waste management, absence of waste management and disposal systems, insufficient financial and human resources and the low priority given to the topic are the most common problems connected with health-care waste. Many countries either do not have appropriate regulations, or do not enforce them. An essential issue is the clear attribution of responsibility for the handling and disposal of waste. According to the 'polluter pays' principle, the responsibility lies with the waste producer, usually the health-care provider, or the establishment involved in related activities. To achieve the safe and sustainable management of health-care waste, financial analyses should include all the costs of disposal.与医疗照护活动产生的医疗废物有关的风险意识缺乏，应有的废物管理训练不足，医疗废物管理和处置系统缺失，经济支持和人力资源不到位，对于此普遍存在的问题没有给予很高的优先处理权。许多国家既没有合适的法规，也没有加强管理。一个重要的事实是对于医疗废物的搬运和处置在职责上要有明确的分工。根据“污染者支付”原则，这个责任与医疗废物产生者密切相关，通常指的是医疗照护活动的提供者，或者是与此活动相关的公司。为了实现医疗废物安全、持续的管理，财政分析报表里必须含有所有处置医疗废物的成本，换言之，医疗废物产生者应支付所有与医疗废物处置有关的费用。 Steps towards improvement改进的步骤Improvements in health-care waste management rely on the following key elements:
[*]building a comprehensive system, addressing responsibilities, resource allocation, handling and disposal. This is a long-term process, sustained by gradual improvements;
[*]建立一个全面的系统来阐明责任、资源分配、搬运和处置。这是一个长期的过程，需要逐步的改进来支撑。
[*]raising awareness of the risks related to health-care waste, and of safe and sound practices;
[*]提高医疗废物风险、安全和行动意识。
[*]selecting safe and environmentally-friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing of waste.
[*]在收集、搬运、储存、运输、加工或处置医疗废物时为了保护民众免受伤害，需选择安全的、对环境无害的管理方法。
Government commitment and support is needed for universal, long-term improvement, although immediate action can be taken locally. WHO's response世界卫生组织的回应The first global and comprehensive guidance document, Safe management of wastes from health-care activities, originally released by WHO in 19993, addresses aspects such as regulatory framework, planning issues, waste minimization and recycling, handling, storage and transportation, treatment and disposal options, and training.It is aimed at managers of hospitals and other health-care establishments, policy makers, public health professionals and managers involved in waste management. It is accompanied by a Teacher's guide, which contains material for a three-day workshop aimed at the same audience.Additionally, WHO guidance documents on health-care waste are now available including:
[*]a monitoring tool
[*]a cost assessment tool
[*]a rapid assessment tool
[*]a policy paper
[*]guidance to develop national plans
[*]management of waste from injection activities
[*]management of waste at primary health care centres
[*]management of waste from mass immunization activities
[*]management of waste in emergencies.
我发现论坛上好多老师英语都好好啊，真是佩服 本人英文 水平实在是.....哪位老师能翻译给我i们学习一下吗？ 好佩服老师的英语水平{:1_1:} 我们政府的责任是越来越大了！ 哪位老师能翻译给我i们学习一下吗？先谢啦！ 老师的英语真{:1_14:}，{:1_12:}，能给个中文版吗？{:1_12:}谢谢先。 自己的英语水平差，无法完全阅读理解。期望能看到中文版的！谢谢老师！ 源于卫生保健活动的废物
重要事实
卫生保健活动产生的废物总量中，约80%属于一般废弃物。
其余20%被视为可能具有传染性、毒性或放射性的危险物质。
全世界每年估计进行160亿次注射，但事后并非所有的针头和注射器都能得到妥善处理。
卫生保健废物含有潜在有害的微生物，可能感染医院的患者、卫生保健工作者以及广大民众。
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卫生保健活动可以保护和恢复健康并拯救生命。但这些活动产生的废物和副产品怎么办？
卫生保健活动产生的废物总量中，约80%是类似于家居废物一般废弃物。其余20%被视为可能具有传染性、毒性或放射性的危险物质。
废物类型
废物和副产品包括各种物质，下面列举说明(百分比为近似值)：
传染性废物：被血液及其副产品污染的废物、传染性病原体的培养物和库存、隔离病房患者的废物、丢弃的含有血液和体液的诊断标本、来自实验室的被感染动物，以及受污染的材料(棉签、绷带)和设备(如一次性医疗器械)；
病理性废物：可辨认的身体部位和被污染的动物尸体；
利器：注射器、针头、一次性手术刀和刀片，等等；
化学品：例如汞，溶剂和消毒剂；
药物：过期、未使用和被污染的药品、疫苗和血清；
基因毒性废物：高度危险、致突变、致畸1和致癌，如癌症治疗中使用的细胞毒性药物及其代谢产物；
放射性废物：诸如受放射诊断材料或放射治疗材料污染的玻璃器皿；
重金属废物：如破碎的水银温度计。
传染性废物和解剖废物合起来占危险废物的绝大部分，高达卫生保健活动废物总量的15%。利器约占废物总量的1%，但若不加以妥善管理将成为疾病传播的主要渠道。化学品和药品占卫生保健活动废物的约3%，而基因毒性废物、放射性物质和重金属成分则约占卫生保健废物总量的1%。
卫生保健废物的主要来源是：
医院和其它卫生保健机构
实验室和研究中心
太平间和尸检中心
动物研究和检测实验室
血库和采血机构
养老院
高收入国家每天每张病床产生的危险废物平均达0.5公斤；而低收入国家每天每张病床产生的危险废物平均为0.2公斤。但是，低收入国家通常不对危险废物和非危险废物进行区分，因此实际的危险废物数量要高很多。
卫生影响
卫生保健废弃物含有潜在有害的微生物，可能感染医院的患者、卫生保健工作者以及广大民众。其它潜在的传染风险包括具有耐药性的微生物从卫生保健机构传播到环境当中。
废物和副产品也可能造成伤害，例如：
辐射灼伤；
利器造成的伤害；
因释放药物产品，特别是抗生素和细胞毒性药物而导致的中毒和污染；
废水导致的中毒和污染；
有毒元素或化合物，如汞或焚烧过程中释放的二恶英所导致的中毒和污染。
利器
全世界每年估计进行160亿次注射。但事后并非所有的针头和注射器都能得到妥善处理，由此引起伤害和感染风险并给重复使用制造了机会。
世卫组织估计，2000年因使用被污染的注射器进行注射在全世界导致了2100万例乙肝病毒感染，200万例丙肝病毒感染和26万例艾滋病毒感染。如果注射器得到了安全处置，这些感染中有许多都是可以避免的。重复使用一次性注射器和针头的现象在非洲、亚洲以及中欧和东欧某些国家特别常见。
在发展中国家，清理废物处置场和人工分拣卫生保健机构的危险废物可能造成更多的危险。这些做法在世界许多区域都很常见。废物处理者面临被针头扎伤和接触有毒或传染性物质的直接风险。
疫苗废物
2000年6月，六名儿童在符拉迪沃斯托克（俄罗斯）一家垃圾场玩弄含有过期天花疫苗的玻璃安瓿后，被诊断患有轻度形式的天花(牛豆病毒)。虽然这些感染没有危及生命，但疫苗安瓿在被弃置之前本应得到处理。
放射性废物
如今世界各地普遍在医疗和其它应用中使用放射源。公众偶尔会接触到放射治疗后未得到妥善处置的放射性废物。这方面记录的几起严重事故有，1988年发生在巴西的事故(四人死亡，28人受到严重辐射灼伤)、1983年发生在墨西哥和摩洛哥的事故、1978年发生在阿尔及利亚的事故以及1962年发生在墨西哥的事故。
与其它类型的卫生保健废物，特别是血液废物和化学品有关的风险恐怕也不容忽略，但尚未得到充分评估。需要开展更多的工作。在此期间，应当采取防范措施。
与废物处置有关的风险
尽管对卫生保健废物进行处理和处置可以减少风险，但处理或处置过程中有毒污染物可能被释放到环境中，从而造成间接健康风险。
废渣填埋地如果构建不当则可能污染饮用水。废物处置设施如果设计、运行或维护不良则会存在职业风险。
焚烧废物已成为广泛的做法，但如果焚烧不充分或焚烧不适当的材料则可能使污染物释放到空气中并产生灰渣。焚烧含氯的材料可以产生二恶英和呋喃2，它们是人类致癌物，并与一系列不良健康反应有关。焚烧重金属或金属含量高的材料(尤其是铅、汞和镉)可能使有毒金属传播到环境中。二恶英、呋喃和金属具有持久性并可在环境中生物累积。因此，含氯或金属的材料不应当被焚烧。
只有温度高达850-1100度并装有特殊气体净化设备的现代焚化炉能够符合二恶英和呋喃的国际排放标准。
目前已具备可替代焚烧的其它手段，如高压灭菌、微波、蒸汽处理与内部混合相结合，以及化学处理等。
废物管理——失败的原因
对与卫生保健废物有关的健康危害缺乏认识，关于妥善废物管理的培训不足，没有废物管理和处置系统，财政和人力资源不足以及对此问题重视不够都是与卫生保健废物有关的最常见问题。许多国家或者没有适当的法规，或者未加以执行。基本问题在于要明确归属处理和处置废物的责任。根据“污染者支付”的原则，责任应由废物制造者承担，通常指的是卫生保健提供者，或参与相关活动的机构。为能够安全和可持续地管理卫生保健废物，财政分析应包括处置废物的全部费用。
实现改善的步骤
改善卫生保健废物管理依赖下列要素：
建立一个综合系统，处理责任、资源分配、处理和处置等各种问题。这是一个长期的过程，需要逐步改善来支撑；
提高对卫生保健废物相关风险以及安全合理做法的认识；
选择安全和有益于环境的管理方法，以便在收集、搬运、储存、运输、处理或处置废物时防止人员受到危害。
尽管可就地采取立即行动，但普遍长期的改善需要政府的承诺与支持。
世卫组织的应对
世卫组织最初于1999年发表了第一版全球性综合指导文件《安全管理卫生保健活动废物》3，涉及的方包括管制框架、规划问题、尽量减少废物、废物的回收、搬运、储存、运输、处理和处置，以及培训等。
该文件的目标对象是医院和其它卫生保健机构的管理人员、决策者、公共卫生专业人员以及参与废物管理工作的管理人员。与此文件同时还颁布了一份《教师指南》，载有针对相同受众的三天讲习班材料。
此外，现在可获得的关于卫生保健废物的世卫组织指导文件还包括：
一项监测工具
一项费用评估工具
一项快速评估工具
一份政策文件
关于制定国家计划的指导
注射活动的废物管理
初级卫生保健中心的废物管理
大规模免疫活动的废物管理
紧急情况中的废物管理
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