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本帖最后由 mickeypank 于 2011-11-9 10:39 编辑
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.
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发表于 2011-11-9 10:34
发表于 2011-11-9 10:43
，
，能给个中文版吗？