AFTER a long-standing “don’t-ask, don’t-tell” policy which left fecal matter and used syringes mixing freely with common waste, the Costa Rican government is steps away from implementing a comprehensive waste-management plan for all the public hospitals in the country.
The Social Security Administration (Caja) closed a four-month bidding process last week that resulted in three consortiums submitting plans to manage the collection, treatment and disposal of hospital waste for at least the next ten years.
An in-depth investigation by The Tico Times last year revealed that untreated hospital waste – including syringes, vials and fecal matter – is regularly discarded in landfills. Hazardous waste also has been found on streets, in rivers and in the hands of citizens (TT, Nov. 7, 2003).
A commission of five representatives from the Caja expects choose a waste-management plan by April, after it reviews the boxes of submitted paperwork.
The selected consortium will then have eight months to implement its plan. The Caja, which has an annual budget of approximately $1.5 million for the service, expects it to go into effect by 2005, according to Dr. Xinia Carvajal, coordinator of the Caja’s Mixed Commission on Solid Hospital Waste.
Hospitals generate regular and hazardous waste, which include sharp objects like razors and needles, infectious and anatomic waste, chemicals and pharmaceutical products, as well as genotoxic, radioactive and metal waste. About 76 public hospitals and clinics in Costa Rica produce approximately 44 metric tons of garbage a week.
NEITHER elimination of body parts – which are deposited in cemeteries – nor pharmaceutical and chemical products will be included in the comprehensive treatment plan, although a plan is in the works for the “immediate future,” Carvajal said.
The three groups bidding on the wastemanagement project are Consortium Asemeco-Sitere, Consortium Declasa-Reenfrio and Consortium Eco Health.
Proposals from these consortiums estimate it will cost between U.S. $0.55 and $0.75 per kilogram to treat and dispose the hospital waste.
One of the companies involved in one of the consortiums is Fénix Médica, a company that had plans to build an incinerator to treat hospital waste in Heredia last fall (TT, Oct. 24, 2003). Community members objected to the project, claiming that burning hospital waste as a form of sterilization released dangerous chemicals. The incinerator proposal has not moved forward.
The Caja has decided against incineration for its waste-treatment program because of the dangerous bio-toxins released when waste is burned, Carvajal said. Instead, a thermal-oxidation process known as autoclave technology likely will be used.
IN addition to following guidelines established by the Caja to properly treat and dispose of hospital waste, proposals must also follow a decree regulating hospital waste that was signed in February 2003 by President Abel Pacheco and Health Minister Rocío Sáenz.
The decree aims to regulate hospital waste and eliminate public health horrors such as the spread of tuberculosis to garbage collectors.
However, compliance with the rules still varies from hospital to hospital.
“This will solve the problem of waste management once and for all,” Carvajal explained in a faxed response to Tico Times questions about the public bid process.
WHILE some hospitals have scrambled to comply with stricter regulations under the new decree, others still mix hazardous and regular waste, provide inadequate treatment facilities or are unaware of regulations.
“No one is complying with the law,” said Miguel Vargas, executive director of the Federación de Municipalidades del Este (Fedemur), administrator of the Río Azul landfill in Desamparados.
Eduardo Vega, mayoral assistant for waste management at the Municipality of Limon, said that although local hospitals have come a long way in separating hazardous waste, some landfills still deposit infectious material with regular waste.
“The Ministry needs to put the Caja in order,” Vega said. “The bidding process is the best the Caja can do.”
THE 2003 decree sets rules for separation, containment, storage, collection, transportation, treatment and final destination for waste from public and private medical facilities, including hospitals, clinics, laboratories and veterinarians.
Detailed information explains why only red bags with international biohazard symbols should be used for hazardous waste. They should be two-thirds filled and never reused or reopened.
According to the decree, each facility must designate an infectious waste representative, and the Health Ministry is responsible for ensuring compliance through its Protection of the Human Environment office.
Collection carts should be cleaned and disinfected every day, clearly marked “infectious-contagious waste” and any elevators used for transport should be disinfected after use. Minimum protective gear should include a complete uniform, gloves and a mask or mouth covering. All personnel handling waste must have proof of all vaccinations.
HOSPITALS must not store waste for more than 24 hours, while smaller clinics can keep garbage for up to 72 hours. When waste is transported, infectious material should not be compacted and should be kept separately.
Despite these rules, the decree does not establish which types of sterilization treatments are acceptable in Costa Rica.
According to Andrés Inser, a civil engineer for technical guidelines in the Department of Environmental Health, hospital waste has long been recognized as a public health problem, but lack of political support and limited personnel made comprehensive legislation and compliance difficult.
“Twenty-nine years after the first law governing national heath, this rule comes out to fill a void,” he said of the 2003 decree.