Books & Electronic Media
Safe management of wastes from health care activities
A. Prüss, E. Giroult & P. Rushbrook, eds, World Health Organization, 1999. Price in industrialized countries Sw. fr. 72, in developing countries Sw. fr. 50.40. Winner of First Prize in the Public Health category of the Medical Book Competition 2000 of the British Medical Association, ISBN 92-4-154525-9.
It was in the early 1980s that the management of health care waste became a major issue. Problems were brought to a head in the industrialized countries by the surge in use of disposable equipment, which led directly to the production of unprecedented quantities of often hazardous waste. Not only were the traditional methods of incineration proving inadequate, but hospitals were having to shut down their incinerators because of new clean air legislation. There was widespread concern both about the environment and about the dangers posed by infectious, toxic and radioactive waste. The need for safe disposal of blood and used needles was further dramatized by the AIDS pandemic.
Governments in industrialized countries were tackling the problems through legislation and giving guidance on best practices to the health care and waste management industries. Further demand for support came from the newly independent states of the former Soviet Union in the early 1990s. Following the United Nations Conference on the Environment and Development in 1992, an increasing number of low and middle-income countries began to tackle their waste management problems.
In some developing countries inadequate waste management can lead to the reuse of disposable injection equipment. This becomes a significant source of infection, mainly with hepatitis B and C. Also, waste workers or scavengers may manually sort the infectious waste without personal protection. Management of sharps waste therefore is one of the three main elements of injection safety.
Insanitary dumps were in most cases the norm, and there was a dearth of detailed practical information on the alternatives. The idea of the handbook thus arose from urgent practical necessities. The current publication is the culmination of the efforts of the worlds experts in this field to provide an up-to-date and practical guide for any country, irrespective of its current state of social and economic development.
It covers all aspects of the management of health care wastes, starting with their definition and characteristics, then dealing with the necessary regulatory controls and planning requirements, and then the segregation, storage, transport, treatment and final disposal of these wastes; it ends with a chapter on training. There is also a section on minimal programmes that should be applied in emergencies or in small rural establishments, field hospitals or refugee camps.
The handbook consists of 230 pages in 16 chapters. It is clearly and interestingly written, well laid out in A4 format, and illustrated with photographs and diagrams which make the concepts and detailed descriptions easily accessible. It includes four annexes with highly technical information for more specialized users, and each chapter includes a useful bibliography. A short glossary explains the key terms used.
I strongly recommend the handbook to anyone with responsibilities in this area. It is the best and most comprehensive guide available at this time and will be a constant source of valuable information. 
W. K. Townend
Chairman, Health Care Waste Working Group
International Solid Waste Association
6 Crutchley Road, Wokingham
Berks RG40 1XA
England