Wewe | Course Paper

Journal of Administrative Science Vol.10, Issue 1, 2013

ISSN 1675-1302

Environmental Policy In Malaysia: Biomedical

Waste, Strategies And Issues

1

Abdul Raufu Ambali,

2

Ahmad Naqiyuddin Bakar, and

3

Farah Murni Merican

ABSTRACT

Management of waste is a general acute problem around the globe. Waste management is of

great concern as urbanization and economic development increase leading to generation of

larger quantity of waste materials. The management of waste materials requires immediate

attention of the newly emerging economy country such as Malaysia. To be more specific,

biomedical wastes are becoming a topic of one cannot deny the important roles play by

biomedical science and its activities on human life and fitness. However, these activities can

generate some wastes that pose severe effects on human health and environment at large,

especially if there is no proper management policy in place. Although some may argue that

waste is generally unavoidable by-product of most human activities but the provision of

expanded healthcare facilities today have added substantial quantities of biomedical waste

into waste stream with severe environmental and human health consequences. This paper

examines the level of biomedical waste in Malaysia. It also addresses the impacts of these

biomedical wastes and the strategic measures taken by Malaysian government. Finally, it

identifies some potential issues associated with policy measures and put forward some policy

recommendations for precautionary measures in the future.

Keywords:Biomedical activities, biomedical waste, Management, Policies, Strategies and

Issues.

Introduction

Clinical waste resulting from healthcare establishment is growing in direct proportion with the

increasing demand of medical service in Malaysia. With attractive packages, health tourism is

thriving in Malaysia which sees hundreds of thousands patients from as far as Europe coming

to seek various medical treatments in the country. Apart from booming health tourism,

pandemics like SARS, Avian Flu as well as changing demographic lifestyles and ageing

nations, more people are seeking medical help, which leads tosubstantial increment in the

amount of biomedical waste generation. By the year 2020, biomedical waste from Malaysian

hospitals is estimated to hit 33 000 tonnes annually. Currently, the capacity of incineration in

this country is limited to processing 18 000 tonnes of wastes per year (Frost and Sullivan,

2010). However, as developing countries undergo economic growth, industrialization,

engineering activities in biomedical science and development, the proper management of

hazardous waste from those activities becomes an area of increasing concern. Responsibility

for management of waste often resides with national government in any country. In fact, the

control of industrial emissions was a concern for the government. To overcome this, the

government enacted the Environmental Control of Toxic and Hazardous Waste Management

Journal of Administrative Science Vol.10, Issue 1, 2013

ISSN 1675-1302

Code and Environmental Quality Regulations related to scheduled wastes was passed in 1989.

In order to bring into action, Environmental Quality Orders and Regulations (Prescribed

Premises) related to Scheduled Wastes Treatment and Disposal Facilities were simultaneously

introduced in 1989. In 1990, the Promotion of Investments Order (made under the Promotion

of Investments Act, 1986) was introduced to regulate environmental issues in the context of

investment activities that can affect any environmental resource. This was later followed by

the Prohibition on the Use of Controlled Substance in Soap, Synthetic Detergent and Other

Cleaning Agents Order passed in 1995. As such, this paper seeks to highlight the initiatives

and course of actions taken by Malaysian government to address the negative consequences

of biomedical wastes that can endanger the health of people and their environment.

Conceptualizing Biomedical Wastes

According to Pruss et al (1999), the World Health Organization (WHO) defined medical

waste as “any waste which consists wholly or partly of human or animal tissue, blood or other

bodily fluids, excretions, drugs or other pharmaceutical products, swabs or dressings, needles

or other sharps; and any other waste arising from medical, nursing, dental, veterinary,

pharmaceutical or similar practice, investigation, treatment, care, teaching or research, or the

collection of blood for transfusion”. Broadly defined in the context of this paper, biomedical

waste is all wastes produced by hospitals, clinics, doctors’ and dentists’ offices, veterinary

clinics, and biomedical research labs. Usually it refers to biomedical wastes that could

potentially spread infectious diseases. This includes human and animal anatomical wastes,

fluids and secretions from patients, contaminated syringes and other “sharps”, contaminated

surgical and nursing supplies, and contaminated laboratory wastes. Biomedical wastes are the

infectious wastes generated from hospitals and improper management of waste from

healthcare facilities that can have direct or indirect health impact on community and

environment at large. A breakdown of waste types and sources results to four major

categories of waste: municipal solid waste, industrial waste, agricultural waste and hazardous

waste. Due to likely infectious consequences, most of the biomedical wastesare classified

under hazardous waste category, which is the major focus of this paper, (WHO, 2003, p.12;

Environmental Quality Regulation, 1998). A clear appreciation of the quantities and

characteristics of the waste being generated is a key component in the development of robust

and cost-effective waste management strategies. In Malaysia, amongst other Asian countries,

quantification and characterization of waste forms the basis for management and intervention

by the government and agencies and/or institutions. Priority is given to the systematic

surveying of waste arising and the quantities, characteristics, seasonal variations and future

trends of waste generation at large. Small- and medium-sized institutions and industries that

generate hazardous wastes include hospitals and health-care centers, electroplating and metal

finishing shops, textile factories, dry cleaners and pesticide users. In general, the principal

sources of wastes are residential households and the agricultural, commercial, construction,

industrial and institutional sectors such as public and private clinics in the country

(Agamuthu, 2001, pp.1-5; DOE, 2009, p.13).

On top of all, biomedical research facilities generate a complex array of wastes, which

may be broadly grouped into two categories: biomedical research wastes that are direct

products of research activities, and other conventional wastes from research support

operations such as facility construction, operation, maintenance, and demolition, and

administrative functions. With some exceptions, conventional wastes from biomedical

research facilities are similar to or indistinguishable from wastes generated by other sources

Journal of Administrative Science Vol.10, Issue 1, 2013

ISSN 1675-1302

such as textile and chemical industries. Biomedical research wastes do contain multiple types

of hazardous materials such as combinations of toxic chemicals, radioactive materials, and

bio-hazardous agents. Bio-hazardous waste is usually considered by the scientific community

to be a waste that could, in a susceptible host, cause infection that may develop into a disease,

which could be expressed as a recognizable departure from normal. However, the public often

perceives a waste to be bio-hazardous on the basis of its source and appearance. Waste

appearing to originate from a hospital, clinic, or biomedical research laboratory is often

assumed bio-hazardous, even if potentially infectious microorganisms or toxins are not

present therein (Agamuthu, 1997, p. 5). Specifically speaking, clinical waste or biomedical

waste “includes a broad range of materials, from used needles and syringes to soiled

dressings, body parts, diagnostic samples, blood, chemicals, pharmaceuticals, medical devices

and radioactive materials” ( World Health Organization [WHO], 2011). Without efficient

infrastructure and adequate waste disposal options, large volume of these wastes may pose

great danger to human health and environment. Without proper management, contaminated

waste poses risk not only to public, but to those who come into contact with them namely

health workers, scavengers, etc. Faulty handling and improper disposal may lead to recycling

and reusing of contaminated waste such as syringes and needles (WHO, 2011). Report by

WHO has shown that in the year 2000, injection with contaminated waste such as syringes

and needles (categorized as “sharps”) have caused millions of Hepatitis B Virus and Hepatitis

C Virus and at least 26000 HIV infections. Studies have also shown that 20% of those

handling “sharps” have experienced “sharp injury”.

Table 1: Percentage of waste type per total waste in public health care centres

Type of waste Quantity

Non

–

infectious waste

80%

Pathological waste and infectious waste

15%

Sharps waste

1%

Chemical or pharmaceutical waste

3%

Pressurized cylinders, broken

thermometers etc

<1%

Source: WHO (2005), Management of Solid Healthcare Waste at Primary Healthcare

Centres – A Decision-Making Guide, Geneva

However, in Malaysia, Private Healthcare Facilities and Services Act 1998 and Private

Healthcare Facilities and Services (Private Medical Clinics or Private Dental Clinics)

Regulations 2006 had been formulated to address the infectious wastes from clinics. Under

these Regulations, hazardous waste includes both infectious and non-infectious waste.

Infectious waste includes human, animal, biological waste or contaminated sharps and any

items that may be contaminated with pathogens, whereas non-infectious waste includes toxic

chemicals, cytotoxic drugs, radioactive, flammable and explosive waste. However, according

to the WHO only 20% of the healthcare wastes are considered infectious to human beings,

while 80% of them are non-infectious in nature as shown in Table 1.

Rationale for Waste Control

Incineration and other medical waste treatment processes can generate secondary wastes and

pollutants if the treatment facilities are not properly designed, constructed, and operated.

Journal of Administrative Science Vol.10, Issue 1, 2013

ISSN 1675-1302

These pollutants may have adverse environmental impacts on human health. Polychlorinated

dioxins and dibenzofurans, and corrosive gases may be produced by medical waste

incinerators. Varying levels of pollutants may also be emitted from alternative non-

incineration treatment processes of biomedical wastes, depending on the method used for

pathogen inactivation and the type and/or nature of wastes being treated. Whether these

pollutants are released into the environment or contained depends on a number of operational

factors and the level of technological advancement inherent in the treatment system. Phenolic

disinfectants are of particular concern because they may disrupt wastewater treatment

processes or result in discharges of toxic effluents that may have serious effects on human

health. Many publicly owned treatment works have set allowable wastewater concentration

limits for phenolic compounds at very low levels, precluding disposal of wastes containing

these disinfectants via the sewerage system. Environmentally speaking, the uncontrolled

dumping of biomedical wastes has the potential for transporting pathogens or disease

producing organisms that can cause significant adverse impacts on human health and the

environment (Prevention and Control of Infectious Diseases Act 1988, Ministry of Housing

and Local Government, 1999, Section 4).

Policies and Regulations on Waste Management

Many groups of stakeholders, including waste producers, regulators, legislators, consultants,

contractors and equipment suppliers, educators, NGOs, media and the general public, are

involved in national waste management policies and strategies in Malaysia. Although each of

these stakeholders plays a potential role, three groups such as municipalities, regulators and

legislators provide the key to effective national waste management policies and strategies that

integrate the responsibilities of all stakeholders in making waste management a successful

venture in the country. Institutions and legislations at the national level generally provide the

basic infrastructure for the implementation of policies, strategies and actions for waste

management in general.

In recent year, three general trends in biomedical waste management private consortia

in 1993 and legislation have been evident in Malaysia. These are the creation of agents for the

strengthening of environmental policies and strategies and the development of more focused

environmental legislation, and the increase of manpower capabilities through education and

training. There has been an upward trend in the status of the above three aspects of waste

management, as government ministries and high level agencies have been established

specifically to control such biomedical wastes.

Policy Guidelines for Managing Biomedical Waste

More than a decade ago, serious concern has been raised regarding the potential for spreading

pathogens, as well as causing environmental contamination due to the improper handling and

management of clinical and biomedical waste. Whilst full regulatory programs and guidelines

to control waste from such institutions have been introduced in most developed countries, in

Malaysia, the Ministry of Health prepared preliminary guidelines for the management of

hospital waste in 1998. The Ministry has published national guidelines for management of

clinical and related wastes and similar biomedical management guidelines have also been

produced at the state levels. This is to rationalize and recommend methods for the

management of health care wastes within the country. In addition, guidelines were drafted for

the management and safe disposal of hospital wastes and the Ministry of Health produced the

“Hospital Waste Management Manual,” which included detailed guidelines for handling and

Journal of Administrative Science Vol.10, Issue 1, 2013

disposing wastes (Saw, C.B. 1994). Department of Environment (DOE) has formulated the

Waste Pollution Prevention and Control Law and/or the Regulations on management of

biomedical hazardous wastes. However, hospital waste is generally collected and disposed of

together with other domestic wastes on the basis of the guidelines provided. In some of the

larger states, individual hospitals have installed on-site incinerators for the disposal of clinical

wastes (WHO/WPRO, 1998, p.12; DOE, 2009, p.9).

Regulatory Measures

In Malaysia, schedule waste related to hazardous clinical or biomedical waste is categorized

into a few categories according to its contents (Department of Environment [DOE], 2009).

Recently, Environmental Quality (Scheduled Wastes) Regulations 2005 (“Regulations”)

serves as a key legal framework that deals specifically with hazardous waste. Subsidiary

legislation which falls under this are (1) The Environmental Quality (Prescribed Premises)

(Scheduled Wastes Treatment and Disposal Facilities) Order 1989; and (2) The

Environmental Quality (Prescribed Premises (Scheduled Wastes Treatment and Disposal

Facilities) Regulations 1989. Based on the research conducted in HUKM, segregation process

was highlighted as vital in managing biomedical waste. The waste is disposed of according to

color coded contained or plastic bag (Zaimastura, 2005). This is in line with the Environment

Quality Act (Scheduled waste) 1989 which stipulated that all healthcare establishments in

Malaysia must adopt the colour coding standard in classifying biomedical waste. Blue plastic

bag / container is used for wastes to be autoclaved, yellow is for wastes that are to be

incinerated and black is for general household wastes (DOE, 2009). After the process of

collection and storage, in central region biomedical waste will be transported to the

incinerator in TelukPanglimaGarang, Selangor. Incineration is the only method in disposing

of medical waste practiced by Radicare. (Zaimastura, 2005) Despite the risk of pollution,