Medical industry duty of care: onerous, but necessary

A recent study on the state of medical waste management in rural South Africa has revealed that areas of the country are underprepared to deal with multiple forms of potentially-hazardous materials. If left unchecked, communities could be exposed to hazardous materials that medical facilities have a legal and ethical duty to dispose of according to very stringent regulations.

“Healthcare risk waste is rightly considered a major threat to the safety of communities if it’s not properly handled,” says Johan van den Berg, MD of Averda South Africa. “We haven’t had any major epidemics in South Africa related to negligence or exposure to such risks, for which we should be grateful.”

A recent study by researchers from the University of Venda, published in June this year, concludes that health care risk waste is not being efficiently managed in Vhembe District in Limpopo. The report was based on 229 responses from managers and staff at 15 healthcare facilities across the district.

Deficiencies in the management of medical waste was attributed more to a lack of awareness and training of medical staff rather than purposeful negligence.

Although the study only looks at one of South Africa’s provinces, it certainly gives pause for thought on the measure of training and awareness that is required to ensure that health care risk waste is managed safely and efficiently.”

The management of healthcare risk waste (HCRW) is governed by the National Environmental Management Waste Act of 2008, which places a particularly burdensome responsibility on any facilities or practitioners that produce medical waste. This includes doctors and clinicians, and hospitals and medical facilities of all descriptions.

Specifically, the law says that this duty of care exists from the source all the way to disposal.

For instance, a clinic cannot absolve itself of responsibility once it has been handed to a waste management company like Averda. The clinic is held responsible right up to final disposal even if it has not physically dealt with or disposed of the materials.

This means that a medical facility has to properly document all its HCRW from the time that it is generated, through the transportation and up to its eventual disposal. Figures from the Department of Environmental Affairs shows that some 50 000 tonnes of medical waste was treated in 2018 at the 18 licenced treatment facilities around the country.

HCRW covers all types of organic and non-organic materials that range from swabs, bedding, bandages and plasters to human tissues, organs, and body parts. Other forms of waste include instruments (broadly called ‘sharps’), such as needles, scalpels, razors and pipettes.

Radiological materials used in the treatment and diagnosis of cancer are an obvious candidate for special treatment, while expired, unused, spilt or contaminated pharmaceutical products and drugs also cannot be disposed of with general waste.

“The biggest challenge for the health care sector is being able to track every piece of waste they generate. This does not have to be done down to the individual material or organic waste, but the regulations do stipulate that they should be able to identify the source and type of HCRW down to the kilogram.

“This is an enormous task, and not one that every facility is able to do with absolute confidence. Obviously, as a specialist waste handler, we have systems and technology that simplifies this task, but this is not the case across the board. And the University of Venda study is evidence of the extent to which this does not happen.”

Specialist waste management companies like Averda are developing advanced systems that will enable producers to properly store, track and report on how and where their HCRW has been treated and disposed. This will give the medical industry greater confidence in its reporting and being able to prove its duty of care, and should give citizens of the country confidence that they are not unnecessarily placed at risk.