Study for Improving Infectious Waste Management Efffiiciency in Thailand

Abstract

This qualitative study was conducted by using documentary research technique and consultation meeting withfiveexperts infourareas (infectious control,publichealthactadministration,decentralization power to local authorities, public health), and two persons who were responsible for infectious waste management during COVID-19 at local and provincial levels. This study aimed for reviewing situation related to management of infectious waste management in Thailand; compare measures between Thailand and international organizations; synthesize above mentioned and other countries’ experiences to provide recommendations tothe Departmentof Health. Principal legislationcontrollinginfectious waste management in Thailand is Public Health Act, B.E.2535 with first specific Infectious Waste Disposal Regulation, B.E.2545. Major sources of infectious waste were 41,786 hospitals (large sites 3.5%, small sites 96.5%), 3,224 veterinary hospitals/clinics and 816 microbiological laboratories. During COVID-19 pandemic, numbers of sources and quantities increased, For examples: hospital infectious waste increase from 0.38-1.40 to 2.85-7.5 kg./bed/day, while infectious waste generation rate from new sources were : field hospitals 1.50-1.82 kg./person/day, State Quarantine 1.32 kg./person/day, RT-PCR test 0.05 kg./sample and vaccination 0.015 kg./dose. The last outbreak caused highest infectious waste quantity to reach 13,297 tons (August 2021)beyondnormaldisposalcapacity(totalcapacityof 14central treatment sites8,340tons/m.).Moreover, some amountof infectious waste still left at sources. The Thai regulationsoninfectious waste management specified measures from sources, transferandcollect withinvicinity, transport todisposal siteanddisposal. These measures were relevance to WHO guidelines and Stockholm Convention on controlling dioxin and furan. During COVID-19pandemicdifferent measures from internationalorganizations andpractices from other countries found. Therefore, to consider measure that appropriate to Thailand context was important. According to WHO, UNEP, USA. CDC, OSHA, UK and Australia suggested that waste from COVID-19 should be treated as normal infectious waste but handle with care. China and South Korea treated them with special measures e.g. disposal within 24 hours, introduced mobile incinerators, pretreatment of waste at sources. Recommendations were (1) Amend Public Health Act and relevance regulations (concrete definition, expand source of waste, strictly control major sources, revise minor source protocol, provide appropriate technologies suitable for remote area or difficult to transfer to disposal site, add protective measures for personal (training, PPE, vaccination) and expansion of transfer and disposal permit). (2) Improve administrative measures by increase cooperation between ministries to support regulation enforcement, provide mechanism ranging from central level to provincial and local levels. At provincial level, Provincial Administrative Authority shall have duty to support and monitor infectious waste management. Long-term plan, other principals i.e. waste to energy, extended producer responsibility should be employed. Some research topics suggested e.g. treatment of infectious waste based on risk, appropriate methods for small scale source or remote area