This is the second edition of the World Health Organization (WHO) handbook on the safe, sustainable and affordable management of health-care waste – commonly known as “the Blue Book”. The original Blue Book was a comprehensive publication used widely in health-care centres and government agencies to assist in the adoption of national guidance. It also provided support to committed medical directors and managers to make improvements and presented practical information on waste-management techniques for medical staff and waste workers. The first edition in 1999 was published at an influential point in time. Public interest in emerging and developing countries to improve health services was growing, and poor waste practices within health-care facilities were being challenged increasingly by interest groups and communities. In the more developed countries, there was a renewed concern about consumption of resources and impacts on global changes to climate and the environment.
In many countries, knowledge about the potential for harm from health-care wastes has now become more prominent to governments, medical practitioners and civil society. Increasingly, managers and medical staff are expected to take more responsibility for the wastes they produce from their medical care and related activities. The indiscriminate and erratic handling and disposal of waste within health-care facilities is now widely recognized as a source of avoidable infection, and is synonymous with public perception of poor standards of health care.
It has been more than 10 years since the first edition of the Blue Book. During the intervening period, the requirements on generators of health-care wastes have evolved and new methods have become available. Consequently, WHO recognized that it was an appropriate time to update the original text. The purpose of the second edition is to expand and update the practical information in the original Blue Book. In June 2007, WHO held a workshop in Geneva with specialists from 31 countries. The specialists reviewed the Blue Book chapter by chapter and proposed new information to ensure the advice remains relevant to current demands on health-care facilities. During the following four years, every chapter was revised by authors from around the world. These authors gave their time voluntarily, and their drafts were extensively peer-reviewed before being edited into a final form.
The new Blue Book is designed to continue to be a source of impartial health-care information and guidance on safe waste-management practices. The editors’ intention has been to keep the best of the original publication and supplement it with the latest relevant information.
The audience for the Blue Book has expanded. Initially, the publication was intended for those directly involved in the creation and handling of health-care wastes: medical staff, health-care facility directors, ancillary health workers, infection-control officers and waste workers. This is no longer the situation. A wider range of people and organizations now have an active interest in the safe management of health-care wastes: regulators, policy-makers, development organizations, voluntary groups, environmental bodies, environmental health practitioners, advisers, researchers and students. They should also find the new Blue Book of benefit to their activities.
Chapters 2 and 3 explain the various types of waste produced from health-care facilities, their typical characteristics and the hazards these wastes pose to patients, staff and the general environment. Chapters 4 and 5 introduce the guiding regulatory principles for developing local or national approaches to tackling health-care waste management and transposing these into practical plans for regions and individual health-care facilities. Specific methods and technologies are described for waste minimisation, segregation and treatment of health-care wastes in Chapters 6, 7 and 8. These chapters introduce the basic features of each technology and the operational and environmental characteristics required to be achieved, followed by information on the potential advantages and disadvantages of each system.