Colour code guide for home health-care waste. (Image courtesy UK Department of Health)

The Ministry of Planning and Development has embarked on a national study to answer the question: In the ongoing global pandemic are home healthcare wastes handled in a safe and environmentally sound manner in Trinidad and Tobago?

This is the main focus of a national online survey launched on September 1st by the Ministry of Planning and Development, in coordination with the Basel Convention Regional Centre for Training and Technology Transfer for the Caribbean, and with support from the United Nations Environment Programme (UNEP).  The outcome of this survey is to address gaps within the national waste management system to minimize the risks posed to sanitation and health workers, the general public, negate any adverse environmental impact, and optimize a national waste system. All responses will be kept strictly confidential and are anonymous.

Although national guidelines exist for management of biomedical waste generated from home healthcare, there is currently a gap in the disposal of this waste stream as there is no established system in place. As a result, home healthcare wastes can become co-mingled with domestic waste and enter the municipal solid waste stream going to landfills. This presents a threat of infection and injury to humans and pollution of the environment- The COVID-19 pandemic has introduced a new concern resulting in increased generation of this type of waste from households, thereby exacerbating the situation.

This survey therefore aims to collect information on the knowledge, what is known; attitudes, what is thought; and practices, what is done by householders that generate biomedical waste. The data from this Knowledge, Attitude and Practices (KAP) Survey will serve as the basis for identifying the strengths, needs and barriers to be targeted for closing these gaps, in accordance with best practice approaches.

Planning and Development Minister Camille Robinson-Regis emphasizes the need for this national research in the context of Government’s goal of placing the environment at the centre of social and economic development.  The Minister also added that the project contributes to Trinidad and Tobago’s achievement of the global Sustainable Development Goals (SDGs), especially SDG 12, ‘Responsible Consumption and Production’.

Improper segregation and disposal of biomedical waste can have many direct and indirect implications on not only the environment but on human health as well.  These are as follows:

●   Biomedical waste is a source of toxic and hazardous pollutants.

●   Spread of illness through human and animal population- by air, land or water.

●   Harm to persons handling waste: needlestick injury and sharps injury incidents from at-home diabetic lancets for example can increase the risk to the health of waste handlers.

●   Risk of infection from contagious diseases and pathogens which are not only are a hazard to healthcare workers inside healthcare facilities but also to domestic waste handlers that deal with co-mingled biomedical waste generated from homes heading to the landfills.

●   Dumping or indiscriminate disposal of wastes including biomedical wastes contributes to pollution of the air, water and soils, impacts wildlife such as entanglement and ingestion as well as secondary implications to the environment e.g. flooding. 

With the advent of the COVID-19 pandemic there has been an increase in the generation of biomedical waste especially through the various personal protective equipment (PPE) being required (e.g. masks, gloves, shields etc.). These disposable type PPE are usually made of plastics, some of them polypropylene the same as those used for straws and bottles and can persist in the environment for long periods. This has therefore added to the plastic, particularly single use plastic pollution problem, negatively impacting our ecosystems and contributing to all the related plastic pollution issues, as plastic does.

It has been estimated that the amount of plastic waste generated worldwide since the outbreak is 1.6 million tonnes per day (Benson, Bassey and Palanisami, 2021).

It is envisaged that this project will improve the capacity of the country to alleviate the pressures within the biomedical waste management sector and to strengthen the national capacity to address any deficits. Attention will also be given to public awareness and knowledge transfer as it pertains to proper management of biomedical wastes, including at the household level. The outcome of this project is to also minimise the risks posed to health care workers, waste handlers, the national community, and the environment from improper handling and disposal of biomedical waste.

Definition of Terms

(as outlined in the Code of Practice for Biomedical Waste Management Trinidad and Tobago)

Biomedical waste may be defined as any solid or liquid waste which may present a threat of infection to humans, including non-liquid tissue, body parts, blood, blood products, and body fluids from humans and other primates; laboratory and veterinary wastes which contain human disease-causing agents; and discarded sharps.

Home healthcare waste includes used expired pharmaceuticals, incontinence pads, dressings, syringes, hypodermic needles, sharps and some infectious waste such as swabs, tissues, etc.  Home healthcare waste is also generated through self-care or home users where patients are provided with devices to administer medication, are on home dialysis or are diabetics. Waste types include, used sharps and syringes.

Background of the UNDP and BCRC’s broader project

(A project led by the Ministry of Planning and Development)

In light of the current COVID-19 pandemic, the United Nations Environment Programme (UNEP) extended technical assistance to countries in the Latin America and Caribbean region to integrate the environment into their response and recovery from the COVID-19 crisis. The Ministry of Planning and Development was able to successfully mobilise technical guidance and financial resources from UNEP to support chemicals and waste management in Trinidad and Tobago for the nation’s COVID-19 response and recovery. As such, this four-month project has been developed with an objective of addressing areas of concern within the existing biomedical waste management system in Trinidad and Tobago, to not only assist with immediate medical related emergencies but also future contingency planning.

There are three main components of the project; Knowledge, Attitude and Practices (KAP) Gap Analysis of Biomedical Waste Management, including KAP surveys on home healthcare waste (households), health institutions and waste contractors which have been launched; an Assessment of the Current status of Biomedical Waste Management; and a Sensitization and Capacity Building Programme on Biomedical Waste Management.

This UNEP funded project is being executed nationally by the Ministry of Planning and Development.

The Ministry of Planning and Development is also the project focal point and chair of a multi stakeholder committee which comprises the Ministry of Health, the Environmental Management Authority (EMA), the Trinidad and Tobago Solid Waste Management Company Limited (SWMCOL), the Tobago House of Assembly (THA) Division of Health, Wellness and Family Development, and the Basel Convention Regional Centre for Training and Technology Transfer for the Caribbean (BCRC-Caribbean).

The BCRC-Caribbean is also facilitating project administration on behalf of the Ministry of Planning and Development. A Public/ Environmental Health Specialist and a Communications Specialist have been contracted to conduct the project works.