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LCQ8: Clinical waste
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     Following is a question by the Dr Hon Elizabeth Quat and a written reply by the Secretary for the Environment, Mr Wong Kam-sing, in the Legislative Council today (June 19):

Question:

     It has been reported that domestic clinical waste (i.e. residual or expired medicines and used injections, etc.), if disposed of together with domestic waste or poured directly into the drains at home, will pollute the environment. Quite a number of countries and regions, including the United Kingdom, South Korea and Taiwan have drawn up guidelines on how to dispose of domestic clinical waste. For instance, people in the United Kingdom are advised to hand over their household residual medicines to pharmacists; "collection boxes for expired medicines" are set up in various drugstores in South Korea for central incineration of expired medicines collected from households; Taiwan has set up "checkpoints for domestic usage of medicines" to assist citizens in disposing of their expired or spoiled medicines and "collection points for medicines" have been set up in most of the hospitals for the collection of specified medicines (such as antibiotics, cancer drugs, etc.). However, the legislation in Hong Kong only regulates the disposal of expired medicines by chemical waste producers, but has not regulated the disposal of domestic clinical waste. Besides, it has been reported that the sewage discharge into the sea from the sewage treatment plants in Hong Kong has been tested to have contained drug-resistant bacteria. Humans may be infected by "super bad bugs" in the food chain, while the drug-resistant bacteria found in municipal wastewater also originate from human excreta subsequent to consumption of antibiotics. In this connection, will the Government inform this Council:

(a)  of the respective quantities of medicines and injections discarded by medical and healthcare institutions as well as their disposal methods in each of the past five years;

(b)  whether it has assessed the annual quantity of clinical waste (broken down by medicine and injection) discarded by households, their disposal methods as well as their impacts on the environment; if it has assessed, of the details; if not, the reasons for that;

(c)  whether the authorities have plans to conduct studies on regulating disposal methods of domestic clinical waste, to draw up guidelines to prohibit indiscriminate disposal of such waste, and to set up collection points to facilitate the public to surrender medicines and injections; if they have, of the details and the implementation timetables; if not, the reasons for that;

(d)  whether it has plans to promote the proper handling of domestic clinical waste among members of the public through educational and promotional programmes, so as to reduce pollution to the environment; if it has, of the details; if not, the reasons for that; and

(e)  whether it has conducted studies on removing the drug residues and drug-resistant bacteria in municipal wastewater; if it has, of the details; if not, the reasons for that; whether it will take measures to reduce the pollution caused by domestic clinical waste and the drug residues and drug-resistant bacteria discharged from human bodies; if it will, of the details; if not, the reasons for that?

Reply:

President:

     Clinical waste generally refers to potentially dangerous waste generated from hospitals, clinics or laboratories, which includes unwanted sharp instruments, laboratory waste, human and animal tissues, dressings etc. These wastes may contain infectious materials and sharps and therefore must be handled properly. In accordance with the Waste Disposal Ordinance, such producers of clinical waste must safely dispose of their clinical waste, whilst any person who collects, transports or disposes of clinical waste is required to obtain a licence under the Waste Disposal Ordinance. The above regulatory controls do not apply to waste generated in domestic households.

     Unwanted medicine, whether expired or not, is not classified as clinical waste. Currently, unwanted or waste medicine and injections generated by healthcare institutions such as hospitals and clinics are classified as chemical waste. The storage, collection, transport and disposal of such waste has to meet the stringent requirements laid down in the Waste Disposal Ordinance and the Waste Disposal (Chemical Waste)(General) Regulation. These control measures do not apply to the disposal of medicine and injections arising from households.

(a)  The quantities of unwanted medicine directly disposed of by medical and healthcare institutions in the past five years are detailed in Table 1. These wastes were transported to the Chemical Waste Treatment Centre for incineration, or to the landfill for final disposal.

Table 1: Quantity of unwanted medicine from medical and healthcare institutions

    Quantity disposed of by medical and
     healthcare institutions (tonnes)

Disposal facility  2008  2009  2010  2011  2012
----------------------------------------------------
Chemical Waste     36.7  40.5  73.0  59.2  73.0
Treatment Centre

Landfill           1.0   3.5   3.0   3.3   1.9

(b) to (d) Following the implementation of clinical waste controls since August 1, 2011, together with the longstanding controls on chemical waste, the disposal of locally generated clinical waste and chemical waste (including medicine and injections) are now being regulated, with these wastes disposed of mainly at the Chemical Waste Treatment Centre. We also publicise through various channels these two regulatory control schemes and promulgate the messages on safe handling of clinical waste and chemical waste.

     When the scope of the Clinical Waste Control Scheme was formulated, we had worked closely with the healthcare profession to examine in detail the experiences of clinical waste control in other countries, taking into consideration the local conditions in Hong Kong. As regards the concern raised on medicine and injections from households, since such wastes do not exhibit the characteristics of chemical waste as defined under the Waste Disposal Ordinance, it is estimated that there is little effect of pollution to the environment or danger to public health. Furthermore, we consider that a more effective management approach is to introduce measures at source, in order to reduce the generation of residual or surplus pharmaceutical materials requiring disposal. At present, in handling individual cases involving large quantities of surplus medicines from patients, the Hospital Authority (HA) already render assistance in taking back the surplus medicine dispensed by public hospitals or clinics operated under HA.

     Given the relatively small quantities of residual medicine and injections generated in households, they are being handled together with general municipal solid waste and are delivered to landfills managed by the Environmental Protection Department (EPD) for final disposal, and hence will not affect public health nor cause pollution.

(e)  According to local and overseas studies, sewage treatment plants in Hong Kong do effectively eliminate some drug residues including antibiotics and estrogens in the sewage. Past studies also indicate that the trace levels of antibiotics residues in Hong Kong waters do not normally pose direct threat to public health or endanger marine life. In addition, the major sewage treatment plants in Hong Kong have been equipped with disinfection facilities, which would help eliminate bacteria, including multi-drug resistant strains, in the effluent.

     Moreover, according to the World Health Organization (WHO) report on pharmaceuticals in drinking water, published in August 2012, published literature and national studies have shown that concentrations of pharmaceuticals in surface water and groundwater sources impacted by wastewater discharges are typically less than 0.1 g per litre. Furthermore, concentrations in treated drinking-water are usually well below 0.05 g per litre, which are generally more than 1000-fold below the minimal therapeutical doses and largely below the allowable daily intakes. Notwithstanding that the available information indicates the potential danger to public health caused by pharmaceutical residue in drinking water is extremely low, the Administration will continue to keep in view the latest scientific evidence and developments including the WHO guidelines on drinking water quality, and will review the drinking water monitoring requirement as necessary.

Ends/Wednesday, June 19, 2013
Issued at HKT 13:34

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