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Indonesia. Indonesian hospitals’ questionable waste management methods could give rise to epidemics of infectious diseases and the widespread contamination of rivers, an official said.

“Only around 10 to 15 percent of [hospital] waste is infectious, while the 85 to 90 percent that isn’t goes straight to the municipal dump,” Sharad Adikari, a senior adviser for environmental health at the World Health Organization, said on Wednesday.

But if hospitals fail to maintain standards for the disposal of the 10 percent of biohazardous waste, he said, it could contaminate the other 90 percent.

“It’s that contamination that ultimately puts the public’s health at risk,” Sharad said. “So we need to focus on how to carefully manage that 10 percent.”

Infectious waste includes cultures and stocks of infectious agents, waste from sick patients, waste contaminated with blood or seminal fluid, discarded diagnostic samples, infected animals from laboratories, contaminated material and equipment, and recognizable body parts and animal carcasses.

Up to 16 million hepatitis B, 4.7 million hepatitis C and 160,000 HIV infections occur every year around the world through the reuse of needles that have not been sterilized, the WHO says.

Imam Hendargo, the Environment Ministry’s deputy for hazardous substances and waste, said there were regulations in place on how hospital waste should be disposed of, but not all facilities abided by these rules, usually due to negligence or a lack of resources.

“We’re working with the Health Ministry on this issue because from the management [point of view], the responsibility lies with [the Health Ministry], given that hospitals and health facilities fall under its jurisdiction,” he said.

“However, it’s our responsibility too because hospital waste is categorized as hazardous.”

Imam said 30 hospitals had signed up this year to take part in a voluntary environmental assessment rating program sponsored by the Environment Ministry.

“We’ll be looking at their waste management as well as the water quality in rivers within their vicinity, because reports of hospitals just dumping their waste into rivers are common,” he said.

“Part of the problem is that it’s too expensive for some of the smaller hospitals and community health centers to properly manage their waste. Some even incinerate it, which is unacceptable.”

Imam said his ministry did not have data on how much waste hospitals across the country produced each year, blaming this on the rapid growth in the number of new hospitals, often without the relevant permits or accreditation.

Yuyun Ismawati, director of the independent toxic chemical watchdog Bali Fokus Foundation, said incinerating waste released more toxins into the atmosphere.

A small-scale incinerator operating at below 800 degrees Celsius can release dioxins, furans and mercury, according to a WHO report from 2000.

“It’s crucial to emphasize the use of non-incendiary waste-management methods, because 67 percent of atmospheric emissions of dioxins is due to incineration,” Yuyun said.

Dioxins are a class of chemicals banned under the Stockholm Convention on Persistent Organic Pollutants.

“We need to promote the use of autoclaves [to sterilize infectious waste by steam] rather than incinerators,” Yuyun said.

He added that the main hurdle in this campaign was the fact that incinerators were cheaper than autoclaves.

Faye Ferrer, from the international watchdog Health Care Without Harm, agreed that hospitals needed to move away from incinerators.

“You can do it by autoclaving, or using steam rather than fire to sterilize infectious waste, such as cotton buds or gloves.”