Disposal of medical wastes (A4 subgroup): evidence-based or intuitive policy?

<p></p><p>ABSTRACT The disposal of healthcare waste (HCW) is a controversial and wide discussion, and the review of the Collegiate Directorate Resolution no. 306/2004, from the National Health Surveillance Agency (Agência Nacional de Vigilância Sanitária - ANVISA), a Brazilian regulation, is appropriate to increase this debate. In this context, through the review of scientific publications, this paper supports choices that promote environmental sustainability and the protection of human health during the HCW disposal process. A bibliographical research including national and international levels and a review of legal instruments about HCW management in Brazil were done. The rules of ANVISA (no. 306/2004) and National Environment Council (no. 358/2005) point out that the final disposal of HCW, specially the subgroup A4, could be done in certified place to disposal HCW, without prior treatment. Several scientific papers mention the lack of evidences about increased risks of some kinds of HCW when compared to domestic waste, and these wastes may have final disposal based on the same criteria. Segregation of the HCW according to the real risks of each group at the moment of the generation of waste, as well as the packaging as a protective barrier, configures a safer risk management procedures against contamination and accidents. The requirement to treat the A4 subgroup before landfill disposal, as argue by some researchers, could represent an increase of unnecessary economical costs without evidences of risk reduction.</p><p></p>