– In Serbia, some 3,000 tons of medical waste are accumulated annually across health care institutions in Serbia, a fifth of which accounts for hazardous and infectious waste.The waste management system is a highly important aspect of health care. –
Health care institutions in Serbia accumulate over 3,000 tons of medical waste annually, a fifth of which accounts for hazardous waste. According to the official data from the Environmental Protection Agency, in 2019, 3,281.75 tons of medical waste were generated in Serbia. Hospitals in Serbia generate an average of 1.8 kg of medical waste per patient bed per day (estimates show there are about 60,000 hospital beds in Serbia).
Needles, syringes, masks, gloves, bandages, scalpels have for years been mixed with and disposed of together with municipal waste in municipal solid waste landfills. Until 2008, Serbia had no infectious medical waste management system. Healthcare institutions took care of medical waste themselves, working on old equipment and without procedures for the disposal and treatment of this type of waste. Some institutions use their own incinerators to dispose of the waste, usually at temperatures that are unsuitable for safe destruction, while only a handful of institutions had autoclaves for sterilisation of the waste prior to disposal.
Thanks to reforms in the healthcare system and the significant support of the European Union (EU), the collection and treatment of medical and infectious waste has been harmonised with the globally accepted procedures. Equipment was purchased and specialised vehicles were procured, allowing proper handling of waste that would otherwise pose a health hazard if disposed of in landfills. The treatment of medical and infectious waste poses a serious health and hygiene risk to healthcare professionals, patients, and employees involved in its collection. Serbia has changed the way it manages medical waste in order to apply European experiences and practices in this area, as part of the harmonization of its regulations with good practices in the EU.
Any waste generated in healthcare facilities, health research centers, or laboratories accounts for medical waste. Infectious medical waste is hazardous waste in a solid or liquid state that can lead to infections (bandages, swabs, syringes, needles, pathological waste, etc.)
European Union donation
In 2003, the Serbian government adopted a National Waste Management Strategy, however, it wasn’t until a couple of years later before a waste management system was introduced. The EU has helped Serbia establish a modern system for the management of infectious medical waste, and in the period between 2007 and 2013, the EU made a donation of 13.5 million euros for the introduction of a modern medical waste management system.
EU support for medical waste management in Serbia
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The National Guide to Good Practice for Safe Medical Waste Management and the Rulebook on Waste Management have also been developed. The EU has funded the development of a system for the separation, collection, labeling, storage, treatment, and disposal of medical waste in Serbia. This has improved the existing waste management system in line with EU standards.
The curriculum for secondary medical schools in Serbia has also been amended, in addition to creating a training programme for health workers. Also, the donation was used to procure equipment for the treatment and transport of infectious waste and create regulations on the collection, export, and destruction of pharmaceutical waste that has been collected by health institutions in Serbia for more than 40 years.
Medical waste treatment
The waste is generated as part of health care provision, during examinations, outpatient and inpatient treatment, laboratory services, and is collected from health centers, hospitals, and institutes throughout Serbia. According to the rules that apply in the world and in Serbia, medical and infectious waste must be treated by sterilization under high-temperature pressure (120 degrees) in special devices (autoclaves), and then must be crushed and disposed of as municipal waste. Only after the application of these procedures, the waste can be properly sterilized and becomes communal. The importance of proper treatment of medical and infectious waste was especially growing at the beginning of the pandemic of COVID-19 in March 2020.
In Serbia, the treatment of medical waste is performed at 121 locations where there are autoclaves, i.e. equipment for the application of procedures that, after treatment, make the waste non-hazardous to the environment. Among the health institutions that received the necessary equipment with the support of the EU is the Health Center Niš, where health services are provided for about 200,000 inhabitants. Although hospitals in southern Serbia are the largest producers of medical waste, this particular health centre generates more than two tons of infectious medical waste per month, which is transported and treated in a waste treatment facility in the nearby village of Trupale, 12 km from Niš.
| High school manuals
Students in 29 secondary medical schools in Serbia were handed 7,500 manuals for medical waste management. Medical waste management, as a school subject, was introduced in medical high schools in Serbia thanks to an EU donation. |
In 2011, the Niš Medical Center also disposed of infectious medical waste from seven health institutions in the Nišava District, as well as from dozens of health facilities in private practice. From 2010 to 2012, about 66 tons of infectious medical waste from the territory of several municipalities were transported and treated in the Niš Health Centre. Employees of waste treatment in Health Centre Niš and other health institutions have completed training in the application of waste management systems.
The Zaječar Health Center, in eastern Serbia, processes between 22 and 25 tons of medical waste annually, which is an average of 68 kg per day. Treatment of infectious medical waste in the Health Centre Zaječar began in May 2008. The new approach to waste treatment, put together with the support of the EU, the Centre has raised the level of health services, and increased patient safety.
| How medical waste is treated in Europe*
Incineration and sterilization of medical waste in autoclaves (high-temperature steam sterilisation) are the main methods used to treat this type of waste. In the UK, 5.5 kg of waste is generated per bed per day, in Ireland 2.6 kg, in France 1.9 kg, in Italy a kilogram, while Germany generates the least medical waste – less than half a kilogram. Hospitals in Italy produce about 250,000 tons of medical waste annually, 60,000 of which tons are incinerated. In Slovenia, waste is treated in recyclables, and in Portugal, almost all incinerators have been shut down and waste is treated in autoclaves. In the past decade, France has been treating medical waste by shredding/steam/drying, while Ireland uses autoclaves. The United Kingdom is the largest producer of medical waste in Europe (about 190,000 tons per year). More than half of it is burned, while the rest is sterilized in autoclaves. *pre-pandemic data |