Achieving compliance with healthcare waste management regulations : empirical evidence from small European healthcare units

Abstract

Healthcare units generate substantial amounts of hazardous or potentially hazardous wastes as by-products of their medical services. The inappropriate management of these wastes poses significant risks to people and the environment. In Portugal, as in other EU countries, the collection, storage, treatment and disposal of healthcare waste is regulated by law. Although legal provisions covering the safe management of healthcare waste date back to the 1990s, little is known about the compliance of Portuguese healthcare units with the relevant regulations. In this study we evaluate the extent of compliance by small private healthcare units with current waste management regulations, and its determinants. Recent estimates indicate that these units account for at least 20% of the healthcare waste produced at the national level. Their large numbers, however, make monitoring and government control of their compliance with legislative requirements problematic. Using data collected by a national survey of over 700 private healthcare units, we find that the majority of these units do not comply with current waste management regulations. An estimated generalized linear model uncovers a regional effect on the degree of compliance, which is also influenced by the type of healthcare delivered, use of service providers, implementation of regular internal audits, etc. The strongest factor influencing the degree of compliance is, however, education and training. This result is extremely important for policy because it shows empirically that providing education and training for all healthcare workers on medical waste issues is crucial in order to attain proper practices in healthcare waste management and compliance with regulations.