Review Clinical solid waste management practices and its impact on human health and environment – A review Md. Sohrab Hossain a , Amutha Santhanam b , N.A. Nik Norulaini c , A.K. Mohd Omar a,⇑ a Department of Environmental Technology, School of Industrial Technology, Universiti Sains Malaysia, 11800 Penang, Malaysia b Institute for Research in Molecular Medicine, Universiti Sains Malaysia, 11800 Penang, Malaysia c School of Distance Education, Universiti Sains Malaysia, 11800 Penang, Malaysia article info Article history: Received 15 July 2010 Accepted 5 November 2010 Available online 24 December 2010 abstract The management of clinical solid waste (CSW) continues to be a major challenge, particularly, in most healthcare facilities of the developing world. Poor conduct and inappropriate disposal methods exercised during handling and disposal of CSW is increasing significant health hazards and environmental pollution due to the infectious nature of the waste. This article summarises a literature review into existing CSW management practices in the healthcare centers. The information gathered in this paper has been derived from the desk study of open literature survey. Numerous researches have been conducted on the man- agement of CSW. Although, significant steps have been taken on matters related to safe handling and dis- posal of the clinical waste, but improper management practice is evident from the point of initial collection to the final disposal. In most cases, the main reasons of the mismanagement of CSW are the lack of appropriate legislation, lack of specialized clinical staffs, lack of awareness and effective control. Furthermore, most of the healthcare centers of the developing world have faced financial difficulties and therefore looking for cost effective disposal methods of clinical waste. This paper emphasizes to continue the recycle-reuse program of CSW materials after sterilization by using supercritical fluid carbon dioxide (SF-CO2) sterilization technology at the point of initial collection. Emphasis is on the priority to inactivate the infectious micro-organisms in CSW. In that case, waste would not pose any threat to healthcare work- ers. The recycling-reuse program would be carried out successfully with the non-specialized clinical staffs. Therefore, the adoption of SF-CO2 sterilization technology in management of clinical solid waste can reduce exposure to infectious waste, decrease labor, lower costs, and yield better compliance with regulatory. Thus healthcare facilities can both save money and provide a safe environment for patients, healthcare staffs and clinical staffs. Ó 2010 Published by Elsevier Ltd. Contents 1. Introduction ......................................................................................................... 755 2. Definition and classification of clinical waste .............................................................................. 755 3. Source of clinical waste ................................................................................................ 756 4. Clinical waste generation............................................................................................... 756 5. Handling of the clinical solid waste ...................................................................................... 757 6. Knowledge on risks and lack of information ............................................................................... 758 7. Treatment of clinical waste ............................................................................................. 758 7.1. Open dump and open burning ..................................................................................... 759 7.2. Landfill ........................................................................................................ 759 7.3. Incineration .................................................................................................... 760 7.4. Autoclaving .................................................................................................... 761 7.5. Microwaves .................................................................................................... 761 8. Determination of suitable method ....................................................................................... 761 9. Supercritical fluid carbon dioxide sterilization.............................................................................. 762 10. Conclusion .......................................................................................................... 764 0956-053X/$ - see front matter Ó 2010 Published by Elsevier Ltd. doi:10.1016/j.wasman.2010.11.008 ⇑ Corresponding author. Tel.: +60 4 6535206; fax: +60 4 6585435. E-mail address: akmomar@usm.my (A.K.M. Omar). Waste Management 31 (2011) 754–766 Contents lists available at ScienceDirect Waste Management journal homepage: www.elsevier.com/locate/wasman