Annals of Burns and Fire Disasters - vol. XII - n° 4 - December 1999

BOOK REVIEWS

NEW WHO BOOK

WORLD HEALTH ORGANIZATION PUBLICATIONS

SAFE MANAGEMENT OF WASTES FROM HEALTH-CARE ACTIVITIES
Edited by A. Priiss, E. Giroult, and P. Rushbrook
1999, xiv + 230 pages + 4 colour plates (available in English; French and Spanish in preparation)
ISBN 92 4154 6298
Sw. Fr. 72 / US $ 64.80 Ill developing countries Sw. Fir. 50.40 Order no. 1150458
WHO, Marketing and Dissemination,
CH-1211 Geneva 27, Switzerland

This handbook provides the first comprehensive guide to the safe and efficient handling, treatment, and disposal of all categories of hazardous waste generated by health-care activities. Although the major emphasis is on waste generated by hospitals, guidelines and advice are also relevant to wastes produced in health centres, research facilities, and laboratories or associated with home care or treatment in doctors and dentists practices.
In publishing this handbook WHO aims not only to promote a sound managerial approach and the use of appropriate technologies but also to inform countries about the health risks that result from inadequate management of health-care waste. With these goals in mind, the book provides both an alert to documented public health and environmental hazards and a catalogue of the technical, managerial, and legislative options available for reducing these risks. All components of a waste management policy - whether at national or institutional level - are considered in detail.
Although recommended policies and procedures have universal relevance, the handbook gives particular attention to conditions in developing countries, where methods for the safe treatment and disposal of hazardous waste may be limited. With these conditions in mind, the handbook includes approaches for gradual improvements together with a catalogue of options for waste management that include both simple and highly sophisticated technologies. Throughout, photographs, line drawings, checklists, tables, and step-by-step procedures are used to enhance the wealth of guidance provided.
The book opens with a definition and characterization of hazardous health-care wastes categorized as infectious waste, pathological waste, sharps, pharmaceutical waste, genotoxic waste, chemical waste, waste with high content of heavy metals, pressurized containers, and radioactive waste. The health consequences of exposure to each category of waste are described in the next chapter, which concerns the nature and severity of associated health hazards, factors influencing the likelihood of exposure, persons at risk, and the significance for public health. Concentrated cultures of pathogens and contaminated sharps are identified as the waste ,items that represent the most acute potential hazards to health. Other chapters consider legislative, regulatory, and policy issues and offer a step-by-step guide to the planning of waste management, including use of a detailed model survey questionnaire for gathering data on waste generation and management practices in hospitals.
Against this background, five chapters offer guidance in a range of specific practices and procedures for safe waste management. Chapters cover strategies for waste minimization, recycling, and re-use; good practices in the handling, segregation, packaging, storage, and transportation of wastes; a wide range of treatment and disposal technologies; treatment and disposal technologies appropriate for specific categories of waste; and the collection and safe disposal of hazardous waste water. The remaining chapters discuss costs, health and safety practices for health-care personnel and waste workers, the management of spillage and other emergencies, basic principles of hospital hygiene and infection control, and training needs. The final chapter sets out a minimum programme of essential waste management practices considered suitable for smaller rural health care establishments and field hospitals in refugee camps and other temporary situations.

RAPID HEALTH ASSESSMENT
PROTOCOLS FOR EMERGENCIES
1999, vi + 97 pages (available in English; French and Spanish in preparation)
ISBN 92 4 154515 1
Sw. fr. 31 / US $ 27.90 - in developing countries Sw. fr. 21.70 - Order No. 1150463

This book provides a collection of ten protocols for conducting rapid health assessments in the immediate aftermath of different types of emergencies. Noting the vital importance of rapid and accurate information in the earliest stage of an emergency, the protocols respond to the urgent need for common standardized technical tools for assessing damage, gauging health risks, and gathering the information immediately needed by decision-makers at the national and international level.
The protocols were prepared by WHO in collaboration with a large number of international agencies and experts with broad experience in the field of emergency management. Although all protocols follow a common format, each is specific to the circumstances, potential hazards, and immediate information needs that characterize a distinct type of emergency. Emphasis is placed on the exact information needed, the best sources of data and methods for rapid collection, and the specific questions that need to be answered in order to draw initial conclusions and direct immediate actions. Although the advantages of using experienced assessments teams are stressed, the book also explains how the protocols can be used to train general health workers as part of emergency preparedness.
The book opens with an introductory protocol covering the aims and methods, responsibilities, complexities, and inherent difficulties of rapid health assessments. Addressed to health authorities as well as assessment teams, the chapter also includes abundant advice on preparedness for emergencies. Details range from the comparative need for speed in different types of emergencies, through a suggested format for presenting the results of assessments, to a list of common logistic, organizational, and technical errors. Advice on the best working practices, including ways to avoid being an "emergency tourist", is also provided.
Against this background, the additional nine protocols are presented according to a common format which covers the purpose of the assessment, preparedness, the steps to follow during the assessment, assessing the impact on health, assessing local response capacity and immediate needs, and presenting results. A general protocol on epidemics of infectious origin is followed by protocols specific to meningitis outbreaks, outbreaks of viral haemorrhagic fever, including yellow fever, and outbreaks of acute diarrhoeal disease, with information specific to dysentery and cholera.
Sudden-impact natural disasters are covered in the next protocol, which includes a day-by-day list of information priorities for different stages of the disaster. A protocol dealing with sudden population displacements offers guidelines for conducting rapid health assessments in all emergencies caused by sudden displacement of refugees or population groups within a country. Included are a sample checklist for rapid assessments and a sample form for weekly reports on morbidity and mortality. Subsequent protocols deal with the special situations of nutritional emergencies and chemical emergencies, including those caused by food contaminated with chemicals or toxins. The final protocol addresses the difficult task of conducting assessments in complex emergencies in which the cause of the emergency, as well as the assistance to the afflicted, is complicated by intense levels of political considerations. The protocol includes a form which has recently been used for rapid health assessment at local level in Bosnia and Herzegovnia.
The book concludes with a brief summary of survey techniques, followed by a tabular presentation of reference values for assessing needs, hazards, and logistic requirements, in developing countries.
The MBC is WHO Collaborating Centre in the field of burns and fire disasters.

FLAME RETARDANTS: TRIS (CHLOROPROPYL) PHOSPATE
AND TRIS(2-CHLOROETHYL) PHOSPHATE
WHO Environmental Health Criteria, No. 209
1998, xix + 106 pages (English with summaries in French and Spanish)
ISBN 92 4 157209 4
Sw. fr. 27 / US $ 24.30 - In developing countries: Sw. fr. 18.90 - Order No. 1160209

This book evaluates the risks to human health and the environment posed by exposure to three flame retardants: tris(I-chloro-2-propyl) phosphate (TCPP), tris(1,3-dichloro-2-propyl) phosphate (TDCPP), and tris(2-chloroethyl) phosphate (TCEP). In view of their many similarities, TCPP and TDCPP are covered together. Data on all three flame retardants are extremely limited and largely confined to studies of environmental levels and adverse effects detected in experimental animals and in vitro test systems.
The monograph on TCPP and TDCPP describes manufacturing processes and summarizes current uses. The vast majority of TCPP is used in rigid polyurethane foams, with main applications in insulation for buildings and in refrigerator casings. TDCPP is likewise added as a flame retardant to polyurethane foam and has some additional applications as a flame retardant for non-woven fabrics. For both chemicals, studies show that residues are found infrequently and at low concentrations in food items. For TCPP, traces have been detected in industrial and domestic effluents but not in surface water or drinking-water. Traces of TDCPP have been detected in sewage effluent, river water, seawater, drinkingwater, and water sediment, and in fish. In view of the low volatility of both chemicals, the report concludes that human exposure from these sources will be very low and will not present an acute health hazard for the general population.
Likewise, no adverse effects on the environment are anticipated from the use of either of these flame retardants.
Experimental studies of TCPP in laboratory animals demonstrate low to moderate toxicity by the oral, dermal, and inhalation routes. Tests indicate that the chemical is neither a skin nor an eye irritant. No studies were available to evaluate reproductive toxicity, immunotoxicity, or carcinogenic potential. In vitro and in vivo mutagenicity studies produced negative results.
Toxicity studies of TDCPP show low to moderate acute toxicity by the oral route and low acute toxicity by the dermal route. The report found no evidence of teratogenicity or mutagenicity. A single carcinogenicity study found an increased occurrence of several turnouts at all exposure levels tested in both male and female rats. In the absence of data on the mechanisms of carcinogenic action, the relevance of these findings to humans could not be assessed. The limited studies of occupationally exposed workers were judged inadequate for evaluation.
The second monograph evaluates TCEP, a flame retardant with declining uses in the production of liquid polyester resins and in textile back-coating formulations. Traces have been detected in river water, seawater, drinking-water, sediment, fish and shellfish, and a few food items. Experimental studies show low to moderate acute oral toxicity. In repeat dose experiments, TCEP caused adverse effects on the brain, liver, and kidneys. ne report concludes that TCEP is not an irritant to the eye or skin and is not teratogenic, although some adverse effects on the fertility of male rats and mice have been demonstrated. Data indicating low environmental exposures support the conclusion that TCEP poses a very low risk of adverse health effects for the general population. Use of TCEP is not expected to cause any adverse effects on the environment.

ADVANCES IN ISSUE BANKING, Vol. I
G.O. Phillips (The North Wales and Oswestry Bank, UK), R. von Versen
German Institute for Cell and Tissue Replacement, Germany)
D.M. Strong (Puget Sound Blood Center, USA), and A. Nather
(National University Hospital Bone Bank, Singapore)
1997, 340 pp., ISBN 981-02-3190-3; price $US 68 / Y47

This volume initiates the publication of a series of specific articles in the field of tissue banking. The book is an instrument for the spreading and extension of know-how in the sector, which the authors thus put at the disposal of all those who in their various specialities use a tissue bank in their professional and research activity. The volume opens with a description and comparison of "Regulatory models for safety and quality of allografts" in Europe and the United States. Chapter 2 considers '7ransplant donation co-ordination" and describes experiences in the United Kingdom, together with the Spanish model. The following chapters deal with the use of autologous bone in orthopaedics, the use of foetal membranes and autologous keratinocyte cultures, and heart valve banking. The volume is completed by an ample consideration of the principles of cell and tissue conservation and sterilization.
Contents: Regulatory models for the safety and quality of allografts; Transplant donation co-ordination; Allografts in orthopaedics; Foetal membranes and cultured keratinocytes; Heart valve banking; Cell and tissue preservation; Sterilization.
Readership: Orthopaedic surgeons, general surgeons, cardiologists, transplantologists, cryobiologists, National Health regulators, and tissue bankers.

ADVANCES IN ISSUE BANKING, Vol. 2
G.O. Phillips (The North Wales and Oswestry Bank, UK), R. von Versen
German Institute for Cell and Tissue Replacement, Germany)
D.M. Strong (Puget Sound Blood Center, USA), and A. Nather
(National University Hospital Bone Bank, Singapore)
1998, 384 pp., ISBN 981-02-3534-8; price $US 78 / t52

The authors of the first volume in the series continue in the same manner in this second volume, considering the activity of Dr Kenneth W. Sell, the pioneer of the modern concept of issue banking. The volume presents the important contributions that the various authors, each in his own field, have given to the development of medical science. Ample chapters are dedicated to important topics of current interest such as the cryoconservation of tissues and organs, the use of allografts in cardiovascular surgery and neurosurgery, as well as the clinical use of human skin, biological membranes, and dermis preserved in the tissue bank.
Contents: The contribution of Kenneth W. Sell to the progress of tissue banking; Progress in blood transfusion and marrow transplantation; Immunological developments in support of orthopaedic surgery; Cryopreservation of organs and tissue; Osseous and osteochondral transplantation; The contribution of issue banking in cardiovascular surgery and neurosurgery; Banking and clinical use of human skin; Biological membranes and acellular dermis.
Readership: Orthopaedic surgeons, general surgeons, neurosurgeons, cardiologists, transplant surgeons, cryobiologists, health regulators, tissue bankers, burn specialists, students.

N. D'Arpa M.D.