A/HRC/18/31 include heavy metals (such as arsenic, cadmium, mercury and lead), acid gases, carbon monoxide and polycyclic aromatic hydrocarbons (PAHs). B. Right to safe and healthy working conditions 45. Information on the hazards associated with the handling of hazardous medical waste, access to training opportunities on the safety procedures to minimize hazards, and proper personal protective equipment constitute essential preconditions for the enjoyment of the right to safe and healthy conditions of work as set out in article 7 (b) of the International Covenant on Economic, Social and Cultural Rights. 46. In many health-care establishments around the world, the lack of adequate waste management plans to ensure the safe and environmentally sound segregation, collection, transport, treatment and disposal of medical waste continue to expose a significant number of people from a wide range of occupations to the risk of injury and illness. The main occupational groups at risk include hospital personnel, workers handling and transporting waste, persons working at waste disposal facilities, and scavengers. 1. Hospital personnel 47. Hospital personnel include doctors, nurses and workers in support services of healthcare establishments, such as hospital cleaners, waste handlers and drivers. 48. In many developing countries, nurses and (to a lesser extent) doctors do not receive adequate information on the hazards associated with the unsafe handling of hazardous medical waste, nor do they receive any training on how to eliminate, or reduce to a minimum, such hazards. Medical personnel often receive limited instructions on the use of personal protective equipment, and are not aware of safety emergency procedures for dealing with spillages (for example, when mercury-containing equipment breaks) and accidents. In some health-care establishments, staff members are not vaccinated against common infectious diseases, such as tetanus and hepatitis. 49. Hospital cleaners and waste handlers are in an even more vulnerable position than the medical staff that produce the waste. An increasing number of them are employed by external contractors rather than being directly employed by the hospital, and may not receive any information on the occupational risks to which they are exposed and on the correct procedures for handling, loading and unloading waste bags and containers. They are often poorly educated, and often do not receive any vaccinations or proper personal protective equipment.17 Disposable latex gloves may be provided, but they are usually thin and offer little protection. In many health-care establishments, it is not uncommon to see medical waste being transported by hand in bin bags, risking spills of toxic or infectious liquids, or staff injuries from protruding needles or other sharp objects. 2. Waste workers and waste recyclers 50. Like hospital cleaners and waste handlers, operators of small-scale medical waste incinerators, garbage collectors and people working in municipal waste facilities, where large amounts of medical waste are mixed and disposed of with general household waste, 17 12 A survey of 300 medical waste handlers employed by a local contractor found that only 7 per cent were trained to handle medical waste and 21 per cent were immunized against hepatitis B. Although almost all wore overalls (presumably the company uniform) when working, only 57.7 per cent wore gloves, 55 per cent wore boots and only 17 per cent wore masks when handling medical waste. The survey showed that prevalence rates of hepatitis B and C were significantly higher in medical waste handlers than those in non-medical waste handlers examined. See Franka et al., “Hepatitis B virus and hepatitis C virus in medical waste handlers in Tripoli, Libya”, Journal of Hospital Infection, vol. 72, No. 3, July 2009.