Bacteria and other disease agents thrive in humid, wetter, warmer climates and replicate more slowly in very cold, very dry climates.

Community engagement remains a key component of outbreak response in order to prevent the spread of disease. Existing community perceptions and beliefs can support or hinder a response, so it is important to understand and address them. Some social norms may need to be modified to prevent disease transmission.

There are still many myths and misunderstandings and judgments made about STIs / STDs. Care needs to be taken to ensure the programme understands local beliefs and behaviours and to ensure prejudices and misunderstandings are not unintentionally propagated.

Soil contamination
Water contamination

Soil and water contamination due to lack of adequate wastewater and infectious waste management facilities or good hygiene practices. Increase of unmanaged solid waste (including the plastic type of waste, medical contaminated waste)

Poor management of healthcare waste exposes health care workers, waste handlers, and the community to infections, toxic effects, injuries, and poisoning and pollution by toxic elements or compounds such as mercury or dioxins that are released during incineration. Infectious waste can contain pathogens that can pose a risk of disease transmission (e.g.: waste contaminated with blood and other body fluids, waste including excreta, and other materials that have been in contact with patients infected with infectious diseases). Blood banks and blood collection services are one of the major sources of healthcare waste.

Unmanaged solid and infectious waste can have significant health and environmental implications. There is particular concern about infection with human immunodeficiency virus (HIV) and hepatitis viruses B and C, for which there is strong evidence of transmission from contact with syringe needles contaminated by human blood, which can occur when sharps waste is poorly managed. Solid waste is often the host to harmful pathogens and is also a breeding ground for insects and rodents, carriers of disease. Bio-hazardous waste, including contaminated tissues and old or contaminated medicines and vitamins, can also lead to unintentional disease transmission if disposed of improperly. Unmanaged solid waste/wastewater/sewerage and faecal sludge can contaminate soils, surface waters, and groundwater.

• Coordinate with the national blood transfusion service, where it exists.
• Only collect blood from volunteers.
• Test all products for HIV, hepatitis B and C, and syphilis as a minimum, with blood grouping and compatibility testing.
• Store and distribute products safely.
• Train clinical staff in the rational use of blood and blood products.
• Conduct a healthcare waste assessment
• Plan for healthcare waste separation and appropriate disposal (see relevant intl guidelines)
• Review public waste management capacities. Identify authorized companies and pay them to adequately dispose of healthcare waste.

• Plan for and fund hazardous waste separation and management with appropriate specialised interventions.
• Where new or separate facilities are established or existing facilities expanded, develop a decommissioning plan and plans for providing water, wastewater, and waste and biohazard waste disposal. Also, consider cooking and personal hygiene requirements.
• Provide training to personnel on infectious waste disposal methods to increase workers’ and patients’ safety.

In the Covid 19 response in Bangladesh, donors and humanitarian actors collaborated in upgrading health facilities, including the safe storage and handling of health waste, including blood products.

• Plan for health waste separation and management is designed with clear resources and capacities
  Health facilities’ water management plans include a section on managing waste and grey waters.
• Percentage of land area that remains without the negative effects of biological hazards (physical and biological)

Mitigation of environmental damage

Include planning time with health facilities managers. Identify where additional resources are needed to support the plan (process and results).