Assessment of Medical Solid Waste Management in Khartoum State Hospitals

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1 Research Article 201 Assessment of Medical Solid Waste Management in Khartoum State Hospitals N. O. Ahmed *1, G. A. Gasmelseed 2 and A.E Musa 3 (1) Department of chemical Engineering, Faculty of Engineering, University of Science and Technology E mail: nazaka48@gmail.com (2) Department of chemical Engineering, Faculty of Engineering, University of Science and Technology gurashigar@hotmail.com E mail: (3) Department of Leather Technology, College of Applied and Industrial Sciences, University of Bahri, Khartoum Sudan (Received: April 02, 2014; Accepted: June 14, 2014) Abstract The management of medical waste is of great significance due to its related potential environmental impacts and public health hazards. This study aims mainly to assess management practices in Khartoum hospitals. Twenty hospitals were undertaken in this study. The methodology is descriptive, cross-sectional and consists of the use of survey and interviews with the authorities of the hospitals. The results showed, that the hospitals generate a total of kg/day of wastes, of which about 5003 kg (80%) are non hazardous and kg (20 %,) are hazardous. The average rate of wastes generation for the hospitals covered was 0.38 kg per bed per day. The study revealed that partial segregation for medical waste is applied in 85% of the waste. In 75% of the hospitals transportation of medical waste to temporary storage areas was done manually. Off-site transportation of solid waste is carried out by vehicles. Infectious-hazardous waste is mixed with general waste and disposed off in a municipal waste landfill. Only one hospital (Friendship hospital) had been equipped with an incinerator.training is available only in 40% of the hospitals investigated and only 30% of protective equipment is available in these hospitals. 55% of these hospitals have no clear policy of waste management; only 20% of studied hospitals have a waste management plan. The study concluded that shortages in waste management in hospitals are generally due to lack of financial resources and training as well as administrative reasons. The study recommended a development and adoption of clear health care waste management plans and policies. Establishment of environmental management systems within health care facilities is essential. Allocation of sufficient financial resources for training as well as building appropriate infrastructure is also of paramount importance. Index Terms Medical waste, Environmental impact, Planning and Management. *Corresponding author: E mail: ali206w@hotmail.com I. INTRODUCTION edical waste is an environmental as well as public health M issue that attracts attention in both industrialized and developing countries. Certain categories of medical waste are among the most hazardous and potentially dangerous of all the wastes arising in the community [1]. Improper management of medical waste may pose health hazards through transmission of diseases. Waste from radioactive isotopes and geotaxis treatment may cause health risks and sever injuries. In addition to health hazards, environmental hazards have to be considered, such as the contamination of soil, water sources and poisonous emissions from improper burning of medical waste. In the long term, medical waste can not only impair the quality of life of the community, but can also affect the welfare of the entire population and the national economy. Until the early 1980s, there was little interest in medical waste, but in 1987 concern over medical waste dominated the media in the United State of America and other countries of the world [1]. In 0This may be attributed to economic, social and administrative reasons. This study assesses medical waste management practices in Khartoum State Hospitals in order to identify the problems and assist in the planning of an appropriate medical waste management system. Hazards of medical waste Exposure to hazardous medical waste can result in disease and injury. This type of waste contains infectious agents, it is genotoxic, contains toxic or hazardous chemicals or pharmaceuticals, radioactive materials and sharps [2]. Environmental Impacts of Medical waste The detrimental impacts on the environment of increased disposable items have included pollution and depletion of nonrenewable natural resources. The dumping of medical waste in uncontrolled areas can have a direct environmental effect by contaminating soils and underground waters [3]. Discharging chemical residues from medical establishment into sewerage system may have adverse effects on the operation of biological sewage treatment plants or toxic effects on the natural ecosystems of receiving waters [3]. Similar problems may be caused by pharmaceutical residues, which may include antibiotics and other drugs, heavy metals such as mercury, phenol and derivatives, and disinfectants and antiseptics [3].

2 202 Obsolete pesticides (chemical waste), stored in leaking drums or torn bags, can directly or indirectly affect those who comes in contact therewith. During heavy rains, leaked pesticides can seep into the ground and contaminate the groundwater. Poisoning can occur through direct contact with the product, inhalation of vapors, drinking of contaminated water, or eating the contaminated food. Other hazards may include the possibility of fire and contamination as a result of inadequate disposal such as incineration or landfill [4]. Special care in handling genotoxic waste is absolutely essential; any discharge of such waste into the environment could have disastrous ecological consequences. The soil and underground water can be contaminated with heavy metals and other toxic products that may enter the food chain. During incineration, if no proper filtering is done, air can also be polluted causing illnesses to the nearby populations. This has not been taken into consideration when choosing a treatment or disposal method by carrying out rapid environmental impact assessment [5]. Incineration produces both toxic air emissions and toxic ash residue. The air emissions affect the local environment, and in many cases, may affect communities hundreds or thousands of miles away. The ash residue is sent to landfills for disposal, the pollutants have the potential to be leached into groundwater. In addition to releasing the pollutants contained in the waste stream to the air and into the ash, burning medical waste actually creates new toxic compounds, such as dioxins. Medical waste incineration has been identified by the U.S Environmental Protection Agency as the third largest known source of dioxin air emission, and contributes to about 10 percent of the mercury emission to the environment from human activities [6]. Medical waste incineration is identified as a primary source of some very toxic pollutants: Dioxin is one of the most toxic chemical known to human kind, while exposure of general population occurs through the ingestion of many common foods [7]. The international agency for research on cancer acknowledged dioxin as cancer causing potential. Dioxins and furans present a special problem for the incineration industry. They are formed directly from chlorine and chlorinated products, which are present in larger volumes of medical waste. In medical waste, chlorinated products would typically include surgical gloves, catheters, polyvinyl chloride (PVC) tubing, blooding bags, etc [7]. The health risks posed by Dioxin and Dioxin-like chemicals include: 1. Effects on the immune system: The immune system is a target for dioxins. 2. Cancer effects: All studies have been positive and demonstrate that dioxins are multi-site carcinogens [7]. 3. Alteration of cell differentiation and proliferation [8]. This study aims to assess solid medical waste management in Khartoum State Hospitals. Specific objectives are to: Develop a comprehensive vision of health care of waste management system in Khartoum State Hospitals. Determination of the components, classification and generation rates of solid medical wastes in Khartoum state hospitals. Propose appropriate solutions and recommendations to support the Ministry of Health in setting up a national health care waste management plan to improve the current health care waste management and disposal practices. II. MATERIALS AND METHODS The methodology for this research includes experimental study, empirical field observation and field-level data collection through inventory, questionnaire survey, formal and informal interviews. A structured questionnaire was designed to collect information addressing the generation of different medical wastes according to amount and sources from different health care establishments. Number of in-depth interviews were arranged to enhance the understanding of previous and existing management practice of medical wastes. Numbers of specific questions were asked to nurses, hospital managers, doctors, and cleaners to elicit their knowledge. Data Collection The data gathered were based on experiments and questionnaires distributed to 20 hospitals. Questionnaire was used to survey the hospital wastes in terms of collection, transportation, segregation, treatment and disposal. The study covered all the categories of Khartoum state hospitals which were classified as follows: Federal Hospitals. State Hospitals. University Hospitals Private Hospitals. Sampling of medical wastes The waste characterization study was carried out accordance with WHO guidelines (WHO 1999, WHO 2001) and adopted the WHO classification of medical wastes: General, Infectious, Pathological, Sharps, Pharmaceutical, Chemical, Genotoxic, and radioactive waste. Sampling procedures represented a core activity under this study where all of the wastes generated in 20 Hospitals were segregated and weighed during a period of five months. The environmental health experts as well as quality control administration, managers of waste collection, storage and transportation recorded the amount of medical waste on data form. The wastes from hospitals were collected from storage areas, the quantity and compositions were determined at each hospital. Data Analysis The experimented data, questionnaire, observations and interviews were analyzed using statistical Excel and SPSS (Statistical Package for the Social Sciences) software. The SPSS was used to provide statistical analysis of data. Data to be analyzed were entered in a format where cases (each question in the survey) are represented by rows and variables (the

3 203 different replies to one question of a survey) are represented by columns. Then the data were manipulated and changed to percentage scale. III. RESULTS AND DISCUSSION The study covered twenty hospitals of different types in Khartoum State. Studied hospitals, types and location are listed in the following table (Table 1): Table 1. Studied Hospital Locations Hospital Frequency Percent Valid percent Cumulative Percent Khartoum Khartoum North Omdurman Umbadda locality Total An average of 0.38 kg/bed/day of hazardous medical Estimation of solid medical waste quantities generated waste was produced in Khartoum State hospitals. Quantities of the generated health-care waste were calculated in Khartoum State hospitals by estimating the total volume of medical waste (all categories) collected during one day. The figure obtained was then divided by the total number of beds to estimate the quantity of medical waste generated per bed per day in each hospital kg/bed/day. The study showed that the HCE investigated generated a total of kg/day of wastes, of which about 5003 kg 80%, are non-hazardous and about kg 20%, are hazardous. The average waste generation rate per bed per day for the HCE undertaken was 0.38 kg/bed/day. Name of hospital Table 2. Total quantity of General and Medical waste. General Medical Waste Waste kg/day kg/day The quantities of waste produced by hospitals were estimated based on data obtained from intensive survey performed in this work. The waste from each unit was weighed on a portable crane scale. Estimated average daily generation varies from 4.2kg to 188 kg per day in Al Naw and Khartoum state hospitals respectively. Waste generation rate per bed per day: total weight per day of medical waste divided by the total number of beds. It varies from 0.96 kg/bed/day in Ahmed Gasim hospital to 0.04 Al Naw teaching hospital. Academy hospital Ahmed Gasim Al Faisal specialized Al Naw teaching hospital Al Ribat university hospital Al Saudi Hospital Al Walidain hospital Bashair teaching hospital E bulk hospital ENT kh hospital Friendship (Khartoum refinery) Friendship (Omdurman) Ibn Kholdon hospital Ibrahim Malik hospital Khartoum North teaching hospital Khartoum teaching hospital Omdurman teaching hospital Radiation and isotopes centre Umbadda teaching hospital Wad El jabal Hospital Total Total quantity kg/day

4 204 Hospital Name Table 3.Quantity of medical waste generated Total Number of beds Medical waste Generated kg/day Academy hospital Ahmed Gasim paediatric hospital Al Faisal specilaized hospital Al Naw teaching hospital Al Ribat icniversity hospital Al Saudi hospital Al Walidain Optical hosp Bashair teaching hospital Elbuluk Peadiatric ENT Kh hospital Friendshiphospital(Khartourefinery) Friendship hospital(omdurman ) lbn kholdoon hospital Ibrahim Malik Teaching hospital Khartoum north teaching hospital Khartoum teaching hospital Omdurman Teaching Hospital Radiatjon and Isotopes Center Umbadda teaching hospital Wad El jabal hospital Total hospitals= 20 In all investigated hospitals there were some problems and procedures associated with medical waste of Khartoum state hospitals, these are: Lack of continuous segregation, collection, transportation and final disposal of pathological and other medical wastes. Lack of treatment facilities such as incinerator or autoclaves for treatment of pathological and infectious wastes. Only 25% of the surveyed hospitals have a document outlining the policy of medical waste management, this includes form of evaluation in 90% of hospitals, standard procedures and operating system (SPOS) in 5% of hospitals. Lack of comprehensive waste disposal plans for the disposal and technical aspects of hazardous wastes, 80% of visited hospitals have no plan for medical waste management. Lack of proper guidelines, legislation, regulations and instructions on medical waste management such as segregation, collection and disposal of various categories of wastes in suitable manner to render it harmless. Lack of coordination between different authorities and stakeholders. Lack of comprehensive and medical waste philosophy at the national level. colour- coding system cannot be applied due to lack of equipment in the health care facilities of the country such as inadequate bag holders, yellow polyethylene (PE) bags or high Quantity of Medical waste generated kg/bed/day density polyethylene (HDPE) waste containers and safety boxes...). IV. CONCLUSIONS The current health care waste management practices observed in Khartoum state hospitals are not fully safe and have harmful environmental effects. These are due to the absence of disposal facilities and the poor financial resources. Evidence shows that the development of appropriate financial means will be the key issue for successful and long term implementation of national health-care waste management plan. Considering its relatively high costs, the government of Sudan may therefore develop in phases strategy aiming at improving the health-care waste management practices in the referral hospital of the country as a first phase. However, the implementation of a health care waste management system has a little chance to remain sustainable as long as a holistic approach is not developed. The sustainable implementation of safe procedures to manage health-care waste will require a lasting commitment of the Government, which should take advantage of the implementation of a potential project to improve key issues. The recommendations of this study include 1. Clear definition of the problem: Before any improvement that can be made in health care waste management, a comprehensive scientific detailed study must be made. 2. Focusing on segregation: Proper segregation has to be achieved through training and international standards.

5 Sharps management system: Proper sharps management should be instituted in all health care facilities to minimize most of the risks of disease transmission. 4. Reduction of hazardous materials. 5. Proper plans, policies and training. REFERENCES [1]. WHO, (2004). Health care Waste Management, Analysis and National Action Plan: the Republic of Moldova: World Health Organization. [4]. Pruss, A., Townend, W. K., (1998). Teacher s guide-management of wastes from health care activiti es, WHO, Geneva. [5]. Pruss A.,Giroult E., Rushbrook P. (1999). Safe Management of Wastes from Health-care Activities World Health Organization, Geneva. [6]. Blenkharan JI.,(2006).Standards of clinical Waste management in UK hospitals. The journal of hospital infection. [2]. Johannessen Lars M., Dijkman Marleen, Bartone Carl, Hanrahan David, Boyer M. Gabriela (2000). Health-care Waste Management Guidance Note, HNP. [3]. Agarwal R.,( 1998). Medical waste issues, practices and policy, seminar on Health and the Environment, New Delhi. [7]. UNEP/SBC (2002). Secretariat of the Basel Convention and World Health Organization: Preparation of National Health-care Waste Management Plans in Sub-Saharan Countries, Guidance Manual. [8]. Franceys R.( 1992). A guide to the development of onsite sanitation, World Health Organization, Geneva.