Health care waste management in Port Harcourt Metropolis

Transcription

1 AMERICAN JOURNAL OF SCIENTIFIC AND INDUSTRIAL RESEARCH 2011, Science Huβ, ISSN: X doi: /ajsir Health care waste management in Port Harcourt Metropolis 1 Stanley, H. O, 2 Okpara, K. E, 3 Chukwujekwu, D. C, 4 Agbozu I. E, and 5 Nyenke C. U 1 Department of Microbiology, University of Port Harcourt, Nigeria 2 School of Medical Laboratory Science, College of Health Science and Technology, Port Harcourt, Nigeria 3 Department of Mental Health, University of Port Harcourt Teaching Hospital, Nigeria 4 Department of Chemical Science, Niger Delta University, Bayelsa State, Nigeria 5 School of Medical Laboratory Science, College of Health Science and Technology, Port Harcourt, Nigeria ABSTRACT The study was designed to evaluate the management of health care waste among various health care establishments both in the public and private sectors in Port Harcourt metropolis. This will help to stimulate further research in this neglected aspect of health care management and make for more effective health care delivery. Sixty questionnaires were distributed randomly among the staff of fifteen health facilities. The instrument was structured to accommodate issues such as availability of unit responsible for the management of health care waste, level of awareness of the risk associated with health care waste and the level of efficiency of the unit. Fifty nine of the questionnaires were retrieved and studied. Twenty six (44.1%) of the respondents were within the private sector, the rest were in the public health establishments. Most establishments had health care waste dumpsites as indicated by the 34 (57.6%) respondents. However only 9.1% of those in primary health care establishments as against 55.6% in tertiary establishments had vehicles for transportation of wastes. Only 35 (59.3%) admitted that their establishments had an established waste management unit. Fourteen (i.e less than 50% of those that have units reported that the management of wastes in their unit was effectively carried out. Knowledge of the potential hazards of health care waste does not automatically translate to effective management of wastes. There is a strong relationship between inadequate health care waste management and the prevalence of nosocomial diseases. Health care waste management is so imperative for efficient health care delivery that urgent and a multi-sectoral collaboration is needed to make it effective. Keywords: Health Care, Waste Management, Hospital. Establishment INTRODUCTION Waste can be described as any useless or unwanted materials rejected as spoiled and o longer required for its original purpose; for which there is no (1 and economic demand and hence must be discarded 2). Human beings and the environment are exposed to a variety of wastes arising from man s activities. Such waste include domestic, commercial, municipal, miscellaneous, institutional and health care wastes among other various categories of waste. Health care waste (HCW) which is referred to as hospital wastes in this study and which is the main focus can be defined as the total waste stream (Solid and liquid) from health care establishments, research facilities and laboratories. Other major sources of health care waste include hospital wards/ toilets, blood banks, laboratories, nursing homes, mortuaries, autopsy centres, laundries, threatres, hospital kitchen and cafeteria as well as institutions of disabled persons. Pruss el all (3) noted that of wastes health care providers generate are nonhazardous waste arising from administrative and house keeping functions of the establishment. These non-hazardous wastes may also include waste from maintenance of the premises of health care facilities. The remaining 5-25% are hazardous to health care and may create a variety of health risks when improperly treated, stored or disposed of. Pathogens may be distributed by insects, rodents and even humans who come in contact with unsafely stored wastes including patients excretions or body fluid.

2 Poor management of hospital waste is known to contribute substantially to spread of nosocomial infections (4). Unfortunately, health care waste management is not yet carried out with a satisfactory degree safety in many parts of the globe especially in the underdeveloped world. This study therefore intends to examine how hospital waste management is carried out health care establishments within Port Harcourt metropolis. This is with a view to raising public awareness about the hazards associated with inappropriate management of medical waste as well as proffering effective management principles which can be adopted elsewhere for similar waste disposal. Policy makers will find the information derived from this study a veritable tool. METHODOLOGY Location: This study was conducted among health establishments in port Harcourt metropolis. Port Harcourt is the capital city of Rivers State in the Niger Delta region of Nigeria. This area has a humid, semihot, equatorial climate (2) with an average rain-fall of 2000mm due mainly to its proximity to the Atlantic Ocean (2). The study was carried out between October and December Sample and Data collected: A sample size of 15 health facilities in port harocurt metropolis was used for this study. The categories cut across all levels of health care viz-primary, secondary and tertiary, private hospitals, laboratories and pharmacy shops. The instrument used for this study is questionnaire structured to accommodate issues such as availability of a unit responsible for the management of health care waste, level of awareness of the risk associated with health care waste and the level of efficiency of the unit. Sixty questionnaires were distributed randomly among the staff of 15 health facilities, and all were retrieved except one. The data was analyzed using the statistical package for social sciences (SPSS) at 5% level of significance and 95% confidence interval. Statistical methods applied include frequency counts and tables, analysis of variance and chi-squares. RESULTS The total number of questionnaires studied were 59. twenty six (44.1%) of the respondents were within the private health sector. The primary, secondary and tertiary levels of government health parastatals have 12 (20.3%), 7 (11.9%) and 6 (10.2%) respondents respectively. Chemists and laboratories have a total of 7 (11.9%). It is also clear that 25(42.4%) of the respondents are health care workers in various government establishments, thus giving a balance in representation between the public and private sectors (see Table 1). Table 2 shows the availability of vehicle for transportation of waste among the various establishments. It appears as if the availability of vehicle increases with level of health care establishment. 55.6% of respondents in the tertiary health care establishments reported that their various establishment have vehicles available for waste disposal. Table 3 shows that majority 34 (57.6%) of health care establishments have health care waste dumpsite. The least percentage of affirmative responders came from tertiary health establishments, 2 (3.4%).Of all respondents, 49 (83.1%) acknowledged cases of reported nosocomial diseases in their establishments within the study period. Table 4 portrays the levels of efficiency of the waste management units across the various establishments. Only 35 (59.3%) out of the 59, admitted that their unit have waste management unit. Fourteen (23.7%) of these respondents (i.e. less than fifty percent of those that answered in the affirmative) reported that their establishments have an efficient waste management unit. Efficiency in this study was considered in terms of properly trained, adequate size and well motivated manpower as well as available materials to work with. It also includes frequent and regular disposal of waste without causing other potential harm, e.g. burning wastes within the hospital premises which can cause environmental pollution with associated respiratory infections. Chi-square test shows that there is no association between the knowledge of health care personnel on the hazards of health care waste and the efficient management of health care waste (p> 0.05). Spearman s correlation shows that there is a strong relationship between inadequate health care waste management and the prevalence of nosocomial diseases. (p> 0.05). 770

3 Table 1: Distribution of respondents by establishment Frequency % Cumulative % Primary Health Centres Secondary Health Centres Tertiary Health Institution Private Chemists/laboratories Others Total Table 2: showing types of establishment and availability of vehicle HAS YOUR ESTABLISHMENT A VEHICLE Types of establishment Yes% No% No response Total% P.H.C 1 (9.1) 10 (90.9) - 11 (100) S.H.C 3 (42.9) 4 (57.1) - 7 (100) Tertiary 5 (55.6) 4 (44.4) - 9 (100) Private 9 (34.6) 17 (65.4) - 26 (100) Lab/Chemist 1 (16.7) 5 (83.3) - 6 (100) No response (100) Total 20(31.7) 40 (66.7) 1 (1.7) 60 (100) Table 3: Showing types of establishment and availability of dumpsite HAS YOUR ESTABLISHMENT A DUMPSITE Types of establishment Yes% No% No response Total% P.H.C 8 (66.1) 4 (33.3) - 12 (100) S.H.C 6 (85.7) 1(14.3) - 7 (100) Tertiary 2 (33.3) 4 (66.7) - 6 (100) Private 15(57.7) 11 (2.3) - 26 (100) Lab/Chemist 3 (42.9) 4 (57.1) - 7 (100) No response (100) Total 34(57.6) 24 (40.7) 1 (1.7) 59 (100) Table 4: Availability of waste management units and their levels of efficiency AVAILABILITY OF UNIT LEVEL OF EFFICIENT OF UNIT NO OF RESPONDENT % Yes Very efficient Yes Fairly efficient Yes Not Efficient No No Establishment Total DISCUSSION The study revealed that majority of health care establishments in Port Harcourt metropolis particularly the public and private sector lacked functional and efficient waste management units and facilities, such as incinerators, vehicles for transportation of wastes, dumpsite etc. This explains why there is poor management of health care waste in Port Harcourt metropolis. 771

4 This incidence of nosocomial diseases in health care establishments in Port Harcourt is an established fact and if nothing is done to check this, there may be an epidemic of nosocomial diseases in the future. This would affect hospital workers, patients and the general public. The climate typical of Niger Delta is (2) humid, semi-hot and equatorial and the relative humidity of over 80% throughout the year and a temperature that varies from o C most comes (2) are excellent for the multiplication of many pathogenic organisms (5). Nosocomial infections now called health care acquired infections affect approximately 10% of all hospital admissions and create a significant burden both clinically and economically (6). Some of these diseases include gastroenteric infections, anthrax, genital infections, respiratory infections, skin infections, meningitis, acquired immune deficiency syndrome (AIDS), fever, hepatitis, septicaemia and bacteriaemia. (7,8&9). Microorganism can transmitted through injuries and needles contaminated by human blood. This can result if solid waste including hypodermic needles are not properly disposed of (10). Besides hospital workers and waste management operators, individuals outside the health care establishment are also at significant risk as there are individuals who scavenge on waste disposal sites (11). Moreover, inadequate incineration or incineration of unsuitable materials can results in the release of pollutants into the air. The incineration of materials containing chlorine can generate dioxins and furans which are classified as possible carcinogens and have been associated with a range of adverse effects (4). Furthermore, this study showed that knowledge of health personnel on the health risks of inadequately managed waste did not automatically translate into efficient management of health care waste in the various establishments. This underscores the reasons for the following recommendations: 1. Health care waste management plans and policies should be put in place to enhance proper handling and management of wastes. 2. Functional and efficient waste management unit should be instituted in all health facilities. 3. Infrastructure for safe disposal and recycling of sharp and other hazardous materials should be put in place. 4. Further research on epidemiological surveys concerning waste management should be carried out in Nigeria. Better assessment of both risks and effect of exposure would help in the improvement of health care waste management and in the planning of adequate protective measures. Limitations: Certain limitations were encountered during this study. It was difficult to ascertain very objectively what efficient waste management unit is. Various responses on what may be termed very efficient, fairly efficient, or not efficient, differ because of individual differences, perceptions and idiosyncrasies. Besides, assessing the facilities for waste disposal management first hand would have guaranteed a more objective assessment. Despite these limitations, this work is a far attempt to raise awareness in an area of health care delivery that is still virgin in Nigeria. The study aims to stimulate interests for further research. Finally, the importance of proper waste management cannot be overemphasized when one considers that the Basel convention was signed by more than one hundred countries on the safe, legitimate transboundary movement of hazardous health care wastes from countries without facilities or expertise to those with both the facilities and expertise (12). REFERENCES Adesida A. A.; Igbuku A. O. Solid Waste Management. Shell Petroleum Developmental Company (SPDC) approach. In London M.D.B (ed) Envionmental News (1988) S (1) 23. Wahab A. B. Waste Disposal and Environmental Hazard Control, Lagos. West African Health Examination Board (1991). Pruss A; Townend W.K. Teachers guide, Management of Waste from Health Activities. Geneva, World Health Organization (1998) WHO: The First global and comprehensive document. Safe Management of Waste from Health Care Activities Released by World Health Organisation (1999) Todd W. T.; Sundar S,; Lockwood O. N. Principles of Infection Disease. In Davidson s Principles and Practice of Medicine (2006). 20 th ed, Published by Churchill Livingstone, Pg Todd W. T.; Sundar S,; Lockwood O. N. Principles of Infection Disease. In Davidson s Principles and Practice of Medicine (2006). 20 th ed, Published by Churchill Livingstone, Pg WHO: Survey of hospital Waste Management in South East Asia Region. New Delhi, World Health Organisation, Regional Office for South East Asia (1995). 772

5 Sessinik P. J. M., Puy, L. Occupational Exposure to Antineoplastic agent at several department in a hospital. Environmental contamination and excretion of cyclophosphamide and ifosfamide in urine of exposed workers. International archive of occupational and Environmental Health (1992) 64: ) Gealt M. A. Transfer of Plasmids PBR 322 and PBR 325 in waste water from laboratory strains of Escheriachia coli to bacteria indigenous to waste disposal System. Applied Environmental Microbiology (1985), 49 (4) Loft F., Abitebul D. Health Professionals infected with HIV in France. The Situation at 31 st December Bulletin 5 (20: ) Heptonstall J, Porter K, Gill O. N. Occupational Transmission of HIV: Summary of Published reports. Atlanta, GA, Centre for Disease Control and Prevention (1993) WHO: Regional guidelines for health care waste management in developing countries (Draft) Working document used at WHO region workshop on chemical waste management (1994). 773