Hospital Waste Disposal: A Review Article

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Hospital Waste Disposal: A Review Article

Nosheen Arshad*, Shamail Nayyar *, Dr. Fatima Amin* and Dr. Khawaja Tahir Mahmood** *Department of Pharmacy, Lahore College for Women University, Lahore, Pakistan

**DTL, Lahore, Pakistan Abstract T h i s i s a r e v i e w p a p e r w h i c h i s p r e p a r e d f r o m t h e s u r v e y s o f h o s p i t a l s a n d r e s e a r c h s t u d i e s . H o s p i t a l w a s t e m a n a g e m e n t i n t h e w o r l d i s a f o r m a l d i s c i p l i n e a n d d o e s o c c u p y a c r i t i c a l p l a c e i n t h e m a n a g e m e n t o f h e a l t h c a r e s e c t o r . T h e m a n a g e m e n t o f h o s p i t a l w a s t e r e q u i r e s i t s r e m o v a l a n d d i s p o s a l f r o m t h e h e a l t h c a r e e s t a b l i s h m e n t s a s h y g i e n i c a l l y a n d e c o n o m i c a l l y a s p o s s i b l e b y m e t h o d s t h a t a l l s t a g e s m i n i m i z e s t h e r i s k t o p u b l i c h e a l t h a n d t o e n v i r o n m e n t . T o a n a l y z e t h e p r e s e n t s i t u a t i o n a n a l y s i s o f m e d i c a l w a s t e m a n a g e m e n t s y s t e m s w a s p e r f o r m e d t o u n d e r s t a n d t h e v a r i o u s h a n d l i n g a n d d i s p o s a l p r o c e d u r e s , t h e k n o w l e d g e a n d a w a r e n e s s o f i n d i v i d u a l s i n v o l v e d i n m e d i c a l w a s t e g e n e r a t i o n , h a n d l i n g a n d d i s p o s a l , a n d t h e p o t e n t i a l i m p a c t s o f t h e w a s t e s t r e a m o n b o t h h u m a n h e a l t h a n d t h e n a t u r a l e n v i r o n m e n t . T h e m e t h o d a d a p t e d f o r p r e s e n t s t u d y w a s l i t e r a t u r e r e v i e w a n d s u r v e y m e t h o d . T h e d a t a c o l l e c t i o n w a s d o n e t h r o u g h q u e s t i o n n a i r e ( d a t a c o l l e c t i o n f o r m ) , i n f o r m a l i n t e r v i e w s a n d s i t e v i s i t s . I t w a s f o u n d t h a t a v a r i e t y o f m e t h o d s w e r e u s e d b y t h e m e d i c a l f a c i l i t i e s t o d i s p o s e t h e i r w a s t e s i n c l u d i n g b u r n i n g b u r i a l , e n t o m b i n g , s e l l i n g , d u m p i n g , a n d r e m o v a l b y m u n i c i p a l b i n s . T h e w a s t e d i s p o s a l p r a c t i c e w a s f o u n d t o b e q u i t e u n s a f e , a n d b o t h c l i n i c a l a n d n o n - c l i n i c a l w a s t e s w e r e f o u n d t o b e t h r o w n t o g e t h e r . T h e r e w a s i n s u f f i c i e n t a w a r e n e s s o f t h e m a g n i t u d e o f t h e m e d i c a l w a s t e s i s s u e b y c o n c e r n e d i n d i v i d u a l s a t d i f f e r e n t l e v e l s f r o m d i r e c t o r o r d i v i s i o n a l h e a d t o w a s t e p i c k e r s . T h e r e w a s n o s a f e t y m e a s u r e o b s e r v e d i n d e a l i n g w i t h w a s t e d i s p o s a l o r l a b o r a t o r y a n a l y s i s o f i n f e c t i o u s d i s e a s e s . M e d i c a l w a s t e i n c i n e r a t i o n i s i d e n t i f i e d a s t h e m o s t p r e f e r r e d d i s p o s a l m e t h o d . I t i s i m p o r t a n t t o p o i n t o u t t h a t t h e r e i s a g r e a t p o t e n t i a l t o e m i t a i r t o x i c p o l l u t a n t s f r o m s u c h i n c i n e r a t o r s i f i m p r o p e r l y o p e r a t e d a n d m a n a g e d . H o w e v e r t h e r e a r e s o m e i n s t i t u t i o n s w h i c h p r a c t i c e t h e m o s t s o u n d h o s p i t a l w a s t e m a n a g e m e n t p r a c t i c e s s u c h a s S h a u k a t K h a n u m a n d S h a l a m a r . F r o m t h i s s t u d y i t c a n b e s a i d t h a t p r o p e r w a s t e m a n a g e m e n t s t r a t e g y i s n e e d e d t o e n s u r e h e a l t h a n d e n v i r o n m e n t a l s a f e t y . K e y w o r d s : H o s p i t a l W a s t e , H o s p i t a l w a s t e m a n a g e m e n t ( H W M ) , H o s p i t a l W a s t e d i s p o s a l INTRODUCTION

H o s p ita l w a ste man a g e me n t is an i mp o r ta n t p ro c e ss t h at mu s t b e d e a l t w i th d i lig e n tly . T h e ma n a g e me n t o f h a z a r d o u s w a ste ma te r ia l r e q u ir e s s p e c if ic k n o w le d g e a n d r egu la tio n s an d i t mu st b e c ar r i ed ou t by s p ecia lis ts in th e field .

H eap s o f l i tter is ta k en to d ump s i tes in d ev e lop ed co un tr ie s. How ev er , in d e v e lo p in g c o u n tr ie s , w a s te mo s t ly en d s u p o n ro a d sid e s a n d emp ty p l o ts. U n tr e a te d w a s t e b e a rs a n e c o n o m i c c o s t f o r r e s i d e n ts o f th e a r ea a n d is also a n env ir o n me n ta l h a z a rd . In cr eas in g p o l lu tio n l e a d in g to e n v ir o n me n t a l c h a n g e s a n d e co n o mi c c o s t r e la ted to w a s te in te r ms o f h ealth h a zar d s an d n e g ativ e i mp a c t o n in fr as tr u ctu r e h ave ch a n g ed the w ay au tho r itie s v iew it. T h o u g h w as te ma n a g e me n t is a r e la tiv e ly n ew ph e no me n o n, it h a s c au gh t th e att en t io n o f g o v er nme n ts a l l o v er th e g lo b e . T o d ay th e te r m w a s te m a n a g e me n t co v er s coll ec ti n g , so r tin g , pr o ces sin g , r ecy c lin g an d r eu s ing mater ia ls th a t w o u ld o th e rw is e b e co n s id er e d a s u s eles s . T h is ar ti c le is co n c er ned w ith c o mp a r in g

p r a c tic e s f o r th e ma n a g e me n t o f h e a lth c a r e w a s te u sin g fiv e ca s e stu d y h o sp it a ls . C o mp lia n ce w ith th e Was te M an a g eme n t R u le s 2 00 5, u nd er th e E n v iro n me n t P r o te c tio n A c t ( 1 9 9 7 ), o f th e G o v er n me n t o f P a k i s t a n w a s u s e d as t h e s t a n d a r d .

U n til fair ly re cen tly , me d i c a l w a st e man ag e me n t w as no t g en er a lly c o n sid er ed an issu e. In th e 19 80s a nd 199 0s, c on cern s a b ou t e x po su r e to h u m a n i m mu n o d e f ic ie n cy v ir u s ( H I V ) a n d h ep a titis B v ir u s (H BV ) l ed to qu es tio ns ab ou t p o t en tia l r i sk s in h er en t in med ic a l w a s t e . T h u s h o s p i t a l w a s t e g e n er a t i o n h a s b e c o me a p r i me c o n c er n d u e t o its m u l t i d i me n s i o n a l r a m i f i c a t i o n s a s a r i s k fa c to r t o t h e h e a lth o f p a tie n ts , h o sp ita l s t a f f a n d ex t e n d i n g b e y o n d t h e b o u n d ar i e s o f th e me d ic a l e s ta b li s h me n t to t h e g e n e ra l p opu la tio n . [1]

H o s p ital w a ste r e fer s to all w a st e , b io log i c o r n o n - b io lo g i c t h a t is d is c a r d e d an d n o t in te n d e d fo r fu r th e r u se . M e d ic a l w a ste is a s u b se t o f h o sp ita l w a s te ; i t r e fe rs to th e ma te ri a l g en e r ated a s a r esu l t o f d iag no s is , tr e a t me n t o r i mmu n i z a tio n o f p a tie n ts a n d

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a s s o c ia t e d b io me d i c a l r e s e a r c h . [ 2 ] B io med ic a l w as te (B MW) i s g e n er ate d in h o sp itals , r es ea rc h in st i tu tio n s , hea lth ca re tea c h in g in s titu te s, cl in ics , la b o r a t o ri es, b lo o d b an ks , an i ma l h o u s e s an d v e te ri nary in s ti tu te s. [ 3 ]

H o s p ita l w a ste ma n a g e me n t me a n s t h e man ag e me n t o f w as te p ro d u ced by h o sp itals u s in g techn iq u es th at w ill ch ec k t h e s p r e a d o f d i s e a se s. [ 4 ] I n d ev el o p in g c o u n t r i e s , a w a r en e ss r e g a r d i n g h o s p i t a l w a s te ma n a g e me n t in te r ms o f i ts s e g r eg a t i o n , c o l l e c t i o n , s t o r a g e , tr a n s p o r ta ti o n an d d is p o sa l is l a c k in g . [5 ,6 ] S tu d ie s i n P ak is t a n s h o w t h a t ar o u n d 2 . 0 k g o f w aste/b ed / d ay is p ro duc ed o u t o f w h ic h 0 . 1 - 0 . 5 c a n be cat eg o r iz e d a s r is k w a s te . [7 ]

T h e ma n ag e men t o f h o sp i tal w aste p o s es a ma jo r p ro ble m in mo s t o f th e c o u n tr ies . In r e c e n t y e ar s , me d ic a l w a ste d is p o s a l h a s p o s ed e v e n mo r e d if f i c u l t i e s w i t h t h e ap p e ar an ce o f d i sp o s ab le n eed l es, sy ri ng es , a n d o th er s i mi l ar i t e ms. T h e re a r e s e v e r a l ca te g o ri e s o f h o sp ita l w a s te s ac co rd in g to th eir w eig h t d en s ity and c o n s titu e n ts. Th e W o r ld H e a l th O rg an iz a ti o n h a s c la s s if ie d me d ic a l w a ste in to d iffe r en t ca teg or ie s, w h ich ar e, in fe c t io u s , s h a rp s, p a th o l o g ic a l , p h ar mace u t ica l an d r ad io ac tiv e.

T h e r e a r e s e v er a l c a t e g o r i e s o f i n f e c t i o u s w a s t e l i k e h u ma n t i s s u e s a n d b o dy p ar t s , an i ma l c ar cas se s, sy rin g es , b lad e s, s aw s, d ru g s, v o mi ts, u r in e, c h emic al s a n d fl u id fr o m la b o r a to r ie s . In fe ct io u s h e a lth - c a re w as te is a ma jo r cau s e o f H IV /A ID S, h e p a titis B an d C v ir a l in fe c t i o n s. Th ese v ir u s e s a re g en er a l l y tr a n s m i t t e d t h r o u g h in ju rie s fro m n eed le s and sh arp ob jec ts, w h ic h a r e c o n ta min a t e d w ith h u ma n b lo o d . T h e r e are h ow ev er , nu me r o u s o t h er d is e a s e s w h ich co uld b e t ra ns mit te d by c o n ta c t w i t h h e a l t h - c a r e w a s t e s . T h e se a r e u r in ary tr act in fec tio n s , r e sp ir at o ry tr ac t in fec t io n s , w ou nd infec t io n s, ba cter e mia , a n d s k in i n f e c t i o n s e tc . [ W H O 2 0 0 4 , 8 ] H ea lth care w aste d isp o sa l in each c oun try d ep end s u pon a n u mb er of fac to r s in cl u d ing s en s itiza ti o n l ev el of th e h eal t h ma n a g e rs a s w e l l a s o th e r p r o fe s sio n a ls , ex is tin g l o cal le g isl atio n s an d av a ilab l e resou r ces. In P ak istan , de sp ite th e

ex i ste n ce o f Pa k ista n B io sa fety Ru les 2 005 , n eith e r p ro per h o sp ital w as te m a n ag e me n t s y s t e ms h av e b e e n d ev el o p ed in v ar io u s h ea lth i n st itu t io n s n o r t h e c o n c er n ed h e a lt h p r o f e s s io n a ls a n d ma n a g e r s a r e a w a re o f th e g ra v ity o f t h e s itu at i o n re su lt in g th er ein . Th e to ta l q u an t ity o f w a ste g e n e r a te d b y th e h e a lth fac i l it ie s i s u s u al ly d is po se d w ith t he mu n icip a l w as te o r bu rn ed o p en ly r ais in g en v i ro n me n t al co n c er n s. T h e s to r ag e o f w a s te b e fo r e d isp o s a l is u s u a lly o p en an d th e e le me n t o f w a s te s e g r eg a tio n fo l lo w ed by ap pr op r iat e d i s p o s al me th o d s for v ar io u s s ec tio n s o f th e w ast e is al mo s t n o n - ex i stin g . [9 ]

S tu d ie s in P ak i sta n show e d th at a rou n d 2. 0 K g o f w as te / b e d /d ay is p r o d u ce d o u t o f w h ic h 0 .1 -0 .5 c a n b e c a t e g o r iz e d a s r is k w as te. D aily ab ou t 4 to 2 , 0 00 K g o f w ast e is g en e r ated by v ar iou s h ea lth o u tl ets ; o f w h i c h 7 5 % t o 9 0 % i s n o n - r i s k p ro d u c e d b y th e h ealt h c ar e p r emi s es , h ou se k eep i ng, a n d a d mi n istr a tiv e f u n c t io n s w h il e o n ly 1 0- 25 % i s in fec t io u s an d n ee d s mo r e c a r e fu l d isp o s a l. Mo r eo v e r , fa ilu r e to d is p o se o ff u se d sy r i n g e s, b la d e s e tc . le a d s to t h e ir r e u s e e n h a n c in g t h e r is k o f d ise a s e tr an s miss io n . [9 ] I n P ak is ta n u su a lly tw o me th o d s a r e b e in g u s ed to d isp o se- o ff t h e ho sp ita l w as te i. e . la n d fil ls a n d in c in e r a ti o n . In la n d fi l l me th o d , h o sp ita l w a s te i s b u ri e d u nd erg rou nd b u t ac co rd in g to h ea lth e x p e r t s n o t a s i n g l e l a n d f i l l i s c o n s t r u c t e d o n s c ie n tif ic l in e s . I n c in e ra to r s in sta l le d a t v a r io u s p la c e s a l so d o n o t h av e p ro p er fi l te r s a n d sc r u b b e r s a n d w h en h o sp ita l w aste is b u rn t, to x ic g a se s lik e d i o x in and ch e mi ca ls a re d is ch a rg e d in th e air w h i ch ca n b e poten tia l car ci n o g en. O n ly a few h o sp ita l s h a v e p ro p e r in c in e r a to r s . H e a lth e x p e r ts r e c o mme n d th a t th e h o sp it a l w a st e s h o u l d b e se g r e g a te d f r o m th e s o l id w a s t e an d sto re d in sp ec ial co n ta in er s. Pr op er la n d fil ls s h ou ld b e co n s tru cte d a n d a ll in c in er ato rs w o rk ing w ith ou t fi l ter s an d s cr ub b er s s h ou ld b e i mmed i ate ly s hut d ow n .

M A T ER IA L S A N D M E T H O D S

A c ro s s -s ec tio n a l stu d y w a s c o n d u c te d in fiv e h o s p ita l s ( 2 p r iv a te a n d 3

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g ov ern men ts ) C h ild r e n ho sp i t al, Sh e ikh Z a y ed h o sp i t a l , S h a u k a t K h a n u m h o s p i t a l , Mia n Mu n s h i ho sp it al, S h al a ma r ho sp ita l o f L a h o r e in Ju ly 2 01 0 . T h is stu d y is b a se d o n th e r eview o f av a ilab le in fo r ma tio n o n med ica l w a s te, a s r e late s to t h eir n a tu r e , i mp a c t s a n d ma n a g e me n t te c h n i q u e s. K eep in g in v ie w th e in fr as tr u c tu r a l r e q u i r e me n t f o r H o s p i t a l Wa s t e Ma n a g e me n t a n d a d h er e n c e to P ak is ta n s H W M R u le s 2 0 0 5 . Meth o d s o f s to r ag e a n d s eg r eg at io n at w a rd / d ep ar tmen t lev el , in te r n al tr an s p or tat io n , ex ter n a l tr a n s p o r ta ti o n an d o n s ite f in a l d i sp o s a l / o ff- s i te d is p o s al w er e s tu d ied fo r a l l 5 h o sp ita ls . I n fo r ma tio n w a s o b ta in e d th r ou gh lite ra tu r e r ev iew an d o n lin e s e a r c h . A ft e r e x te n s i v e l i t e r a t u r e s e a r c h , a q u e s tio n n a ir e w a s d e v e lo p e d to c o lle c t in fo r ma tio n r eg a rd in g d is p o sa l o f b io med ic al w a ste g en e r ated in t h e h o sp ita ls . T h e h o sp ita ls w e r e v is i te d a n d th e ad min i s tr at i o n o f th e in st i tu tio n s w e re in te r v iew ed t o g et in - d ep th kn ow ledg e reg ard ing w aste man ag e men t p o licy and tr ai n in g o f s taf f. T h e s tu dy w as e x p lain ed to th e m a n d v e rb a l co n s en t w a s o b ta in e d . T h e s ta tis tica l te c h n iq u e u s ed fo r th e a n a ly si s o f c o l le c te d d a ta w a s e sti ma t io n o f s i mp le p e rc en ta g e.

OBSERVATIONSANDRESULTS

A cro s s- s ect io n al s tu dy w a s c on du cted in fiv e te a c h i n g h o s p ita l s o f L a h o r e th r o u g h co nv en ien ce s a mp l in g . H o sp i ta ls o f b o th g ov ern men t an d priv ate se cto r w e re i n c l u d e d . T h e h o s p i t a l s w e r e v i s i t e d a n d th e p r e se n c e o r a b s e n c e o f w a st e man ag e me n t tec h n iqu e w as no te d . Th e a d min is tr a t o r s o f th e in s ti tu t i o n s w e re in te r v iew ed t o g et in - d ep th kn ow ledg e reg ard ing w aste man ag e men t p o licy and tr ai n in g of s t af f. D ata co ll e cted fr o m q u e s t i o n n a i r e w a s a n a ly z e d u s i n g p e r c e n ta g e s.

D iffer en t ty p e s o f w as te pr od u ced in h o sp ita ls i n c lu d in g ra d i o a c tiv e in v i site d h o sp itals as s h ow n in fig u re 1 . Th is s h o w ed t h a t p r o p e r w as t e d is p o sa l i s r equ ir e d in a ll h o sp ital s. 20% 80% 0% 20% 40% 60% 80% 100%

l type Allof  wastetype of except waste  radioactiveincluding radioactive

Figure 1. Type of waste material in hospital

S eg r eg a tio n o f w ast e is a n i mp o r tan t st ep in w a s te ma n a g e me n t p la n . S eg r e g a t io n is s e p a r a tio n o f r is k w a ste fr o m n o n -r is k w aste at so urce, that is at th e w ard b e d s id e , op e r a tio n th e a tr e , la bo r a to ry , o r a n y o th e r r o o m i n t h e h o sp i t a l w h e r e t h e w a s t e i s g e n e r a t e d , by t h e d o c t o r, n u r s e , o r o th e r p ers o n g e n er a t in g t h e w a ste . S e g r eg a tio n is d o n e in a l l h o s p ita ls a s s h o w n in fig u r e 2 . 100% 0% 0% 20% 40% 60% 80% 100% 120% Yes No

Figure 2. Is there segregation of waste?

O v e ru s e o f in je c t io n s is c o mmo n in g e n e ra l me d ic a l p r a c tic e in th e d e v e l o p in g c o u n t r i e s , i n c l u d in g P a k is t a n . A l l d is p o sa l med ic a l e q u ip me n t a n d su pp lies in c lu d ing s

y r ing es , nee d les , p la sti c b o tt l es , d r ip s an d in fu sio n bag s sh all b e cu t o r b ro k en and r e n d e r e d n o n - r eu s a b le a t t h e p o i n t o f u se b y t h e p e r s o n i n - c h a r g e . N e ed l e c u t t e r u s e d in 60 % o f h o sp ita ls.

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Figure 3. Needle cutter for used syringes H o s p ita l w a ste g e n e ra tio n p la n s h o w s th e d is p o sa l poin ts o f w ast e o f ev ery w a rd a nd d e p a r t me n t , d e ta ils a n d n u mb e rs o f e v e ry c o n ta in e r a n d tr o lle y s u s ed fo r th e d is p o sa l, time ta b le s s h o w in g fr e q u e n cy o f w as te co lle ctio n , du ties a nd r es po n si b ilit ie s fo r ea ch o f th e d if fer e n t c a te g o r ie s o f h o sp ita l sta f f me m b e r . F i g u re 5 sh o w s th a t 6 0 % o f h o sp i ta ls h a v e w a ste g e n e r a tio n p l a n .

Figure 4. Hospital has waste generation plan Was te man ag e men t t e a m is r es p o n s ib le fo r b ett er ad min is tr at io n , p r ep ar ati o n , ca re fu l p lan n ing, mo n ito r in g, p eri o d ic r e v iew and co n tro l d is p o s al op erat io n s f ig ur e 5 show s th a t 6 0 % o f h o sp ita l h a v e w a st e ma n a g e me n t te a m.

Figure 5.Existence of hospital waste management team.

V ac cin at io n o f h o sp ital e mp loy ees is essen tia l. It p r o tec ts th e emp loy ee s a g ain st many in fectio u s d iseases lik e H B V and e mp loy e es o f a l l h o s p ital s v i s ite d w e r e v a c c in a te d a s s h o w n in fig u r e 6 .

Figure 6. Employees involved in handling of waste are vaccinated

S e g r eg a tio n o f w a s te i n d if fe r e n t c o lo r ed b a g s lik e y e llo w , r ed an d b la c k c o lo r ed c o n t a i n er s w as p ra c t i c e d i n 8 0 % o f h o sp ital s a s show n i n fig u r e

Figure 7. Different colors bags used for waste disposal

F o r o n - site tr a n s p o rt atio n d iffe r e n t ty p e o f tr an s po r tat io n me an s w e r e p r esen t a mo n g th e m car ts w e re co mmo n ly u sed as shown in fi g u re 8 . 40% 40% 20% 0% 10% 20% 30% 40% 50%

Open cart Close cartGarbage bags Figure 8. Internal collection of waste by. T ra n spo r ta tio n to fin al tr eat me n t sit e w as d o n e b y h o sp it a l e mp lo y e e s i n 8 0 % o f h o sp ita l s.

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Figure 9. Transportation of waste to final treatment by 20% 80% 0 0% 50% 100% Autoclave Incinerator

Figure 10. Final treatment of waste is done by D ep e nd ing up on th e ty pe and n atu re o f th e

w a s te ma t e r ia l a n d t h e o rg an is ms i n th e w as te, r isk w a ste sh ou ld b e i n acti v ated o r r e n d e re d sa fe b e fo r e f in a l d is p o s a l by a s u itab le t h er ma l, c h e mica l , ir r ad iat io n in c i n e r a tio n , fi l tr a t io n o r o th e r tr e a t me n t me th o d , o r b y a c o mb i n a tio n o f su c h me th o d s, in v o lv in g p r o p e r v a lid a ti o n a n d

mo n ito r in g p ro c edu r es . F igu r e 1 0 show s th a t in c in e r a tio n w a s c o n s id e r ed th e fin a l tr ea t men t me th o d in 8 0 % o f h o sp itals . H o s p i t a l e mp l o y e e s , p r i v a te c o m p a n y a n d o th e r co-o p er a tiv e h o sp ita ls co u ld be in v o lv ed in w as te man a g e men t as s h ow n in fig u r e 11.

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Ra d io activ e w a ste wh ic h h a s d ecay ed to b a c k g ro u n d le v e l sh a ll e i th e r b e b u r ie d in th e lan d fill si te o r i n cin e r a ted :

40% 40% 0% 10% 20% 30% 40% 50%

Incinerator Buried in pits

Figure 12. Final disposition of nuclear waste in

I n fe c t io u s l iq u id w aste fr o m la b or a t o ri e s, d if f e r e n t d e p a rt me n ts i s p r o d u c e d i n a l l h o sp itals b u t 40 % h o sp ita ls h a v e li q u id w as te man a g e men t p l an .

Figure 13. Is there any liquid waste management plan?

R e co rd k eep in g o f w as te g en e ra ted is v ery i mp o r ta n t a s i t p r o v id e s i n fo r ma ti o n a b o u t c a te g o r ie s a n d q u an tit ie s o f w a s te h a n d le d e v e ry d a y . R e c o rd o f w a s te g e n e r a te d k e p t in 60 % o f h o sp ita ls as show n in fig u r e 14 .

Figure 14. Record of waste generated kept

P h ar mac is t is me mb e r o f w a ste ma n ag e me n t t ea m i n 8 0 % o f h o sp i ta ls a s h o w n in fig u r e 1 5 .

Figure 15. Is there any role of pharmacist in hospital waste management?

DISCUSSION

T h e g e n e r ato r o f w a ste is r e s p o n sib l e fo r en s ur in g p ro p er d i sp o s al. H os p itals a r e s o cia lly ob li g e d t o ma in ta in a cle a n e n v i ro n me n t a n d d is p o s e me d i c a l w a s te in o rd e r to p r e v e n t p o ll u tio n a n d in fe c t io n w ith in and n e a r th e h o sp ital. T h e ho sp ita l w a s te ma n a g e me n t p l a n o u t lin e s t h e in te r p re tati o n o f the leg is lat i o n o r a s ta n d a rd p ro to c o l t o a c h ie v e e ss e n tia l e l e me n t s f o r e s t a b li s h me n t o f a p ro p e r h o sp ita l w a s te ma n a g e me n t s y ste m. [ 1 0 ] In th e cu r r en t st u dy it w as fo un d th a t o n ly tw o h o s p ita ls h a d w e ll d o c u me n te d w a st e man ag e me n t p lan s a s w ell a s p r o p er w ast e man ag e me n t t ea m. T h e re a r e ‘ G u id e lin es fo r H o sp i ta l W a s t e Ma n a g e me n t I n P ak istan ’ p r ep are d by th e En viro n men ta l H ea lth U nit , o f t h e M in i stry o f H eal t h , G o v er n me n t o f P a k is t a n , s in c e 1 9 9 8 . T h is g iv e s d e ta i le d in fo rma t io n c o v e r in g a ll a s p e c ts o f s a fe h o sp it a l w a s te ma n a g e me n t in th e co un try , in clu d i ng th e risk asso ciated w ith th e wa ste , fo r matio n o f a w as te man ag e me n t te a m in h o spita ls, t h eir r es po n s ib ilit ie s, p lan , co l lect i o n , s eg r eg a tio n , tr a n sp or ta tio n , s to r age , d is p o sa l me th o d s, co n t ain er s and t h eir c o l o r c o d in g , w as t e m i n i m i z a t i o n te c h n iq u e s, p ro te c ti v e c lo th i n g , e tc . F u r th er that h e avy p en al ties sh al l b e i mp o s ed on th e in s titu t io n s fo u n d to b e n e g l ig e n t.

B ad p r actices o n r eu s ed n eed les w as men t io n e d by jo u rn alis ts an d by S . B a tte r ma n in h is re p o r t o n s ma ll me d ic a l w a s t e i n c i n e r a t o r s p re p a re d f o r WH O : ” I n s o me co u n t ri es ( e. g. , Pa k ista n ) , c o n t a min a t e d d isp o sa b le n e e d le s a r e o fte n s c a v e n g ed , r e p a ck a ge d , so l d a n d r eu s ed 40%  60%  0% 20% 40% 60% 80% Yes No

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w ith o u t st e ri l iz a t io n . S u c h p r ac tic e s a r e a s so c ia te d w ith se r io u s h e a lth i m p lic a t io n s d u e to th e tr an smis si o n o f in fe ctio u s d i s e a s e , es p e c i a l l y h e p a t i t i s a n d A ID S . ” Me d i c a l w as te i n P a k is tan is l an d- fil le d an d bu rn ed in s ma l l sc ale in c in er ato r s lo c a te d i n sid e h o sp i ta ls . T h e s e in c in e r a to r s g e n e r a lly d o n o t h av e an y A P C d ev i c e s w ith s o me e x cep ti o ns, fo r exa mp le th e s i mp l e A PC ( air po l lu tio n co n tro l) sy s te m in th e w ast e in ci n er ato r in Sh au k at K h a n u m H o s p i t a l , L a h o r e . T h er e a r e n o d io x in e mi s sio n s me a s u re me n ts a s th e r e is n o la b o r ato ry c a p a b le o f d o in g su c h meas u r e me n ts i n P ak i sta n . Wa ste i n c i n er a t i o n r e s i d u e s a r e mo s t l y b u r i e d in d ee p p it s in s id e ho sp i tals a r eas a nd /or la n d - fil le d in d u mp s it es u s ed fo r mu n ic ip a l w a s te in g e n e r a l. T h es e d u mp sit e s h a v e n o lin i n g /in su l at io n i n mo st o f th e h o sp ita ls . T h e r e is lack o f a w a r en es s o f th e ma n a g e me n t r e g a rd in g d e ta ile d la w s a n d r e g u la tio n s g o v e rn in g h e a lth c a r e w a ste ma n a g e me n t. T h is e n c o u r ag e s r e u s e a n d u n hy g ie n ic r e c y c lin g o f w a s te ma t e r ia l. P a k i sta n is in a p h a s e o f c r e a t in g a w a re n e s s a n d imp le me n t i n g h o s p ita l w a s te ma n a g e me n t te c h n iq u e s. T h e co n c er ted effo r ts n eed e d mig h t fal l sh o rt , if th e attit u d e s o f the sta f f an d th e pub lic to w ard s th is , is n o t ch an g ed . [ 1 1 ]A c c o r d i n g t o U S A ID w i t h r e s p e c t t o d r i n k in g w a t e r s u p p ly a n d w a s t e w a t e r man ag e me n t a t s ele cted h ea lth fa cil it i e s , b o th o f th e m a r e a ls o i n a c r itic a l s itu at i o n . I n app ro pr ia te h o spita l w as tew at er man a g e men t is a s o ur ce o f e n v iro n me n t al p o llu t io n a n d h ealth r is k s . H o s p ita l w a s te w a ter is lo ad e d w i th p ath o g en ic mic r o o rg an is ms , h e avy meta ls , d is in fect an ts , d e t er g en ts , so lv e n ts, p h ar mace u t ica ls, a mo n g o th er s. U n c o n t r o ll e d d i s c h a r g e i n mo s t o f h o sp ita ls en h an c es t h e eco - tox ic o lo g ic a l r is k fo r e n v ir o n me n t a n d to x ic o r in fec t io u s r is k fo r h uman s . W it h r efer en ce t o h o s p i t a l w as t e ma n a g e me n t , i n s t i t u t i o n a l s tr en g th en i n g to d eve lo p , i mp l e me n t a n d en fo r ce reg u l atio n s o n h o sp it al w a st e ma n ag e me n t is n eed ed .

S en s itiz a t i o n, mo t iv atio n ca mp ai g n s a n d tec h n ica l c o urs es amo n g p rofes sio n a ls , tec h n icia n s a n d sa n itary w or k er s sh ou ld b e

ca r ri ed ou t; s o t h at th ey id e n tify th e ms e lv e s w ith the ir r e spon s ib ili t ies . S u g g e s te d s tr a te g y to d e v e lo p tr a in in g co ur s es s ho u ld b e “T r ain i n g of tr a in ee s” . C o u r s e c o n te n t a n d p la n n in g p ro c e d u re s a r e i n c l u d e d . In r e lat i o n t o w as t e w a te r m a n a g e me n t, a n a d e q u a te w a s t ew a t e r tr e a t me n t sy s te m is r e q u ir e d a t a l l fa c i l it ie s. D isc h ar g in g o f h o sp ita l w a s te w a te r to mu n ic ip a l s e w e r s w i th o u t p r e tr e a t me n t is n o t r e c o mme n d e d . M in i ma l r equ i re me n ts fo r s ma l l fa c il it i es w ou ld b e in stal latio n o f prop er se p tic tan k s and s o a k - a w ay sy s te ms .

I t i s fu n d amen t a l to e n s ur e a g oo d d esi gn, c o n s tru c t io n , fu n c tio n i n g , an d mo n ito r in g o f s e p t i c t a n k a n d s o a k - a w ay sy s t e m, o th e rw i s e o do r n u i s a n c e, f l o od i n g a n d p o llu t io n p r o b le ms c o u ld b e g e n e r a te d . A p ro p er and on - ti me ma in te n an ce t o t he sy ste m, in c lu d i n g a p e r io d i c mo n ito r in g ar e als o o blig ato ry a ctiv i t ies . A t th e e n d it is r e c o mme n d e d to i mp le me n t t h e s u g g e s t e d me a s u re s o n h o s p i t a l w as t e m a n a g e me n t, d r i n k in g w a t e r s u p p l y a n d w as tew a ter ma n ag emen t in se lect e d fac i l it ie s; w h ich ar e go in g to i mp r o ve h u ma n h e a l t h a n d e n v i r o n me n t.

CONCLUSION

P r o p e r co lle c tio n a n d s eg r e g a tio n o f b io me d i c a l w as t e a r e i mp o rt a n t. T h e r e i s n o t e n o u g h i n f o r ma t i o n o n me d ic a l w a s t e ma n a g e me n t te c h n o log ie s a n d it s i mp a c t o n p u b li c h e a l t h a n d e n v ir o n me n t. P r a c t ic e o f p ro p er me d ic a l w a ste d is p o s a l a n d man ag e me n t is a ls o in a d equ at e. H ow ev e r, th e r e is n e e d f o r r a is in g a w a r e n e s s a b o u t med ic a l w aste and its re la te d issu es. C o mp r e h en siv e a n a ly s is o f c u rr e n t w a st e man ag e me n t p r ac tice s in b o th g ov ern men t an d priv ate h o sp i ta ls. A rra ng e men t o f p ro p er tr a in in g p ro g ra ms o f h o s p ita l s ta f f a n d h e a lth p r o f e s s io n a ls . M o n i to r in g a n d e v a lu a ti o n o f h o s p ita l w a s te ma n a g e me n t i n t e r v e n t i o n s . T h e n e e d f o r h e a l t h c a r e w a s te ma n a g e me n t p la n n in g to fa c il it a te th e i mp le me n ta tio n o f n e c e ss a ry me a su r e s to i mp r o v e t h e p r e s e n t h e a lth c a re w a st e ma n a g e me n t s itu a ti o n . T h e ro l e f o r p h a r ma c i s t s i n t h i s a r e a i s s ig n ific a n t. A s o n e p h a rma c is t sta te d , " if w e se l l i t, w e a r e r e sp o n si b le fo r c o lle c t in g

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a n d d is p o si n g it a s w e ll" . E le me n t s o f th e r o le fo r ph ar ma c is ts in clu d e . E sta b lis h in g a d is p o s a l p ro c e ss , p o s sib ly i n co n ju n c t io n w i t h a s s o c i a t i o n s, ma n u fa c t u r e r s a n d h o sp ital a d min is t ra t i o n. E s tablis h in g a p ro g r a m f o r th e r e tu rn an d dis p o sa l o f u n u s ed d ru g s w h ic h in c lu d e s : En c o u r a g in g p a ti en ts t o re tu rn th eir d r ugs to t h e p h ar ma c y , C o l l e c t i n g e x p i r e d , d is c o n tin u e d a n d u n u sed d r u g s fr o m p ati en ts , T ab u la tio n an d do cu me n tatio n o f

v o lu me o f w as te a nd rat i o n a l e / c a u s e s/ so urce s fo r w aste a n d U si n g th is in fo r ma tio n to s u p por t th e n e e d fo r w a s te r e d u c tio n p ro g r a ms a n d a t tr a c t o r ma in ta in s p on so r sh ip. ACKNOLEDGEMENT T h e au thor s w ou ld lik e to th an k al l t h e p e o p l e w h o su p p o rt e d , in c a r ry in g o u t th e wh o le study esp ecially V ic e Ch a n cello r, L a h o r e C o l l e g e f o r w o me n u n i v e r s i ty a n d P r o je c t s u p er v i s o r D r. K h a w a j a T a h ir Mah mo o d . REFERENCES 1 . G o r d o n J G , R e i n H a r d t P A , D e n y s G A ( 2 0 0 4) : M e d i c a l w a s t e m a n a g e m e n t . I n : M a y h a l l C G ( E D s . ), H o s p i t a l e p i d e m i o l o g y a n d i n f e c t i o n c o n t r o l , ( 3 r d ) . L i p p i n c o t t W i l l i a m s a n d W i l k i n s p u b l i c a t i o n , p p : 1 7 7 3 - 8 5 . 2 . R u t a l a W A , W e b e r D J ( 2 0 0 5 ) . D i s i n f e c t i o n , s t e r i l i z a t i o n a n d c o n t r o l o f h o s p i t a l w a s t e . I n : M a n d e l l , D o u g l a s a n d B e n n e t t ' s P r i n c i p l e s a n d p r a c t i c e o f i n f e c t i o u s d i s e a s e s ( 6 t h e d. ) , E l s e v i e r C h u r c h i l l L i v i n g s t o n e P u b l i c a t i o n , p p : 3 3 3 1 - 4 7 . 3 . S h a r m a M ( 2 0 0 2 ) : H o s p i t a l w a s t e m a n a g e m e n t a n d i t s m o n i t o r i n g , ( 1 s t e d . ) , J a y p e e B r o t h e r s M e d i c a l P u b l i c a t i o n 4 . M a h m o o d M , S h a h a b S , M a l i k R , A z i m W. A s t u d y o f w a s t e g e n e r a t i o n , c o l l e c t i o n a n d d i s p o s a l i n a t e r t i a r y h o s p i t a l . P a k J M e d R e s , 2 0 0 1 ; 4 0 : 1 3 -1 7 . 5 . A t h e r S . H o s p i t a l w a s t e m a n a g e m e n t . J C o l l P h y s i c i a n s S u r g P a k 2 0 0 4 ; 1 4 : 6 4 5 - 6 . 6 . U y s a l F , T i n m a z E . M e d i c a l w a s t e m a n a g e m e n t i n T r a c h e a r e g i o n o f T u r k e , . W a s t e M a n a g R e s 2 0 0 4 ; 2 2 : 4 0 3 - 7 . 7 . H a s h m i S K , S h a h a b S . H o s p i t a l a n d b i o m e d i c a l w a s t e m a n a g e m e n t . I n : I l i y a s M , E d i t o r , C o m m u n i t y m e d i c i n e a n d p u b l i c h e a l t h . 4 t h e d . K a r a c h i: T i m e P u b l i s h e r s , 2 0 0 3 , p p . 4 2 6 - 3 7 . 8 . A h m e d R e h a n : H o s p i t a l W a s t e M a n a g e m e n t i n P a k i s t a n : C a s e S t u d y R e p o r t S p e c i a l W a s t e F r a c t i o n s : H o s p i t a l W a s t e A u g u s t 1 9 9 7 9 . F a z l i H a k i m K h a t t a k : H o s p i t a l W a s t e M a n a g e m e n t i n P a k i s t a n , P l a n n i n g C o m m i s s i o n , G o v e r n m e n t o f P a k i s t a n , I s l a m a b a d 1 0 . S h a h i d a R a s h e e d , S a i r a I q b a l , L u b n a A . B a i g , K e h k a s h a n M u f t i: H o s p i t a l W a s t e M a n a g e m e n t i n t h e T e a c h i n g H o s p i t a l s o f K a r a c h i 1 1 . B a s u R N , I s s u e s i n v o l v e d i n h o s p i t a l w a s t e m a n a g e m e n t : a n e x p e r i e n c e f r o m a l a r g e t e a c h i n g i n s t i t u t i o n . J A c a d H o s p A d m 1 9 9 6 ; 8 : 7 9 - 8 3

Figure

Figure 1. Type of waste material in hospital

Figure 1.

Type of waste material in hospital p.3
Figure 9. Transportation of waste to final treatment by  20% 80% 0% 050%100% Autoclave Incinerator

Figure 9.

Transportation of waste to final treatment by 20% 80% 0% 050%100% Autoclave Incinerator p.5
Figure 10. Final treatment of waste is done by  D ep e nd ing up on  th e ty pe and  n atu re  o f th e

Figure 10.

Final treatment of waste is done by D ep e nd ing up on th e ty pe and n atu re o f th e p.5
Figure 13. Is there any liquid waste management  plan?

Figure 13.

Is there any liquid waste management plan? p.6
Figure 12. Final disposition of nuclear waste in

Figure 12.

Final disposition of nuclear waste in p.6

References

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