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
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
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.
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.
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.
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
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
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
