Biomedical waste management in nursing homes and smaller hospitals in Delhi

The management of biomedical waste is a crucial issue in health and environmental management. Rules in India were promulgated in 1998, originally with a deadline of December 2000 and extended to December 2002; however, the actual situation remains far from satisfactory. A study conducted in 2001 by CEE, New Delhi; indicated an implementation deficit. To gauge the present situation, a survey was undertaken during 2005-2006. A systematic analysis of current biomedical waste management practices in smaller nursing homes and hospitals in Delhi was carried out. A total of 53 nursing homes, with bed strengths ranging from 20 to over 200, were included. The survey results show that there is a marked improvement in the segregation practices of biomedical waste in small private hospitals and nursing homes. The majority of nursing homes and hospitals were found to be using a service provider for the collection, management, and disposal of healthcare wastes. Data was collected through a questionnaire and field visits. This paper discusses the relevant data indicative of current practices of healthcare waste management in the nursing homes and small healthcare facilities in Delhi.     

Healthcare waste management practices and risk perceptions: Findings from hospitals in the Algarve region,Portugal

The management of healthcare wastes is receiving greater attention because of the risks to both human health and the environment caused by inadequate waste management practices. In that context, the objective of this study was to analyse the healthcare waste management practices in hospitals of the Algarve region, Portugal, and in particular to assess the risk perceptions of, and actual risk to, healthcare staff. The study included three of the six hospitals in the region, covering 41% of the bed capacity. Data were collected via surveys, interviews, and on-site observations. The results indicate that waste separation is the main deficiency in healthcare waste practice, with correct separation being positively related to the degree of daily contact with the waste. Risk perceptions of healthcare staff show the highest levels for the environment (4.24) and waste workers (4.08), and the lowest for patients (3.29) and visitors (2.80), again being positively associated with the degree of daily contact. Risk perceptions of healthcare staff are related to the difficulties of the correct separation of wastes and the lack of knowledge concerning the importance of that separation. The risk of infection with needlesticks/sharps is higher during patient care than during waste handling, and the frequency of these injuries is related to the daily tasks of each healthcare group (doctors, nurses, and housekeepers). Furthermore, legislative definitions and classifications of healthcare wastes appear to have conditioned the management practices associated with, and the perceptions of risk concerning, healthcare wastes.     

Medical waste management in Ibadan, Nigeria: obstacles and prospects

Quantification and characterization of medical waste generated in healthcare facilities (HCFs) in a developing African nation has been conducted to provide insights into existing waste collection and disposal approaches, so as to provide sustainable avenues for institutional policy improvement. The study, in Ibadan city, Nigeria, entailed a representative classification of nearly 400 healthcare facilities, from 11 local government areas (LGA) of Ibadan, into tertiary, secondary, primary, and diagnostic HCFs, of which, 52 HCFs were strategically selected. Primary data sources included field measurements, waste sampling and analysis and a questionnaire, while secondary information sources included public and private records from hospitals and government ministries. Results indicate secondary HCFs generate the greatest amounts of medical waste (mean of 10,238 kg/day per facility) followed by tertiary, primary and diagnostic HCFs, respectively. Characterised waste revealed that only approximately 3% was deemed infectious and highlights opportunities for composting, reuse and recycling. Furthermore, the management practices in most facilities expose patients, staff, waste handlers and the populace to unnecessary health risks. This study proffers recommendations to include (i) a need for sustained cooperation among all key actors (government, hospitals and waste managers) in implementing a safe and reliable medical waste management strategy, not only in legislation and policy formation but also particularly in its monitoring and enforcement and (ii) an obligation for each HCF to ensure a safe and hygienic system of medical waste handling, segregation, collection, storage, transportation, treatment and disposal, with minimal risk to handlers, public health and the environment.     

Healthcare waste management: current practices in selected healthcare facilities, Botswana

Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.     

Risk management for outsourcing biomedical waste disposal – Using the failure mode and effects analysis

Using the failure mode and effects analysis, this study examined biomedical waste companies through risk assessment. Moreover, it evaluated the supervisors of biomedical waste units in hospitals, and factors relating to the outsourcing risk assessment of biomedical waste in hospitals by referring to waste disposal acts. An expert questionnaire survey was conducted on the personnel involved in waste disposal units in hospitals, in order to identify important factors relating to the outsourcing risk of biomedical waste in hospitals. This study calculated the risk priority number (RPN) and selected items with an RPN value higher than 80 for improvement. These items included “availability of freezing devices”, “availability of containers for sharp items”, “disposal frequency”, “disposal volume”, “disposal method”, “vehicles meeting the regulations”, and “declaration of three lists”. This study also aimed to identify important selection factors of biomedical waste disposal companies by hospitals in terms of risk. These findings can serve as references for hospitals in the selection of outsourcing companies for biomedical waste disposal.     

A total quality management approach to healthcare waste management in Namazi Hospital,Iran

BackgroundHealthcare waste comprises all wastes generated at healthcare facilities, medical research centers and laboratories. Although 75–90% of these wastes are classified as household waste posing no potential risk, 10–25% are deemed to be hazardous, representing a potential threat to healthcare workers, patients, the environment and even the general population, if not disposed of appropriately. If hazardous and non-hazardous waste is mixed and not segregated prior to disposal, costs will increase substantially. Medical waste management is a worldwide issue. In Iran, the majority of problems are associated with an exponential growth in the healthcare sector together with low- or non-compliance with guidelines and recommendations. The aim of this study was to reduce the amounts of infectious waste by clear definition and segregation of waste at the production site in Namazi Hospital in Shiraz, Iran.Materials and methodsNamazi Hospital was selected as a study site with an aim to achieving a significant decrease in infectious waste and implementing a total quality management (TQM) method. Infectious and non-infectious waste was weighed at 29 admission wards over a 1-month period.ResultsBefore the introduction of the new guidelines and the new waste management concept, weight of total waste was 6.67 kg per occupied bed per day (kg/occupied bed/day), of which 73% was infectious and 27% non-infectious waste. After intervention, total waste was reduced to 5.92 kg/occupied bed/day, of which infectious waste represented 61% and non-infectious waste 30%. The implementation of a new waste management concept achieved a 26% reduction in infectious waste.ConclusionA structured waste management concept together with clear definitions and staff training will result in waste reduction, consequently leading to decreased expenditure in healthcare settings.     

Medical wastes management in the south of Brazil

In developing countries, solid wastes have not received sufficient attention. In many countries, hazardous and medical wastes are still handled and disposed together with domestic wastes, thus creating a great health risk to municipal workers, the public and the environment. Medical waste management has been evaluated at the Vacacai river basin in the State of Rio Grande do Sul, Brazil. A total of 91 healthcare facilities, including hospitals (21), health centers (48) and clinical laboratories (22) were surveyed to provide information about the management, segregation, generation, storage and disposal of medical wastes. The results about management aspects indicate that practices in most healthcare facilities do not comply with the principles stated in Brazilian legislation. All facilities demonstrated a priority on segregation of infectious-biological wastes. Average generation rates of total and infectious-biological wastes in the hospitals were estimated to be 3.245 and 0.570 kg/bed-day, respectively.     

Status and challenges of hospital solid waste management: case studies from Thailand, Pakistan, and Mongolia

Healthcare waste management is a serious public health concern. In developing countries, compared to developed nations, the management of infectious wastes has not received sufficient attention. Recently, worldwide awareness has grown of the need to impose stricter controls on the handling and disposal of wastes generated by healthcare facilities. This exploratory study attempted in seven selected hospitals to explain the situation of healthcare waste management, with a focus on handling practices, occupational safety, and the implementation status of waste management policy, together with other pertinent policy issues. It was noted that the current system of healthcare waste management was underdeveloped and was in dire need of immediate attention and improvement, especially in Mongolia and Pakistan; the medical waste management practices were better in the hospitals studied in Thailand. This study underscores the importance for improvement of medical waste management of a national regulatory framework, a sound internal management system, and programs to train and ensure the safety of related personnel, as well as programs to estimate quantities of waste generated and to evaluate appropriate techniques of disposal. Once a healthcare waste management plan has been prepared, a regular program of inspection and review can be undertaken within the healthcare institution. A good inspection program can also expose problems and new issues in managing healthcare wastes.     

Clinical solid waste management practices and its impact on human health and environment--A review

The management of clinical solid waste (CSW) continues to be a major challenge, particularly, in most healthcare facilities of the developing world. Poor conduct and inappropriate disposal methods exercised during handling and disposal of CSW is increasing significant health hazards and environmental pollution due to the infectious nature of the waste. This article summarises a literature review into existing CSW management practices in the healthcare centers. The information gathered in this paper has been derived from the desk study of open literature survey. Numerous researches have been conducted on the management of CSW. Although, significant steps have been taken on matters related to safe handling and disposal of the clinical waste, but improper management practice is evident from the point of initial collection to the final disposal. In most cases, the main reasons of the mismanagement of CSW are the lack of appropriate legislation, lack of specialized clinical staffs, lack of awareness and effective control. Furthermore, most of the healthcare centers of the developing world have faced financial difficulties and therefore looking for cost effective disposal methods of clinical waste. This paper emphasizes to continue the recycle-reuse program of CSW materials after sterilization by using supercritical fluid carbon dioxide (SF-CO2) sterilization technology at the point of initial collection. Emphasis is on the priority to inactivate the infectious micro-organisms in CSW. In that case, waste would not pose any threat to healthcare workers. The recycling-reuse program would be carried out successfully with the non-specialized clinical staffs. Therefore, the adoption of SF-CO2 sterilization technology in management of clinical solid waste can reduce exposure to infectious waste, decrease labor, lower costs, and yield better compliance with regulatory. Thus healthcare facilities can both save money and provide a safe environment for patients, healthcare staffs and clinical staffs.     

Healthcare waste management in Asia

The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper places recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties – budget support, developing policies and legislation and technology and knowledge management.     

Medical waste management in China: A case study of Nanjing

Medical waste management is of great importance due to its infectious and hazardous nature that can cause undesirable effects on humans and the environment. The objective of this study was to analyze and evaluate the present status of medical waste management in the light of medical waste control regulations in Nanjing. A comprehensive inspection survey was conducted for 15 hospitals, 3 disposal companies and 200 patients. Field visits and a questionnaire survey method were implemented to collect information regarding different medical waste management aspects, including medical waste generation, segregation and collection, storage, training and education, transportation, disposal, and public awareness.The results indicated that the medical waste generation rate ranges from 0.5 to 0.8 kg/bed day with a weighted average of 0.68 kg/bed day. The segregated collection of various types of medical waste has been conducted in 73% of the hospitals, but 20% of the hospitals still use unqualified staff for medical waste collection, and 93.3% of the hospitals have temporary storage areas. Additionally, 93.3% of the hospitals have provided training for staff; however, only 20% of the hospitals have ongoing training and education. It was found that the centralized disposal system has been constructed based on incineration technology, and the disposal cost of medical waste is about 580 US$/ton. The results also suggested that there is not sufficient public understanding of medical waste management, and 77% of respondents think medical waste management is an important factor in selecting hospital services.The problematic areas of medical waste management in Nanjing are addressed by proposing some recommendations that will ensure that potential health and environmental risks of medical waste are minimized.     

Report: The assessment of hospital waste management:a case study in Tehran

Hospital waste management is an important process that must be dealt with diligently. The management of hazardous waste material requires specific knowledge and regulations and it must be carried out by specialists in the field. In this cross-sectional study, we assessed the main stages of hospital waste management including separation, containment, removal and disposal of waste materials in public hospitals affiliated with Tehran University of Medical Sciences (TUMS). We selected 108 units of six hospitals (three general hospitals and three subspecialty hospitals) from those hospitals supervised by TUMS using the cluster sampling method. The measurement was conducted through a questionnaire and direct observation by researchers. Association analysis was done by statistical tests; Fisher exact test and chi-squared using SPSS software. According to the results obtained by the questionnaire, most of the studied wards scored moderately in terms of quality of their performance in all stages of waste management. About one-fifth of the wards were suffering from poor management of their medical waste and only a minority of wards obtained good scores for managing their waste materials. The findings also revealed significant associations between temporary waste storage and collection and the level of education of the managers (P = 0.040, P = 0.050, respectively). In summary, the study indicated a moderate management in all processes of separation, collection, containment, removal and disposal of waste materials in hospitals with several observed problems in the process.     

Modelling seasonal variation in biomedical waste generation at healthcare facilities

A mathematical model can help waste planners to optimize waste management systems related to environmental protection. It can also help government bodies set guidelines and regulations, and evaluate prevailing strategies for handling and disposal of waste. In this paper, a technique to develop a mathematical model to correlate the generation rate of biomedical waste (contaminated with blood and body fluid) as a function of bed occupancy and type of ailment (in terms of seasonal changes) using data for two consecutive years from three different healthcare facilities is presented. The data exhibit different trends in biomedical waste generation rates and number of beds occupied in two different years. However, the seasonal variation in biomedical waste production rate remained nearly the same during these 2 years. The fixed trend in biomedical waste generation rate in two consecutive years could be due to similar seasonal illnesses pattern and social factors.     

Development of a waste management protocol based on assessment of knowledge and practice of healthcare personnel in surgical departments

Background:Good healthcare waste management in a hospital depends on a dedicated waste management team, good administration, careful planning, sound organization, underpinning legislation, adequate financing, and full participation by trained staff. Hence, waste management protocols must be convenient and sensible.Aim of study:To assess the knowledge and practice related to waste management among doctors, nurses, and housekeepers in the surgical departments at Al-Mansoura University Hospital, and to design and validate a waste management protocol for the health team in these settings.Subjects and methods:This cross-sectional study was carried out in the eight surgical departments at Al-Mansoura University Hospital. All health care personnel and their assistants were included: 38 doctors, 106 nurses, and 56 housekeepers. Two groups of jury were included for experts’ opinions validation of the developed protocol, one from academia (30 members) and the other from service providers (30 members). Data were collected using a self-administered knowledge questionnaire for nurses and doctors, and an interview questionnaire for housekeepers. Observation checklists were used for assessment of performance. The researchers developed the first draft of the waste management protocol according to the results of the analysis of the data collected in the assessment phase. Then, the protocol was presented to the jury group for validation, and then was implemented.Results:Only 27.4% of the nurses, 32.1% of the housekeepers, and 36.8% of the doctors had satisfactory knowledge. Concerning practice, 18.9% of the nurses, 7.1% of the housekeepers, and none of the doctors had adequate practice. Nurses’ knowledge score had a statistically significant weak positive correlation with the attendance of training courses (r = 0.23, p < 0.05). Validation of the developed protocol was done, and the percent of agreement ranged between 60.0% and 96.7% for the service group, and 60.0% and 90.0% for the academia group.Conclusion and recommendations:The majority of the doctors, nurses, and housekeepers have unsatisfactory knowledge and inadequate practice related to health care waste management. The knowledge among nurses is positively affected by attendance of training programs. Based on the findings, a protocol for healthcare waste management was developed and validated. It is recommended to implement the developed waste management protocol for the surgical departments in the designed hospital, with establishment of waste management audits.     

Results of a hospital waste survey in private hospitals in Fars province, Iran

Hospital waste is considered dangerous because it may possess pathogenic agents and can cause undesirable effects on human health and the environment. In Iran, neither rules have been compiled nor does exact information exist regarding hospital waste management. The survey presented in this article was carried out in all 15 private hospitals of Fars province (Iran) from the total numbers of 50 governmental and private hospitals located in this province, in order to determine the amount of different kinds of waste produced and the present situation of waste management. The results indicated that the waste generation rate is 4.45 kg/bed/day, which includes 1830 kg (71.44%) of domestic waste, 712 kg (27.8%) of infectious waste, and 19.6 kg (0.76%) of sharps. Segregation of the different types of waste is not carried out perfectly. Two (13.3%) of the hospitals use containers without lids for on-site transport of wastes. Nine (60%) of the hospitals are equipped with an incinerator and six of them (40%) have operational problems with the incinerators. In all hospitals municipal workers transport waste outside the hospital premises daily or at the most on alternative days. In the hospitals under study, there aren't any training courses about hospital waste management and the hazards associated with them. The training courses that are provided are either ineffective or unsuitable. Performing extensive studies all over the country, compiling and enacting rules, establishing standards and providing effective personnel training are the main challenges for the concerned authorities and specialists in this field.     

Hospital waste management in Libya: A case study

In Libya, as in many developing countries, little information is available regarding generation, handling and disposal of hospital waste. This fact hinders the development and implementation of hospital waste management schemes. The specific objective of this study is to present an appraisal of the current situation regarding hospital waste management in Libya. Procedures, techniques, methods of handling, and disposal of waste are presented, as well as the amounts and compositions of hospital waste. This research was conducted in the form of a case study. Fourteen different healthcare facilities in three cities, Tripoli, Misurata, and Sirt, all located in the northwestern part of Libya, were selected for investigation. The investigation showed that the hospitals surveyed had neither guidelines for separated collection and classification, nor methods for storage and disposal of generated waste. This deficiency indicates the need for an adequate hospital waste management strategy to improve and control the existing situation. The average waste generation rate was found to be 1.3 kg/patient/day, comprised of 72% general healthcare waste (non-risk) and 28% hazardous waste. The average general waste composition was: 38% organic, 24% plastics, and 20% paper. Sharps and pathological elements comprised 26% of the hazardous waste component.     

Healthcare waste management in Algeria and Mostaganem department

Algeria as other developing countries faces an array of challenges for healthcare waste management. The management of healthcare waste is of major importance due to its public health risks and potential environmental hazards. Many efforts have been made by the government authorities in order to better manage the waste from healthcare facilities. However most healthcare facilities do not comply with the principles stated in Algerian legislation. A data study was made on 95 hospitals across the country, and the three health sectors of Mostaganem department (Mostaganem, Ain Tédles, and Sidi Ali) were surveyed. The yearly production of infectious healthcare waste in this Algerian department is estimated at 92 tons, which is 1.38% of the national waste production. This represents an average of 0.15 kg/bed/day, which is lower than the national value of 0.72 kg/bed/day. The total healthcare waste by sector ranges from 0.7 to 1.22 kg/bed/day, and healthcare waste comprises 16% of total waste, which is equal to the national percentage.     

Resolving complexities in healthcare waste management: a goal programming approach.

The wide variety of activities at healthcare facilities generates different types of waste. There is always a danger of spreading infection due to mishandling of infectious waste or sharps. Hence, a variety of policies and actions have been taken to improve healthcare waste management systems. A large body of literature is available which suggests methods for tackling different problematic situations but management is confronted with a variety of complex problems, such as the choice of technological options to control infection, legal and budget restrictions and the timely removal of waste, which can, at times, conflict with each other. Hence, a planning model is presented that is based on a trans-shipment goal programming approach wherein the waste flow is optimized for multiple objectives under different priority structures or with different relative importance (weights). The use of the model is demonstrated as a decision-making tool that would help the management to understand the effects of their policies on the system performance. The model is validated for a case application representing a real-life situation. It can be easily seen that, in the case in which the management is biased toward a higher level of safety protection towards infection control, they have to compromise on cost control and to some extent on environmental pollution control.     

Report: biomedical waste management practices at Balrampur Hospital, Lucknow, India.

Biomedical waste has become a serious health hazard in many countries, including India. Careless and indiscriminate disposal of this waste by healthcare establishments and research institutions can contribute to the spread of serious diseases such as hepatitis and AIDS (HIV) among those who handle it and also among the general public. The present study pertains to the biomedical waste management practices at Balrampur Hospital, a premier healthcare establishment in Lucknow, in North India. The study shows that infectious and non-infectious wastes are dumped together within the hospital premises, resulting in a mixing of the two, which are then disposed of with municipal waste at the dumping sites in the city. All types of wastes are collected in common bins placed outside the patients wards. For disposal of this waste the hospital depends on the generosity of the Lucknow Municipal Corporation, whose employees generally collect it every 2 or 3 days. The hospital does not have any treatment facility for infectious waste. The laboratory waste materials, which are disposed of directly into the municipal sewer without proper disinfection of pathogens, ultimately reach the Gomti River. All disposable plastic items are segregated by the rag pickers from the hospital as well as municipal bins and dumps. The waste is deposited either inside the hospital grounds, or outside in the community bin for further transportation and disposal along with municipal solid waste. The open dumping of the waste makes it freely accessible to rag pickers who become exposed to serious health hazards due to injuries from sharps, needles and other types of material used when giving injections. The results of the study demonstrate the need for strict enforcement of legal provisions and a better environmental management system for the disposal of biomedical waste in the Balrampur Hospital, as well as other healthcare establishments in Lucknow.