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.     

Storage,collection and disposal of Kariakoo market wastes in Dar es Salaam,Tanzania

In many developing countries, the market is still the most important source of commerce for traders and provisions for the general public. The transmission of disease in the market place involves factors relating to the host, the agent and the environment. This study examines the quality of solid waste management in Kariakoo market, Dar es Salaam. The main problems identified were poor market design and lack of a well organized waste storage, collection and disposal systems. Two-thirds of the waste consists of vegetable matter. Proposals for improved design of storage and collection facilities are described. Experiments revealed wastes from the market are readily decomposable by composting. A change in the design of covered markets and improvements in waste handling are essential to reduce the potential health hazards in developing countries.     

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.     

Assessment of medical wastes management practice: a case study of the northern part of Jordan

This study includes a survey of the procedures available, techniques, and methods of handling and disposing of medical waste at medium (between 100 and 200 beds) to large (over 200 beds) size healthcare facilities located in Irbid city (a major city in the northern part of Jordan). A total of 14 healthcare facilities, including four hospitals and 10 clinical laboratories, serving a total population of about 1.5 million, were surveyed during the course of this research. This study took into consideration both the quantity and quality of the generated wastes to determine generation rates and physical properties. Results of the survey showed that healthcare facilities in Irbid city have less appropriate practices when it comes to the handling, storage, and disposal of wastes generated in comparison to the developed world. There are no defined methods for handling and disposal of these wastes, starting from the personnel responsible for collection through those who transport the wastes to the disposal site. Moreover, there are no specific regulations or guidelines for segregation or classification of these wastes. This means that wastes are mixed, for example, wastes coming from the kitchen with those generated by different departments. Also, more importantly, none of the sites surveyed could provide estimated quantities of waste generated by each department, based upon the known variables within the departments. Average generation rates of total medical wastes in the hospitals were estimated to be 6.10 kg/patient/day (3.49 kg/bed/day), 5.62 kg/patient/day (3.14 kg/bed/day), and 4.02 kg/patient/day (1.88 kg/bed/day) for public, maternity, and private hospitals, respectively. For medical laboratories, rates were found to be in the range of 0.053-0.065 kg/test-day for governmental laboratories, and 0.034-0.102 kg/test-day for private laboratories. Although, based on the type of waste, domestic or general waste makes up a large proportion of the waste volume, so that if such waste is not mixed with patient derived waste, it can be easily handled. However, based on infections, it is important for healthcare staff to take precautions in handling sharps and pathological wastes, which comprises only about 26% of the total infectious wastes. Statistical analysis was conducted to develop mathematical models to aid in the prediction of waste quantities generated by the hospitals studied, or similar sites in the city that are not included in this study. In these models, the number of patients, number of beds, and hospital type were determined to be significant factors on waste generation. Such models provide decision makers with tools to better manage their medical waste, given the dynamic conditions of their healthcare facilities.     

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.     

RECOMMENDATIONS FOR THE MANAGEMENT OF WASTES FROM HEALTHCARE FACILITIES IN HELSINKI

In Helsinki, Finland, new guidelines have been adopted for the management of wastes from healthcare facilities. The purpose has been to rationalize waste management, reducing the amount of waste needing special treatment and lowering costs, while at the same time maintaining occupational safety and preventing environmental hazards. The changes are mainly due to the new definition of infectious waste, based on practical assessment of the possibility of spread of infection via the wastes. As a result, it has been possible to omit one chain of waste handling which has led to simpler practices and economic benefits. Sanitary landfill has been accepted for disposal of clinical waste, except for the biological waste to be incinerated for ethical reasons and infectious waste contaminated by class 4 viruses,Yersinia pestisorBacillus anthracis. Diseases caused by these micro-organisms are not a practical problem in Finland.     

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.     

Characteristics of healthcare wastes

A comprehensive understanding of the quantities and characteristics of the material that needs to be managed is one of the most basic steps in the development of a plan for solid waste management. In this case, the material under consideration is the solid waste generated in healthcare facilities, also known as healthcare waste. Unfortunately, limited reliable information is available in the open literature on the quantities and characteristics of the various types of wastes that are generated in healthcare facilities. Thus, sound management of these wastes, particularly in developing countries, often is problematic. This article provides information on the quantities and properties of healthcare wastes in various types of facilities located in developing countries, as well as in some industrialized countries. Most of the information has been obtained from the open literature, although some information has been collected by the authors and from reports available to the authors. Only data collected within approximately the last 15 years and using prescribed methodologies are presented. The range of hospital waste generation (both infectious and mixed solid waste fractions) varies from 0.016 to 3.23kg/bed-day. The relatively wide variation is due to the fact that some of the facilities surveyed in Ulaanbaatar include out-patient services and district health clinics; these facilities essentially provide very basic services and thus the quantities of waste generated are relatively small. On the other hand, the reported amount of infectious (clinical, yellow bag) waste varied from 0.01 to 0.65kg/bed-day. The characteristics of the components of healthcare wastes, such as the bulk density and the calorific value, have substantial variability. This literature review and the associated attempt at a comparative analysis point to the need for worldwide consensus on the terms and characteristics that describe wastes from healthcare facilities. Such a consensus would greatly facilitate comparative analyses among different facilities, studies and countries.     

The treatment of infectious waste arising from home health and medical care services: present situation in Japan

The management of waste materials arising from home health and medical care services (HHMC wastes) in Japan is now receiving greater attention from governmental workers dealing with general household waste materials. In general, HHMC waste materials are collected in a mixed form, transported and disposed of along with municipal solid wastes. As a result, municipal workers are suffering needle stick accidents so that infections associated with HHMC waste materials may occur. The collection and transportation by patients and their families of HHMC waste materials with sharp-edges, such as injection needles, to medical-related facilities can prevent municipal workers from experiencing needle-prick accidents. One of the most important strategies for medical-related facilities is hence the education of patients and their families. Improved rules for handling HHMC waste materials are essential for the safe and effective management.     

Hazardous healthcare waste management in the Kingdom of Bahrain

Hazardous healthcare waste has become an environmental concern for many developing countries including the Kingdom of Bahrain. There have been several significant obstacles facing the Kingdom in dealing with this issue including; limited documentation regarding generation, handling, management, and disposal of waste. This in turn hinders efforts to plan better healthcare waste management. In this paper, hazardous waste management status in the Kingdom has been investigated through an extensive survey carried out on selected public and private healthcare premises. Hazardous waste management practices including: waste generation, segregation, storage, collection, transportation, treatment, and disposal were determined. The results of this study along with key findings are discussed and summarized. In addition; several effective recommendations and improvements of hazardous waste management are suggested.     

The current situation of solid waste generation and its environmental contamination in China

In China, controlling environmental pollution resulting from solid waste (SW) and hazardous waste (HW) has become one of the most pressing tasks in the field of environmental engineering. It is reported that the annual generation of industrial solid waste (ISW) in China exceeded 0.6 billion tons in the 1990s, and is increasing every year. Although ISW management has been strengthened in recent years, about 40% of SW is put in uncontrolled landfill without appropriate treatment. According to statistics from the national Environmental Protection Agency, the cumulative ISW uncontrolled landfill in China had reached 6.6 billion tons by the end of 1995, occupying around 55 000 hectares of land. Although some major uncontrolled landfills were constructed, nonetheless groundwater contamination resulted from the use of low-standard liners and poor management. Furthermore, about 20 million tons of ISW was discharged into the environment illegally, and a third of this waste was discharged directly into water bodies, making ISW one of the greatest pollution sources for surface water and ground water. Environmental pollution accidents resulting from SW occur about 100 times a year in China, and environmental issues frequently arise because of ISW pollution. The practices of SW management, treatment, and disposal started relatively late in China, and for a long time the management of SW pollution has received little attention compared with water and air pollution management. China faces problems such as the insufficiency of management laws and regulations, insufficient investment, inadequate treatment and disposal technology, and a lack of qualified technicians. At present, most treatment and disposal technology cannot meet the requests for solid waste pollution control. In order to protect, restore, and improve environmental quality in China and to realize sustainable development, the safe management and disposal of solid and hazardous wastes is a pressing challenge. In recent years, much attention has been paid to SW management in China, and investment to develop management and treatment technologies has increased. In 1995, the Law for Solid Waste Pollution Protection was issued, and work on solid waste treatment and disposal began to be legally managed. SW treatment and disposal facilities have been constructed, and now operate in some large and medium-sized cities. In particular, rapid improvements have been seen in ISW recycling, collection, and disposal of municipal solid waste and regional HW management. All the figures in this paper are from 1995, and represent the situation in China in that year. Received: April 18, 2000 / Accepted: May 15, 2000     

Guidelines for the evaluation and assessment of the sustainable use of resources and of wastes management at healthcare facilities.

This paper presents guidelines that can be used by managers of healthcare facilities to evaluate and assess the quality of resources and waste management at their facilities and enabling the principles of sustainable development to be addressed. The guidelines include the following key aspects which need to be considered when completing an assessment. They are: (a) general management; (b) social issues; (c) health and safety; (d) energy and water use; (e) purchasing and supply; (f) waste management (responsibility, segregation, storage and packaging); (g) waste transport; (h) recycling and re-use; (i) waste treatment; and (j) final disposal. They identify actions required to achieve a higher level of performance which can readily be applied to any healthcare facility, irrespective of the local level of social, economic and environmental development. The guidelines are presented, and the characteristics of facilities associated with sustainable (level 4) and unsustainable (level 0) healthcare resource and wastes management are outlined. They have been used to assess a major London hospital, and this highlighted a number of deficiencies in current practice, including a lack of control over purchasing and supply, and very low rates of segregation of municipal solid waste from hazardous healthcare waste.     

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.     

SOLID WASTE MANAGEMENT IN TEHRAN

The main objective of this paper is to analyse the present status of solid waste management in Tehran, and subsequently, to draw up a policy regarding their generation, collection, on-site handling, storage, processing, recycling, transportation and safe disposal. Through a detailed survey, all functional elements of the present solid waste management system in Tehran were studied. Factors affecting the important management issues in the operation of Tehran's solid waste management system are discussed. Key design data and other useful information selected from a variety of reliable sources are presented. The practical aspects associated with solid waste management systems, such as organizational structure, financing, operations, equipment management, personnel, reporting, cost accounting and budgeting, ordinances and guidelines, and public communications are described.     

Trends and problems of solid waste management in developing countries: a case study in seven Palestinian districts

There is a great interest in solving problems related to municipal solid waste (MSW) management in the Palestinian territory. However, few studies have been done to assess the extent of these problems and suggest the best alternative solutions. This study aims at assessing MSW conditions in the seven major districts in northern West Bank, Palestinian territory. The study focuses on comparing several MSW management elements (such as collection, budget, and disposal) in municipalities, village councils, and refugee camps in the studied districts and the problems faced by these institutions in handling the waste. It also provides information on MSW collection service availability and waste disposal practices in the districts studied. It was found that, although MSW collection service was available for 98% of the residents in the areas surveyed, no proper treatment or landfill procedure was followed for the collected waste in most of these areas. Instead, waste burning in open dumpsites was the most common practice. Moreover, due to inefficient collection of waste disposal fees from the residents, municipalities were forced to sometimes cut the collection service and reduce its labor force, especially in villages. The budget for MSW management was between 2% and 8% of the total budget of the municipalities studied, indicating a low priority for this issue.     

Treatment and disposal alternatives for health-care waste in developing countries--a case study in Istanbul, Turkey.

Efficient health-care waste management is crucial for the prevention of the exposure of health-care workers, patients, and the community to infections, toxic wastes and injuries as well as the protection of the environment (Safe Management of Wastes from Health-care Activities. World Health Organization, Geneva). The amount of health-care waste produced in the Istanbul Metropolitan City in Turkey is 30 ton day(-1) in total. The method used for the final disposal of most of the health-care waste of Istanbul is incineration. However, a great portion of the infectious waste is disposed of with the domestic waste into the sanitary landfill because of improper segregation practices applied in the health-care institutions. Therefore the alternatives for the treatment and disposal of health-care waste were evaluated. The technical information related to the available treatment technologies including incineration, microwave irradiation, mobile or stationary sterilization, etc. were also investigated. The capital investment cost, transportation/operational costs for each alternative method and the different locations for installation were compared. When the data collected were evaluated, it was found that separate handling and disposal of health-care waste generated on the European and the Asian sides of the city was the most economic and practicable solution. As a result, it was concluded that the capacity of the Kemerburgaz-Odayeri incineration plant is enough to incinerate the health-care waste generated on the European side of Istanbul, the construction of a new incineration plant or a stationary sterilization unit for the disposal of health-care waste generated on the Asian side was the most effective alternative.     

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.     

Measurement and management of hospital waste in southern Iran: a case study

One of the requirements for development of human societies is the establishment of new healthcare centers. A variety of wastes are generated in healthcare centers depending on the type of activities. This study was conducted to identify, measure and manage different types of hospital wastes as a case study in a hospital located in southern Iran. For this purpose, a questionnaire was initially designed and distributed among the relevant experts to survey the current trend of waste management in the hospital in terms of waste collection, storage and disposal. Afterwards, the hospital waste was sampled during two seasons of fall and winter. The samples were weighted for seven consecutive days in the middle of each season. Approximately, 10 % of the total waste bags per day collected round the clock were selected for further analysis. The obtained results indicated that infectious-hazardous and pseudo-household wastes were, respectively, about 3.79 kg/day/bed, 1.36 kg/day/bed and 2.43 kg/day/bed of the total generated waste in the hospital. As the research findings suggest, proper separation of infectious and pseudo-household wastes at the source would be an essential step towards mitigating environmental and health risks and minimizing the cost of the hospital waste management.     

Solid waste collection and recycling in Nibong Tebal, Penang, Malaysia: a case study.

The implementation of a suitable solid waste management programme with appropriate methods of recycling as an inherent element is vital to the alleviation of the problems associated with solid waste generation, handling and disposal, environmental conservation, public hygiene, etc. The present work is a case study on solid waste collection and recycling practices in Nibong Tebal town, Penang, Malaysia. The amount and types of domestic waste generated, household participation in recycling, identification of existing problems related to the implementation of the recycling programme, etc. formed the basis of this study. Surveys (interviews/questionnaires) and on-site observations were conducted to gather information on the solid waste collection and recycling practice of the residents. A focus group of 60 individuals was selected and their response to a questionnaire, prepared according to a Likert scale, was obtained and analysed. The majority of the respondents expressed concerns about recycling and wanted more to be done in this regard. Illegal collection, aesthetically displeasing sites and a lack of public awareness were problems of major concern. Issues related to inadequate funding and manpower as well as end market are also addressed and suggestions made.