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.     

Solid waste management in Abuja, Nigeria

The new city of Abuja provided an opportunity to avoid some of the environmental problems associated with other major cities in Africa. The current status of solid waste management in Abuja has been reviewed and recommendations for improvements are made. The existing solid waste management system is affected by unfavourable economic, institutional, legislative, technical and operational constraints. A reliable waste collection service is needed and waste collection vehicles need to be appropriate to local conditions. More vehicles are required to cope with increasing waste generation. Wastes need to be sorted at source as much as possible, to reduce the amount requiring disposal. Co-operation among communities, the informal sector, the formal waste collectors and the authorities is necessary if recycling rates are to increase. Markets for recycled materials need to be encouraged. Despite recent improvements in the operation of the existing dumpsite, a properly sited engineered landfill should be constructed with operation contracted to the private sector. Wastes dumped along roads, underneath bridges, in culverts and in drainage channels need to be cleared. Small-scale waste composting plants could promote employment, income generation and poverty alleviation. Enforcement of waste management legislation and a proper policy and planning framework for waste management are required. Unauthorized use of land must be controlled by enforcing relevant clauses in development guidelines. Accurate population data is necessary so that waste management systems and infrastructure can be properly planned. Funding and affordability remain major constraints and challenges.     

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.     

Environmental audits of hazardous waste disposal and treatment facilities

Hazardous waste generators have a duty of care in ensuring that their wastes are disposed of in an environmentally acceptable manner. Increasingly, generators are being made liable for environmental damage at the site of a waste disposal contractor if their wastes have been accepted by that facility. An audit procedure is described, that permits generators to examine the performance of waste vendors and to assess their potential liability as a result of using the site. Post-audit decisions in estimating the degree of risk and selecting appropriate waste contractors are also discussed.The purpose of this paper is to guide the prospective auditor through the site assessment procedure, highlighting areas of particular concern in relation to present or future potential liabilities. The audit procedure that is described, applies to all types of waste disposal operations in all countries, since the principles of good waste management do not vary.     

Disaster waste management: a review article

Depending on their nature and severity, disasters can create large volumes of debris and waste. The waste can overwhelm existing solid waste management facilities and impact on other emergency response and recovery activities. If poorly managed, the waste can have significant environmental and public health impacts and can affect the overall recovery process.This paper presents a system overview of disaster waste management based on existing literature. The main literature available to date comprises disaster waste management plans or guidelines and isolated case studies. There is ample discussion on technical management options such as temporary storage sites, recycling, disposal, etc.; however, there is little or no guidance on how these various management options are selected post-disaster. The literature does not specifically address the impact or appropriateness of existing legislation, organisational structures and funding mechanisms on disaster waste management programmes, nor does it satisfactorily cover the social impact of disaster waste management programmes.It is envisaged that the discussion presented in this paper, and the literature gaps identified, will form a basis for future comprehensive and cohesive research on disaster waste management. In turn, research will lead to better preparedness and response to disaster waste management problems.     

Implementing separate waste collection and mechanical biological waste treatment in South Africa: A comparison with Austria and England

The degradation of organic compounds found in municipal solid waste (MSW) under the anaerobic landfill conditions produces gas and liquid emissions that can protract well into the landfill after-care period. The European Landfill Directives regulate the amount and nature of the organic compounds disposed into landfills. In South Africa and other developing countries, MSW is still landfilled without any kind of pre-treatment. This paper presents a pilot project of mechanical biological waste treatment (MBWT) in South Africa implemented at municipal level in the city of Durban using passively aerated open windrows. Based on case studies from Austria, England and South Africa, a waste minimisation model which can facilitate full-scale implementation of MBWT in developing countries is presented. MSW was treated in open windrows for 8 weeks. Composting temperature reached a maximum of 65 °C in less than 10 days. The results of eluate tests on waste samples from the windrows at the end of composting show a reduction of BOD₅ and BOD₅/COD ratios equal to 35.7% and 16.7%, respectively. The percent waste composition of the treated MSW was 28.3% putrescibles, 17.4% garden refuse, 13.3% plastic, 12.4% fabrics, 12% paper and other elements. The waste composition shows that more than 40% of un-treated organic material and also more than 40% non-biodegradable and recyclable materials are still landfilled without any form of biological treatment or resource recovery. A simple wet and dry waste collection model can promote recycling, treatment of biological waste before landfilling, resource recovery, labour intensive jobs and hence sustainable landfilling in the South African scenario as well as in similar developing countries.     

Solid health care waste management status at health care centers in the West Bank – Palestinian Territory

Health care waste is considered a major public health hazard. The objective of this study was to assess health care waste management (HCWM) practices currently employed at health care centers (HCCs) in the West Bank – Palestinian Territory. Survey data on solid health care waste (SHCW) were analyzed for generated quantities, collection, separation, treatment, transportation, and final disposal. Estimated 4720.7 m³ (288.1 tons) of SHCW are generated monthly by the HCCs in the West Bank. This study concluded that: (i) current HCWM practices do not meet HCWM standards recommended by the World Health Organization (WHO) or adapted by developed countries, and (ii) immediate attention should be directed towards improvement of HCWM facilities and development of effective legislation. To improve the HCWM in the West Bank, a national policy should be implemented, comprising a comprehensive plan of action and providing environmentally sound and reliable technological measures.     

Quantification of greenhouse gas emissions from waste management processes for municipalities--a comparative review focusing on Africa

The amount of greenhouse gases (GHG) emitted due to waste management in the cities of developing countries is predicted to rise considerably in the near future; however, these countries have a series of problems in accounting and reporting these gases. Some of these problems are related to the status quo of waste management in the developing world and some to the lack of a coherent framework for accounting and reporting of greenhouse gases from waste at municipal level. This review summarizes and compares GHG emissions from individual waste management processes which make up a municipal waste management system, with an emphasis on developing countries and, in particular, Africa. It should be seen as a first step towards developing a more holistic GHG accounting model for municipalities. The comparison between these emissions from developed and developing countries at process level, reveals that there is agreement on the magnitude of the emissions expected from each process (generation of waste, collection and transport, disposal and recycling). The highest GHG savings are achieved through recycling, and these savings would be even higher in developing countries which rely on coal for energy production (e.g. South Africa, India and China) and where non-motorized collection and transport is used. The highest emissions are due to the methane released by dumpsites and landfills, and these emissions are predicted to increase significantly, unless more of the methane is captured and either flared or used for energy generation. The clean development mechanism (CDM) projects implemented in the developing world have made some progress in this field; however, African countries lag behind.     

Facilitating the improved management of waste in South Africa through a national waste information system

Developing a waste information system (WIS) for a country is more than just about collecting routine data on waste; it is about facilitating the improved management of waste by providing timely, reliable information to the relevant role-players. It is a means of supporting the waste governance challenges facing South Africa - challenges ranging from strategic waste management issues at national government to basic operational challenges at local government. The paper addresses two hypotheses. The first is that the identified needs of government can provide a platform from which to design a national WIS framework for a developing country such as South Africa, and the second is that the needs for waste information reflect greater, currently unfulfilled challenges in the sustainable management of waste. Through a participatory needs analysis process, it is shown that waste information is needed by the three spheres of government, to support amongst others, informed planning and decision-making, compliance monitoring and enforcement, community participation through public access to information, human, infrastructure and financial resource management and policy development. These needs for waste information correspond closely with key waste management challenges currently facing the country. A shift in governments approach to waste, in line with national and international policy, is evident from identified current and future waste information needs. However, the need for information on landfilling remains entrenched within government, possibly due to the poor compliance of landfill sites in South Africa and the problems around the illegal disposal of both general and hazardous waste.     

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.     

Integrated solid waste management based on the 3R approach

Integrated solid waste management (ISWM) based on the 3R approach (reduce, reuse, and recycle) is aimed at optimizing the management of solid waste from all the waste-generating sectors (municipal, construction and demolition, industrial, urban agriculture, and healthcare facilities) and involving all the stakeholders (waste generators, service providers, regulators, government, and community/neighborhoods). This article discusses the concept of solid waste management (SWM). Initially, SWM was aimed at reducing the risks to public health, and later the environmental aspect also became an important focus of SWM. Recently, another dimension is becoming a critical factor for SWM, i.e., resource conservation and resource recovery. Hence, the 3R approach is becoming a guiding factor for SWM. On the one hand, 3R helps to minimize the amount of waste from generation to disposal, thus managing the waste more effectively and minimizing the public health and environmental risks associated with it. On the other hand, resource recovery is maximized at all stages of SWM. Lately, the new concept of ISWM has been introduced to streamline all the stages of waste management, i.e., source separation, collection and transportation, transfer stations and material recovery, treatment and resource recovery, and final disposal. It was originally targeted at municipal solid waste management (MSWM), but now the United Nations Environment Programme (UNEP) is promoting this concept to cover all waste generating sectors to optimize the level of material and resource recovery for recycling as well as to improve the efficiency of waste management services. The ISWM concept is being transformed into ISWM systems to replace conventional SWM systems. This article further discusses the implementation process for ISWM. The process includes a baseline study on the characterization and quantification of waste for all waste generating sectors within a city, assessment of current waste management systems and practices, target setting for ISWM, identification of issues of concern and suggestions from stakeholders, development of a draft ISWM plan, preparation of an implementation strategy, and establishment of a monitoring and feedback system. UNEP is assisting member countries and their cities to develop an ISWM plan covering all the waste generating sectors within a specific geographical or administrative area such as a city or municipality. This umbrella approach is useful to generate sufficient volumes of recycling materials required to make recycling industries feasible. This is also helpful for efficient reallocation of resources for SWM such as collection vehicles, transfer stations, treatment plants, and disposal sites. UNEP is assisting cities to develop and implement ISWM based on the 3R approach. These experiences could be useful for other countries to develop and implement ISWM to achieve improved public health, better environmental protection, and resource conservation and resource recovery.     

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.     

Greenhouse gases accounting and reporting for waste management – A South African perspective

This paper investigates how greenhouse gases are accounted and reported in the waste sector in South Africa. Developing countries (including South Africa) do not have binding emission reduction targets, but many of them publish different greenhouse gas emissions data which have been accounted and reported in different ways. Results show that for South Africa, inventories at national and municipal level are the most important tools in the process of accounting and reporting greenhouse gases from waste. For the development of these inventories international initiatives were important catalysts at national and municipal levels, and assisted in developing local expertise, resulting in increased output quality. However, discrepancies in the methodology used to account greenhouse gases from waste between inventories still remain a concern. This is a challenging issue for developing countries, especially African ones, since higher accuracy methods are more data intensive. Analysis of the South African inventories shows that results from the recent inventories can not be compared with older ones due to the use of different accounting methodologies. More recently the use of Clean Development Mechanism (CDM) procedures in Africa, geared towards direct measurements of greenhouse gases from landfill sites, has increased and resulted in an improvement of the quality of greenhouse gas inventories at municipal level.     

Investigation of health care waste management in Binzhou District,China

In China, national regulations and standards for health care waste management were implemented in 2003. To investigate the current status of health care waste management at different levels of health care facilities (HCF) after the implementation of these regulations, one tertiary hospital, one secondary hospital, and four primary health care centers from Binzhou District were visited and 145 medical staff members and 24 cleaning personnel were interviewed.Generated medical waste totaled 1.22, 0.77, and 1.17 kg/bed/day in tertiary, secondary, and primary HCF, respectively. The amount of medical waste generated in primary health care centers was much higher than that in secondary hospitals, which may be attributed to general waste being mixed with medical waste. This study found that the level of the HCF, responsibility for medical waste management in departments and wards, educational background and training experience can be factors that determine medical staff members’ knowledge of health care waste management policy. Regular training programs and sufficient provision of protective measures are urgently needed to improve occupational safety for cleaning personnel. Financing and administrative monitoring by local authorities is needed to improve handling practices and the implementation of off-site centralized disposal in primary health care centers.     

Municipal solid waste management in Rasht City, Iran

Pollution and health risks generated by improper solid waste management are important issues concerning environmental management in developing countries. In most cities, the use of open dumps is common for the disposal of wastes, resulting in soil and water resource contamination by leachate in addition to odors and fires. Solid waste management infrastructure and services in developing countries are far from achieving basic standards in terms of hygiene and efficient collection and disposal. This paper presents an overview of current municipal solid waste management in Rasht city, Gilan Province, Iran, and provides recommendations for system improvement. The collected data of different MSW functional elements were based on data from questionnaires, visual observations of the authors, available reports and several interviews and meetings with responsible persons. Due to an increase in population and changes in lifestyle, the quantity and quality of MSW in Rasht city has changed. Lack of resources, infrastructure, suitable planning, leadership, and public awareness are the main challenges of MSW management of Rasht city. However, the present situation of solid waste management in this city, which generates more than 400tons/d, has been improved since the establishment of an organization responsible only for solid waste management. Source separation of wastes and construction of a composting plant are the two main activities of the Rasht Municipality in recent years.     

Alternatives for treatment and disposal cost reduction of regulated medical wastes

Many hospitals or health care facilities have faced financial difficulties and thus they have attempted to find cost-effective treatment and disposal methods of their regulated medical wastes (RMWs). This study investigated generation volume and sources, composition, and treatment and disposal methods for RMWs obtained from three out of the five typical city hospitals in Massachusetts for which we could obtain relevant data on medical waste. Also, this study compared the generation patterns and amounts of RMWs between the hospital and the medical school. The yearly operational treatment and disposal costs of RMWs based on different treatment and disposal methods were analyzed for one hospital. The most cost-effective option of four different treatment and disposal options studied was to combine on-site incineration and microwave technologies. Finally, this study identified measures for the effective waste characterization methods for the reduction of treatment and disposal costs of RMWs. By careful exclusion of non-RMW from RMW waste streams, hospitals can reduce the RMW volume that requires special treatment and reduce disposal costs.     

A Review Of The Management Of Radioactive Wastes In Medical Institutes

Amongst the waste from health care institutions, radioactive waste represents a special category since it cannot be modified or neutralized by any available conventional means. Accordingly, disposal of radioactive waste can mean only its transfer from a place where it represents some hazard to somewhere else where it can be retained without undue risk. Radioactive waste arises in health care institutes as a result of diagnostic, therapeutical or research uses of unsealed radioactive substances. Sometimes, sealed sources withdrawn from further use might also be subject to disposal. Most radionuclides used in medicine are short-lived beta-, or beta-gamma emitters and represent a low risk, if properly handled, that is if due care is taken to prevent significant contamination of the workplace and personnel. Low-activity gaseous and liquid waste can usually be discharged to the environment directly; medium-activity or high-activity waste should be stored for variable periods to allow natural decay before specialized disposal.This paper presents a review of the different types of radioactive wastes produced in hospitals, and introduces many of the sources of generation and subsequent disposal options. An example is given of the wide range of guidance available, both by national bodies in Hungary and international agencies, such as the International Atomic Energy Agency (IAEA), World Health Organisation (WHO) and International Committee on Radiological Protection (ICRP).     

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.     

Current status of waste management at home-visit nursing stations and during home visits in Japan

A questionnaire survey was conducted with the aim of examining the problems involved in the disposal of infectious waste at home-visit nursing stations and in its handling during home visits by nurses. From among the home-visit nursing stations registered with the National Association for Home-Visit Nursing Care, 1,965 offices were selected at random and questionnaires were sent to the selected offices. Nurses at 1,314 offices (66.9?%) responded to the survey and responses from 1,283 offices were identified as suitable for analysis after excluding 26 offices that closed and five offices whose main field of care was psychiatry. Offices were classified by management configuration. Offices attached to hospitals were classified as “attached office” and all others were classified as “independent office”. More attached office nurses recovered medical waste from patients’ homes than did independent office nurses. They were also more likely to transport waste with them during the course of a day’s visits. There was a significant difference between attached and independent offices in the burden of expense for waste disposal. Both offices have strong concern about waste treatment containers and handling in improvement in home medical care (HMC) waste disposal. Thus, in order to alleviate these concerns, it is necessary to provide nurses with containers for medical waste suited to home-visit nursing care and tools for preventing injuries. Japanese government should address HMC waste disposal more comprehensively through necessary legislation, subsidization and standardization.