Medical waste production at hospitals and associated factors

This study was conducted to evaluate the quantities of medical waste generated and the factors associated with the generation rate at medical establishments in Taiwan. Data on medical waste generation at 150 health care establishments were collected for analysis in 2003. General medical waste and infectious waste production at these establishments were examined statistically with the potential associated factors. These factors included the types of hospital and clinic, reimbursement payment by National Health Insurance, total number of beds, bed occupancy, number of infectious disease beds and outpatients per day. The average waste generation rates ranged from 2.41 to 3.26kg/bed/day for general medical wastes, and 0.19-0.88kg/bed/day for infectious wastes. The total average quantity of infectious wastes generated was the highest from medical centers, or 3.8 times higher than that from regional hospitals (267.8 vs. 70.3Tons/yr). The multivariate regression analysis was able to explain 92% of infectious wastes and 64% of general medical wastes, with the amount of insurance reimbursement and number of beds as significant prediction factors. This study suggests that large hospitals are the major source of medical waste in Taiwan. The fractions of medical waste treated as infectious at all levels of healthcare establishments are much greater than that recommended by the USCDC guidelines.     

Healthcare waste management in the capital city of Mongolia

Inconsistencies are present in the management options for healthcare wastes in Mongolia. One of the first critical steps in the process of developing a reliable waste management plan requires the performance of a waste characterization analysis. The objectives of this study were an assessment of the current situation of healthcare waste management (HCWM) and characterization of healthcare wastes generated in Ulaanbaatar. A total about 2.65 tonnes of healthcare wastes are produced each day in Ulaanbaatar (0.78 tons of medical wastes and 1.87 tons of general wastes). The medical waste generation rate per kg/patient-day in the inpatient services of public healthcare facilities was 1.4-3.0 times higher than in the outpatient services (P<0.01). The waste generation rate in the healthcare facilities of Ulaanbaatar was lower than in some other countries; however, the percentage of medical wastes in the total waste stream was comparatively high, ranging from 12.5% to 69.3%, which indicated poor waste handling practices. Despite the efforts for the management of wastes, the current system of healthcare waste management in Ulaanbaatar city of Mongolia is under development and is in dire need of immediate attention and improvement. It is essential to develop a national policy and implement a comprehensive action plan for HCWM providing environmentally sound technological measures to improve HCWM in Mongolia.     

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.     

Management of immunization solid wastes in Kano State, Nigeria

Inadequate management of waste generated from injection activities can have a negative impact on the community and environment. In this paper, a report on immunization wastes management in Kano State (Nigeria) is presented. Eight local governments were selected randomly and surveyed by the author. Solid wastes generated during the Expanded Programme on Immunization were characterised using two different methods: one by weighing the waste and the other by estimating the volume. Empirical data was obtained on immunization waste generation, segregation, storage, collection, transportation, and disposal; and waste management practices were assessed. The study revealed that immunization offices were accommodated in either in local government buildings, primary health centres or community health care centres. All of the stations demonstrated a high priority for segregation of the infectious wastes. It can be deduced from the data obtained that infectious waste ranged from 67.6% to 76.7% with an average of 70.1% by weight, and 36.0% to 46.1% with an average of 40.1% by volume. Non-infectious waste generated ranged from 23.3% to 32.5% with an average of 29.9% by weight and 53.9% to 64.0% with an average of 59.9% by volume. Out of non-infectious waste (NIFW) and infectious waste (IFW), 66.3% and 62.4% by weight were combustible and 33.7% and 37.6% were non-combustible respectively. An assessment of the treatment revealed that open pit burning and burial and small scale incineration were the common methods of disposal for immunization waste, and some immunization centres employed the services of the state or local government owned solid waste disposal board for final collection and disposal of their immunization waste at government approved sites.     

Developing a master plan for hospital solid waste management: a case study

Disposal of about 1750tons of solid wastes per day is the result of a rapid population growth in the province of Khuzestan in the south west of Iran. Most of these wastes, especially hospital solid wastes which have contributed to the pollution of the environment in the study area, are not properly managed considering environmental standards and regulations. In this paper, the framework of a master plan for managing hospital solid wastes is proposed considering different criteria which are usually used for evaluating the pollution of hospital solid waste loads. The effectiveness of the management schemes is also evaluated. In order to rank the hospitals and determine the share of each hospital in the total hospital solid waste pollution load, a multiple criteria decision making technique, namely analytical hierarchy process (AHP), is used. A set of projects are proposed for solid waste pollution control and reduction in the proposed framework. It is partially applied for hospital solid waste management in the province of Khuzestan, Iran. The results have shown that the hospitals located near the capital city of the province, Ahvaz, produce more than 43% of the total hospital solid waste pollution load of the province. The results have also shown the importance of improving management techniques rather than building new facilities. The proposed methodology is used to formulate a master plan for hospital solid waste management.     

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.     

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.     

Management of hazardous waste in Thailand: present situation and future prospects

 This paper deals with the present scenario of hazardous waste management practices in Thailand, and gives some insights into future prospects. Industrialization in Thailand has systematically increased the generation of hazardous waste. The total hazardous waste generated in 2001 was 1.65 million tons. It is estimated that over 300 million kg/year of hazardous waste is generated from nonindustrial, community sources (e.g., batteries, fluorescent lamps, cleansing chemicals, pesticides). No special facilities are available for handling these wastes. There are neither well-established systems for separation, storage, collection, and transportation, nor the effective enforcement of regulations related to hazardous wastes management generated from industrial or nonindustrial sectors. Therefore, because of a lack of treatment and disposal facilities, these wastes find their way into municipal wastewaters, public landfills, nearby dump sites, or waterways, raising serious environmental concern. Furthermore, Thailand does not have an integrated regulatory framework regarding the monitoring and management of hazardous materials and wastes. In addition to the absence of a national definition of hazardous wastes, limited funding has caused significant impediments to the effective management of hazardous waste. Thus, current waste management practices in Thailand present significant potential hazards to humans and the environment. The challenging issues of hazardous waste management in Thailand are not only related to a scarcity of financial resources (required for treatment and disposal facilities), but also to the fact that there has been no development of appropriate technology following the principles of waste minimization and sustainable development. A holistic approach to achieving effective hazardous waste management that integrates the efforts of all sectors, government, private, and community, is needed for the betterment of human health and the environment. Received: February 26, 2001 / Accepted: October 11, 2002     

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.     

Medical waste management in Trachea region of Turkey: suggested remedial action.

The main objective of this paper was to analyse the present status of medical waste management in the Trachea region of Turkey and subsequently to draw up a policy regarded with generation, collection, on-site handling, storage, processing, recycling, transportation and safe disposal of medical wastes. This paper also presents the results of study about awareness on how to handle expired drugs. Initially all health-care establishments in Tekirda?, Edirne and Kyrklareli provinces in Trachea region were identified and the amounts of hospital wastes generated by each of them were determined. Current medical waste-management practices, including storage, collection, transportation and disposal, in surveyed establishments were identified. Finally, according to results, remedial measurements for medical waste management in these establishments were suggested. Unfortunately, medical wastes are not given proper attention and these wastes are disposed of together with municipal and industrial solid wastes. The current disposal method is both a public health and environmental hazard. When landfill sites are visited, many scavengers can be seen sorting for recyclable materials, a practice which is dangerous for the scavengers. In addition, it was found that some staff in health-care establishments are unaware of the hazard of medical wastes. It is concluded that a new management system, which consists of segregation, material substitution, minimization, sanitary landfilling and alternative medical waste treatment methods should be carried out. For the best appropriate medical waste management system, health-care establishment employers, managers and especially the members of house- keeping divisions should be involved in medical waste management practice.     

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.     

A purview of waste management evolution: special emphasis on USA

The generation of waste in urban regions over time is seen to impact the balance of anthropogenic and natural resources. Various national and international initiatives to manage urban solid waste are in place and has thus have evolved at present to form an assortment of different subcomponents involving environmental, administrative, regulatory, scientific, market, technology, and socio-economic factors, which has increasing bearing on the US due to its volume and nature of discards. This paper draws together the various aspects of municipal solid waste (MSW) management as it evolved, particularly in the American society through reviewing works and findings. In many parts of the country, waste management at present, primarily involves landfilling, incineration with and without energy recovery, recycling and composting. Legislation, nature of wastes and market trends continue to redefine management operations and its responsibilities and impacts. Complexities are added to it by the nature of urban development as well. New studies and concepts like 3Rs, cradle-to-cradle, industrial ecology, and integrated waste management are adding new dimensions for solving waste problems towards achieving sustainable resource use. Local initiatives, both public and private are in the forefront of adopting alternate waste management procedures. The assistance from various government and private bodies, supporting shifts in waste management approaches, have immense value, as according to the new paradigms, nothing goes to waste.     

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.     

Report: Treatment of medical waste in Nisava and Toplica districts, Serbia

If there are no clearly defined management procedures, medical waste may represent a source of serious health hazards. Medical waste management was evaluated at the three hospitals in the Nisava and Toplica district, in Serbia. All the stages of existing waste management (segregation, collection, storage, transportation and disposal of waste) were examined by interviewing the personnel involved in the management of waste. The generated waste was a mixture of hazardous and non-hazardous waste. The study found that waste management performance in this district was poor and that there were problems in every stage of management. The results indicate that the waste generation rate was 1.92 kg bed(-1) day(-1) and consisted of 98.7% general waste and 1.3% sharps. Inappropriate segregation practices were the biggest problem and led to increased quantities of general waste. There were no specific regulations for the segregation of the medical waste. None of the surveyed hospitals have a system to refine wastewater and there were no training courses about hospital waste management.     

Medical waste management in Turkey: A case study of Istanbul

The objective of this study was to analyze the present status of medical waste management in the light of the Medical Waste Control Regulation (MWCR) in Istanbul, the largest city in Turkey. About 17% of the hospitals, 20% of bed capacity, and 54% of private hospitals in Turkey are located in Istanbul. The first regulation about medical waste management in Turkey was published in 1993, and as a candidate state, it was changed in 2005 in accordance with EU Environmental Directives. In this work, a survey of 14 questions about the amount, collection, and temporary storage of medical wastes was applied to 192 hospitals in Istanbul through face-to-face interviews. It was found that the estimated quantity of medical waste from the hospitals is about 22tons/day and the average generation rate is 0.63kg/bed-day. Recyclable materials are collected separately at a rate of 83%. Separate collection of different types of wastes is consistently practiced, but 25% of the hospitals still use inappropriate containers for medical waste collection. Almost 77% of the hospitals use appropriate equipment for the medical waste collection personnel. The percentage of the hospitals that have temporary storage depots is 63%. Medical waste management in Istanbul is carried out by applying the MWCR.     

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.     

A mathematical model to predict the composition and generation of hospital wastes in Iran

The aim of this study is to investigate the quality and quantity of hospital wastes in Iran. The generated hospital wastes have been estimated by the number of hospitals and the number of active beds in each province of Iran in 2001. All data and information have been gathered from: (i) Iran Statistics Center, (ii) literature review, and (iii) hospital waste investigations for an average hospital. Physical analyses have been conducted in terms of various materials (plastic, textile, paper, metal, and others) and components (biological, infectious, medical, and regular wastes). Based on the above-mentioned investigation and information, a mathematical model has been developed to calculate the generation of (infectious) hospital wastes for any desired year. Utilizing the model, generated infectious hospital wastes has been estimated as 698,937 tones for 2008 (short-term) and 3,494,387 tones for 2028 (long-term period). If the real infectious wastes are collected separately, then the generated infectious wastes will be reduced by 15.1% of the above-mentioned amount (139,787 tones for 2008, and 698,877 tones for 2028). Results of physical analysis show the components of the hospital waste as: (a) infectious, 67.3%; (b) medical, 8.8%; (c) biological, 1.8%; and (d) common municipal wastes, 22.1%. An appropriate collection method requires training the staff at hospitals along with preparation of the required facilities. Of course, both of these requirements are cost intensive.     

A system dynamics approach for hospital waste management

Healthcare services provided by hospitals may generate some infectious wastes. Although a large percentage of hospital waste is classified as general waste, which has similar nature as that of municipal solid waste and, therefore, could be disposed in municipal landfills, a small portion of infectious waste has to be managed in the proper manner in order to minimize risk to public health. Many factors involved in the hospital waste management system often link to one another, which require a comprehensive analysis to determine the role of each factor in the system. In this paper, we present a hospital waste management model based on system dynamics to determine the interaction among factors in the system using a software package, Stella. A case study of the City of Jakarta, Indonesia is selected. The hospital waste generation is affected by various factors including the number of beds in the hospitals and the NIMBY (not in my back yard) syndrome. To minimize the risk to public health, we found that waste segregation, as well as infectious waste treatment prior to disposal, has to be conducted properly by the hospital management, especially when scavenging takes place in landfill sites in developing countries.     

Analyzing composition and generation rates of biomedical waste in selected hospitals of Uttarakhand,India

In India, a few studies have been conducted for analyzing the generation rates and composition of medical waste (MW). Inadequate information about the amount and composition of MW results in ineffective management practices. The present study seeks to evaluate healthcare waste (HCW) generation rates by healthcare facilities (HCFs) available in Uttarakhand, a northern state of India. Study also focuses on modeling the quantity of different types of MW generated at various HCFs and determining significant factors contributing towards MW generation. Seasonal variation in amount of MW generated from various HCFs has also been considered. To achieve these objectives, cross-sectional as well as longitudinal data have been collected from various HCFs in Uttarakhand, India. The survey revealed that around 36% of the total HCFs did not segregate their MW as per policy guidelines. Cross-sectional data for May 2015 were collected from 75 HCFs to analyze and model the composition and quantity of HCW generated. Multiple Linear Regression and Artificial Neural Network techniques were applied to model cross-sectional data. In the composition of the overall MW, ‘yellow waste’ carries the maximum share, followed by ‘red waste’ and then the ‘blue waste’. In addition, the ‘type of HCF’ and ‘bed occupancy’ have been modeled as the important factors, contributing towards the MW generations rates. Longitudinal data for 2 years (2013 and 2014) were collected to examine seasonal variation in HCW generation rates using polynomial regression analysis. Result shows that MW quantity also varies with the change in the season. Findings of the study will help hospitals and waste treatment facilities to predict amount of waste that may be generated, and plan resources towards efficient handling and disposal of MW.     

Medical wastes characterisation in healthcare institutions in Mauritius

This study was initiated to characterize solid and liquid wastes generated in healthcare institutions and to provide a framework for the safe management of these wastes. The project was carried at three major medical institutions, namely, the Jeetoo Hospital, the Sir Seewoosagur Ramgoolam National (SSRN) Hospital and the Clinic Mauricienne. A waste audit carried out at these sites revealed that approximately 10% of solid wastes was hazardous in nature, consisting mainly of infectious, pathological and chemical wastes. The average amount of hazardous wastes per patient per day was found to be 0.072 kg at Jeetoo hospital, 0.091 kg at SSRN hospital and 0.179 kg at the clinic. The amount of hazardous wastes generated as a function of the number of occupied beds was found to follow a relationship of type y=0.0006x-0.19, where y was the amount of hazardous wastes generated per bed per day and x was the number of occupied beds. The waste quantifying process also revealed that at SSRN Hospital, 0.654 m(3) of water was being consumed per patient per day and the amount of wastewater produced was 500 m(3)/day. Further analysis revealed that the wastewater was polluting with chemical oxygen demand (COD), biological oxygen demand (BOD(5)), total suspended solids (TSS) and coliform content well above permissible limits.