Modern Health Care: Hospital Wastes Management and Caring

Healthier environment became one of the most important tasks undertaken by governments around the world. This has always been an important aim of mankind and providing the population with basic health care. Increasing emphasis has been placed on the improvement of international health care by the various specialists, UN Organizations such as WHO, UNECEF, ILO and others. In order to realize this aim the most important task is to organize the basic health care system throughout the world. For obvious reasons, it is necessary for the developing countries or nations to organize an adequate healthcare structure, to educate and train the required number of personnel and to build and equip the necessary institutions. So, the organizations that have experience in this relevant field like medical research, environmental sciences and development should come forward to train the workforce.

The health care and hospital wastes:

The hospital wastes or clinical wastes are all that wastes which are potentially infectious and hazardous food, chemical materials are all mixed together as they are generated, collected, transported and finally disposed off. This hazardous situation develops due to failure to establish and follow segregation protocols and infrastructure. The studies have shown that the waste leaving hospitals / clinics in Bangladesh as a whole infectious and potentially hazardous chemicals.

Hospital /clinical wastes formation:

The hospital wastes / clinical wastes or their slurry is directly thrown into the drainage systems or open space or water. These wastes contain used sharps along with waste bandages, gauges, spares, sharps and used needles etc. The used sharps are often contaminated with serious diseases like HJV/ AIDS hepatitis-A and B, blood borne diseases and other unknown diseases. These wastes are invariably disposed off in front of the organizations or agencies, which are for the benefit of the patients'. These ultimately deter the life if innocents and the environment.

The polluting processes:

The slurry are leaching out incessantly and going down into the open water making the water a huge pollution and ultimately to the environment. Some times become toxic to aquatic organisms. The unscrupulous vendors with the help of the poor foot path waste collectors collect the used waste, sharps from the heap or bins or land fill for the purpose of selling to the health care center. On the other hand when a pedestrian goes along the path where contaminated sharps or medical wastes are heaped up pierce or punched his body then he may caught with the respective unknown diseases. Some unscrupulous personnel of generator small or large collect used sharp for illegal business with the other health care center. Similarly, other non-sharp wastes may transmit various deadly and infectious diseases from occupational or accidental contact with them. Therefore, continued negligence in disposing of these medical wastes could one day bring about a catastrophic disaster if immediately not taken care.

The risk to the general public is secondary and occurs in three ways :

i. Accident exposure from contact with wastes at municipal disposal bins

ii. Exposure to chemical or biological contaminants in water

iii. Exposure to chemical pollutants from incineration of the wastes

Hospital wastes management:

The waste management is a concerted and systematic approach. The principle mainly based on two main options- first one segregation and destruction and the other one is sharps' management.

a. Segregation of wastes- the first step;

Prior to treatment and disposal the wastes should be segregated preferably at the point of generation. It is the best step to safe guard the occupational health systems including the health care workers.

The wastes may contain mercury and other heavy metals, chemical solvents and preservatives (e.g., formaldehydes which are known as carcinogens) and plastics i.e. PVC, which when combusted produce dioxins and other pollutants having a serious human health risk, not only to workers but also to the general people.

Imposing segregation practices within hospitals to separate biological and chemical hazardous wastes, less than 10 per cent of the waste stream will result in a clean solid waste stream 91 which can be easily, safely and cost effectively managed through recycling, composting and land filling the residues. This resulting waste stream has a high proportion of organic wastes i.e. food and recyclable wastes such as paper, plastic, metal and actually very little that is truly disposable.

Proper training, standards and tough enforcement, waste stream can be turned into resources inducing some managerial and special treatment. Training, proper containers, signs and protective gear for workers are all necessary components of this process to assure that segregation taken place and are maintained.

b. Management of Sharps;

The Sharps are needles, syringes, lancets and other invasive tools. About 9-10 percent of the waste is potentially infectious and hazardous too. The most eminent threat is on human health.

Proper sharps' management is to be instituted in all health care facilities throughout the country.

The following principles may be followed to cover the risks of disease transmission from medical wastes;

i. Proper segregation of these materials in rigid, puncture proof containers

ii. Proper equipment and containers distributed every where sharps are generated e.g. needle cutters and needle boxes

iii. A secure accounting and collection systems for transporting the contaminated sharps for treatment and final disposal

iv. Proper training of all hospital personnel on handling and management of sharps and personal protection.

The best alternative and cost effective method to minimize the toxicity of clinical wastes or for making useable of the sharps, is steam sterilization/ autoclave. The chemical treatment, microwave technology and stabilization with cement (prevent migration tendency for contamination of underground water and soil whenever those keep under earth) are also effective. Some times serious toxic sharp or non-sharp materials are kept under earth for relief of air pollution hut again this is not proper or sound technology in respect of clinical waste management. This needs to bum or cement stabilization and be kept under the earth.

c. Collection and transportation of the hospital wastes;

A secured internal and external collection and transportation system for the wastes should be an over all policy involvement. While waste is segregated at the point of generation, the wastes are only to be mixed together by the workers by physical collection. Here again the concern is the workers' safety and ultimate cost to the environment and the health safety of the people is to be ensured.

d. Safety through education, training for personnel protective equipment;

The personnel handle hospital wastes are at great risk from exposure to the potentially infectious wastes and chemical hazardous wastes. This process starts with the clinical workers who generate the wastes without proper knowledge. Their exposure risks need protective gear .The workers who collect and transport the wastes from hospitals and clinics. The staff who operates a hospital incinerator or who takes the municipal bins and transport it to city dumping sites and the rag pickers who represents informal waste management sector should have all the necessary skills and training. Otherwise, the public health would be in great threat.

Conclusion:

Health care agencies are of mushroom growth in day by day. These are in authorized or unauthorized form at the urban, most to peri-urban areas. These so-called organizations are heaping their clinical wastes unconventionally. There is little or no observatory capacity for the management, treatment, and recycling or final disposal of hazardous wastes in Bangladesh Hospitals seeking to segregate hazardous wastes are left with little or no option for safe disposal. The development of such industries in Bangladesh, which are capable of managing hazardous wastes, is essential. Sometimes, lack of waste segregation practices in most hospitals, the hazardous materials is often mixed into general solid waste for disposal into municipal bins. They represent a serious health hazard to workers and the people. At this time even they were segregated the lack of real alternatives to properly dispose of them would mean that they would be stockpiled, potentially creating yet another threat.

A study report reveals that around seventeen thousand tons wastes are being produced per day at the urban area of our country and within twenty-five years these will reach to over forty seven thousand tons. It would be a social curse and burden for the generations to come. Now time has really knocking us to plan and develop all sorts of pollution free land and society Though there are enough limitations, yet have all the opportunities for getting relief too, from this curse. The associates, such as experts like physicians, policy makers, administrators, nurses and clinic handling personnel even the patients who are directly involved to produce and discharge the clinical waste should be aware of handling collection, segregation and discharging. Further, the hospitals possessing incinerators should have proper technical management personnel to handle the instruments property.

Various studies on hospital waste management concluded that approximately 50 of the wastes generated are organic and could be composted. Another large segment includes recyclable materials, leaving a relatively small segregation and pollution prevention combined with a clear definition of the problem and the goal will provide the best, most environment friendly safe and cost - effective solution to waste disposal.

Now it is immensely felt that health care facilities need to tie into a municipal system of proper waste management in our system of waste disposal management. This is to ensure that they are meeting their mission of providing for the public health. Only such an infrastructure could probably be the best organization, which could make to begin the process of improving their waste management practices and ensuring public health and workers safety.

Submitted By:
MOHAMMED LUTFOR RAHMAN CHOWDHURY
M.Sc, P.G. (Dip) ITC, Enschede, The Netherlands

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Comments

The method of sterilization is not the best process for the final disposal of hospital waste. If the cheaper, but at what cost. There is an environmental liability that will impact the landfill or final disposal sites for these wastes. the best procedure is the proper cremation. Where compliance with the limits of generation of dioxins and furans to the environment. sterilization is a process that mitigates medriocre part of the problem but does not provide an effective solution.

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