Assessment of Healthcare Waste Management Practices Among Health Workers
CHAPTER ONE
Objective of the Study
The main objective of this study is to assess the waste management practices of health workers in four healthcare facilities in Abeokuta South Local Government Area of Ogun State. The specific objectives are to:
- identify different types of waste generated in Healthcare facilities in Abeokuta South Local Government (ASLG);
- determine the level of knowledge of health workers on Healthcare waste management and its segregation;
- assess the healthcare waste management as practiced by health workers and
- determine how healthcare wastes are finally disposed off, by the healthcare facilities in ASLG.
CHAPTER TWO
LITERATURE REVIEW
General Background
With the recent rapid growth of private health sector, the need of safe and proper medical waste disposal is become important. Hospital waste is frequently described to be an environmental pollutant as well as a serious health concern. The problem arises if the unsafe disposal of hospital wastes resulting in hepatitis B and C (jaundice), and HIV/AIDS. The materials presented in this chapter are aimed at providing an overview of medical waste issues in terms of medical waste types, its sources, and management. Finally, the last section makes some concluding remarks on the overall chapter.
Relevant Literature
Generally, hospital waste is defined as the discarded or unwanted material solid waste which is generated from the diagnosis, treatment, or immunization of human beings or animals, in research pertaining thereto, or in the production or testing of biological (Lee, 1989). These have the potential to cause disease and are a health risk. It is a by-product of health care that includes sharps, non-sharps, blood, body parts, chemicals, pharmaceuticals, medical devices and radioactive materials (WHO, 2002). The HCEs are one of the major producers of solid wastes which are hazardous in nature. Poor management of clinical wastes exposes health workers, waste handlers and the community to infections, toxic effects and injuries (Ecoaccess, 2004).
Medical Waste Types and Sources
Medical wastes are mainly categorized into non-hazardous and hazardous wastes (Figure 2.1). The non-hazardous waste includes wool, kitchen wastes, etc. that do not pose any special handling problem, hazard to health or the environment and is generated in the patients’ ward areas, out-patient-department (OPD), kitchens, offices, etc (Mato and Kaseva, 1999). The hazardous waste includes pathological, infectious, sharps and chemical wastes and are normally produced in labour wards, operation theatres, laboratories, etc (Mato and Kaseva, 1999; Or and Akgill, 1994). Some definitions of hazardous wastes are (Henry and Heinke, 1996; Mato and Kaseva, 1999):
- Pathological wastes consist mainly of tissues, organs, placentas, blood, etc.
- Infectious wastes contain pathogens in sufficient concentrations or quantity that, when exposed to it, can result in diseases. Examples are, waste from surgeries with infectious diseases, contaminated plastic items, etc.
- Sharps include needles, syringes, broken glass, blades and any other items that could cause a cut or puncture.
- Chemical wastes comprise of expired medicine, discarded chemicals – usually from cleaning and disinfecting activities.
The characteristics of waste from hospitals are almost similar in all countries except for amounts generated due to standard procedures executed in the medical field. Legislation on the safe disposal of medical wastes may vary from country to another (Henry and Heinke, 1996).
There are a number of literatures on the types of medical wastes and its generation, mainly the sources of the wastes in HCE. Askarian et al, (2004) explain the type and nature of hospital wastes generated from private hospitals in Fars province in Iran and also describes the existing management systems of the generated wastes in hospitals. Da Silva et al, (2004) focused on types of medical wastes from the hospitals in Rio Grande do Sul of Brazil and illustrated the waste management pattern. Surveying a total of 91 healthcare facilities, they 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.
CHAPTER THREE
MATERIALS AND METHODS
Introduction
The methodology for this study includes empirical field observation, site selection and field level data collection through inventory, questionnaire survey and interviews in formal and non-formal ways. The relevant secondary data for this research were mainly analyzed to address the central issues on medical waste management with relation the generation of wastes and the overall management status of health care wastes of the study area. In order to fulfill the objectives, the tasks were structured for data collection and data analysis.
Survey design and data collection planning
These clinics and diagnostics centers are growing with plan. The clinics are growing in both the residential areas and the commercial areas. So it is difficult to manage the hospital wastes and the present situation is very dangerous from the point of view of environment and health.
Preliminary Field Investigations
General information was collected about the study area by preliminary field investigation. During the period of primary field investigation the aim, scope and objectives of the study were maintained carefully. Infrastructure of the HCEs, dustbin condition and facilities, municipal dustbin condition, drainage system, land use pattern, communication system, building arraying etc. were observed at a glance to make an idea about the study area. This investigation helped to select the sampling size, sampling technique and also the preparation of questionnaire.
Assessing the Relevant Existing information
In this stage various books, journals, reports on medical waste management and its health hazard both in national and international context were reviewed to achieve the necessary information that was helpful to develop a research design, it also made aware about the context of the questionnaire.
CHAPTER FOUR
RESULTS AND DISCUSSION
The study population consisted of 20 (25%) males and 60 (75%) females consisting of doctors, nurses, pharmacists, laboratory technicians and health attendants. Their mean age was 30 + 7 years. Nine (90%) of doctors, 18(90%) of nurses, 7(87.5%) of pharmacists, 5(83.3%) of laboratory technicians and 21(58.3%) of healthcare workers knew about waste segregation. Segregation at source was known by 80%, 70%, 50%, 90%, and 5.6% of doctors, nurses, pharmacists, laboratory technicians and healthcare attendants respectively.
Whereas all the doctor respondents knew about injury resulting from poor waste management, only 35% of health care attendants possessed the same knowledge. Table 1 shows that 35.7%, 53.4%, and 50% of doctors, nurses, and healthcare attendants knew sharps should be separated from other wastes. The table showed that 6(60%) of doctors, 16(80%) of nurses, 6(75%) of pharmacists, 5(90%) of laboratory technicians, and 25(69.4%) of healthcare workers knew about colour coded bags. Also 10(100%) of doctors, 18(90%) of nurses, 3(37.5%) of pharmacists and 18(50%) of healthcare attendants went for dumpsite as site for temporary storage of waste. Table 2 shows that the proportion of doctors, nurses, pharmacists, laboratory technicians and healthcare attendants that displayed positive attitude to containment of sharps were 40%, 30%, 50%, 33.3%, and 38.9% respectively.
CHAPTER FIVE
CONCLUSION AND RECOMMENDATION
Conclusion
The collection, storage, transport, treatment and disposal of medical wastes are of growing environmental problem in Nigeria, which needs immediate attention before it goes out of hand. In the studied government HCEs medical wastes are not properly managed. Most of the HCEs do not have nay budgetary provision to manage their generated waste systematically. Medical waste management is an integral part of health care. Because of the communicable diseases such as the AIDS/HIV and hepatitis Bad n C viruses, people are increasingly concerned over the disposal of medical waste. Many of the workers are injured by the sharp, infectious, chemical and radioactive wastes. Moreover, some of respondents were facing stink and afraid of containing diseases from the infectious waste.
From percolation of hospital waste ground water is polluted from leachate and aquatic life system is totally disturbed as it restricts sun light to enter in to the bottom level of water body. Again it disturbs the pH level of water body.
It can be concluded that the existing system of medical waste management of the studied HCEs is neither satisfactory not adequate. Insufficient vehicle, lack of
manpower, technology and complex maintenance procedures obstruct systematic medical waste management. An environment friendly management system for the proper management of medical wastes has to be developed. In this respect, an eco-design of the proper management of the medical wastes have been proposed.
In many countries the safe disposal of medical waste is considered very important and handled in a very professional manner. They have effective systems of tracking waste generators, and follow specified regulations for segregation, collection, treatment and disposal of medical waste.
Recommendations
In Abeokuta LGA, medical waste is generally disposed in the same was ordinary domestic waste. In order to arrange a proper ad systematic medical waste management, the following obsevation should be considered:
- Medical wastes are needed to be segregated separated, according to its characteristics, at the point of generation. All the HCEs should use the WHO permitted color-coded, high-density polyethylene bags for easy identification and segregation of hospital solid wastes could be used in HCEs
- Modern techniques and technological devices such as moving dustbins, crane, separate collection system bins, etc. could be used in the hospital management system.
- 3R principles (reuse, recycle and reduce) of waste generation could be followed through composting and following other process.
- Non-hazardous wastes were finally dumped as sanitary landfill system and the hazardous wastes could be disinfected prior to dispose.
- Human resources development with other logistic support could be ensured.
- To avoid the risk of health effect from the wastes, on-site incineration of the entire hospital waste with appropriate air pollution controls, is the best available means of processing prior to disposal. A strong monitoring system should be developed for the whole management system.
REFERENCES
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