HOSPITAL WASTE HOSPITAL WASTE MANAGEMENTMANAGEMENT

PRESENTD BYPRESENTD BY

GROUP-C1GROUP-C1BHARATI KC(09)BHARATI KC(09)

SAMJHANA SHRESTHA(31)SAMJHANA SHRESTHA(31)

SEEMA GIRI(32)SEEMA GIRI(32)

SUNIL KOIRALA(36)SUNIL KOIRALA(36)

INTRODUCTION Health care waste includes all the waste, solid or liquid Health care waste includes all the waste, solid or liquid

waste generated by health care establishments, research waste generated by health care establishments, research facilities, and laboratories. facilities, and laboratories.

Healthcare waste is a byproduct of healthcare that includesHealthcare waste is a byproduct of healthcare that includes sharps, sharps, non-sharps, non-sharps, blood, blood, body parts, body parts, chemicals,chemicals, pharmaceuticals, pharmaceuticals, medical devices and radioactive materials.medical devices and radioactive materials.

Continue……Continue……

Health care waste management refers to all the activities, Health care waste management refers to all the activities, administrative and operational, involved in the handling, administrative and operational, involved in the handling, treatment, storage, and disposal of waste. treatment, storage, and disposal of waste.

A part of hospital hygiene and maintenance activities which A part of hospital hygiene and maintenance activities which involves the management of waste produced by hospitals involves the management of waste produced by hospitals using such techniques that will help to check the spread of using such techniques that will help to check the spread of diseases through it. diseases through it.

Health care waste management involves following steps in Health care waste management involves following steps in sequence: sequence:

SegregationSegregationWaste collectionWaste collectionTransportationTransportationWaste storageWaste storageWaste treatment and disposalWaste treatment and disposal

STATEMENT OF THE PROBLEMSTATEMENT OF THE PROBLEM Injections with contaminated syringes caused:Injections with contaminated syringes caused:

21 million hepatitis B virus (HBV) infections (32% of all new 21 million hepatitis B virus (HBV) infections (32% of all new infections);infections);

Two million hepatitis C virus (HCV) infections (40% of all new Two million hepatitis C virus (HCV) infections (40% of all new infections); andinfections); and

At least 260 000 HIV infections (5% of all new infections).At least 260 000 HIV infections (5% of all new infections).

(WHO 2002) (WHO 2002) More than 90% of healthcare institutions do not practice More than 90% of healthcare institutions do not practice

safe waste handling, storage and disposal methods and most safe waste handling, storage and disposal methods and most healthcare institutions rely on municipal services for their healthcare institutions rely on municipal services for their

ultimate disposalultimate disposal. . ((Poudel, 2002). ).

Cont..Cont..

22 developing countries showed that the proportion of 22 developing countries showed that the proportion of health-care facilities that do not use proper waste health-care facilities that do not use proper waste disposal methods ranges from 18% to 64%.(WHO disposal methods ranges from 18% to 64%.(WHO assessment 2002).assessment 2002).

Uncontrolled burning , reuse of disposable items , Uncontrolled burning , reuse of disposable items , unintentional injuries from improperly discarded sharps unintentional injuries from improperly discarded sharps are common and lead to life threatening infections such are common and lead to life threatening infections such as hepatitis B, hepatitis C and HIV.(World Bank 2000)as hepatitis B, hepatitis C and HIV.(World Bank 2000)

OBJECTIVESOBJECTIVES General Objective:General Objective:

To study the health care waste management To study the health care waste management practices in hospitals of Kathmandu valleypractices in hospitals of Kathmandu valley

Specific Objectives:Specific Objectives:

To determine :To determine :the total quantity of waste generated in hospitals the total quantity of waste generated in hospitals

per day.per day.The segregation practice of waste.The segregation practice of waste.Collection of waste.Collection of waste.Transportation of waste.Transportation of waste.

CONT…..CONT…..

Storage practice of waste.Storage practice of waste.Methods used for waste treatment.Methods used for waste treatment.Waste disposal practices.Waste disposal practices.Hospital policy regarding waste, Hospital policy regarding waste,

occupational health and safety.occupational health and safety.

METHODOLOGYMETHODOLOGY Study designStudy design

Descriptive cross-sectional studyDescriptive cross-sectional study Types of DataTypes of Data

Primary data was taken through self survey. Primary data was taken through self survey. Study areaStudy area

The study was done in Bir Hospital and The study was done in Bir Hospital and Kathmandu Medical College situated in Kathmandu Medical College situated in Kathmandu Valley.Kathmandu Valley.

Data collection procedureData collection procedure A semi structured questionnaire schedule was A semi structured questionnaire schedule was

designed which was administered to the manager designed which was administered to the manager who sees the overall hospital waste managementwho sees the overall hospital waste management . .

CONT…CONT… Data analysis and managementData analysis and management

The collected data was classified, tabulated, The collected data was classified, tabulated, manipulated and analyzed using MS- EXCEL.manipulated and analyzed using MS- EXCEL.

Study durationStudy durationThe study duration was from 25The study duration was from 25thth November to 15 November to 15thth

DecemberDecember

Limitation of the studyLimitation of the studyOnly two hospitals were considered in our study. Only two hospitals were considered in our study.

The questionnaire prepared was not self sufficient The questionnaire prepared was not self sufficient to cover all the dimensions of hospital waste to cover all the dimensions of hospital waste management.management.

FINDINGSFINDINGS

Segregation of wasteSegregation of waste

CONT…CONT…Segregation of waste

BIR HOSPITAL KMC

Waste Segregation At source(at wards) No

Waste classification

Yes Yes

Waste classified into

Non-risk waste Risk waste

General wasteInfectious waste

Use of color coded containers

Yes(bins with proper labeling and pictures)

Yes (without labeling)

CONT..CONT..

Color coded containers and the type of waste collected

Non risk wasteBlue: bottles and cans onlyGreen: Papers onlyLight blue: plastics onlyBlack: biodegradable only like food wastes, fruit peelings

Risk wasteBrown: Metals onlyRed: Sharps Scalpels, syringes cotton swabs, dressingsPurple: Genotoxic waste(oncology ward) 

Green:General wasteRed:Infectious wastes

Collection of wastesCollection of wastes

Collection of wastes Bir Hospital KMC

Frequency of waste collection

Once a day Every alternate day

Personnel engaged in waste collection

Trained staffs Sweepers

Collected waste taken to Hospital collection point

No separate collection: all wastes taken to Municipal collection point

System of documentation and registration of collected waste

Yes No

Transportation of wastesTransportation of wastes

Transportation of wastes

Bir Hospital

KMC

Use of separate trolleys for transporting separate wastes

Yes No

Cleaning of transportation trolley after use

Yes No

Storage of wasteStorage of waste

Storage of waste Bir Hospital KMC

Provision of separate room for storage

Yes (an area near treatment site shielded by bars but without roof)

No

Waste stored for 24 hours

Treatment of wasteTreatment of waste

Cont..Cont..Treatment of waste

Bir Hospital KMC

Methods used for waste treatment

AutoclavingNon risk waste classified into:• recyclable recycling• non recyclable art crafts•gauge piece vermicomposting•biodegradable waste biodigestion plantRisk waste:•Genotoxic waste Chemical treatment•Mercury shielded in mercury house•Pathological waste no treatment as such

Incineration•Double chambered incinerator

Waste disposal practiceWaste disposal practice

Name of the Hospital

Waste Disposal Practice

Bir HospitalReduced quantity of wastes including pathological wastes are ultimately disposed in Kathmandu Metropolitan City container

KMCAll wastes are disposed in Kathmandu Metropolitan City container

Hospital Policy, Occupational health and Safety  Hospital Policy,

Occupational health and Safety

Bir Hospital KMC

Health care waste management

committee

Yes No

Waste management plan Yes No

Use of PPE Yes( aprons,

glove , masks,

caps, boots etc)

Yes

Vaccination program for staff Yes(Hepatitis B,

Tetanus)

Yes

Training related to health care

waste management to concerned

staff

Yes No

DISCUSSIONDISCUSSION Our study, found that waste generated in Bir Hospital was Our study, found that waste generated in Bir Hospital was

333 kg/day where as in KMC it was 50 kg/day. While the 333 kg/day where as in KMC it was 50 kg/day. While the total wastes generated by government, private hospitals and total wastes generated by government, private hospitals and nursing homes in Nepal was 1 ton/day .(UNEP 2002)nursing homes in Nepal was 1 ton/day .(UNEP 2002)

Color coded container were found used for collecting Color coded container were found used for collecting separate waste in Bir hospital while only two color coded separate waste in Bir hospital while only two color coded containers(Green and Red) were used in KMC for collecting containers(Green and Red) were used in KMC for collecting general and infectious waste respectively. While in our general and infectious waste respectively. While in our country most of the hospitals collect all medical wastes country most of the hospitals collect all medical wastes including pathological wastes, syringes, blades and others in including pathological wastes, syringes, blades and others in a normal bin.(SEF)a normal bin.(SEF)

Cont..Cont..

Trained staffs were engaged in waste collection in Trained staffs were engaged in waste collection in Bir hospital while waste collection was left to Bir hospital while waste collection was left to sweepers in KMC.sweepers in KMC.

System of documentation and registration of System of documentation and registration of collected waste was practiced in Bir while such collected waste was practiced in Bir while such system was absent in KMC.system was absent in KMC.

No Burn Technique such as autoclaving was used No Burn Technique such as autoclaving was used for waste treatment in Bir hospital while for waste treatment in Bir hospital while incineration capable of producing pollutants was incineration capable of producing pollutants was used for waste treatment in KMC. used for waste treatment in KMC.

Cont..Cont.. Committee for health care waste management with Committee for health care waste management with

waste management plan was available in Bir hospital waste management plan was available in Bir hospital while absent in KMC. while absent in KMC.

Regarding occupational health and safety, provision of Regarding occupational health and safety, provision of training for staffs on waste management was available in training for staffs on waste management was available in Bir while absent in KMC.Bir while absent in KMC.

The use of PPE like gloves, aprons etc. were practiced The use of PPE like gloves, aprons etc. were practiced during handling wastes in both Bir hospital and KMC. during handling wastes in both Bir hospital and KMC. In context of the other health care center of the country In context of the other health care center of the country personnel who handle hospital wastes don’t even use personnel who handle hospital wastes don’t even use gloves .gloves .

CONCLUSIONCONCLUSION We can conclude from the study that the hospital waste We can conclude from the study that the hospital waste

management practices were satisfactory enough in Bir management practices were satisfactory enough in Bir hospital as compared to KMC since initiatives had been hospital as compared to KMC since initiatives had been taken by Bir hospital to manage its wastes through taken by Bir hospital to manage its wastes through private organization.private organization.

Bir hospital had attempted to reduce the volume of Bir hospital had attempted to reduce the volume of waste to be disposed off through employing techniques waste to be disposed off through employing techniques such as sending recyclable materials to recycling, such as sending recyclable materials to recycling, vermicomposting, setting biogas plant through the use vermicomposting, setting biogas plant through the use of biodegradable wastes etc. while such practices were of biodegradable wastes etc. while such practices were

absent in KMCabsent in KMC..

RECOMMENDATIONSRECOMMENDATIONS

To Bir Hospital:To Bir Hospital:Alternative methods for treating pathological Alternative methods for treating pathological

waste such as cremation and other innovative waste such as cremation and other innovative techniques should be explored which prevents techniques should be explored which prevents disposal of such waste to municipal container and disposal of such waste to municipal container and minimizes risk of infection.minimizes risk of infection.

Separate storage room for waste not considered by Separate storage room for waste not considered by health care waste management centre should be health care waste management centre should be built.built.

CONT…CONT… To KMC: To KMC: 

Segregation at source should be practiced through Segregation at source should be practiced through the use of standard color coded containers with the use of standard color coded containers with proper labeling in every ward.proper labeling in every ward.

Waste collection and transportation should be Waste collection and transportation should be separate for different types of waste generated.separate for different types of waste generated.

Training regarding the hospital waste Training regarding the hospital waste management for waste handlers should be management for waste handlers should be encouraged.encouraged.

Efforts should be directed towards establishing Efforts should be directed towards establishing waste management centre with waste management waste management centre with waste management plans within the hospital for proper waste plans within the hospital for proper waste management.management.

CONT..CONT..

To both the hospitals:To both the hospitals:

Efforts should be directed towards reducing the Efforts should be directed towards reducing the volume of waste generated through internalizing volume of waste generated through internalizing proper management practices and in preventing proper management practices and in preventing mixing of hospital wastes with general municipal mixing of hospital wastes with general municipal wastewaste

REFRENCESREFRENCES Bulucea, C. A. V., Bulucea, A. V., Popescu, M. C., & Bulucea, C. A. V., Bulucea, A. V., Popescu, M. C., &

Patrascu, A. F. (2008). Assessment of Biomedical Waste Patrascu, A. F. (2008). Assessment of Biomedical Waste Situation in Hospitals of Dolj District. Situation in Hospitals of Dolj District. International International Journal of Biology and Biomedical EngineeringJournal of Biology and Biomedical Engineering(1), 19-28.(1), 19-28.

Paudel, R., & Pradhan, B. (2010). Health care waste Paudel, R., & Pradhan, B. (2010). Health care waste management practice in a hospital. management practice in a hospital. Journal of Nepal Journal of Nepal Health Research Council, 8Health Research Council, 8(2), 86.(2), 86.

Poudel, K. (2002). Hospital waste: Hidden Hazard. Poudel, K. (2002). Hospital waste: Hidden Hazard. The The National Newsmagazine, 21,National Newsmagazine, 21, 27. 27.

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