Hospital waste (mis)management

Adverse health outcomes associated with mishandling of healthcare waste and by-products are many

Hospital Waste Management (HWM) means the controlling of waste produced by hospitals using techniques that will check the spread of diseases. In many developing countries, awareness regarding hospital waste management in terms of its segregation, collection, storage, transportation and disposal is lacking.

It is a system that handles hospital-generated waste, including infectious, chemical, expired pharmaceutical and radioactive items, and sharps. Efficient waste management is critical for hospitals because it can be pathogenic and environmentally hazardous. Moreover, some of these items can be re-used and misused. Syringes, for example, are used by intravenous drug users.

When it comes to medical waste, every country has different regulations. Research on these regulations and relevant updates requires special attention since negligence can create major health hazards.

The waste generated from hospitals, health care centres, medical laboratories, and research centres comprising of discarded syringe needles, bandages, swabs, plasters, and other types of infectious waste are often disposed of with the regular non-infectious waste.

As we know, medical waste is hazardous, toxic, even lethal. If not properly disposed of or treated, these items pose grave risks for humans and the environment, like disease transmission and environmental poisoning and pollution.

Adverse health outcomes associated with mishandling of healthcare waste and by-products are many. They include sharps-inflicted injuries, including Habitats C and AIDS; toxic exposure to pharmaceutical products, in particular, antibiotics and cytotoxic drugs released into the surrounding environment, and to substances such as mercury or dioxins, during the handling or incineration of health care wastes; chemical burns arising in the context of disinfection, sterilisation or waste treatment activities; air pollution arising as a result of the release of particulate matter during unsafe medical waste incineration; thermal injuries occurring in conjunction with open burning and the operation of medical waste incinerators; and radiation burns.

It is estimated that about 16 billion injections are administered every year. But not all needles and syringes are disposed of safely. This created a risk of injury and infection and opportunities for reuse.

Measures to ensure the safe and environmentally sound management of health care wastes can prevent adverse health and environmental impacts from such waste including the unintended release of chemical or biological hazards, including drug-resistant micro-organisms, into the environment thus protecting the health of patients, health workers and the general public.

According to one estimate, hospitals in Pakistan produce about 250,000 tonnes of waste per year. Pakistan generates 2 kg of waste per bed per day. This waste includes used syringes, blades, used gloves, chemicals and drugs. Hospital waste has been reported to be poorly handled and managed by the hospital staff and administration. This leads to environmental and health consequences within hospitals as well as to outside population.

Hospital waste is required to be managed on daily basis as the amount of waste we generate every day is huge. If we do not process it on regular basis, then it starts piling up and becomes a great health challenge.

Treatment and disposal of healthcare waste may pose health risks indirectly through the release of pathogens and toxic pollutants into the environment. The disposal of untreated health care wastes in landfills can lead to the contamination of drinking, surface, and ground waters if those landfills are not properly constructed. The treatment of health care wastes with chemical disinfectants can result in the release of chemical substances into the environment if those substances are not handled, stored and disposed in an environmentally sound manner.

Hospital waste management in the public and private hospitals in the Punjab is regulated by Punjab Hospital Waste Management Rules, 2014 notified by the Environment Protection Department, Government of the Punjab under the provisions of the Environmental Protection Act, 2012.

HMW from the point of generation to the final disposal is primarily the responsibility of the concerned public/private hospital in collaboration with district, tehsil and UC level administrations under local government/TMA. The term Hospital means a clinic, laboratory, dispensary, pharmacy, nursing home, health unit, maternity center, blood bank, autopsy centre, research institute, veterinary institutions, including any other facility involved in healthcare and biomedical activities.

The Punjab Hospital Waste Management Rules, 2014 provides an institutional mechanism for collection, segregation, transportation to the temporary storage, final disposal of the waste on site or transportation of the waste for off-site disposal and actions to be taken in case of accidents and spillages.

These Rules also prescribe the roles and responsibilities of different levels of the hospital staff to control pilferage and ensuring that waste is disposed of as per international standards. However, some challenges comprising hospital staff attitude, patient awareness, shortage of sanitary workers, privation of required facilities, equipment and technical needs and budgetary constraints etc may disrupt accomplishment.

Punjab Healthcare Commission (PHC), since 2013, has prescribed Minimum Service Delivery Standards (MSDS) under the provision of the Act for Hospitals and has also imparted training to the staff of hospitals in the Punjab, for the implementation of the recommended service delivery standards. Two years after the introduction of MSDS, the PHC has proactively started monitoring the compliance of the Standards having direct impact on patient safety in hospitals through Special Inspections. This also includes Hospital Infection Control, Operation Theatre Surveillance and Hospital Waste Management Measures.

In a recent campaign of Special Inspections more than 400 hospitals were inspected. During these inspections the Commission assessed implementation of the whole system of hospital waste management from the point of generation, collection, storage and disposal.

The compliance status for HWM was 65 percent in all inspected hospitals. The compliance rate of 193 public sector HCEs was 66 percent while of 211 private sector HCEs was 65 percent. The results of the assessment show that the segregation of the Hospital waste is the weakest area (73 percent).

Since hospital waste disposal is a critical safety issue both for the patients and the service providers as well as for the population at large, there is a dire need to implement the said rules professionally and competently. Hospital waste is required to be managed on daily basis as the amount of waste we generate every day is huge. If we do not process it on a regular basis, then it starts piling up and will become a great health challenge and environment problem for all of us.

The writer is a freelance contributor based in Lahore

Hospital waste (mis)management: Adverse health outcomes associated with mishandling of healthcare waste and by-products are many