 |
|
Hospitals and clinics are the only one source of infectious waste generation. Hospital wastes are heterogeneous mixtures composed of general refuse, laboratory and pharmaceutical chemicals and their containers, and pathological wastes. As a result, some infectious wastes do not separate from general waste. However, thers are only a small percentage of the waste streams. Even then, these may contain potentially infectious wastes and cause the community's waste problem. There is an obvious evidence that these are contaminated in a manner that renders these capable of transmitting disease, and that the only documented transmission of disease from hospitals waste has been from contaminated sharps such as syringes, etc. Therefore, these have to be handled with careful methods wherever they are generated. Inadequate handling of hospital waste may cause serious public health consequences and may also impact on the environment. Hospital waste management is an important and necessary component of environmental health protection.
GTZ initiated this study on waste from hospital and clinics in Phitsanulok Province. To improve hospital waste management, it is important to begin by surveying the facility of current hospital waste practices. A waste survey should therefore be undertaken about the information of the waste planning process. This survey should provide information on types and quantity of wastes, which are arising at each point of production, and methods of storage, handling, treatment and disposal. It should also provide the number of beds and occupancy rate for health-care establishments. In this study, the definition of waste is divided into 3 groups namely:
The objectives of this project are:
In addition, the work attempts to examine the number of clean incinerations and whether it complies with the Ministry of Public Health’s emission standards.
Study area: Phitsanulok Province is located in the lower part of northern Thailand, about 390 km from Bangkok. The total area is approximately 10,896.05 square kilometers as seen in Fig.1. There are nine government hospitals under Ministry of Public Health and seven private hospitals, which are located only in the municipality. Selection of hospital and clinics: Hospital selection: In this study, twelve hospitals were selected that are divided into five government hospitals and seven private hospitals. However, Buddhachinnarat hospital is the central hospital in the lower part of northern Thailand. In addition, the other four community hospitals are in Nakorn Thai, Chattrakarn, Phrom Phiram and Neon Maprang. Survey forms were designed specially for data collection and analysis. Clinic selection: 184 clinics were inducted in this study. The sampling strategy for survey was based upon the distribution of clinic establishments in each district. Methods of study: Field observation and surveys were designed and conducted to characterize the hospital waste. After survey data was completed, we adopted it for the determination of Phitsanulok Province needs for the hospital waste management. Questionnaires: Questionnaires were used to survey the hospital waste in terms of collection, transportation and treatment of hospital waste and to collect available information for analysis of the system. Sampling: Parallel to the interviews, the physical compositions of waste in hospitals and clinics were determined. The waste from hospitals and clinics were collected from storage areas (only red bags). Before segregation, we sprayed these wastes by disinfectant solution (0.5% Sodium hypochlorite). Masks and large forceps were used to segregate waste into several types. During segregation, we weighted each type of medical waste and discarded into red bag. This waste composition study is part of a continuing effort to measure and understand the waste generated in hospitals and clinics. The composition study is based on field sorting events around Phitsanulok Province between November 1 and November 7, 2000. The waste samples were analyzed along a week. The raw survey data was compiled and managed so as to enable the estimation of waste generation quantities/management practices. The average quantity of hospital/clinic waste was computed on wet weight from the field observation.
The daily waste generation (kg/bed) in hospitals and clinics in Phitsanulok Province are shown in tables I and II respectively. The medical waste composition from all hospitals in Phitsanulok is shown in Table III. Table I: Waste generation by waste type in twelve hospitals in Phitsanulok
Table II Waste generation by waste type in clinics in Phitsanulok
Table III Medical waste composition from all hospitals in Phitsanulok
The results of this study involving a total of 196 health care facilities in Phitsanulok Province can be summarized as following:
This information can be used in allocating resources for treating hospital waste. This waste must be treated separately from other wastes in view of its potential infectious constitution. We make the following recommendations: 1. The average of general waste in hospital is 88.0% of the total waste. A high proportion of it is generated from organic material from food preparation and remnant and the others are paper, plastic bottle, etc. The further management of this waste can be proceeded into by 4 methods viz. 1) municipality system 2) landfill 3) sales for pastures 4) recycle. 2. The average of medical waste in hospital is 10.6% of the total waste, with the maximum being generated from emergency department (ER), and a small portion by wards, laboratory, etc. The management of this waste can be proceeded into 4 methods that is, 1) autoclaving and chemical sterilization 2) incineration 3) landfill 4) recycle. 3. The average of hazardous waste in hospital is 0.4% of the total waste, the highest resulting from the X-ray lab., the others are work place i.e. fluorescent lamp in the office, etc. The further management of this waste can be proceeded into by 3 methods viz. 1) landfill 2) incineration 3) recycle i.e. photographic fixing solution. Hospital waste generation differs not only in each country, but also within a country itself.(4) The waste generation depends on numerous factors such as waste management methods, type of hospital establishment, specializations of the hospital, ratio of reusable items in use, ratio of day care etc. It is therefore suggested that these data can only be used as examples, but it cannot be used as a basis for waste management within an individual hospital establishment.(5) Though this survey has been limited, it still provides more reliable data on local waste generation than any estimation that is based on data from other countries or types of establishments. Generally, there are four key steps of hospital waste management (6): 1) segregation into various components, including reusable and safe storage in appropriate containers 2) transportation to waste treatment and disposal sites 3) treatment 4) final disposition. The current waste management practice has been observed at many hospitals. It appears that all wastes, such as potential infectious waste, waste from office, general waste, food, construction debris, and hazardous chemical materials are all mixed together while they are being generated, collected, transported and finally disposed of. Imposing segregation practices within hospitals to separate biological and chemical hazardous wastes (less than 10% of the waste stream) will result in a clean solid waste stream (90%), which can be easily, safely and cost-effectively managed through recycling, composting and land filling the residues. The resultant general waste stream has a high proportion of organic wastes (food) and recyclable wastes (paper, plastic, metal). Actually the numbers of recyclable wastes are very little and they are mostly disposed after use. Several hospitals in Phitsanulok have already set up segregation programs in locals. If proper segregation is achieved through training, clear standards, and tough enforcement; it will effectively decrease infectious waste; however some of it still need special treatment.(7) Apparently the segregation programs have decreased the number of waste; on the other hand, it has increased resources for the programs. Proper management of hospital waste can minimize the risks both within and outside healthcare facilities. The first priority is to segregate wastes into reusable or non-reusable, hazardous or non-hazardous components.(8) An important management is to set the institution of sharps management system, waste reduction, avoidance of hazardous substances as far as possible (e.g. PVC-containing products, mercury thermometers). Besides, it has to ensure workers’ safety and provide secure methods of waste collection and transportation. Moreover it should provide necessary installations for safe treatment and disposal mechanisms.If the good segregation program is successful, it can reduce less than 8% of their waste stream. It is critical that wastes should be segregated before disposal. This most important management is to safeguard the occupational health of health care workers.(9) Hospitals currently burn wastes or dump wastes in municipal bins, which are transported to unsecured dumps. Some wastes have contained mercury and other heavy metals, chemical solvents and preservatives (e.g. formaldehyde) which are known carcinogens, and plastics (e.g. PVC). When the wastes are combusted, they produce dioxins and other pollutants, which pose serious human health risks not only to workers but also to general public through food supplies. Next is the risk to the general public which occurs in three ways: 1) accidental exposure from contact with wastes at municipal disposal bins; 2) exposure to chemical or biological contaminants in water; and 3) exposure to chemical pollutants (e.g., mercury) from incineration of the wastes. The mismanagement of hospital waste poses risks to people and the environment, healthcare workers, patients, waste handlers, waste pickers, and the general public are exposed to their health risks from infectious waste (particularly sharps), chemicals, and hazardous waste.(10,11) Improper disposal of hospital waste, including open dumping and uncontrolled burning, increases the risk of spreading infections and the risk of exposure to toxic emissions from incomplete combustion. For these reasons, occupational health and safety should be considered in a component of hospital waste management plans. As a result of this failure to establish and follow segregation protocols and infrastructure, the waste leaving hospitals as a whole is both potentially infectious and potentially hazardous (chemical). At greatest risk are the workers who handle the wastes (hospital workers, municipal workers and rag pickers). Finally, the proposed central incinerator in the large hospital is the best way in hospital management in Phitsanulok Province. This comes with the benefit of lesser investment and easier maintenance than their own present day incinerators. In addition, autoclave could be the alternative technology for medical waste treatment because it is air pollution free.
This study has been funded by The Deutsche Gesellschaft fÜr Technische Zusammenarbeit (GTZ). All government officers from Phitsanulok Municipality including all hospitals and clinics support technical data. The help rendered by Mr. Pirit Sukkad and Mr. Bundit Aoywatananukul in carrying out waste sampling, segregation and weighting in completion of this project is thankfully acknowledged.
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
