hospital waste management

The hospitals mentioned suffer a severe lack of medical waste management awareness on all levels, it is noted that the most important priorities in the management of hospital waste is the "Treatment of the Medical Waste " created in those medical centers, implementing a proper and a safe way for both humans and environment. Hospitals are one of the main creators of medical wastes which are dangerous. Collection, storage and final disposal of these wastes has been and remains to be a stern issue.
Waste generated in health care facilities, including general waste, sharp objects and non-sharp, the blood, the body parts, chemicals, pharmaceuticals, and medical devices. A large amount of waste generated in any health care facilities are general waste and can be disposed of with community waste. The residual quantity which is medical waste requiring special treatment. The mismanagement of medical waste could put workers in the field of health care, and waste processors, and the society to infectious agents and dangerous substances, and increase the threat of injury. It can also harm the environment. Additionally, if the waste did not correctly disposed, can individuals from the community have a chance to reuse already used medical materials (mainly needles) without sterilization. Unsterilized waste is a big threat of infection.
Access to two cases of hospitals in Jordan, which considered to be a developing Arab country that took really large steps forward in the medical waste management, with a similarities in the nature of the idea, and thus in the implementation on the hospitals of Libya.  Fist case: Medical Waste Treatment At The King Hussein Medical Centre In Jordan

The management of medical waste in the King Hussein Medical Centre is directed by a group of 7 employees hired for the purpose of managing the handling of medical waste in the centre. The group meets ones a month and issues commendations to all the centre’s divisions and supervises the operation of the management instructions by the responsible persons. Proper implementation of the waste treatment in the centre’s medical waste exists as follows:
1. Creating techniques for the collection, segregating, transport and disposal of medical waste for example:
(i) Categorising the type of waste,
(ii) Splitting medical waste from non-medical (general) waste,
(iii) By using the right labelled bags based on a colour rule,
(iv) Putting waste in see-through labelled bags if unavailability of a suitable bag category,
(v) Transporting bags of the waste on containers which are wheeled and utility gloves must be used when dealing with damaged bags or waste then neutralizing them.
2. Implementing stringent verdict when deal with sharps and sharp injuries.
3. Implementing detailed techniques for the sanitization of used iteams.
4. By using advanced and different sterilization (solution) techniques (vapour, chemical, hot-air, and gas),for example, instruments used for operations.
5. Creating subcommittees for disposal in more units in order to regulate the medical waste disposal. Pre-disposal and disposal performs of medical waste in the King Hussin Medical Centre consist of:
(i) The Collection of a specific waste objects in yellow bags , then removing them to the burner. Such objects contain needles, gloves, and contaminated disposable medical tools,
(ii) Storage sharps in sharp containers,
(iii) Cleaning operating objects and loading them into bags before transporting them to decontamination,
(iv) Body parts must be placed in labelled bags before they being send to dead refrigerator.

 Second Case:
Practices of Medical Waste Management in Hospitals in Northern Jordan

1. Segregation of Healthcare Waste:
Infectious waste, pathological waste and sharps are separated from the central waste of hospitals. The hospitals used plastic yellow colour bags for infectious waste, others used red bags for the high infectious waste. Sharps are separated in sharp yellow containers in a small number of the hospitals and the remaining larger number of the hospitals used different coloured containers. All expired pharmaceutical materials of all hospitals are re-send back to suppliers.
Little less than a half of the hospitals applied particular techniques regarding pharmaceutical waste handling, the other hospitals dispose of it in the general waste stream. Of the first group of hospitals with particular techniques, some give back the waste to providers, the other hospitals disposed of the waste with the rest of the medical waste in yellow bags. Genotoxic waste is keep apart in red coloured bags. Laboratories generates Chemical waste, usually in liquids, disposed through the community sewer system. Other hospitals save it in special designed containers, then a pre-treatments process is applied just before the disposal it in the public sewer system.

2. Storage and transportation of the healthcare waste:
• A temporary storage facility must be available
• A central storage facility must be available
• refrigerated storage must be available for pathological waste
• Storage facilities must be sterilized
• Storage facility must be disinfection daily
• A storage facility must have:
(a) Linking to sewer system
(b) source of Water
(c) Air circulation
(d) Isolated and safe
(e) Easily cleaned
(f) Massive container for storing
• Sufficient storage facility area and volume
• Carts must be assigned to transport medical waste inside the hospital?
• Vehicles must be assigned to transport medical waste offsite
• non-medical and medical waste must be transported separately for treatment and/or temporary storage

Many of the components listed above were created by the Jordanian Ministry Of Health regulatory requirements (MOH, 2001).
One to four carts is used in each hospital. Most of the carts were yellow colouedr , wheeled with a cover. 12 hours is the maximum time period for temporary storage, and 2 days is the maximum time for storage in the central storage. Private contractors with little experience were used to collect and transport inside the hospitals and who have a major number of overturned containers. Normally, the workers of the private part did not use necessary protecting equipment while handling the waste which can be a cause of a possible risk of accident and individual injuries. Vehicles used for transporting the medical waste to outside hospitals, did not meet the safety requirements of the regulator.

 What Can Be Done :
These Libyan hospitals need a strong strategy for waste managing and controlling that must be set and presented for correct waste management execution. The strategy must define clearly the approaches of waste segregating, collecting, storing, and final disposal, taking into account what resources are available. It can be stated - probably - as the one practice in the hospitals of Jordan - with some modifications if necessary -. Clarifying the different roles and responsibilities for each member of the team. The responsibility of waste management must be assigned on a particular person. Daily, weekly, and monthly reports must be received from each department, to the waste management manager, who is the first person responsible for any mismanagement in front of the higher authorities like the mister of health which is the regulator for the proper handling and disposal of the medical waste management system. Regular reports are highly important to prevent mistakes and accidents that can easily lead to injuries and infections and to make sure that the strategy for the waste treatment is implemented and implemented correctly.
Designing a team member to organize and coordinate the system of the medical waste treatment. Training entire staff should be included in the management plan. Four main elements in the policy of waste handling should be addressed as following:
1. Waste Sorting: is categorization waste by kind (for ex. pharmaceutical waste, infectious waste) into coloured coded bags where waste was generated. Medical waste generated by the hospitals is only a small amount of the total waste, and it must be carefully handled to decrease the possibility of infections of injury. As a result, separating the waste where it created will significantly decrease the quantity that requirements to be specially handled. Medical and general waste should be disposed using separated containers. Segregating the waste by type should be done by the person who generates it. To help distinguish between general-and medical-waste, colour Plastic bags must be used. Sorting waste should be established by using a three bin system as follows: infectious and pathologic waste that needs to be incinerated, must be disposed in Red bags. Radioactive waste (if any) must be disposed in Yellow bags and distributed by atomic energy organizations for. For general waste, Black bags are used and it must be disposed with the general waste and to be transported by the municipals.
2. Waste Handling: is the collection and transportation of waste inside the hospital. Medical waste must be carefully handled before disposal. Collecting it should not be by emptying into open carts from patient-care zones; it might lead to infection of the surrounds and to scavenging of waste that can increase the risk of injury between worker, patients and visitors.
 Filling the Bags: containers of waste and sharps should be thrown away when they come to be 3/4 filled every day or after every shift. The purpose for this is to decrease the hazard of plastic bags exposed and of an injury from a distended sharp element in sharps containers.

3. Short-term storage:
It is the storage of the waste inside the facility till it can be transported to last disposal. Transporting the waste to short-term storage by the end of every single shift witch is normally 8 working hours. In order to lessen the risk of injury and of infection, reduce the time for waste kept inside the facility. A controlled access area should be used for storing the waste which is slightly trafficked by clients, staff, or visitors. Short-term storage time must not be more than 2 days. It is better to have on each floor of the facility, a room for waste storing, if not, A central room for storage must be available. The storage room must be included in the cleaning programme.

4. Final disposal: is the removal of all types of medical waste, liquid, sharps, and hazardous chemical waste from the inside storage of the facility, by using the Burn and Non-Burn methods:

 Non-burn method or (Burying method): using this method requires an enough space to dig a burial pit to put the waste in and must be circulated with a wall or a fence. Worker who are responsible for burring the waste must follow the steps below:

- Burial pit must be at least 50 meters away from the closest source of water, positioned downward from any wells, free off standing water, and in a no flooded area.
- A burial hole must be 2-5 meters deep and1-2 meters wide. The bottom of the hole must be minimum 1.8 meters above the water level.
- Create a wall or a fence round the location to keep animals away.
- Cover the hole with 10-30 cm of dirt every time the waste is added. Once the level of waste get to 30- cm high of ground, fill the hole with dirt, seal it with concrete, and then dig a new hole.
 Burning technique: the best way for solid medical waste disposal is incineration, as the high temperature of (1300 °C) can kill microorganisms and decreases the volume of waste. It is recommended that burning must be in an incinerator or in an oil drum. Incinerator must be placed on solid ground to avoid grass or plants from catching fire. The reason of burning medical waste is to reduce the quantity of waste. The residual ash from incineration must be treated and disposed as a general waste.

 (Safe Sharps Disposal):
The main reason of working exposure to blood borne pathogens in all health care workers is injury from sharp objects like needle sticks or other. By 20 pathogens is identified to be spread because of percutaneous contact to blood. The most significant of these pathogens are HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV). Infection with one of these diseases is possibly life threatening – and avoidable.
 Disposal of used Needles:
All used needles must be placed in special sharps container and never re-cap needles.
 Disposal Sharp Containers or (Safety Box)
On no occasion throw away sharps and needles in the bags of clinical waste, as might the staff of housekeeping get injured. Sharps disposal container must be:
Functional: the containers must stay in a good condition all through the period of usage, and must have suitable capacity size and safe to open.
Accessible: the Containers must be easily reached by all staff and to be found in all zones wherever sharps are used.
Visible: the containers must be obvious to all staff. Staff members must be capable to see the amount to which the container is filled (only plastic containers).
Accommodated: design of the Containers must be suitable, environmentally safe, and easily stored.

References:

Owies, R et al. , (2005): “ Medical Waste Management in Jordan: A study at the King Hussein Medical centre” Volume – 25.
Abdulla, F et al. , (2008): “ site investigation on medical waste management practices in northern Jorden” Volume – 28.
Ministry of Health (MoH), 2001. Medical waste management regulations. Official Journal of the Hashemite Kingdom of Jordan, Amman-Jordan (4511).
WHO, 2000. Hazardous Waste from Health Care Facilities. World Health Organization, Rome, Italy.