08 January 2013, Kantipur.com
Nepal - Rajesh Karki, a Bir Hospital paramedic, recalls the time when hazardous medical waste, including syringes, bloody cotton swabs, used plasters and wraps, were mixed together haphazardly and discarded like so much household waste to be taken away by a municipality vehicle. Apart from the foul smells emanating from such waste, dissected organs and foetuses were a normal sight on hospital premises.
However, things have changed in the last three years. “All the 26 wards and the emergency area have multi-coloured bins where different kinds of waste are collected and properly managed,” Karki said. “Everyone feels the difference now.”
The country’s oldest hospital, on July 20, 2010, launched a medical waste management programme, which has since become an example for the country. The hospital administration, with support from Health Care Foundation-Nepal (HECAF), started the programme to properly manage and dispose of hazardous medical waste that had long been finding its way into community landfills.
The hospital, in spite of the malaise infecting most government institutions, has successfully and properly managed its waste, elevating it far above the numerous private hospitals in the country. Private institutions need to be made more responsible, given the amount of waste they produce. Of the total 13,613.5 tonnes of waste produced by hospitals annually, the Ministry of Health and Population (MoHP) attributes around 9,307.93 tonnes to the private sector.
Gopi Neupane, general secretary of the Association of Private Health Institutions Nepal, said that expensive machines required to sort through and dispose of the waste were the main hurdles for private hospitals to initiate waste management. “Many hospitals run in rented buildings. There is little space for such machines,” said Neupane. “However, of late, we have requested all our member hospitals to place separate dustbins to segregate waste.”
However, while Neupane claimed that each hospital would require around Rs 5 million for proper waste management, Mahesh Nakarmi, programme director at HECAF, said around Rs 2.5 million will be enough for a standard setup. “It is the hospital’s negligence. If they can invest hundreds of millions for medical equipment, such a small sum should not be a big deal for private hospitals,” said Nakarmi. According to Nakarmi, a good autoclave machine, which sterilises equipment by bombarding it with hot steam, costs around only Rs 1.5 million. The remaining million rupees is enough to establish the whole waste management setup, from waste generation to disposal.
For a standard waste setup, going by Bir Hospital standards, three separate bins should be put in place to segregate biodegradable, degradable and non-degradable waste. Additional bins are required for special wards such as the Intensive Care Unit (ICU) and chemotherapy. Each ward should have a needle disposing machine to destroy syringes after use. At Bir, the waste is then transported to the Waste Treatment and Storage Area every 24 hours, located on its premises, and segregated into hazardous and non-hazardous wastes and disposed of accordingly.
Out of the total hospital waste, around 75 to 90 percent is non-hazardous while the remaining 25 to 10 percent is hazardous. While non-hazardous waste is similar to the domestic waste produced by most households, hazardous waste can pose a serious threat to the environment and people exposed to it, said experts.
The government, for its part, has attempted implementation of the Solid Waste Management Act 2011. A high-level team led by Krishna Hari Baskota, secretary at the Prime Minister’s Office, and comprising of officials from the concerned ministry, recently conducted a surprise check at two private hospitals in Kathmandu and Bir. Baskota said that the government is concerned over the haphazard disposal of waste, which can often result in serious public health problems. “We have instructed the line ministries, especially the Health Ministry, to make sure that all the hospitals across the country comply with the Act,” Baskota said.
Dr Tirtha Raj Burlakoti, chief of the Curative Division at the MoHP, claimed to have not registered any new hospital without a proper waste management system and not renewed the licences of registered hospitals if they lack such a system.
The Solid Waste Management Act 2011, which explicitly states that the “responsibility for processing and management of hazardous waste, medical waste, chemical wastes…under the prescribed standards shall rest with the person or institution that has generated the solid waste,” has made it mandatory for all institutions to manage the waste on their own. However, very few hospitals have complied with the Act.
Neupane said that all private hospitals have agreed to the Act but the government also needs to arrange for a Common Treatment Facility (CTF), where waste from hospitals can be collected and treated jointly. Nakarmi, citing the example of India where wastes are often “lost” on their way to treatment, responded that those demanding for a CTF should ensure that their waste reaches the treatment zone “safely.”
Although a few initiatives are already underway, the “Baseline injection safety assessment in Nepal-2012” conducted by the MoHP, showed appaling results. The study, conducted in 60 district hospitals, 11 zonal hospitals and four regional hospitals, showed that 92 percent of hospitals had loose disposable syringes, lacking any kind of packaging, on hospital premises. Also, 15 percent of the hospitals surveyed had poor standards of hospital waste water management, along with open containers with sharp objects like syringes and knives, exposing people to injury. Almost 61 percent of the hospitals had sub-standard practices of waste segregation and almost 80 percent burned their waste in open areas, exposing the public to harmful chemicals released during the incineration.
Data from the World Health Organization (WHO) also suggests that prompt action is necessary in waste management. According to the WHO, 260,000 new HIV infections were directly related to the poor management of medical waste worldwide in 2000. One infected syringe carries a 30 percent risk of Hepatitis B, 1.8 percent risk of Hepatitis C and 0.3 percent of HIV.
Medical waste in a nutshell
Hazardous: These include cotton, soiled bandages, dressing, blood bags, human and animal tissue, body parts, chemicals, drugs, waste generated by the clean-up of hazardous waste spills and any other soiled material used for treatment.
Non-Hazardous: These includes paper, cardboard, metal containers, floor sweepings and kitchen waste. These material don’t need special treatment and storage facilities but need to be collected separately from hazardous waste. If strict separate collection is not practiced, the entire medical waste treatment process can be rendered redundant.
Sharps: These include (whether infected or not) needles, syringes, scalpels, blades, glass, infusion sets, saws, knives, broken glass and items that can puncture human skin and cause infections. Sharps, whether contaminated or not, should also be collected separately from other waste.
(Source: Nepal Health Research Council)