Assessment of Medical Waste Among Health Workers in Ussa Local Government Area, Taraba State
Chapter One
AIM AND OBJECTIVES OF THE STUDY
The aim of the study is to assess the medical waste management practices among health workers in In Ussa LGA. The specific objectives of the study are to:
- characterize the nature of the Healthcare Waste (HCW) generated in the two hospitals;
- determine the quantity of HCW generated in the hospitals;
- examine methods of HCW collection and disposal in the hospitals;
- identify and map out the waste dumpsites of the two hospitals; and
- assess the effectiveness of HCW management practices in the hospitals.
CHAPTER TWO
LITERATURE REVIEW
INTRODUCTION
This chapter presents the review of relevant literatures that are of importance to the study. Several concepts and techniques were also defined in order to provide the direction of the study.
WASTES
Waste has been defined as any “unwanted material arising in the course of production and consumption” (Encarta, 2007). The UK Government‟s Environmental Protection Act 1990 goes further to define waste as“any substance which constitutes a scrap material, an effluent or unwanted surplus substance arising from the application of any process. Any substance or articles which demand to be disposed of as being contaminated, broken, worn out or otherwise spoiled (explosives are not included)”.The European Economic Community (EEC) defined waste as: “any substance or object the holder disposes of or is demanded to dispose of pursuant to the provisions of the national law in force (Commission of the European Communities, 1992)”. According to Uwa (2008), a waste is any substance for which the owner or generator has no further use and which he discards. Waste may be solid, semi-solid, liquid orgaseous; and in each case may be toxic or non-toxic, combustible or non-combustible.
Everywhere in the world, waste is often discussed according to some criteria which are outlined by Uwa (2008):-
The source of the waste e.g.: domestic, commercial, industrial, agricultural and hospital.
The method of disposal e.g.: landfill, incineration, tipping, composting, pulverisation.
The degree of risk for human health and environment e.g.: toxic waste, infectious waste.
Economic value, for example, in relation to the production of a solid refuse-derived fuel (RDF).
Advertisements
Waste is generated daily by households, hospitals, commercial establishments, industries, governmental operations, and virtually every element of society. Waste is generally taken to include all gaseous, liquid waste generated from a large range of community activities, i.e. simply trash, rubbish or garbage. A significant quantity of solid is hazardous. Municipal waste composition changes with time and by region. For instance in 1939 it was mostly garbage mixed with paper products, cans, dust, bottles, and cinders. From about 1955, waste grew less dense as less ash was produced. Since 1977, greater quantities of paper, glass and plastics have been produced imparting a higher calorific value to waste. In the USA, waste includes refuse, garbage, slurries and all materials that are normally discarded after use and also by-products of manufacturing or mining activities that are normally discarded (Longe and Williams, 2006). In the UK waste includes municipal solid waste whose average composition is: metals (mainly ferrous) 9%, glass 9%, paper 32%, plastics 8%,vegetable 20%, dust and others 18%, textiles and others 4%(Abdel-Salam, 2010).
CHAPTER THREE
RESEARCH METHODOLOGY
INTRODUCTION
This chapter presents the study area and the methodology adopted in carrying out the research.
RESEARCH METHODOLOGY
Reconnaissance Survey
Reconnaissance survey of the two hospitals was carried out with the purpose of familiarization with the hospital systems and the waste dump sites. The specific type and sources of data required to achieve each of the study objectives are outlined below:
Types of data utilised
The types of data required for this research include:
Co-ordinates of the waste dumpsite
Amount of waste generated per bed per day in each of the hospitals using a weight measuring scale; and The nature of HCW, methods of HCW collection and disposal; the effectiveness of HCW management practices in the two hospitals.
Sources of data
The data used for the study are from primary and secondary sources and include:
Primary sources
Co-ordinates of the waste dumpsite: This was sourced from the study area using Global Positioning System (GPS).
Pictures of the waste dumpsite: The pictures were taking using camera in the field.
Amount of waste generated per bed per day in each of the hospitals: The amount was calculated using a weight measuring scale.
CHAPTER FOUR
PRESENTATION OF RESULTS AND DISCUSSIONS
INTRODUCTION
This chapter shows the presentation of results obtained from the field. The results are presented in tables, charts and maps. The discussion of the results is also presented in this chapter.
CHAPTER FIVE
SUMMARY, CONCLUSION AND RECOMMENDATIONS
SUMMARY
This study assessed medical waste management practices among health workers in Ussa LGA. The study specifically embarked on the characterization of healthcare wastes (HCW) in the two hospitals and the quantity of wastes generated per day per bed in the hospitals. The study also examined methods of HCW collection and disposal in the hospitals as well as the effectiveness of HCW management practices in the hospitals. Finally, the study identified and mapped out the waste dumpsites in the two hospitals.
The study used co-ordinate data of the waste dumpsites in the hospital sourced from the study area using Global Positioning System (GPS) to establish and map the locations of the dumpsites in the hospitals on the topographic map. The study equally used the amount of waste generated per bed per day in each of the hospitals collected through a weight measuring scale. Two sets of structured questionnaires were used to extract information about nature of HCW, methods of HCW collection and disposal and the effectiveness of HCW management practices from the staff involved in waste management in the hospitals. Pictures of the waste dumpsites from the hospitals were equally taken using camera in the field. Geographic Information Systems and descriptive statistics were used as the analytical methods.
MAJOR FINDINGS
The study revealed that at the FUTHW, all the HCW according to UNEP/WHO (2005) were generated. They are Recyclable wastes, Biodegradable wastes, Other non-risk wastes, human anatomical waste, sharps, non-hazardous pharmaceutical wastes, potentially hazardous pharmaceutical wastes, hazardous pharmaceutical wastes, cyto-toxic pharmaceutical wastes, blood and body fluids, Infectious wastes, highly infectious wastes, other hazardous wastes and radioactive wastes. At the TSSH, all the wastes found in FUTHW except human anatomical wastes, other hazardous wastes and radioactive wastes were equally found.
It was found out that the total quantities of HCW generated at FUTHW and TSSH are 845kg and 77kg per day respectively. This translates to 1.18kg and 1.54kg per day per bed at FUTHW and TSSH respectively.
Waste collections at the two hospitals were in receptacles/storage containers displayed at the patients‟ bedsides and at strategic locations within and outside of the various units/wards before been sorted and onward transfer to storage before been disposed.
Disposal at TSSH were incineration and open dumping methods. The wastes often incinerated are Sharps, Potentially hazardous Pharmaceutical wastes, Hazardous Pharmaceutical wastes, Cyto-toxic pharmaceutical wastes, Blood and body fluids, Infectious wastes and Highly infectious wastes while Recyclable wastes, Biodegradable wastes, Other non-risk wastes and Non-hazardous Pharmaceutical wastes were dumped in an open dumpsites within the hospital premise before been conveyed away. At the FUTHW, the three mainly used disposal methods were burial, incineration and open dumping depending on the nature of the waste. However, landfill method was been used for biodegradable wastes.
From the study, both the FUTHW and TSSH can be classified as Level 2 hospitals based on their operational performance in waste management in accordance with the Townend and Cheeseman (2005) guidelines.
CONCLUSION
Healthcare services are aimed at preventing potential human health risks and environmental hazards as well as improving wellbeing. In the process, however, wastes that are potentially harmful are generated. Poor management of these healthcare wastes (HCW) exposes the health workers, patients, waste handlers and the general public to health risks. The following conclusions can be deduced from the findings of this study involving In A.B.U. Ussa LGA:
All the waste categories according to UNEP/WHO classification were present at FUTHW while all but radioactive wastes, other hazardous wastes and human anatomical wastes are present at TSSH.
The rate of waste generation at FUTHW (1.18kg/bed/day) and at TSSH (1.54kg/bed/day) falls within reported range of 0.562kg/bed/day to 1.56kg/bed/day.
Waste collections at the two hospitals were in receptacles/storage containers displayed at the patients‟ bedsides and at strategic locations within and outside of the various units/wards before been sorted and onward transfer to storage before been disposed.
Disposal at TSSH were largely incineration and open dumping methods. Although treatment and disposal of health-care waste has been done fairly well in the hospitals to reduce risks, indirect health risks may occur through the release of toxic pollutants into the environment through treatment or disposal.
There is low awareness about the health hazards related to health-care waste, inadequate training in proper waste management, absence of waste management and disposal systems, insufficient financial and human resources and the low priority given to the topic are the most common problems connected with health-care waste. The hospitals either do not have appropriate regulations, or do not enforce them since the essential issue is the clear attribution of responsibility for the handling and disposal of waste.
The management practices at FUTHW and TSSH give room for so much concern considering the fact that both hospitals are classified as Level 2 hospitals based on their operational performance in accordance with the Townend and Cheeseman (2005) guidelines. This implies that some aspects of sustainable waste management are yet to be implemented. The hospitals have enormous population influx based on patronage and the availability of high number of students on training should be seen to be high above board in waste management to avoid outbreak of infection.
RECOMMENDATIONS
The following recommendations are proffered to the management of the hospitals and such others of the same performance level:
Improvements in health-care waste management that will rely on the following key elements:
building a comprehensive system, addressing responsibilities, resource allocation, handling and disposal. This is a long-term process, sustained by gradual improvements; raising awareness of the risks related to health-care waste, and of safe and sound practices; selecting safe and environmentally-friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing of waste
The management of the two hospitals should increase attention and diligence to avoid the substantial disease burden associated with poor practice, including exposure to infectious agents and toxic substances and enhanced the use of incinerators that provide an interim solution especially since the options for waste disposal such as autoclave, shredder or microwave are limited.
Whatever the technology used, best practice must be promoted to ensure optimal operation of the system. To reduce exposure to toxic pollutants associated with the combustion process such as dioxins, furans, co-planar PCBs, nitrogen and sulphur oxides as well as particulate matter and to minimize occupational and public health risks, “best practices” for incineration must be promoted, and must include the following elements:
Effective waste reduction and waste segregation, ensuring that only appropriate wastes are incinerated;
Citing incinerators away from populated areas or areas where food is grown, thus minimizing exposures and thereby risks;
A properly engineered design, ensuring that combustion conditions are appropriate, e.g., sufficient residence time and temperatures to minimize products of incomplete combustion;
Construction following detailed dimensional plans, thus avoiding flaws that can lead to incomplete destruction of waste, higher emissions, and premature failure of the incinerator;
Proper operation, critical to achieving the desired combustion conditions and emissions. In summary, operation must: utilize appropriate start-up and cool-down procedures; achieve (and maintain) a minimum temperature before waste is burned; use appropriate loading/charging rates (both fuel and waste) to maintain appropriate temperatures; ensure proper disposal of ash; and ensure use of protective equipment to safeguard workers;
Periodic maintenance to replace or repair defective components, including inspection, spare parts inventory, record keeping, and so forth;
Enhanced training and management, possibly promoted by certification and inspection programmes for operators, the availability of an operating and maintenance manual, management oversight, and maintenance programmes.
Management and operational problems with incinerators, including inadequate training of operators, waste segregation problems, and poor maintenance, are recognized as critical issues that should be addressed in assessment and waste management plans.
Given the importance of effective healthcare waste management practices and the current unsustainable level of performance, it is important to investigate the effects of the healthcare wastes from the two hospitals on the total environment (soil, water and air).
REFERENCES
- Abah, S.O. and Ohimain, E.I. (2011). Healthcare waste management in Nigeria: A case study of Ibadan Teaching Hospital. Journal of Public Health and Epidemiology, 3(3): 99-110.
- Abah, S.O. and Ohimain, E.I. (2010). Assessment of Dumpsite Rehabilitation Potential using the Integrated Risk Based Approach: A case study of Enugu, Nigeria. World Appl. Sci. J., 8(4): 436-442.
- Abdel-Salam, M.M. (2010). Hospital solid waste management in El- Beheira Governorate, Egypt. Journal of Environmental Management, 91(3), 618-629.
- Adegbite, M.A. Nwafor, S.O, Afon, A. Abegunde, A.A. and Bamise, C.T. (2010). Assessment of dental waste management in a Nigerian tertiary hospital. Waste. Manag. Res., 28, 769-777.
- Ajadike, J.C. (2003). “Pollution and management problems of Medical waste in Nigeria. In Adina, E. N. Bkop, O. B. and Aftah, V. I., (eds) Environmental Pollution and Management in the tropics. Lagos: Snaap Press Ltd pp. 243 – 252.
- Ajimotokan, H.A. and Aremu, S.A. (2009). Healthcare waste management. First annual civil engineering conference university of Ilorin, Nigeria, 26-28.
- Akinwale, C. and Sridhar, M.K.C. (2010). Increase in Healthcare facilities and rapid environmental degradation: A technological paradox in Nigeria‟s urban centres. African Journal of Environmental Science and Technology, 4(9), 577 – 585.
