Effective management of medical waste

For many observers, many Nigerian roads are filthy as they are filled with the carcasses of accident vehicles and all manner of rubbish thrown out of moving vehicles. But for many environmental experts, the health sector is among the worst culprits of poor waste management. They worry because medical and hospital waste have direct effect […]

For many observers, many Nigerian roads are filthy as they are filled with the carcasses of accident vehicles and all manner of rubbish thrown out of moving vehicles.

But for many environmental experts, the health sector is among the worst culprits of poor waste management.

They worry because medical and hospital waste have direct effect on human hygiene and easily pose a health threat to members of the public.

They say, for instance, that visitors to hospitals could suffer fresh ailments after inhaling odours oozing from blood-sucked bandages used to treat wounds or other blood-sucked operation equipment that are carelessly disposed by hospital authorities.

According to Dr Akin Fajolu, a Lagos-based Public Health Consultant, medical waste refers to waste generated from activities within healthcare facilities such as hospitals, clinics and medical laboratories.

Others include medical research centres, pharmaceutical industries and radiological centres.

According to him, a prime step toward effective health management must start from an effective management of the waste generated from the sector for the safety of the patients, the workers and the immediate community.

To do that, he says that medical authorities must give special attention to planning, procurement, staff training and behaviour.

The staff, he says, must also be trained on the use of tools, machines, pharmaceutical equipment and the proper disposal methods inside and outside the health facilities.

“t is very crucial that the medical authorities manage the waste well,’’ he says, adding that such is necessary to prevent exposure to toxins by the society.

According to him, 80 per cent of the total health wastes are similar to domestic waste, while the remaining 20 per cent are considered hazardous.

Mr Ola Oresanya, Managing Director, Lagos Waste Management Authority (LAWMA), agrees with Fajoku.

Oresanya says waste produced in the course of healthcare activities carries a higher potential for infection and injury than any other type of waste.

According to him, inadequate and inappropriate handling of it may have serious impact on the environment.

In view of its place in the overall health care effort, he suggests that it be made an integral feature of healthcare services.

He says that medical wastes could be solid, liquid or gaseous. He adds that they are normally generated during the process of diagnosis, immunisation, treatment and medical research.

Other avenues of generating waste, he says, include stocks and dishes as well as swabs used to inoculate cultures, slides; sharps: scalpels, lancets, needles, suture needles, broken glasses and vials.

“It could also be pathological waste like human or animal tissues, as well as organ or body parts removed during surgery, like placenta and umbilical cords.’’

Others include infectious wastes involving discarded cultures of infected patients, live or attenuated vaccine or serum, as well as discarded gloves.

Other categories of medical waste, he further says, are body fluid like blood, semen, vaginal secretions and medical hardware constituents like mercury in blood pressure machines.

They could also include thermometers, batteries, fluorescent lamps; and general waste like household waste and the recyclable; and emission from incinerators and kitchens.

Oresanya, who describes the hospitals as major generators of specialised waste, identifies other various sources of medical wastes to include laboratories, biotechnology institutions and production units, trado-medical centre, blood banks and collection centres.

Others, he says, include funeral homes and mortuaries, as well as dental laboratories.

According to him, a joint survey carried out in 2004 by the Federal Ministry of Health and an NGO — Making Medical Injection Safer — revealed that open dumping of infectious waste was observed in 83 per cent of the facilities visited.

“These dangerous practices provide an opportunity for equipment re-use and pose a health threat which is preventable with a good management system,’’ he observes.

He identifies current medical waste management systems in Lagos to include burning in open air, open pit burning, dropping in uncovered bins and the burying without treatment.

Other waste management methods, he says, include the use of cart pushers to transport waste, the use of unaccredited waste collectors, the washing in public drains, and use of cellophane bags for collection of waste.

To ensure effective management of medical wastes, he suggests an integral approach involving all stakeholders who will first segregate such waste based on categories.

Such segregated waste, he says, should be collected in identifiable containers, bins or bags of differentcolours.

According to him, the means of identification should be conspicuously displayed at each waste collection point to ensure proper procedure of transportation toward disposals.

He says that waste routes must be designated, while hospitals must find ways to effectively dispose the category that can be disposed internally.

“With such categorisation, different waste groups can be treated depending on costs, safety, the back up services and environmental acceptability’’.

Commenting on how lives could be saved with good healthcare waste management, Oresanya suggests a need to develop and plan a comprehensive healthcare waste management strategy.

He also suggests a planned and programmed waste collection treatment and disposal device, which are appropriate for waste type and local circumstances.

Other devices, he says, include the use of regional incineration facilities, as well as established training programmes for workers so as to support the quest for quality work.

On the benefit of good medical waste management, Fajolu says that it will reduce HIV/AIDS, sepsis and hepatitis transmission from contaminated needles and poorly disposed medical items.

He says that it will also control zoo-noses — a disease passed to human through insects, birds, rats and other animals.

Other benefits include reduced community exposure, prevention of illegal repackaging of contaminated needles, as well as the prevention of the long-term effect such as cancer from the release of toxic substances like dioxin and mercury into the environment.

On the control and prevention of hazards associated with the healthcare waste management, he suggests more enlightenment programmes on waste issues by training all key stakeholders.

“Such training will be particularly useful in the use and disposal of injection, the commonest instrument often abused,’’ he says.

He further suggests a reduction of medical waste via the selection of appropriate and sustainable methods of treatment and final disposal.

Mrs Abimbola Jijoho-Ogun, a LAWMA Official, who says the issue is of utmost concern. According to her, it must always be taken care of when budgets are being proposed for hospitals.

“Handling the waste from medical services must be a key components in the budgets of healthcare.’’

To make that possible, she says, however, that there is the need for a reliable data for use in healthcare waste management.

Supporting the LAWMA official, Dr Abimbola Showande, Country Director, John Snow Incorporated, an NGO, says that there is indeed the need for proper financial support toward proper medical waste disposal.

Dr Jide Idris, the Lagos State Commissioner for Health, believes medical waste management is crucial to meeting set goals in the sector.

He suggests the establishment of an effective and sustainable medical waste management plan in the country.

According to him, medical waste is not being properly collected and disposed by the healthcare providers.

Idris said that a monitoring team of health facilities recently confirmed this. He lists the risks and hazards of improper disposal of medical waste as numerous.

“As needle sticks and injures, so does improper waste management transmits diseases and infections like cholera, dysentery and environmental pollution,’’ he says.

For effective waste management in the medical sector, analysts suggest that the waste generators be encouraged to work with stakeholders and governments at all levels to agree on the best way out.

That way, they say, society will be freed from the hazards associated with the poor handling of medical wastes. (NANFeatures)