dr. said el quliti - a general procedure for assessing and improving the efectiveness of medical...

A General Procedure for Assessing and Improving of Medical Waste Management

Dr. Said Ali El-QulitiProfessor, Dept. of Industrial Engineering,

King Abdulaziz University, Jeddah, and

Professor, Operations Research and Decision Support Dept., Faculty of Computers and Information, Cairo University

A General Procedure for

Assessing and Improving of

Medical Waste Management

 Agenda

Agenda1- Hazardous Medical Waste.2- Types of Hazardous Medical Waste.3- Dangers of Medical Wastes.4- Disposal Methods for Medical Wastes.5- General Guidelines (How to Deal with Medical Wastes).6- Assessing the Medical Waste Management Systems.

6.1 Data Collected 6.2 Assessed Parameters:

•Typology of Respondents.•Estimated Healthcare Wastes.•Segregation and Classification of Medical Wastes.•Medical Waste Storage Tools.•Disposal Methods for Medical Wastes.•Hours Spent in Management of Medical Wastes.•Cleanliness of Health Facilities. •Knowledge of Health Workers on Medical Wastes.

6.3 Final Evaluation of the System.

•Medical Solid Waste are similar to household wastes.• Hazardous waste, represents 20% of medical

waste.

The UN, the World Bank and the World Health Organization (WHO) define medical waste as hazardous if: toxic, infectious, incendiary, or cause allergies or cancer.

1- Hazardous Medical Waste

2- Types of Hazardous Medical Waste

a) Pathological, infectious or contaminated wastes,b) Hazardous chemical wastes,c) Radioactive wastes.

a) Pathological, infectious or contaminated wastes Pathological Waste

• Remnants of delivery rooms.

• Human organs and tissues.

• Eradicated tumors.

• Blood and body fluids.

Infectious Waste• Infectious germs (bacteria - Viruses - parasites - fungi):

bacteriological farms, viral laboratories and remnants of experimental animals.

• Waste of isolation patients (infectious diseases).• Remnants of dialysis room.• Remnants of the operating rooms: Masks and shoe covers, gloves and so on.• Remnants of the dental injection, cups, gloves and so on.• Contaminated instruments such as the esterification of all kinds -

medical dressing, gauze and cotton - Transmission of blood instruments.

• Gypsum, and leftover tools contaminated with patient's body fluids and secretions.

Contaminated WastesCause wounds, scratches or holes. Such as:Syringes, Scalpels, instruments of medical solutions, broken glass, ampoule, Slides, … and so on.

b) Hazardous Chemical Wastes• Resulting from medical activities:1. Formaldehyde.2. Waste chemical substances used in X-rays.3. Organic solvents such as methylene chloride - chloroform.4. Organic chemical wastes such as some disinfectants

and detergents.5. Inorganic chemical wastes, such as acids

and alkalis: sulfuric, hydrochloric and nitric acids.6. Highly toxic heavy elements:– Mercury compounds: produced from broken medical

instruments such as thermometers, damaged blood pressure measuring devices, and the remnants of dental fillings.

– Ray films Waste (raw or used films)

c) Radioactive wastes

Include wastes containing radioactive materials, such as:• Radium needles - 226, and • Cobalt tablets- 60 .

3- Dangers of Medical Wastes• They are filled with microbes and viruses transmitting diseases, especially those that are transmitted by blood.• A reason for the breeding of insects, flies and rodents, and

the expansion of diseases to wider areas.• The plastic materials (needles, syringes and bottles)

when burning leads to the emission of carcinogenic substances such as dioxin.

• The wrong way to deal with medical wastes may lead to infection with dangerous diseases as AIDS and Hepatitis transmitted by blood.

4- Disposal Methods for Medical Wastes

4-1 Sanitary Landfill

4-2 Burning

4-3 Sterilization

a) Sterilization by Steam and High Temperatures

b) Infrared (or Ultraviolet) radiation Sterilization System

4-4 Disposal of Radioactive Waste

4-1 Sanitary LandfillAn earth pit isolated from ground water to protect it from pollution. The base is equipped with a network for water discharging resulting from rain and decomposition of organic materials. A layer of gravel and sand is placed over the network to facilitate entry of water into the drainage network. Waste is primary treated, distributed on the base of the hole and pressed to reach the amount of 0.8 - 1.0 tons per m2.

Advantages:1 - Low cost and ease of application, no high-tech.2 - Absorb massive amounts of solid wastes.3 - Replanting the area with trees.4 - Access to methane.

Sanitary Landfill (Cont’d.)

Disadvantages:1 - Leakage of air pollutant gases: methane, carbon dioxide.2 - Possibility of contamination of water sources by

waste water resulting from landfill.

4-2 Burning• Able to treat many types of medical waste, except:

Radioactive materials, mercury and compressed containers.• The best way is to burn at a temperature of 1200

° C for two seconds only.• Avoid burning in bad incinerators or burn randomly,

this leads to the formation of dangerous dioxin.

• Incineration is not a solution to the problem, it is a simple transfer of pollutants from waste itself to the smoke and ash. • The ash contaminates soil and groundwater.

Burning Method Disadvantages:

4-3 SterilizationThe recent methods for safe disposal of medical wastes. This method has become a trend in the world

Sterilization ways:a) Sterilization by Steam and High Temperatures• Environmentally safe for all medical

wastes except anatomical parts and animal contaminated bodies because the steam can’t penetrate.• Not suitable for handling hazardous radioactive materials,

or toxic wastes.

b) Infrared (or Ultraviolet) radiation Sterilization System

Each hospital or clinic is provided with an empty plastic box, When filled, put into the sterilization unit, it comes out in the form of ordinary waste.

4-4 Disposal of Radioactive Wastes1. Keeping the radioactive material in an

insulated and sealed bowl , then set aside to lose half-radioactive-life.

2. Kept in a more compact and insulating box, and then buried in the soil.

5- General Guidelines (How to deal with medical wastes)

1.Segregation of medical and non-medical wastes within the health facility until dealt with according to seriousness.

2- Color Coding

General Guidelines (Cont’d.)

3- Collection of sharp and contaminated materials in small containers with lid (Yellow containers), containers are of reinforced plastic and should not be filled fully. Then send to treatment , rather than throw in the regular garbage bags.

Containers should be far from beds of patients.

General Guidelines (Cont’d.)

4- Location of the temporary waste collection area in health facilities away from food stores, restaurant and kitchen.

Not to store medical wastes in open spaces, preferably in an enclosed ventilated space.

General Guidelines (Cont’d.)

5- Use and Reformation of modern waste disposal instruments (like incinerators and sterilizers) in hospitals and regularly maintaining or replacing.

General Guidelines (Cont’d.)

6- Use advanced recent methods to treat some wastes instead of burning, such as sterilization before putting them in bags and dispose.

General Guidelines (Cont’d.)

7- Liquid wastes (solvents) should not be thrown in public network before primary treatment, to avoid damage of the network and the environment.

General Guidelines (Cont’d.)

8- Put unusable units of blood (expired or virus infected blood) in reinforced yellow bags until properly disposed.

General Guidelines (Cont’d.)

9- Expired drugs or bad stored should be returned to the supplier. Not disposed with household garbage.

General Guidelines (Cont’d.)

10- Arrange awareness and training programs, on the dangers and managing of medical wastes for: workers, nursing staff and administrators of health facilities.

6- Assessing the Medical Waste Management Systems

6.1 Data Collection. 6.2 Assessed Parameters.6.3 Final Evaluation of the System.

6.1 Data Collection• Primary data: interviews, and observations. • Secondary data: documents. • to examine the performance of medical

waste management tools in: collecting, storing, transporting and treating the medical wastes, and to examine knowledge of health workers.

• Typology of Respondents.• Amount of Healthcare Wastes.• Segregation of Medical Wastes.• Medical Waste Storage Tools.• Disposal Methods for Medical Wastes.• Hours Spent in Management of Medical Wastes.• Cleanliness of Health Facilities. • Knowledge of Health Workers on Medical Wastes.

6.2 Assessed Parameters:

Typology of RespondentsTypology Category Typology

Characteristics Response (%)

Age (Years) 21 – 30 31 – 40 41 – 5050 +

Education Level PrimarySecondary DiplomaB.Sc. degreeGraduate studies

Working experience (Years)

1 - 34 - 1011 – 1515+

Amount of Healthcare WastesLevel of Health facility

Waste excluding

sharps

Sharps (Container)

Garbage from wards

Hospital (kg/bed/day)

Health Centers (kg/person/day)

Dispensaries (kg/person/day)

Healthcare level

Status for segregation of medical wastes

Total

Segregated Mixed %

Hospitals 100

Health centers 100

Dispensaries 100

Total 100

Segregation of Medical Wastes

Classification of Medical Wastes

Health facility level

Status of medicalwaste tools Total

Color coded Not color coded %

Hospitals 100

Health centers 100

Dispensaries 100

Total 100

Medical Waste Storage Tools Plastic Metal Non

Safety boxes

Waste Pit

Available %

Functioning %

Status of Medical Waste Disposal Tools

Level of Health facility

Status (%)Good Fair Bad

HospitalHealth CentreDispensaries

Disposal Methods for Medical Wastes

Level of Health facility

Sanitary Landfill

Burning Sterilization Disposal of Radioactive

Waste

Temporary Waste

Collection Area

Hospital

Health

Centre

Dispensaries

Hours Spent in Management of Medical Wastes

Health facility level 

Hours spent in management of medical

wastes (%) Total

1-2 hours

3-5 hours

6-8 hours

Hospitals 100Health centers 100Dispensary 100

Total 100

Cleanliness of Health Facilities

Healthcare level

Cleanliness Total (%)High Moderate Poor

Hospital 100

Health centre 100

Dispensary 100

Total 100

Knowledge of Health Workers on Medical Wastes

Healthcare level

Knowledge Level Total

High Moderate Poor %

Hospital 100Health centre 100Dispensary 100Total 100

6.3 Final Evaluation of the System

Degrees Weight Marks

1 Typology of Respondents.

2 Estimated Healthcare Wastes.

3 Segregation and Classification of Medical Wastes.

4 Medical Waste Storage Tools.

5 Disposal Methods for Medical Wastes.

6 Hours Spent in Management of Medical Wastes.

7 Cleanliness of Health Facilities.

8 Knowledge of Health Workers on Medical Wastes.

Total

Hospital: ……………………………..

Hospital Health centre Dispensary Others

1

2

3

…

…

…

Total

City Evaluation

Final Assessment of Medical Waste Management System

Final City Evaluation

Recommendations for Improving