phd work 1.docx

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ASSESSMENT OF HOSPITAL WASTE MANAGEMENT OF SOME

SELECTED FACILITIES IN BAUCHI METROPOLIS

Ph.D. CIVIL ENGINEERING (STRUCTURES)

RESEARCH PROPOSAL

BY

USMAN ABUBAKAR

(PGS/201!201"/2/P/#0$#

DEPARTMENT OF CIVIL ENGINEERING

ABUBAKAR TAFAWA BALEWA UNIVERSITY% BAUCHI

SUPERVISORS&

PROF. A. U. ELINWA

(Ch'*'+ S,- C**33)

E+4. D. DUNA SAMSON

(M*5 S,- C**33)

APRIL% 2016

1


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1.0 INTRODUCTION

1.1& P'*57

The Establishment of a healthcare system is a basic requirement

of every civilized society. Food, medicines, chemicals, equipment

and instruments are used while treating out patients cum patients

admitted into Hospital. Naturally, this leads to production of a

variety of medical and non medical wastes. ppropriate

management and minimization e!orts need to be put in place to

reduce the quantity and volume of these types of waste. The ris"

associated with healthcare waste and its management has gainattention across world in various events, local and international

forums and summits. The genda #$ of the %nited Nations

&onference on Environment and 'evelopment (%N&E') in *io de

+ameiro, +une $#, also identi-ed healthcare waste as being

amongst the environmental issues of great concern to the global

community. &heng et al (#) noted that although medical waste

presented a relatively small portion of the total waste in a

community, its management is considered an important issue

worldwide. The %nited Nations Environment /rogram (%NE/)

argues in their 0nternational 1ource 2oo" on Environmentally

1ound Technologies for 1olid waste management that among

these wastes, healthcare waste is one of the most problematic

types.

The growing a3uence and increasing population concentrated

urban areas have increase the generation of all types of waste

including medical waste. &o"er et al (#) noted that as the

2


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demand for more healthcare facilities increases there is also an

increase in medical waste generation in Nigeria. 2abalola (#)

added that in developing countries li"e Nigeria, high H0450'1

prevalence, high morbidity among the general population has

resulted in high hospital admissions and as a result management

of the medical waste generated become a ma6or challenge in

most healthcare facilities. /oor conduct and inappropriate

disposal methods applied during handling and disposal of medical

waste is increasing signi-cant health hazards and environmental

pollution due to the infectious nature of the waste. ccess to a

clean environment has been recognized as being essential to the

improvement of healthy and social environment. The Federal

7overnment of Nigeria (F7N) has rapidly embar"ed on programs

for delivery of good sanitation to most cities town and villages

8lubu"ola (#).

0n recognition of the signi-cant of clinical waste management the

F7N through the Federal 9inistries of Environment and Health

(F98E and F98H) undertoo" a study on the management of

medical waste in $:, to assessing how critical waste could be

managed within referral and primary healthcare centers (&o"er et

al, #;). &onsequently in $


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vision to raise the environmental sustainability, human health and

natural resources, awareness to meet the needs of current and

future generations(&o"er et al, #>).

'espite all the e!ort to provide good sanitation and soundmedical management, Fadipe et al,(#) noted that numerous

aspect of clinical or healthcare waste management are found to

be haphazard and challenging in most frican Hospitals. &linical

waste is increasingly becoming a problem particularly in Nigerian

healthcare facilities (Ndubisi et al, #$). 0ndiscriminate dumping

of medical waste, clinical waste mi=ed with household waste and

this waste being conveyed using bare hands and transported in

open truc"s from some health facilities have been observed

(&o"er, #$$). 8lubo"ola(#$) noted that environmental quality

in Nigeria has deteriorated due to improper medical waste

segregation, collection, transportation and disposal methods used

in healthcare facilities. 9ongam( #$?) also added that improper

management practice are still evident from point of initial point of

generation, collection to -nal disposal. lthough, signi-cant

progresses have been made in healthcare waste management,

the e=isting healthcare waste management practices in Nigeria

still need a great deal of modi-cation and improvement.

This investigation wor" has been motivated by these

aforementioned challenges noted in medical waste management

practices in Nigerian healthcare facilities. 0t is hope that the

-ndings of this study will be used to bridge the "nowledge gap


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and improve on the medical waste management practice in

2auchi metropolis being the study area.

1.2& S3'3*+3 8 3h -57*

The non sustainable management of Healthcare waste (H&@)

has increasingly continues to generate public interest due to the

health problems associated with e=posure of human being to

potentially hazardous waste arising from healthcare. /resently,

considerable gaps e=ist with regards to the assessment of

healthcare waste management (H&@9) practices particularly in

Nigeria and in several other countries in subAsaharan frica. Thenature and quantity of H&@ generated cum institutional practices

with regards to sustainable methods of H&@9, including waste

identi-cation, segregation, collections, transportation, treatment

and -nal disposal are often poorly observed and documented in

several developing countries li"e Nigeria, despite the ris" posed

by the improper handling of the H&@ ( Farzadi"a et al, #). 0t is

also of serious concern that the level of awareness, particularly of

health wor"ers regarding H&@ has never been adequately

documented. The practical information on this important aspect of

H&@9 is inadequate and research on the public health

implications of inadequate management of H&@ are few and

limited in scope.BCocasay, #> and 8himain, #$) believed that

several hundred of tones of H&@ are deposited openly in waste

dump sites and surrounding environment, often alongside with

non hazardous solid waste. near total absence of institutional

arrangements for H&@in Nigeria has been by others (&o"er et al,

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$;). The poor segregation, handling and disposal practices of

many hospitals, clinics and health centers are li"ely

representatives of practices throughout Nigeria and this poses

serious health hazards to people living in the vicinity of such

healthcare facilities ('avid et al, #$#). /revious studies reported

that handling of waste at some healthcare facilities is haphazard,

with used of unacceptable methods of transport such as mortuary

trolleys (&lementina, #$D). 1tephen et al, (#$$) also added that

clinical waste has the potential to cause damage to most aspect

of the environment, especially to land, water, air and wildlife. 0t is

therefore, requires that medical waste be managed in a safe

manner using suitable treatment and disposal methods (8"e,

#>). 0t is against this bac"ground that the researcher wishes to

assess the medical waste management practices in 2auchi

metropolis healthcare facilities.

1.# 9,3:;'3+ 8 3h 3,


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The information and recommendations from the study could be

used to help in ensuring e!ective management of medical waste

in 2auchi metropolis healthcare facilities which could in turn help

to reduce ris"s to healthcare wor"ers, the community at large and

the environment. 0t is hope that the research -ndings may help

2auchi state 7overnment, departments and local authorities in

improving the e=isting policies and planning measures in order to

mitigate ris"s of improper management of medical waste. The

-ndings of the study could also enable the 1tate 7overnment

through the ministries of health and environment to address

identi-ed gaps and strengthen proper management of clinical

waste and could also help to supplement and complement the

e=isting "nowledge on clinical waste management system used in

2auchi metropolis healthcare facilities. @ith the site visits and inA

depth interviews to be conducted in the selected healthcare

facilities, sustainable medical waste management plan will be

proposed.

1.& A* '+< O5=;3

1..1& A*

The aim of this study is to conduct assessment of hospital

waste management practices and environment at some selected

healthcare facilities in 2auchi metropolis

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1..2& O5=;3 8 3h 3,


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number in 2auchi metropolis that registered with 2auchi state

ministry of health headquarters, 2auchi would be selected based

on the modi-ed methods of %nited Nations Environmental

/rograms5@orld Health 8rganization (%NE/5@H8, #:) and

Townend and &heeseman (#:) guidelines.

CHAPTER TWO

2. O LITERATURE REVIEW

2.1 P'*57


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8ne of the long standing and most challenging tas" for human

being is to live on a piece of land without spoiling it. Hospitals are

health institutions providing patient care services, and the public

seem to be unaware of the adverse e!ects of the garbage and

-lth they generate. 1harma (#>) added that it is ironic that

health facilities which provide succor to the ailing can also

generate various type of medical wastes. 9oving to # thcentury,

the advert of complicated diseases and ailments led to more

complicated medical waste being generated, which required more

organized methods of waste management. /oor management of

medical waste e=poses healthcare wor"ers, waste handlers and

the community to infections, to=ic e!ects and in6uries in addition

to environmental damages (/russ et al., $).

2.2 H'73h;' ?'3

Healthcare waste can be de-ned as the total waste stream that is

generated from healthcare establishments, health related

research facilities, laboratory and emergency relief donations.

Hospitals, clinics, laboratories, medical research centers,

pharmaceutical manufacturing plants, pharmacies, blood ban"s,

veterinary healthcare centers and nursing home healthcare

activities are some the generators of healthcare waste.

+ang (#$$) de-nes healthcare waste to include a number ofwaste materials such as blood soa"ed bandages, culture dishes

and other glassware, discarded needles and lancets, cultures,

stoc"s and removal body organs.

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1harma et al.,(#$) de-nes healthcare waste as waste arising

from medical, nursing, dental, veterinary, pharmaceutical or

similar investigative, treatment care or research practice. &o"er

(#) added that healthcare waste may prove hazardous to

those that come in contact with it. The term healthcare waste has

often been used interchangeably with other terms such as

medical waste, hospital waste, clinical waste, biomedical waste or

biohazardous waste around the world (6ang, #$$). 0n Nigeria, this

waste is generally "nown as healthcare, also @orld Health

8rganization (@H8) and other 0nternational bodies refer this

waste as healthcare waste, recognizing that all waste generated

from healthcare facilities are by product of healthcare activities

(&lementina, #$D). /russ et al., (##) used the term medical

waste as to deal with all types of produced by healthcare

facilities.

@aste generation from healthcare activities can be broadly

categorized general waste and hazardous waste (8gbonna et al.,

#$#).The ma6or portion of waste generated in healthcare

activities is composed of general waste that can be treated in the

same way as domestic waste. However, this remains true only

when proper segregation of waste is practiced according to the

type at source. There are di!erent estimates regarding the share

of hazardous and non hazardous waste constituents of healthcare

waste. 8be"pa et al., (#$#) and 1harma (#$?) estimated that

between >: and of the waste produced by healthcare

facilities is general waste comparable to domestic waste. 0n

addition Fadipe (#$$) reported that ;: of the waste produced

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in hospitals and clinics is non contaminated and pose no ris" of

infection. ccording to the @H8, between $and #:is

hazardous due to its composition. The remaining >:to

poses no ris" of infection transmission as it is comparable to

domestic waste.This mainly comprise waste produced in the

administration and house"eeping sections of the facilities.

Healthcare waste was further classi-ed into two ma6or categories

by @H8(#:)

$ Healthcare general waste is the proportion of healthcare waste

that is not hazardous and comparable to household waste.

# Healthcare ris" waste is the proportion of healthcare waste that

is li"ely to contain pathogenic organism in suGcient quantities to

cause diseases. This waste is commonly referred to as clinical

waste or biomedical waste in certain quarters and falls under

general cluster "nown as hazardous waste.

Healthcare ris" waste is further classi-ed into various other

types according to speci-c composition (8gbonna and %bani,

#$#).

0nfectious waste refers to waste which is suspected to

contain pathogens such as e=creta from patients and wound

dressing.

/athological waste consist of tissue, body parts, human

fetuses, blood and body uid

1harps are category of healthcare waste comprising of items

which can cause cuts and in6uries. These include needles,

scalpels and bro"en glass.

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&hemical waste contains residues of chemical used in

hospitals such as disinfectants and reagents used in

laboratories.

/harmaceutical waste contains remains of pharmaceutical

products such as e=pired drugs.

The below -gure shows how Hossain et al., (#$$) classi-ed

healthcare wastes which agreed with @H8 (#:) healthcare

waste classi-cation system.

F4, 2.1& C7':;'3+ 8 ?'3 8* h'73h;'

8';73 (H'+% 2011)

1#


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P7'3 2& P'3h74;'7 ?'3& ;+3 8 h,*'+ 3,

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problems facing the hospitals in developing countries in terms of

medical waste management were identi-ed

Kac" of necessary rules, regulations and instructions on

di!erent aspect of collection and disposal of waste. 9i=ing of hazardous waste with domestic waste of the

hospital.

Failure to quantify the waste generated in a reliable records.

Failure to use appropriate color bags thereby limiting the

bags used to one color for all waste.

bsence of dedicated waste manager and committees

responsible for monitoring medical waste management

practices.

Kac" of education and training on medical waste

management.

ssessment studies on medical waste management in developing

countries have detected several problems and defaults such as

segregation, handling and storage not appropriately conducted.

/ractices for waste minimization are poor, hazardous and

common waste are mingled and disposed in the open dumps or

land-lls, waste incinerators are not equipped with an emission

control apparatus, chemical waste is disposed through the public

sewage system and there are no sta! training programs (2abalola

et al., #$?). He added that some cleaners were found to salvage

used sharps, saline bags, blood bags and test tubes for resale or

reuse.

0n a study by &o"er et al., (#) in 0badan, Nigeria, it was

observed that the secondary and primary healthcare centers do

#6


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not practice any scienti-c disposal of clinical waste. Hospital

waste is often thrown in open garbage dumps or in nearby

dumps. @here waste is segregated by hospital sta!, it is done for

the purpose of retrieving useful items. This gives way to

malpractices as waste recycling by rags pic"ers and possible

reuse of used syringes has become accepted way of life. Hospitals

are currently burning waste or dumping in bins which are

transported to unsecured dumps.

*ag pic"ers in the hospital, sorting out the garbage are at a ris" of

getting tetanus and H04 infections.

#>


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2iomedical waste management strategies include planning

and organization characterization of waste and losses,

development of waste minimization option, technical andregulatory, and economic feasibility, implementation, monitoring

and optimization continued and outgoing evaluation of reaching

zero generation status.

0mplementing e!ective biomedical waste management

programmes require multi sectional cooperation and interaction

at all levels. Establishment of national policy and a legalframewor", training of personnel, and raising public awareness as

essential elements of successful healthcare waste management.

9anagement of healthcare waste should thus be put into a

systematic, multifaceted framewor", and should become an

integral feature of healthcare services.

Each hospital is required to develop a waste management

plan that provides for a thorough segregation and treatment of

waste. The main aims of biomedical waste management are

9inimizing ris" of personnel, general public and

environment.

9inimizing the amount of waste generated.

1egregation and separation of wastes

'esignation of deposit areas in the wards.

Establishment of safety routes for the transportation of

the waste.

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Establishment of a safe and proper area for the

temporary storage.

/roper waste treatment and disposal.

#.0 M'3'7 '+< M3h


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to be employed and showing how the research strategy addresses

speci-c aim and ob6ective of the study(2abu et al, #). The

research focuses on an assessment of medical waste

management at -ve selected healthcare facilities in 2auchi

metropolis. The research designs to be adopted by the study are

quantitative and qualitative (mi=ed method approach).

The mi=ed method approach involves both collecting and

analyzing qualitative and quantitative data and is practical in the

sense that the researcher is free to use all method possible to

address a problem('avid and 8gbonna, #$?). The method also

helps the researcher to lay out researcher questions,

methodologies, data collection and analysis needed to conduct a

research.

#.2 S3,


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Five healthcare facilities in 2auchi 9etropolis would be selected

as a representative of the healthcare institutions in the area.

1amples for the study would include three 7overnment and two

private owned healthcare facilities. The samples would be made

up of one referral or tertiary hospital, one secondary or specialist

hospital and primary health center owned by 7overnment, while

the remaining two are to be private clinics. 2y virtue of their

numbers, T2%,Teaching hospital(tertiary) 1pecialist hospital

2auchi (secondary) and %nder-ve primary health center

automatically will be included into the samples. For the purpose of

location and patronage, *eemee and msad clinics would be

selected.

#.#.1 S3,


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/opulat ion

1 izeONO(=P

y)

Health@or"ers

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leO.

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nci l lary1ta!Oy

Fig. ?.# 1trati-ed random sampling plan (Tayobo and 8yeniyi,

#$#)

#. D'3' C77;3+ '+< R';h I+3,*+3

4arious research instruments would be used to ensure reliability

and validity of data that could be collected. &are would be ta"en

to ensure that the research procedures are same at each

healthcare facility included in the study sample. The use of

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various research instruments may li"ely improve the quality of the

research -ndings and hence the enhancement of validity of data.

#..1 ,3++'

uestionnaire would be used to collect primary data from

sampled healthcare wor"ers and ancillary sta! of the selected

healthcare facilities. uestionnaires are to be used mostly to

gather information from "ey respondent on their views concerning

the types of medical waste generated, segregation at source,

collection pattern, storage and transporting style, treatment and

disposal methods and ris"s relating to medical waste

management practices. survey questionnaire is to be adopted

because it allows participants to give their views anonymously

and this reduces bias from the researcherJs owned opinion and

also with no verbal or visual clues to inuence the respondents

(1harma, #).

#..2 S3,;3,< I+3? G,


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of segregation, handling, collection and storage are being done

accordingly and if clinical waste receptacles would be provided,

wastes are deposited in appropriate containers, transported

correctly and incinerated according to %NE/5@H8(#:) technical

guidelines on medical waste management.

9easurements would be used to e=press observations numerically

in order to investigate casual relationship. 0tems to be measured

are to be quantity of waste generated and number of patients

who visit the facilities per day. The generated waste would be

measured by ensuring that the waste type generated is put into

preAweight separate container labeled for speci-c type of waste.

digital weighing scale would be used to measured the waste. n

average weight of seven days measurement will be used to

calculate the daily generated waste type per patient and per bed.

camera would also be used in collecting data from the -eld

observations. measurement5observation sheet would be used to

record data to be obtained.

#." P73 S3,


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#.6 D'3' P+3'3+ '+< A+'7 T7

'ata analysis is a practice in which raw data is ordered and

organized so that useful information can be e=tracted from it

(9ahasa and *uhigo, #$D). The types raw data of this researchto be measurements, questionnaire responses and observation to

be made. &harts, graphs and te=tural writeAups of data are to be

used to analyze the data. These method are meant to re-ne and

distill the data so that readers can glean interesting information

without needing to sort through all the data on their own.

1tatistical /ac"age for 1ocial 1cience(1/11) will be used topresent and analyze the data that would be collected. 1ervices of

a statistician may be employed during this phase of the research

process. The raw data will be presented in tables, bar chart graph

and pie chart. 9icrosoft e=cel would be used to produce these

tables and graphs. /lates will also be used to present the

collected data. &omments will be made on each -nding.

&orrelation coeGcients for the amount of waste generated versus

the number of patients who visits the healthcare facilities survey

would calculated. The method of data presentation to be used will

help to clarify data and draw new conclusions.


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INTERVIEW GUIDE& FOR ENVIRONMENTAL OFFICER

$ To what e=tent do healthcare facilities implement and comply

with the $< Nigerian Technical 7uidelines on medical waste

management

# Has the above document being evaluated to assess if it is

addressing all clinical waste issues

? 0s the Nigerian Technical 7uidelines commensurable with

0nternational 1tandard on Environmental issuesR

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D @hat are the ris"s that inappropriate clinical waste

management poses to the environment and human healthR

: How often does 21E/ monitor the management of clinical

waste in healthcare facilitiesR

< 0s clinical waste disposing same as municipal waste at land-llR

INTERVIEW GUIDE& FACILITY WASTE MANAGER/ HEALTHSAFETY OFFICER.

$ How many people visit your healthcare facility (H&F) per day

# @hat is the daily generation quantity of clinical waste in your

H&F

? How many in6uries related to clinical waste have been reportedin the past $# months

D How many health wor"ers in your H&F have received Hepatitis 2

vaccinationR

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: How often is clinical waste collectedR

< 0f the clinical waste is not collected as scheduled, what do you

do with it.

> 0s clinical waste storage accessible to any person or scavengerR

; 'o you record any clinical waste management informationR

How often is inAservice training on clinical waste management

for health wor"ers doneR

$ @ho is responsible for providing a continuous clinical waste

training for for the health wor"ersR

$$ How do you manage ris" associated with clinical wasteR

$# 'o you chec" if clinical waste collected is properly incinerated

before -nal land-ll disposalR

$? @hat are the problems that you encounter in managing clinical

wasteR

$D @hat are the initiatives ta"en for e!ective managing clinical

wasteR

INTERVIEW GUIDE& PERSONNEL RESPONSIBLE FOR

CLINICAL WASTE COLLECTION AND DISPOSAL

$ How often do you collect clinical waste in this H&FR

# How much waste do you collect in Cg5dayR

? 0s the clinical waste you collect, segregated at sourceR

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D @here is clinical waste store, waiting for collection and disposal

: How secure are the clinical waste storage facilities

< @hat do you used in transporting the clinical wasteR

> is the transportation of clinical to designated

; @here is clinical waste treatedR

'id clinical waste handlers received any training in

management of clinical wasteR

$ re waste handlers provided with protective clothing when

handling clinical wasteR

$$ 'o waste handlers receive any vaccination against hepatitis 2

$# @hat are the ris"s associated with clinical waste that have

been encountered by the past $# months.

$? @hat are the problems that you encountered in collection and

disposal of clinical waste.

$D @hat recommendations would you give for the improvement

of medical waste managementR

OBSERVATION/MEASUREMENT SHEET

PLACE OF OBSERVATIONAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA

DAY $ # ? D : < >DATEuantity of clinical

waste generated per

"#


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dayNumber of outpatient

per day1ources of clinical

waste1egregation of waste at

source ME1 or N82ags &ontaining waste

Asecured fastened

Anot securely fastened

A/laced at the right

placeAleft for too long1upply of receptacles

dequate5inadequate

Ared plastic

Asharp container

/edal bins

8thers specify%sed of color coded

and labeled receptacles9ode of transport to

storage place

Ause of hand

Apedal bins

Aother specify%sed of protective

clothes when handling

wasteTypes of protective

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clothing used&linical storage room

Asecure5insecure

Aventilated5not

ventilated

Apresent of scavengers

Apresent of worms, ies

and animals

A/resent of leachates

Awaste spilling1tate of waste

Arotten

Asmelling

Adry&ollection

Acollected5not collected1torage room,

bins5trolleys cleaned

after collection@aste transportation

o!site

Aused designated

vehicle

Aused any vehicle

/resence of incineratorAincineration procedure

followed5not followed

Aresidues collected to

land-ll5not collected

""


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