Improving Hospital Waste Management System

Hospitals are synonymous with hope and healing. In addition to the services they provide, they generate various types of waste daily. Unlike general waste, they generate hazardous, infectious, and often lethal waste that must be treated and disposed of correctly. In developing country including Nepal, management of hospital waste has not been given due importance, which may pose several critical issues of public health and environmental challenges.  It is, therefore, demanding urgent attention.

There are two broad categories of hospital waste. The first category includes general waste such as paper, packaging, and leftover food, and the second category includes hazardous waste such as infectious materials, sharps like needles, chemical waste, pharmaceuticals, and pathological waste. About 10-25 per cent of hospital wastes are generally hazardous as per the World Health Organisation; however, if mixed with general waste, the entire waste becomes risky and hazardous.

Waste generation

In most of the developing countries, hospitals and healthcare facilities are expanding rapidly. Along with the expansion of facilities, the amount of waste generation increases exponentially. The Kathmandu valley serves as a medical hub with increasing numbers of both public and private hospitals, but often ignores the importance of hospital waste management, which is not adequate in most of the hospitals.

The government has formulated national guidelines such as “Hospital Waste Management Guidelines, 2009” and “Healthcare Waste Management Standards” in order to safely handle hospital waste. These documents provide a framework for hospital waste segregation, collection, storage, treatment, and disposal. However, the reality is different and often not adequate.

The problem lies in smaller and mainly under-resourced hospitals where waste segregation at the source is inadequately practiced. Oftentimes, hazardous and infectious waste are mixed with general waste owing to a low level of awareness. There is an absence of colour-coded containers and a low level of awareness and inadequate knowledge among healthcare workers, particularly cleaners and waste handlers, who are given responsibility to manage both hazardous and general wastes. Besides, there lacks sufficient personal protective equipment.

It is to be noted that improper hospital waste management is not only an environmental issue but also a public health hazard. Infectious waste such as syringes, bandages soaked with bodily fluids, contaminated gloves, and pathological leftovers can directly expose cleaners and waste handlers to deadly pathogens. On the other hand, needle-stick injuries resulting from improperly disposed sharps can transmit diseases such as HIV, hepatitis B, and hepatitis C. The problem increases exponentially when hazardous waste is mixed with general waste.

Improper hospital waste disposal also exposes the community at large. Hospital waste dumped in open pits or mixed with municipal waste can contaminate all air, water, and soil. Another area of concern is open space burning of medical waste that releases dioxins and furans, which are highly toxic compounds associated with respiratory ailments and even cancer. In cities where drainage and waste system is not adequate, medical waste often compounds sanitation problems and infectious risk to the general public.

Several factors hinder effective hospital waste management. Small and resource-limited healthcare settings often lack waste management facilities such as incinerators and autoclaves. Poor maintenance and poor emission controls compound the problem.

Moreover, training on waste segregation, proper disposal, and techniques of risk reduction to the waste handlers is often inadequate or inconsistent. At the same time, there lacks a system for regular inspections due to manpower shortage and penalties for non-compliance. In many of the healthcare institutions, investment in waste management technologies and recurring costs for safe disposal are not prioritised. Informal waste pickers are also at risk of contamination and infections.

People who are most vulnerable, such as cleaners, waste handlers, and informal waste pickers, bear the brunt of inadequate waste management. Most of the waste handlers who are often from a socio-economically disadvantaged cluster work with waste without proper personal protective equipment, which includes gloves, masks, boots, or training. On the environmental aspect, a poor hospital waste management system contributes to the pollution of soil, water, and air.

Waste treatment infrastructure

All stakeholders from the government, healthcare institutions, communities, and international partners should work collectively to address this issue. The government should prioritise strengthening waste treatment infrastructure, such as autoclaves and incinerators. However, these technologies should be made mandatory depending on the scale and waste profiles of the hospital.

All hospital employees should be made aware of the importance of proper hospital waste management. Regular training programmes must be institutionalised that include practical demonstrations. Refresher training is equally important, particularly for waste handlers. Waste segregation at source should be made non-negotiable. Regulatory bodies with adequate manpower should conduct regular audits and enforce compliance.

Equally important is to acknowledge the hospital’s performance through recognition and certification. It is also important to make patients and family members visiting hospitals aware of waste segregation practices. A wall chart or public campaign can help increase responsible behaviour among visitors.

The harmful effects of poor medical waste practices are well documented, though proper management is not effectively practiced at all levels. The practical solutions are accessible and achievable with collective efforts. It is, therefore, called upon all the stakeholders to cooperate and work collectively in order to make the hospital a true place of hope and well-being.

(Dr. Lohani is the clinical director at the Nepal Poison Information Centre. lohanis@gmail.com)