FACULTY’S INSIGHTS

Improving Medical Waste Management in Healthcare Facilities: A Review of Current Practices and Strategies

Introduction

Healthcare Waste Management (HWM) is a significant issue in many of the world's developing nations. Health, safety, and environmental problems for all parties involved in such societies might result from shortcomings in HWM. The cost of managing healthcare waste worldwide is projected to experience a compound annual growth rate of 5.3%, increasing from $11.77 billion in 2018 to $17.89 billion in 2026 (RD Reports and Data, 2020). Several countries undergoing economic transition are anticipated to experience a significant surge in healthcare waste generation as a result of stringent government regulations and the ongoing COVID-19 pandemic (RD Reports and Data, 2020).

The already unsustainable growth in the production and disposal of medical waste was drastically intensified in 2020 by the COVID-19 pandemic, which poses an immediate risk that could potentially result in environmental pollution and a public health emergency if not adequately contained and managed. According to research, before the COVID-19 pandemic, more than 50% of the global population faced potential hazards from environmental pollution and public health concerns due to inadequate medical waste disposal. The World Health Organization (WHO) has reported that contaminated syringes have resulted in approximately 21 million new infections of hepatitis B, 2 million new infections of hepatitis C, and 260,000 new infections of HIV, which collectively account for nearly 32%, 40%, and 5% of all new conditions, respectively (WHO, 2018). Furthermore, a study conducted in 24 countries undergoing economic transition revealed that 18% to 64% of healthcare facilities do not employ appropriate methods for medical waste disposal. The study concluded that, on average, only 58% of facilities in 24 low-income countries had adequate and safe healthcare waste disposal procedures in place.

Hospital Waste Management

Hospital waste management encompasses the procedures involved in the proper handling and disposal of the various types of waste generated by healthcare institutions, including hospitals, clinics, and laboratories. Hospital waste can be categorized into infectious, hazardous, or general waste and necessitates specific handling and disposal practices to ensure the safety of healthcare personnel, patients, and the environment.

Effective hospital waste management practices involve the segregation, collection, storage, transportation, treatment, and disposal of different waste types in a safe and sustainable manner. The various kinds of waste generated by hospitals comprise infectious waste, such as contaminated dressings and used syringes, sharpswaste,such as needlesand scalpels, pharmaceutical waste,such as expired drugs, and chemical waste, such as disinfectants and laboratory reagents.

The hospital waste management practices implemented may differ depending on the geographic location and available resources of the healthcare facility, in addition to local regulations and guidelines It is imperative to have effective hospital waste management practices in place to prevent the transmission of infections and diseases, safeguard healthcare workers and patients, and minimize the adverse environmental impact of healthcare facilities.

Classification of Hospital Waste

Hospital waste can be classified into different categories based on its properties and potential risks. The most common classification of hospital waste includes the following categories: a. General waste: This includes non-hazardous waste similar to household waste, such as food waste, paper, and plastic. General waste poses a low risk of infection or contamination. b. Infectious waste: This includes waste contaminated with pathogens, such as blood, bodily fluids, and laboratory cultures. Infectious waste poses a high risk of infection and must be handled and disposed of carefully. c. Sharps waste: This includes waste that can puncture or cut, such as needles, syringes, and scalpels. Sharps waste poses a high risk of injury and infection and must be disposed of in specialized containers. d. Chemical waste: This includes waste that is by laboratory and diagnostic procedures, such as disinfectants, solvents, and heavy metals. Chemical waste poses a risk of chemical contamination and must be handled and disposed of in accordance with specific regulations. e. Radioactive waste: This includes waste that is generated by diagnostic and therapeutic proceduresinvolvingradioactivematerials,suchasnuclearmedicine.Radioactive wasteposes a risk of radiation exposure and must be handled and disposed of in accordance with specific regulations.

Methods to Manage Hospital Waste

a. Incineration: This involves burning waste materials at high temperatures to reduce the volume of waste and kill any infectious pathogens. Incineration is commonly used for infectious and sharps waste.

b. Autoclaving: This involves using pressurized steam to sterilize waste and reduce its volume. Autoclaving is commonly used for infectious waste and laboratory waste.

c. Chemical disinfection: This involves using chemicals such as chlorine or sodium hypochlorite to disinfect waste and render it safe for disposal. This method is commonly used for infectious waste.

d. Landfilling: This involves disposing of waste in aspecially designed landfill, where the waste is isolated from the environment. Landfilling is commonly used for general waste and noninfectious medical waste.

e. Recycling:This involves recovering valuablematerials from waste, such as paper,plastic, and metal. Recycling is commonly used for non-infectious medical waste, such as packaging materials.

The effective management of hospital waste requires reducing waste generation and implementing sustainable waste management practices, including waste reduction, segregation, and recycling. The appropriate waste management method depends on the type and volume of waste and local regulations. Planning and carefully implementing sustainable waste management practices can minimize the negative impacts of hospital waste on public health and the environment.

Precautions/ Practices

If you are involved in the disposal of hospital waste, it is important to follow certain safety guidelines to protect yourself and others. Here are some tips to keep in mind: a. Wear appropriate personal protective equipment (PPE): When handling hospital waste, it is important to wear gloves, gowns, and other PPE as required to minimize the risk of exposure to infectious materials. b. Follow proper waste segregation practices: Segregate different types of waste at the source to prevent contamination and ensure that each type of waste is handled and disposed of appropriately. c. Use designated containers for sharps: Sharps waste, such as needles and scalpels, must be disposed of in designated puncture-proof containers and labeled with appropriate warning signs. d. Do not overfill waste containers: Overfilled containers can pose a safety risk and may make it difficult to close and seal the container properly. e. Follow established procedures for waste handling and disposal: Make sure you are familiar with the procedures for handling and disposing ofdifferent types of hospital waste, and follow them carefully to minimize the risk of exposure to infectious materials. f. Properly label waste containers: Clearly label all waste containers with the appropriate waste category and other necessary information to ensure safe handling and disposal. g. Wash your hands thoroughly after handling waste: After handling hospital waste, be sure to wash your hands thoroughly with soap and water to minimize the risk of contamination. By following these safety guidelines, you can help to minimize the risk of exposure to infectious materials and protect yourself and others when handling and disposing of hospital waste.

Biomedical Waste Situation in India

In July 1998, the Government of India, through the Ministry of Environment and Forest, first announced the Biomedical Waste Management (BMW) rules. In India, the issue of BMW was made worse by the fact that scavengers would sort through open and unprotected healthcare waste without using gloves, masks, or shoes, with the intention of recycling it. Additionally, there was a problem with the reuse of syringes without proper sterilization (WHO-2004).

Between2002and2004, theInternationalClinical EpidemiologyNetworkinvestigatedtheexisting practices, setup, and framework for biomedical waste management (BMWM) in primary, secondary, and tertiary healthcare facilities (HCF) across 20 states in India. Their findings revealed that approximately 82% of primary, 60% of secondary, and 54% of tertiary HCFs in India did not have a credible BMWM system in place.

According to information found on the Government of India website, 484 TPD (tonnes per day) of BMW are produced nationwide from 1,68,869 HCFs. Sadly, just 447 TPD are treated. 37 TPD is not addressed, too. 28 CBMWTFs (Common BMW Treatment Facility) are currently being built, leaving 198 CBMWTFs in service. There are 1,31,837 HCF using CBMWTFs, and around 21,870 of those HCFs have on-site treatment centers.

According to the BMW Rules, 1998 and as amended, any HCF or CBWTF operator who wants to use other cutting-edge and improved technologies than those listed in Schedule I of the Rules must contact the Central Pollution Control Board (CPCB) to have the necessary standards established so that the required authority can consider granting authorization. For the treatment of BMW, the CPCB gave conditional or preliminary approval to new technologies between 2010 and 2013 (except than those that were disclosed under the BMW Regulations). They include sharp blaster (needle blaster), plasma pyrolysis, waste sharps dry heat sterilisation and encapsulation, and PIWS 3000 technology (Static/Mobile).

Conclusion:This article highlights the need for further exploration in the field of medical waste disposal to address the growing global demand for it. The rise in healthcare usage due to various factors has led to increased production of medical waste and put a strain on existing disposal systems. Current disposal methods involve sorting waste at healthcare facilities and treating it through incineration or autoclaving, which have drawbacks such as adverse environmental and health effects. To minimize the impact of medical waste, generating less waste is the most effective approach.

About Author

Prof. Swain is working as a Faculty Associate at IBS, Hyderabad. She has done her Ph.D in the area of Operational practices in Healthcare Sector. She has a total teaching experience of more than ten years. She has published many publications in national and international peer review journals..