Friday, September 25, 2009

Our Hospitals and Health Care Waste

By Sani Garba Mohammed

Hospitals are places where healthcare services are provided ranging from curative, preventive, rehabilitative and promotive. The hospital[s] can be specialist, teaching, general etc. Hospitals have different department that manage the various activities taking place in it, there are administrative, medical, nursing, social services and others. The least department you will find in our hospitals [if any], is environmental health department, I said this because; hospitals administrators/health ministries do not regard environmental health services as important in their management despite its relevance in hospital[s] setting. They tend to see hospital as only where a patient will see a doctor, or become hospitalised to cure his/her illness, and or carry a research on patients, no more no less. As a result, various biomedical/healthcare wastes are being generated in these hospitals with little or no attention being paid to it. Some of our hospitals are dirty, full with filth, produce offensive odour and other controllable environmental hazard, yet nothing is being done to checkmate the situation.

This article will look into health care waste, their risk, the relevance of environmental health in health care wastes management, and what to be done to control them and makes our hospital in healthy and habitable environment.

Healthcare waste according to WHO are “total waste stream from a healthcare or research facility that includes both potential risk waste and non risk waste materials”. The risk waste includes but not limited to the following: infectious waste, anatomical waste, sharp waste, chemical waste, pharmaceutical waste. The non/low risk waste include those solid waste that does not contain high-risk waste types like infectious, examples are, office paper, packing materials etc.

The risk and hazards of biomedical waste include needle stick injuries [through recapping, mishandling of needle and using unsterile syringe and needles], transmission of disease [infection like HIV/AID, Hepatitis], re-using of some types of waste, e.g. syringes and needles [accidental or intentional], environmental pollution [air, water and land], radiation exposure, fire outbreak, public nuisance [offensive smells, unsightly debris], nosocomial infections etc. 

With all these risk and hazard associated with biomedical/healthcare waste, it is unfortunate that our hospitals have no reliable and dependable standard of controlling it. Those charge with handling of the waste [in case if any], are non-professional and to some extent ignoramus about the danger of the waste they are handling. 

In most cases the biomedical waste are not properly organized in term of it minimization, segregation [as in non-infectious waste, infectious waste, sharp waste] etc, handling and storage, because of lack of professional that can supervise and handle the issue effectively and efficiently. All these duties are work of environmental/public health department, to be supervised by Environmental Health Officers, but they could not be found in our hospitals.

A survey in Kano state hospitals [general and specialist], reveals that none of them has any department of environmental health, to carry out these activities; all these work are under different department likes works or general services, which receives less attention because of the ignorance of authorities concern. The federal hospitals in Kano, that is Aminu Kano Teaching Hospital [AKTH]and National Orthopaedic Hospital [NOH], Dala, all have department of environmental health, but only AKTH has equip staffs and working materials. This survey shows our hospitals institutions do not have environmental health department, and where there is, their duty is restricted to only one aspect-making environment look clean. I am sure this survey is also applicable in most Nigerian states.

Is environmental health not an aspect of health control that deserves to be look after, why paying lip service to it, is our responsible authorities aware of this biased against environmental health control in our hospitals? The answer to these and more question will determine whether our hospitals are worth being taken care of.

It should be noted that proper health care waste management minimizes the spread of infections and reduces the risk of accidental injury to staffs, patients, visitors and the community; reduces the likelihood of contamination of the soil, or ground water with chemicals or micro organism; attract fewer insects and rodents and does not attract animals; reduces odours; and helps provide an aesthetically pleasing atmosphere. As such, the importance of biomedical/healthcare waste control cannot be overemphasized. 

No matter how much we invest in equipping our hospitals with work force, working materials etc without investing in the hospital environment, by creating environmental health department with adequate environmental health practitioners, the maximum outcome of our hospitals services will be partial.

Key steps in biomedical/healthcare waste are waste minimisation, segregation, handling and storage, transportation and disposal.

Waste minimisation: this is the best way to minimize waste, i.e. all purchase of materials and supply be made with waste reduction in mind and all action to be taken in the hospital environment that will result into waste should be monitored and control to make sure it is reduces to the barest level, using the available technology in the hospital. This will reduce environmental impact on air pollution and land fill capacity.

Segregation: This is the system of separating waste type at the place where it is generated, for instance, the dustbin/container designed for non infectious waste like paper/packaging materials, bottles/cans, garbage should be different with the bin that is designed for infectious waste like gauze/dressing, anatomical waste etc. So also, sharp waste like needle, scalpel, blade etc. The National Environmental Health Practice Regulation 2007 specified colour coding for different types of waste, Black for non infectious waste [like paper, bottles etc], Yellow for infectious waste [like gloves, body fluids etc], Green for recyclable/organic waste [like metal, plastic can, leaves etc] Red for highly infectious waste [like pathological and anatomical waste etc], Brown for chemical waste [like formaldehyde, solvents, etc] and Yellow [with radioactive label] for radioactive waste. As such, this should be observed in our hospitals were applicable.

 The waste should be handle in the safest way by persons responsible for handling and storage. The handlers must never engage in handling the waste without putting personal protective equipments [PPEs], and should never sort through the waste after it has been place in the bin. The storage should not be in such a way that it will not pose a danger to the handler and others within the hospital and the surrounding. The dustbin/container should be durable, resistance to heat and water, have a well fitting lid, be washable and portable. It should also be lined with colour-coded placed at convenient location, not to be used for any other purposes in the healthcare facilities, and be decontaminated, cleaned and disinfected after each use.  
I am sure if these measures would be adopted, certainly an appreciable level of sanity would be achieve in our hospital
Lastly, for these measures to have a greater impact, all our hospital should as a matter of urgency creates office of Environmental Health services by employing adequate number of Environmental health officers, in line with National Environmental Health Services Regulation provision, section 95, subsection 1 and 2.