Hospital waste

Hospital or healthcare waste is the by-product of health services rendered to the population by healthcare providers like public and private hospitals, general medical practitioners, academic and research institutions, medical laboratories, blood banks and blood collection services and other associated establishments.
Waste generated by healthcare activities includes a broad range of materials, from used needles and syringes to soiled dressings, body parts, diagnostic samples, blood, chemicals, pharmaceuticals, run-down medical devices and radioactive materials. The considerable amount of this waste generated during the process of healthcare services' delivery is hazardous both for human health and environment, as it causes environmental pollution, hence need to be disposed of properly and in a specified way.
The World Health Organisation has classified medical waste into different categories, which are, infectious, sharps, pathological, pharmaceutical and radioactives.
According to Dr Imran Khan (Indus Hospital), an expert in hospital waste management, there are several categories of infectious waste produced during the delivery of healthcare services, such as human tissues and body parts, animal carcass, syringes, blades, saws, drugs, vomits, urine, chemicals and fluid from laboratories.
He says that this kind of infectious waste of the hospitals/healthcare establishments is needed to be segregated from the solid waste and stored in special containers so that it could be disposed of in the specified way. Poor management of healthcare waste potentially exposes healthcare workers, waste handlers, patients and the community at large to infection, toxic effects and injuries, and risks polluting the environment. It is essential that all medical waste materials are segregated at the point of generation, appropriately treated and disposed of safely. But the situation at health facilities of the largest city of the country is pathetic as far as the management and disposal of the healthcare waste is concerned. Even the major public sector healthcare facilities have either no proper system of management and disposal of the waste or whatever system they have is non-functional. No proper and modern waste management system is in place in the public and private sector hospitals except one or two.
Dr Qaiser Sajjad, Central Finance Secretary and former President Pakistan Medical Association (PMA) Karachi chapter, says that there was not a single hospital in the public sector and even in private sector (with the exception of one) in Karachi where the hospitals wastes were segregated or disposed of as per the international standard and Hospital Management Rules 2005 or a modern and scientific waste management system was in place.
Usually two methods are being used to dispose of the hospital waste ie landfills and incineration. In landfill method, hospital waste is buried underground but according to health experts overwhelming majority of the landfill sites are not constructed on scientific lines. Incinerators installed at various places also do not have proper filters and scrubbers and when hospital waste is burnt, toxic gases like dioxin and chemicals are discharged in the air which can be potential carcinogen.
According to Dr Imran, only Agha Khan Hospital Karachi has a proper waste management system and functional incinerators to burn the infectious waste. Health experts recommend that the hospital waste should be segregated from the solid waste and stored in special containers. Proper landfills should be constructed and all incinerators working without filters and scrubbers should be immediately shut down.
A visit to three major public sector hospitals of the city, Jinnah Post Graduate Medical Centre (JPMC), Civil Hospital Karachi (CHK) and Abbasi Shaheed Hospital (ASH) revealed that there was no proper and functional waste management system. The incinerators of CHK, and Abbasi Shaheed hospital are closed for a long time.
There is no proper monitoring of the waste disposal process in these public sector health facilities, as one can find even the hazardous/infectious waste in the premises or adjoining areas of these hospitals. A detailed visit to and adjoining areas of JPMC, CHK and ASH revealed that the hospital waste is thrown out in the dustbin/collection points of municipal waste, as there were used syringes, blades, saws and other materials mixed with the municipal waste.
At a collection point of a municipal waste in Bazerta Lane, a locality adjacent to JPMC, children were playing with used syringes. The situation at other hospitals is also the same. When Medical Superintendent (MS) Civil Hospital Saeed Qureshi was contacted, he said that due to construction work, the incinerator of the hospital was closed. He said that healthcare waste generated at CHK was given to Karachi Municipal Corporation for burning out at its incinerator, for which it has been paid. But the hospital sources said that large portion of the waste, which can be recycled or reused, is sold out. Sources said that the incinerator at JPMC was also non-functional, but the management said that the incinerator was operating and hazardous waste was being burnt safely. Director Administration JPMC Chaudhry Ikram says that the incinerator is being run for about eight hours daily. Over 100kg of infectious waste is being brunt safely on the scientific lines at the incinerator.
The infectious healthcare waste is a major cause of HIV/AIDS, hepatitis B and C and viral infections. These viruses are generally transmitted through injuries from needles and sharp objects, which are contaminated with human blood, said Dr Qaiser Sajjad. There are, however, numerous other diseases which could be transmitted by contact with healthcare wastes. These are urinary tract infections, respiratory tract infections, wound infections, bacteraemia, and skin infections etc, he added.
He maintained that major portion of the hospital waste is thrown out in the municipal waste collection points. "There are more than three thousands scavengers in the city who can be seen searching for recyclable waste items in garbage bins in various city localities.
As infectious waste such as needles and other chemical materials thrown at these garbage bins, scavengers get injured due to needles and contract Hepatitis and other infectious diseases unknowingly," he added. Dr Imran pointed out to another aspect of the issue. According to him, unsafe disposal of used syringes, blades etc leads to their reuse enhancing the risk of disease transmission.
"Unsafe disposal of the hospital waste is said to be one of the major reasons that we have high prevalence of hepatitis B and C infections, particularly among healthcare workers," he added. Sources said that there was a potential market of healthcare waste in recycling business. Plastic ware industry is the biggest buyer of used syringes, infusion and blood bags. Sources said that handlers of waste at healthcare facilities are involved in selling the waste to people engaged in recycling business.
They said that there are about 300 units in New Karachi and other areas of the city, which are involved in recycling of hospital waste especially plastic and syringes, blood bags infusions. A worker of one such unit told Business Recorder that even water coolers, hot pots and other plastic utensils were made of hospitals' plastic waste.
Any healthcare waste left by scavengers is either taken for final disposal by municipal authorities in open trucks or burned in a smoldering fire, polluting the environment. Even before this process takes place, dogs, cats and birds flock the community waste sites in search of food, contribute to further spread of infectious materials in the locality.
It is an irony that Karachi Municipal Corporation (KMC), which has a major incineration plant, but most of the private and public sector hospitals dumped their waste in open spaces or dispose of it with municipal waste. Dr Shaukat Malik, member PMA's executive committee, said that there were guidelines for hospital waste management in Pakistan in the form of Hospital Management Rules 2005, prepared by the Ministry of Environment in consultation with the Environmental Health Unit of the Ministry of Health, and other stakeholders covering all aspects of safe hospital waste management, including the risk associated with the waste, formulation of waste management teams, their responsibilities, collection, segregation, transportation, storage and disposal methods. But, he deplored, these rules are not followed by healthcare facilities providers.
The situation is alarming which needs immediate action on part of the government, concerned authorities and health facilities' providers. Though the major hospitals and healthcare facilities could have their own waste management and disposal systems, but small hospital, clinics, laboratories, blood banks and others could not afford such a facility, hence the government needs to set up centralised disposal points for hospital waste in 18 towns of Karachi.
Though the KMC provides a disposal service that collects and incinerates waste from hospitals for a fee. Despite this, most hospitals prefer to dump their waste in the open. The practice is highly hazardous. There is a need for awareness about hazards of such waste among all high-risk groups. The government and concerned authorities are required to launch crackdown on the trade of recycled syringes and other waste.