Mishandling medical waste is a leading cause of diseases

medical waste

Proper disposal of healthcare waste could slash hospital admissions

Saturday October 26 2019

Close to a third (29 percent) of health facilities do not safely dispose of medical waste, exposing healthcare workers, patients, waste handlers, and communities to health risks, reveals a Nation Newsplex review of health service delivery data.

Even though waste management is an integral part of hospital hygiene and infection prevention and control, four in five facilities lack guidelines on healthcare waste management while two in three do not train health providers on managing refuse safely, according to the Kenya Health Service Delivery Indicator Survey (SDI) 2018 Report released recently. Of these facilities, just one in eight have both the guidelines and history of training.

The survey, by the World Bank and Ministry of Health, finds that 17 percent of facilities in urban areas and more than double the proportion in rural areas do not dispose of their waste properly. A higher share of public facilities (a third) compared to private ones (a fifth) do not manage their waste properly. More than a quarter of health centres, dispensaries and clinics and a fifth of first-level hospitals poorly dispose of their waste.

Due to poor medical waste segregation practices, it is common to find that up to half of waste in some facilities in Kenya is infectious, according to the Ministry of Health, but ordinarily less than a fifth of medical waste is considered infectious in parts of the world with good waste-segregation practices.

Medical waste, a product of healthcare activities, is a potential source of infection if not handled properly. Incorrect disposal of the waste can harm patients, health workers, local communities and the environment. Other workers involved in handling refuse and street children who scavenge on dumpsites are also at risk.

Healthcare settings produce infectious waste that may lead to hospital-acquired infections and HIV and AIDS among healthcare workers, waste handlers, and patients.

In Kenya, the actual burden of hospital-acquired infections has not been accurately quantified, but it is projected to account for about 10-25 percent of admissions in public health facilities, according to the Health Ministry’s Healthcare Waste Management Plan 2016-2021. Some of the risks to staff from patients through such waste include HIV and AIDS, TB, hepatitis B and C and viral haemorrhagic fever such as Ebola. World Health Organization figures attribute nearly five percent of new HIV infections, a third of new hepatitis B cases, and about 40 percent of new hepatitis C cases globally to injections with contaminated syringes.

Multidrug-resistant TB also poses a great threat to health providers and the public. The World Health Organization estimates that millions of healthcare workers are exposed to percutaneous (through the skin) injuries with infected sharp objects every year.

Due to poor medical waste segregation practices, it is common to find that up to half of waste in some facilities in Kenya is infectious, according to the Ministry of Health, but ordinarily less than a fifth of medical waste is considered infectious in parts of the world with good waste-segregation practices.

Similar to the SDI findings, health facilities scored poorly in waste management in the 2013 baseline survey report for the Health Sector Support Project funded by the World Bank. The study assessed performance in five thematic areas, including policies and procedures, management and oversight, logistics and budget, training and occupational health and treatment and infrastructure. All the facilities surveyed scored poorly in all the thematic areas and the overall average score was 14 percent based on a predetermined scoring criteria of poor (0 percent- 49 percent); fair (50 percent-74 percent) and good (above 75 percent).

Another study that assessed waste-disposal practices in 24 non-government facilities in Nairobi found that no facility had a medical waste management plan, and only one in eight had a waste management team headed by a waste management officer.

Healthcare waste consists of a broad range of materials, from used needles and syringes to medical devices, body parts, soiled dressings, diagnostic samples, blood, chemicals, pharmaceuticals, devices and radioactive materials. Medical waste includes all the waste produced within healthcare facilities, research centres and laboratories related to medical procedures.

Trauma and infection

Healthcare waste is a source of potentially dangerous micro-organisms and there are many different kinds of exposure − through injury (cut, prick), contact with the skin mucous membranes, inhalation and ingestion.

Nursing staff face the highest risk of viral infections such as HIV and hepatitis B and C, through contaminated needles. Sharps and pathogenic cultures are regarded as the most hazardous medical waste.

Other examples of infections that can be caused by hazardous medical waste include gastrointestinal infections, through faeces and vomit, and respiratory infections acquired through inhaled secretions and saliva.

The World Health Organization divides medical waste into five categories according to the risks involved. In the first category are sharps, which are waste that entails risk of injury. In the second group are waste that involves risk of contamination like blood, secretions or excreta, as well as anatomical such as body parts and tissue, and cultures of infectious agents, including refuse from infectious patients placed in isolation wards. Some waste in this category does not necessarily pose a health or environment risk but must be treated as special waste for ethical or cultural reasons.

The third class is pharmaceutical, cytotoxic, chemical waste and those containing heavy metals. In this category are spilled/unused or expired medicines and used medication receptacles, leftover cytotoxic drugs (used to destroy cancer cells). Also included are batteries, mercury waste (broken thermometers or manometers, fluorescent or compact fluorescent light tubes) as well as discarded laboratory solvents, disinfectants, photographic developers and fixers.

The fourth classification consists of pressurised containers like gas cylinders and aerosol cans, while the fifth group is radioactive waste which contains radioactive substances including radionuclides used in laboratories or nuclear medicine, urine or excreta of patients treated. The simplest way to identify the different types of waste is to sort and collect them in separate containers or plastic bags that are colour-coded and/or marked with a symbol as per the WHO coding recommendation.

Waste must be collected regularly with each type of waste collected and stored separately. Infectious waste (categories one and two) must never be stored in places that are open to the public and the means used for transporting waste must be reserved for that purpose. If possible, different means should be used for each type of waste.

The choice of waste treatment and disposal techniques depends on a number of parameters, including the quantity and type of wastes produced and whether or not there is a waste treatment site.

The Health Sector Support Project situational analysis in NGO health facilities found that waste segregation was insufficient, as no facility had a general waste category, hence all the waste produced within these facilities is considered hazardous and needs treatment prior to disposal. Waste storage facilities were not sufficient and were poorly secured. Waste was also transported manually in almost 90 percent of the healthcare facilities, putting waste handlers at risk of injuries and infections. The only treatment method found to be in use within the facilities was incineration, and only about half of facilities were found to have functioning incinerators.

In the devolved system of government, county governments are accountable for refuse removal and disposal.

There is an urgent need to address the medical waste problem given the increased production of various types of healthcare waste as healthcare facilities expand in size and number, and due to ongoing immunisations and treatment of various conditions including emerging and re-emerging communicable and non-communicable diseases. Today, there are about 10,820 health facilities ranging from the smallest clinic to the largest referral hospitals owned by the government, private investors, as well as faith-based and non-governmental organisations.