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SUSTAINABLE HEALTH CARE WASTE MANAGEMENT (HCWM)

To make Healing and healthy Green environment


IN THE MENELLIK II REFERRAL HOSPIAL
__________________________________________________________________________________________________________________________________________________________________________________

Master of Advanced Architectural Design(MAAD)


Architectural Design Research Studio I
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Ashenafi Ezo, ID No GSR059/10
CONTENTS

introduction…………………………………………………… 3
literature review…………………………………….........13
case study………………………………………………………20
analysis…………………………………………………………..22
findings……………………………………………………….....22
recommendations……………………………………......38
conclusions……………………………………………………..38
INTRODUCTION
Location

Addis Ababa, Ethiopia Sidistkillo, around Jan meda


Background of the study Area
The study was conducted to quantify waste generation rate in Menellik II referral hospital, Addis
Ababa City. Addis Ababa is the capital city of Ethiopia, with the total population of 3,384,569,
within area of 527 km2.
The hospital was opened in 1909 which has now 29 active specialized case teams and 199
numbers of beds.
The daily visits of patients and their attendants to the hospital are found to be 646.
In Menellik II Referral Hospital, healthcare wastes pose a risk on Community Health as well as
contaminate the environment.
Healthcare wastes management practice in Menellik II Referral Hospital have given less
attention by healthcare workers and healthcare managers.
Statement of the problems
The existed HCWM practice in the Menellik II Referral Hospital, poses risks on the public Health
issues and Environments, and challenges it faced during the application of the waste
management, due to awareness gaps on the handling of the waste at the point of generation
and all process of HCWM practices segregation, collection, treatments, transportation and
disposal of wastes.
Objectives of the study
The general objective of the study was to assess the existing experience of HCWM in Menellik II
Referral Hospital practice, challenges and drawbacks and its pollution impact on the target
peoples’ health and the surrounding environment.

Specific objectives:
To assess the current HCWM practices.
To evaluate the Health care waste generation rate.
To know the impacts of hazardous hospital waste on the community health and environments.
To suggest the sustainable HCWM practice systems for current inappropriate practices.
Research questions
Major research question
Does current healthcare waste management practices pose risks to human health and pollute
the environment? Or Cause Sustainable Environmental impact and public health issues
problems?

Specific research questions


Does healthcare waste management practice in Menellik II Referral Hospital risk to human
health and pollute the environment?
How the unsuitable HCWM practice affect the environment and public health?
How much healthcare waste generation rate in Menellik II Referral Hospital?
Is it possible to implement sustainable HCWM practice according to the Sustainable way
(reducing, reusing and recycling) hospital hazardous waste?
Research Problems
Low standards health care waste management practice.
Awareness gap and information flow problems between the management body and the
workers.
There are no suitable enough space to do the best disposal hazardous health care waste.
The identification or segregations problems practice at the point of waste generation.
There was no appropriate HCWM Guidelines, Rules and Regulations frameworks for Hospital
waste management practices.
Significance of the study
Despite of the fact stated by the (WHO, 2004) 15% to 25% of healthcare wastes are
hazardous and healthcare activities lead to the production of wastes that may also lead to
adverse Community health related and environmental pollution effects.
In Menellik II Referral Hospital do not have access to appropriate health-care waste
management options that are safer to the Sustainable environment and public health,
incineration may be an acceptable response because of economical issues but it is the highest
causes in emission of toxic byproducts to environments (air, water and soil).
Scope and Limitation of the study
Scope of the study was limited only to the assessment of the existing healthcare waste
management practice particularly hazardous waste and its pollution impact on the sustainable
environment and community health issues in Menellik II Referral Hospital.
Research methodology
Generally, the approaches to address the research should be;
Reviewing related documents such as sources of data from various internet, governmental
documents and previous research documents.
Site observation – direct physical observation and assessing existing situation of HCWM in the
study area
Simple Interviewing and Highlight discussion with concerned stake holders such as
professionals, beneficiaries’, concerned institutions.
Data collection
Primary Data: - Interviewing and discussion with selected key informants, personnel as well
physical observation of the study area were the primary data collection techniques
Secondary Data: - These are most significant data that are needed for the actual study,
these are gathered from, written some literatures like books, Magazine, internet websites,
photos, Satellite images and governmental documents most important data sources.
LITERATURE REVIEW
HCWM
Health Care (HC): A place where medical activities such as diagnosis, monitoring, treatment
and other related activities are taken under the supervision of medical practitioners.
Healthcare waste (HCW): Materials generated as a result of patient diagnosis, treatment, or
the immunization of human beings or animals is referred to Healthcare waste (Manyele, 2004).
Health care waste management (HCWM): is the generation, segregation, collection,
transportation, processing, recycling, or disposal of Healthcare waste materials.
Environmental Effects of Healthcare: Hospital waste production and energy consumption
affect environmental health and the health of every person in the affected area.
Sustainable Environment (SE): “Sustainable Environment is a development that meets
the needs of the present without compromising the ability of the future generation to meet
their own needs.
Green Hospital is the one which is continuously upgrading public health by reducing
environmental impacts and eventually by eliminating hospitals roles in disease burden.
Classification of Healthcare waste (HCW)

WHO estimates
Non-Risk HCW (75-90)% 85% of HCW is non-hazardous
10% is infectious
5% is non-infectious
HCW
Risk HCW (10-25)%
Classification of Healthcare waste (HCW)
Non-hazardous HCW;- Hazardous Healthcare waste /Health care
General waste/non-risk healthcare wastes, on – risk wastes
risk waste is that which is comparable to normal Infectious wastes
domestic garbage and presents no greater risk,
Pathological wastes
therefore, than waste from a normal home i.e.
Sharps
General office wastes
Pharmaceutical wastes
Packing or leftover food
Geno toxic wastes
(75-90)% total amount of HCW
Chemical wastes
Which are , Recyclable, Biodegradable, Other
non-risk HCW Heavy metals
Radio-active wastes
Categories of Health Care Waste(HCW)

1. General Waste
2. Infectious Waste
3. Pathological Waste
4. Sharps
5. Pharmaceutical waste
6. Geno toxic Waste
7. Chemical Waste
8. Waste with high content of heavy metals
9. Pressurized Containers
10. Radioactive Waste
Color coding systems for HCWM

Color of Type of waste


container/bag

Black Non-infectious dry waste


Blue Non-infectious wet waste (kitchen, dietary etc.)

Yellow Infectious and Pathological waste

Yellow with black band Chemical waste including those w/ heavy metals

Orange Radioactive waste

Red Sharps and pressurized containers


Generation Sources of HCWs

HCW (Healthcare waste): includes health care activities such as diagnosis and treatment
immunization
Medical wards
Operating theatres and surgical wards
Other health care units: mostly general waste with small percentage of infectious waste (mostly
sharps).
Laboratories
Pharmaceutical and chemical stores
Support units - general waste only.
Health care provided by nurses – general waste, a limited amount of infectious and some sharps
Physician's offices – general waste, a limited amount of infectious and some sharps
Dental clinics and dentist's offices - general waste, a limited amount of infectious, sharps and
waste with high heavy metal content
Impacts of the HCW
Significant Environmental impact and Public health issues problems
Due to the poor HCWM result staff members, beneficiaries and nearby residents are facing
different problems.

Poor HCWM practice real problems for


MAN
COMMUNITY AND
ENVIROMENT
Sustainable Healthcare Waste Management
WHO has published the principles describing safe and sustainable management of healthcare
wastes
The combined toxic and infectious effects of medical wastes, as environmental and public health
threats, have not been noticed significantly.
More than half of the world’s population is at the risk of health effects of healthcare wastes.
The UN has invited all to “develop a comprehensive international legal framework to protect
human health and the environment from the adverse effects of improper management in
disposal of hazardous medical wastes”.
ANALYSIS AND FINDINGS

HCWM Practice at Menellik II Referral Hospital


Healthcare waste segregation practice
The use of a color coding system for HCW containers (black, yellow, red, and blue) was practiced
without labeling.
There was no segregation of HCW in to waste categories to the available color coded waste containers
at the point of generation except the sharp waste made at puncture proof safety box.

At the separation point of waste generation Color coding system for HCW containers
HCW handling at the point of waste generation
HCWM in Menellik II Referral hospital was very
poor handling practice.
HCW bin put in the walkway and pedestrian was
not emptied and clean daily.

HCW interim(primary) storage and


transportation materials of Menellik II hospital
HCW storage
All case teams temporarily stored wastes in cleanable and closed dust bins.
All HCW categories sent to the facility dedicated place of onsite storage (municipal garbage tank capacity
of 8 m3) mixing together in a manner potential to infection and hazard

HCW interim(primary) storage and transportation materials of Menellik II hospital


HCW collection practice
HCW was collected daily at the morning except
the major operating room made within average
of 8 hours. Generally poor/Week collection HCW
collection practice.

HCW materials of Menellik II hospital


HCW transportation systems
Most of the devices used for on-site transportation of HCW
were closed bin with wheel.
The municipal garbage tank contained all mixture of waste
was over full and droppings of refuse around the surrounding
because of delay in offsite transportation service to the
municipal disposal area
HCW treatment and disposal
There are no disinfection before disposal, waste storage and collection utilities. There was no treatment practice
at all.
The main disposal mechanisms are:- incineration, open burning; burring in to amputation pit and open
dumping on municipal dumping site as well as on the hospital back yard.

Amputation pit for disposal of Open dumping HCW at the back yard of the A newly built for HCW incineration
pathological waste in Menellik II hospital Hospital of Menellik II hospital
Incineration and Burring Disposal systems
The hospital has functional low combustion, single chamber incinerator incinerating all type of the
wastes together without separating especially general waste.
produced air pollutant emission.

Burring of HCW on backyard of Menellik Burning in Low temperature Incinerator


II Hospital
HCW Disposals Comparisons
%
Burial

Open Burning

Transportation to offside

Low Temperature
Incineration

Comparisons of HCW Disposals


HCW reducing, recycling and reusing
Their was no Healthcare waste minimization mechanisms.
Reusing and recycling was not employed
Lack of commitment to initiate a recycling program was therefore the main factor of HCWM.

Water bottle plastic stored for recycling dispersed near the incinerator open field in Menellik II hospital
HCWM Practice flow chart

Health care waste management practice color coding systems Menellik II hospital
HCWM Practice flow chart for pollution control

waste management practice flow chart on


pollution control systems Menellik II hospital
HCW at Source of Generation
A total of 4524 patients visited the hospital within a week, of which 1151 (25.44%) patients
admitted to IPDs and the remaining was 3373(74.56) seen at OPDs.

759
654
1000
622
565 607 933
790 813 778
730
800

600
118
400
168 165 159 269 151 163 48 171 174
211 No of outpatient flow/day
200 No of inpatient flow/day
patient flow/day in all case teams(OPD+IPD)
0
Monday Tuesday Wednesday Thursday Friday Saturday Sunday

patient flow/day in all case teams(OPD+IPD) No of inpatient flow/day No of outpatient flow/day


Daily attendance of patients and HCW generation in IPDs, OPDs and all case teams respectively (%) in Menellik II referral hospital.
Generation rate of HCW
The average total HCW generation rate of the hospital was estimated to be 0.493 kg/staff/day,
1.94 Kg/bed/day and 0.49 Kg/total patient/day by weight, and 0.012 m3/bed/day by volume
yielding a density of 160.95 kg/m3.

1.2
1
0.8
0.6 Kg/TP*/day

0.4 Kg/OP**/day
0.2
Kg/bed/day
0
General Infectious Pathological Pharmaceuticals Radiological

Kg/bed/day Kg/OP**/day Kg/TP*/day


*TP=Total patient (IPD+OPD) **OP=Outpatient only

Table 3. Daily generation rates by types of HCW (Mean, SD) in Menellik II referral hospital
Health Care Waste Composition
Regarding the composition of healthcare waste, almost similar in inpatients and outpatients except general
healthcare waste 28% in inpatients and 43% in outpatients.
The infectious waste was 86% in inpatients whereas 46% in outpatients. These proportional variations have a
statistical significance.

A. Total waste stream B. Inpatient C. Outpatient


% % % 1%
2% 1% 0% 6% 0% 1% 0%
2% 0% 0%
3% 1%
2% 0%

41% 54%
29%
Infectious 46%
General
Sharp 43%
Radiological 68%
Pharmaceutical
Photological

The composition contribution and generation of HCWs in inpatients, outpatients& total HCW stream in Menellik II hospital.
Healthcare Waste Generation Rate
Among Case Teams Patient flow, total healthcare waste and its types (general and
hazardous waste) were compared among different case teams

61.93
80 71.71
44.79 47.57
40.64 57.5 41.07
46.43
60 41.64 52.29 50.21 30.25 48.86
22 33.58 42.43
27 18.57 29 18.29
21.79 28.71
21.71 25
40 29.67
15.63 4.5
10.5 0
13.79 13.53.75 13.57 Hazardous HCW
20
Total HCW
0

Total HCW General HCW Hazardous HCW


CONCLUSION AND RECOMMENDATION
Recommendation
Possible solution: Sustainable Green hospital Approach will be achieved through:
Sustainable Healthcare waste managements
Waste minimization (reduce, reuse and recycle)
Safe treatment and disposal mechanisms of HCWM
Sustainable HCWM
Green hospital points to a hospital that see environment as part of their quality service.
It has orientation for green products, non-toxic environment, green cleaning, and reduction of
waste and provides a healing garden
Green Hospital is the one which is continuously upgrading public health by reducing
environmental impacts and eventually by eliminating hospitals roles in disease burden.

The needs for Sustainability


Health facilities affects air, water and environments
Public Health problems
Scavengers, animals and surrounding land fill
area community problems
They Infected by the HIV, Hepatitis, TB
Air, water and soil Pollution
The needs for Sustainability

Relationships of the
environment,
community and
healthcare facilities
Waste minimization
Waste minimization can be achieved by the following strategies:
purchase items made from recycled glass and metals that can be disinfected and reused;
Sterilize reusable, and reduce the number of pre-sterilized disposable items;
Adopt policies and procedures for the management of waste generated;
Establish effective policies in cooperation with the authorized manufacturer of plastics for
recycling;
Use the steam sterilization method, preferred to chemical disinfection to prevent the generation
of hazardous chemical wastes
Safe and Proper HCW Disposal and
Treatment
If a proper management and control procedure is applied, healthcare waste should not have
any adverse effects on human health and the environment.
proper waste categorization and reducing, not only the disposal costs and environmental risks of
them will be controlled and prevented enables a large proportion of non-medical wastes to be
recycled
Conclusion
Green hospital will be achieved through the strong commitment of medical health staff to
assume the leadership of the health prevention measures and environmental protection in the
future.
Management of hospital waste consists of measures including avoidance, reuse, recycling and
disposal that by doing the measures, steps are taken toward fulfilling one of the basic principles
of Green Hospital which is waste management.
REDUCE
REUSE
Reduce
RECYCLE
RECOVERY

DISPOSAL
Recycle
Reuse SUSTAINABLE ENVIRONMENT
THANK YOU

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