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Medical Waste Management during COVID-19 Pandemic: A Study of
Sukraraj Tropical & Infectious Disease Hospital and Bir Hospital
Presented by: Ojeshwi Risal
Human and Natural Resources Studies
Department of Development Studies
Kathmandu University, School of Arts
Background
Waste (also known as rubbish, trash, refuse, garbage, junk, litter) is
unwanted or useless materials.
According to the (World Health Organization, 2018) , health care
waste is generated by institutions such as hospitals, health centers,
medical research institutes, pharmaceutical manufacturing plants,
pharmacies, blood banks, and home health care activities.
●
Health facilities and diagnostic procedures generate two categories of garbage:
general trash and hazardous waste.
●
The garbage generated by healthcare operations is classified as general waste in 85 percent of
cases, while the rest is classified as hazardous waste in cases when it is contagious, toxic, or
radioactive.
Each year, 274 hospitals in Nepal generate a total of 10,520 tonnes of non-hazardous healthcare
waste and 3,094 tonnes of hazardous medical waste. (UNDP, 2017).
●
●
The COVID-19 pandemic has caused an increase in medical waste and viral transmission, requiring
modern treatment techniques to reduce risk to healthcare personnel, trash handlers, and others.
●
COVID-19 virus transmits largely by droplets of saliva or nasal discharge when an infected person
coughs or sneezes, according to the World Health Organization.
●
Waste management systems failed very quickly as a result of the coronavirus disease 2019 (COVID19).
Statement of Problem
●
The study’s goal is to examine how well healthcare institutions handle trash while providing data that
may be used to these facilities effective management of medical waste.
●
The health institutions in Nepal are working hard to achieve high standards in the treatment of medical
waste, but their efforts are being hampered by limited resources and insufficient skills.
●
According to the report published by MOHP, health care institutions in Nepal produced approx
20,18,450 Kilograms of health care risk waste annually (assuming 0.5 kg per patient per day) in 2001
(MOH 2003).
Objective of the research
The main objective is to understand the current practices of medical waste
management in two hospitals of Kathmandu Valley, namely Sukraraj Tropical & Infectious
Disease Hospital and Bir Hospital
201
MoH
The specific objectives of the study are outlined below:
Cina
● To study the present methods of hospital waste management.
● To identify the challenges of medical waste management among the selected hospital
during COVID-19
● To explore the consequences, especially the environmental risks associated with
medical waste.
Research Questions
General Question
How Sukraraj Tropical & Infectious Disease Hospital and Bir Hospital manage the medical
waste?
Specific Questions
i. What are the present methods of minimization, segregation, collection, storage,
treatment, and disposal of hospital waste?
ii. What are the challenges among the selected hospital during COVID-19?
iii. What are the environmental risks associated with medical waste?
Rationale / Justification of the study
2001
The problem of Health Care Worker disposal in the hospitals and other healthcare
MH
establishments
has become an issue of increasing concern, prompting hospital administration
to seek new ways of scientific, safe and cost-effective management of the waste, and keeping
their personnel informed about the advances in this area. The need for a proper health care
waste management system is of prime importance and is an essential component of quality
assurance in hospitals.
Limitations of the research
1
The study solely
focuses on solid
medical wastes only.
2
3
The number of
incoming patients in
the hospital fluctuates
but the bed remains
constant. This study
assumes that all the
beds present in the
hospital are occupied.
The study examines
and characterizes
medical wastes from
the selected hospitals
as a
whole, not from
different departments
of the hospitals.
Literature Review
In the eighteenth century, nothing was understood about sanitation or how to properly dispose
of medical waste around the world.
Lister found in the 1870s that the fast spread of illness in hospitals was due to a lack of effective
2001
cleanliness and medical waste disposal processes. (Gregory & Tulchinsky, n.d.)
MH
The COVID-19 pandemic has placed a great deal of pressure on healthcare systems worldwide,
including the management of medical waste.
The literature review found that both Sukraraj Tropical & Infectious Disease Hospital and Bir
Hospital have implemented measures to properly manage medical waste during the COVID-19
pandemic.
Literature review also provides valuable insights into the medical waste management practices in
Nepal during the COVID-19 pandemic and can serve as a useful reference for other healthcare
facilities facing similar challenges.
Research Methodology
Research design
Mixed method research
Data analysis
2001
SamplingMH
technique
Purposive sampling
-
Methods as designed by
Creswell mixed method
Excel
Descriptive frequency table
Data Collection
Study area & Sample size
Bir hospital and Sukraraj Tropical & Infectious Disease
Hospital
20 Research participant, 10 on each hospital
-
Documentation review
Questionnaire
Key informant interview
Observation
Continue….
Data Triangulation, Validity
and Reliability
-
-
-
This study used several data
gathering approaches and
instruments to guarantee
triangulation, which verified the
findings.
These methods include semistructured interviews and
questionnaire-assisted interviews.
Questionnaires were created based
on the study’s goals using clear,
intelligible language and subjected to
supervisor review to verify reliability.
Ethical Consideration
-
-
-
To protect the rights of the participants in the study, sufficient
time was allotted for them to express their views on the
research questions.
Before utilizing their responses in the study, informed consent
was obtained from the participants and the necessary
permissions were obtained to ensure the proper use of their
data.
Any secondary data used in the research has been properly
acknowledged and referenced to ensure compliance with
ethical standards.
RESULT & DISCUSSIONS
Study Site
1947 B.S.
Sukraraj Tropical & Infectious
Disease Hospital also popularly
known as Teku Hospital
No. of beds: 458
19 33 A.D
Bir Hospital
No. of beds : 100
Categorization and Types of Waste Generated
S.N.
Hospital Name
Types of waste categories
Infectious
1.
2.
Non
infectious
Bir Hospital
Sukraraj Tropical &
Infectious Disease
Hospital
Types of waste generated
Hospital Name
Infectious
Bir Hospital
Non infectious
Sharps
Soiled dressing, amputated body parts, Fruit peels, plastic bottles, Syringe needles,
gloves, etc.
leftover foods, paper, broken glass, blades,
cardboard, wrap paper.
etc.
Sukraraj Tropical & Infectious Genotoxic wastes, gloves, gauze, rubber Paper, bottles, fruit peels,
Scissors, rubber
Disease Hospital
tubes, body parts, masks
discarded food items,
tube, broken glass,
plastics, etc.
Amount of Waste Generated per day
S.N.
Hospital Name
Total beds Waste category and amount
generated in kg/day
Infectious
1.
2.
Bir hospital
Sukraraj Tropical &
Infectious Disease
Hospital (Teku
hospital)
Total
Total waste
generated in
kg/day
Noninfectious
458
60
320
380
100
12
65
77
72
385
457
TRAININGS
Frequency of trainings
S.N.
Hospital Name
Type of Trainings
1.
Bir Hospital
Practical Trainings
Sukraraj Tropical & Infectious Disease
Hospital
hand wash, waste
segregation, autoclave
guidelines, infection
control, personal
protective equipment
SAFF (waste handle,
transportation)
COVID-19 pandemic
2.
NA
3-6 months
Waste Minimization
Bir Hospital
Teku Hospital
Wastes are reduced, reused and
recycled.
Wastes are reduced and
recycled
Reduced: Procurement of
reusable items
Reduced: X ray files
replaced by CDs.
Reused: linens
Use of cloth bags instead of
plastic bag while buying
medicines.
Recycled: Saline pipes, paper,
plastic, metal
Waste Segregation
Bir Hospital
Teku Hospital
Hard plastic containers of 50
liters are used for general and
infectious wastes.
Hard plastic containers of 50
liters are used for infectious and
noninfectious wastes.
Color coding system:
Black: Biodegradable wastes
Light Blue: Plastics
Green: Paper
Dark Blue: Bottles and cans
Red: Infectious wastes
However, steel containers are
used for genotoxic
wastes.
Language used in the Labels:
Nepali and English.
Color Coding System:
Black: Biodegradable
Green: Paper
Red: Infectious
Language used in the labels:
Nepali and English
Waste Collection
Bir Hospital
The generated wastes are collected
by waste management staff that are
hired by the private contractor.
Time of waste collection in a day:
Infectious & Noninfectious wastes:
2-3 times
Sharps are collected every 4 days.
Protective equipment such as
masks, caps, goggles, boots, aprons
and gloves are used while handling
waste.
Teku Hospital
Wastes are collected by waste
management staff. Infectious and
non-infectious wastes are
collected twice a day, once at
7:30 am and at 2pm.
Personal Equipment used:
Apron, long boot, mask, gloves,
cap, long forceps and glasses.
Waste Storage
Bir Hospital
Wastes are stored in the basement
of the Trauma Center.
Noninfectious wastes are separated
While infectious wastes are kept
near the autoclave machine area.
Wastes are stored for 15 days.
Teku Hospital
Infectious waste: Autoclaving
area
Noninfectious waste: Separated
and stored in
cabinets
Beside recyclable items, wastes
are stored for 24 hrs.
Recyclable items: 2 times per
month
Waste Transport
Bir Hospital
Depending on the nature of wastes,
different waste trolleys are used for
transportation of waste.
Both infectious and non-infectious
wastes are transported
through the same path.
Teku Hospital
Waste trolley designed for
transportation is used.
All wastes are transported
through the same path.
Waste Treatment
Bir Hospital
Wastes are treated before
disposal. Infectious wastes
are autoclaved, and
sometimes chemical
disinfectants are used.
- Chemical disinfectants
(sodium hypochlorite acid)
are used for genotoxic and
radioactive wastes.
No. of autoclave present: 2
Model of Autoclave: NAT
Purchased Year: 2008
Teku Hospital
-
-
Infectious: Autoclave and
chemical disinfectants
Chemical disinfectants
used: Hypochlorite solution
for genotoxic waste, Dettol,
phenyl and virex.
No. of autoclave present: 1
Model of autoclave: ARKO
Purchased year: 2011
Waste Disposal
Bir Hospital
-
-
-
Pathological wastes such as
Placenta, amputated body
parts are buried.
Treated infectious wastes are
then collected by the private
vendor and dumped in an
unknown location.
Recyclable materials are
utilized either by selling them
or making handicrafts.
Teku Hospital
Use of burial pit (placenta and
amputated body
parts) outside hospital premises.
Treated infectious wastes are
taken by the
municipal waste management
unit.
Bir Hospital
Waste Disposal : 45k
Earnings from recyclable items : 40k
Sukraraj Tropical & Infectious Disease
Hospital
Waste Disposal: 36k
Earning from
recyclable
item: 30k
Norvic.
I. Hospital
Waste Disposal : 36k
Earnings from recyclable items:30K
C
O
S
T
Challenges for managing the health care waste during COVID-19
-
During the peak of the COVID-19 pandemic, hospitals across the world became
centers of attention.
COVID-19 can contaminate objects and wastes, presenting a health risk if not
managed effectively.
One of the measures to fight COVID-19 was the use of face masks and PPE.
Checklist to Manage COVID-19 waste management
Bir Hospital
-
PPE should be worn all time while handling and
transporting waste from designated area to
Personal
Protective
Earnings
from recyclable items
: 40k
treatment
zone.
Equipment
Staff should select appropriate PPE to prevent risk
of infection and overuse of PPE
-
Waste minimization
Waste Reduction at source
Preference to recyclable and reusable items
Use separate color-coded containers/bins to discard
Sukraraj Tropical & Infectious
Disease
generated waste.
Hospital Waste Disposal:
36k layered waste bags
Use double
Waste Segregation
Dispose
Earning from recyclable
item:sharps
30k in puncture proof container
Seal the bag before transporting
Spray the bag with 1 % sodium hypochlorite
solution before transporting to treatment zone or
Waste Disposal
: 36k
temporary storage point
Waste Collection and
labeling
-
Norvic. I. Hospital
Earnings from recyclable items:30K
Bir Hospital
Waste
Transportation
Place the waste bag in a close trolley while transporting
to the treatment zone or temporary storage point.
Disinfect
Earnings from recyclable items
: 40k the trolley and waste containers with 1%
hypochlorite solution daily and after each use.
Waste storage
-
Waste should not be stored more than 24 hours in a
temporary storage area.
Waste treatment
-
Treat the waste with Autoclave, Friction Heat system or
any other waste treatment technology
Treat
for 60 minutes at 121 to 135 degree Celsius
Sukraraj Tropical & Infectious
Disease
If treatment zone is not available within healthcare
Hospital Waste Disposal: facility
36k coordinate with waste treatment provider
Earning from recyclable item: 30k
Waste disposal
Treated waste can be discarded as regular waste.
Norvic. I. Hospital
Waste Disposal
: 36k
disinfect
if PPE is reusable.
Earnings from recyclable items:30K
Safely remove PPE and dispose if it is non- reusable and
Discussion
●
●
●
●
●
Both hospitals have implemented training programs for healthcare workers to ensure that
they understand the proper methods of handling and disposing of medical waste.
The results also say that these hospitals have taken appropriate steps to ensure the safe
and effective management of medical waste during the pandemic.
However, ongoing monitoring and assessment of these practices are necessary to ensure
their continued effectiveness and to identify any areas for improvement.
Considering the global transmission of COVID-19, excessive biomedical waste has become
a new major threat to public health as well as to the environment during this pandemic.
(WHO, 2020)
For instance, in August 2021, scientists discovered a fish trapped in a medical latex glove
during a canal cleanup in the Dutch city of Leiden, prompting them to investigate whether
there was a broader problem.
Environmental Risk
●
●
●
●
●
Improper incineration and disposal of hazardous waste can pollute air,
water and soil.
Open collection and disposal of hazardous waste may cause air borne
contamination and hence increase air borne infection.
The leftover ash when buried can leak into the ground resulting in both
soil pollution and groundwater contamination.
Improperly treated waste into the landfill or river system can damage
aquatic life and spread water borne infection like cholera, typhoid,
hepatitis, and so on.
Hospital waste into the virgin soil may transfer drug resistant
characteristic into the normal bacteria
PHOTOS OF BIR HOSPITAL & TEKU HOSPITAL
Photos of Respondents
CONCLUSION
●
COVID-19 has caused a significant increase in medical waste production.
●
Both the hospitals reduce risk of cross-contamination and disease transmission through
proper waste separation, record-keeping, and safe disposal.
●
The COVID-19 epidemic has exposed the flaws in the healthcare waste management
system and the urgent need for change.
●
Develop better waste management methods to ensure safety of healthcare staff,
patients, waste handlers, and environment.
●
The COVID-19 pandemic has highlighted the shortcomings of the healthcare waste
management system, but the experiences of Bir Hospital and Sukraraj Tropical &
Infectious Disease Hospital demonstrate that medical waste may be managed in a way
that protects public health and the environment.
Thank you! ☺
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