December 2013, Volume 4, No.6 International Journal of Chemical and Environmental Engineering

Bio-Medical Waste Handling and Management in Riyadh, Saudi Arabia Abdullah Al-Hadlaq*a Zayed Ali Huneitib, Wamadeva Balachandranc a

Technical College, Department of Biomedical Engineering Riyadh Saudi Arabia University of Hail College of Engineering Department of Electrical Engineering Hail Saudi Arabia c Brunel University School of Engineering & Design Centre for Electronic Systems Research Uxbridge, Middlesex UB8 3PH UK Corresponding author Email:[email protected] b

Abstract: Riyadh is witnessing an increase in the number of people travelling from all over the Kingdom to benefit from the high quality healthcare services and the establishment of small & medium size clinics. This has resulted in an increase in the amount and type of medical /biomedical waste. Medical/biomedical waste is any waste generated in the course of healthcare activities such as the diagnosis, maternity, treatment or immunization of human beings or in research activities that may include humans or animals. The generation of medical wastes will continue to be an ongoing phenomenon as long as human civilization persists. This type of waste carries a higher potential for infection and injury than any other type of waste. Medical waste management is of immense importance because of the potential environmental hazards and public health risks it poses. Consequently, there has been increased public concern about the management of healthcare waste in recent years. Proper handling, segregation, mutilation, disinfection, storage, transportation and final disposal procedures are crucial for safe and scientific management of medical waste. Appropriate management and minimisation efforts are necessary to reduce the quantity and volume of waste, as well as to reduce handling and disposal expenses. Although significant progress has been made in healthcare waste management, existing healthcare waste management practices still need a great deal of modifications and improvement. This paper presents the findings of a study that was aimed to quantify the amount of medical waste generated in Riyadh by collecting information on existing handling, treatment and disposal practices of medical waste by the different generators as well as costs of medical waste disposal. This research work is carried out with the aspiration to propose an efficient management system that will reduce environmental burdens and economic costs as well as improve social acceptability. . Based on the analysis of the data collected, a list of recommendation is given to improve the hospital waste management strategy and to create a sustainable clean environment in Riyadh City. Keywords: Medical waste; Waste management; Biological waste; Waste treatment;

1. Introduction The recent developments in healthcare units are precisely made for the prevention and protection of community health. Sophisticated instruments have come into existence in various operations for disease treatment. Such improvement and advances in scientific knowledge has resulted in per capita per patient generation of wastes in health care units. Waste generated in the process of health care are composed of variety of wastes including hypodermic needles, scalpels, blades, surgical cottons, gloves, bandages, clothes, discarded medicine and body fluids, human tissues and organs, chemicals etc., These are the most environmentally sensitive healthcare byproducts and needs a greater attention which has to be monitored (Remy, 2001). World Health Organization states that 85% of hospital wastes are actually nonhazardous, whereas 10% are infectious and 5% are noninfectious but they are included in hazardous wastes. About 15% to 35% of hospital waste is regulated as infectious waste. This range is dependent on the total amount of waste generated (Glenn and Garwal, 1999). Medical wastes may be a threat to the public since health

care foundations are normally situated in the heart of

cities. Improper waste management will result in negative impacts on both human health and the environment. The generated waste, if not properly managed, can cause dangerous infection and posses a potential threat to the surrounding environment, persons handling it as well as to the public. Health and environmental effects, uncertainty regarding regulations and negative perceptions by waste handlers are some important concerns in health care waste management in a country (Freeman, 1998). Globally this issue has been seriously considered and appropriate waste management systems are being developed and installed. A number of difficulties are being faced at many places in the implementation of this plan in practice. Currently, in the Kingdom of Saudi Arabia, medical waste disposal is governed by government agencies and regulations including private organisation. Therefore, the management of medical waste needs improvement in addition to policy to regulate and ensure the delivery of safe, efficient and reliable waste management services.

Bio-Medical Waste Handling and Management in Riyadh, Saudi Arabia

The immediate focus should be to develop a system to regulate whilst encouraging and providing opportunities for the private sector to carry out its operations centred on the collection, transportation and disposal of hazardous waste. This research study was conducted in order to assess current practices of medical waste management and handling in Riyadh region. It was carried out with the aspiration to propose an efficient management system that will reduce environmental burdens and economic costs as well as improve social acceptability.

2. Methodology

1) General information, 2) Activity Measure, 3) Waste Generated, and segregation 4) Treatment, Transportation and Disposal, 5) Regulations and 6) Recommendations A pilot study was conducted to test the reliability of the questionnaire. Unclear items were modified to be easily understood by participants. All participants gave informed consent to participate in the study.

2.3 SPSS Analysis

The methodology for conducting this study can be broken down into four major tasks, these are: 1. Development of the questionnaire. 2. Identifying the main waste generators in Riyadh city. 3. Conducting site visits to a selection of waste generators, 4. Analysis of results in order to make projections regarding waste generation and management procedures in the selected hospitals.

Analyses of data was performed by the use of Statistical Package for Social Science (SPSS) version.17 Software and the Microsoft Excel computer software. Descriptive statistics such as means and ranges have been computed. Appropriate tests of significance performed to determine the relationship between socio-demographic variables and the variables related to knowledge and health worker awareness, and practice regarding management of medical waste.

2.1 Data collection

3.1 General Results

In order to fulfil the objective of the study, data were collected from various hospitals in Riyadh city. All hospitals studied were considered to be medium hospitals, based on the number of beds, as each had more than 50 beds. The study was conducted in different health care settings. A total of 30 questionnaires were sent out to hospitals in Riyadh city, both government and private hospitals were included. The main tools used in the data collection were questionnaires, interviews, site visits and personal observations. The data gathered from the survey was entered into a computer and was analysed using statistical software packages namely Excel and SPSS. The focus was on evaluation of the risks of infections associated with improper handling of hazardous medical waste, also assessing the use of sustainable and safe procedures of handling and disposing of medical waste and lastly assessing the time taken to store medical waste in the selected health facilities in the surveyed hospitals. Secondary data such as available documents, e.g., different reports from different departments served also as a source of information.

A total of 30 (100%) surveys were sent to hospitals in Riyadh city, all of these surveys were returned. 50 % (15 of 30) of the respondents said that they were privately owned hospitals, and the other 50% (15 of 30) reported that they were government owned. 76.6% (23 of 30) of the respondents classified themselves as practicing general medicine and surgery, 6.6% (2 of 30) of the surveyed hospitals classified themselves as psychiatric facilities, 3.33% (1 of 30) classified themselves as rehabilitation centre, 6.6% (2 of 30) classified themselves as obstetrics/gynaecology facilities, and 6.6% (2 of 30) classified themselves as other medical facilities.

2.2 Questionnaire Design Two different set of questionnaire’s were prepared. The main questionnaire has been developed for medical stuff(doctors, nurses, laboratory technicians)., and the second one to the hospital administration. The questionnaire aimed at gathering information about the generation, segregation, collection, internal and external storage, transportation, treatment and disposal of medical waste in government and private hospitals in Riyadh city. The questionnaires were divided into six sections. They were

3. Results and Discussion

3.2 Activity Measure All hospitals were asked to provide the following data; the number of inpatients administered on a monthly basis, the percentage occupancy of the beds and the number of outpatients treated in an average month. The average number of inpatients administered on a monthly basis by the participating hospitals is 12,236 patients. It was found that the average for a typical governmental hospital is 19,194 patients, whereas for a private hospital is 5,278 patients. In addition, the survey has shown that the average number of outpatients administered on a monthly basis by government hospitals in Riyadh city is 14,800 and that by private hospital is 2,270.

3.3 Waste Generation The survey revealed that the total quantity of general waste generated by 30 hospitals is about 26,778 kg/day. The survey has also indicated that medical waste constituted 17.6% (4,733kg/day) of the total waste generated. The daily quantity of general and medical waste generated by each government hospital is shown in

344

Bio-Medical Waste Handling and Management in Riyadh, Saudi Arabia

Table 1. The quantities of waste for the private hospitals are presented in Table 2.

compared to infectious waste.

Gene Medica ral l General waste Medical Numbe waste/d Name of waste/mo /day waste/mont r of ay in hospital nth in Kg in Kg h in Kg beds Kg

Medica l waste /bed / day in kg

Gener al Medical Medical General waste Medical waste/d waste Name of waste/mo /day waste/month Number ay in /bed / day hospital nth in Kg in Kg in Kg of beds Kg in kg

Amal

5000kg

166.6 1000kg

502

33.33

0.066

Saultan

28080kg 936

7020kg

450

234

0.52

KSH

7800kg

260

2850kg

130

95

0.73

National 12600kg 420

1800kg

124

60

0.48

KAUH

7500kg

250

2000kg

220

66.66

0.3

Hamady

42000kg 1400 6000kg

325

200

0.6

KFMC

106200kg 3540 18200kg

1095

606.6

0.55

Moasah

18000kg 600

2250kg

160

750

0.46

300

233.3

0.7

Meshary 10800kg 360

1800kg

140

60

0.42

Obaed

17640kg 588

2440kg

200

98

0.40

38400kg 1280 4800kg

Yamamah 42000kg 1400 7000kg Miltary

86400kg 2880 14400kg

1200

480

0.4

Eman

18400kg 613.3 2700kg

215

90

0.42

COSE

300

160

0.53

Force

23400kg 780

430

130

0.3

Green-cr 8000kg

266.6 1200kg

55

40

0.72

1094

600

0.54

Mubark

7800kg

260

94

43

0.46

German

20000kg 666.6 3000kg

300

100

0.33

Kingdam 5000kg

166.6 1000kg

100

33

0.35

Falah

6000kg

200

990kg

50

33

0.6

Dallah

26400kg 880

6600kg

360

220

0.61

3900kg

KingSaud 90000kg 3000 18000kg

1300kg

Salman

31500kg 1050 4500kg

264

150

0.56

KUH

60000kg 2000 15000kg

780

500

0.64

N-Guared 70000kg 2333. 15000kg

690

500

0.56

21000kg 700

300

133.3

0.44

1200

610

0.5

Habieb

82000kg 2733. 1380kg

100

46

0.46

990

505

0.5

Eligent

5400kg

50

30

0.6

2808

2107

KKEH

4000kg

Miltary2 128100kg 4270 18300kg KFSH

106050kg 3535 15150kg

2677 Total 803350kg 8.2 142000 kg 9410

4733.89

Total 328120

180

900kg

1093 7.1 42480

Table 1. Quantities of waste generated by per government hospitals

Table 2. Quantities of waste generated by per private hospitals

It can be seen that the quantities generated vary from hospital to hospital and depend on the type of health-care facility and local standard conditions. In each hospital, the quantities of waste were physically weighed in specialised units, and the quantities are based on 90% bed– occupancy. The exact quantity of medical waste produced by health care facilities such as general hospitals, medical centres, operating rooms and medical laboratories should be determined in order to develop a good waste management system. Besides, the amounts of different categories within medical waste have to be identified. This was achieved by telephone conversations with hospital authorities, interviews with hospital managers and medical waste handlers, and by physical checks. Normally health care wastes are categorised into two types such as infectious and non-infectious (Saini and Dadhwal, 1995). In this study, the term ‘‘medical wastes’’ refers to all types of potentially hazardous waste. Infectious waste includes all those medical wastes, which have the potential to transmit viral, bacterial or parasitic diseases. It includes both human and animal infectious wastes and waste generated in laboratories and veterinary practice. These wastes are hazardous in nature. Non infectious wastes are generated from packaging, food preparations and visitors activities. This waste is large

As shown in Figures 1 and 2, all hospitals covered by this survey have generated much more general waste than medical waste.

Kg medical waste

GeneralWaste

Figure 1 Quantity of general and medical wastes generated (government hospitals)

The results of the study have revealed that general waste makes up at least 82% of all waste generated at the surveyed medical facilities. This waste is no different from general household or office waste which may includes paper, plastics, liquids and any other materials that are not potentially infectious.

345

Bio-Medical Waste Handling and Management in Riyadh, Saudi Arabia

     

Figure 2. Quantity of general and medical wastes generated (private hospitals)

Pathological wastes consisting of tissues, organs and body parts (Type C) sharps including needles, syringes etc. (Type D) carcasses, body parts , bedding of animals exposed to pathogens (Type E) waste from rare, unusual or highly communicable diseases (Type F) dialysis waste (Type G) other discarded material associated with patient care (Type H)

Table 3 shows the percentage of each type for the surveyed government hospitals. Sharpies (type D) constituted the highest percentage (ranging from 20 to 50 percent) of the generated medical waste. The second highest percentage is type C (ranging from 10 to 40 percent).

The World Health Organization (WHO) estimated the total medical waste per person per year is anywhere to be from 0.50 to 3.00 kg/bed/day in both developing and less developed countries. The study has shown that the total waste generation rate for government hospitals is about 4,733kg/day, representing an average of waste generation rate of 0.5kg/bed/day. While the total waste generation rate for the private hospitals is in the region of 2,107kg/day, giving an average of waste generation rate of 0.75kg/bed/day.

Table 3. Percentages of types of medical waste (government hospitals) MEDICAL WASTE AS DESCRIBED IN A-H

3.4 Type of Waste Generated The World Health Organisation categorises medical waste into: Sharps  Infectious  Pathological  Radioactive  Pharmaceuticals  Others (often sanitary waste produced at hospitals) Accordingly, medical waste consists of solids, liquids, sharps, and laboratory waste that are potentially infectious or dangerous and are considered a threat to the community and the environment. Infectious wastes was described as ‘‘biohazardous’’, ‘‘health-services hazardous’’, ‘‘pathological’’, ‘‘biological’’ and ‘‘hazardous infectious’’ (Meaney and Cheremisihoff, 1989). However, the term medical waste used in this survey corresponds to the definition of medical waste listed in EPA’s (Environmental Protection Agency) Medical Waste Tracking Act (3), which is also used in the guidelines of health care waste management prepared by ministry of health on Saudi Arabia. Under these regulations and guidelines, medical waste may include the following:  cultures and stocks of infectious agents and associated biological (Type A)  blood, blood products and body fluids (Type B)

hospital

A

B

C

D

E

F

G

H

Amal

10

10

30

30

0

20

0

0

KSH

11

25

15

21

0

25

0

3

KAUH

20

20

20

20

1

10

5

4

KFMC

23

10

27

38

0

0

1

1

Yamamah

8

12

30

20

25

0

0

5

Miltary

13

11

31

33

2

2

4

3

Eman

20

15

30

30

0

1

1

3

Force

8

20

30

20

5

5

5

2

King Saud

8

20

35

30

2

1

2

3

Salman

14

15

30

35

0

2

2

2

KUH

10

8

40

30

1.5

4

2

5

N-Guared

20

14

13

29

1

3

10

10

KKEH

20

10

10

50

0

0

0

5

Miltary2

20

10

12

28

0

5

5

30

KFSH

15

10

11

40

10

2

10

2

Table 4. Percentages of types of medical waste (private hospitals) MEDICAL WASTE AS DESCRIBED IN A-H hospital

Saultan National Hamady Moasah Meshary Obaed COSE Green-cr Mubark German Kingdam Falah Dallah Habieb Eligent

346

A

B

C

D

E

F

G

H

Bio-Medical Waste Handling and Management in Riyadh, Saudi Arabia

The above results are plotted in Figure 4 for the government hospitals and in Figure 5 for the private hospitals. It can be noticed that the total percentages for type A and type B are equal for the government hospitals. The findings of this study showed that Type E and type G constituted the lowest quantities for both government and private hospitals. The waste generated by psychiatric and other types of hospitals was different from that of the one generated by general hospitals. Two of the respondents categorised themselves as psychiatric or other hospitals. The hospitals were also asked to list the sources of medical waste in terms of the wards in which they were generated. Each department in the health facility generates a certain amount of waste which varies depending on the activities carried out in the particular department.

Figure 6. Collection containers with different colour coding and labelling

WHO recommends that medical waste be segregated into the appropriate containers/ bags at the point of generation. Part of the questionnaire was aimed to investigate whether or not the facility practices waste segregation. In addition, the following were investigated: if the colour coding system was used in managing waste in the facilities, the type of containers used in collection of waste in the health facilities and if those containers were readily available all the time for use. The survey revealed that almost all (97.6%) of the hospitals surveyed practised some sort of medical waste segregation. Table 5 shows the type of medical waste segregated and the percentage of segregating hospitals.

60

50 40

solid

30

animals articales

20

pathological

10

blood

cultures kfsh

kkeh

miltary2

kuh

n-guard

salman

force

kingsaud

iman

miltary

kfmc

yamamah

ksh

kauh

amal

0

Table 5.: segregation of medical waste

Figure 4. Types of medical waste for government hospitals

Waste category segregated

% of segregating hospitals

70

Type

D

90.2

60

Type

B

75.6

cultures

Type

A

73.2

blood

Type

C

70.1

30

pathological

20

Type

H

70.1

articales

10

Type

F

61

animals

Type

G

53.6

Type

E

46.3

50 40

0

solid

Figure 5. Types of medical waste for private hospitals

3.5 Waste segregation Management of medical waste is segregation (separation) and identification of the waste. Therefore, it is important to have an efficient segregation system as well as designated storage area within the healthcare establishment. The most appropriate way of identifying the categories of medical waste is by sorting the waste based on colour code within the recommendations and guidelines of the WHO. Figure 6 presents some of the recommended colour coding techniques and types of containers to be used for the segregation and storage of the various elements of medical waste (taken from C. Visvanathan & Radha Adhikari 2006).

It was noticed that the hospitals that have been visited did not segregate all medical waste categories from one another. However, sharps and cultures were segregated from other medical waste prior to treatment and disposal. In all visited hospitals both red bags and general trash bags were present in all rooms in addition to a sharp container mounted on the wall of the rooms.

3.6 Body Parts Human body parts present both a sanitation and public health risk. For these reasons, body parts must be disposed off properly. In this study, the term ‘disposal of body parts’ is the practice and process of dealing with the remains of a deceased human being. In general, several methods for disposal of human body parts are practiced. In many cases, the manner of disposal is dominated by spiritual concerns and a desire to show respect for the

347

Bio-Medical Waste Handling and Management in Riyadh, Saudi Arabia

dead, and may be highly ritualised. This event may be part of a larger funeral ritual. Many religions as well as legal jurisdictions have set rules regarding the disposal of body parts. Since the experience of death is universal to all humans, practices regarding body parts disposal are a part of nearly every culture. Different religions and cultures have various funeral rites that accompany the disposal of a body. When it is not possible for a body to be disposed of promptly, it is generally stored at a morgue. The body parts are a pathological waste and this type of waste consists of fragments of tissues and organs, nonviable foetuses, placenta, all of these waste from human body parts are required to be handled separately in accordance to Islamic fatwa No.8099 dated 21 safer 1405 H. Accordingly, body parts are separated in black bags and stored in the morgue that will be collected by the council of Riyadh city to be buried on the cemetery, once every two weeks.

3.7 Treatment and Disposal of Healthcare Waste Part of the questioner was aimed to investigate the treatment methods and the onsite treatment facility at the targeted hospitals. In addition, the presence of any specifically designated area for health care waste disposal was investigated too. The disposal method used in health facilities and means of healthcare waste transportation were also investigated. Investigations were also made to find out whether the respective establishments had facilities to incinerate wastes, and the size of the incinerator if it existed. Furthermore, the investigation was extended to establish operating conditions of the incinerator. The survey asked the hospitals about the method they used for treatment and disposal of medical waste. The following are the results from the answers to the section in the survey requesting information on treatment and cost of disposal of the wastes. All the hospitals and health care Centres in Riyadh city are not allowed by law to carry out onsite medical waste treatment, this is to safeguard against pollution. Consequently, there are no onsite incinerators, all types of medical waste treatment are conducted off site by contractors. The final disposal of the healthcare waste is implemented through different private companies using different types of waste disposal. One of these companies is using a microwave irradiation process at their facilities in Riyadh. The other two companies in Riyadh city use incinerators with emission controls that are compliant with the PME regulations (Alzahrani et al.,2000). The latest guidelines issued in February 2001 by the Saudi government stipulated that all on-site treatment plants have to shut down and to sub-contract the process to specialised companies that are licensed by PME. Currently, seven companies that offer medical waste handling and treatment in various parts of Saudi Arabia. More companies are expected be granted license from PME in the near future.

Unified code for the management and disposal of medical waste was established in 1999 and it was adopted in 2005 (Alshallash et al.,2007). The regulations impose restrictions on the generation, transport, handling, storage, treatment, disposal of healthcare waste. The regulations recommended the following: 1. The private sector will be encouraged to invest and assume a vital and increasing role in the safe treatment and disposal of infectious waste. 2. All existing incinerators at various on-site medical facilities in the GCC should be decommissioned by 2004. 3. Both the government and private sector have to provide training and conduct workshops and seminars to educate healthcare staff on the proper and safe handling, packaging, transporting, and disposal of infectious waste. In addition the government of Saudi Arabia was one of the parties that signed the “1989 Basel convention” coordinated by United Nation Environment Program (UNEP). This convention deals with transboundary movement of hazards waste and is also applicable to hazardous healthcare waste. The Saudi Government has formulated the Bio-Medical Waste (Handling and Management) Rules in 1998 (hereafter referred to as the Bio-Medical Waste Rules) in order to specify procedures that have to be followed in the management and disposal of waste. The rules regulate the disposal of bio-medical waste including human anatomical waste, blood, body fluids, medicines, glassware, soiled, liquid & biotechnology waste and animal waste. The rules have been formulated as framework for handling & management of biomedical wastes. The rules are applicable to all hospitals, nursing homes etc in the country and also apply to all persons who generate, collect, receive, store, transport, treat, dispose or handle biomedical waste in any form.

3.8 Cost of disposal of medical waste Regarding the cost of disposal of medical waste, all of the respondents had said that they use off-site commercial facilities to treat at least most of their waste. In Riyadh city, the average total cost of disposal in terms of cost/hospital/month was 3,090SR for a government hospital. While the average total cost of disposal in terms of cost/hospital/month was 2,000SR for a private hospital. All respondents had given the cost of waste treatment and transportation of waste. The information provided in Table 6 is for the governmental hospitals and that in Table 7 is for the private sector.

348

Bio-Medical Waste Handling and Management in Riyadh, Saudi Arabia Table 6.cost of medical waste treatment per year in government hospital Name of hospital

Costs (SR) per month

Amal

02222

KSH

02222

KAUH

02222

KFMC

00022

Yamamah

0222

Miltary

02222

Eman

02222

Force

02222

King Saud

02222

Salman

02222

KUH

02222

N-Guared

022222

KKEH

00222

Miltary2

02222

KFSH

02222 020022

Total

Table 7.cost of medical waste treatment per year in private hospital Name of hospital

Costs (SR) per month

Saultan

02222

National

00222

Hamady

02222

Moasah

02222

Meshary

02222

Obaed

02222

COSE

0222

Green-cr

02222

Mubark

00222

German

02222

Kingdam

02222

Falah

0222

Dallah

02222

Habieb

0222

Eligent

02222

Total 020222

4. Conclusions & Recommendations This study was carried out to assess hospitals waste management practice in Riyadh. The study identified the sources, types, waste generation rates and various waste disposal techniques of medical wastes from 30 hospitals. Health care waste management in Riyadh's Hospital is not up to the mark. The general awareness on the subject is very much lacking on part of managers, producers, and handlers of waste. The generation of medical waste in health care facilities has been increasing in quantity and variety, due to the wide acceptance of single-use disposable items (e.g. gloves, plastic syringes, medical packages, bedding, tubing, IV bad and containers). The management of medical waste has been a major

concern due to potentially high risks to human health and the environment. In the past, medical waste was often mixed with household waste and disposed off in municipal solid waste landfills. In recent years, increased public concerns over the improper disposal of medical waste have led to a movement to regulate the waste more systematically and stringently by the ministry of health and the PME on Saudi Arabia. Waste minimization and recycling are still not wellpromoted, No previous and ongoing program on waste minimization was witnessed, which results in significant amounts of medical waste to be disposed. Efforts have to be made for minimization and recycling of medical waste prior to final disposal, especially many medical PVC wastes and plastics, if not infected or contaminated. Incineration with emission control and microwave irradiation will be dominant as a medical waste treatment because other common waste treatment methods will no longer be available in the near future. Therefore, toxic substances such as dioxin emissions at medical waste incinerators should be closely monitored to reduce potential risks to humans and the surrounding environment. Other potential treatment technologies, such as plasma arc, should be examined as alternatives to incineration in order to better manage medical waste in Riyadh's hospitals. Nearly all the healthcare facilities studied promote segregation of Group D wastes, especially sharp wastes. However, not much attention is given to the other types of wastes, which are usually managed without a perspective for recycling and are collected through the municipal collection system. All wastes are collected manually by workers and then transported to the on-site storage area by using uncovered trolleys. This practice exposes visitors and patients to possible contamination. On-site storage containers at all clinics have poor conditions due to the location and situation. These containers are placed near the main streets within the health facilities buildings. Also an improper disposal of all body parts wastes as hazardous waste, and a comprehensive and detailed study needs to be undertaken to assess the quantities of body parts generated at the health care facilities. The medical waste management situation in the Riyadh's health care facilities, is far from ideal. To ensure improvement and continuity in the management practices, healthcare institutions should develop clear plans and policies for the proper management and disposal of waste. The awareness and training on waste management issues among the medical or sanitary staff was at its lowest level. They need to be integrated into routine employee training, continuing education, and management evaluation processes for systems and personnel.

5. Recommendations Based on the study presented above, the following recommendations are made in order to improve the hospital waste management strategies and practices that

349

Bio-Medical Waste Handling and Management in Riyadh, Saudi Arabia

exists at present:

Definitions and Goals Set Before any clear improvement can be made in clinical waste management, consistent and scientifically based definitions must be established as to what is meant by clinical waste and its components and what the goals are for how it is managed. Importantly, in the clinical wastes, "potentially infectious waste" as a category must first be addressed for the proper management of treatment and disposal.

Focus on segregation As a result of failure to establish and follow segregation protocols and infrastructure in government and private hospitals in Riyadh city, the waste leaving healthcare facilities, as a whole is both potentially infectious and hazardous. No matter what final strategy for treatment and disposal of wastes is selected, it is critical that wastes are segregated (preferably at the point of generation) prior to treatment and disposal. This most important step must be taken to safeguard the occupational health of health care workers. Effective and efficient waste segregation systems should be developed and implemented. Proper segregation should be achieved through training, setting clear standards and tough enforcement.

Focus on sharp waste management A proper sharps management should be instituted in all health care facilities. In this way, most of the risk of disease transmission from clinical waste would be prevented. Proper segregation of these materials in rigid, puncture proof containers which are then monitored for safe treatment and disposal is the highest priority for medical waste management in hospitals.

proper personal protective equipments. Proper education and training must be offered to all employees from doctors to workers, to labourers and rag pickers to ensure an understanding of the risks that wastes pose, how to protect themselves, and how to manage wastes (especially how to properly segregate). Education and training programmes must be developed which speak to each population in Riyadh city in a way that will best meet the needs and build understanding and change behaviour in that population with regard to safe dealing of generated medical waste. Staff training and awareness underpin several of the short and medium/long term solutions suggested to reduce the waste at the source. Demonstrative programmes should be conducted for employees who are in direct contact with the healthcare waste, to provide an improved understanding of the risks and the importance of health and safety measures during handling and segregation. Organising awareness and training program for the staff of healthcare facilities. The training should including the medical practitioner/doctor/paramedical staff, sanitation staff and users of medical facilities. Improper disposal of all wastes, municipal solid waste, hazardous wastes, industrial wastes, human wastes, etc. poses a major health hazard in Riyadh city. Develop an infrastructure for safe disposal of waste in government and private hospitals in Riyadh city

Develop and activate cooperation.

Emphasis needs to be put on waste reduction of hazardous materials

Establish effective collaboration between the Ministry of Health, PME and organisations concerned in management and disposal of medical wastes in Riyadh city These organisations should be given wide responsibility to monitor in controlling the waste management procedures. Documents pertaining to the quantity of waste generated and the healthcare waste management practices in the hospital need to be maintained. Periodical surveillance of health care waste management practices should be conducted.

Proper Collection System

A medical waste audit

Focus on reduction of generated hazardous waste

If the benefits of segregation are to be realised then there must be secure internal and external collection and transportation systems for waste. In addition the very real concern of hospital administrators and municipal officials to prevent the reuse of clinical devices, containers and equipment after disposal should be taken into account in any management scheme.

Cohesive Waste Management Plan To ensure continuity and clarity in these management practices, health care institutions should develop clear plans and policies for the proper management and disposal of wastes. They need to be integrated into routine employee training, continuing education and hospital management evaluation processes for systems and personnel. Ensure worker safety through education, training and

A medical waste audit is a useful tool to find out the sources of waste in a health care facility, their compositions, and rates of generation. An audit may also provide information on waste minimization and handling practices, segregation efficiency, “over classification,” regulatory compliance, and costs. Separate clinical waste storage area should be allocated away from public access. Information with respect to risks involved in healthcare waste management practices have to be disseminated, for public or general community.

Avoid Incineration: The rush to incinerate clinical waste as an ultimate solution to a problem without definition is an injustice to developing countries, public health and the environment. Lesser risks are associated with the treatment of

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unsegregated wastes through other treatment technologies such as autoclaving, hydroclaving, microwaving and chemical disinfection, which affect workers more than general public and contaminate water sources rather than air if improperly operated. Choices of treatment technologies should be made in line with a clear knowledge of the waste stream to be managed and the goal to be achieved through treatment. Technology should fit the situation and work in the management system to achieve the final goal as part of the overall system, not as a replacement for the system. Plasma arc technology should be examined as alternative to incineration.

Development of Sanitary Landfills, Sewage Treatment:

[7]

Al-Qudah, O., Evaluation of medical waste disposal methods and their applications in Jordan. A Masters Thesis, Jordan University of Science and Technology, Irbid, Jordan. 2000

[8]

Blackman Jr. W.C. Basic Hazardous Waste Management, seconded.Lewis Publishers/CRC Press, New York, USA, (1996) (Chapter 12).

[9]

C.E Da Silva, A.E Hope, M.M. Ravanello, Medical waste management InBrazil, Waste management (2005)25 600-605

[10] Christen, J. Dar es Salaam, Urban Health Project: Health-care waste management in district health facilities: situational analysis and system development. St Gallen, Switzerland, Swiss Centre for Development Cooperation in Technology and Management (SKAT) , (1996). [11] Coad, A., Managing medical waste in developing countries. Report of a Consultation on Medical Wastes Management in Developing Countries, WHO, , (1992) Geneva, Switzerland.

The Development of sanitary landfills, sewage treatment plants and other waste management facilities is necessary to securing public health in the country and providing for the ultimate safe disposal of those wastes which cannot be otherwise recycled, composted or reused.

[12] C. Visvanathan , Radha Adhikari, A. Prem Ananth The Second Baltic Symposium on Environmental Chemistry Kalmar, Sweden, November 26-28, 2007

Research

[14] Environmental Protection Agency. Medical waste management and disposal. Pollution Technology. Review No. 200, Noyes Data Corporation, Washington, DC, USA, (1990)

A comprehensive and detailed study needs to be undertaken to assess the quantities of solid waste generated at the health care facilities. The components, composition and quantities needs to be assessed and confirmed which will form the basis of planning, designing and implementation of waste management facilities. Mass awareness campaign needs to be planned, designed and implemented to make the people aware of the consequences of infectious waste.

Body parts Improper disposal of all body parts wastes as hazardous wastes. A comprehensive and detailed study needs to be undertaken to assess the quantities of body parts generated at the healthcare facilities.

REFERENCES [1]

Abdullah F, Qdais HA, Rabi A:. Site investigation on medical waste management practices in northern Jordan.Waste Management, (2008)28(2):450-458.

[2]

A.D Patil, A.V. Shekdar, Health Care waste managementin India, Journal of Environmental Management (2001)63,211-220.

[3]

Ahmad Bdour B. Altrabsheh b, N. Hadadin a, M. Al-Shareif Assessment of medical wastes management practice: A case study of the northern part of Jordan. Elsevier, , (2006)

[4]

Ahmed, Rehan Hospital Waste Management inPakistan, National Committee on Solid Waste CleansingAssociation, Denmark 1993.

[5]

Al-Khatib I. A.; Occupational safety of cleaning personnel in Palestinian district hospitals. Eastern Mediterranean Health Journal, , (2006) 12(5):637-52.

[6]

Almuneef, M., Memish, Z., Effective medical waste management:it can be done. American Journal of Infection Control, , (2003) 31 (3), 188–192.

[13] Diaz, L.F., Savage, G.M., Eggerth, L.L., Alternatives for the treatment and disposal of healthcare wastes in developing countries. Waste Management , (2005) 25 (6), 626-637.

[15] Freeman, H.M.. Standard Handbook of Hazardous Waste Treatment and Disposal, , (1998) (2nd ed.). USA: McGraw-Hill [16] Glenn, Mc.R & Garwal, R. Clinical waste in Developing Countries. An analysis with a Case Study of India, and a Critique of the BasleTWGGuidelines. , (1999) [17] Hagen DL, Al-Humaidi F, Blake MA: Infectious waste surveys in a Saudi Arabian hospital: an important quality improvement tool. Am J Infect Control ; (2001)29(3):198-202. [18] Hayashi Y., Shigematsu, M., Proper disposal (management) of medical wastes infection prevention and waste management (Clean Hospital Project) at Hiroshima City, Asa Hospital. Rinsho Byori, (2000) (Suppl. 112),26-31. [19] Jang Yong-Chul, Lee Cargro, Oh-Sub Yoon, Hwidong Kim , Medical waste management in Korea. Journal of Environmental Management, , (2005) 80(2006)107-115. [20] Kane, A. Lloyd, J. Zaffran, M. & Kane M. Ref. No. 0058 789 In Focus Unsafe injections in the developing world and transmission of blood borne pathogens Bulletin of the World Health Organization, , (1999) 77 (10) 801-807. [21] LaGrega, M., Buckinham, P., Evans, J. Hazardouss Waste Management. , (1994) McGraw-Hill, New York, USA. [22] Lee, B.-K., Ellenbecker, M., Moure-Ersaso, R., Alternatives for treatment and disposal cost reduction of regulated medicalwastes.Waste Management, (2004) 24, 143–151. [23] Massrouje, H.T.N. – Nov,Medical waste and health care workers in Gaza governorates. Eastern Mediterranean Health Journal, , (2001) volume7 No.6 (1017-1024). [24] Mato, R., Kaseva, M., Critical review of industrial and medical waste practices in Dar es Salaam City. Resources, Conservation and Recycling, (1999) 25, 271–287. [25] Meaney,J.G.,Cheremisiho, P.N.,Medical waste strategy Pollution Engineering, , (1989) October, 92–106 [26] Miyazaki, M., Une, H.,. Infection waste management in Japan: A revised regulation and management process in medical institutions. Waste mange. , (2005) 25,616-621

351

Bio-Medical Waste Handling and Management in Riyadh, Saudi Arabia [27] Mohee. R Medical Waste characterization in healthcare institutions in Mauritious, Waste Management 25(2005) 575-581. [28] Prüss, Annette Giroult, Eric Rushbrook Philip, 1999. Safe management of wastes from health-care. ISBN 92 4 154525 9 (NLM classification:WA 790).WHO. [29] Remy, L. Managing Hospital Waste is a Big. Nasty Deal, Great Western Pacific Costal Post. , (2001) [30] Saini, R.S. & Dadhwal, P.J.S. Clinical waste management: a case study. Journal of Indian Association for Environmental Management, , (1995) 22, 172–174. [31] Silva, C.E., Hoppe, A. E., Ravanello, M. M., Mello, N. Medical waste generation in the Vacaca ´ river basin - RS. In: Proceedings of the Sixth National Seminar on Solid Wastes. , (2002) Gramado, RS, Brazil,pp. 1-4. [32] Tiejen L. bossemeyer D. Mcintosh N. Infection preventionguidelines for healthcare facilities with limited resourcespublisher "JHPIEGO";Baltimore,USA. , (2003) [33] World Health Organization, (WHO). 2004. Decisionmakingguide"Management of solid healthcare waste at primary healthcarecenters" ISBN 92 4 159274 5.

[34] World Health Organization, (WHO). 1997. Action plan for the development of national programme for sound management of hospital wastes. An outcome of the Regional Consultation on Sound Management of Hospital Waste, Chiang Mai,Thailand, , (1996) 28.29 November. New Delhi, World Health Organization Regional of South- East Asia. [35] World Health Organization (WHO), 2000. Safe health-care waste management Aide mémoire for a national strategy for healthcare waste management, at World-Wide Web,www.healthcarewaste.org. [36] World Health Organization (WHO), 1999 "Guidelines for safe disposal of unwanted pharmaceuticals in and after emergencies, "WHO/EDM/PAR/99.2. Geneva: WHO. 2000. [37] World Health Organization (WHO), 2004 "Health-care WasteManagement", policy paper, Department of Protection of the Human Environment Water, Sanitation and Health20. Geneva 27,Switzerland. [38] World Health Organization (WHO), 2000 "Wastes from HealthcareActivities", Fact Sheet No. 253. Geneva. [39] World Health Organization, 1999. In: Pruss, A., Giroult, E., Rushbrook,P. (Eds.), Safe Management of Wastes from HealthCare Activities, 1999. Geneva, Switzerland

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