Waste is an unwanted or unusable material, substance or by-product. Waste that is generated in a Healthcare facility is classed as Health Care Risk Waste (HCRW) includes sharps (syringes, disposal scalpels, blades etc.), non-sharps (swabs, bandages, disposal medical devices etc.), blood and anatomic waste (blood bags, diagnostic samples, body parts etc.), chemical (solvent, disinfectants etc.) pharmaceuticals and may infectious, toxic, create injuries or radioactive.
In a Healthcare facility setting HCRW is in handle by the health care personnel and waste management personnel (this can be the Environmental Health Practitioner). The aforementioned personnel need to work hand in hand to ensure that there is proper management and handling of HCRW. Improper handling and management of HCRW presents a great deal of harm in the community and therefore presenting a risk of exposure to diseases and polluting the environment.
The risk to the community includes intentional and unintentional exposure in the absence of a safe waste management system. Intentional exposure occurs through the widespread reuse of disposal material (especially syringes) in developing counties and result in the main disease burden caused by inadequate health care waste management. (Haneline M, Meeker W. (2011). Main disease outcomes of concern include Hepatitis B Virus (HBV), Hepatitis C Virus (HCV) and Human Immunodeficiency Virus (HIV) transmission.
Unintentional injuries may occur when the community is exposed to inadequately disposed waste for example through scavenging on waste sites. The risk to waste workers and health personnel who handle health care wastes are currently being investigated. If adequate measures are taken, the risks to the segment of the population should be low. Most cultures are sensitive to the aesthetics of HCRW or perceives the risk as being high to the point that waste works sometimes refuse to handle the wastes.
To date there is no low-cost, environmental friendly and safe disposal option for health- care waste are available. Low-cost options are often polluting and are therefore indirectly potentially harmful to human health. The absence of management however also puts human health at risk. Significant improvements can however be achieved by management option such as purchase policies, and isolation and improper treatment of key segment of the waste.
2. Objectives of the study
‘ To evaluate the attitude, knowledge and practice of health care personnel’s towards the health risk waste.
‘ To evaluate the legal compliance of the health care contractor and the dumping of health care risk waste.
‘ To create the awareness or education on health care waste to all health care personnel’s.
3.1. Study area
The study was conducted among the 7 Municipal clinics in Johannesburg South Region F.
4. Study design
This was a descriptive cross sectional study using a self-administered questionnaire, a random sample of operational managers, and nurses employed at the 7 municipal clinics. Of 25 questionnaires issued, 19 (12 (63%) nurses and 7 (37%) were completed. A potential limitation was self- reporting, the result may not be true reflection of the participants practice.
5. Data collection
The data was collected using questionnaires; questionnaires were distributed to different facility workers in different department of different Municipal health clinics. The focus was on evaluation of behavior and attitude on handling health care risk waste, segregation, disposal, storing, and collecting of health risk waste in municipal health clinics. Secondary data was obtainable from reports of infection control nurses on using of Standard operational procedure (SOP).
6. Data Analysis
Statistician: based on the responses from the questionnaire the statistician will help to create the graphs and analyse the participant’s responses into data.
‘ The permission for this study was granted from Primary Health Care Manager of city of Johannesburg South Region F.
‘ A written consent by the participants agreeing to be part of the study.
Health care workers do their best to help people stay healthy. But if the waste from the health care risk waste is not handled safety, it can spread illness to the health workers and the surrounding community. Health care risk waste includes waste from the clinics, hospital, laboratories, blood banks, dental clinics, birth centers and animal hospitals. It does also include the waste from the immunization programs (also called immunization campaigns) and medical waste aid missions and waste produced from caring for the sick at home (Conant J, Fadem P, (2008).
Most waste from health care centre are ordinary waste like paper, cardboard and food scraps. But some health wastes are contaminated with blood fluids that may carry harmful germs and spread disease. Used needles and other sharp tools can cause injury and spread disease. Some health care waste, such as plastic, contains toxic chemicals. When waste that carried harmful germs and toxic chemicals is mixed with ordinary waste, the mixed waste becomes a threat to all who handle it. That is why separation of waste is so important.
Safe handling of health care risk waste uses the same basic method used to dispose of other solid wastes. But wastes contaminated with the body fluid and germs must be disinfect end and dispose of in ways that protect the health care people and the environment.
9. Literature review
9.1 Minimum approach to overall management
All personnel dealing with health care waste should be familiar with main categories of the health care waste set out in either national or local regulation on waste classification. As the minimum, manager’s responsibilities for health care waste should conduct a walkthrough of the facility to identify the medical areas that produces waste to obtain an initial estimate of the types and quantities of waste generated and to understand how waste is handled and dispose of. A rapid assessment, combining observation with the interview and survey questionnaires, should provide sufficient data to identity problems and begin the process of addressing them (WHO; 2010).
9.2 Generation of the health care
Understanding the types of waste produced in the health care facility is an important first step in a safe disposal. Waste generation is used in estimating the required capacity for containers, storage areas transportation and treatment technologies. Waste generation data can be used to establish baseline data on the rates of production in direct medical area and for procurement specification, planning, budgeting, and calculating revenues from recycling, optimization of waste management system and environmental impact assessment.
Health waste generation is best obtained from quantitative waste assessment. An assessment entails defining goals defining goals, planning, enlisting the cooperation of the staff, procurement of the equipment (e.g. weighing scales, personnel protective equipment) data collection, analysis and recommendation. The process of waste assessment provides an opportunity to improve the current practice, sensitize health workers about waste and determine the potential for waste minimization. Implementing rigorous segregation can avoid over-seizing of equipment and data result in cost savings.
An audit of health care risk waste conducted in Gauteng identified three critical problems in health care waste management system, namely: environmental damage, occupational health and public health and public health. These critical problems arose as a result of excessive and incorrect manual handling of HCRW, the unsafe utilization of equipment and excessive emission of pollutants from health care risk waste treatment plants (Fischer et al 2003).
9.3 Immunization programs
A large numbers of people around the world are protected from diseases such measles, tetanus and polio by receiving special injection trough immunization programs are often run by international organization like world health organization (WHO) and UNICEF, together with national and local government and with the companies that make and sell vaccines (Conant J, Fadem P, (2008).
These programs often do not include good plans for disposing waste of waste, in many cases they leave waste behind to be handled by the communities receiving the immunizations. This often leads to incinerating or burning the wastes in the open, creating health problems for people and their environment.
9.4 Internal and external collection
According to the Policy for KwaZulu-Natal: Health Care Risk Waste Management, 2008. Segregation practices must be implemented at the point of segregation to ensure that different categories of health care risk waste go into a correct waste streams. Health care waste must be accumulated at the point of generation as it gets generated and must not be allowed to lie around for any length of time. Different categories of waste must be collected in appropriate receptacles and full receptacles must be properly sealed and recommendation of the SANS 1024:2004 must be strict adhere to.
Radioactive, pharmaceutical and chemical waste, each requires special handling and disposal channel as their treatment is different from other categories of health care risk waste. Special protocol for radioactive waste must be followed including special secure intermediate storage for decay and dedicated secured disposal. Pathological waste and chemical waste must suitably containerized and labelled appropriate special treatment by suitable technology and provision of Medicines and Related Substances Control Act, 1965 (Act 101 of 1965 section 27 and 27) of Regulation Promulgated under this Act.
9.5 Health care waste practices
All individual exposed to health care risk waste are potentially at risk of being injured or infected (WHO, 2002). Some of the health facilities have been reported to dispose of syringes in the pit latrines (Anicetus, 2006). When the syringes are not dispose of properly by burning (destructive incineration) burying, patient to the community transmission of the infection can occur.
10. Result and Discussion
Health care risk waste management in all Municipal Health clinics depends on the number of workers in different departments. If the number of personnel’s in health facilities is not satisfactory, the health care personnel’s may devote most of their time in attending the patients with little attention paid to health care risk waste management.
11. Conclusion and recommendation
The important of training regarding health care risk waste management needs emphasis, lack of proper and complete knowledge about health care risk waste management impacts practices of appropriate disposal. Health care risk waste management must be a part of public health establishment, district and provincial operational plans, work plans, and performance agreements for all the relevant officials who serve on public health establishment, district, and provincial waste management committees. Inspection must be taken at least once a month to ensure monitoring of the public health establishment and the health care personnel should be trained quarterly to improve their understanding on health risk waste or whenever they are new regulation of city bylaws in place. The health care facility shall dispose of all waste in accordance with National, provincial regional and municipal regulation, legislative and bylaws.
List of References
Segregation, Packaging and Storage Guidelines for Health care waste, health services executive department of health and children 2010.
WHO (2012). Antimicrobial resistance. Available on http:www.wh.int/mediacenter factsheet/fs194/en /, accessed 24tth august 2012.
Abah, S., Ohimain E (2011). Healthcare waste management in Nigeria a case study,. Journal of public health and epidemiology, 3(3) 99-110.
Policy for Kwazulu-Natal: Health risk waste management (2008).
Haneline M, Meeker W. (2011). Introduction to public health for chiropractors
Conant J, Fadem P (2008). A community guide to environmental health.
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Adams J, Bartram J, Chartier Y, (2008) (WHO).essential for environmental health standards in health care.
South African Bureau of Standards. Code of practice: handling and disposal of waste material within health care facilities. SABS 10248, the council of South African Bureau of Standards, Pretoria.
WHO (2004a). Safe Health Care Waste Management: Policy Paper. Geneva, World Health Organization. Available at http://www.healthcarewaste.org