Abstract
The study aimed to assess disposal practices and quantify the microbial load present in SMW from ten sub-district level healthcare facilities and 385 households in Yilo Krobo municipality, Ghana. Disposal of solid medical waste (SMW) was assessed by questionnaire-based surveys, unstructured interviews and field observations. Microbiological analysis identified species and counts of bacteria present in SMW from both sources. Sociodemographic factors influencing the method of SMW disposal in households were evaluated using logistic regression analysis, with statistical significance set at p<0.05. Open burning (29%), burying (25%) and disposal at a dumpsite (49%) were common methods used by households to discard SMW. SMW disposal at a dumpsite was associated with age of respondents in households. Older people (50+ years) were three times more likely to place SMW in household waste later discarded at a dumpsite, compared to younger persons (20–30 years) [a0R, 95%CI = 3.37, 1.41–8.02]. In sub-district level healthcare facilities, open burning and burying were the most common methods used. Bacillus subtilis, Klebsiella pneumonia, Pseudomonas aeruginosa, Clostridium tetani, Enterococcus faecalis, Acinetobacter spp. Escherichia coli, Bacillus cereus and Enterococcus faecium) were bacteria identified in SMW recovered from both the healthcare facilities and the households. Klebsiella pneumoniae, Acinetobacter spp. and Clostridium tetani were found exclusively in untreated SMW generated in the healthcare facilities. Bacillus spp. and Pseudomonas spp. were found in one sample of treated SMW. The microbial load in SMW from healthcare facilities and households ranged from 0.036 x 103cfc/mg to 0.167 x 103 cfc/mg and from 0.118 x 103cfc/mg to 0.125 x 103cfc/mg respectively. This highlights the need for institutionalizing appropriate treatment methods in sub-district level facilities or strengthening the linkages with higher level facilities to ensure regular and adequate treatment of SMW. Public guidance on management of SMW generated in households which is context specific should also be provided.
Highlights
According to the World Health Organization (WHO), medical waste has been defined as an end product of medical services and includes items such as medical devices, sharps, blood, body parts, chemicals, pharmaceuticals, and radioactive materials [1, 2]
solid medical waste (SMW) was generated in households and respondents reported categories similar to those in sub-district level healthcare facilities in a multi-phased study in Yilo Krobo Municipality, Ghana
The study confirmed the presence of pathogenic bacteria in SMW
Summary
According to the World Health Organization (WHO), medical waste has been defined as an end product of medical services and includes items such as medical devices, sharps, blood, body parts, chemicals, pharmaceuticals, and radioactive materials [1, 2]. Identified bacterial pathogens such as Pseudomonas spp., Corynebacterium diphtheriae, Escherichia coli, Staphylococcus spp. which are known to cause respiratory tract infections and other diseases have been reported in SMW and should be carefully controlled to prevent associated nosocomial infection [6]. Some of these bacteria exhibit resistance to antibiotics. Drugs that were used to treat associated diseases are losing their impact due to emerging drug resistant microorganisms including Escherichia coli and Klebsiella pneumonia [6] This resistance threatens the effective control against these bacteria that cause UTI, pneumonia and bloodstream infections, resulting in longer hospital stay and higher costs of care. Pathogens present in untreated waste can leach out and contaminate the soil and surface water [7]
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