Medical waste management in Iraq: a case study of Baghdad

Medical waste status is a severe public health problem worldwide. Proper medical waste management is of paramount importance. However, there is insufficient information about medical waste management and lack of management in different countries. The aim of this research was to investigate and evaluate the present status of medical waste management in different countries. We systematically searched Embase, PubMed/MEDLINE, Scopus, PubMed Central, Google Scholar databases, as well as medRxiv using the following keywords: medical waste, waste management, disposal, healthcare per-capita generation, gross domestic product (GDP), and hospital. A total of 38 eligible articles were identified. Correlations were calculated between the amount of medical waste generated (kg bed.day-1) vs. GDP per capita ($) and ranking of healthcare system performance. A negative correlation was found between medical waste generation rate and ranking of healthcare system performance. According to the findings of this study, the medical waste generation rate in different countries ranged from 0.14 to 6.10kg bed.day-1. About 25% of countries segregated medical waste, and about 17% used standard storage for all medical waste. Shortcomings were also found in waste collection, storage, transportation and transfer, and disposal of medical waste management activities in different countries. Only about 25% of countries simultaneously used three techniques, such as autoclaving, incineration, and landfill for disposal and treatment of medical waste, and 91% used incineration method. This study highlights an essential need for particular medical waste management guidelines and regulations, technologies, knowledge and financing to upgrade medical waste management worldwide. This study can be considered to be a good guide for further research on medical waste management in developing and developed countries.

Management of medical waste is of great importance due to its infectious and hazardous nature that can cause adverse impacts on human health and environment. The objectives of this study were to estimate the current generation of medical solid waste and its existing management practices in Hanoi city, Vietnam. This study also aimed at providing the predictions for future generation of medical solid waste that could serve as scientific basis for planning of medical waste management in Hanoi city. Based on the collected secondary data, the analyses indicated that the generation rate of total medical waste (including normal and hazardous medical waste) is 0.86 kg/bed.day, in which the generation rate of hazardous medical waste is 0.14 kg/bed.day. The major problem associated with existing management practices of medical waste is the treatment and disposal stage. There are no official recycling activities for normal medical waste at present although its legal basis has been setting up in the Medical Waste Management Regulation in 2007 issued by Ministry of Health. With respect to the treatment of hazardous medical waste, incinerators-the major applied technology are being operated inefficiently. For overcoming these obstacles, the local government and relating agencies need to put more effort, in terms of financial and human resources, in facilitating the official recycling activities for normal medical waste and developing more environmentally-friendly alternative treatment technologies for medical waste, towards the gradual replacement of unnecessary incineration. The study predicted that in 2020 and 2030, the quantities of total medical waste generated in Hanoi city would be 30.44 and 46.05 tons/day, respectively which 1.7 and 2.6 times higher than those in 2010. This would be challenging the local government in managing medical waste generated in the future.

Highlight:There was an increase in the accumulation of B3 waste in health centers during the COVID-19 pandemic.The knowledge and skills level of health center staff in medical THM waste management before and after medical THM waste management training were determined.Medical THM waste management training was increasing the knowledge and skills level of health center staff. Abstract:The generation of medical toxic and hazardous material (THM) waste at public health centers tends to increase during the Covid-19 pandemic. Only 6.89% of the health centers have medical waste management practices that meet the standards. Medical waste management practices not in accordance with the procedures can be a source of infection, even though only 56% of health workers have good knowledge and attitudes in solid medical waste management. For this reason, it is necessary to increase the skills of health center staff in managing medical THM waste during the Covid-19 pandemic. The purpose of this study was to determine the level of knowledge and skills of health center staff in medical THM waste management before and after medical THM waste management training. The training participants were 20 health center staffs who filled out a pretest questionnaire to measure their level of knowledge and skills prior to the training. The training materials include THM waste, medical THM waste, medical THM waste management and medical THM Temporary Storage. After the training, a post-test was conducted to measure the knowledge and skills scores of the trainees. The results of this study indicated that there was a significant difference in knowledge before and after training (p < 0.05). The average knowledge score before training was 6.2 (sufficient knowledge) and after training 8.15 (good knowledge). There was a significant difference in skill scores before and after training (p <0.05). The average skill before training was 6.3 (adequate) and after training 8.65 (good). In conclusion, there was an increase in the skills of health center staff in managing medical THM waste during covid-19 pandemic after participating in medical THM waste management training by the Community Service Team, Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia.

Medical waste is rising on policy agendas as a serious public health and environmental issue. The aim of this study was to assess current practices of medical waste management, which include waste generation, collection, storage, segregation, disposal, and use of protective equipment, in village clinics in rural China. Based on survey results from 236 randomly selected village clinics in 21 counties from three provinces of China, we used descriptive statistics to determine the medical waste management of village clinics in sample area. We found that the generation rate of medical waste in sampled village clinics was approximately 0.65 kg per day or 0.17 kg/patient per day on average. Given the large number of primary healthcare facilities and population in rural areas of China, the total quantity of medical waste generated in these facilities is noteworthy. However, we also found poor compliance levels with the national regulations regarding medical waste management practices. A large proportion of medical waste was still not packed in required containers, and almost all village clinics did not segregate correctly. Moreover, a significant portion of village clinics used improper disposal methods and lacked the necessary protective equipment. Medical staff in these facilities pointed out four main difficulties in complying with national regulations: a lack of funding, equipment, designated areas, and management personnel specifically delegated for medical waste management. These findings suggest that Chinese policymakers and health administrators should pay more attention to rural areas in addressing potentially hazardous medical waste management practices by investing financial support as well as developing specific guidelines tailored to resource-strained rural primary healthcare facilities.

ObjectiveThe purpose of this paper is to describe current practices of medical waste management, including its generation, investments, collection, storage, segregation, and disposal, and to explore the level of support from upper tiers of the government and health care system for medical waste management in rural China.MethodsThe authors draw on a dataset comprised of 209 randomly selected rural township health centers (THCs) in 21 counties in three provinces of China: Anhui, Shaanxi and Sichuan. Surveys were administered to health center administrators in sample THCs in June 2015.ResultsThe results show that the generation rate of medical waste was about 0.18 kg/bed, 0.15 kg/patient, or 0.13 kg/person per day on average. Such per capita levels are significant given China’s large rural population. Although investments of medical waste facilities and personnel in THCs have improved, results show that compliance with national regulations is low. For example, less than half of hazardous medical waste was packed in sealed containers or containers labeled with bio-hazard markings. None of the THCs segregated correctly according to the categories required by formal Chinese regulations. Many THCs reported improper disposal methods of medical waste. Our results also indicate low levels of staff training and low rates of centralized disposal in rural THCs.ConclusionsMedical waste is a serious environmental issue that is rising on the agenda of policymakers. While a large share of THCs has invested in medical waste facilities and personnel, it appears that actual compliance remains low. Using evidence of low rates of training and centralized disposal, we surmise that a lack of support from upper tiers of management is one contributing factor. Given these findings, we recommend that China’s policymakers should enhance support from upper tiers and improve monitoring as well as incentives in order to improve medical waste management.

Countries worldwide are struggling to develop strategies and infrastructure for appropriate disposal of the increasing medical waste generated by the COVID-19 pandemic. This study examines the available knowledge and current practices in medical/healthcare waste management worldwide, particularly in countries with transitional economies, including the dependence of medical waste generation rate on various socioeconomic and environmental parameters. Here, we conducted a meta-analysis of medical and healthcare waste management practices in 78 countries. We identified impediments and challenges facing the integration of medical waste management into a prospective circular economy according to statistical correlations with human development index (HDI), life expectancy (LE), healthcare expenditure (HE) per capita of gross domestic product (GDP), and environmental performance index (EPI). The results highlight the importance of knowledge and awareness of best practices for infection and injury prevention for waste management among workers. An average of 38.9% of medical waste was segregated for proper management, and only 41% of workers were trained in-service for medical waste disposal. Plastic materials constituted approximately 35% of medical waste, presenting an opportunity for sustainable resource recovery and recycling. It is imperative for all countries to adopt environmentally sustainable management of medical waste to prevent catastrophic stockpiling of infectious waste during and after pandemics. Additionally, we present an outline for future studies on medical waste generation rate and various socioeconomic and environmental parameters that should be investigated in future work to promulgate an inventory of the database for sustainable management of medical/healthcare waste.

Kwaingga Public Hospital is categorized as type C hospital because there are several aspects need to be improved for management and quality in order to fill the standard from Ministry of Health. Especially for a medical waste management, hospital staffs said that an incinerator has potential to explode due to bad structure because its pillar consists wood. This study aimed to observe the management of medical waste and general waste in Kwaingga Public Hospital. This study is qualitative study where the population is all staffs that work in Kwaingga Public Hospital, and the study sample is six Hospital staffs including hospital director, planning division, treasurer, and sanitarians. They have been deep interviewed and recorded. Study took visual documentations. There are 20 trashes distributed in hospital for daily waste and it is end in a small landfill in hospital backyard. This managed by 10 cleaning services and the staffs said that that number is still inadequate. Sanitarian staffs are six and they all have background sanitation diploma, but they still have overload tasks and they don’t get any training for development yet, the last training was in 2012. There are incinerator, wastewater treatment plant, septic tank, filtration for wastewater, and an old incinerator; there is no machine for destroyed needles. Unfortunately, the incinerator was rarely to use since its structure is bad and has potential to explode; also diesel fuel cost is expensive, so the medical waste burned manually including needles. Similarly, wastewater treatment plant is rarely used due to electricity cost, so it only runs if the wastewater is full. Wastewater treatment plant had bought from Local government Revenue costing 4.5 billion rupiah. Salary for contact staffs and cleaning services are also from local government revenue. Therefore, local government revenue must be increased its allocation for hospital waste management.

In this study the medical waste generation rates at Amana and Ligula hospitals were measured and analyzed. The rate of medical waste generation is high; about 2,250 kg/day in Amana and 2,500 kg/day in Ligula hospital. The waste generation rate per patient per day is also high about 1.8 (Amana) and 2.0 (Ligula) kg/patient.day. The daily medical waste generation rate is not constant, and fluctuates randomly. About 6 to 10% of waste generated is left uncollected. Eight medical waste categories were measured and compared: general waste, pathological waste, radioactive waste, chemical waste, infectious waste, sharps waste, pharmaceutical waste, and pressurized containers. The results indicated general waste to have high generation rate while others waste types such as chemical and radioactive wastes have low generation rates. Due to differences in generation rates, the data was normalized in order to compare statistical parameters used to assess medical waste generation rates. The statistical parameters used include: range, skewness, kurtosis, probability density functions and histograms. The study revealed that management of medical waste is still facing critical problems and requires skilled health workers, appropriate technologies and suitable equipment for collection, storage and transportation. The study will enable hospitals to understand trends in variations of medical waste generation and accommodate fluctuations in their plans and budgets. Key words: Measured medical waste in selected Tanzania district hospitals, variations of waste generation, average waste generation, waste collection efficiency; range of waste generation, normalized waste generation

Medical waste management in Kenya has been greatly affected by the country's elevated production levels. The majority of medical facilities do not have an extensive medical waste management system, or if they do, they do not handle waste thoroughly, and therefore is detrimental to humans and the environment. This research focuses on health facilities’ management of medical waste in Kamukunji sub-county, assessing the specific problems of medical waste management in that area. This was a study focusing on healthcare workers, their working conditions and habits. This study was an analytical cross-sectional study design. Multistage sampling methods for the selection of 10 health facilities and 141 study participants. The R square was 0.746, indicating that medical waste management was harmed by a lack of funding, insufficient logistics, a lack of disposal sites, and a lack of understanding. This demonstrated a 74.6 percent variance in healthcare waste management due to a lack of funding, insufficient logistical supply, a lack of disposal site, and a lack of awareness. The remaining 25.4% implies that there were additional issues affecting the healthcare waste management systems of the ten health facilities evaluated. By explicitly identifying a given color with a certain category and its accompanying hazard, segregation aids to make waste processing safer. During the research period, Pumwani Maternity Hospital generated the most medical waste (80Kg) and Bahati Health Center generated the least (15Kg). The study concludes that periodic updates in medical waste management are necessary, as is refresher training for healthcare professionals and waste handlers. Additionally, it is advised that each health care facility have a safe and hygienic system in place for the handling, segregation, c collection, storage, transportation, treatment, and disposal of medical waste. All health facilities in Kenya, the study states, should adhere to the National Policy on Injection Safety and Medical Waste Management (2007). The 2007 strategy aims to emphasize the need of advocating for both the support and execution necessary to adequately manage healthcare waste. Keywords: Medical waste generation, health risks, medical waste management solutions, challenges of medical waste management, health facilities

Recent happening globally especially in the developing country such as Nigeria has shown that there is need to conduct a survey on medical waste management due to direct or indirect adverse effect on the environment and human health. The medical waste management in private hospitals in Lagos State was assessed. Information on hospitals was collected from Lagos State Ministry of Health, Aluasa. Nine hospitals were visited and questionnaires and schedules were administered on the current status of medical waste management such as hospital generation information, waste amount, separation, collection, temporary storage and training.Data collected were analysed using descriptive statistics. The results showed that the total medical wastes were 207.16 Kg/day. Of the total medical wastes produced in studied area in one day, 119.07 Kg consisted of hazardous-infectious wastes, 85.91 Kg municipal wastes and 2.18 Kg sharp wastes. The average generation rate of total medical waste was 1.14 ± 0.2 Kg/bed-day. However, these rates were 0.72 ± 0.01 Kg/bed-day, 0.47 ± 0.01 Kg/bed-day and 0.01 ± 0.002 Kg/bed-day for hazardous-infectious, municipal and sharp wastes respectively. The percentages of hazardous-infectious wastes, municipal wastes and sharp wastes were 60.00%, 39.10% and 0.83% respectively. The hospitals waste management was evaluated poor in terms of separation, collection, transportation, temporary storage and training aspects and good in the treatment aspect.

Medical waste management has not received enough attention in recent decades in Iran, as is the case in most economically developing countries. This study investigated the quantities, generation rate, quality and composition of medial waste generated by hospitals in Sistan and Baluchestan province in Iran. A comprehensive inspection survey was performed for 14 hospitals located in the study area. Field visits were conducted to provide information on the different medical waste management aspects. The total number of beds in the hospitals was 2139, and the anticipated quantity of medical waste generated by these hospitals was about 6100 kg day(-1). The results indicated that the medical waste generation rate for total waste, infectious waste, general waste and sharp waste were 2.76, 1.36, 1.37 and 0.042 kg bed(-1) day(-1), respectively, which was comprised of 51.6% of infectious waste, 47.2% general waste and 1.2% sharps waste. The most frequently used treatment practice for solid medical waste was disposal in an unsanitary dumpsite after open burning. The results also showed that segregation of various medical waste types in the hospitals had not been conducted properly. The study revealed the need for training and capacity building programmes for all employees involved in management of the medical waste.

Despite the public health and environmental consequences associated with medical waste, much attention has not been given to its management in health care centres in developing countries. This study assessed medical waste generation and management practices in the Cape Coast Teaching Hospital in Ghana. The study employed mixed methods. Quantitative and qualitative data were collected from seventy four (74) hospital employees using structured questionnaire, interview and observation. Quantitative data was analyzed using descriptive and t-test statistics at p<0.05. Qualitative data was analyzed using thematic content analysis procedure. The study found that the Cape Coast Teaching Hospital generates an average daily medical waste of 35.12 kg (mean = 278.71, SD = 20.263; t = 36.39, p<0.05 and medical waste per patient per day was 0.1291 kg. Waste segregation was practiced using coloured bags (20.3%), metal dust bins (36.5%) and boxes (43.2%). The hospital has no written policy guidelines for handling medical waste. The poor management practices of medical waste generated in the Teaching Hospital is a situation-driven as it was not clearly backed by any well-designed policy framework. This raises many questions about the human health and environmental implications and level of attention the Ministry of Local Government and Rural Development (MLGRD) and Ministry of Health (MOH) give to medical waste management practices in the Hospital. There is the need for a sustainable medical waste management system at the Cape Coast Teaching Hospital to avoid its negative impact on human health and the environment. Keywords: Medical Waste, Medical Waste Management, Cape Coast Teaching Hospital, Central Region, Ghana. DOI: 10.7176/JEES/11-10-02 Publication date: October 31 st 2021

A study on problems of management of medical solid wastes in Dar es Salaam and their remedial measures

Purpose This study analyzed factors related with medical solid waste management. Method A qualitative study, involved 172 health workers as participants. Findings This study explained variables related with medical solid waste management were educational level (p = 0.0081; PR = 0.63), attitude (p = 0.0202; OR = 1.27), availability of medical solid waste disposal facility (p = 0.000; OR = 2.01), implementation of policy in medical solid waste (p = 0.0140; PR = 1.340). The most variable related with medical solid waste management was availability of solid medical waste disposal facility (OR = 4.588). However, length of work and knowledge were no relation. Conclusion This study suggested significant relationship between education level, attitude, availability of medical solid waste disposal facility and implementation of policy in medical solid waste management. The most variable related with medical solid waste management was availability of medical solid waste disposal facility.

Medical waste management in China: A case study of Nanjing