Assessment of Medical Waste in Tehran Province Hospitals

Introduction
Medical waste contains highly toxic metals, toxic chemicals, pathogenic viruses and bacteria, which can lead to pathological dysfunction of the human body. The hazards of exposure to hospital waste can range from gastro-enteric, respiratory, and skin infections to more deadly diseases such as Hepatitis B & C, and HIV/AIDS. Additionally, medical waste contains potentially harmful micro-organisms, which can infect public health and may presents a high risk to human and environment Hospital waste management is an important and necessary component of environmental health protection. Poor management practices of healthcare waste can present significant inconveniences and health risk to the inhabitant. Healthcare waste management includes all activities involved in waste generation, segregation, transportation, storage, treatment and final disposal of all types of waste generated in the healthcare facilities, stages of which require special attention. The main objective of this research is the study of the medical waste management in hospitals of Tehran Province.


Materials and methods
This is a cross-sectional study based on questionnaire, interview, observation and meetings performed in Tehran province Hospitals in 2015. This study was conducted to determine the amount of hospital waste that was produced, the condition of segregation of waste, type of storage containers used, temporary storage area, collection procedures, transport and treatment of waste, and disposal of hospital waste at these hospitals. In each hospital, after interviewing hospital directors, waste management employees and other personnel as well as observing the process of collection and disposal of waste. For assessment of treatment technologies, standard tests including TST strip test and spore tests were used.


Discussion of Results & Conclusions
It is important to determine the weight and composition of the waste stream in order to improve proper waste management strategies. The quantity of medical waste depends upon several factors such as the size of healthcare facility, the segregation program of medical wastes, the medical activities, type of services provided, economic, social and cultural status of patient and the general condition of the area where the hospital is situated. Hospital waste is produced from various activities in hospitals such as administrative departments, housekeeping, food preparation, laboratories, surgical operating and so on. According to the results of the present study (figure 1), Total active beds in 165 surveyed hospitals were 26444 beds, which produced 91.22 ton/d of medical wastes, and per bed production of wastes was 3.44 kg/d. Of all wastes in hospitals, 38.35% were infected wastes (1.31 kg/day/bed), 57.85% were non- infected wastes (1.99 kg/day/bed) and 3.75% were pharmaceutical and chemical wastes (0.13 kg/day/bed). The treatment efficiency of 81.29 % of hospitals was accepted (TST and Spore test results were negative).


Figure 1. a) Percentage of medical waste b) Waste generation rate per bed (Kg/day) c) TST test results of treatment systems




Figure 2. a) Percentage of infectious wastes treatment systems b) Percentage of Medical Wastes segregation c) Percentage of managed chemical & pharmaceutical wastes

Results from the study indicated (figure 2) that all of the hospitals surveyed (42.27%) segregated and packed various medical wastes in color-coded plastic bags.After segregating and collecting the medical wastes, the staff should transport them to the temporary storage location. Several methods are applied for the treatment of medical wastes such as autoclave, hydroclave, microwave, chemical disinfection, dry heat disinfection and disinfection with super heated steam. Waste treatment leads to a decrease in volume, weight, and risk of infectivity and organic compounds of the waste. The generator of waste is responsible for ensuring proper disposal and treatment of the medical wastes and also the prevention of pollution and infection within and near the hospital. This study revealed that 93.93% hospitals in Tehran Province are doing treatment on their infectious wastes. They use proper (controlled with special tests) autoclaving method for the treatment of their wastes. After all of the above process, hospitals deliver their generated wastes to municipality. Municipality transports hospital wastes into the Kahrizak landfill. Most pharmaceutical & chemical wastes ( 79.80 % hospitals) are collected in white bags and, therefore, follows to Qazvin & Markazi provinces disposal sites of hazardous wastes.
Insufficient segregation, classification of waste was noted at all surveyed hospitals. For the most part, some of the general waste was mixed with infectious waste, which was collected, transported and disposed of in a similar manner as infectious waste .Environmental measures were not available. To implement better medical waste management, there should exist bins with different colors and appropriate yellow bags for infectious solid waste, black suits bins or bags for household like solid waste, white plastic bags or bins for pharmaceutical and chemical waste and safety box for sharp infectious waste .It seems necessary High rate of infectious waste shows the need for establishing executive rules and standards for medical waste management.The effect of number of inpatients and outpatients treated in the hospitals on healthcare waste generation rate varied from hospital to hospital. It was observed that as the number of inpatients and outpatients increase, the hospital waste generation rate will also increase. A number of gaps exist regarding proper hospital waste management in the Tehran province. Therefore, there is an urgent need for raising awareness among healthcare workers and supporting staff on healthcare waste management issues (segregation, storage, collection, transport, treatment and disposal) and their relevance in addressing public health and environmental risks.This study focused on the determination of hospital waste generation rate, composition and assessment of its management system using mixed study designs. Both quantitative and qualitative data collection techniques were implemented to collect data on hospital waste generation and its management systems.
Medical managers should update their knowledge and further educating their staff; implying careful and constant monitoring of waste management. This study may create awareness regarding the magnitude of the problem of waste management in hospitals of Tehran province and may stimulate interests for systematic control efforts for hospital waste disposal. Hospital waste management cannot succeed without documented plans, certain equipment, defined staff trainings, and periodic evaluations.
Considering the quality and quantity of the generated hospital wastes especially infectious wastes and their unfavorable effects on the peoples' health and environment, it is necessary to compile a distinct policy for the management of hospital wastes.