INTRODUCTION
Hospital waste is becoming increasingly complex due to changing technologies and increase in the services that the hospitals perform for the community.
Hospital wastes pose a serious public health problem. This is primarily caused by the diversity of the individual components of the waste, which constitute a risk to health if inadequately handled.
In addition to their infectious and toxic characteristics, the highly variable and inconsistent nature of medical waste streams has increased public concern about storage, treatment, transportation, and ultimate disposal.
Hospital waste includes all types of waste generated from a facility. Medical waste is the one, which is generated as a result of patient diagnosis; treatment or immunization of human beings or animals and a portion of this category of waste has potential to transmit an infectious disease.
Waste management includes waste minimization, waste segregation, waste collection, waste transportation, waste storage, waste disposal and waste reuse. The improper management of biomedical waste causes serious environmental problems in terms of air, water and land pollution.
The study aimed at describing the problem of hospital waste in Riyadh City including total amount, generation rates, types, management, and future planning.
MATERIAL AND METHODS
The study included 14 major hospitals in Riyadh. A questionnaire was designed to include description of each hospital and characteristics of the wastes produced by these hospitals. This questionnaire was filled out by every hospital administration in the study. Inquires were made to all companies dealing with management of wastes as to details of each step in waste management from collection, packaging, labeling, transportation, and treatment. Data were collected, entered to the PC using Epi-info Ver, 6.4d, CDC software package for epidemiologic studies. Frequencies and cross tabulations were produced.
RESULTS
This study was conducted in 14 hospitals in Riyadh City, 7 (50%) public and 7 (50%) private hospitals with a total number of beds of 3007, with a median of 162 beds, a minimum of 30, and maximum of 800 beds. Hospital age median was 19.5 years with a minimum of 5 years and a maximum of 49 years. Bed utilization rate median was 75%, a minimum of 40%, and a maximum of 99% (Table 1 ).
Total daily medical waste from the 14 hospitals were 1347 Kg with a median of 55 Kg, a minimum of 1O Kg, and a maximum of 600 Kg of medical waste daily. For non-medical waste, the ·daily total of 11175 Kg were collected every day, a minimum of 20, and a maximum of 6000. All hospital collected waste whether medical or non-medical on daily basis. None of the hospitals collected wastes on weekly or monthly basis.
Table 1: Hospitals · characteristics in Riyadh city
Characteristic | Numbers and % |
Number of hospitals | 14 ( 7 Public & 7 Private) |
Total number of beds | 3007 beds |
Minimum | 30 |
Maximum | 800 |
Hospital age median | 19.5 yrs |
Minimum | 5 yrs |
Maximum | 49 yrs |
Bed utilization rate median | 75% |
Minimum | 40% |
Maximum | 99% |
All hospitals had contracts for management of the wastes outside of the hospital; none managed their wastes inside the hospitals (Table 2).
Table 2: Hospitals Waste characteristics in Riyadh city, generation ate/hospital/day
Characteristic | Details |
Total Medical Waste Weight (Kg) | 1347 |
Median | 55 |
Minimum | 10 |
Maximum | 600 |
Total Non-Medical Wasta Weight | 11175 |
Median | 450 |
Minimum | 20 |
Maximum | 6000 |
It was found that public and private hospitals were comparable as regards many of the study variables. Regarding hospital age, public hospitals had a median of 20 years while private hospitals had 18 years with no statistical difference p=0.5 using Kruskal Wallis test (Table 3). As regards numbers of beds, public hospitals tended to be larger, with a median of 215 beds, a minimum of 100, and a maximum of 800, while for the private ones a median of 120, a minimum of 30, and a maximum of 250. No statistical difference was detected between them p=0.09 using Kruskal Wallis test (Table 3).
Regarding hospital bed use rates, public hospitals were higher in rates compared to private ones, with a mean of 78% ± 16 utilization rate compared to 67% ± 14 utilization rate for private hospitals, p=0.275 (Table 3).
Table 3: Characteristic of Public and Private Hospitals
Characteristic | Public Hospitals | Private Hospitals |
Hospital Age (years) | ||
Median | 20 yrs | 18 yrs |
Minimum | 5 yrs | 8 yrs |
Maximum | 49 yrs | 36 yrs |
No. of Beds | ||
Median | 215 beds | 120 beds |
Minimum | 100 beds | 30 beds |
Maximum | 800 beds | 250 beds |
Bed Usage (%) | ||
Median | 76% | 70% |
Minimum | 59% | 40% |
Maximum | 99% | 80% |
Table 4: Characteristics of Waste in Public and Private Hospitals
Characteristics | Public Hospitals | Private Hospitals |
Medical Waste Weight | ||
Median | 90 kg | 20 kg |
Minimum | 20 kg | 10 kg |
Maximum | 600 kg | 70 kg |
Non-Medical Waste Weight | ||
Median | 775 kg | 80 kg |
Minimum | 400 kg | 20 kg |
Maximum | 6000 kg | 500 kg |
Tables 3 and 4 show the median amounts of the weight of the hospital wastes whether medical or non-medical for public and private hospitals. Public hospitals tended to have higher generation rates of waste weights, compared to private ones, 90 Kg median weight for public compared to 20 for private hospitals p=0.137. As for non-medical waste, 775 median for public and 80 for private hospitals, p=0.129.
From table 5, the average weight of medical wastes per bed found to be 0.55 kg/ bed in public hospitals and 0.35 kg/ bed in private hospitals. While for the rate per bed use, it was found to be 1 .8 kg /used occupied bed in public and 0.5kg/used bed in private hospitals.
Table 5: Amount of dally medical waste per bed and per rate of bed utilization
Amount of Medical Waste | Public | Private |
Medical waste weight per bed/day | 0.55 kg | 0.35 kg |
Medical waste weight per rate of occupied beds | 1.8 kg | 0.5 kg |
All hospitals collect waste on daily basis and have the waste treated outside the hospital through specialized private companies, according to and fulfilling the guidelines of the Saudi Ministry of Health, issued in 1999. There are four companies for medical waste management in Riyadh. All of them follow standard procedures recommended by WHO and Saudi Ministry of Health medical waste management. Hospitals are not licensed to function until having a contract with one of these companies for their medical waste management. In the hospitals, wastes are segregated at the source into non-medical waste which is collected in black plastic bags and thrown into the street containers. Medical waste is collected in yellow plastic bags and stored in a cooled, isolated, and sealed room. Sharps are collected in yellow containers. Cytotoxic waste is kept in special containers for periods known to tum them nontoxic, while radioactive materials, laboratory chemicals, and expired drugs are dealt with by the supplying companies.
DISCUSSION
These are descriptive data about the medical and non-medical wastes for major hospitals in Riyadh. It is important to have such data to compare it to international figures and to assess current plans of management of such sources of risk for health care workers, waste management workers and surrounding environment.
Comparing our results to Al-Zhrani et al, 2000 they found that hospital wastes generation rate was 1.13+0.96 kg/bed/day. These results are comparable to the present study since it was found that it ranged from 0.55 kg to 1.8 kg in public hospitals.
On the international level, Basu; 1996, found that medical waste in major hospitals in India reached 0.775 kg per bed which is comparable to the present results. Mattoso and Schalch 2001 who studied hospital wastes in Brazil found it to be 1 kg per bed, which is also close to the present findings.
It is difficult to standardize medical and non-medical waste generated by hospitals in different countries, because the differences and variations in social and economic background of every country have to be respected.
In reviewing UK hospital wastes management planes, Moritz 1995, emphasized that it is vitally important to draw up a waste management strategy and a legislation to reference waste generation, storage, handling, transportation, and disposal, typically as in Saudi Arabia. Moritz also found that in UK, all health care institutions were responsible for allocating the human resources and expertise in hospital waste management and contracting specialized professional companies engaged in hospital waste management.
As for China, the main focus of hospital waste management plans as explained by Li J et al., 2002, was that every major hospital institution should manage its own wastes by recycling, treatment, and incineration in addition to the option of using landfills to dispose wastes.
In the US, Carpenter et al, 1999, mentioned that there were continuous efforts to assess the environmental impacts of different hospital waste management plans and specific use of incinerators to dissolve such risks.
RECOMMENDATIONS
From the findings in the present study and other local and international studies, hospital waste management is a priority for all countries. Use of different approaches in managing hospital wastes aimed at eliminating the risk of these wastes to patients, health care workers, and the surrounding environment. Proper training of workers and provision of equipment and clothing suitable for personal protection of waste management staff. Also establishing an effective occupational health program to immunize workers, post exposure prophylaxis, mandate treat, and carry out surveillance. Medical waste itself should be treated as a source of risk during segregation, transportation, and treatment. Clear and applicable policy should be put and applied to supervise and assess hospitals in different steps of waste segregation, appropriate packaging, waste identification, waste storage, and transportation.