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A Term Paper for the partial fulfillment of M. Sc. second year in Environmental Science Submitted by: Ganesh Karki Executive summary: Introduction: Total wastes generated by hospitals and healthcare establishments are generally termed as hospital wastes.

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In other word, Hospital waste means all wastes coming out of hospitals, it may be biological or non-biological that is discarded, and is not intended for further use in a hospital. Mainly there are two types of wastes generated from hospital. They are classified as Risk Waste and Non-risk waste. The Non-risk waste covers 75-90% of total waste generation whereas risk waste covers only 10-25% of total hospital waste. (Visvanathan C. 006) The Risk waste consists of chemical waste such as Lab reagents, Disinfectants, Solvents, Pathological waste such as Body parts, Blood & other fluids, Pressurized containers such as Gas cylinders, Cartridges & Aerosol cans, Infectious waste such as Lab Cultures, waste from isolation wards, tissues, Pharmaceutical Waste such as Expired or no longer needed pharmaceuticals, Used or damaged medicinal material such as heavy metal content Batteries, broken thermometers, Blood pressure gauges, Needles, infusions sets, Scalpels, knives, blades etc. (WHO, 1999). The hospital wastes have high potential for hazards.

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So, hospital waste can cause pollution and disease if it is not handled properly. Infectious waste, especially sharps, poses a risk to anyone who comes into contact with it. The WHO estimates that 40% of hepatitis cases and 12% of HIV cases worldwide are caused by occupational exposure. Chemical, pharmaceutical and radioactive waste generated from hospital, which need specialist handling. Added to this, there will be large amounts of more ordinary trash including packaging, paper and food which can make up around 80% of the waste stream. A large hospital can produce tons of waste every single day. Hospital waste in Kathmandu valley:

Hospital and health care waste management poses a serious challenge in Nepal, especially in the Kathmandu Valley. Hospital wastes, both hazardous and non-hazardous, are scattered around the health facilities in the valley. Such improper management not only poses a great risk to the service providers and patients, but also has an adverse impact on the environment. Some 80 percent of the total waste generated from health care activities is general waste and is comparable to domestic waste. The remaining 20 percent is considered hazardous materials that may be infectious, toxic or radioactive in nature.

In the context of Nepal, all wastes are turning hazardous because of improper management. Hence, the management of health care waste is an integral part of the national health care system (Baral B. , 2008). Hospitals and nursing homes in the Kathmandu valley alone produce over 250 kg of hazardous medical wastes each day (The Rising Nepal, 2005). A number of surveys have been conducted in the Kathmandu Valley to establish an overview of the health care waste management. Two of them include surveys of the quantities of health care waste (HCW) and health care risk waste (HCRW).

The first survey was conducted in 1997 (ref. VII) and included measurements of the quantities of waste generated at 11 hospitals in the Kathmandu Valley. The average quantity of waste estimated for all 11 HCFs appear from table 2. 3 below (ENPHO 2001). |Category of waste |Average amount of waste for all 11 | | |health care facilities | |Health care waste (HCW) |0. 4 kg/patient/day (rounded figure) | |Health care risk waste (HCRW) |0. 16 kg/patient/day (rounded figure) | Treatment of Hospital Waste in Kathmandu valley: In most of the hospitals in Kathmandu valley, all of this trash is mixed together and burned in low tech, highly polluting incinerators, or in the open with no controls whatsoever. It is now well established that incinerating medical waste produces large amounts of dioxin, mercury and other pollutants.

These end up in the air, where they can be transported thousands of miles to contaminate the global environment, or in the ash, which is frequently dumped without thought for the load of persistent toxins that it carries. If it is not burned, medical waste can end up dumped with municipal garbage. Wherever this happens, rag pickers face a daily danger. There is some possibility to resell some components of the waste, for example, syringes for illicit re-use.

More than 90% of healthcare institutions do not practice safe waste handling, storage and disposal methods and most healthcare institutions rely on municipal services for their ultimate disposal. In Kathmandu Valley, Tribhuvan University Teaching Hospital and Patan Hospital have incinerators to treat their wastes. Other hospitals and health facilities, however, rely on containers provided by Kathmandu Municipality. Bir Hospital, the country’s oldest hospital, has been in a peculiar position ever since local residents destroyed its incinerator a few years ago.

Teku Hospital treats patients affected by all kinds of infectious diseases, including HIV/AIDS, Hepatitis B, C and cholera, the absence of incinerators forces it to dump infectious waste in normal containers, threatening the health of local residents (Poudel, 2002). In many hospital of Kathmandu valley incinerators are operated more like a back-yard burner. One of the difficulties with ensuring hospital waste is the lack of funding. Many donors that conduct essential work to strengthen healthcare services, provide medical supplies or organize immunization programs do not include any provision for medical waste management (SWMRMC, 2004)

Objectives: The feasible and modern strategic objectives for management of hospital waste are: • Putout the broad information about hospital wastes and their management. • Encourage hospital waste management and the maintenance of healthy environment in hospital and surroundings. • To create awareness amongst the staff, patient and community. Methodology: 1. Desk study: to study the book, journal, lecture, term papers, research paper, thesis and literature review on other several relevant studies. Result and Discussion:

Management of hospital waste in the hospital of Kathmandu valley is one of the most important issues. Numerous hospitals have been established in the Kathmandu valley. Many of these hospitals are situated especially at populated area. So there is high risk of pollution contamination of hospital hazards to the surroundings. The method of waste disposal in hospital of Kathmandu valley is very unsafe and ill-managed. In most of the hospitals in Kathmandu valley, all of this trash is mixed together and burned in low tech, highly polluting incinerators, or in the open with no controls whatsoever.

The rarely segregated hospital wastes are also mixed together in times of collection by municipality due to the use of same transporter for both risk and non-risk wastes. Management of hospital waste in Kathmandu Valley is confronted with a number of issues. These include: • The major fraction (75-90%) of the waste generated by hospitals is, in general, non-risk wastes and resembles residential and institutional wastes. The remaining fraction (10-25%) is hazardous (risk) and may pose a variety of health risks.

Therefore there is a need to promote the concept of “source separation” as apriority action. • The hazardous fraction of the hospital waste poses risk to individuals exposed to such wastes, both within and outside establishments, workers in waste disposal facilities and scavengers. It is therefore, necessary to examine such hazardous wastes from broader perspectives; from generation to collection, storage and disposal. • Commonly used technologies are incineration, land filling, burning, autoclaving, chemical treatment, microwave disinfection and plasma touch technique.

These treatment technologies are influenced by prevalent standards, policies and legislations. But in many hospital of Kathmandu valley incinerators are operated more like a back-yard burner. Hospital incinerators are the biggest dioxin releasers. • In Kathmandu valley mushrooming clinics and health centers, often unregistered, are the major source for operational problems in healthcare waste management. • Management of hospital waste is addressed in the national policies in Nepal but it is very weak in terms of enforcement of these regulations. Some of the potential source reduction practices in hospital could be: Segregation: Waste segregation can drastically reduce the volume and toxicity of the waste stream. The volume of the infected waste can be reduced after proper segregation and significant cost can be saved for its treatment. Material/device substitution: Proper procurement practices can help to reduce the harm. There are some viable substitutes for many products that contain PVC plastic, mercury etc. For example mercury based thermometer can be substituted by electronic sensing devices. The lack of information on hospital waste management in the Kathmandu valley is a serious weakness and hampers effective management of hospital waste. • Mostly problem is in government hospitals where lack of budget is forwarded as the reason for not managing hospital wastes. The major issue for management of hospital waste in the hospitals of Kathmandu valley is the lack of budget and awareness. This is usually a direct result of the lack of enforcement by government and subsidy or grants to the hospitals. Hospitals and public health care units are supposed to safeguard the health of the community.

However, the waste produced by the medical care centers if disposed of improperly, can pose an even greater threat than the original diseases themselves. So, it is very sensitive to community livelihood. Policies for more effective management of the hospital waste of Kathmandu valley will have to better demonstrate, in economic terms, the contribution this management makes to the Kathmandu’s overall environmental safeguard. Economic incentives, grants and subsidy in the management of hospital waste are vital for those hospital and clinic which have poor economic condition.

Action to manage hospital waste in the hospitals of Kathmandu valley has to ultimately be done by the hospital and medical care centers that generate those wastes. Unless hospitals and medical care center in the Kathmandu valley have the incentives, the capabilities, and the opportunities to manage hospital waste safely, they are unlikely to do so. Therefore policy reforms and awareness and training have to be taken to create condition at the hospital level to manage the hospital waste in hospitals of Kathmandu valley.

National and international networks of hospital waste management must be expanded and the advancement of existing management technique must be done. Conclusion: Most of the hospitals and medical care centers of the Kathmandu valley are facing a great and tragic situation if the hospital wastes of these establishments are not managed properly. Along with hospital and surroundings area all valley and the sites where those waste are dispose are also facing high risk to environment and community. However, some works have been done to minimize the risk of hospital waste.

The policies, laws and regulations are found in Nepal for hospital waste management but due to the weak enforcement this is dysfunctional. Some hospital and medical care centers have some initiation to manage hospital waste. They are doing incineration and segregation of waste to make easy to handle. But in many hospital of Kathmandu valley incinerators are operated more like a back-yard burner and waste collectors from municipality mix them with household waste and dispose in same disposal site as non-risk waste. These constraints can be avoided with the modern technologies, awareness and training.

Properly managed hospital waste in the hospitals of Kathmandu valley can continue to provide better and safer health facilities to the communities. The management strategies for hospital waste must aim to maintain the condition of the hospital environment and to protect the environment from pollution. To achieve this goal it will be necessary to design management strategies and programs that take into account the needs of the hospitals as well as the aspirations of the communities and environment who share the risk with hospitals.

Developing such programs requires a much better understanding of potential of hospital waste and generation process and amount. Thorough analysis of the constraints for improving management of hospital waste and modifications in policies and current approaches help to make better management. These actions are crucial for managing the hospital waste and ensuring sustainable health facilities in the face of growing threats from modernization and the greatly expanding human population. References: Baral B. 2008, The Rising Nepal (detail nai tha vayena)

Environment & Public Health Organization (ENPHO) 2001: Environmental Impact Assessment of Medical Waste Management in Kathmandu. Poudel, K. 2002: Hospital waste: Hidden Hazard, The National Newsmagazine, 21: No: 27 SWMRMC, 2004: A Diagnostic Report on State of Solid Waste Management in Municipalities of Nepal, Solid Waste Management and Resource Mobilization Centre, Lalitpur. The Rising Nepal 2005: Medical wastes major threat to urbanites (July, 6). Visvanathan C. 2006. Asia 3R Conference, 30 October – 1 November, 2006 Tokyo, Japan World Health Organization (WHO, 1999): Wastes from Healthcare Activities.

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