Healthcare centers need to respect the sanity of the surrounding community, nurture or consider the ecological environment as an asset for improving the general health of the society. An integrated approach towards ensuring a clean environment that will accelerate transition to stable and sustainable development becomes the main objective of a health care waste management program (Hassan, Ahmed, Rahman & Biswas, 2008). Demand for healthcare services increases every day, and this means that the amount of wastes healthcare centers release into the environment also increases each day. The only way a healthcare can improve environmental safety is by designing a wastes management program that corresponds to the amount of wastes released within and outside the healthcare institution. This report analyzes the most common health care wastes and theirs respective disposal methods as applied in major healthcare centers (Hassan, Ahmed, Rahman & Biswas, 2008). The report is structured into sections one and two with the first section discussing health care wastes, methods of disposal and a relevant cases study while the second section highlights an interview conduct on health care wastes and available management methods.
Health care wastes and management methods
Health care wastes defined
Health care waste describe all forms of wastes produced by major health institutions, research facilities, and laboratories dealing with health issues (Benjamin, 2007, p. 11). The term also defines wastes coming from minor streams like the wastes released in the course of treating a patient. For example, spillage of a drug during its administration to a patient may be termed as a minor health care waste. Studies conducted reveal that between 75 and 90 percent of substances produced by healthcare providers as wastes cause little damage to health of the surrounding community as compared to domestic wastes since most health care waste undergo several treatments before their dumping (UN Human Settlement Programme & United Nations Human Settlements Programme, 2010). While the main source of health care wastes is considered to be healthcare institutions and laboratories, other sources that must also be considered for the purposes of developing a proper management plan include wastes from home care facilities like dispensaries, health units and other hazardous health care equipment used and disposed in open places (Lesotho & Synergy Holdings, 2005). The inclusion plan that organizations can use in controlling hazardous wastes requires proper understanding of health care waste and relevant waste management programs.
Waste streams generated from health care facilities
The basic classification of the different streams of waste revolves around the level of damage, sources and ease of disposal. Most studies concentrate on hazardous health care waste, ignoring other wastes that do not pose any threat to the environment. Following the level of damage and the various streams or sources, health care wastes can be grouped into the following categories.
These health care wastes are known to contain mainly pathogens, such as bacteria, fungi, different viruses and parasites. Such health care wastes have high levels of pathogens and can cause diseases very easily in particular hosts. The streams of such wastes include laboratory works and other stock of infectious agents, surgeries conducted on patients, isolated patients in their respective wards, and contact with patients undergoing hemodialysis, contact with laboratory animals, or contact with infected instruments or items used while conducting medical researches and other important laboratory processes.
This category of health care wastes includes tissue, human fetus, animal carcasses as well as other body parts and body fluids. This stream includes anatomical sources like human and animal body parts, which is considered an important subcategory of harmful wastes.
This category includes sharp objects that may result in major cuts or minor injuries, or wounds. The specific objects considered sharp and streams of health care wastes include hypodermic needs, normal needles, scalpel or razors, surgery knives and infusion sets, clinical nails as well as broken glasses (Joosten, Bongers & Janssen, 2009, p. 35). This category of health care wastes is considered very hazardous and may result into unexpected injuries whether infected or not infected. In fact, most health care institutions advise on proper storage and disposal of sharps because the kind of threat they pose to people, both medics and patients is very high.
This category includes expired, contaminated and spilt medical products, drugs and different kinds of vaccines, which should also be disposed wisely after use. The streams in this category include those items that have been used to hold pharmaceuticals and other medical equipment like bottles and specific drugs.
The genotoxic category of wastes is considered highly infectious and may contain carcinogenic properties or maybe even teratogenic characteristics. This waste category raises the quest for serious safety measures because any contamination usually leads to severe health complications. The streams of genotoxic wastes include vomits, urine and stools especially where specific drugs like cytostatic are administered to the patient.
The most specific waste in this category include disposed solids, liquids and gases, which may result from experiments, general cleaning and housekeeping as well as disinfecting procedures. Health care wastes can only be considered harmful if they are toxic, corrosive, flammable, reactive or genotoxic in nature (Joosten, Bongers & Janssen, 2009, p. 35). Without these characteristics, disposal of chemical wastes may not be a major challenge to health care institutions, manufactures and regular users.
Other than the mentioned groups of wastes and particular streams, other categories of health care wastes include formaldehyde, photographic chemicals, solvents, organic chemicals and inorganic chemicals. The category of formaldehyde is one most important source of chemical wastes used in many institutions providing medical services. Formaldehyde is a disinfectant chemical used by clinical officers to clean and remove germs from equipment used during surgery (Marx & Slonim, 2003, p. 27). Formaldehyde spillage may be dangerous especially when the chemical gets in contact with the body, may cause itches, blisters or even skin rashes if not cleaned well. These streams of health care wastes together with other unmentioned sources should be properly controlled to ensure little environmental contamination or prevent direct contact with people because the health damage may be severe.
Waste streams management and processes inside and outside health care facilities
Irrespective of the nature or scale of production, this study suggests that designers and managers of health care facilities take active roles towards improving their health care waste management approaches (Paulus, Davis & Steele, 2008, p. 75). In this line of management, health care institutions, manufacturers and laboratory operators should give health care waste management the first priority, and operate through specific procedures that will help in reducing the of exposure at relatively lower costs. The health care waste managers must understand that the most prolific effect of poor disposal of these cuts and subsequent exposure to various types of diseases. Therefore, every management goal should aim at developing a complete waste management program that will improve safety disposal of waste products from inside or outside health care centers.
The table below represents a summary of waste management processes applicable to managing some of the health care wastes mentioned above. The procedures followed in ensuring proper disposal and management of wastes remain common to both small scale and large scale producers of health care waste.
|Type of waste||Management option||Comments if necessary|
|Solid infectious wastes||Perform incineration or bury the infectious waste and their products.||Health care units should not that autoclaving may not be appropriate for pathological wastes like animal body parts or human body parts.|
|Stools form patients suffering from cholera/ diarrhea||Such patients should be isolated from the community and the stool be captured in a bucket. Add disinfectant like chlorine oxide powder or hydrated lime to kill bacteria and other causative agents before disposal. In case the disease has affected people in large scale, there will be need to disinfect the whole hospital and its sewage to avoid re-infection. The treated stool is then poured into a pit without contaminating water sources|
|Infectious body fluids like blood||Such body fluids should be disinfected using chloride oxide powder, or any other chemicals that will not add to waste.
Add treated fluids where such body fluids are disposed, for example in pits to improve their filtration into the soil. The disposal process should prevent such fluids from getting into drinking water or into water sources regularly used by people.
|Sharps||Clinical officers must separate such objects from other wastes once used. Should be put in transparent plastics or metal containers for easy disposal. If necessary, the plastic containers should be labeled ‘sharp’ using stickers, or maybe infectious wastes. Once their functions are over, the sharp objects should be incinerated but if they are to be used, the clinical officer must ensure that the sharp objects are properly sterilized with either bleach or any available disinfectant as long as no stain is left.|
|Pharmaceuticals||If the pharmaceuticals are in small quantities, perform incineration, or remove the outer coverage and bury in safe site.
In case of large quantities, determine whether the pharmaceutical waste is water soluble. If yes, dilute with large amounts of water to reduce toxic level and then discharge to a fast flowing river or any other moving fast moving watercourse.
|The immediate response chosen in each case is neither cheap nor easy and therefore health care institutions and manufactures of pharmaceuticals must dispose these chemicals when in small quantity.|
|Chemicals||Bury together with infectious waste products since any small quantity of small chemical waste may be so much infectious than a person can expect. In some situation, burning or incineration becomes an alternative especially when the wastes are non-biodegradable.
Another alternative would be to return the wastes to respective suppliers, perform subcontract for incineration, or export the waste products to locations with enough disposal facilities
|The options mentioned here are neither cheap nor easy to perform and the waste disposal unit must ensure that these wastes do not accumulate. In other words, the disposal facilities available for use are considered by the clinical officers inadequate. This means that health care centers should minimize the amount of chemical wastes and spillage.|
|Halogenated substance||Bury||NEVER BURN: burning halogenated substance will create highly toxic pollutants, which will result into health damages in various areas.|
Most recent health care management approaches in different countries
Most countries establish policies and regulations to control the disposal of health care wastes. For example, UK developed a policy of Integrated Healthcare Waste Management, which brings together all stakeholders and the general public through a combined and centralized option with effective pollutant control system. The IHWM applies the techniques of collaborative performance, community cleaning services and individual responsiveness towards improving environmental sanity (Johnson & Baum, 2001, p. 17). Similarly, Abu Dhabi’s Healthcare Waste Management programs correspond to improved disposal methods and increasing the number of pits and disposal sites in big healthcare institutions.
The US government combines the elements of healthcare waste management similar to Abu Dhabi’s alongside sensitizing people on the best disposal methods. Community sensitization is so far the best approach a country can use to ensure that all members of the society remain responsible as far as disposal of wastes is concerned. In general, the kind of approaches countries give on issues of healthcare wastes management depend on aspects of healthcare policies, regulations and specific programs available in the country.
Waste management failure of deficiency: a case of Cleveland Clinic
The production and increasing quantities of wastes exposes cities to nexus of further threats of environmental degradation. For the case of Cleveland Clinic in Abu Dhabi, the estimated quantity heath care wastes stand at 1.7 billion metric tons. Since the Clinic is still developing, its health care wastes are not properly managed majorly because the available facilities are not sufficient enough to cope with the accelerated pace of wastes production. The clinic’s wastes collection rate is below the 70 percent minimum level and more than 50 percent of wastes collected are in most cases disposed of in uncontrolled landfilling means or undergo informal recycling processes. Cleveland Clinic faces challenging waste management decision due to failure to incorporate basic facilities that can aid in collection and disposal of health care wastes. Otherwise, the clinic finds collection, recycling treatment and disposal of health care wastes very costly. Even though the management has a plan to build and operate a sanitary landfill and incineration unities, the high funds required in the entire process make substantial operations inefficient and other maintenances costly in terms of time. The community also seems to be concerned with their own activities, not ready to donate land for the establishment of pits. This together with issues of finances makes it hard for Cleveland Clinic to improve its waste collection and disposal programs.
The different waste streams generated within Cleveland Clinic and wastes management methods
Like any other healthcare unit or facility, Cleveland Clinic faces streams of health care wastes, which include sharps, pharmaceuticals, genotoxic, and chemicals wastes. For Cleveland Clinic, the category of sharps includes items like hypodermic needles, scalpel and clinical knives. The clinic has not grown in its operations to include items like infusion sets. Other items under this category include bottles used in holding and keeping chemicals, used boxes and tubing. Genotoxic vomits, urine and stool from patients while the chemical wastes include both solid, liquid and gaseous waste (Kotler, 2011, p. 82). The last category of wastes result from the various chemicals used within and outside the clinic, which can be either chemical drugs and disinfectants. In all the cases, the clinic must consider the best method to be used in handling or controlling the negative environmental impact of these Health care wastes.
The concerned parties otherwise known as the stakeholders in the case of Cleveland include health workers, clinical officers, managers, patients, the surrounding community and the government whose operations are constrained by poor health conditions, inefficient waste disposal and increasing heaps of health care wastes (Kotler, 2011, p. 82). Even though the clinic have the full responsibility of ensuring proper disposal of its health care wastes, all stakeholder must join hands in developing a clean environment alongside ensuring that people are protected from all the conditions that may lead to simultaneous infections.
With the mentioning of poor methods of waste disposal and the increasing cases of disease infection in Abu Dhabi, the selected health care waste management will provide an immediate response towards improving the general environment and community health status. Developing disposal pits and incineration sites becomes the first improvement for Cleveland Clinic and the surrounding community. From this case, it becomes clear that Cleveland clinic produces numerous dangerous chemicals, sharp objects and other pharmaceuticals that must be disposed of through more appropriate means to reduce chances of infection and reinfection. In general this proper understanding of the various healthcare waste management programs used by the clinic will help improve the life of people from Abu Dhabi (Kotler, 2011, p. 86). In the case of stools form patients, the health care waste management unit responds by isolating patients from the community, putting patients under control units and ensuring that every waste released by these patients are dumped appropriately. In most cases, the clinic operates like other health care centers and uses disinfectant like chlorine oxide powder or hydrated lime to kill bacteria and other causative agents before disposing of the stools and body fluids.
Barren River Community Health Care Wastes Planning Council
A Health Care Waste Management Interview
Interviewer ……………………………………….. Date …………………………
Note: The interview is regulated by research ethics, which only considers including the details of an interviewee if he/she approves, and where the interviewee does not accept his/her details to be recorded, we are obliged to respond by excluding any detail that may reveal the identity of the interviewee.
- What role and responsibilities do you perform in the waste management system?
As the chief officer in charge health care waste management for Barren River Community Health Care, my core duty is to ensure proper disposal of wastes, design programs for processing and recycling of used, unused and expired equipment and giving immediate response through first aid in case of an accident due to poor disposal of health care wastes. In general, my duty as the officer in charge of every system in Barren is to ensure that every member of the community healthcare takes a central role in preventing pollution and any physical damage that may result from health care wastes. This is basically the main target, and offers plan upon which ever stakeholder operates.
- How does Barren River Community Health Care manages wastes within and outside its premises?
The community health care has a program that precludes all the health care stakeholders ranging from workers, managers, sponsors, patients to clients with each group charged with a responsibility of ensuring that the general environment within and outside the healthcare premises is free of health care waste. The health care community currently works with a team of 40 members who conduct regular cleaning of the surrounding towns, villages and other dispensaries, making sure that all health care wastes are disposed according to the underlain concepts. Since most of the wastes are plastic or glass bottles, the members in most cases collect and transport these bottles for recycling.
- What makes Barren River Community Health Care different from other wastes management councils
Barren River is Unique in its system of management, how things are conducted and the kinds of relationship the health care management council have with the members of the public. The top manager who is the Chief Officer coordinates all the cleaning activities, assigns tasks to members, signs contracts with the members of the community and ensures that every person involved in cleaning responds. Other team members, otherwise known as field marshals take full charge, moving from town to town, village to village and within other healthcare institutions, collecting and disposing health care wastes but with the permission relevant authorities.
- Can you say that the wastes management plans used by the community health care are sufficient enough to protect the community from any hazard?
As the case stands, the processes followed by the team members and Barren Healthcare Waste management in general corresponds to health care ethics of creating a healthy environment for the general benefit of the society. The disposal methods ranging from incineration, burying to recycling of waste products are generally accepted by leading health care wastes disposal units and therefore makes out team believe that they are the best in town.
- What are the major challenges the community health care is facing towards fulfilling its objective of proper wastes management?
Every health care waste disposal unit faces a variety of challenges, and such problems like inadequate disposal facilities, poor response on the side of volunteers and constantly heaping health care waste are common to most health care units.
In general, the discussions presented in this report give an overview of the most specific health care management programs used by most countries based on healthcare operational standards and values (Fireman, Bartlett & Selby, 2004, p. 23). In every healthcare setting, the need to create a healthy environment overrides other objectives, and this becomes the foundation for all the health care management programs established by healthcare centers. Throughout the report, the main theme of analyzing the most common health care wastes and their respective disposal methods as applied in major healthcare centers remains clear. The report defines health care wastes as a combination of all kinds of wastes produced by major healthcare institutions, healthcare research facilities and healthcare laboratories (Fireman, Bartlett & Selby, 2004, p. 23). The report also reveals that health care wastes can as well refer to wastes originating from minor sources like those produced in the course of treating a patient either at home or in healthcare centers. The various streams of healthcare wastes identified in this report include Infectious wastes, Pathological waste, Sharps, Pharmaceuticals, Genotoxic and Chemicals wastes with their respective disposal methods.
The report becomes relevant to the case of Cleveland Clinic in Abu Dhabi, the deficiencies the clinic is facing and the best plan Cleveland can use to improve waste disposal. Apart from section one of the discussion that focuses on theoretical concepts, section two of the report is an actual interview that presents the real issues health care waste managers face in their execution plans (Fireman, Bartlett & Selby, 2004, p. 25). This report is therefore crowned with high levels of originality and provides the basic understanding of the challenges most healthcare centers face in their bid to improve community health status.
Benjamin, L. (2007). Three Black generations at the crossroads: Community, culture, and consciousness. Lanham, Md: Rowman & Littlefield.
Fireman, B., Bartlett, J., & Selby, J. (2004). Can disease management reduce health care costs by improving quality?. Health affairs, 23(6), 63-75.
Hassan, M. M., Ahmed, S. A., Rahman, K. A., & Biswas, T. K. (2008). Pattern of medical waste management: existing scenario in Dhaka City, Bangladesh. BMC Public Health, 8(1), 36.
Johnson, A., & Baum, F. (2001). Health promoting hospitals: a typology of different organizational approaches to health promotion. Health promotion international, 16(3), 281-287.
Joosten, T., Bongers, I., & Janssen, R. (2009). Application of lean thinking to health care: issues and observations. International Journal for Quality in Health Care, 21(5), 341-347.
Kotler, P. (2011). Reinventing marketing to manage the environmental imperative. Journal of Marketing, 75(4), 132-135.
Lesotho., & Synergy Holdings (Lesotho). (2005). National health care waste management plan. Maseru: Ministry of Health and Social Welfare.
Marx, D. A., & Slonim, A. D. (2003). Assessing patient safety risk before the injury occurs: an introduction to sociotechnical probabilistic risk modelling in health care. Quality and Safety in Health Care, 12(suppl 2), ii33-ii38.
Paulus, R. A., Davis, K., & Steele, G. D. (2008). Continuous innovation in health care: implications of the Geisinger experience. Health Affairs, 27(5), 1235-1245.
UN Human Settlement Programme, & United Nations Human Settlements Programme. (2010). Solid waste management in the world’s cities: Water and sanitation in the world’s cities 2010. London: UN-HABITAT/Earthscan.