بررسي فرايند مديريت پسماندهاي بيمارستاني در كرج

Evaluation of Hospital Waste Management Process in Karaj* Hospitals.

In this paper different alternatives for hospital waste disposal in Karaj are compared with respect to practicability. The objective of this study is to conduct a survey of present practices (e.g. available procedures, techniques, and methods of handling and disposing of hospital waste), and determine the generation rate of hospital wastes. The study was performed in city of Karaj. Karaj is one of the largest cities in the country. There are 11 hospitals in Karaj (8 governmental hospitals and 3 private hospitals) with a total of 1443 active beds. All the hospitals selected for surveying. Several methods were used to collect data. Survey questionnaires were distributed by the author in each hospital. These questionnaires were based on Likert style. The questionnaires contained information regarding the generation of waste and the core aspects of segregation, collection, internal and external storage, transport, treatment, and ultimate disposal. On-site inspections and interviews were conducted by the author after being authorized by hospital management. To support and supplement information collected in the survey, interviews were conducted with the managers responsible for environmental healthcare in each hospital, as well as with all levels of employees who work in collection, handling and disposal of waste within the hospital. SPSS Software program was used to analyze the collected data. One of the first and most important steps in the development of risk or cost analyses in the field of medical waste management involves understanding the generation rates and quantity of the waste that needs to be managed and treated. Waste is produced from the various activities performed in the hospitals. Domestic waste is generated from food preparation, administrative departments, housekeeping and so on. These wastes have the same composition as municipal solid waste and should be segregated correctly and dealt with by the municipal waste disposal system. Infectious waste is a byproduct of diagnostic and experimental activities and therapeutic methods such as surgery, dialysis, biopsies, injections and chemotherapy. The results of the survey indicate that in these hospitals 4505 kg solid waste is produced each day that 46.67 % of them were Domestic like waste, 52% was infectious waste and 1.37% was sharp cutting materials. The mean of daily waste generation was 3.12 Kg per active bed. The Domestic like and infectious wastes were not segregated properly. Fazili,A. and et al. In 100% of cases, plastic bags were placed in plastic bins with tight led for storing infectious wastes. In all hospitals, safety boxes were used for sharp cutting materials. In general, plastic bags were more often used for collecting wastes in different departments of the hospital. Plastic bags and waste bins were used as a waste container in different wards. Most of these plastic bags are not standard and made from low grade materials. They tear easily, causing litter, odor and unsightly conditions which can endanger safety and public health. The wastes were collected at the end of every shift (three times in a day) from the wards and collection frequency was once in a day. In all hospitals, the managers of the hospital pay for the collection, and disposal of Domestic like wastes. In 82% of hospitals, infectious wastes were collected and disposed without any pre-treatment. These wastes are transported to Halghe-Darreh disposal site where especially designed for disposal of infectious wastes. Only in 9% of these hospitals, infectious wastes were separated and disinfected by autoclaves and 9% of these hospitals had incineration facilities (Table 1&2). The residue from these facilities transported to municipal landfill of Karaj. Tablel: Evaluation results of Hospital waste management process in Karaj Hospitals Operation Poor Intermediate Desired Segregation from origin Collection Storage in place ✓ Transport Pre-Treatment V Disposal V Table2 : Infectious Waste Disposal Methods in Karaj Hospitals No Infectious Waste Disposal Methods Number of Hospitals Percentage 1 Incineration 1 9 2 Autoclave 1 9 3 Land disposal without pre-treatment 9 82 4 Total 11 100 There is a house keeping division in each hospital which is responsible for collection of solid wastes from the wards. Very often, this division is not well equipped to do its duty. Employees are not trained and no provision is made for their training and instructions. This division is only responsible for waste collection, while they must be responsible for waste management. No classification criteria are being applied for hospital wastes in Karaj and no major distinction has been made so ever between infectious and domestic like wastes. The incinerator does not play any major role in waste disposal of the hospitals in Karaj. Odor, air pollution, lack of expert operator, improper design and poor management are among the factors affecting this malfunction. In design and construction of hospitals no attention has been paid to the waste management. For instance, almost in all hospitals the storage areas are not designed and constructed properly. There have not been any investigations on the problems of hospital waste management in karaj. Ignorance about these sorts of problems could lead to environmental disaster and harm the community. As yet no solid and reliable information is available on composition, description and classification of hospital wastes in Karaj. There is not any specialized legislation regarding hospital wastes in Iran. The following recommendations are presented according to their degree of importance: • Development of laws, regulations and guidelines concerning all functional elements of hospital waste management. • Development of an organizational structure within the Karaj hospitals for proper solid waste management system. • Continual training of employees, managers and especially the members of house keeping division. • More detailed studies concerning quality, quantity and composition of hospital wastes. • Classifications of hospital wastes.