WASTE PRODUCTION IN HEALTH CARE CENTERS

This is a complete on Hospital Waste Management that is condtucted in a well known hospital of Pakistan Hayatabad Medical Complex Peshawar.

Table of contents For Hospital Waste Management.

S. No	Topics	Page No.
	Abstract
	Acknowledgement
	List of Tables
	List of Figures
	List of Abbreviations
1.	Brief History of H.M.C
2.	Development Work of H.M.C
3.	Statistical Date of H.M.C
4.	Objectives of the Study
5.	Limitations and Difficulties
6.	Hospital Waste Management
7.	Risks from Wastes
8.	Waste Segregation
9.	Some Wastes Disposal Records of H.M.C
10	Waste Treatment Methods
11	Summary of Container and color Coding
12.	Waste Management Plan
13.	Waste Management Team
14.	British Standard’s Institution Classification of Wastes
15.	Proper Literature Review for Hospitals
16.	Literature Review for Hospital Radiation
17.	Radiography
18.	Protection Against Unsealed Sources in Medicine
19.	Radioisotope Therapy
20.	Control and Disposal of Radioactive Materials in Medicines
21.	Analysis of the Existing Situation
22.	Failure of the Present Solid Waste Management System
23.	Literature Review
24.	Conclusion and Recommendations
25.	References

lIST OF TableS

S. No	Tables	Page No.
A – 1	Bed Strength of HMC Peshawar 2008
A – 2	Infectious Waste Disposal Record of Hayatabad Medical Complex Peshawar
A – 3	Infectious Waste Disposal Record of Hayatabad Medical Complex Peshawar
A – 4	Infectious Waste Disposal Record of Hayatabad Medical Complex Peshawar
A – 5	Infectious Waste Disposal Record of Hayatabad Medical Complex Peshawar
A – 6	Infectious Waste Disposal Record of Hayatabad Medical Complex Peshawar
B	Summary of Container and Color Coding

ABSTRACT

Our project was about Hospital waste management of Hayatabad Medical Complex, Peshawar. Hospital waste management may be defined as “The discipline which deals with the generation, collection, storage, transfer, transport, processing and lastly disposal of waste manner that is in accordance with the principles of environmental & public health engineering, economic, aesthetic and ecological considerations.”

We visited hospital several times and carefully observed the waste management procedures and found them to be unsatisfactory and against the required standards. There are no proper facilities for wasted collection, storage, transfer, treatment and disposal. The so called facilities that are provided are not fully utilized by the patients, visitors, and faculty of the H.M.C including nurses and sweepers etc.

We visited different wards of H.M.C and found that there is no proper use of the provided facilities. The hospital staff is not competent in their respective duties i.e the sweepers do not collect the waste frequently, do not clean the containers, nurses were found to be disposing the syringes by using stones rather than using the cutter.

We met the different members of waste management committee like the head of the radiology department, sanitary inspectors, incinerator, on-duty doctors, nurses etc and interviewed them

Finally, we visited the landfill area where these wastes after treatment or without any treatment are dumped and found no boundaries of that area and are open to the public and stray animals. We concluded the following

· The average waste generated is 0.62 kg/bed/day.

· 94% injections in H.M.C are administered through reused equipment. These unsafe injection accounts for 62% of hepatitis B, 84% of hepatitis C and 3% of new HIV cases.

BRIEF HISTORY OF HAYATABAD MEDICAL COMPLEX, PESHAWAR

The HMC was built in 1971 and is spread over an area of 105 acres. It is located at the gateway of KHYBER in Phase 4 hayatadad. The Rigilalma township lies on its North, Village Achni and Southern part of hayatabad i.e phase 1 and 6 on is South, on West lies the Tribal area of Jamrud while on its East lies doctors and nurses hostel.

In 1990 Hayatabad Medical Complex got the status of PGMI (Post Graduate Medical Institute). The PGMI started function on 27 August 1990 at HMC, at that time the capacity 681 beds.

It offers numerous specialized courses for post graduate students. The HMC is working as a modern hospital with almost all types of diagnostic and curative facilities. The Eye and ENT block completed in June 1994, however the Air conditioner facilities are not yet completed due to scarce resources. Gyne and Paeds Blocks have already been completed with out Air Conditioner facilities.

Table – A1: BED STRENGTH OF HMC PESHAWAR 2008

S.NO	NAME OF UNIT	BED STRENGTH
		CHAMBER (BEDS)		SIDE ROOMS (BEDS)		TOTAL
		MALE	FEMALE	MALE	FEMALE
1	MEDICAL	27	27	4	4	62
2	SURGICAL	38	28	4	4	74
3	GYNAE-A	-	28	-	2	30
4	GYNAE-B	-	32	-	2	34
5	LABOUR ROOM	-	10	-	5	15
6	EYE (MALE)	30	-	3	-	33
7	EYE (FEMALE)	-	30	-	3	33
8	PAEDS-A	24		3		27
9	PAEDS-B	36		-		36
10	PAEDS CARDIOLOGY	14		-		14
11	NURSERY	16		-		16
12	ENT	21	21	1		43
13	ORTHOPAEDICS	20	16	2	2	40
14	NEURO SERGERY	12	9	-	-	21
15	ICU	8		-	-	8
16	HEAD INJURY	6	6	-	-	12
17	GASTROENTEROLOGY	18	18	1	1	38
18	CCU	14		-	-	14
19	CARDIOLOGY	18	11	2	1	32
20	PLASTIC SYRGERY	6	8	-	-	14
21	ONCOLOGY	10	10	-	-	20
22	ENDOCRINOLOGY	12	12	2	2	28
23	CASUALTY	9		-	-	9
		TOTAL				653
24	PRIVATE ROOMS	ORDINARY ROOMS		VIP ROOMS		TOTAL
		24		4		28

At present the following specialties are working in Hayatabad Medical Complex

General Surgery 2 Units

General Medicine 2 Units

Gynecology & Obstetrics 2 Units

Ophthalmology 2 Units

Pediatric Medicines 2 Units

Pediatric Surgery 1 Unit

Orthopedic 2 Units

Cardiology 1 Unit

Neurology Surgery 1 Unit

Physiotherapy Department 1 Unit

Dermatology 1 Unit

Clinical Pharmacy Department 1 Unit

Radiology Department 1 Unit

Accident & Emergency 1 Unit

Department

Dental department 1 Unit

Anesthesiology Department 1 Unit

DEVELOPMENTAL WORKS IN HMC

1. An amount of Rs. 68,800,000/- were sanctioned for construction of Doctor Hostel during the financial year 2009-20010.

2. An amount of Rs, 96,100,000/- were incurred for the construction of Nurses Hostel (2 Blocks) and Paramedics (1 Block) during the financial year 2009-2010.

3. Detail of various other development works are as under:

· Construction of Over Head Reservoir 50,000 Gallons, Pump Chamber, internal road, External Water Supply, External Sewerage and External Electrification.

In addition to above various developmental works are being carried our in the hospital such as:

· Establishment of three bedded CCU in casualty

· Renovation of Bath rooms in CCU of Cardiology Unit

· Painting of various units in the Cardiology Block including private rooms.

· Face lifting of Surgical Block

· Renovation of Female Medical C Ward

· Renovation and up-gradation of laboratory in the OPD

· Purchase of Sui gas, greasers for House Job Doctors and Nurses Hostel

· Renovation of the Kitchen, dinning hail and TV lounge in the nursing hostel

· Construction of halls at four corners of the hospital which will have the Facilities of Telephones, fax, photocopier and Internet for the patient attendants

· Establishment of a full fledged bank branch in the hospital premises having all facilities including ATM (AUTOMATED/AUTOMATIC TELLER MACHINE).

PATIENT TURNOUT

It is the busiest hospital of the province. The total number of patients exceeds ten lacs per year. On the average 700 patients per day visit in Casualty Deptt.

OUT DOOR PATIENTS DEPARTMENT

The OPD of this hospital is overcrowded and almost 1200 patients are examined and treated on average per day the OPD building has a well established department of Radiology and Physiotherapy.

STATISTICAL DATA OF HMC

Total number of patient treated/tests/diagnosed during the year 2008

S. No, Department Total Patient Treated/ Diagnosed

1. General OPD 283833

2. Casualty 235594

3. Ward Admission 38078

4. Private Room Admissions 468

5. Major Operation 11453

6. Minor Operation 3086

7. Casualty minor cases 14460

8. U1trasound 16173

9. X-Ray 41578

10. E.C.G. 18074

11. Dia1yis 45

15. MRI 207

16. C.T. Scan 10268

17. Doppler Study 577

18. mammography 112

19. ECHO 4890

20. ETT 452

21. OGDs 2887

22. ERCPs 250

23. Deaths 1801

24. Colonoscopy 240

25. Band Procedure 197

Total Staff of HMC 1405

Tee thing Staff 49

Professors 14

Associate Prof: 15

Asstt Prof: 20

Consultants 15

SMO’s 24

MO’s 69

TMO‘s 132

Nursing Staff

CNS 1

NS 1

Head Nurses 21

Nurses 221

Student Nurses 300

Ministerial Staff 45

Para Medical Staff 248

Ward Orderlies 118

Sweepers 131

OBJECTIVE OF THE STUDY

· To know that how much waste is generated per day at this hospital.

· To know about the process of collection / disposal in this hospital.

· To recommend to the higher authorities for waste minimization and improvement in the process of disposal.

· The medical facilities are working to save lives but in these facilities such wastes are produced which are dangerous to life and leads to spread of infection and diseases in the community. This is due to the fact that the medical professionals in particular and the general public in general are unaware of the hazardous nature of the waste.

· The problem is very essential of great concern for the Medical professional and general public to take care of the hospital waste and dispose it in such away to stop spreading diseases to the community the hospital management should also pay due attention to this grave situation and to protect the patients of their attendants of this menace problem. Unfortunately with the explosion of population the Government of Pakistan is unable to take any measure to stop this problem of spreading the disease to every one around us, which is populating the whole nation with disease which in turn leads to less economic productivity and ultimately leading to death.

· In this advanced age of science and technology tremendous progress and advancement have been made in providing various methods and equipments for the care of population in general and hospital patients in particular.

· Hundred of single services items have been marketed to reduced the hospital acquired infection but on the other and increasing the waste generation in hospital and other areas. In the existing situation the hospitals and other agencies have been very slow to improve their techniques for the handling and disposing off the waste generated in these areas. Although the matter is of great concern and needs due attention but unfortunately none of the hospitals have a proper waste disposed strategy or system. The municipal corporation has laws and regulations for the disposal off waste at the hospital level but none of these rules, laws or legislation is being enforced or followed. Hence every body knowingly proving out refuse of deadly waste near schools community and other public places and also in drinking and cultivating water. Today in this era of development hardly anyone is aware of the gravity of this pollution hazard. No one knows where the hundreds of o i.e of medical waste including large amount of infectious waste are going. It has been seen and observed that some scavengers in our country are collecting and reselling. This medical waste back to the institutions for reuse to get a few coins. These people are the biggest enemies of our society who are killing innocent people which such practices for gating there livelihood such illegal practices are not allowed any where in the world.

· The whole Peshawar city has no proper treatment plan for my solid/liquid waste. All medical waste and other solid waste of the city a dumped near communities openly with out any protection for them. This practice pollutes the land, water and air of the whole city.

IMPORTANCE OF STUDY

Management of hospital waste is very important because on one hand is simple but if not properly managed it will act as a biological weapon or a bomb, which is being produced by our selves to kill the innocent lives with out their knowledge.

The responsibility for the proper handling of hospital waste dos not rest on the hospital management and health services providers but also the municipal authority are equally responsible for the final disposal of the waste.

For proper handling of the problem a multicultural approach should be followed and every should play his role in handling the problem and saving the lives of innocent people.

LIMITATION AND DIFFICULTIES

The main problem is that of awareness in the medical professionals and general public. No body is giving due importance to hospital waste. Although progress has been made in methods and equipment for the patient care through single services items to reduce the hospital acquired infection, but it has increased the risk of hospital waste generation. All though the matter is of great concern but none of the hospitals has a proper waste disposal strategy or system. The main fact is that there is no Job description for the lower staff and all work is carried out in a haphazard way. The other problems are that of monitoring one and there is no proper monitoring for waste collection and disposal.

Moreover the waste generated at hospitals can be weighed and an average amount is taken. Hospitals have got incinerators for handling infectious waste but the non infectious waste (which is some times contaminated with infectious waste) produced the problem. If the incinerators are used properly for infectious and non infectious waste then the problem will be solved to a greater extent and the spread of infections to community will be stopped. As the non infectious waste is carried to the land fill site, there is no proper disposal and hence the problem of air and water pollution remains there. As importance is given to environmental pollution, so the hospital waste will also be given importance. Sometime the incinerators are out of order due to load shedding of natural gas or due to any fault and take longer time for repair & availability of gas which also create great problem for the storages/disposal of infectious waste in the hospital premises. In case of incinerator not working the wastes are disposed through a manual system which do not completely dispose the toxic substances (i.e. do not ensure uniform & complete burning of infectious wastes) but also release the deadly smoke which have toxic & infectious particles in it which adversely affect the health of not only the patients but also the other people (visitors + hospital staff). The main problems are that this manual disposal system is in the premises of hospitals but it should be at a suitable place either outside or at appropriate site in the hospital. Moreover there is no control on scavengers and hence they increase the spread of infection to themselves and to the community.