Follow-up Study on Adoption of National Health Care Waste Management Guidelines at Health Care Institution at Kathmandu

Abstract

Executive Summary: Nepal Health Research Council (NHRC) with support of World Health Organization (WHO) has developed a “National Health Care Waste Management Guideline” in 2002, and circulated it in different Health Care Institutions. It has classified health care waste as waste that poses risk due to its contents of infectious materials and other hazardous substances compared to other kinds of waste. The guideline aims to develop effective health care waste management system in health care institutions and to expertise medical professionals in the health care waste management in Nepal and explains about different procedures for managing, handling and disposing of the health care waste generated in different health care institutions. With the objective to monitor and evaluate Health care waste management practices, to recommend specific needs/modifications, and follow-up report on adoption of National Health Care Waste Management Guidelines at health care institution this study was conducted on five different health care institutions at Kathmandu. The study respondents comprised of the health care waste management personnel (waste handlers, sweepers, and waste transporters), house keeping in-charge, matron, attending nurse at wards, medical director, and other experts who have been involved in the health care waste management in selected hospitals. It also focused on the different organization that take part on health care waste management such as Kathmandu Municipality City (KMC), Nepal Health Research Council (NHRC), Ministry of Local Development (MLD), Solid Waste Management and Resource Mobilization Centre (SWMRMC), World Health Organization (WHO), Ministry of Health and Population (MoHP), Department of Health Services (DHS). Health-care waste (HCW) also called, as clinical waste is a reservoir of potentially harmful microorganisms, which can infect hospital patients,health-care workers and the general public. It comprises of 10 - 25 per cent of total Health Care Waste generated. Health care waste is considered hazardous as it contains items such as sharp objects (needles, razors, scalpels), pathological waste (disease causing waste), other potentially infectious waste, pharmaceutical waste, biological waste, and hazardous chemical waste where as the remaining of 75-90 percent of healthcare waste is classified as non-clinical or general waste, and contains items such as kitchen and office waste. Even though knowing such fact, improper handling of health care waste contaminates both infectious and non-infectious waste. Even though a variety of technologies have been developed for the storage, collection, treatment and disposal of health-care wastes, most of infectious medical wastes are disposed and treated haphazardly along with general waste in Kathmandu. Thus, healthcare workers, patients, waste handlers, waste pickers, and general public are exposed to health risks from infectious wastes (particularly sharps), chemicals and other special health care wastes. This in turn resulted in high risk factor to patients, health care workers and general public. On monitoring and evaluation, Patan hospital and TUTH set a good example on waste minimization, Segregation, Labeling, Color Coding, Storage, Treatments and Disposal Practices among surveyed hospitals. Though each hospital has assigned colour-coding system for different types of waste, it has not been strictly practiced and lacks uniformity. Training in form of practicalrather than verbal has led to decrease in overall rate of infection in all the cases. Illiteracy of the patients as well as visitors was found to be a profound factor, which has created difficulty in generating awareness among the visitors. Improper disposal of health care waste has lead to increase in higher health risk to public. To minimize such risks, infectious and hazardous wasteproduced should strictly be treated by hospital themselves before final disposal to municipal container. But due to lack of strong guidelines and policies, such process has not been practiced. Thus, The need of a central incinerator was felt which could eliminate such problems since the health care facilities are willing to pay for it. This opportunity can easily be utilized by the concerned authority and can launch the programme for proper disposal of health care waste efficiently. But the incinerator to be built should be of environmental standards for air emissions and treatment efficiency should be established. In case of unavailability of such incinerators, use of auto clave and microwave can be an alternative method. The method is cheaper, saferand simple which can become a good practice for smaller nursing homes and clinics. Use of special type of closed transportation devices can significantly reduce hazard to public. Municipality responsible for management of the health care waste is treating all type of health care waste as municipal waste and finally disposes it by land filling. Hospital also is equally responsible for mixing of infectious with general waste in municipal containers in few of the surveyed hospital. Need of an alternate organization or authority was felt with active participation between different concerned government bodies in collaborative health care waste management, which could categorize health waste, segregate and dispose properly. Also it can be suggested that the same organization be involved in providing the containers for each waste to each health care institutions. Legislation concerning wastewater treatment and land filling was also lacking. At present, Nepal has no rigorous laws or regulation, which is enforced in the field of health care waste. It was discovered that improved HCWM systems have only recently been introduced in a small number of health care institution and private hospitals since the circulation of the guidelines. The study indicates that there is a need to improve the handling and disposal methods of hospital waste for almost all the available medical facilities along with final treatment. Public awareness through mass media, proper hygiene education to the scavengers, mandatory staff education in waste segregation, and legislation to regulate hospital waste management systems will change the traditional habits of different groups of people involved in this sector. Development of specific standards would bring out clarity and encourage private sector to engage in HCWM services. Address on the shortcomings obtained from monitoring committee regarding health care waste was a key factor lacking which can be easily solved. In conclusion, need of the institutional framework is felt, including needs identification, areas that need strengthening, and training for regulatory personnel at different levels of hospital management, hospital staff, and NGOs, if any, engaged in this activity. That is to conclude finally, though the hospitals in which the guideline is distributed has implemented the National Health Care Waste Management Guideline in some level, the level is not very satisfactory.