Comparative Analysis of Healthcare Waste Management Practice in two General Hospitals in Nigeria

By Olubukola Betty Olatoye
September 2009

The Author is a Project Coordinator with Berthys Easy Everyday Konsult in Sango-Ota, and a Fellow Member of the Institute of Chartered Chemists of Nigeria. → See also:

Abstract:
This research work was carried out between January and June, 2008 to determine the variations and similarities in the activities within two general hospitals located in separate Local Government Areas of Lagos state, so as to ensure that relevant evacuation and other HCWs management plans are properly done, based on informed recommendations, it will also ensure that national regulatory guidelines compliance can be easily attained. Using Physical observation, waste quantification or estimation and documented information provided in the hospital records, sectional data within each hospital were collated and analysed by employing relevant statistical analytical tools like ANOVA, Sectional Grouping, Mean, Median, Mode, Sd, CV etc. The collated data of the hospitals showed similarities in many areas, confirming that similar activities take place within HCFs and variations in other areas, confirming that many factors, both external and internal affect the generation of wastes and all other activities within HCFs. ANOVA analysis of the HCFs’ wastes showed similar trends, and variations in different sections within an HCF and among the two HCFs. The grouping of sections with similar wastes generations showed obvious differences in the source of collated data in terms of quantity of generated wastes and the pattern of waste generation in similar sections of two HCFs.

List of Acronyms and Abbreviations

HCHealthcare
HCFHealthcare Facility
HCFsHealthcare Facilities
HCGWsHealthcare General Wastes
HCWsHealthcare Wastes
OAGHOrile Agege General Hospital
GHLGeneral Hospital Lagos
JSIJohnsnow Incorporation
MMISMaking Medical Injection Safe
HCWHHealthcare Without Harm
INTOSAIInternational Organization for Supreme Auditing
MECPCMaster in Environmental Chemistry and Pollution Control
MIPANMember Institute of Public Analyst of Nigeria
MICCON     Member, Institute of Chartered Chemist
MNISPMember Nigeria Institute of Safety Professionals

Healthcare Wastes

Healthcare waste (HCW), is defined as ‘the total waste stream from a healthcare facility (HCF). According to the Basel, 2004 list, HCWs are grouped into Y1-4, Y6, Y14, Y16, Y29 and Y31. HCWs management is a serious environmental impacting issue that must be addressed using series of management instruments that will help to alleviate the inherent havoc that these categories of wastes have been causing and can cause to unsuspecting communities and the inhabitants. The HCWs impacts can spread through contact of various waste handlers with the generated wastes and then the transfer of contagious diseases to families, friends, neighbors and close associates. The impacts can also spread through unchecked disposal of contaminated wastewater into the public drains and also via movement from dumpsites to other areas, through surface and underground movement i.e. horizontal and vertical transmission of vectors, diseases and disease causing agents, which will eventually impact humans, animals and plants (WHO/CEPIS, 1994; WHO, 1997; WHO, 1995;INTOSAI, 2003). The type of waste of emphasis in this research work is Hospital waste.

Categories of HCWs according to UNEP/SBC-WHO 2006 report

Infectious waste, Pathological and anatomical waste, Hazardous pharmaceutical waste, Hazardous chemical waste, Waste with a high content of heavy metals, Pressurized containers, Highly infectious waste, Genotoxic/Cytotoxic waste, Radioactive waste.

Factors Affecting HCWs Generation

External Factors

Internal Factors Affecting Waste Generation in HCFs

Waste Management

Combining the definitions of Alo, (2006) and Osibanjo, (2003) waste management is the various activities from generation of waste to final disposal. It involves, strategic measures taken in the generation, characterization, quantification, storage, handling, collection, transportation, and disposal of wastes. It also covers managerial, technological and remediation measures involved in the corrective actions of existing waste practices as well as the continuous plan towards ensuring sustainable waste management within a locality e.g. Hospital Waste management in Lagos metropolis.

Past Research Works On HCWs

Researches have been conducted all over the world, on HCWs and HCWM; Coker et. al., 1999, Wong and Ramarathnam, 1994 all used quantification, physical observation and questionnaire administration as methodology for collating generated wastes data. Consultants and government agencies as well as institutions report hospital waste management in Florida; solid waste management in Florida, 2000; working draft report HCWH, 2002; Jorge et. al., 2000; international meeting report on HCWM, 2007; Alexander, 2001; INTOSAI, 2003; Shell medical waste EIA., 2002 etc. all discussed the various management intertwined activities necessary for proper HCWM. Some other researchers also dealt with data analysis tools needed for better predictions of the effect and impact of pollution as well as proper mitigations of HCWs. Longe and Williams, 2006 presented a range of between 0.562kd/bed/day and 0.670kg/bed/day with between 26% and 37% infectious waste portion for Lagos state. The UWEP report on waste management of HCFs prepared in Karachi in 2001 stated that generation of HCWs according to type of establishments in high income countries showed that the daily generation rate for general hospitals was between 2.1 and 4.2kg/bed. LAWMA findings within Lagos also reported a 1.5kg/bed/day waste generation while Pescod and Saw, 1999 recorded a range of 1-3.5kg/bed/day and between 0.3 and 0.9 kg/bed HCWs referred to as hazardous waste. The recorded percentage compositions of proportions of different types of wastes at various sources in Shaio Clinic, Bogota Showed that kitchen and cafeteria are areas where highest generation of wastes occurs followed by the surgery theatre, while gynecology ward or clinic as well as the doctors or consultants sections recorded both medium and low wastes generation. A survey of the total number of beds for each type of hospital in the capital of Sofia in Bulgaria was conducted, the quantity of wastes generated per occupied bed, showed that the quantities of potentially infectious and hazardous hospital Wastes averages around 0.4 kg/bed/day.

Research Methodology and Findings

Research Methodology

This research work was carried out between January and June, 2008 to determine the variations and similarities in the activities within two general hospitals located in separate Local Government Areas of Lagos state, so as to ensure that relevant evacuation and other HCWs management plans are properly done based on informed recommendations, it will also ensure that national regulatory guidelines compliance can be attained easily. Using Physical observation, waste quantification or estimation and documented information provided in the hospital record, sectional data within each hospital were collated and analysed by employing relevant statistical analytical tools like ANOVA,

Sectional Grouping, Mean, Median, Mode, Sd, CV etc. the collated data of the hospitals showed similarities in many areas, confirming that similar activities takes place within the HCFs and variations in other areas, confirming that many factors, both external and internal affect the generation of wastes and all other activities within an HCF. Using a combination of direct observation and wastes quantification/estimation, both primary and Secondary Data were gathered, the Primary data were collated through the field survey undertaken by visiting the chosen Hospital site for over a month each, where Oral interviews, Field video and photography, discussion with workers, quantification of various sectional wastes using two scales, one with +/-0.1 accuracy with a minimum range of 0.02g and having the capacity to accommodate 3.0kg and the second with +/-0.5 accuracy with a minimum range of 1kg and having the ability to withstand 120kg weight, observations within the HCF was also undertaken during the specified period.

The report of the National Health-Care Waste Management Plans in Sub-Saharan Countries Guidance Manual prepared collaboratively by Secretariat of the Basel Convention and World Health Organization UNEP/ SBC – WHO assessment document, prepared in 2006 is the international standard of reference for this report. The draft HCWM plan, 2007 prepared for FMenv. and the Federal Ministry of Health, National Injection Safety Forum report prepared in March 2005, as a collaboration project with USAID and JSI (MMIS project) are the national standards considered in this research work.

Choice of Hospitals for primary data collation:
Presently Lagos is one of the most populated states in Nigeria and the commercial nerve center, thus pollution issues are higher, prevalent and more visible, these are factors that informed the choice of picking Lagos as the case study for this research work. Also, a projected increase in HCWs is envisaged as the population and urbanization of Lagos towns and neighboring towns progresses, which can be accelerated by increase industrialization. In addition, attainment of a MEGA city status can only achieved when environmental issues are properly managed and appropriately mitigated.

Findings

Tables 1a to 10b and Figures 1 to 4 presents the various quantifications and other relevant findings within the two HCFs. 25 sections and 34 sections generate HCGWs only in OAGH and GHL respectively, some of these sections are merged together during waste quantification. The quantities of wastes produced per day per section here ranges between 0.00 and 38.00kg/day/section in OAGH and 0.02 and 62.36kg/day/section in GHL, total waste generated ranges between 48.92kg/day and 117.07kg/day in OAGH and 62.98kg/day and 170.04kg/day in GHL.

In the in-patient sections of OAGH, the total waste generated within each section ranges between 0.00 and 19.84kg/day, the Non-sharp HCWs ranges between 0.00kg/day and 13.62kg/day and the total generated in all the section together ranges between 13.80kg/day and 47.50kg/day, this is equivalent to between 44.17% and 61.59% of the total generated wastes in all the sections, the domestic waste portion ranges between 0.00kg/day and 6.22kg/day, while the collective total ranges between 17.44kg/day and 29.67kg/day which is equivalent to between 38.41% and 55.83% indicating that more HCWs were produced in the wards. Sharps generated in each ward ranges between 0 and 198 pieces/day giving a collective total of between 321 and 772 pieces/day, which leads to the production of between 0sharp box/month and 14 sharp boxes/week in each section and this is equivalent to generating between 22sharp boxes/week and 54sharp boxes/week. Between 0 and 19 patients are usually found in each of the wards and a collective total ranging between 50 patients/day and 111patients/day. In the in-patient sections of GHL, the total waste generated within each section ranges between 0.46 and 20.62kg/day, the Non-sharp HCWs ranges between 0.04kg/day and 10.26kg/day and the total generated in all the section together ranges between 23.84kg/day and 42.62kg/day, this is equivalent to between 33.32% and 38.98% of the total generated wastes in all the sections, the domestic waste portion ranges between 0.38kg/day and 10.36kg/day, while the collective total ranges between 47.71kg/day and 66.72kg/day which is equivalent to between 61.02% and 66.68% indicating that less HCWs were produced in the wards in contrast to that of OAGH. Sharps generated in each ward ranges between 0 and 181 pieces/day giving a collective total of between 389 and 849 pieces/day, which leads to the production of between 0sharp box/month and 13 sharp boxes/week in each section and this is equivalent to generating between 27sharp boxes/week and 59sharp boxes/week. Between 0 and 30 patients are usually found in each of the wards and a collective total ranging between 154 patients/day and 231patients/day.

In the out-patient sections of OAGH, the total waste generated within each section ranges between 0.04 and 13.90kg/day, the collective total ranges between 19.48kg/day and 57.34kg/day, the Non-sharp HCWs ranges between 0.00kg/day and 10.10kg/day and the total generated in all the section together ranges between 8.3kg/day and 28.08kg/day, this is equivalent to between 42.61% and 48.97% of the total generated wastes in all the sections, the domestic waste portion ranges between 0.00kg/day and 3.8kg/day, while the collective total ranges between 11.18kg/day and 29.26kg/day which is equivalent to between 51.03% and 57.39% indicating that less HCWs were produced in the out-patient sections of OAGH in contrast to that of the In-patient sections of the same hospital (OAGH). Sharps generated in each section ranges between 0 and 330pieces/day giving a collective total of between 54 and 1,059 pieces/day, which leads to the production of between 0sharp box/month and 17sharp boxes/week in each section and this is equivalent to generating between 3sharp boxes/week and 53sharp boxes/week. Between 0 and 397 patients are usually attended to in each of the Out-patient sections and a collective total ranging between 379patients/day and 1,050patients/day. In the out-patient sections of GHL, the total waste generated within each section ranges between 0.02 and 13.03kg/day, the collective total ranges between 34.8kg/day and 90.42kg/day, the Non-sharp HCWs ranges between <0.02kg/day and 10.14kg/day and the total generated in all the section together ranges between 1132kg/day and 36.72kg/day, this is equivalent to between 32.53% and 40.61% of the total generated wastes in all the sections, the domestic waste portion ranges between <0.02kg/day and 12.84kg/day, while the collective total ranges between 23.48kg/day and 53.68kg/day which is equivalent to between 59.39% and 67.47% indicating that less HCWs were produced in the out-patient sections of GHL this is similar to what was found in the same section of OAGH. Sharps generated in each section ranges between 0 and 372pieces/day giving a collective total of between 110 and 1,504 pieces/day, which leads to the production of between 0sharp box/month and 19sharp boxes/week in each section and this is equivalent to generating between 6sharp boxes/week and 75sharp boxes/week. Between 1and 365 patients are usually attended to in each of the Out-patient sections and a collective total ranging between 303patients/day and 1,031patients/day, this is similar to that of OAGH.

Note: estimated quantities of the sharp boxes was based on a minimum of 80 items and maximum 120 items, which was taken to be equivalent to ¾, filled sharp box. Some of the sections are not directly attended by patients unless they are referred there thus, the number of patients attended to in such sections were not fully used, considerations were however made for situations when patients were not attended to and may need to revisit the section at another date without going to any other section, in the light of this the whole patients attended to was assumed to be new in radiology section and their number was fully used for the calculation while 10% of that in the laboratory sections were incorporated as new patients. For the water use analysis, the assumed totals were based on the assumption that 100L will be used per patient daily, while 60L out of this will be channeled directly into the public drain in the In-patient sections, also, 20L will be used in the Out-patient sections with about 0.05L being channeled directly into the public drain, it was also assumed that about 25% of the out-patient will need to use the toilet facilities available within the hospital where water will then be utilized, armed with these assumptions, the total water utilized within the in-patient and Out-patient sections of the OAGH and GHL was thus calculated based on the number of patients attended to within each section.

Using the average number of patients found in all the sections of OAGH the values of utilized water in the out-patient sections was found to range between 16.43 and 2737.86L/day/section, with a total of 8054.27L/day, and equivalent to 14.54L/pat./day, while the quantity discharged directly into the public drain ranges between 0.04 and 6.85L/day/section, with total of 19.12L/pat./day, and equivalent to 0.03L/pat./day. The various mean of quantified utilized water the Out-patient sections of GHL showed that the total water values was found to range between 3.57 and 1947.85L/day/section, with a total of 9674.14L/day, and equivalent to 13.34L/pat./day, while the quantity discharged directly into the public drain ranges between 0.01 and 4.87L/day/section, and total of 23.80L/day, and equivalent to 0.03L/pat./day. The variations in the statistical data confirmed the heterogeneity characteristic of HCWs.

The values of total water utilized in the In-patient sections of OAGH was found to range between 71.43 and 1714.29L/day/section, with a total of 8299.99L/day, and equivalent to 103.75L/pat./day, while the quantity discharged directly into the public drain ranges between 42.86 and 1028.57L/day/section, with total of 4980.02L/day, and equivalent to 62.26L/pat./day. 0.24% of the total utilized water in the out-patient sections was discharged A gross total of 19354.26L/day was estimated to be the value for water utilized in OAGH having added the total values calculated for Laundry, Canteen and utensils cleaning, a total of 7999.19L/day was estimated as being the quantity discharged into the public drain, which is equivalent to 60.00% of the total water utilized within the wards. 0.25% of utilized water in the out-patient sections was discharged. The values of total water utilized in the In-patient sections of GHL was found to range between 128.57 and 2485.71L/day/section, with a total of 19214.27L/day, and equivalent to 100.07L/pat./day, while the quantity discharged directly into the public drain ranges between 77.14 and 1465.71L/day/section, with total of 11482.85L/day, and equivalent to 59.80L/pat./day. A gross total of 33838.41L/day was estimated to be the value for water utilized in GHL having added the total values calculated for Laundry, Kitchen, Canteen and Utensils cleaning, a total of 16456.65L/day was estimated as being the quantity discharged into the public drain. 59.76% of water utilized within the wards was discharged into the public drain. Collectively, about 41.33% of the total water utilized in OAGH was discharged into the public drain without any form of treatment, while, 48.63% of the total water utilized in GHL was discharged into the public drain without any form of treatment.

The ANOVA analysis of OAGH In-patient sections shows that the Non-sharp HCWs and total HCWs data were less significant, the gross total, domestic wastes and sharps HCWs data less non-significant, this collectively shows that though the analysed data were generated within different sections, but the rate of generation was similar, this can be buttressed with the fact that most sections attends to the same number of patients daily, also the wards have similar total number of beds and the bed occupancy rates were also similar. The error exhibited on the analysed data was however shown to be very small as indicated by the very closely related values of the actual and the corrected values of the sum of squares. The ANOVA test was carried out at 0.05 or 95% confidence level. The ANOVA analysis of GHL In-patient sections showed that only the Non-sharp HCWs exhibited low Significance while all other data showed low non-significance, this non-significance is probably due to similar activities within the sections as explained for the OAGH. Exhibited error was also very low, as shown by the corrected sum of squares.

The ANOVA analysis of OAGH Out-patient sections showed that the Sharps, Non-sharps and Total HCWs exhibited between High and moderate Significance while domestic and gross total waste data showed low non-significance, this non-significance is probably due to varied activities within the sections. Exhibited error was still shown to be very low, indicated by the corrected sum of squares, except for domestic waste data. The larger sum of squares corrected values in the gross and domestic waste data may be due to varied attendance at the sections, because of strict adherence to clinic days observed in the hospital, thus the number of patients were very low in some days and relatively high in other days, making waste generation to vary significantly during these periods. The ANOVA analyses of the Out-patient sections of GHL are predominantly characterized by high significance for all the collated data of the various quantified waste categories. This is totally different from what was observed in the OAGH data and this exists due to the similar reason of high heterogeneity in activities within each section, the level of accuracy of the collated data in GHL was however shown to be better than that of OAGH as indicated by the corrected sum of squares.

The ANOVA analysis of quantified waste data of HCGWs sections in OAGH showed that the data analysed exhibited low significance, the corrected sum of squares was however very high, this can be said to be due to the variations in administrative activities within the sections which determines the quantity of generated wastes, also contributed can be the short period devoted to quantifications. The ANOVA analysis of quantified waste data of HCGWs sections in GHL showed that the data analysed depicted low significance but the corrected sum of squares was also very high as exhibited by the OAGH data of similar sections, similar reason may be said to have caused this. In conclusion, high significance existed in the data collated in the Out-patient sections of both OAGH and GHL, though obvious variations are seen in the two data from the different HCF. Moderate to low significances were generally observed the In-patient and HCGWs sections analysed data in the HCFs, this can be attributed to the fact that patients within the wards of OAGH ranges between 0 and 25 per section daily and the beds also ranges between 1 and 19 in each section with a mean of 9, while in GHL, patients ranges between 0 and 26, while the beds ranges between 7 and 25 with mean of 18, in the same vein, the number of workers in the HCGWs sections are usually similar daily, whereas, the Out-patient sections shows higher variations in sectional activities and the number of patients seen within the various sections also differs considerably.

To explain further the information gathered from the one-way ANOVA analysis and other observations, the variations and similarities of sections were further presented using various statistical grouping tables, where values of the mean of analysed data that differs by +/- 0.15 for HCGWs generating sections or ± 0.5 for sections under the HCWs generating sections. Groups will be arranged in ascending order of quantified wastes, thus group denoted as group 1 will have group members with least quantified waste. Out of the 25 sections identified in the HCGWs section of OAGH, 10 groups can be formed. Group 3 have the highest number of sections (7), followed by group 1 (5), groups 5 to 10 however have one member only. Out of the 33 sections identified in the HCGWs generating sections in GHL, 12 groups can be formed Group 2 have the highest number of sections (9), followed by group 1 (7), group 6 to 12 however have one member only. Out of the 11 sections identified in the In-patient sections of OAGH, 6 groups can be formed. Groups 3 and 4 have the highest number of sections (3) each, followed by group 1 (2), groups 2, 5 and 6 have one member only. In the In-patient sections of GHL, out of the 15 sections identified, 8 groups can be formed. Group 5 have the highest number of sections (5), followed by groups 1, 3, 4 and 6 (2), groups 2, 7 and 8 have one member only. In the Out-patient sections of OAGH, out of the 20 sections identified, 7 groups were formed. Group 1 has the highest number of sections (7), followed by groups 5 (4), then groups 3 and 4 (3) groups 2, 6 and 7 have one member only. In the Out-patient sections of GHL, out of the 31 sections identified, 8 groups were formed with the section each having quantified wastes that differs from each other within + or- 0.50 target. Groups 1 and 3 have the highest number of sections (9), followed by groups 2 (5), then groups 4 (3), groups 5, 7 and 8 have one member only, while group 6 have 2 member.

  1. Gynecology
  2. Female Medical
  3. Female Surgical
  4. Male Medical
  5. Male Surgical
  6. Pediatrics
  7. Casualty
  8. Maternity
  9. Female Isolated
  10. Male Isolated
  11. Private Room

Figure 1 · Number of Beds and Number of Patients in the OAGH Wards
Fig 1

Table 1-A · Quantities of Wastes Generated in HCGWs Producing Sections in OAGH
Section Range (kg/day) Total (kg/month)
1 Accounts 0.06 – 0.183
2 Main Store 0.26 – 0.606
3 Audit section 0.06 – 0.162
4 Cashier section 0.16 – 0.642
5 Resource Centre 0.26 – 0.882
6 Birth registration 0.34 – 0.982
7 Mini Market 6.98 – 9.781
8 Security section 0.72 – 2.222
9 Laundry 0.16 – 0.325
10 Sorroundings 9.08 – 36.645
11 Garden Trimmings 0.00 – 4.292
12 Canteen 16.00 – 38.0010
13 Engineering 12.08 – 15.08100
14 Tailoring section 0.26 – 0.982
15 Head Admin. 0.16 – 0.484
16 Nurse Admin. Office 0.08 – 0.264
17 Administration Office 0.34 – 0.944
18 Duty Manager’s office 0.02 – 0.081
19 Chief Matron’s (Apex) office 0.18 – 0.382
20 Head Engineering Administration 0.26 – 0.581
21 Medical Director 0.20 – 0.682
22 Hospital Secretary 0.32 – 0.982
23 Controller of pharma. Service 0.02 – 0.082
24 Medical records 0.64 – 1.283
25 Social Welfare 0.28 – 0.583
Total 48.92 – 117.07172
Table 1-B · Quantities of HCGWs Generated in GHL
Section Range (kg/day) Total (kg/month)
1 Audit section 0.12 – 0.163
2 Accounts Section 0.16 – 0.323
3 Main Store 0.46 – 1.4410
4 Nurse Admin office 0.26 – 0.762
5 Surrounding 16.74 – 50.26-
6 Cashier Section 0.56 – 0.962
7 Pathology Store 0.52 – 1.783
8 Laundry Section 0.14 – 2.765
9 Hospital Secreatry’s office 0.16 – 0.405
10 Kitchen 29.80 – 62.3615
11 Canteen 2.36 – 7.063
12 Engineering Section 6.00 – 28.00150
13 Security Section (Gate house) 0.20 – 0.861
14 Medical Engineering Office 0.34 – 1.846
15 Head Admin. 0.14 – 0.502
16 Pathology Account 0.38 – 0.442
17 Administration Office 0.44 – 0.824
18 Chief Matron’s (Apex) office 0.10 – 0.183
19 Medical Director 0.20 – 0.381
20 Pharmacy Store 0.56 – 1.143
21 Head Pharma. Service 0.26 – 0.781
22 Medical records 0.10 – 0.363
23 Social Welfare 0.36 – 0.861
24 Tailoring section 0.58 – 1.365
25 Pathology admin section 0.14 – 0.562
26 LASACA 1.08 – 2.866
27 Junior Cooperative store 0.12 – 0.3210
28 Senior Cooperative store 0.12 – 0.4019
29 Doctors’ library 0.02 – 0.08-
30 Nurse common room 0.04 – 0.14-
31 Confidential matters office 0.08 – 0.222
32 Consultants offices 0.20 – 0.501
33 Environemntal officers’ office 0.06 – 0.101
Total 62.98 – 170.04274
Table 2-A · Wards’ (In-patient) Collated Data in OAGH   (Total Nș of Beds = 99)
Section Range of Total
Waste kg/day
Range of Non-Sharp
HCWs kg/day
Range of Domestic
Waste kg/day
Range of Sharps
items/day
Nș of Sharp Boxes
used/week kg/day
Bed Occupancy
Rate
Range of Patients
Attended
Gynecology 3.38 – 6.341.66 – 2.981.72 – 3.3627 – 562 – 4/week (0.62)63.64% – 100.00%7 – 11
Female Medical 3.20 – 5.581.52 – 3.021.68 – 2.5622 – 582 – 4/week (0.70)75.00% – 112.50%6 – 10
Female Surgical 3.02 – 5.241.06 – 2.601.96 – 2.6428 – 622 – 4/week (0.78)55.56% – 88.89%5 – 8
Male Medical 2.06 – 5.631.04 – 2.1.02 – 2.7118 – 721 – 5/week (0.66)55.56% – 122.22%4 – 11
Male Surgical 3.46 – 7.861.66 – 4.021.80 – 3.8440 – 633 – 4/week (0.58)55.56% – 111.115 – 11
Pediatrics 6.94 – 17.402.30 – 11.704.64 – 5.70125 – 1989 – 14/week (1.08)42.11% – 89.47%8 – 19
Casualty 1.94 – 5.700.82 – 3.241.12 – 2.4628 – 712 – 5/week (0.92)62.50% – 112.505 – 10
Maternity 6.86 – 19.843.36 – 13.623.50 – 6.2229 – 1692 – 12/week (0.94)63.32% – 115.79%9 – 24
Female Isolated 0.38 – 1.660.38 – 1.660.004 – 61 – 2/month (0.52)25.00% – 75.00%1 – 3
Male Isolated 0.00 – 1.460.00 – 1.460.000 – 60 – 2/month (0.82)0.00% – 75.00%0 – 3
Private Room 0.00 – 0.540.00 – 0.360.00 – 0.180 – 110 – 3/month (0.88)0.00% – 100.00%0 – 1
Grand Total 31.24 – 77.2513.80 – 47.58
44.17% – 61.59%
17.44 – 29.67
55.83% – 38.41%
321 – 77222 – 54/week (0.77)
17.30 – 41.61 kg/week
2.47 – 5.94kg/day
48.54% – 107.77%50 – 111
Table 2-B · Wards’ (In-patient) Collated Data in GHL   (Total Nș of Beds = 271)
Section Range of Total
Waste kg/day
Range of Non-Sharp
HCWs kg/day
Range of Domestic
Waste kg/day
Range of Sharps
items/day
Nș of Sharp Boxes
used/week kg/day
Bed Occupancy
Rate
Range of Patients
Attended
5.58 – 7.701.78 – 2.383.80 – 5.3216 – 261 – 2/week (0.68)48.00% – 68.00%12 – 18
4.66 – 6.460.90 – 1.763.76 – 4.7016 – 1 – 3/week (0.72)50.00% – 78.57%6 – 11
6.18 – 10.021.44 – 3.344.74 – 6.6821 – 381 – 3/week (0.90)60.00% – 76.00%14 – 19
3.86 – 5.540.42 – 0.903.44 – 4.645 – 220 – 2/week (0.60)61.54% – 76.92%7 – 10
0.46 – 0.640.08 – 0.180.38 – 0.460 – 110 – 3/month (0.76)14.29% – 42.86%0 – 3
5.28 – 8.061.06 – 2.404.22 – 5.6677 – 1185 – 8/week (0.90)60.87% – 82.09%14 – 19
2.46 – 3.720.32 – 0.762.14 – 2.964 – 130 – 1/weeks (1.28)45.45% – 72.72%5 – 8
5.36 – 8.701.66 – 3.363.70 – 5.3442 – 783 – 5/week (0.98)60.00% – 72.00%14 – 19
3.46 – 5.680.90 – 1.762.56 – 3.926 – 230 – 2/week (1.22)69.23% – 84.62%9 – 12
5.54 – 7.662.06 – 2.523.48 – 5.1433 – 672 – 5/week (1.02)76.00% – 92.00%19 – 23
4.22 – 5.742.00 – 2.742.22 – 3.0019 – 321 – 2/week (0.92)60.00% – 80.00%8 – 12
7.70 – 9.122.32 – 3.725.38 – 5.4038 – 903 – 6/ week (0.56)64.00% – 96.00%16 – 25
0.44 – 0.760.04 – 0.160.40 – 0.600 – 60 – 2/month (0.60)7.69% – 16.67%0 – 2
Accident 5.49 – 8.923.60 – 6.381.89 – 2.42 – 983 – 7/week (0.78)92.31% – 130.77%10 – 20
Casualty 10.86 – 20.625.26 – 10.265.60 – 10.3670 – 1815 – 13/week (0.8087.50% – 116.67%20 – 30
Grand Total 71.58 – 109.3423.84 – 42.62
33.32% – 38.98%
47.71 – 66.72
66.68% – 61.02%
389 – 84927 – 59/week (0.85)
22.95 – 50.15 kg/week
3.28 – 7.16 kg/day
56.41% – 84.62%154 – 231
Table 3-A · Out-patients Sections’ Collated Data in OAGH
Section Range of Total
Waste kg/day
Range of Non-Sharp
HCWs kg/day
Range of Domestic
Waste kg/day
Range of Sharps
items/day
Nș of Sharp Boxes
used/week kg/day
Range of Patients
Attended
Pediatric Clinic 1.46 – 2.840.98 – 2.140.48 – 0.700 – 30 – 1/3month (0.50)55 – 123
Mini Theatre 3.40 – 6.842.50 – 6.240.90 – 0.6018 – 631 – 4/week (1.04)2 – 7
GOPD 1.84 – 3.240.02 – 0.061.82 – 3.180 – 60 – 1/month (1.24)86 – 242
MOPD 0.18 – 1.560.00 – 0.080.18 – 1.480 – 50 – 1/month (0.98)9 – 59
SOPD 0.36 – 1.400.02 – 0.100.34 – 1.300 – 90 – 2/month (0.86)11 – 56
Eye/Optometry 0.22 – 0.840.00 – 0.020.22 – 0.820 – 490 – 2/week (0.64)8 – 56
Dental 2.90 – 4.481.96 – 3.740.94 – 0.740 – 970 – 5/week (0.92)13 – 57
ENT 0.18 – 0.460.00 – 0.020.18 – 0.440 – 30 – 1/3month (0.58)4 – 16
CWC 0.30 – 1.420.02 – 0.180.28 – 1.240 – 3300 – 17/week (1.04)30 – 138
DOT / Heart-to-heart 1.54 – 2.141.54 – 2.1400 – 1130 – 6/week (0.98)102 – 147
ANC 0.94 – 2.760.00 – 0.080.94 – 2.680 – 60 – 1/month (0.76)48 – 147
Family Planning 0.36 – 0.920.20 – 0.700.16 – 0.220 – 450 – 2/week (0.80)6 – 25
Radiology 0.08 – 0.580.00 – 0.040.08 – 0.540-0 – 32
Laboratory 2.06 – 3.640.04 – 1.642.02 – 2.000 – 1060 – 5/week (0.84)90 – 175
Operation theatre 1.16 – 13.900.86 – 10.100.30 – 3.8010 – 670 – 5/week (0.92)1 – 7
*Fee paying pharmacy 1.50 – 3.140.00 – 0.081.50 – 3.06-106 – 250
*Free drugs pharmacy 0.38 – 3.060.00 – 0.080.38 – 2.980-198 – 397
Injection Room 0.04 – 0.160.04 – 0.140.00 – 0.0226 – 1571 – 8/week (1.32)5 – 34
Dressing Room 0.10 – 0.380.10 – 0.380.00 – 0.000-3 – 40
*Registration / Card room 0.48 – 3.580.02 – 0.120.46 – 3.460-13 – 912
Grand Daily Total 19.48 – 57.348.30 – 28.08
42.61% – 48.97%
11.18 – 29.26
57.39% – 51.03
54 – 1,0593 – 53/week (0.89)
2.67 – 47.17kg/week
0.38 – 6.74kg/day
379 – 1050
Table 3-B · Out-patients Sections’ Range of Collated Data in GHL
Section Range of Total
Waste kg/day
Range of Non-Sharp
HCWs kg/day
Range of Domestic
Waste kg/day
Range of Sharps
items/day
Nș of Sharp Boxes
used/week kg/day
Range of Patients
Attended
Skin 0.06 – 0.180 – 0.040.06 – 0.140 – 20 – 1/3month (0.50)25 – 33
Psychiatric 0.02 – 0.080.02 – 0.020.02 – 0.040 – 80 – 2/month (1.04)1 – 5
GOPD/CH 1.26 – 3.460.10 – 0.721.16 – 2.740 – 1060 – 5/week (1.24)181 – 243
MOPD 0.46 – 3.940.06 – 0.620.40 – 3.320 – 270 – 1/week (0.98)28 – 205
SOPD 1.74 – 5.340.08 – 1.861.66 – 3.480 – 300 – 2/weeks (0.86)29 – 178
Eye/Optometry 0.12 – 2.320.02 – 0.260.10 – 2.060 – 160 – 1/week (0.64)8 – 104
Dental 4.12 – 12.083.04 – 10.141.08 – 1.920 – 580 – 3/week (0.92)47 – 69
ENT 0.08 – 0.360.02 – 0.140.06 – 0.220 – 40 – 1/month (0.58)1 – 47
Chest Clinic 0.38 – 1.800.38 – 1.8000 – 1130 – 6/week (1.04)78 – 175
VCT Clinic 0.48 – 2.360.48 – 2.3600 – 830 – 4/week (0.96)39 – 49
Plaster Room 0.86 – 2.720.38 – 1.080.48 – 1.640 – 150 – 1/week (0.98)2 – 7
Radiology 0.98 – 1.880.02 – 0.180.96 – 1.700-10 – 36
VCT Lab. 1.46 – 2.360.78 – 1.420.68 – 0.940 – 3370 – 17/week (0.86)78 – 108
Operation theatre 1.02 – 7.840.68 – 4.500.34 – 3.3410 – 650 – 5/week (0.90)1 – 5
Fee paying pharmacy 8.40 – 13.080.12 – 0.248.28 – 12.840-210 – 365
Free drugs pharmacy 0.74 – 1.860.02 – 0.040.72 – 1.820-148 – 245
Blood for life office 0.04 – 0.200.02 – 0.040.02 – 0.160 – 100 – 2/month (0.76)1 – 3
VCT pharmacy 1.88 – 2.580.18 – 0.461.70 – 2.120-85 – 120
Medical records 1.12 – 3.020.06 – 0.141.06 – 2.880-538 – 693
Haematology 0.14 – 0.940.08 – 0.560.06 – 0.3873 – 3724 – 19/week (0.82)15 – 85
Immunoassay 0.02 – 0.040.020.02 – 0.040 – 20 – 1/3month (0.50)1
Bacteriology/T.B. 3.48 – 5.743.36 – 5.560.12 – 0.180 – 1000 – 5/week (0.68)119 – 267
Parasitology 0.26 – 0.920.16 – 0.320.10 – 0.600 – 60 – 1/month (0.54)18 – 38
Pathology surrounding 2.08 – 4.380.60 – 1.621.48 – 2.760--
Blood bank / transfusion 0.04 – 1.380.02 – 0.180.02 – 1.204 – 361 – 3/week (0.96)6 – 36
Biochemistry 0.16 – 1.820.04 – 1.320.12 – 1.5023 – 862 – 6/week (0.90)25 – 108
Phlebotomy 0.98 – 1.540.12 – 0.220.86 – 1.320-62 – 85
Grd. Floor 0.98 – 2.040.18 – 0.240.80 – 1.800--
First floor 0.24 – 0.680.08 – 0.280.16 – 0.400--
Second floor 0.14 – 0.420.04 – 0.100.10 – 0.320--
Rehabilitation 1.06 – 3.060.16 – 0.240.90 – 2.820 – 280 – 1/week (0.86)17 – 72
Grand Daily Total 34.80 – 90.4211.32 – 36.7223.48 – 53.68110 – 1,5046 – 75/week (0.83)303 – 1,031
Field Survey, 2008 32.53 – 40.61%67.47 – 59.39%4.98 – 62.420.71 – 8.92
Table 4-A · Estimated Water Utilisation and Percentages in Out-patient and In-patient Sections in OAGH
Out-patient Sections Av. Total Water utilized in Out-patient sections (L/day)(Equivalent in L/pat./day) Av. Wastewater discharged directly into the public drain (L/day) and (Equivalent L/patient/day) from the Out-patient sections In-patient Sections Av. Total water utilized in In-patient sections (L/day) (Equivalent in L/pat./day) Av. Wastewater discharged directly into the public drain (L/day) (Equivalent L/patient/day) from the In-patient sections Gross water utilized in In-patient and Out-patients sections Gross Total Wastewater produced in In-patient and Out-patientsections in L/day % of Wastewater discharged into the public drain from In-patient section % of Wastewater discharged into the public drain from Out-patient section % of Wastewater discharged into the public drain from the total water used
1 Paediatric clinic 358.57 (72) 0.90 Gynecology Ward 957.14(10) 574.29
2 Mini Theatre 20.71 (4) 0.04 Female medical ward 785.71(7) 471.43
3 GOPD 670.71 (134) 1.68 Female Surgical Ward 657.14(7) 394.29
4 MOPD 100.71 (19) 0.24 Male medical ward 857.14(9) 514.29
5 SOPD 171.43 (20) 0.25 Male Surgical Ward 785.71(7) 471.43
6 Eye clinic 107.14 (21) 0.30 Pediatrics Ward 1357.14(12) 814.29
7 Dental Clinic 122.71 (34) 0.30 Casualty Ward 742.86(7) 445.71
8 ENT Clinic 34.29 (7) 0.09 Maternity Ward 1714.29(16) 1028.57
9 CWC 273. 57 (55) 0.68 Female Isolated Ward 214.29(2) 128.57
10 DOT / Heart-to-heart 463. 57 (93) 1.16 Male Isolated ward 157.14(2) 94.29
11 ANC 297.14 (59) 0.74 Private Room 71.43(1) 42.86
12 Family Planning 89.29 (9) 0.09 Total 8299.99(80) (103.75) 4980.02(62.26) 60.00 0.24
13 Radiology 60.71 (7) 0.10
14 Laboratory / Blood Bank 466.43 (79) 0.99
15 Operation Theatre 16.43 (3) 0.04
16 Fee Paying Pharmacy 875.00 (139) 1.74
17 Free Drug Pharmacy 1002.86 (201) 2.51
18 Injection Room 86.43 (17) 0.22
19 Dressing Room 98.57 (20) 0.25
20 Registration 2737.86 (548) 6.85
Total 8054.27 (577) (13.96) 19.12 (0.03) 16354.26 4999.19 25.73 0.01 41.33
Other Water Utilization 3000.00
19354.26
3000.00
7999.19
Table 4-B · Estimated Water Utilisation and Percentages in Out-patient and In-patient Sections in GHL
Out-patient Sections Av. Total Water utilized in Out-patient sections (L/day)(Equivalent in L/pat./day) Av. Wastewater discharged directly into the public drain (L/day) and (Equivalent L/patient/day) from the Out-patient sections In-patient Sections Av. Total water utilized in In-patient sections (L/day) (Equivalent in L/pat./day) Av. Wastewater discharged directly into the public drain (L/day) (Equivalent L/patient/day) from the In-patient sections Gross water utilized in In-patient and Out-patients sections Gross Total Wastewater produced in In-patient and Out-patientsections in L/day % of Wastewater discharged into the public drain from In-patient section % of Wastewater discharged into the public drain from Out-patient section % of Wastewater discharged into the public drain from the total water used
1 Skin clinic 101.43(20) 0.23 A¹Female Surgical 1,485.71(15) 871.43
2 Psychiatric clinic 9.29(3) 0.03 A² Female Surgical 871.43(9) 522.86
3 GOPD 790.00(221) 1.98 B¹ Male Surgical 1685.71(17) 1011.43
4 MOPD 361.43(101) 0.90 B² Genito-urinary 842.86(8) 505.71
5 SOPD 286.43(80) 0.72 B³ Burn Unit 128.57(1) 77.14
6 Eye /Optometry 227.86(64) 0.57 C¹ Male Surgical 1657.14(17) 994.29
7 Dental 207.86(58) 0.52 C² Male Dental & E.N.T 642.86(6) 385.71
8 ENT 84.29(24) 0.21 D¹ Female Medical 1685.71(17) 1011.43
9 Chest (HIV / TB) 473.57(133) 1.19 D² Female Medical 1014.29(10) 608.57
10 VCT (HIV/ AIDS) 155.00(43) 0.39 E¹ Male Medical 2100.00(21) 1260.00
11 Plaster room 13.57(4) 0.03 E² Children Surgical 1071.43(11) 642.86
12 Radiology / X-Ray 110.0(22) 0.27 F¹ Male Medical 2028.57(20) 1465.71
13 VCT Lab. 326.14(91) 0.82 F² Eye Surgical 128.57(1) 77.14 59.76 0.25
14 Operation Theatre 13.57(3) 0.04 Accident Emergency 1385.71(14) 831.43
15 Fee Paying Pharmacy 1500.00(300) 3.14 Casualty Emergency 2485.71(25) 1465.71
16 Free Drugs Pharmacy 654.29(183) 1.64 Total 19,214.27(192) (100.07) 11482.85(59.80)
17 Blood for Life Office 7.14(2) 0.02
18 VCT. Pharmacy 360.7(109) 0.90
19 Medical records 1947.85(626) 4.87
20 Haematology Lab. 306.43(61) 0.77
21 Immunoassay Lab. 3.57(1) 0.01
22 Bacteriology Lab. 677.86(136) 1.70
23 Parasitology Lab. 95.86(36) 0.23
24 Pathology surrounding 0 0
25 Blood bank/transfus 91.43(18) 0.23
26 Biochemistry Lab 394.29(79) 0.99
27 Phlebotomy 270.71(76) 0.86
28 Grd. Floor/cashier 0 0
29 First floor 0 0
30 Second floor 0 0
31 Rehabilitation 203.57(57) 0.54
Total 9674.14(725)(13.34) 23.80 (0.03) 28888.41 11506.65 33.93 0.01 .63
Others 4950.00
33838.41
4950.00
16456.65
Table 5-A · One-way ANOVA Analysis In-patient Sections in OAGH
Sums of Squares df Mean Square F Sig
Non-sharp HCWs
(kg/day)
Between Groups 41.663 9 4.629 547.843 0.033*
Within Groups 8.450E-03 1 8.450E-03
Total 41.672 10
Sharp HCWs
(kg/day)
Between Groups 2.677 9 0.297 237.938 0.050
Within Groups 1.250E-03 1 1.250E-03
Total 2.678 10
Total HCWs
(kg/day)
Between Groups 64.197 9 7.133 440.307 0.037*
Within Groups 1.620E-02 1 1.620E
Total 64.213 10
Domestic HCWs
(kg/day)
Between Groups 26.482 9 2.942 181.632 0.058
Within Groups 1.620E-02 1 1.602E-02
Total 26.498 10
Gross Total HCWs
(kg/day)
Between Groups 165.337 9 18.371 208.286 0.054
Within Groups 8.820E-02 1 8.820E-02
Total 165.425 10
Table 5-B · One-way ANOVA Analysis In-patient Sections in GHL
Sums of Squares df Mean Square F Sig
Non-sharp HCWs
(kg/day)
Between Groups 49.671 13 3.821 389.886 0.040*
Within Groups 9.800E-03 1 9.8000E-03
Total 49.681 14
Sharp HCWs
(kg/day)
Between Groups 1.075 13 8.272E-02 8.441 0.264
Within Groups 9.800E-03 1 9.800E-03
Total 1.085 14
Total HCWs
(kg/day)
Between Groups 1244.876 13 95.760 87.436 0.084
Within Groups 1.095 1 1.095
Total 1245.972 14
Domestic HCWs
(kg/day)
Between Groups 59.123 13 4.548 16.610 0.190
Within Groups 0.274 1 0.274
Total 59.397 14
Gross Total HCWs
(kg/day)
Between Groups 196.902 13 15.146 55.319 0.105
Within Groups 0.274 1 0.274
Total 197.176 14
Table 6-A · One-way ANOVA Analysis Out-patient Sections in OAGH
Sums of Squares df Mean Square F Sig
Non-sharp HCWs
(kg/day)
Between Groups 34.023 18 2.268 32402.857 0.000***
Within Groups 2.800E-04 1 7.000E-05
Total 34.023 19
Sharp HCWs
(kg/day)
Between Groups 2.242 18 0.149 2135.714 0.000***
Within Groups 2.800E-04 1 7.000E-05
Total 2.243 19
Total HCWs
(kg/day)
Between Groups 367.699 18 24.513 12.363 0.013*
Within Groups 7.931 1 1.963
Total 375.630 19
Domestic HCWs
(kg/day)
Between Groups 8.622 18 0.575 1.160 0.491
Within Groups 1.983 1 0.496
Total 10.605 19
Gross Total HCWs
(kg/day)
Between Groups 45.596 18 2.533 1.839 0.0530
Within Groups 1.378 1 1.378
Total 46.973 19
Table 6-B · One-way ANOVA Analysis Out-patient Sections in GHL
Sums of Squares df Mean Square F Sig
Non-sharp HCWs
(kg/day)
Between Groups 29.306 23 1.274 2399.750 0.000***
Within Groups 3.717E-03 7 5.310E-04
Total 29.309 30
Sharp HCWs
(kg/day)
Between Groups 2.039 23 8.867E-02 15.452 0.001**
Within Groups 4.017E-02 7 5.736E-03
Total 2.079 30
Total HCWs
(kg/day)
Between Groups 743.092 23 32.308 38.978 0.000***
Within Groups 5.802 7 0.829
Total 748.894 30
Domestic HCWs
(kg/day)
Between Groups 107.902 23 4.691 26.227 0.000***
Within Groups 1.252 7 0179
Total 109.154 30
Gross Total HCWs
(kg/day)
Between Groups 140.349 23 6.102 29.447 0.000***
Within Groups 1.451 7 0.207
Total 141.799 30
Table 7-A · One-way ANOVA Analysis of Quantified Waste Data of HCGWs Sections in OAGH
Sums of Squares df Mean Square F Sig
Non-sharp HCWs
(kg/day)
Between Groups 2563.624 23 111.462 1465.640 0.021*
Within Groups 7.005E-02 1 7.005E-02
Total 2563.700 24
Table 7-B · One-way ANOVA Analysis of Quantified Waste Data of HCGWs Sections in GHL
Sums of Squares df Mean Square F Sig
Non-sharp HCWs
(kg/day)
Between Groups 3518.238 30 117.275 30.527 0.032*
Within Groups 7.683 2 3.842
Total 3525.922 32
Table 8-A · Grouping of Sections with Similar Quantified Wastes in OAGH HCGWs
Group 1 Group 4
18 Duty Manager’s office 0.03 6 Birth registration 0.56
23Controller of pharma. Service 0.04 5 Resource Centre 0.62
3 Audit section 0.09 24 Medical records 0.63
1 Accounts 0.10 14 Tailoring section 0.64
16 Nurse Admin. Office 0.14 Group 5
Group 2 8 Security section 0.84
9 Laundry 0.19 Group 6
19 Chief Matron’s (Apex) office 0.28 11 Garden Trimmings 4.29
15 Head Admin. 0.34 Group 7
Group 3 7 Mini Market 7.14
20 Head Engineering Administration 0.37 Group 8
21 Medical Director 0.38 13 Engineering 13.72
2 Main Store 0.40 Group 9
4 Cashier section 0.42 10 Sorroundings 21.17
25 Social Welfare 0.42 Group 10
22 Hospital Secretary 0.50 12 Canteen 29.71
17 Administration Office 0.51
Table 8-B · Grouping of Sections with Similar Quantified Wastes in GHL HCGWs
Group 1Group 4
29Doctors’ library0.0523Social Welfare0.61
33Environmental officers’ office0.0817Administration Office0.64
30Nurse common room0.096Cashier Section0.69
1Audit section0.103Main Store0.73
18Chief Matron’s (Apex) office0.12Group 5
31Confidential matters office0.148Laundry Section0.78
27Junior Cooperative store0.207Pathology Store0.87
Group 220Pharmacy Store0.88
22Medical records0.21Group 6
2Accounts Section0.2224Tailoring section0.95
25Pathology admin section0.26Group 7
28Senior Cooperative store0.2614Medical Engineering Office1.04
19Medical Director0.27Group 8
9Hospital Secreatry’s office0.2926LASACA1.96
15Head Admin.0.33Group 9
13Security Section (Gate house)0.3511Canteen4.31
32Consultants offices0.36Group 10
Group 312Engineering Section12.84
16Pathology Account0.40Group 11
4Nurse Admin office0.445Surrounding35.16
21Head Pharma. Service0.50Group 12
10Kitchen50.04
Table 9-A · Grouping of Sections with Similar Quantified Wastes in OAGH In-patient Sections
Group 1Group 4
11Private Room0.315Male Surgical Ward4.82
10Male Isolated ward0.621Gynecology Ward4.87
Group 22Female medical ward5.04
9Female Isolated Ward1.04Group 5
Group 38Maternity Ward11.83
4Male medical ward4.28Group 6
3Female Surgical Ward4.286Pediatrics Ward12.79
7Casualty Ward4.59
Table 9-B · Grouping of Sections with Similar Quantified Wastes in GHL In-patient Sections
Group 1Group 5
5B³ Burn Unit0.421A¹ Female Surgical6.87
13F² Eye Surgical0.458D¹ Female Medical7.05
Group 26C¹ Male Surgical7.14
7C²Male Dental & E.N.T3.0810E¹ Male Medical7.20
Group 3Group 6
4B² Genito – urinary4.6414Accident Emergency8.11
9D² female Medical4.903B¹ Male Surgical8.45
Group 4Group 7
11E² Children Surgical5.4912F¹ Male Medical8.64
2A² Female Surgical5.64Group 8
15Casualty Emergency16.12

Presentation of OAGH Pictures

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  1. Scavengers at work during waste packing in OAGH and using bare hand used for packing wastes to put pure water sachet into mouth when thirsty.
  2. Scavengers at Abule Egba Dumpsite, rushed at the deposited content of the waste vehicle, (collected in OAGH) not minding the type of waste being poured.
  3. Other Hazardous wastes generated within the wards in OAGH.
  4. Overfilled Deposit shed in OAGH, leading pouring of mixed wastes into the entrance of the deposit site.
  5. Inappropriate waste found in the red nylon in OAGH.
  6. Different types of HCWs collected with liquid content of urine bag still inside it, indicated by the inflation of the bag in OAGH.
  7. Improper partitioning of waste container in OAGH.
  8. Medical waste collection drum filled with cartons in OAGH.
  9. Sharp box placed at the entrance of OAGH waste collection shed.
  10. Collection of all wastes together in OAGH by LAWMA staff.
  11. Air Pollution, caused by using dilapidated vehicle to collect waste in OAGH by LAWMA staff.
  12. Waste collection contractor using bare hands to pack mixed HCWs in OAGH.
  13. Sharp box collected with all other wastes in OAGH.
  14. Another view of waste deposition at the entrance of OAGH waste deposit shed.
  15. Recyclable cardboard cartons deposited into the waste shed in OAGH.
  16. Overflowing domestic wastes section in OAGH.
  17. Researcher kitted with PPEs during the data collation.
  18. Protruding sharp packed into the red nylon in OAGH.
  19. Brown bag containing laboratory wastes packed with other wastes during LAWMA collection in OAGH.

Presentation of GHL Pictures

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  1. Unkempt surrounding in GHL, due to dumping of obsolete equipment.
  2. Urine bags filled with urine and dumped into the waste container for disposal in GHL.
  3. Cesspool waste (human excreta) found at the back of emergency ward of GHL.
  4. Wastewater flowing into the public drain without any form of treatment in GHL.
  5. Improper waste collection in the theater section of GHL, where body part was lumped with other HCWs generated.
  6. Another view of Anatomic waste found in GHL theatre HCWs container for disposal into the transit point and to be collected later into the public dumpsite.
  7. Mixture of domestic and other HCWs generated in the Laboratory section of GHL.
  8. Mixture of domestic and HCWs lumped together in the blood bank section of GHL.
  9. Waste collection practice in GHL, where yellows nylon and its HCWs content is dropped into the black nylon containing domestic wastes.
  10. Already dropped yellow nylon seen inside the black nylon in GHL.
  11. Waste scavenging. in GHL.
  12. Scavenging animal in the deposit shed in GHL.
  13. Recyclable boxes thrown into waste shed in GHL.
  14. The back of the ground floor of the Doctor’s quarter in GHL, where passersby and patients’ relatives utilizes as convenience both at night and during the day time.
  15. Already analysed Laboratory samples through into the overflowing wastes in front of the waste collection shed, which is located along a major road, where scavengers can have access to it in GHL.
  16. Old Sharp deposit pit in GHL, where a separate room, located close to the main entrance of the hospital is being used for storing sharp boxes, which is usually collected separately.
  17. Researcher, during the data collation.
  18. Sharp found in the wastes and sample containers in GHL.
  19. Laboratory wastes packed with waste samples of patients for onward deposition into the waste shed in GHL.

Conclusions

Total waste segregation was not practiced on the HCFs sites used as case studies, no waste reduction or minimization measures exists on site, Information and communication process is lacking in most sections and it is affecting environmental practices. Many sections do not keep proper records on the quantities of materials used for treating patients; neither do they normally quantify their generated wastes daily. Staff and visitors are not incorporated into the waste management data. Co-disposal of domestic and HCWs is the normal practice existing in HCFs in Lagos and co-collection of the generated wastes by wastes collectors was also observed to be the norm and non observance of most colour codes recommended for keeping wastes was the practice.

Highly infectious wastes like in DOT, VCT Laboratories are packed and disposed along with all other wastes. No form of water treatment facility was seen on the HCFs used for the data collation of this project. All the bathrooms and wash-hand basins drains are directly linked to the public gutters. No maternity wards, ANC, CWC or pediatrics clinic exists on the GHL facility, these sections have been converted to a separate hospital and with separate management. Miscellaneous allocations are presently being used to address environmental issues in the HCFs. All sections do not have adequate posters on HCWs management information, however, some wards and Out-patient sections have information posters about treatment of HCWs and handling sharps in GHL, none was found in OAGH.

Improperly monitored transit points exist on the HC facilities. Non-observation of wastes meant for different colour coded containers is the general practice. Non-availability of nylons affects workers willingness to observe colour codes. All forms of containers were used to carry wastes on the HCFs. Non-challant attitude to waste segregation are observed amongst all categories of staff in the health care sector and ways of ensuring enforcement have not been determined. Properly handled Kitchen and canteen wastes generated in both HCFs can be recycled as Dog food or sold out to those producing organic fertilizers. Monitoring and evaluation of wastes management activities have not been planned for in HCFs.

Due to the practice within the GHL that prevents patients’ visitors to stay within the ward overnight, most of them make use of any hidden area to ease themselves at night, thus polluting the environment, especially under the Doctors’ quarters (that is being managed by a separate management and all health care workers are now being allocated to the building), this building is strategically located and has close proximity to the emergency wards, thus many night visitors uses the dark to liter the place with human faeces and urine such that the section exhumes foul odour that does not befit the status of an health facility, broken beds and other bad or obsolete office equipment also liters this place and no form of cleaning has been done there for over three years before the collation of this data. In OAGH the aesthetic of the environment has been better protected because one visitor is entitled to stay with the patient, this has also eased the stress of work of staff when there is need to perform special duty on the patient, like bathing and helping the patient to use the toilet. The wards were observed to be devoid of unwashed human body odour as compared to many sections of the GHL. There is high variation in the values of wastes generated within each section, indicating very highly heterogeneous and dynamic system.

A total of 99 beds were present in OAGH while 271 existed in GHL. According the information provided from the record section of GHL, more males were admitted into the wards in GHL in 2007, but more death occurs among admitted females. More females attended the out-patient sections in GHL in 2007, but more males’ death occur here. This type of information could not be assessed in OAGH.

In GHL, between 6 and 75sharp boxes are generated per week and between 1and 365 patients are usually attended to in each of the Out-patient sections, the collective total number of patients seen in this section ranges from 303patients/day to 1,031patients/day, this is similar to that of OAGH where between 3 and 53sharp boxes are generated per week and between 0 and 397 patients attended to in each of the Out-patient sections and a collective total of patient ranges between 379 and 1,050patients/day. In OAGH In-patient sections, between 22sharp boxes/week and 54sharp boxes/week are produced., between 0 and 19 patients are usually found in each of the wards and a collective total ranging between 50 patients/day and 111patients/day. In GHL, sharps generated in the wards ranges between 27sharp boxes/week and 59sharp boxes/week. Between 0 and 30 patients are usually found in each of the wards and a collective total ranging between 154 patients/day and 231patients/day.

A lot of Xyrofoam packs were used for packaging pharmaceutical products and food items bought for workers and patients. These xyrofoam packs are normally made with Ozone depleting substances, which can be easily released during burning, a method of waste disposal generally practiced within Nigeria and in the dumpsites. The disposal of medical waste in municipal landfills without prior treatment to eliminate or reduce contaminations may pose serious health threat and environmental hazards if not stopped. Landfills were also observed to be open dumps without adequate design consideration to guaranty their protection of the environment from the disposal of such hazardous wastes. Leachates from beneath the landfill base could have the possibility of containing heavy metals and other organic pollutants that could lead to gross contamination of surface and groundwater resources.

Generally, waste management has not been organized into a structured format that is in line with national and international laid down guidelines, by both generators and collection agencies, however, significant is already being placed on the proper management of waste by the government of Lagos state. therefore a monitoring and evaluation system must be put in place to mandate all the stakeholders to comply with policy, when it is eventually launched.

Recommendations

Official waste audit should be undertaken and training of environmental and waste auditors for HCFs should be undertaken. Collaboration of waste auditors with financial auditors will expose financial misappropriation and fund diversion or any form of fraud. Imposition of documentations of consumables and appendage of signature or signatures will help to verify actual amount of consumed materials, which will then be correlated with declared amount on account records. Formulation of HCWM policy should be undertaken.

Any form of non-challant attitude should be checked by regular training and retraining of personnel and application of sanctions when all the relevant elements and instruments have been put in place. Adequate training curriculum must be developed for various categories of HC workers.

Seasonal data collation must be done for accurate quantification to be achieved and the highly heterogeneity of data must be considered while deciding the sessions for data collations. Peculiar nature of a particular settlement must be put into consideration for the collated data.

Funding of Environmental projects must take definite percentage of the monthly allocations in the hospital. Regular and periodic replacement of PPEs must be done using a time-table of how long the producer of such equipment stipulated for it to be used. Information dissemination should be intensified while better communication channels should also be established for prompt circulation of relevant information.

Construction of an E. T. P. within each HCF will reduce exposure of community settlers to contaminated wastewater poured directly into the public drain without any form of prior treatment. International standards relevant to the management of waste within and outside the African setting should be consulted to be able to adequately address HCWM issues.

Monitoring of transit point to prevent dumping of household wastes used by workers and visitors should be done to prevent increase waste load that will mean increase money for its disposal. The use of smaller nylons for collection of HCWs in sections where very small quantities are generated and then collection into larger special nylons for daily disposal will help to reduce wastage of larger nylons and also prevent handlers (who normally keep this type of wastes for long) from being infected.

Extensive research on the subject matter of hospital waste should be funded at various levels and done for adequate period to be able to have reliable data bank that will be useful for effective management of the wastes.

Combination of treatment technologies (like autoclaving, sterilizing, disinfecting and shredding) should be explored for proper HCW treatment, before final collection at the transit point by LAWMA officials for final disposal either in an incinerator or on a controlled landfill.

Use of environment friendly waste-to-wealth measures like waste-to-energy and recycling where possible should be explored to ameliorate the land use for keeping solid wastes.

Since most sections have similar activities at the HCFs, supply of HCWs disposal and handling materials can be easily determined and estimated appropriately. Arrangement for waste collection should also be based mainly on the total generated waste of HCFs so as to make sure that solid waste accumulation is prevented in all HCFs, by prompt and timely evacuation. Regular quantification of generated wastes should thus be made compulsory to relevant staff.

Since significant is already being placed on the proper management of waste by the government of Lagos state, therefore a monitoring and evaluation system must be put in place to mandate all the stakeholders to comply with policy, when it is eventually launched.

References

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