An Exploration In Search of Policy, Guidelines and Rules

By Tabassum Dana

A well recognised but baffling model of our modern development activities is that we are reaching for prosperity at the cost of potential perils. Environmental degradation seems to have become an inevitable part of our ‘development activities’. Quite often we are attempting to develop ourselves at the cost of damaging if not annihilating our environment; as if there is no tomorrow and no next generation that will also need resources to survive. More alarmingly, some of our activities are so blatantly dangerous that we can easily be compared to the proverbial ostrich who buries its peak in sallow sand with closed eyes, pretending that there is no danger lurking around the corner. Some of these activities need no knowledge of an expert, sagacity of a saint or theory of a wise to be able to fathom the dangers inherent in such actions or their perilous consequences.

We focused on the hospital waste that could be easily identifiable both in terms of the actors involved and the parameters of damage, and for which a few implementable measures can have a substantial redressing impact. The hospital waste disposal is the last thing that cross our mind. We only term the hospital for treatment purposes not even how these hospitals are creating potential danger to society. Regarding the hospitals we think how to facilitate and upgrade hospitals with equipment’s not even thinking how the waste are being disposed. The hospital waste is one percent of solid waste, which contaminate the total solid waste that could be recycled for different purpose. It is well known fact that many patient, particularly those undergoing operations in our hospitals, subsequently ‘develop’ infections, often leading to fatalities. The rate, of prevalence, types and other indicators of such disease through endogenous and exogenous infections are not documented by any hospital, as far as we could gather. Nevertheless it may be appropriate to assume that many of our diseases may well be linked to the disposal ‘system’ of hospital waste.

The picture of waste handling is very scary and dangerous and waste management condition of the city hospitals is rather simple. There are several departments such as surgical department, pathological department, gynaecological department and wards emergency etc from where the waste is being generated. The waste of each department is collected in a bucket and then disposed in the DCC dustbins or in the river near by. It has been found that in all three hospitals waste is being collected in the same procedure and disposed in the same manner. Our findings from the hospital visits do not seem to have any arrangement, policy and regulations on the following aspects of waste disposal and management procedures.

there is no incinerator or any alternative method for safe disposal of waste
there is no written waste management guideline or procedure
there is no rule or regulation on waste management
there is no method for quantifying the amount of waste generated
there is no system for separating or segregating the waste before disposal
there is no designated or special site for waste disposal
there is no method or mechanism for handling unexpected hazardous waste situation
there does not seem to be any specific awareness among cleaners, as well as doctors, nurses and visitors to the hospitals
there is no protection or protective mechanism for cleaners or others handling waste which are often infectious and potentially dangerous
there is no specific training program for the nurses and cleaners regarding waste handling, disposal or management

Moreover, some hospitals are not maintaining any sharp box and even selling some of the waste such as used saline bags. The above sorry state of affairs stems from the fact that there is:

No National Plan for Sound Hospital Waste Disposal and Management
No Authority, national or local, for looking into Hospital Waste Disposal and Management
No National Law for Hospital Waste Disposal or Management.

Hence, immediate attention to hospital waste disposal system need to include the above matters and issues. Some suggestion could be made form our point of view regarding hospital waste management:

At National Level

The concerned Ministry (health and family planning), along with the Department of Environment should formulate

A National Waste Management Policy;
A National Waste Disposal and Management Guideline;
An omnibus law for dealing and disposing of waste

At Hospitals
Total Waste Management Plan:

Hospitals should make effort, first, to quantify and qualify the types of waste generated by them. At initial stage these should be separated and a plan of action initiated for the disposal of different types of waste differently, depending on their potential and actual hazard.

Simple and introductory steps

hospitals should provide for different coloured bins/baskets for separation and disposal of different types of waste at the source.
different coloured plastic or other appropriate bags should be maintained for collecting the separated waste:

yellow bags for infectious
red for highly infectious
brown for chemical and pharmaceutical wastes
black for non-infectious, and
‘sharp box’
infectious, pathological, and sharp waste should also be marked with international biohazard symbol
waste containing bags must be effectively sealed.

Awareness

an emergency planning should be put into place for unexpected hazardous waste or accidental spillage of waste and the staff informed about the plan and specific responsibility in the event of such an emergency outlined
hospitals must undertake awareness programme concerning disease, other hazards and dangers from hospital waste among cleaners, nurses, and attendants of patients
separate awareness programme on special problems related to sharp box disposal should also be carried out

Alternative Strategy

An alternative strategy could incorporate the following steps towards an effective, safe and comprehensive hospital / clinical waste disposal system.

Conduct A National Survey

Design and Test survey
Conduct the Survey
Infer policy and steps from the findings of the survey
Disseminate the result and recommendations

Formulate a National Policy

Formulate a National Policy, with help from the survey findings
Disseminate the Policy
Designate Implementing Authority

Develop Common Waste Disposal Actions

Regional Treatment Facility
Co-operative Treatment Facility
Alternative Treatment Facility

Legislate Rules and Acts

Consider International Principles
Include Technical Standards
Use Hospital Input
Interim legislative action for rules under various Acts
Draft a National Law on Hazardous and Toxic Material

Institute National Training and Awareness Programme

Develop Train-the-trainer Program
Modify Health Curricula
Obtain Professional Assistance
Conduct Awareness Activities for Hospital Personnel

Review

Develop a Review System
Implement the Review System
Disseminate information rove Program

These are our own guidelines in selecting areas of attention on the issue of disposal of hospital waste.