ENVIRONMENTAL AUDIT OF SMALL HOSPITALS: A CASE STUDY AT THE ANINWAAH MEDICAL CENTRE, EMENA-KUMASI

ABSTRACT
The management of medical waste is of importance due to its infectious and hazardous nature that can cause risks on the environment and public health. The study was conducted to evaluate the medical waste management practices, to determine the amount of waste generated and to prepare an Environmental Action Plan (EAP) for the Aninwaah Medical Center, Emena, Kumasi. The survey was conducted at the Aninwaah Medical Center since its waste management practices were not so clear to some staff. To examine the medical waste management practices, the study employed a range of methods including questionnaires survey which targeted 100 randomly selected health care workers and ancillary staff, formal interviews with facility managers, field observations and literature reviews. Compliance with EPA-Ghana guidelines and other recommended used as standards to assess the hospital waste management practices. The waste management practices were analysed for a week to capture the daily management practices. It was observed that medical waste generation rate at the Aninwaah Medical Centre ranged from 0.126-0.157kg/patient/day. About 95% of the waste generated was general/non-infectious waste and sharps. The audit also revealed that segregation procedures the wastes generated were not constantly followed. The hospital workers are not given the proper training and insufficient protection. It was revealed that there are no laws in Ghana on how medical wastes are managed. In view of that, hospitals are not obliged to strictly follow any laws or procedure in the management of medical waste.


CHAPTER ONE
INTRODUCTION
1.1 Background Information
Hospitals play a pivotal role in protecting people's health and are a necessary part of our society. As such they must be examples of economic, environmental and social responsibility (Serb C, 2008). The amount of medical waste is increasing constantly throughout the world, raising the issue of its safe and economic disposal as a grave concern (DenBos and Izadpanah, 2002). This is because waste from Healthcare Facilities (HCFs), arising principally from hospitals and clinics, is potentially dangerous since it can spread diseases because of the infectious nature of the wastes, and/or cause injury through the mismanagement of clinical solid/liquid waste (Abd El-Salam, 2010; Al-Khatib and Sato, 2009).

Until recently, medical waste management was not generally considered an issue. In the 1980s and 1990s, concerns about exposure to Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) led to questions about potential risks inherent in medical waste. In 1983, a premier meeting organised by the World Health Organization (WHO) was held at Bergen, Norway to discuss medical waste management issues (Lee et al, 1996).

Medical waste is generally described as any solid/liquid waste that is generated in the course of diagnosis, treatment, or immunization of human beings, or animals, in research pertaining to, or in the production or testing of biological materials (EPA, 2005; OSHA, 1991). Though not all medical wastes are hazardous some waste from healthcare or medical facilities are high risk, hazardous and can affect human health as well as pollute the environment. In a working environment where poor health care waste management practices are the norm, exposure to infectious wastes due to blood borne pathogens could predispose healthcare workers, patients, and clients to infections (Johannessen et. al. 2000; Sawalem et. al., 2009; Pruss et. al., 1999; Akter, 2000).

Although great strides have been made in the field of healthcare system over the years, the health of the public, patients and professionals alike are affected by poor waste management practices (Shinee et. al, 2008).

Hospitals undertaking an environmental audit are conducting a type of internal investigation to assess the hospital's compliance with the broad scope of environmental regulations which govern health care entities. An environmental audit provides hospital management with a concentrated opportunity to evaluate whether the facility has a system in place to achieve and maintain compliance while detecting and correcting non-compliance (Riesel, 1986).

The audit forces hospital management to regard the hospital's various units as a whole, which is necessary in several regulatory contexts. For example, whether a hospital is required to hold certain air permits may depend on the level of emissions from facilities such as boilers, generators or backup generators used in the event of power outage.

1.2       Statement of the Problem
A hospital management team's confidence is enhanced when the hospital's balance sheet fairly states the financial position of the hospital after the financial statement has been audited by an independent certified public accountant. The hospital management team should have similar confidence that the hospital is operating in compliance with Environmental Protection Agency (USEPA) and state environmental regulations if the hospital has undergone a periodic review of the hospital's environmental operations. While independent financial audits are part of a hospital's business cycle, environmental audits are not a regular practice.

Hospital preparedness for the USEPA inspection or inquiry is enhanced where the hospital has in place an audit protocol, a practice of conducting environmental audits. These audits, like financial internal control audits, detect systemic weaknesses in the hospital's procedures which presently may have led to no problems but are at risk to lead to a troubled future. Environmental audits provide the hospital (which shores up internal control weaknesses to guard against fraud) the opportunity to improve procedures, conduct employee training or acquire updated equipment to lessen the risk of an environmental violation.

The Aninwaah Medical Center and some hospitals in Ghana are not exceptions of this problem hence it is prudent for the medical waste problems and situations to be looked at and to find possible remedial measures to them.

1.3       Objectives of the Study
The objectives of the study are to:

* identify the types and quantities of waste generated at the hospital;

* assess the current medical waste management system;

* prescribe suitable treatment options for waste identified;

* integrate the Protocols recommended for managing hospital waste by the EPA, EU, and WHO into their management system; and 

* prepare a detailed Environmental Action Plan (EAP) for the hospital.

1.4       Research Questions
What are the types and quantities of waste generated at the hospital?

What is the current medical waste management system operated by the hospital?

Is the hospital operating a suitable treatment options for its wastes?

Has the hospital integrated the protocols recommended for managing hospital waste by the EPA, EU, and WHO into their management system? and

Does the hospital have a comprehensive Environmental Action Plan (EAP)?

1.5       Significance of the Study
This study will be a significant endeavour in promoting good work environment in the hospital and motivation of its employees. This study will also be beneficial to management and corporate bodies when they employ effective hospital waste management in their workplace. By understanding the needs of the workers and benefits of quality healthcare delivery, the management and public can be assured of an advantage. Moreover, this research will provide recommendations on how to evaluate the performance of any health institution in accordance to protocols for environment.

Moreover, this study will be helpful to the health practitioners in training and informing them in the area of waste management, objectives, and strategies. It will also serve as a future reference for researchers on the subject. And importantly, this research will educate the public in deciding on whether the healthcare facility is really fulfilling its responsibility to the community or it is just showing off to promote its business, hence the need for this environmental audit.

1.6       Scope of the Study 
This study will be limited to a general medical hospital type which has a capacity of less than 100 beds. A general environmental evaluation/audit will be conducted. All options of design recommendations and modifications will be limited to environmental and economic evaluation components merely with objective of pollution reduction along with environmental improvement. The study will be conducted at the Aninwaah Medical Center, Emena, Kumasi near KNUST. The study will be concentrated on the waste generated at the facility (pathological waste, sharps, needles etc).

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Item Type: Ghanaian Project Material  |  Attribute: 94 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH50  |  Delivery: Within 30Mins.
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