ABSTRACT
Effective management of solid medical waste (SMW) is an
important issue confronting many developing countries including Ghana. Ghana
has many health facilities of which the University Hospital, KNUST, Kumasi
(UH-KNUST) forms part. This research took place between November 2015 and
February 2016 at the UH-KNUST, a Level C District Hospital, with an average
daily out-patient attendance of 325 patients. Data for the study were gathered
from both primary and secondary sources. Primary data was collected through
segregation, quantification and weighing of solid medical waste (SMW)
generated. Questionnaires were also employed in obtaining primary data. The
Hospital generates non-hazardous (general) and hazardous (infectious,
pharmaceutical, pathological, heavy metal and sharp) wastes which are currently
co-disposed into skip containers on-site. UH-KNUST treats only their sharp
waste using incineration, without air pollution control device. Quantities of
waste generated were measured twice daily using plastic bags, cardboard boxes
and buckets of known weights and a weighing scale. A total of 5422.0 kg and
4262.2 kg of non-hazardous and hazardous wastes respectively were generated
within the 16-week study period. Quantities of specific SMW generated in all
wards/units were statistically different. The existing management practices,
which serves as basis for providing sustainable management measures to issues
of waste handling and disposal at the Hospital were identified. This was done
by personal observations and administering of questionnaires to waste handlers
and healthcare staff. Limitations identified include: inadequate
education/sensitization of healthcare personnel and waste handlers, lack of
hospital waste management department and policy, non-adherence to segregation
of waste, and no documentation of waste generated and waste handling
procedures. Sustainable management measures such as effective and regular
sensitization of all healthcare workers and patients on the
importance of segregation and the risks involved in poor handling of SMW among
others were recommended to reduce the negative impacts of improper management
of SMW on human health and environmental resources. A waste management plan was
developed for the UH-KNUST to serve as a guideline in managing its SMW. Putting
these measures in place will address the various health and environmental
issues identified at the UH-KNUST.
CHAPTER ONE
INTRODUCTION
1.1 Background
Rapid industrialisation, coupled with population growth, high
standard of living and economic development has hastened the rate of solid
waste generation worldwide (Minghua et al., 2009). Management of solid waste is
one of the most difficult issues that the world faces. Huge quantities of solid
wastes are generated each day by human activities (Mohee and Bundhoo, 2015).
Management of these solid wastes especially its disposal is a very essential
problem confronting most developing countries (Van Beukering et al., 1999)
including Ghana. As discussed by Hosetti (2006) solid wastes can be grouped as:
agricultural waste from fields and farms; institutional waste from offices,
schools and colleges; municipal waste; commercial waste from markets, hotels
and medical facilities and residential waste from households. It also includes
waste from sources such as construction and demolition, industrial and
treatment plant sites (Tchobanoglous et al., 1993).
Osei-Mensah et al. (2014) alludes to solid waste management (SWM)
as the source separation, proper collection, sorting, transportation, storage,
treatment, recycling and disposal of solid waste. The management must be done
in an environmentally sustainable manner by considering most appropriate
practices of nature conservation, public health delivery, aesthetics
beautification, and engineering (Puopiel, 2010; Nyankson, 2013). Recently, poor
management of solid waste, mainly domestic, industrial and commercial wastes
(Puopiel, 2010) has raised lots of concerns regarding their significant health
and environmental related issues (Da Silva et al., 2005; Mensah, 2012). In
Ghana, less consideration has been given to various solid wastes including solid medical waste (SMW).
As observed by Mensah (2012), the consequences of poor management of SMW is
environmentally damaging and threatens human life. Some of the waste-related
diseases include dysentery, typhoid and malaria (Akter, 2000; Puopiel, 2010).
Environmentally, water, air and soil are polluted if SMW is not properly
managed (Hosetti, 2006). The aesthetic value of the immediate environment is
also decreased.
Due to their potentially hazardous or unusual features,
special waste like SMW (Uriarte, 2008) which comprises of hazardous and
infectious materials, sharp objects and other forms of waste generated from
hospitals, clinics, laboratories, pharmacies, maternity homes and
dental/veterinary clinics need to be treated and disposed separately and should
not be mixed with municipal solid waste (Blackman, 2001). A more thorough but
economical approach is required to effectively manage the challenges posed by
SMW, by managing the different portions of the SMW stream based on their
physical, chemical and biological characteristics. Hence, the need for
effective segregation of the waste stream.
1.2 Problem
Statement
The UH-KNUST forms part of the major hospitals in the Kumasi
Metropolis. In the last few years, the UH-KNUST has developed both in
infrastructure and administration receiving patients from the University
community and over 30 nearby communities. There is a growing perception that,
standard practices by the WHO, EPA Ghana and the MLGRD are not observed. This
suggests that the existing SMW management practices present occupational hazard
to waste management workers and healthcare staff, health risk to patients,
hospital staff and the surrounding communities and a potential source of pollution to
environmental resources such as air, soil and water. For instance, there have
been cases of needle-stick injuries, a situation that can lead to the
transmission of infectious diseases. Unfortunately, information on the quantities,
characteristics and handling of SMW generated during the provision of
healthcare services at the UH-KNUST have not been reported. The situation calls
for investigation into the SMW management practices at the UH-KNUST. Hence, the
research seeks to examine the practices in place for the management of SMW at
the UH-KNUST and provide sustainable measures for lapses if any by answering
the following questions:
What are the quantities and composition of SMW generated in
the wards/units of the Hospital?
What are the existing management practices for SMW?
Are there any limitations in the current management
practices?
1.3 Justification
Taking into consideration the risks, both on human health
(patients, hospital staff and nearby communities) and the environment, the
rapid increase in the generation of SMW is alarming (Airlina, 2015). Ghana’s
EPA and the MLGRD acknowledge the urgent need for proper waste management
wherever it is economically viable as well as provides a positive influence on
the environment (Osei-Mensah et al., 2014). Knowledge in the existing
management practices at the UH-KNUST, as aimed by the study, will help
ascertain the degree of adherence to standard practices and the necessary steps
taken to address any shortfalls associated with the effective management of
SMW. This will serve as a baseline data for effective decision-making and
provision of sustainable strategies for the management of SMW.
The aim of the study is to examine the SMW management
practices at the UH-KNUST and the related health, occupational and
environmental risks.
Specific objectives are to:
* determine the quantity and composition of SMW generated in
the UH-KNUST within the period of study;
* identify existing management measures in place for SMW and
* propose sustainable management strategies in solving issues
related to the management of SMW.
1.5 Scope of Study
The study was carried out at the UH-KNUST in the Ashanti
Region of Ghana. Samples of SMW from all the wards and units of the Hospital
were collected for analysis within the study period. These included all the
Theatre, Dental and Eye clinics, the General OPD with the emergency and
casualty unit, Administration, Pharmacy, Laboratory, X-Ray and Scan unit, the
Public Health Unit (PHU) and all five wards namely Children’s, Maternity,
Otumfuo Osei Tutu Medical Centre (VIP ward), Male and Female wards. The study
covered the sources of SMW generation, its composition, management practices
through to the final disposal on-site (at the hospital premises). Waste such as
human excreta was exempted from the study. The activities of the waste
management firms from when the waste is collected on-site to its final disposal
site (off-site) was also excluded from this study.
The study was organized in five (5) chapters. The first
chapter gives a general introduction about the research work. It provides an
overview of the problem of SMW management at the UH-KNUST and gives reasons for
the study. In chapter two, relevant literature regarding SMW management is
reviewed, thus, the sources, categories and processes of SMW management.
Chapter three focuses on the materials and methods employed in the collection
and interpretation of data for the research work including personal
observations, questionnaire administration and weighing of SMW. The chapter
gives a very brief description of the study area. In chapter four, the findings
are presented using tables, pictures and figures. Analysis of the work is also
given in chapter four. Chapter five concludes the study with a summary of the
entire research findings and recommendations.
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