Assessment of Medical Waste Management in Teaching Hospitals in Mosul City : A Descriptive Study

Background and aim: Medical waste management is of great importance due to its infectious and hazardous nature that can cause undesirable effects on humans and the environment. The objective of this study was to identify segregation, storage, transportation, treatment and disposal practices in teaching hospitals in Mosul City. Material and method: A descriptive study is designed to assess medical waste management in Mosul Teaching Hospitals started from December 2012 to March 2013. The target population (health personnel) of study is approximately (448) participants served in mentioned hospitals were asked to answer study questionnaire. Statistical processing was conducted by the use of SPSS version 17 and Minitab. Chi-square test was used as the test of significance to determine the presence of association between variables; P < 0.05 was considered significant. Results: The results indicated that 79.2% of the respondents indicated that each type of waste clearly identified by a coloured code or symbol. The results also showed that 75.1% of the respondents stated that the waste is stored collected regularly. The most significant result with respect to whether the means of conveyance and transport are cleaned regularly was 40% of the respondents stated that they have no idea about that. The results also showed that 53.8% of the respondents stated that there is no other options rather than incineration have been examined for final disposal of medical waste. Conclusion: The study concludes that the segregation of medical waste is done regularly and effectively, i.e. each type of medical waste is identified by a coloured code, and there are containers and bags everywhere waste is generated. Concerning to medical waste transport the means of conveyance and transport are available but there is lack of maintenance of these means or replacing them with new ones.


INTRODUCTION
In developed countries, legislation and good practice guidelines define medical wastes and state the various possible ways for collection, transport, storage and disposal of such wastes.In addition, the best available technologies are used for the development of alternatives for proper disposal of medical wastes with minimal risks to human health and the environment (Tudor et al., 2005).Generally there is no single disposal practice as a solution of the problems of managing hospital waste, so in most cases, a number of practices include landfills, incineration, autoclaving, and recycling are used in combination.Each practice has its own weaknesses and strengths (Nemathaga et al., 2008).Health-care waste consists primarily of pathological, infectious, chemical, pharmaceutical, and domestic wastes as well as sharps that have been contaminated with blood, infectious agents, tissues, organs, etc (Alagoz and Kocasoy, 2008).The hospital waste, in addition to the risk for patients and personnel who handle these wastes possess a threat to public health and environment.Handling, segregation, mutilation, disinfection, storage, transportation and final disposal are vital steps for safe and scientific management of medical waste in any establishment.The key of minimization and effective management of medical waste is segregation (separation) and identification of the waste.The most appropriate way of identifying the categories of medical waste is by sorting the waste into color coded plastic bags or containers (Rao et al., 2004).
The waste generated from hospitals is now recognized as a significant problem that may have bad and dangerous effects either on the environment or on human beings through direct or indirect contact.Some of the health impacts are results from exposure to hazardous hospital wastes include mutagenic, tetragenogenic and carcinogenic effects, respiratory damage, central nervous system effects, reproductive system damage and others (Felicia et al., 2008).The roles of nursing staff in the process of MWM are the identification and segregation of waste according to classification at the point of generation, supervision and monitoring of the activities of ward reception and cleaner in relation to waste management, and conduction of health education session for the patient and attendant on medical waste management (Musa and Rahman, 2012).Health care waste management (HCWM) is a process aims to help ensuring proper hospital and health-care facilities, hygiene and safety of health care workers and communities in dealing with medical waste.It includes planning and procurement, construction, staff training and behavior, proper use of equipment, proper treatment and disposal methods of medical waste inside and outside the healthcare establishment and evaluation for the process of health care waste management.The present study aimed at to identify segregation, storage, transportation, treatment and disposal practices in teaching hospitals in Mosul City.X 2 = 310.110;d.f.= 6; P-Value = 0.00

DISCUSSION
Table 1 relates to separate of waste indicates that 79.2% of the respondents indicated that each type of waste clearly identified by a coloured code or symbol; 9.0 % answered that each type of waste is not clearly identified by a coloured code or symbol; While 9.8% stated that they have no idea about this process.This confirms an important fact that is in sometimes each type of waste is not clearly identified by a coloured code or symbol.
With respect to is sorting carried out effectively from waste production to storage 29.8% of the respondents indicated that they have no idea about how the process is done; 51.4% stated that sorting carried out effectively from waste production to storage; while 16.8 % indicated that the process of segregation is not done effectively.This indicates informing the whole medical staff about the medical waste management plan applied in the hospitals.
Bendjoudi and colleagues stated that the mass fraction of health care waste HCW considered hazardous (pathological, infectious, chemical, pharmaceutical) is 10-25%, representing a potential threat to health care workers, patients, the environment, and even the general population, if not treated and/or disposed of appropriately; 75-90% by mass of HCW is classified as household waste (cleaning tissues, plastics, papers) that possess no additional risk to health or the environment (Bendjoudi et al., 2009).
In the West Bank, the survey results showed that there is no segregation of waste except for sharps.Two thirds of HCFs have acceptable sharp boxes (sometimes plastic bottles).Less than fifty percent segregate other types of waste like waste generated in operating theatres and labs which includes infectious and pathological waste.Only 7.6% of the facilities use color coding (they use red or yellow bags for infectious waste).One third of HCFs lacks proper onsite storage containers.It is very common that all healthcare waste is mixed with the general waste in open baskets that are lined with very thin plastic bags.The bags are not strong enough and in many cases can be easily punctured allowing leakage and spillage to occur.Labeling Mosul Journal of Nursing, Vol.1, No.2, 2013 of containers is not used and there is no way to distinguish between waste coming from the kitchens or that from the laboratories (Environmental Quality Authority, 2005).
Table 2 relates to medical waste collection and storage indicates that 75.1% of the respondents stated that the waste is collected regularly; 8.1 % answered that the waste is not collected regularly; While 14.9% stated that they have no idea about the regularity of this process.This confirms an important fact, that the waste is collected regularly in the hospitals concerned with the study.
With respect to whether the storage time for collected bags is according to the time identified in the medical waste plan, the most significant result was that 26.7% of the respondents indicated that they have no idea about the storage time; 60.8.9% stated positively about that; while 10.5 % sated that the storage time of collected bags is according to the time identified in the medical waste plan This indicates that some of hospitals staff have no idea abut medical waste management plan items.
With respect to whether the storage section of medical waste outside the hospital is protected from others but staff, 24.5% of the respondents indicated that there is no protection for the storage section of medical waste outside the hospital ; 54.9% stated positively about that; while 18.6 % indicated that they do not know anything about that.This indicates the need of more protection on the storages of medical waste outside the hospitals.
According to the World Health Organization regulations, the storage of waste within the hospital should not exceed 72 hours in winter, 48 hours and summer (in cold areas).However, in the hot areas, storage should not exceed 48 hours in winter and 24 summer hours (WHO, 2005).
Table 3 relates to medical waste transport indicates that 74.4% of the respondents stated that there are means of conveyance and transport reserved for medical waste; 9.8 % denied that; While 13.8% stated that they have no idea about that.
With respect to whether the means of transport meet the requirements (easy to load and unload, no sharp corners, easy to clean) 49.9% of the respondents stated positively about that; 22.3 % denied that ; While 25.8% stated that they have no idea about that.This indicated that the means of transport need to be changed every some years.
With respect to whether the means of conveyance and transport cleaned regularly 39.2% of the respondents stated positively about that; 18.8 % denied that; While the most significant result was that 40% stated that they have no idea about that.This indicated that many of responsible staff neglects monitoring the process of cleaning the means of transport.
The transfer of health-care waste sites must be within the hospital by wheeled vehicles or by other vehicles or containers fitted with hand wheels that are not used for any other purpose.The transfer mean must meet the following standards: 1. Easy loading and unloading.2. The absence of sharp edges that can cause severe damage to the waste bags or containers during loading and unloading.3. Easy cleaning and must be clean and sterilized every day using the appropriate purgatory.All bags must be closed tightly and must be sound at the end of transport operations (Environmental Quality Authority, 2005).Table 4 relates to medical waste treatment and final disposal indicates that 57.1% of the respondents stated that the treatment methods have been assessed in terms of environmental protection and health protection; 18.2 % denied that; While 22.8% stated that they have no idea about that.
With respect to whether other options rather than incineration have been examined, 19.9% of the respondents stated positively about that; 25.8% stated that they have no idea about that; While the most segnificat result was that 53.8% the respondents stated that there is no other options rather than incineration have been examined.This indicated that other means of treatment and final disposal are not widely used.
With respect to whether particular attention is paid to the treatment of sharps and highly infectious wastes (lab cultures, wastes from care of infectious patients), 65.6% of the respondents stated positively about that ; 13.1 % denied that ; While 22.8% stated that they have no idea about that..This indicated that the responsible staff is aware of the danger of highly infectious wastes.
Lee and others conducted a study in 2004 showed that 49-60% of medical waste is treated by various incinerations, 20-37% by autoclave sterilization, and 4-5% by other methods.Incineration and steam autoclave sterilization are the main methods currently being used and are considered mature technologies (Lee et al., 2004).
Mosul Journal of Nursing, Vol.1, No.2, 2013 A descriptive study designed to assess medical waste management in Mosul Teaching Hospitals started from December 2012 to March 2013.The study was conducted in five teaching hospitals (Al Jumhory , Ibn Sina, AL Salam, Ibn AL-Atheer and AL-Khansaa) located in Mosul city.A structured questionnaire consists from three parts was used to collect data.Part one was contained on demographic data sheet of the study sample in hospital.The second part is divided into two main sections which is the concepts of medical waste and the policy of medical waste management.While the third study was approximately (448) participants served in mentioned hospitals were asked to answer study questionnaire.They were chosen purposively from the hospitals concerned with the study.They were related to medical waste management.A total of (40) administers, (96) physicians, (167) nurses, (102) laboratory staff, and (43) service workers were participated.Data were prepared, organized and entered into a computer file; Different statistical methods were used to analyze the data in this study.Statistical processing was conducted by the use of SPSS version 17 and Minitab.Chi-square test was used as the test of significance to determine the presence of association between variables; P<0.05 was considered significant.RESULTS Table (1): Health personnel knowledge about medical waste segregation (No. 448)