Disposal of hospital solid waste

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 Disposal of hospital solid waste

Prof. Altaf Hussain Rathore, FRCS.

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It was 1968 when I returned from UK after doing my FRCS. I visited a private surgical hospital of a big town of Pakistan. I noticed a dresser was changing the dressing of a patient lying on a charpoy (bed) in the open space of hospital compound. When he removed the main, fully soiled dressing of the patient, he threw it on the floor. Then a waiting stray dog quickly took it in his mouth and carried away, perhaps for his family.  This was the “dispenser’s way” of disposing hospital solid waste.

Prof. Altaf Hussain Rathore

I was employed in another private maternity hospital of a small town as a surgeon. At mid night there was a big disturbance in hospital compound as if the hospital staff was chasing some animal. It came out that a jackal has entered hospital premises and guards were trying to get him out. It was a great surprise for me because these wild animals like fox and jackals are shy and afraid of human population and how come they entered this hospital full of people. On investigation it was revealed that usually the sanitary workers or the relatives of the patients burry the placenta (pregnancy left over after delivery). Sometimes, out of carelessness some workers throw away the left over in the hospitals trash dumps and these wild animals enter the hospital to devour this feast. This was the condition of the private hospitals at that time and you could imagine the state of affair of the big government hospitals.

Actually there was no specific rule in Pakistan up to early 1980s for the disposal of the hospital solid waste. It used to be thrown openly in the hospital dust bins, was then taken away by the municipal corporation truck like ordinary trash. Before that it used to lie open for days to the animals, birds, insects and worms and used to be a big source of public nuisance and health hazard. Sometimes it was burnt in these dumps with lot of pollution in the atmosphere.

Then the Government of Pakistan thought of making some rules and regulations for the disposal of hospital waste which was imported from the West. Accordingly the hospital waste is divided into

  1. Infected; like soiled dressings, linen, disposables like tubes, catheters, syringes, drip sets, bottles and human solid and semi-solid excreta.
  2. Non- infected; like food material, wrapping and papers etc.

There is a third category which should be buried straightaway in the land, like human amputated and removed parts, placentas, laboratory dead animals and also the sharp objects like knife blades, pins, needles and broken glasses.

Non-infected is disposed of in the municipal normal waste dumps. The main fuss is about the infected waste, the principal lying under its disposal is to turn it into the non-infected one and then burry it in the landfills. For the above process it is either

A- Burnt.

B- Exposed to the ultrasound.

Mind it, from the very beginning, starting in the hospitals infected, non-infected and sharp waste should be received and stored in different containers with color coding. The sanitary workers handling them should put on special protective masks, caps, gowns, gloves and boots when handling the infected materials. The containers with the infected material should be airtight. The most popular method is burning because ultrasound is quiet expensive and is impracticable. For burning of the waste there are special machines called incinerators in which the petroleum gas is the fuel. Its basic principal is that the trash burns out with the least emission of the smoke and the poisonous gasses. The government is strictly pressurizing the hospitals, clinics, laboratories and dispensaries through the health care commission to practice this routine religiously. I don’t know how much they are successful in their efforts.

Now let us have a critical look at this subject,

  1. Burning of trash to nothing, then burying in earth is very expensive and is a wasteful practice. Can we afford it for long period?
  2. Tons of hospital solid waste is coming out every day. How long and from where will we get the land for the landfill?
  3. Burning, burying and transport to the proper place is a very cumbersome procedure. It needs lot of man power, incinerators, vehicles and excavators.
  4. In the western countries they are leaving this method because resources are going down every day so instead of burning and wasting, they have adopted recycling.

So why cannot we recycle our trash? The hospital waste contains;

    a-     Plastic and rubber.
    b-      Cotton and linen.
    c-      Cadmium from the battery cells.
    d-      Glass.
    e-      Other metals.
    f-       Human excreta.

Instead of burning why can’t we boil them in high pressure boilers? It will kill any living being including bacteria, viruses, protozoa, plants and animals. Once the infected material is sterilized then we can separate the individual contents like cotton, linen, plastic, rubber, metals and glass, process them and make use in industry or daily usable articles. Whatever is left behind can be used as a biological fertilizer.

In nut shell Pakistan is a poor country and cannot afford luxuries of wastage i.e. burning and destruction. We have to rethink of new methods of disposing of our solid hospital waste, which is cheaper as well as productive. Because it is not trash, it is gold, if we work little harder.

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