|Year : 2020 | Volume
| Issue : 1 | Page : 39-43
Evaluation of hospital waste management among tertiary-care hospitals, Menoufia Governorate, Egypt
Shaimaa Y. Abd El Raouf1, Omiyma A El Fateh Mahrous1, Yasser H Ibrahim2, Hala M Gabr1, Aziza S El Badry1, Faten E Younis1
1 Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Air Pollution, National Research Center, Cairo, Egypt
|Date of Submission||27-Aug-2019|
|Date of Decision||13-Oct-2019|
|Date of Acceptance||21-Oct-2019|
|Date of Web Publication||25-Mar-2020|
Shaimaa Y. Abd El Raouf
Shebien El.Kom, Menoufia
Source of Support: None, Conflict of Interest: None
To assess the current status of hospital waste management (HWM) and assess environmental lead and cadmium levels at tertiary-care hospitals in Menoufia Governorate.
HWM has become a critical issue as it poses risks to health and the environment.
Materials and methods
This is a cross-sectional study that included tertiary-care hospitals in Menoufia Governorate (Menoufia University, National Liver Institute, and Shebin El-Kom Teaching Hospitals) to evaluate HWM through an observational checklist. Air samples had been taken from the studied hospitals for environmental measurements of lead and cadmium levels.
The administrative tools for HWM were sufficient in the studied hospitals. Waste sorting items were somewhat sufficient, but characteristics of bags and practices during collection and transport of health-care waste were sufficient in the studied hospitals. Waste storage items and special records for hospital waste were somewhat sufficient. Lead and cadmium environmental measurements were within the recommended exposure limit reported by NIOSH.
HWM was still in its early stage in Menoufia Governorate Hospitals. So, more supervision and implementation of strict rules for HWM were recommended.
Keywords: heavy metals, management, medical waste
|How to cite this article:|
El Raouf SY, El Fateh Mahrous OA, Ibrahim YH, Gabr HM, El Badry AS, Younis FE. Evaluation of hospital waste management among tertiary-care hospitals, Menoufia Governorate, Egypt. Menoufia Med J 2020;33:39-43
|How to cite this URL:|
El Raouf SY, El Fateh Mahrous OA, Ibrahim YH, Gabr HM, El Badry AS, Younis FE. Evaluation of hospital waste management among tertiary-care hospitals, Menoufia Governorate, Egypt. Menoufia Med J [serial online] 2020 [cited 2020 Mar 30];33:39-43. Available from: http://www.mmj.eg.net/text.asp?2020/33/1/39/281290
| Introduction|| |
Medical waste is 'all wastes produced in health care or diagnostic activities',. WHO states that of the total amount of waste generated by health-care activities, ∼85% are generally nonhazardous waste. The remaining 15% are considered hazardous material that may be infectious, toxic, or radioactive. High-income countries generate on average up to 0.5 kg of hazardous waste per bed per day, while low-income countries generate on average 0.2 kg. However, health-care waste is often not separated into hazardous or nonhazardous wastes in low-income countries making the real quantity of hazardous waste much higher. It is a well-established fact that there are many adverse and harmful effects to the environment including human beings, which are caused by the 'hospital waste' generated during the patient care. Hospital waste is a potential health hazard to the health-care workers, community, and the flora and fauna of the area.
This study aimed to assess the current status of hospital waste management (HWM) and to study environmental lead and cadmium measurements among tertiary-care hospitals in Menoufia Governorate.
| Materials and Methods|| |
A cross-sectional study was carried out in Menoufia Governorate in the northern part of the country in the Nile Delta, to the south of Gharbia Governorate and to the north of Cairo.
This study was conducted from the beginning of October, 2017 to the end of July, 2019. The study was approved by the local ethics committee in Menoufia Faculty of Medicine. All tertiary-care hospitals in Menoufia Governorate were chosen to evaluate the medical waste management (Menoufia University (1292 beds), National Liver Institute (450 beds), and Shebin El-Kom Teaching (512 beds) Hospitals). An official permission letter was obtained and directed to the administrators in these hospitals.
An observational checklist (consisting of 39 questions which include six items that represent the medical waste management steps: questions for availability of the administrative tools for health-care waste management, availability of the waste sorting items, characteristics of bags and plastic containers for waste, practices during collection and transport of health-care waste, availability of waste storage items and records, and finally availability of special records for medical waste) was used.
The questions were answered with 'yes,' 'to some extent,' or 'no.' 'Yes' means total fulfillment of the observation; 'to some extent' means partial fulfillment of the observation; and 'no' means nonfulfillment of the observation. The checklist items were given scores. Each positive answer was given a score of 2. A score of 1 was for the answer of 'to some extent,' while each negative answer was given a score of 0. The total score was measured for each item of HWM step in the used tool and the total score ranged from 0 to 78. The hospital that achieved more than or equal to 75% of the total score was considered to have level 1 (sufficient); those that achieved a range of 50–74% was considered to have level 2 (somewhat sufficient), and those that achieved less than 50% were considered to have level 3 (insufficient).
This checklist was completed during five different visits to each one of the studied hospitals in the different working shifts by the aid of health-care workers.
Air samples had been collected from the area surrounding the shredding system in the studied hospitals by a portable air sampler. Four readings were reported from each hospital where the mean values were recorded. Also, other four readings were collected from different control sites (away from the studied hospitals). Membrane filter paper (20 μm in diameter) was used for the collection of respirable dust and its lead and cadmium content. The air was aspirated by a vacuum pump at a rate of 2 l/min, and the reading of the gas meter was recorded before and after the sampling period. The volume of air was calculated from gas meter readings.
Lead and cadmium levels were determined by an atomic absorption spectrophotometer (SOLAAR-UNICAM 989) at the National Research Center, Cairo, Egypt. The samples were first dissolved before aspirating to atomic absorption using a mixture of acids (NHO3, H2 SO4, and HCL).
Data were analyzed by an IBM compatible personal computer with SPSS statistical package, version 20 (SPSS Inc. Released 2011; IBM SPSS statistics for Windows, version 20.0; IBM Corp., Armonk, New York, USA). Qualitative data of each item were expressed in number and percent (%). Quantitative data were expressed as mean, SD, and median. Mann–Whitney U test: a nonparametric test of significance used for comparison between two abnormally distributed quantitative variables. Kruskal–Wallis test: a nonparametric test of significance used for comparison between more than two groups with abnormally distributed quantitative variables.
P value of less than 0.05 was considered statistically significant.
| Results|| |
The first item for HWM was the availability of the administrative tools for medical waste management. It was sufficient in the studied hospitals: Menoufia University, National Liver Institute, and Shebin El-Kom Teaching Hospitals (75, 75, and 87.5%, respectively).
The waste sorting items were somewhat sufficient in the studied hospitals: Menoufia University, National Liver Institute, and Shebin El-Kom Teaching Hospitals (50, 50, and 66.6%, respectively).
Characteristics of bags and plastic containers were sufficient in the studied hospitals: Menoufia University, National Liver Institute, and Shebin El-Kom Teaching Hospitals (75, 78.6, and 78.6%, respectively).
Practices during collection and transports of health-care waste were sufficient in the studied hospitals: Menoufia University, National Liver Institute, and Shebin El-Kom Teaching Hospitals (80, 75, and 85%, respectively).
Waste storage items were somewhat sufficient in the studied hospitals: Menoufia University, National Liver Institute, and Shebin El-Kom Teaching Hospitals (59.1, 63.6, and 72.7%, respectively).
Special records for medical waste were somewhat sufficient (66.67%) in Menoufia University, National Liver Institute, and Shebin El-Kom Teaching Hospitals [Table 1].
|Table 1: Total score for medical waste management in the studied hospitals|
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Lead and cadmium environmental measurements were within the recommended exposure limit reported by NIOSH [Table 2].
|Table 2: Comparison between different studied hospitals regarding environmental measurements for lead and cadmium|
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Environmental lead level of National Liver Institute, and Shebin El-Kom Teaching Hospital was significantly higher than that of control (P < 0.05) [Figure 1] and [Table 2].
|Figure 1: Comparison between different studied hospitals regarding environmental measurements for lead.|
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Environmental cadmium level of Shebin El-Kom Teaching Hospital was significantly higher than that of control (P < 0.05) [Figure 2] and [Table 2].
|Figure 2: Comparison between different studied hospitals regarding environmental measurements for cadmium.|
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| Discussion|| |
Medical waste management is a major problem in most of the countries and the appearance of disposable needles, syringes, and other similar items has increased the difficulties in health-care waste disposal. This study was conducted to assess medical waste management among tertiary-care hospitals in Menoufia Governorate through identifying the current waste management operating procedures and determining gaps and pitfalls in the current operating procedures.
This current study has shown that the existence of medical waste management committee in the studied hospitals was ineffective. This was in agreement with Oli et al.. which assessed health-care waste management in some hospitals in Southeast Nigeria and showed that the existence of health-care waste management/infection control committee was higher in governmental hospitals than private hospitals.
In the present study, the studied hospitals had a policy for HWM. This is in agreement with the results of El-Shinawey et al., who carried a study in Tanta University Hospitals to evaluate HWM, while these findings were opposite to another study in Khartoum State Hospitals, Soudan by Ahmed et al. which recorded a lack of comprehensive waste disposal plans.
In this study, the studied hospitals had a lack of baskets with tight cover and open by foot. This may be due to lack of financial resources for HWM or fear of catching the infection if baskets open by the hand. Also, El-Shinawey et al.. found that the containers were not covered all the time.
The present study reported that segregation of hospital waste was found in the studied hospitals. This was consistent with previous researches in Egypt and China,. This was in contrast to previous studies in Abuja, Istanbul, and Mongolia,, who reported that most of the health-care institutions did not have appropriate color-coded bags or containers for sorting different types of waste.
In this study, the used bags were suitable for their desired purpose (good plastic and good thickness) and the criteria of sharps containers were suitable. This was in concordance with El-Shinawey et al., who found that the used bags were suitable for their desired purpose in 82% of departments; however, 18% of these bags were not suitable to the containers. This was opposite to the findings of Coker et al., who found that inappropriate waste receptacles were used in some health-care centers in Nigeria.
The studied hospital replaced bags and sharps containers if they were three-fourth full. Also, Abd El-Salam investigated the HWM practices at eight randomly selected hospitals located in Damanhour City of El-Beheira Governorate and found that less than two-thirds (62.5%) of surveyed health-care facilities did the same, but El-Shinawey et al. showed that fewer percent (29.5%) of the studied departments at Tanta University Hospitals closed the two-thirds filled bags and sharps containers.
Collection of waste in the current study was done regularly in the studied hospitals as the same as reported by El-Shinawey et al. in Egypt and Bdour et al. in Jordan. However, in Ibadan, Nigeria, the studied health-care facilities had no definite or regular collection time, and medical waste was always overspilling from receptacles because of not being collected.
This study revealed that no cards were put on bags and containers in the National Liver Institute and the other two hospitals had some departments who do that. Shreedevi who compared the biomedical waste management policies of Apollo Hospital with Delhi Pollution Control Committee guidelines found that the labeling was done before carrying it to central storage.
In this study, transport facilities were easily loaded, emptied, and had smooth surface Also, Shreedevi found that closed lid trolleys were used to transport medical waste.
Despite the availability of protective equipment in the studied hospitals, most workers did not use them regularly. This was in contrast to Abd El-Salam and Shreedevi who found that waste handlers used personal protective equipment.
There was a suitable storage area for the produced waste in the studied hospitals. Birpinar et al. in Istanbul, Turkey, found that 63% of the hospitals had temporary storage sites while El-Shinawey et al. revealed that there was no storage area for the produced waste.
The studied hospitals showed that the storage area was fully accessible to animals. This came in agreement with previous researches,,,.
There was no availability for recording weight of the waste at different departments in Menoufia University and National Liver Institute Hospitals. On the other hand, Shebin El-Kom Teaching Hospital had this facility in some departments. This was in agreement with El-Shinawey et.al., Odette et al., and Abor and Bouwer.
Lead and cadmium environmental measurements were within recommended exposure limit reported by NIOSH (50 and 5 μg/m3, respectively). This was in agreement with Ismail et al. in Malaysia who found that the mean and SD of cadmium in the respirable dust (0.59 ± 50.27 μg/m3) was within the permissible exposure limit. Also Jonah et al. who have done a similar study in Nigeria to assess heavy metal and air quality around a health-care waste incinerator facility reported that no measureable concentrations of chromium, copper, and lead were detected but found the concentrations of iron (0.202 mg/l) and magnesium (18.309 mg/l) were below the WHO acceptable limits while cobalt (0.171 mg/l), nickel (3.466 mg/l), manganese (3.589 mg/l), and zinc (10.61 mg/l) were higher than the approved limits.
| Conclusion and Recommendations|| |
From this study, it was noticed that the defect in medical waste management of the studied hospitals was mainly in availability of the waste sorting items and availability of the waste storage items. So, it was recommended that health education programs should be implemented to increase awareness among health-care-related personnel about the importance of sorting of hospital waste at its source of origin. It is the key step for reduction of medical waste. Strict rules for HWM should be applied as waste generation particularly biomedical waste imposes increasing direct and indirect risks on the society. Also, strict measures and supervision should be applied to these hospitals.
The authors acknowledge the participants who participated in this study and gave their time to provide valuable information.
This research was supported (in part) by a grant from the Fogarty Institute and the National Institute of Environmental Health Sciences (R01 ES022163). The contents are solely the responsibility of the author(s) and do not necessarily represent the official views of the NIH.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Adnane MI, Belkacem K, Abdelkarim E, Mohamed B. Medical waste management: a case study of the Souss-Massa-Draa Region, Morocco. J Environ Prot 2013; 4
International Committee of the Red Cross. (2011). 19, avenue de la Paix. 1202 Geneva, Switzerland. Available at: www. Icrc.org.november, 2011.
[Accessed May 2019].
Cronk R, Bartram J. Environmental conditions in health care facilities in low-and middle-income countries: coverage and inequalities. Int J Hygiene Environ Health 2018; 221
Pepin J, Abou Chakra CN, Pepin E, Nault V, Valiquette L. Evolution of the global burden of viral infections from unsafe medical injections. PloS One 2014; 9
Dehghani MH, Azam K, Changani F, Dehghani EF. Assessment of medical waste management in Educational Hospitals of Tehran University Medical Science. Iran J Environ Health Sci Eng 2008; 5
El-Shinawey AK, Atalla AA, Abbas KM, Atlam SA. Assessment of hospital waste management in Tanta University. Tanta Med J 2017; 45
Blade L, Yencken M, Wallace M, Catalano J, Khan A, Topmiller J, et al
. Hexavalent chromium exposures and exposure-control technologies in American enterprise: results of a NIOSH field research study. J Occup Environ Hyg 2007; 4
NIOSH. Cadmium. NIOSH pocket guide to chemical hazards
. Atlanta, GA: National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention. 2005
Arshad N, Nayyar S, Amin F, Mahmood K. Hospital waste disposal: a review article. J Pharm Sci Res 2011; 3
Oli AN, Ekejindu CC, Adje DU, Ezeobi I, Ejiofor OS, Ibeh CC, et al
. Healthcare waste management in selected government and private hospitals in Southeast Nigeria. Asian Pac J Trop Biomed 2016; 6
Ahmed NO, Gasmelseed GA, Musa AE. Assessment of medical solid waste management in Khartoum State Hospitals. J Appl Ind Sci 2014; 2
Kumari R, Srivastava K, Wakhlu A, Sighn A. Establishing biomedical waste management system in Medical University of India – a successful practical approach. Clin Epidemiol Glob Health 2013; 1
Bassey BE, Benka-Coker MO, Aluyi HS. Characterization and management of solid medical wastes in the Federal Capital Territory, Abuja Nigeria. Afr Health Sci 2006; 6
Alagoz BA, Kocasoy G. Treatment and disposal alternatives for healthcare waste in developing countries − a case study in Istanbul, Turkey. Waste Manag Res 2007; 25
Shinee E, Gombojav E, Nishimura A, Hamajima N, Ito K. Healthcare waste management in the capital city of Mongolia. Waste Manag 2008; 28
Coker A, Sangodoyin A, Sridhar M, Booth C, Olomolaiye P, Hammond F. Medical waste management in Ibadan, Nigeria: obstacles and prospects. Waste Manag 2009; 29
Abd El-Salam MM. Hospital waste management in El-Beheira Governorate, Egypt. J Environ Manag 2010; 91
Bdour A, Altrabsheh B, Hadadin N, Al-Shareif M. Assessment of medical wastes management practice: a case study of the northern part of Jordan. Waste Manag 2007; 27
Shreedevi D. (2007). Hazardous waste management at the healthcare facilities. India. Available at: http://www. Indus. org/healthcare.
[Last accessed on 2019 May 15].
Birpinar ME, Bilgili MS, Erdogan T. Medical waste management in Turkey: a case study of Istanbul. J Waste Manag 2009; 29
Taru P, Kuvarega A. Solid medical waste management, a case of Parirenaboryatwa hospital, Zimbabwe. Rev Biomed 2005; 16
Odette R, Masika J, Venance T, Soatiana J, Christiane N, Lamine C, Bin L. Assessment of healthcare waste generation and its management systems: a prevalence survey of the healthcare facilities in Madagascar. IOSRJ Environ Sci Toxically Food Technol 2014; 8
Abor PA, Bouwer A. Medical waste management practices in a Southern African Hospital. J Health Care Qual Assur 2008; 21
Ismail SN, Salleh FH, Abidin EZ, Kather NA. Cadmium (Cd) exposure among waste collector in urban area, Malaysia. Malay J Med Health Sci 2013; 14
Jonah UU, Alhassan MM, Uwem UM. Heavy metal and air quality assessment around a healthcare waste incinerator Facility in Nigeria. Am J Mater Synth Process 2017; 2
[Figure 1], [Figure 2]
[Table 1], [Table 2]