Waste disposal to be streamlined

By Ranil Wijayapala

For all the Local Government Authorities, the subject of waste management has become an endless and thankless job though it is one of the key responsibilities vested with them under the Local Government Authority Act.

The healthcare waste that is generated from health care establishments, research facilities and laboratories has also become a major problem for Local Government Authorities as this hazardous waste is posing a risk for these waste collectors and also for the environment and also for the public in general.

With the increasing number of hospitals, laboratories and other health care facilities, the risk posed by the health waste is increasingly posing a threat for the environment and also the general public as health waste generated from these hospitals is mixed into the municipal waste collected by the Local Government Authorities in the absence of a proper mechanism to dispose health waste.

According to statistics in Sri Lanka we have 923 hospitals in the government sector and the number is much higher when considering the mushrooming private hospitals in the country.

According to Deputy Director Western Province Waste Management Authority Nalin Mannaperuma, the problem regarding improper handling of the medical waste has become a big issue in the Western province which generate more than 60 per cent of the solid waste in the country.

“In the Western province alone there are about 120 hospitals. Total number of health care waste generated from hospitals is amounted to 61 tons per day and in the Western Province alone it is 25 tonnes. This is only from the government hospitals. This might be triple if we considered the number of private hospitals in the Western province”, Mannaperuma added.

But out of the total hospital waste only 25 per cent is considered hazardous waste.

“If we take the Western province, out of the 25 tonnes of hospital waste collected daily from the hospitals, nearly 25 per cent is hazardous type of health waste. If we take this figure on district-wise hazardous and highly hazardous waste collected is 3.28 tons in the Colombo district, 1.28 tonnes in the Gampaha district and 0.48 tons in the Kalutara district per day,” he added.

But the basic problem with regard to the hazardous health waste is that, except for few places these hazardous waste is also handled by the waste collectors from the Local Government Authorities.

At present, these health waste disposal procedure follows various disposal practices such as burning in rudimentary incinerators, burning in open fires on the ground or in pits, on site burial, on site dumping, placental pits and by disposal at municipal dump.

“This will cause environmental risks such as contamination of soil, surface and ground water, pollution of air due to unscientific open burning and the release of risky hydrocarbons and other toxic gases”, he added.

Apart from that, this will also create health risks such as spreading of hepatitis, B, C and HIV and injury from sharps, allergies and repacking.

“Health care waste is different from our domestic waste and must be segregated, collected, stored, transported and disposed properly. If the hospital waste gets mixed with the perishable waste used for manufacturing compost, that will affect the compost manufacturing. The compost is meant for edible crops. If the compost gets contaminated that will be a problem for the environment and even for the general public”, Mannaperuma added.

“So the Waste Management Authority of the Western Province came forward to address this issue through 'Pivithuru Suwapiyasa' program to streamline the process of handling the health care waste in the western province.

“In the Western province the government hospital generates 25 tonnes of hospital waste. But all 25, tonnes will not be hazardous. Out of that only 25 per cent is hazardous waste. We can easily handle this 25 per cent of hazardous waste if we can separate them from the general waste”, he added.

According to World Health Organisation throughout the world an estimated 16 000 million injections are administered every year. But not all needles and syringes are properly disposed of, creating a risk of injury and infection and opportunities for re-use. Therefore the WHO estimates that injections with contaminated sy-ringes caused 21 million hepatitis B virus (HBV) infections, two million hepatitis C virus infections and 260 000 HIV infections worldwide in the year 2000 alone.

It says many of these infections were avoidable if the syringes had been disposed of safely. Apart from that, the WHO indicates that in developing countries, additional hazards occur from scavenging at waste disposal sites and the manual sorting of hazardous waste from healthcare establishments.

Waste handlers

“These practices are common in many regions. The waste handlers are at immediate risk of needle-stick injuries and exposure to toxic or infectious materials if they are mixed into municipal garbage”, he added.

It is the responsibility of the central government to deal with the highly hazardous medical waste such as radio active waste from the Cancer hospital which is considered highly hazardous health care waste.

“But if we do not segregate these hazardous and highly hazardous health waste from the general waste collected from the hospitals, the disposal cost will be high. That will also create financial risks due high cost involved in health care waste management”, he added.

“If we do not separate the hospital waste Rs.10,000 has to be spent to dispose each metric ton of hospital waste. Infectious waste has to be treated at the incinerator. For that we have to spend Rs.10,000. If separated, the non infectious waste can be disposed by spending 75 cents per Kilo gram. We can have a 71 percent cost saving if we properly handle these hospital waste”, he added.

At present health care waste is also handled by the Local Government authorities. Local Government Authorities used to collect the health care waste in the same vehicle they collect municipal waste.

“The municipal waste is not infectious, but when hospital garbage is loaded in to the same vehicle the other garbage also can be infectious. If we make use of that perishable waste for composting that will also be contaminated”, Mannaperuma added.

The Waste Management Authority of Western Province through “Pivithuru Suwapiyasa” program expect to launch a program under the slogan “Create Clean Environment, Enjoy Healthy Life” to manage the health care waste generated by medical institutions of both government and private sector in the Western Province.

“Through Pivithuru Suvapiyasa program what we are planning to do is to the reduce the non infectious waste from the hospital waste and effectively destroy the infectious waste by following proper procedures, because after the segregation of garbage at hospitals itself there are so many ways of disposing the infectious medical waste”, Mannaperuma added.

“There are so many options for non infectious waste. The recyclable waste we can recycle. Non recyclable waste we can use for composting”, he added.

To streamline the health care waste the authorities managing the hospitals have to follow six steps.

“First we have to minimise garbage that is collected at hospitals. For this we have to introduce new rules and regulation. For example we have restricted the creation of garbage like we are creating certain hospitals as polythene free zones after searching for polythene before visitors arrive at the hospitals. After we impose such laws, without spending that much of money we can do something to minimise the waste collected at the hospitals”, he added.

Colour code

For this, the patients and the general public and hospital staff have to be enlightened on a regular basis, as the people visiting the hospitals change on a daily basis.

Then the hospital waste has to be segregated.

“Within the hospital too segregation has to be done. We have introduced a colour code for the segregation of the hospital waste”, he added. Though this colour code system is a novelty in Sri Lanka it is being used in many countries for the separation of garbage source itself.

“Waste separation is the most difficult part in the waste management. Most of the people are not used to this system. We have introduced this colour system to make this process easy for the public”, he added.

For different types of waste different colours have been assigned. Green for garden waste, food and kitchen waste, red for glass, blue for paper, cardboards, orange for plastic and polythene brown for tin and metal.

The yellow coloured bins can used to collect infectious waste like human tissues, anatomical waste, organs, body parts, placenta, animal waste, any pathological and surgical waste microbiology and biotechnology waste (cultures, stocks, specimens of microorganisms, live or attenuated vaccines etc), cytotoxic pathological waste, soiled waste (swabs, bandages, mops, any item contaminated with blood or body fluids).

The bins with orange strip in yellow background can be used to collect infectious plastics such as IV tubes/bottle, tubings, gloves, aprons, blood bags urine bags, disposable drains, disposable plastic containers, endo-tracheal tubes syringes, tubes, canulas, catheters, gloves and dialysis equipment.

Bins with a red stripe in yellow background can be used for sharp waste such as needles, scalpels, blades, broken glass etc while coloured bins is for others.

“We have to introduce this system to the public and they have to be enlighten about this colour system”, he added.

At the third step we have to streamline the collection of health care waste in order to avoid both the accumulation and the rotten perishable waste within the premises itself. It must be collected at the proper time on a regular basis”, he added.

“Specially designed trolleys can be used to collect segregated waste to a central storage area of the hospital”, he added.

Final disposal

Fourthly, segregated waste should be stored in designated places before discharging for treatment or final disposal. The place of the storage facility should be safe enough to avoid possible hazards. Infectious waste such as pathological and anatomical waste should be stored under highly controlled conditions equipped with deep freezer to avoid rotting until it is treated or disposed.

“Transportation also should be done using designated vehicles and it should be free of sharp edges, and should be easy to load and unload and fully enclosed to prevent any spillage on the road during the transportation”, he added.

Apart from that, transportation should be properly documented and all vehicles should carry a consignment note from the point of collection to the treatment facility.

At the sixth stage, separated perishable waste can be used for composting while the recyclable waste materials such as paper, cardboard, plastic, polythene, glassware can be sent for recycling.

“Infectious waste should be disposed of in protected pits while infectious body parts can be disposed in deep burial pits. Infectious waste also can be treated by autoclave microwave or it can be incinerated at a high temperature”, he added.

“In Sri Lanka we do not have incinerators. Therefore we have to depend on other disposal methods or store them safely until such facilities are made available”, he added. “But finally, waste which is incinerated or autoclaved should be land filled in a secured manner to avoid hazard to human and the environment”, he added.

“We are going to implement this program with the support of the hospital authorities to streamline the process of disposing health care waste. At present a number of hospitals are working with the Western Province Waste Management Authority and we hope to implement this in all hospitals in the Western province to ensure that health waste will not become a problem for the human and the environment”, Mannaperuma added.