Hospital Waste Management

Each person on the earth generates waste to carry out his activities. 'The word "Waste" is highly subjective, while some persons see waste as a risk to public health and the environment, some find it as a mere necessary inconvenience and nuisance-necessary because it must be generated as long as man exist in the world to carry out day-to-day activities'(Efe.S, 2013). For the survival of man there is a need of health care institutes which help them to be healthy but on the other side these hospitals are a source of hazardous waste production and contribute in contamination of environment, which effects human health. Azmal et al (2014, P.2633) illustrates that "the healthcare sector is contributing paradoxically in intensifying many environmental problems, at the same time, while forcing to deal with the related effects emerged. Healthcare sector, due to the application of products and technologies, resource consumption, waste production and its daily constructions and operations, is a significant source of pollution all around the world". The hospital waste directly poses latent health risk to all living organisms especially to humans and environment, which make it difficult for them to maintain their impact as sustainable organizations. "Hospitals around the world are facing problems in the process of becoming a sustainable environment and evidence indicates that developing countries are incurring more barriers in this field"(Azmal et al, 2014, p.2633). The unemployment in developing countries raise the level of illegal works which includes the selling of hazardous waste includes syringes, drips etc. so they earn by selling these things without sterilization. Efe (2013, p.4) said that waste is a source of income and it poses serious challenges for the developing countries". Hospital waste management on all levels of organization are required to minimize the production of hospital waste and to prevent human health from diseases and environmental contamination. Mbarki et al (2013, p. 914) describes it as "Improper management practice impacts both directly and/or indirectly the healthcare staffs, patients and hospital environment. It is of great importance to manage medical waste in a proper manner to avoid risks to both human health and the environment." The first and important thing to consider should be to raise the level of awareness among hospital staff as well as in public by newspaper, media and leaflets. Okoye and Odoh(2014, p.125) explains it as "Media, information posters and pamphlets are the best source to develop awareness among citizens regarding hospital waste's hazardous effects on them and on environment ". Proper training given to waste handlers and hospital staff may also help for proper waste management on all levels. Arshad et al (2014, p.1418) suggested that "Sensitization, motivation campaigns and technical courses among professionals, technicians and sanitary workers should be carried out; so that they identify themselves with their responsibilities. Suggested strategy to develop training courses should be "Training of trainees". The installation of technology for hospital waste management require some support from the government in the form of funding, which can help the management and administration for proper disposal from collection to disposal. Main Body: Hospital waste management is the important issue for the environmental protection and human health. Today global warming increases day by day so with all other factors hospital waste that is also called hazardous waste is posing high risk to the human health and environment. According to (Azmal, et al,2014, p.2633) "we are at a place, when the dual crises of public health and the environmental issues are emerging and where these two destructive powers are intersecting".

Hospital waste generates from medical institutions like hospitals, clinics and medical laboratories that may be infectious and hazardous for human health and environment. Nie (2014, p.) states that "Medical waste refers to hazardous waste materials generated by healthcare activities, including a broad range of materials, from used needles and syringes to soiled dressing, body parts, diagnostic samples, blood, chemical, pharmaceuticals, medical devices and radioactivity materials (WHO 2005)". To avoid the hazardous effects of this infectious waste the attitude towards the management of waste should be careful. So there is a lot of work done from last few years on hazardous waste minimization from hospitals and its management in developing countries as well as developed countries. Arshad et al(2011, p.) illustrates that "Hospital waste management in the world is a formal discipline and does occupy a critical place in the management of health care sector". The important thing is to minimize the waste generation per person that can be done by aware the people about effects of hazardous waste on human health and environment. Okoye and Odoh (2014, p.) support it as "Awareness is an important tool for sensitization of public opinion to environmental issues and challenges. Educating all and sundry on the importance of environmental protection is one of the most effective ways to protect nature".Hazardous waste generation rate depends on institutes and vary in its percentage as well. The health institutions include hospital, clinics and laboratories; most of the hazardous waste is generated from hospitals. According to Shareefdeen (2012, p.1626) from total waste generated by hospitals 35percent is hazardous waste includes infectious and sharps waste while remaining 65percent is non-hazardous waste. Although the rate of hazardous waste is less than non-hazardous waste but still it has fatal effects on its exposure. Hospital waste can cause severe diseases to waste handlers as well as hospital staff, if not treated or handled carefully. Rao (2008, p.207) explains it as "The hazards of exposure to bio-medical waste can range from gastro enteric, respiratory, and skin infections to more deadly diseases such as HIV/AIDS, and Hepatitis". "Hospital waste management means the management of waste produced by hospitals using techniques that will check the spread of diseases"(Arshad, 2011, p.1413). For proper waste management some hospitals follow proper plan from segregation to incineration, which is necessary for proper management of hazardous waste. Arshad(2011, p.1417)said that "The hospital waste management plan outlines the interpretation of the legislation or a standard protocol to achieve essential elements for establishment of a proper hospital waste management system". The honest staff is required at each level of hospital waste management because they will perform their duties by their environmental friendly attitudes towards waste handling. Mbarki et al, (2013, p.914) explains it as "Good medical waste management in a hospital depends on a dedicated waste management team, good administration, careful planning, sound organization, underpinning legislation, adequate financing, and full participation by trained staff". Different waste disposal methods are followed by organizations like open dumping, landfill and incineration. It is evident from the study of Efe (2013, p.10) that "open dumping with 54percent is the major method of disposing and managing solid waste in Ughelli. Land filling accounted for 15percent and Incineration for 7percent". It varies from country to country but most of the countries prefer to use the incineration process for hospital waste disposal and try to find any other useful and efficient technique. Shareefdeen (2012, p.1625) describes that "The main method of medical waste treatment in most countries of the Middle East is incineration; however, other techniques that produce less pollution are now being introduced". As all stages of Hazardous waste management include collection, segregation, transportation and disposal. Azmal, et al(2014, p.2637) demonstrates that "Similar to any type of waste management, safe disposal of hospital waste includes four key steps such as segregation, collection and storage, containment, transportation and safe disposal." So the employees should be aware of all precautions to handle the hospital waste. Arshad (2011, p.1413) found that "the awareness about all levels of hospital waste management which includes segregation, collection, storage, transportation and disposal is lacking in the developing countries". So to minimize all risk relevant to public health and environment, there should be economic and hygienic disposal from health care organizations at each level. The literature relevant to hospital waste management is explaining all aspects of problems and issues for the lay man, organizational employees and environment. For this Azmal et al(2014, p.) said "Hospitals have always been the focal point of social systems identity. Thus, they act as the mirror of the community and should be responsible for it". The literature reviewed shows that all work done on hazardous waste and its management provides clear picture of practices followed by employees in waste management and response of people and governments towards waste handling and its management. It is found by Sridhar and Adejumo (2014, p.) that "the governments use 20 - 50percent of their annual budgets on Solid Waste Management, only 20 - 80percent of solid waste is collected. The uncollected or illegally dumped wastes by the people end up in open dumps and water bodies, leading to the contamination of surface and ground water and this constitutes human health and environmental concern". For environmental protection and human health, there is a need of protective measures on all levels of organizations and communities by defined governance and proper development of strategy for management of hazardous waste. Azmal et al, (2014 p. 2634) illustrates that "Green Hospital officially recognizes and confirms the relationship between human health and the environment, indicating that we could understand it only through governance, strategy and its operations. Green Hospitals connect local needs to environmental actions and primary prevention methods through active participation in community and environment health, justice in health and green economy". Few studies found that the dump sites of hazardous wastes play a great role in crime world and those hazardous and infectious wastes includes syringes, drips etc. use for crimes. White and Heckenberg(2011, p.1257) states that "The waste management area presents numerous opportunities for crime. This is acknowledged by the illegitimate international trade and transportation of hazardous wastes, the role of organized criminal syndicates in waste management, and the illegal dumping of waste by legitimate corporations". So to avoid these problems there should be strict compliance of rules, regulations and policies designed by government. "The law which prohibits indiscriminate dumping of wastes along the highways, roads, channels, gorges, vacant lands except at designated refuse disposal sites should follow by all hospitals. In order to ensure compliance, the law makes it mandatory for every management officer to provide required resources to the employees to fulfil their duties and obey the rules" (Ijaiya, 2013, p.1242). Health Care Organizations need the support from the governments through financing for the implementation of rules and policies regarding hospital waste management including installation of new required technology like incinerator. Azmel et al,(2014, p. 2636) shows that "World Health Organizations (WHO) has published the principles describing safe and sustainable management of healthcare wastes, as a necessity in public health issues, and also the procedure to achieve all the related measures to supply the needed financial resources. Also governments all around the world have been called to take further actions in case of medical wastes through the World Health Assembly". Conclusion: The review of the literature found that almost literature covers all aspects specific to its area of discussion. Different aspects includes definition of hazardous waste, types of hospital waste, its handling, practices followed in developing countries verses developed countries, policies and management of hospital waste. "Medical wastes are highly hazardous and put people under risk of fatal diseases. The understanding of medical waste management and control techniques is important" (Shareefdeen, 2012, p.1628). It is found that there is a need of hospitals which help the humans to get rid of diseases but also their focus should be on environmental protection. "Green Hospital is the one which is continuously upgrading public health by reducing environmental impacts and eventually by eliminating hospitals roles in disease burden" (Azmal et al., 2014, p.2634). It is found that the number of hospitals increases continuously which causes increase in production of hazardous waste, which make it more difficult to comply with the rules and regulations regarding management of hazardous waste (Mbarki et al, 2013, p.917).

The work done on hospital waste convey thinking of the writers, their observations and clear explanations of problems, types of effects of mismanagement of hospital wastes, people response towards the issues regarding hospital waste and its management, policies and its implementations etc. and the management of all these issues by hospital waste management officer. Nordin (2013, p.38)describes that "Bridging the gap in perception of safety, between managers and non-managers and between different health care staff groups in order to improve patient safety is of utmost importance".

The hospitals can reduce environmental contamination by adoption of the strategies, which can help the attainment of sustainable development of the hospitals. Pudussery (2011, p.66) states that "NHS should consider including more strategies which should aim at sustainable development. The study has found that the hospital can be benefited both environmentally and economically by improving the medical waste management strategies". It is found in most of the literature that the developing countries have no any précised method of waste disposal and if they have installed some technology for waste disposal then the workers are unaware that how to operate that machine or technology. Rao(2008, p. 302)mentions in his study the same thing that "The most common method used for disposal of biomedical waste in developing countries is by throwing it outside the clinic or on road pavements (31%), although some did mention that they use the services of the common waste management facility". As discussed above that the open dumping sites increases the illegal selling of hazardous waste and the situation become more vulnerable. (White and Heckenberg, 2011, p. 1262) discussed in detail that "It is difficult to assess the present and future environmental harms and crimes, within the context of the dynamics, dimensions and discourses of a particular industry and jurisdictional domain". To develop efficient waste management plan there is the need of improvements, which have to be made at the medical waste management at various levels. "An effective strategy must put into consideration the characteristics of the target community, the major stakeholders view point about the environmental challenges and efforts being made by the government in solving the environmental problem"(Okoye, 2014). On international level World health organization tried for implementation of safe disposal and management of hospital waste. Azmel et al.(2014, p. 2636) states that "The UN Special Reporter on the Human Rights Commission has invited all the individuals and governments to develop a comprehensive international legal framework to protect human health and the environment from the adverse effects of improper management in disposal of hazardous medical wastes". It is concluded that on the government level, policies and regulatory plans for proper waste management should be designed and implemented to minimize risks relevant to human health and environment and proper financial support should also be available to the health sector so that they will be able to comply with those rules and regulations. Azmal et al, (2014, p. 2636) highlighted that "the healthcare waste management is still poorly funded and implemented, unfortunately, and the combined toxic and infectious effects of medical wastes, as environmental and public health threats, have not been noticed significantly".