Sie sind auf Seite 1von 6

Journal of Emerging Trends in Engineering and Applied Sciences (JETEAS) 4(4):588-593 (ISSN: 2141-7016)

588


Management of Health-Care Waste: A Case Study of Two National
Teaching and Referral Hospitals in Kenya

Kei Robert, M. and Njagi Ananias, N.

School of Public Health, Moi University.
P.O. BOX. 4606 30100 Eldoret, Kenya.
Corresponding Author: Kei Robert, M.
___________________________________________________________________________
Abstract
It may be necessary for a Public health institution to segregate hospital waste in order to facilitate collection and
disposal. In addition, this would save on treatment cost by setting appropriate waste minimization strategies,
minimize environmental pollution and hence reduce risks to public health. This would also, provide accurate
planning data for health care waste minimization and hence promote public health in all health facilities. The
study was done in Kenyatta National Hospital, Nairobi and Moi Teaching and Referral Hospital, Eldoret. This
was Analytical study design covering four waste categories. The samples were taken on infectious; pathological;
sharps and chemical waste from wards and other units. The weights of the samples were taken daily for seven
(7) consecutive days, during the wet and dry seasons. Their quantities and generation rates based on bed
capacities in each institution were computed. Kenyatta National Hospital was found to be generating 0.61
kg/bed/day and Moi Teaching and Referral Hospital, 1.03 kg/bed/day. The study determined that Health-care
waste was not well segregated in the two National teaching and Referral Hospitals. Therefore, it was
recommended that the two Institutions should do regular weighing of the segregated waste categories and
maintain records in order to monitor progress in generation rates. Further analytical research should be done to
determine the extent of the problemin the other hospitals of Kenya.
__________________________________________________________________________________________
Keywords: health-care waste; waste segregation; categorization. quantification.

INTRODUCTION
Health care waste is hazardous material which forms
10% to 25% of the total waste generated in a
healthcare institution (WHO, 1994; WHO; 1999). It
is generated during patients diagnosis, treatment or
immunisation (Rutala & Maryhall, 1992). If not
properly managed, it may pose a big public health
problemto healthcare workers, the patients and the
general public. In Japan, 1987, two interns were
fatally injured by needles used on patients infected by
a virulent mutant of hepatitis- B, (WHO,1994).

Development of health care sector has been
prominently guided by values such as patient
/personnel safety and service quality. The efforts to
minimise environmental impacts caused by health
care wastes are sometimes not prioritised. (Karlsson
and Ohman, 2005). In addition, some cultural
practices as observed by Pruess et al. (1999),
interfere with proper management of the waste. The
commentator notes that in Asia religious beliefs
require that human body parts are returned to a
patients family in tiny coffins to be buried in
cemeteries. Literature review shows that some
relatives demand that amputated body parts of their
relatives be returned to themfor burial.

It is generally known that management of health care
waste is a tedious, foul, difficult, expensive and
complicated exercise.. Proper handling of waste
during storage, transportation, treatment and disposal
is therefore important. Poor management of health
care waste can cause significant inconveniences and
become a health risk to the population (Sheshinski,
2002; WHO, 2005). It has been observed that health
care waste has more heavy metals than Municipal
solid waste ( Sabiha-Javied and Tufail, 2008; Zhao et
al., 2008; Zhao et al., 2010). This makes
categorization and quantification necessary to enable
decision-making on safe and effective treatment. In
this way, segregation, categorization and
quantification support health-care waste
minimization. In the same way, it supports
environmental protection efforts, occupational safety
and, regulatory compliance.. Source reduction of
health-care waste is therefore a necessary undertaking
that may support this endeavour. It encompasses
material elimination, change or product substitution,
technology or process change, good operating
practice and preferential purchasing green
purchasing (WHO, 2005; Drain et al., 2003;
Takeuchi et al., 2005).

Management of health care waste should be
sustainable, environmentally safe, economically
affordable and socially acceptable, (Woolridge et al.
2005). This is possible if accurate health-care waste
generation rates in categories are known. Various
Journal of Emerging Trends in Engineering and Applied Sciences (JETEAS) 4(4): 588-593
Scholarlink Research Institute Journals, 2013 (ISSN: 2141-7016)
jeteas.scholarlinkresearch.org

Journal of Emerging Trends in Engineering and Applied Sciences (JETEAS) 4(4):588-593 (ISSN: 2141-7016)
589

studies recommended that waste categories be
standardized for the convenience of its management.
Other studies have shown that, Medical waste may be
classified into eight categories that includes,
infectious, pathological, sharps, chemical,
pharmaceutical, genotoxic, radioactive and waste
with high metal contents, (WHO 1994; 1999).
Further categorizations have been made by Basel
Convention describing five categories, (WHO, 2005).
Again, USA, Environmental Protection Agency has
eight categories (WHO, 1994). Supporting the above,
Okeke (2011) also made reference to eight health-
care waste categories.

A situation analysis contained in a study by Ministry
of health, Kenya (MOH, 2005) revealed that medical
waste in urban centers was generally managed as any
other waste. Most of the time it is disposed of in
crude public dumps such as Dandora site in Nairobi
and other solid- waste dump sites situated in most
municipalities. Safe management of health-care waste
is necessary for the promotion of public health.

Kenya government introduced National Guidelines
for health-care waste management in 2006.
Implementation of the guidelines was supported by
regulations formulated under National Environmental
Management and Co-ordination Act.,(2006). The
National Health-care Waste Management Plan covers
four phases of implementation over the period 2006
to 2016.

At the time of conducting this study, the country was
in its third year of the Plan implementation. It has
gone through the first two annual phases that include
consolidation and development stages (2008-2010).
However many activities for the first phase had not
been implemented in the two referral hospitals under
study. The two institutions have commenced waste
segregation, storage in labeled and coded containers
followed with incineration as medical waste
treatment option.

PROBLEM STATEMENT
Various studies recommend that waste categories be
standardized and minimized for the convenience of
its management. A situation analysis contained in a
study by Ministry of health, Kenya (MOH, 2005)
revealed that medical waste in urban centers was
generally managed as any other waste and hence
posing public health risk.

LIMITATION
Due to financial constraints the study was limited to
two public and national referral hospitals in Kenya

METHODOLOGY
This was Analytical study design for hospital wastes
in two National Teaching and Referral hospitals in
Kenya. The medical waste categories generated in
various wards and units were segregated into four
categories. The four categories under study included,
infectious, pathological, sharps and chemical wastes.
They were weighed daily and weights recorded for
seven consecutive days during the wet and dry
season.

The wastes collected covered the following aspects:
Infectious waste -cultures and stocks of
infectious agents associated with biological
medical laboratories, waste from surgery,
autopsy on patients with infectious diseases,
waste from patients in isolation wards or
undergoing haemodialysis.
Pathological waste- tissues, organs, body parts,
human foetuses, blood and body fluids.
Sharps which could cause a cut or puncture
especially needles or blades released after use in
patients care, syringes (with or without attached
needles). Pasteur pipette, scalpel blades, blood
vials, needles with attached tubings and culture
dishes (regardless of presence of infectious
agents). These were collected in safety boxes.
Chemical Waste (mainly disinfectants) and
other waste considered hazardous, corrosive,
flammable, or reactive and/ or genotoxic.

In the two institutions, weighing of the four
categories of hazardous health-care waste was done at
a receiving yard awaiting transfer to the incinerator.
The chemical waste recorded as waste was based on
supplies to various wards and hospital units during
the sampling period as there was no method in place
to account for chemicals generated as waste.

The exercise was carried out, (for the dry season), in
Kenyatta Teaching and Referral hospital between
15/7/09 and 21/7/09 and Moi Teaching and Referral
hospital between 13/6/09 and 19/6/09. For the wet
season the seven (7) days samples were taken
between 28/10/09 and 3/11/09 for Kenyatta Teaching
and referral hospital and 31/10/09 and 6/11/09 for
Moi Teaching and Referral hospital..

RESULTS AND DISCUSSION
Kenyatta Teaching and Referral hospital
Wet Season Medical Waste Generation.
The following are the summaries of the weighed
health-care waste during the seven days of the wet
season:-

Table 1.0: Quantities of medical waste generated
during wet season
Seven days Infectious
(kg.)

Pathological
(kg.)

Sharps
(kg.)

Chemical
(kg)

Sum 6571.0 286.0 262.7 205
Mean(kgs/d) 938.7 40.8 37.5 29.3
SD 170.43 32.37 19.91 -
CV% 18.16 79.23 53.06 -
% by cat. 89.7 3.9 3.7 2.8

Journal of Emerging Trends in Engineering and Applied Sciences (JETEAS) 4(4):588-593 (ISSN: 2141-7016)
590

During the wet season there were varied differences
in mean generation rates with the highest being
infectious waste and the lowest chemical waste. The
daily infectious waste generation over the seven days
varies very slightly with a coefficient of variation of
18.16% as compared to the much fluctuating daily
quantities of pathological waste with a coefficient of
variation of 79.23 %.

(ii) Dry Season Medical Waste Generation

Table 2.0: Quantities of medical waste generated
during dry season
Seven
days
Infectious
(kg)
Pathological
(kg)
Sharps
(kg)
Chemical
(kg.)

Sum 7367.5 102.5 348.6 290
Mean
(kgs/d)
1052.5 14.6 49.8 41.4
SD 129.57 14.57 15.99 -
CV 12.31 99.52 32.10 -
% by cat.

90.8 1.3 4.3 3.6

During the dry season, there were varied differences
in mean generation rates with the highest being
infectious waste and the lowest, pathological waste.
The daily generation of infectious waste however,
does not vary in quantities greatly as the coefficient
of variation is 12.31% (Table 2.0). Pathological waste
daily generation fluctuates greatly with a coefficient
of variation of 99.52 %.

The comparison test based on the coefficient of
variation derived fromthe data for the wet and dry
season on infectious, pathological and sharps waste
generation reveal that there is no significant
difference in generation between the two seasons as
follows.
Infectious waste, p=0.9436. ( Not
significant)
Pathological waste, p =0.1564. (Not
significant)
Sharps, p=0.0507. ( Not significant)

The seasonal variations for wet and dry season in
hazardous health-care waste generation rates
remained nearly the same during the two seasons.
The fixed trend in the three hazardous waste
generation rate during the wet and dry season could
be due to lack of patients influenced greatly by
climatic conditions like rainfall (Katoch and Vineet,
2011). The materials consumption during health
services delivery are almost the same. Therefore, it
could be easy to plan the quantities of materials
required for waste reduction

b) Moi Teaching and Referral Hospital-
i) Wet Season Medical Waste Generation
The following are the summaries of the weighed
health-care waste during the seven days of the wet
season
Table 3.0: Quantities of medical waste generated
during wet season
Seven
days
Infectious
(kg)
Pathological
(kg)
Sharps
(kg)
Chemical
(kg.)

Sum 2889.4 256.0 209.8 139
Mean
(kgs/d)
412.8 36.6 29.9 19.9
SD 50.8 4.3 5.9 -
CV 12.31 11.65 19.97 -
% by cat 82.7 7.3 6.0 3.9

During the wet season, there were varied differences
in mean generation rates with the highest being
infectious waste and the lowest, chemical waste.
From Table 3.0, the coefficient of variation for
infectious, pathological and sharps waste indicate a
close relationship in quantities of the respective waste
categories generated daily for the seven days during
the wet season.

(ii) Dry Season Medical Waste Generation

Table 4.0: Quantities of medical waste generated
during dry season
Seven days Infectious
(kg)
Pathological
(kg)
Sharps
(kg)
Chemical
(kg.)

Sum 5740.8 456.5 408.1 125
Mean
(kgs/d)
820.1 65.2 58.3 15.9
SD 99.5 40.1 17.5 -
CV 12.13 61.48 30.04 -
% by cat 85.3 6.8 6.1 1.9

During the dry season, there were varied differences
in mean generation rates with the highest being
infectious waste and the lowest, chemical waste.
The daily pathological waste generation over seven
days had varied quantities as confirmed by a
coefficient of variation of 61.48%.
The comparison for wet and dry season coefficient of
variation for infectious, pathological, and sharps
waste revealed the following:-
Infectious waste, p-value 0.8521 (Not
significant).
Pathological waste, p-value 0.000
(Significant)
Sharps waste, p-value 0.042
(significant)

The comparisons for the coefficient of variation
between wet and dry seasons at Moi Teaching and
Referral hospital for infectious, and sharps waste
shows that there was no significant difference. This
implies that the health-care materials demand and
consumption during the wet and dry seasons was
almost the same. There was however, significant
difference in generation of pathological waste and
sharps during the wet and dry season. It implies that
there was varied consumption of healthcare materials
during the wet and dry season. Budgetary

Journal of Emerging Trends in Engineering and Applied Sciences (JETEAS) 4(4):588-593 (ISSN: 2141-7016)
591

arrangements and healthcare materials procurement
will also vary with seasons.

(iv) Summary Health-Care Waste Generation
Rates
The following aremedical waste generation rates for
the two institutions:-
(i) Hazardous health-care waste generation
rates relationship for wet and dry seasons
At Kenyatta Teaching and Referral hospital, there
was no significant difference in generation rates for
the various hazardous waste categories as revealed by
the values for the coefficient of variations. The
hospital is situated at the capital city of the country
and has served as a referral institution for more than
50 years. As a referral hospital for the long period, it
has attained financial stability more than Moi
Teaching and Referral hospital to sustain the health
care services. The patients population is affected by
seasonal changes.. Hazardous health-care waste
generation rates for the waste categories analysed do
not change with seasons.

At Moi Teaching and Referral hospital, except for
infectious waste category, there was significant
difference in quantities of pathological and sharps
waste categories. This institution was recently
established as Teaching and Referral Hospital,
serving the western region. It is yet to achieve a
stable service delivery capacity to sustain high level
medical materials supply and a constant patients
referral system. The fluctuating medical supplies
would therefore produce the evident pattern of
medical waste generation. Health seeking behavior
could be influenced by adverse weather conditions..
This could create a significant difference in health-
care waste generation rates between the wet and dry
season.

The four hazardous health-care waste categories form
the largest proportions generated daily in the two
institutions. The generation rate based on bed
capacity for each of the two institutions during the
wet and dry seasons was 0.61 kg/bed/day at KNH
(1800 beds) and 1.03 kg/bed/day at MTRH (712
beds). The rates however, were affected by the
hospitals bed- occupancy rate. At KNH, the bed-
occupancy rate was 300% (KNH, 2011) while that of
MTRH was 99%. An evaluation study in Taiwan
shows that the amount of health-care waste generated
is directly associated with the number of bed
occupancy.(chang et.al.2009).

Further research shows that lower income countries
have lower health-care waste generation rates than
high income countries (WHO (2006) and Chaurel et
al. (2008). . Generation of hospital waste differed not
only across different countries but also within the
same country by type of establishment (Jahandideh et
al. (2009) and Patwary et al. (2009)). The
commentators further observed that the other factors
that influence variations in generation rates include
re-imbursements by National Health Insurance,
capacity of the hospital, type of specialization, bed
occupancy, number of beds for infectious diseases,
outpatients per day and proportion of re-usable items.
These factors also contribute to the difference in
generation rates for the two hospitals.

The health-care waste generation rate of 0.61
kg/bed/day compares well with several studies from
developing countries such as (Longe and William,
2006); (Longe and William, 2006); (TAl-Khatib et
al., 2009); (Abdalla et al, 2008); (WHO, 2006);
(Nemathaga et al., 2008); (Bendjoudi et al., 2009);
(Taghipour and Mosaferi, 2009); (Patwary et al.,
2009) and ( Abdalla et al., 2008).

AERD (2009) observes that in Kenya, the amount of
infectious waste generated in healthcare facilities was
1:1 or higher than the general waste. This proportion
for the two institutions almost confirms the computed
values. It is an indication that the two institutions
have not perfected their health-care waste
segregation. The most affected category is infectious
waste collection and disposal. The definition of
infectious waste varies widely from country to
country and that ambiguity of the waste category
could lead to improper segregation of the waste that
forms 25% of the hazardous category
(Chaerul et al. (2008))

CONCLUSION AND RECOMMENDATIONS
Conclusion
The following conclusions and recommendations are
derived from the findings of the study. Considering
the four categories of health-care waste studied,
(infectious, pathological, sharps and chemical waste),
KNH generated 0.61 kg/bed/day and MTRH, 1.03
kg/bed/day. KNH generated infectious waste to
general waste in the ratio of 0.7:1 and MTRH
0.6:1.Segregation of health-care waste in the two
institutions was not done satisfactorily. The study
found that .there was no accounting of used
chemicals as waste after use in the two institutions.

Recommendations
The two institutions should do a regular
weighing of the segregated waste categories
and maintain records to monitor progress in
generation rates. This would provide accurate
data for planning health care waste
minimization schemes and hence promote
public health in the hospitals
Further analytical research should be done to
determine the extent of the problem in the
other hospitals in Kenya.




Journal of Emerging Trends in Engineering and Applied Sciences (JETEAS) 4(4):588-593 (ISSN: 2141-7016)
592

ACKNOWLEDGEMENT
The authors acknowledge the financial support from
Moi University for the completion of the study. More
appreciations go to National Science and Technology
and Institutional Ethics Committee for the approval
of the study .
The authors further thank the management of the two
institutions for allowing their staff to participate in
the study.

REFERENCES
Abdullah F., Qdais H.A., et.al (2008). Site
Investigation on Medical Waste Management in
Northern Jordan. Journal of Waste Management, 28:
450-458

Agenda for Environment and Responsible
Development. (2009). Needs Assessment for
Hospitals in African Countries in Relation to
Infectious Waste Treatment. Final Report. Available
from:< http://gefmedwaste.org/downloads/Report:
Needs>, accessed on 24
th
June, 2005.

Al-Khatib I.A., Sato C. (2009). Solid Health-care
Waste Management Status at Healthcare Centres in
the West Bank-Palestinian Territory. Journal of
Waste Management, 29: 2398-2403

Bendjoudi Z., Taleb F., et.al. (2009). Health-care
Waste Management in Algeria and Mastaganem
Department. Journal of Waste Management 29 :
1383-1387

Chaerul M., Tanaka M. et.al. (2008). A System
Dynamic Apparatus for Hospital Waste Management.
Journal of Waste Management 28:

Cheng Y. W., Sung F.C., et.al (2009). Medical Waste
Production at Hospitals and Associated Factors.
Journal of Waste Management 29, Issue 1: 440-444.

Drain P.K., Ralaivao J.S., et.al. (2003). Introducing
auto-disposable syringes to the national
immunization programin Madagascar. Bulletin of the
World health organization, 81: (8).

Jahandideh S., J ahandideh S, et.al. (2009) The use
of Artificial Neural Networks and Multiple Linear
Regression to Predict Rate of Medical Waste
Management J ournal of Waste Management, 29:
2874-2879.

Karlsson M. and Ohman D.P. (2005). Material
Consumption in the Health-care Sector: Strategies to
Reduce its Impact on Climate Change-The Case of
Region Scania in South Sweden. J ournal of Cleaner
Production, 13: 1071-1081


Kenyatta National Hospital (2011). General
information (Home Page) Available
from:<http://www.knh.or.ke>, accessed on 8
th
April
2011.

Longe E. O. and Williams A. (2006). A Preliminary
Study of Medical Waste Management In Lagos
Metropolis, Nigeria. Iran J ournal of Environmental
Health Sciences Engineering, 3 No. 2: 133-139

Ministry of Health (2005). Kenya National Health-
care waste management plan . Draft Report by
Environmentalists Sans Frontiers Consultants.

Nemathaga F., Maringa S. et.al. (2008). Hospital
Solid Waste Management Practices in Limpopo
Province, South Africa: A Case Study of Two
Hospitals. Journal of Waste Management,28: 1236-
1245
Okeke P.U. (2011). The Impact of Health-care Waste
on Public Health. European J ournal of Cancer and
Clinical Oncology, (22):1489-1493

Patwary M.A., OHare W.T, et.al (2009).
Quantitative Assessment of Medical Waste
Generation in the Capital.City of Bangladesh. J ournal
of Waste Management, 29: 2392-2397

Pruess A., Giroult E. et.al (eds.) (1999). Safe
Management of Wastes from Healthcare Waste
Activities. WHO, Geneva,159-165 ISBN 92 4
154525 9

Rutala W. A. and Maryhall C.G. (1992). Medical
waste, Infections Control and Hospital Epidemiology,
38-48.

Sabiha-J avied M. and Tofail S.K. (2008). Heavy
Metal Pollution from Medical Waste Incineration at
Islamabad and Rawalpindi, Pakistan. Microchemical
Journal. 90 (1): 77-81.

Sheshinski R.H. (2002). Indirect data collection for
waste statistics and waste indicators. Statistical
Journal of the United Nations, ECE, 19: 53-63

Taghipour H. and Mosaferi M. (2009).
Characterization of Medical Waste From Hospitals in
Tabriz, Iran. Journal of Total Environment,
407:1527-1535.

Takeuchi H., Kikuchi I., et.al (2005). Disposal
Laparoscopic surgical instruments and the economic
effects of repackaging. J ournal of Laparoendoscopic
Surgical Techniques, 15, No.2, 2: 176-181.

Woolridge A., Morrissey A. et.al (2005). The
Development of Strategic And Tactical Tools, Using
Systems Analysis, for Waste Management in Large
complex 44(Organizations: A Case Study in UK

Journal of Emerging Trends in Engineering and Applied Sciences (JETEAS) 4(4):588-593 (ISSN: 2141-7016)
593

Health-care Waste. Journal of Resources,
Conservation and Recycling: 115-137

World Health Organization (2006). Health-care waste
management training at national level. Available
from:<.http://www.healthcarewaste.org/en/440_train
_medium.html.>, accessed on 13
th
June 2011.

World Health Organisation (2005). Technical Briefs.
Journal of Environmental Health, 66, 1: 40-41.

World Health Organisation (1999). Guidelines for
Safe Disposal of Unwanted Pharmaceuticals in and
after Emergencies. Available from:
<http://www.who.int/water_sanitation_health/medica
lwaste/unwantedpharm.pdf>, Accessed on 18
th
Aug
2011.

World Health Organisation (1994). Managing
Medical Wastes in Developing Countries. Report of a
Consultant on Medical Wastes Management in
Developing Countries.

Yong Z., Gang X., et.al. (2009). Medical Waste
Management in China: A Case Study of Nanjing.
Journal Waste Management, 29: 1376-1382.

Zhao L., Zhang F. S., et.al. (2010). Typical Pollutants
in the Bottom Ashes froma Typical Medical Waste
Incinerator. Journal of Hazardous Materials, 173:
181-185.

Zhao L., Zhang F. S., et.al (2008). Chemical
Properties of Heavy Metals in Typical Hospital
Incinerator Ashes in China. J ournal of Waste
Management, 29 (3) :1114-21.

Das könnte Ihnen auch gefallen