Mohammad

Ali Jinnah University

Report

Name : Romesha

Registration # : SP21-MBAB-0040

Topic : Hospital Waste Management

Submitted to : Dr. Hina Fatima

Date : 03/01/2024

Course : Advanced Research Methodology

Section : AW

Pages : 13

Table of Contents
Abstract……………………………………………………………………………01

Introduction……….…………………………………………………………….…01

Problem Statement………………………………………………………………...02

Literature Review…………………………………………………………………02

Waste Segregation…………………………………………………………………02

Methodology……………………………………………………….

……………...04Research

Design……………………………………………………………….….05

Data Collection & Analyses………………………………………………………05

Method used for Disposal of Bio-Medical Waste……...………………………….06

Frequency Table……………………………………………………………..06 & 07

Types of Wastes & its impact……………………………………………………..08

Result & Discussion……………………………………………………………….09

Recommendations…………………...……………………………………….……09

Limitations Of the study…………………………………………………………...09

Way ahead...……………………………………………………………………….10

Conclusion…………………………………………………………………………10

References………………………………………………………………...……….10
Abstract
Waste management has become a critical aspect of healthcare activities to ensure the safety of
patients, workers & environment of the planet. Hospital wastes have various kinds that impact
nature & healthcare in different ways, some of them are very dangerous & hazardous but some
of them are less harmful, so they need the extra care & responsible facilities to discard or dumb
the wastes.
In this case study we will do a deep analysis of how the developed countries manage the
wastes & how the developing countries are adopting such techniques to reduce, reuse, recycle
the waste of hospitals as much as they could.
We will do comparative analysis vs world healthcare system with the local (Pakistani) hospital
wastes management activities, the observations/surveys/or interviews are held by the
researcher in areas of Karachi & find out the best possible ways to discard wastes in
responsible landfills or reuse & recycle it by certain processes as per the requirements of WHO
followed by the developed countries.

Keywords: Waste management, hospital wastes, recycle, reuse,

reduce, responsible waste disposal, biomedical waste

Introduction
The purpose of the study is to find out the
differences between major countries & Pakistani management. Hazardous and infectious waste
hospital wastes managements & the often requires special treatment methods before
Segregation of wastes, Storage management, disposal. This may involve incineration,
Transportation, Treatment of disposal, autoclaving, or other approved processes.
Compliance with regulations, training & Compliance with local, national, and
awareness and monitoring & processing are International regulations governing medical waste
the main stages to handle the wastes properly. management is crucial. These regulations may
specify the types of waste, treatment methods, and
The areas of the study are the major countries of disposal practices that must be followed.
the World, Africa, China, India, US & compare
them to the local hospitals (Pakistani) wastage The waste management staff should be aware of the
system. segmentations of wastes & should know the
hazardous impacts on human health to ensure the
Hospitals generate different types of wastes safety measurements of their own & other
including general, hazardous, infectious, & personnel’s at the facility area.
pharmaceutical wastes. By segregating the Healthcare personnel should receive training on
wastes the management will become easy to proper waste segregation, handling, and
handle the wastes by assigning all parts of disposal procedures. Regular awareness
wastes to a certain department or waste programs can help reinforce good waste
management team to segregate the categories management practices and keep staff informed
& process it accordingly. about any updates or changes in protocols.
After the segregation process the storage of waste
is another responsible job, waste should be stored Hospitals are encouraged to adopt
appropriately to prevent cross contamination & Environmentally friendly waste management
ensure the implementations of the SOPs of waste practices, such as recycling whenever possible

Page 01
and minimizing the use of hazardous materials. be collected in leak proof containers clearly
labeled as cytotoxic waste (Acharya and Singh
Meeta, 2000).
Problem Statement: Also contributes to environmental sustainability.
It is essential for healthcare facilities to develop
Without any safety procedures, municipal and implement comprehensive waste management
workers and scavengers in the city handle plans tailored to their specific needs and regulatory
hospital garbage on a regular basis, putting them requirements.
at risk for lethal infectious infections. The study will find the difference between the
world waste management system & local waste
About 1100 tons of trash is produced everyday management by using qualitative & quantitative
by hospitals in Karachi, and these wastes are not methods to find out the gaps & problems facing
separately handled on contemporary lines since during the handling of the wastes & dumbing into
improper waste disposal poses a major risk to somewhere where the residents are not located
public health. (Business Recorder, Aug 18, 2023) nearby.
Needles and syringes should be destroyed with the
Hospital waste is usually treats as the general help of needle destroyers and syringe cutters
garbage of the city & dumbing on irresponsible provided at the point of generation. Infusion sets,
landfills without proper segregation. bottles and gloves should be cut with curved
scissors.
Healthcare facilities don’t even a proper system
to manage their wastes carefully even not a Disinfection of sharps soiled linen, plastic and rubber
single person thinks about it like a serious issue. goods are to be achieved at point of generation by
usage of sodium hypochlorite with minimum contact
of one hour. Fresh solutions should be made in each
Literature review: shift. On site collection requires staff to close the
The areas of the study are the major countries waste bags when they are three quarters full either
of the World, Africa, China, India, US & compare by tying the neck or by sealing the bag. Kerb side
them to the local hospitals (Pakistani) wastage storage area needs to be impermeable and hard
system. standing with good drainage. It should provide easy
access to waste collection vehicles (Srivastava,
Wastes generated in the process of healthcare 2000).
are composed of verities of wastes including
hypodermic needles, scalpels, blades, surgical Biomedical waste should be transported within the
wastes (cottons & Band-Aids), gloves & safety hospital by means of wheeled trolleys, containers
wares, discarded blood, medicines & body fluids, or carts that are not used for any other purpose.
human organs & other operational wastes &
chemicals etc.
The trolleys have to be cleaned daily. Offsite
transportation vehicles should be marked with the
The other wastes categorized as radioactive name and address of the carrier.
wastes, mercury containing instruments, PVC Biohazard symbols should be painted. Suitable
plastics etc. these are the most environmentally system for securing the load during transport
sensitive healthcare by products & and needs a should be ensured. Such a vehicle should be
greater importance which has to be monitored. easily cleanable with rounded corners. All
(Remy,2001). disposable plastic should be subjected to
shredding before disposing off to the vendor.
Sharps should be collected in puncture proof
containers. Bags and containers for infectious Final treatment of biomedical waste can be done
waste should be marked with the Biohazard by technologies like incineration, autoclave,
symbol. Highly infectious waste should be hydroclave or microwave (Rao, 1995). According
sterilized by autoclaving. Cytotoxic wastes are to

Page 02
to the qualitative study conducted in Islamabad IPCAF score was less than 200 denoting that
the duration of the study was months where the infection prevention and control implementation is
researchers was researching the prescription deficient and significant improvement is needed.
patterns of the doctors to check if they prescribe
the medicines according to the required pattern The median IP CAF score was 117.5 with an
to prescribe the necessary medicines only to interquartile range of 53.75. With the exception of
reduce the wastes by their formation & it was the central sterile services unit at one hospital,
resulted that most pf the doctors were departments at all hospitals failed to meet even 50%
prescribing more than 4 medicines just because of required IPC standards. (Saba Sabul, et al, 2019).
the companies was paying high incentives &
remunerations to increase the sales of the Delivery of sound healthcare services is a challenge
medicines. (Ahmed Latif, et al) for many resource-constrained countries of the
world. Pakistan is also such a country with a poverty
The study found that different hospitals in the headcount ratio of 22.30% (Bank 2005) and where
study area produced about 47 kg of biomedical social health insurance covers only 5% of the
waste on a daily basis, with DHQ Alpuri population (Ahmed and Shaikh 2008). Thus, the
generating the most waste (12 kg/day), followed people have to rely on private healthcare service
by THQ Besham (10 kg/day). Most of the waste providers. Some of these are supported by
collected from the hospitals fell into the category charitable institutions and hence provide an
of non-risk waste (65%), followed by bio-waste affordable alternative to public services. However,
(35%). Several techniques, including burning, Pakistan also has the highest rates of population
sterilization, on-site dumping, and other growth and urbanization in the region (Murtaza
methods, were used for proper deposition of Haider et al. 2014).
medical waste in the study area. However, there
was no specific method of disposing and treating Waste characterization:
biomedical waste (36% of the time) in the current Hospital waste was sorted into two types, namely
study. Furthermore, bio-waste was stored for 1-2 general and biomedical wastes. Biomedical waste
days before disposal in most cases (72%). The consisted of all waste segregated for onward
study also found that the waste produced in the submission to a commercial firm for incineration
hospitals in the study area was primarily and final disposal. It consisted, mainly, of empty
responsible for causing various diseases in plastic drips, used blood infusion bags, cotton
humans, followed by disease in animals and swabs, dressings and plasters, syringes, used
distraction of the study area's ecosystem and testing kits, laboratory sample containers,
natural environment. (Waqar Ahmad1, nosography tubes, and sharp boxes containing
Muhammad Ayub2, Izhar Ul Haq, 2023) needles,
Broken vials, cut glass, etc. General waste
Infection Prevention: consisted of all waste collected for landfilling at
In November and December 2019 at five public the local municipal waste dumping ground. The
sector hospitals of Islamabad. The World Health weighted average general and biomedical waste
Organization’s Infection Prevention and Control generated at the private hospitals were
discovered to be 0.89 and 0.26 kg/patient/day,
Assessment Framework (IPCAF) was used to respectively.
assess the strengths and weaknesses of hospitals
regarding infection prevention and control. Adapted General types of wastes:
tools derived from Centers for Disease Control and
Prevention and Infection Prevention Society were  Risk Waste
used for detailed assessment of various  Non-Risk Waste
departments. Data was analyzed using Microsoft
Excel 2016. Results: In all five hospitals, the total
  Infectious Waste
 Pathological waste
Risk Waste  Sharps
 Radio Active Wastes
 Pharmaceutical wastes
 Genotoxic Waste
 Chemical Waste

 Paper & Cardboards

 Packaging
Non-Risk Wastes  Food Wastes
 Aerosols

Infectious Wastes  Laboratory Work Waste * Waste from Infected patients

 Wastes from surgeries & autopsy * Discarded & disposable materials &
equipment.

Pathological  Tissues * Organs * Body Parts * Fetuses * Blood

Wastes  Bodily Fluids
The Ministry of Environment, Government

of Pakistan has issued a notification about the hospital waste generation load has increased
hospital waste management disposal. This tremendously which generated 143 tons of
notification gives guidelines regarding hospital additional waste only in a form of syringes,
waste management policy; presence of waste needles & safety boxes. (Singh, et al, 2018).
management team and their responsibilities.11
All the hospitals included in our study follow a In the context of Asia, issues regarding the proper
waste management plan made by their management of healthcare waste exist due to the
administration. They also hold a well-trained large population of Asian developing countries,
team supervised by the administrator of the high rates of urbanization and high financial need
hospital. to manage it in a proper way & their failing to
implement the proper waste management practice.
While in contrast few studies carried out in Joshi H. D. (2013).
dental hospitals indicate that they do not hold
any such policy.1,6 A study carried by Khatri, et Waste Segregation:
al, 12 among dental practitioners of different
hospitals of Pune reported that the majority of For better management and handling of different
practitioners were registered with local types of waste, the first step is to segregate the
governing bodies. waste in different categories and assign proper
trained & professional staff for each of the
Healthcare waste (HCW) is a term used for all segregated waste category to protect the
types of waste produced by healthcare facilities, environment & also protect the health of line
research centers, and laboratories during the workers.
diagnosis, treatment, and immunization of
Different medical centers apply different segregation
human beings and animals (Khan et al. 2010;
techniques but the most general & useful tactic is
Pieper et al. 2017)
“Color Bucket”. To make proper waste handling the
color buckets play a vital role in segregation the
According to WHO, healthcare waste can be assigned color to an assign waste can contribute the
categorized into two main classes of task among different individuals & given trainings
Non-hazardous and hazardous wastes. The about the process of disposal or recycles or reuse
non-hazardous waste consists of 75 to 90% of according to the nature of wastes.
total healthcare waste, while the remaining 10 to
25% of the waste is considered hazardous Methodology
waste (Pieper et al. 2017). A case study will be conducted to check the waste
management practices of local areas with the
Globally, proper waste management practices comparison with the major cities of populated
are still lacking in implementation all over the continents, this study will find out the failures &
areas although the regulations and plans have mismanagement of wastes in local area hospitals &
been made. (Kumar et al, 2014). propose significant solutions for the problems of
As of the latest data, 1 in 3 healthcare facilities in waste handlings.
the world is still not safely managing the hospital
waste. Joshi H. D. (2013). Study Type: The study will be conducted in
There are still deficiencies in practices and Qualitative & Quantitative data by interviews,
solutions to reduce the healthcare waste and its surveys & observation based on the experiences of
impact on the health of humans and the professionals & experts also the findings will
environment. conclude the quantitative analysis through various
Especially after the COVID-19 pandemic the authentic data bases of Government & health sector
to check the ratio of waste management across the
city Karachi, The study was from Nov 2023 to
January 2024 in 2 Govt. & 2 Private hospitals in Methods to manage waste:
Karachi, the selected hospitals are playing major There are many methods to manage the waste &
role in the medical facilities across the city & have a dumb & reuse it according to the country’s policy but
lot of contribution in waste management. there are some basic methods to segregate the
waste, dumping or burn it with proper handling &
Research Design: A cross sectional research to process.
 Ash Pit
find out the differences between developed &
 Needle Pit
developing countries hospital waste management  Pit Brutal
practices.
Ashpit:
Characteristics of surveyed hospitals, Karachi A process were the garbage and wastes can be burn
The high income countries generate an average up in responsible burning storages or facilities and turn
to 0.5 kg of hazardous waste per hospital bed per them into Ashes.
day; while low-income countries generate an
average 0.2 kg.

Data Collection & Analysis:

For this research study, data were collected from the
3 renowned Government & 2 renowned Private
hospitals to check their waste management system
& policies which they made to reduce reuse (If
Possible) & re cycle wastes to reduce the impact on
environment & enhance resource utilization and
allocation.

Variables Govt. Pvt.

Hospi Hospitals
tals (n=2)
(n=3)

Bed Capacity 1500 200

Approx. Daily 2000 800

Patient
Types of Wastes Produce at different
Medical centers

Healthcare facilities generate more dangerous causing chemicals. Even if feeding supplies,
biomedical waste that can lead to a variety of paperwork, and packaging materials
ailments in humans and other living things. The are included in the non-risk trash, they do not
biomedical waste was divided into two groups: pose a danger of spreading any illnesses. Bio-
non-risk bio-waste and risked bio-waste. The risk waste, both hazardous and non-hazardous, was
of bio-waste comprises trash having the capacity gathered inside the research area.
to create numerous forms of diseases since this
garbage contains diverse types of cells, tissues, The study's indicated that the trash generated by
body parts, medications, and other infection- the area's hospitals is mostly to blame for a
variety of human illnesses, as well as diseases in animals and disturbances to the region's
ecology and natural surroundings.

Hospital biomedical waste is more dangerous

and can lead to a variety of illnesses in humans The correct management of biomedical waste is
and other living things. There were two one of the most important issues facing the
classifications for the biomedical waste: world today. It has lately become a major worry
biohazardous waste and non-hazardous waste. for authorities in hospitals, nursing homes, and
Hospital staff interviews were used in the current the environment. Because improper handling of
study to collect data on the effects of biomedical biomedical waste can have serious
waste produced by hospitals. consequences for both the environment and
human health, there is cause for worry.

An announcement on the disposal of hospital

waste management has been released by
Pakistan's Ministry of Environment. The
hospital's waste management policy, the team's
presence, and their responsibilities are all
outlined in this notification.11. An administration-
Results & Discussions: made waste management strategy is followed by
The results indicate that facility available for on- every hospital that is part of our research.
site treatment of biomedical waste in the Additionally, a hospital administrator oversees a
hospitals and chances of prevalence of different well-trained workforce that they manage. Few
diseases have positive correlation because our Page research,
08 however, conducted at dental
value of significance in t-test (0.38) is higher hospitals suggest that they do not have this kind
than 0.05. of policy.1.6% Most dental professionals in Puna
were registered with local regulatory  Management of wastes
organizations, according to a survey conducted  Should acquire proper equipment
by Khatri et al. (12) among practitioners at  Must apply segregation & slot colors to
several hospitals. the bags or containers.

It is imperative that biomedical and hazardous Limitations of the study:

trash be separated at the point of origin to The study was conducted by extracting data
prevent the intermingling of these types of through observations, personal interviews & past
garbage with ordinary household waste. It is events of the hospitals any type of
advised to use color-coded bags or containers misinformation should be guided by the interview
for various infectious waste kinds so that the can be discussed at argumentative studies, the
garbage may be tracked from its source to its margin of level should be considered
disposal location. accordingly.
The data were collected by 2 private & 3 Govt.
All hospitals employ color-coded waste hospitals results & discussions are shared
segregation systems for contagious and above, any type of future difference can be
noninfectious materials, albeit it was not made covered by the time & resources.
clear which color codes were being followed. We
utilize blue color bags for non-infectious garbage
and yellow color tags for infectious waste at our Way Ahead:
hospital. Sharps are likewise kept in well- The future correlated research can be discussed
labeled, puncture-proof containers. about the AI implementations in the medical
industry & their applications, their pros & cons &
Prior to disposal, medical waste should be the financial investments needs to implement the
Page 09
handled as little as possible, and waste handlers advanced technology to reduce, reuse, and
should be outfitted with the appropriate safety recycle waste and proper disposing off the
equipment to assist prevents accidents from the wastages.
waste they collect.
The trash handlers need to dress in protective Conclusion:
eyewear, industrial aprons, heavy-duty boots, We draw the conclusion that the hospital waste
face masks, and heavy-duty gloves. generation rate in the studied city was
comparable to the national average. It was,
Every hospital that took part in the current study nonetheless, less than those seen in other
said that they had given the waste handlers emerging nations.
safety clothes. On the other hand, according to a
study done in Karachi, trash workers received Hospitals evaluated had different policies
protective clothes from two of every five regarding the transportation, storage, final
hospitals. Thirteen However, Mushtaq A et al. 6 disposal, and segregation of waste. The city's
claimed that hospital administration had not sole public hospital handled garbage in a
given any appropriate protective clothes. comparatively ineffective manner. In several of
the hospitals, pathological objects were also
Recommendations: found in the general garbage.
 Hospital must have a monitoring tool
 Hospitals have a cost assessment tool This made it more difficult to sift through general
for wastage and medical garbage. The report also revealed
 A rapid Assessment tool that trash workers were not properly equipped
 A policy Paper with safety gear.
 Guidance to develop plans
The fact that some of the wards had occupancy Assessment of Biomedical Waste Segregation, Safe
rates higher than 100% and others with Disposal, and Effective Management Techniques: A
occupancy rates lower than 50% suggests that Study in District Shangla, Khyber Pakhtunkhwa,
Pakistan Waqar Ahmad1 , Muhammad Ayub2 , Izhar
the hospital needs to improve its resource
Ul Haq 3
management. In a similar vein, medium-sized
and smaller private hospitals must concentrate [[email protected]] 1 [The University of Haripur]
more on enhancing waste management in order 2 [The University of Haripur 3 [University of Poonch
to match the efficiency of public hospitals. Rawalakot]

Staff training is necessary to do this, as nursing Infection prevention and control situation in public
staff at private hospitals had a much lower level hospitals of Islamabad
of awareness compared to their counterparts in Saba Savul1, Farida Khurram Lalani1, Aamer Ikram1,
Muhammad Amjad Khan1, Mumtaz Ali Khan1, Jamil
public hospitals. In this sense, staff awareness
Ansari1 1 National Institute of Health, Islamabad,
and knowledge may increase in parallel with
Pakistan.
hospital waste management performance and
efficiency. The Journal of infection in developing countries

However, this study's scope can be expanded in

the future and utilized for benchmarking and Assessing knowledge, performance, and efficiency for
comparison, allowing for the conduct of hospital waste management—a comparison of
comparable surveys in other regions of the government and private hospitals in Pakistan
nation as well as within a larger regional context.
Mustafa Ali & Wenping Wang & Nawaz Chaudhry &
The results of the analysis may be utilized to Yong Geng & Uzma Ashraf
inform public policy that is aimed at ongoing Environ Monit Assess (2017) 189:181
evaluation and monitoring of healthcare waste Page 10
management if sufficient data is available. https://pafjpmc.org/who-we-are/about-jinnah-
postgraduate-medical-college/

https://pubmed.ncbi.nlm.nih.gov/22455273/

WASTE MANAGEMENT AT DENTAL HOSPITALS

References: OF RAWALPINDI – ISLAMABAD REGION
(Salma Khalid1*, 2021) Mustafa Ali & Wenping Wang & Nawaz Chaudhry &
Current practices of waste management in teaching Yong Geng & Uzma Ashraf - Received: 8 November
hospitals and presence of incinerators in densely 2016 /Accepted: 16 March 2017 # Springer
populated areas Salma Khalid1*, Najibul Haq2 , Zia- International Publishing Switzerland 2017
ul-Ain Sabiha3 , Abdul Latif1 , Muhammad Amjad
Khan4 , Javaid Iqbal4 and Nowsher Yousaf4 https://www.dawn.com/news/1750784

Influences of Pharmaceutical Industry on Prescription Analysis of physicochemical parameters of hospitals

Practices in Public and Private Hospitals of wastewater: a case study in Faisalabad, Pakistan
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Ahmed Latif1 , Muhammad Siddique Ansari2 , and Asma Bibi Department of Zoology, Wildlife &
Muhammad Ibrahim Ansari3 , Rabia Malik4 , Abdul Fisheries, Faculty of Sciences, University of
Ahad Sohoo5 , Firdous Sohoo6 , Umaira Zaib7 Agriculture Faisalabad-Pakistan

Business Recorder (18 Aug, 2023). Accuracy study of image classification for reverse
vending machine waste segregation using
Exceed Journal of Biological and Computer Sciences convolutional neural network
Tan Hor Yan1,2, Sazuan Nazrah Mohd Azam1,2,
Zamani Md. Sani1 , Azizul Azizan3 1Faculty of
Technology and Electrical Engineering, Universiti
Teknikal Malaysia Melaka, Melaka, Malaysia 2Center
for Robotics and Industrial Automation, Universiti
Teknikal Malaysia Melaka, Melaka, Malaysia
3Advanced Informatics Department, Razak Faculty of
Technology and Informatics, Universiti Teknologi
Malaysia, Kuala Lumpur, Malaysia

Application of Multi-Criteria Decision Approach in the

Assessment of Medical Waste Management Systems
in Nigeria

The interplay of circular economy with industry 4.0

enabled smart city drivers of healthcare waste
disposal

Ankur Chauhan a , Suresh Kumar Jakhar b, * ,

Chetna Chauhan c a Indian Institute of Management
Bodh Gaya, Bihar, India b Indian Institute of
Management Lucknow, Uttar Pradesh, India c Indian

Institute of Management Rohtak, Haryana, India

Journal of Cleaner Production
Mmemek-Abasi Etim * , Sunday Academe, PraiseGod
Emenike and David Omole
The Study on Hospital Waste Management Practices
Among the Different Hospitals of Bheemdatta
Municipality of Kanchanpur District, Far-Western
Region, Nepal Umesh Chand1 , Mahesh Bahadur
Mahara2 , Amit Bhatta3 , Ankita Joshi4

1Assistant Lecturer, Far-West University,

Mahendranagar Kanchanpur 2Assistant Professor,
Amity College, Pokhara University, Mahendranagar
Kanchanpur 3Assistant Lecturer, Amity College,
Pokhara University, Mahendranagar Kanchanpur
4Health Care Student, Amity College, Pokhara
University, Mahendranagar Kanchanpur

Utilization of a waste audit at a community hospital

emergency department to quantify waste production
and estimate environmental impact
The Journal of Climate Change and Health
Sarah Hsua , Swechya Banskotaa , Winston
McCormicka , Julia Capaccib , Christian Bustamanteb
, Katelyn Morettia , David Wiegna , Kyle Denison
Martina,b, * a Warren Alpert Medical School of Brown
University, 55 Claverick Street, Providence, RI, USA,
02903 b Department of Emergency Medicine, Kent
Hospital, 455 Toll Gate Road, Warwick, RI, USA,
02886