Original Article

Assessment of Hospital Waste Management Practices in Public and Private

Healthcare establishments of Rahim Yar Khan
1 2 3
Bismillah Sehar, Samina Waseem, Naeem ul Hassan

Abstract
Background: Hospital waste is considered dangerous as it may pose undesirable effects on human health.
Objective: To assess the hospital waste management practices in private and public-sector healthcare establishments
at district Rahim Yar Khan.
Methodology: This cross-sectional study was conducted in conveniently selected 34 healthcare establishments
(HCEs) of district Rahim Yar Khan, from 1st January to 30th March 2018. Healthcare establishments included wards of
a tertiary care hospital, basic health units, private clinics and hospitals of the district. Variables included were number
of beds, color coding, hospital waste segregation at source, appropriate transportation vehicle, storage site and
vehicles. SPSS version 21 was used for data entry and analysis.
Results: Twenty-six (76.5%) of the healthcare establishments have waste segregation at source and 1 (2.9%) of HCE
have no proper color coding and 21 (61.8%) of the HCEs have workers wearing protective gears and fifteen (44.1%)
have appropriate vehicle for waste transport. Waste disposal was incineration in nineteen (55.89%) of HCEs. Eleven
(57.9%) of the public sector HCEs were following segregation. (p=0.00) In private sector method of disposal of waste
was mostly land disposal 7 (46.7%) while in public sector HCEs, was mostly incineration in 14 (73.7%%). (p=0.00)
and out of total 34 HCEs, training about handling and waste management were given in only one (6.6%) of Private
Hospitals.
Conclusion: Most of the healthcare establishments have a good waste segregation, baskets with color coding,
individual bed side bins available however personal protective gears, waste transport system and waste disposal
methods were deficient. There was a mixed pattern of individual steps of waste handling among private and public
sector hospitals.
Key words: Hospital waste, Practices, Public, Private, Healthcare Establishments

Article Citation: Sehar B, Waseem S, Hassan N. Assessment of Hospital Waste Management Practices in Public and Private
Healthcare establishments of Rahim Yar Khan. JSZMC 2020;11(1):34-39

Introduction of this is lack of awareness or lack of funds and labor

Hospital waste is defined as "any solid waste that for this purpose. In developing countries, awareness
is generated in the diagnosis, treatment, or and information on hospital waste management
immunization of human beings or animals, in practices and needs in terms of its segregation at the
research pertaining thereto, or in the production or source, collection at source and storage in separate
testing of biological."1 In most of the developing specified areas, purpose built transportation and
3
countries, solid waste has not got that sufficient appropriate disposal is lacking as well. There is a
attention, which is necessary. In many countries, careless attitude regarding hospital waste and the
hazardous waste, which includes medical waste is practice of indiscriminate disposal of the hospital
usually handled and disposed of along with waste by healthcare establishments is wide spread,
domestic waste, thus creating and a source of a additionally laboratories and research institutions
great health risk in municipal workers, public and can contribute to the transmission of so many
2
local environment. Solid waste handling or devastating diseases such as hepatitis and AIDS
management is yet one of the major challenge for (HIV) for those who handle hospital and also among
healthcare facilities where related staff working the general population.4 Inappropriate medical waste
threre and surrounding population are unaware of disposal incidents and the fear of acquired
the hazards it can cause. Perhaps the major cause immunodeficiency syndrome have been constantly

1. Frontier Medical College & Dental College, Abbottabad, Pakistan.

2. Department of Community Medicine, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan, UHS, Lahore, Pakistan.
3. Medical Specialist, CMH, Rawalpindi, Pakistan.

Correspondence: Dr. Bismillah Sehar, Assistant Professor, Frontier Medical College & Dental College, Abbottabad, Pakistan.

Email:drseharnaeem@gmail.com Received: 10-01-2019 Reviewed: 05-07-2019

JSZMC Vol.11 No.01 34

 Original Article

drawn national attention and so the actions, to management of waste from injection activities,
5
medical or hospital waste management practices. management of waste at primary health care centers,
Hospitals or health centers are setting where sick management of waste produced from immunization,
8
people of having different diseases and victims and in emergencies. In 2002, the results of WHO
encountering accident are given healthcare conducted an assessment in many developing
provided by the medical experts. Every human countries and it reported that the proportion of the
being who faces any health problem, is expected to healthcare settings not using proper waste disposal
protect his or her life, by visiting the healthcare methods is quite poor and ranges from 18% to 64%.9
center. This is obviously the reason that these Pakistan is currently in phase of creating demand by
healthcare centers or establishments would more and more awareness compaigns and has started
generate wastes that are hazardous to human implementing hospital waste management
health and the environment. Medical waste procedures and techniques. The concerted efforts are
includes the materials which are produced from not upto the mark yet, and if the attitudes of the staff
the medical treatment and scientific research.6 and the public towards this, is not changed,
10
Hospital waste management is described as the situasation is not going to change soon. The
management of hospital waste, which is produced unauthorized reuse and recycling practice
by hospitals using evidenced based procedure and particularly of disposable syringes is a very serious
techniques that control the spread of diseases. The problem in the world. It poses a potential danger to
11
lack of this management results in the spread of almost everyone. In many parts of Pakistan this
many diseases as both the infectious and visible mishandling has led to uncontrolled spread of
noninfectious waste may mix up or is improperly disease. Keeping in mind this situation, and identify
handled. Hospital waste can be divided into either the problems and suggest appropriate medical waste
two main groups or into many categories based on management system, this research aimed on the
their pathogenicity and other variables. WHO has objective to assess the practices of the hospital waste
classified it into: sharps, infectious, pathological, management methods practiced in healthcare
radioactive, pharmaceuticals and others. Improper establishments of district Rahim Yar Khan.
w as t e man ag emen t can lead to s er io u s
environmental pollution, unpleasant odors for Methodology
humen being, and infestations by the insects, This was a cross sectional study, carried out in the
rodents and worms, and it could results in the public and private sector healthcare establishments
transmission of diseases such as typhoid and viral (Wards, Clinics and hospitals) of Rahim Yar Khan,
hepatitis, through injuries which results from January to March, 2018. A total of 34 healthcare
sharps or needles that are contaminated with establishments (hospitals, wards and clinics) were
human blood or secretions. The major sources of included by convenient sampling technique in this
such type of wastes are mostly hospitals, clinics, study. Owner/ In charge of public and private sector
laboratories, blood transfusion center and healthcare establishments were approached for data
hemodialysis centers, maternity homes and collections. Inclusion criteria: All the public and
7,8
mortuaries. Medical waste is also produced in private healthcare establishments of district whose
amny other establishments like general owner/ in charge who gave informed verbal consent
practitioner and dental offices, acupuncture, home for data collection. Exclusion criteria: Owner/ In
7
care services for the sick, drug injecting addicts. charge who did not showed willingness for inclusion
WHO has assigned methods for the management in study. Data was collected from owner/ In charge of
of hospital waste. It includes minimization, the hospital by using a pretested predesigned
segregation, storage and treatment. Treatment of questionnaire. Variables included were: Number of
the hospital waste could be made by autoclave or beds, Nature of hospital, Color coding of baskets,
burning by incineration. Final disposal should be Segregation done, Presence of individual bins,
made by sanitary landfills. Safe management of Methods of disposal, training to waste handlers, and
hospital waste generated at health-care Number of persons. Data was presented on variables
establishments should include a cost wise like; Number of beds of hospital, collection of waste,
assessment and rapid assessment procedure, a segregation of waste, disposal, transportation, and
policy guidelines, guidance national plans for the storage of waste. Mean and standard deviation for

JSZMC Vol.11 No.01 35

 Original Article

numerical variables like number of beds of private hospitals were providing individual bins at
hospital and Variables like hospital waste each bed. Individual bins were available in only
collection, segregation, and disposal were thirteen out of total nineteen of the public-sector
presented as percentage. SPSS version 21was hospitals. (p=0.01) Appropriate vehicle for
used for data entry and analysis. Ethical approval transportation of waste was absent in about 70% of
was sought from Institutional Review Board and the public-sector hospitals while in up to 60% of the
informed verbal consent was taken from hospital private hospitals had appropriate transportation
in charge. vehicle. (p=0.09)

Results Table I: Practices of waste segregation at source,

The total number of beds all 34 healthcare color coding, bins for each beds, transport
establishments (HCE) was 33±5. Fifteen (44.1%) facility, training and waste disposal methods.
of HCEs were private clinics and 19 (55.9%) were (n=34)
public hospital wards. Over all thirty three Variable Frequency Percentage
(97.1%) had proper color coding system available.
Twenty-six (76.5%) of the HCEs were having Waste Segregation at source
their hospital waste segregated at source.
Yes 26 76.5
Individual bins were available in twenty-eight
(82.4%) of HCEs. Half of the HCEs i-e 50% of No 8 23.5
hospitals and clinics were using plastic containers.
In twenty one (61.8%) hospitals, sanitary workers Color Coding
had protective gears. (Table I) Face masks were Yes 33 97.1
being in practice by hospital waste handlers in
nineteen (55.9%) of the HCEs, followed by use of No 1 2.9
boots and hand gloves in five (14.7%) and ten
Individual Bins
(29.41%) respectively.
In only fifteen (44.1%) out of thirty-four of HCEs, Yes 28 82.4
appropriate vehicle for transportation of waste
from ward to storage site was available. In twenty- No 6 17.6
four (70.6%) hospitals and clinics, storage site of Protective gears
the waste collected was present while in ten
(29.4%) hospitals, it was outside the hospital and Yes 21 61.8
clinic's premises. In only four (11.8%) of HCEs,
No 13 38.2
waste was collected most frequently 6 times a day
while in three (8.8%) 3 times a day, in nine Appropriate transport
(26.5%) twice a day and in eighteen (52.9%) waste
was collected once a day. In nineteen (55.89%) out Yes 15 44.1
of 34 hospitals, waste was incinerated while in No 19 55.9
nine (26.47%) and six (17.64%), it was dumped in
land disposal and openly burnt respectively. Method of Disposal
A manager was allocated to look for the hospital Land disposal 9 26.5
waste management in twelve (35.3%) of the HCEs
(Hospitals and clinics). Waste was segregated at Incineration 19 55.9
source in all fifteen (100%) private-sector
hospitals while in public-sector only 11 (57%) of Open burning 6 17.6
the hospitals followed the rule for segregation of
waste. (p=0.004) Proper color coding of bins was
being done in fourteen (93.3%) of Private
Hospitals while all of the public-sector hospitals
were following color coding with 100% results
(p=0.1). Regarding bins availability, all of the

JSZMC Vol.11 No.01 36

 Original Article

Table II: Comparison of private and public-sector healthcare establishments about waste
segregation, disposal and training of healthcare handlers
Variable Waste Management Step P value
Segregation at source Yes No Total
Private 15 (100%) 0 (0%) 15 (100%)
Public 11 (57.9%) 8 (42.1%) 19 (100%)
Total 26 (76.5%) 8 (23.5%) 34 (100%) 0.004
Nature of Disposal Land disposal Incineration Open burning Total
Private 7 (46.7%) 5 (33.3%) 3 (20%) 15 (100%)
Public 2 (10.5%) 14 (73.7%) 3 (15.8%) 19 (100%) 0.002
Total 9 (26.5%) 19 (55.9%) 6 (17.6%) 34 (100%)
Training given Yes No Total
Private 1 (6.6%) 14 (93.4%) 15 (100%)
Public 0 (0%) 19 (100%) 19 (100%) 0.001
Total 1 (3%) 33 (97%) 34 (100%)

Figure I: Problems faced for hospital waste Discussion

handling In Pakistan the overall practices of hospital garbage
disposal are poor and result in an incalculable spread
of infectious diseases.10,11 Due to the insufficient
number of workers, lack of training among those
workers along with lack of proper equipment, proper
garbage disposal poses to be a problem. In this study,
methods of garbage disposal were noted by a
convenient sampling technique. A total of 34 HCEs
were surveyed, out of these 34 only 26 segregated
waste.
In a study conducted in Karachi 8 teaching hospitals
were surveyed out of which only 2 hospitals had
proper waste management including segregation on
spot and color coding. Other than that, few had
Figure I shows that sixteen (47.1%) considered incinerators working.12 This is comparable to our
lack of training as the problem in effective waste study in which 76.5% segregated the waste at source,
management while seven (20.58%) considered 55% used an incinerator and 82.4% had individual
lack of resources as a problem. Seven (20.58%) of bins. Whereas 2.9% had no color coding, and 23.5%
total 34 of hospitals and clinics considered lack of were not segregated waste. Our study also concluded
responsibility as a problem in waste management that 18 out of 34 used plastic bags whereas 19 used
while only four (11.74%) regarded lack of staff as plastic containers and 1 used metal container. In 21 of
an issue. these 34 hospitals, the sanitary workers were wearing
protective gear and 13 were not. This gear included
Table II shows the practices of waste segregation 79.4% wearing face masks, 29.4% wearing boots and
at source, method of disposal of waste and traing 55.9% were wearing hand gloves.
about handling and waste management at private In a study in Rawalpindi and Islamabad in Pakistan a
and public sector HCEs. total of ten hospitals were surveyed which included 6
public and 4 private hospitals. Neither had proper
waste disposal methods and only 4 disposed of
hazardous waste separately. There was no color
coding and no waste disposal trolleys. Only one
public sector hospital had an incinerator whereas the

JSZMC Vol.11 No.01 37

 Original Article

private hospitals maintained an open dumping centers and 95% of clinical laboratories the
13
wasteland. In another case study in Dental segregation of waste was done. This is comparable to
hospitals of Pakistan, Rawalpindi and Islamabad, our segregation practices in that study only 26
a total of five hospitals were surveyed. Out of (76.5%)of them have their waste segregated at the
18
these five, four had color coding and segregation source and 8(23.5%)hospitals don't do so.
at source. When the incinerator facilities were
surveyed 2 hospitals had incinerators whereas Conclusion
three didn't. Area of storage was present in only Most of the healthcare establishments that included
14
one hospital. wards, clinics and basic health units, have a good
In a study in Bahawalpur regarding medical waste waste segregation, baskets with color coding,
managing practices, 48 hospitals were surveyed individual bed side bins available in our study
(24 public and 24 private). In public sector however personal protective gears, waste transport
hospitals, only half of hospitals were segregating system and waste disposal methods were
hospital and medical waste from other common insufficient. There was a mixed pattern of individual
waste while in private sector healthcare steps of waste handling among private and public
establishments it was practiced only in 16.6% sector hospitals, some steps like segregation of
settings. This was not even near to satisfactory waste, and individual bed side bins were practiced
situation and similar situation was noted in our significantly better in private hospitals whereas,
study. Interestingly as in our study, separate area waste disposal by incineration and transport
for segregation was labeled and practiced all availability for waste was better in public hospitals.
public-sector hospitals and more than half (58%)
private sector hospitals. They reported that proper Authors Contribution: BS: Conception of work
containers for the waste segregation, color coded and Design of Work. SW: Drafting and Revising.
baskets for types of hospital waste and use of NH: Analysis of data and drafting.
protective gears by waste handlers in public and All the authors gave final approval for publication
private sector was 100%, 75%, 33.3% and 58.3%, and agreed to be accountable for all aspect of work.
33.3%, 25% respectively. These findings are also Conflict of Interest: None
close to our results in many aspects. Additionally,
Sources of Funding: Self
in public sector establishments, proper container
for transport of waste within hospital and storage
area for waste was present in all public-sector References
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