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Abstract
Medical Establishments in Libya
Libya is one of developing countries; it has a large area that is around 1,750,000 square kilometres with different Medical Establishments (85 general hospitals 25, special centres, and 1250 different size polyclinics) distributed in the whole country. All of them generate medical waste with poor management which, in turn, exposes health care workers, waste handlers, and the community to the hazards of infections, toxic effects and injuries. It may also have environmental damage. At present, many rural hospitals and clinics discard their medical waste in trash which, in return, has got its great risk of spreading diseases among scavengers and population. Some bury their waste which likely gets into groundwater or causes surface contamination. Others bum their waste in improper incinerators which consequently exposes the downwind communities to toxic byproducts such as dioxins and mercury, and generating potentially hazardous ash. As immunization and health programs expand the problem of the medical waste treatment, disposal becomes critical. No previous study has tackled the current problem, so it was attempted, through the present study, to set up a sound managerial approach and to use appropriate technologies and to show up the health risks resulting from inadequate management ofHCW.
Tripoli Medical Center
Tripoli Medical Center is the place where the study was carried out. It is one of the gigantic health achievements of the Great EI-Fateh Revolution for the benefit of the Libyan Arab People. It is also considered one of the most advanced health establishments with the provision of high quality medical care and it is an advanced center for medical education and training of the medical and para-medical staff
Location:
The Center is located in Tripoli. It is constructed on a total area of (278150) sq. meters. The total covered area is about (150000) sq. meters.
The Center is also distinguished by its nearby location to EI-Fateh Medical University. There is 2000 employees in the hospital distributed in different health works.
o The total numbers of beds are 1438.
Aims of the work
1- To study medical waste management in Tripoli Medical Center.
2- To examine and investigate personnel at risk engaged in management of medical waste generated from Tripoli Medical Center.
3- To assess the health risks associated with the management of medical waste of Tripoli Medical Center.
4- To recommend an optimal medical waste management in Tripoli Medical Center, which
could be implemented nationally as well.
Materials & Methods Study Setting:
The study has been conducted in the Tripoli Medical Center. Study Design:
Descriptive study.
Target Population:
- Personnel engaged in support services in medical waste management of the hospital.
- Personnel engaged in medical waste management facilities in the municipality of
Tripoli City.
Sampling Design:
The sampling size has been divided into two groups, three hundred HCWWs and three hundred controls. The HCWWs have been selected as follows. Two-hundred fifty persons responsible for medical waste collection in the different departments in Tripoli Medical Center who are with direct contact with medical waste and they have a minimum working period with not less than 6 months; fifty persons working in the Municipality medical waste management facilities are responsible for transportation of medical waste from the hospital to the disposal site selected with the same period of work..
The control is three hundred persons, chosen by random sampling technique from persons who are not in an indirect contact with the medical waste.
Data Collection:
The data collection is classified into environmental data and human data.
Environmental Data:
1- Medical waste management system was investigated starting from the onset of generation till final disposal.
2-A meeting has been fixed up with the manager engineer who is responsible for the environmental unit in the hospital. He has arranged for a big meeting with the selected workers from each floor with the head of the nursing staff to explain the aim of work and the program and the plan for segregation and collection of medical waste generated every day and to distribute the instruction needed for all the hospital staff especially nurses so as to start waste segregation in different containers according to the label. The containers should be left in place for 24 hours until the next day. Then the waste should be weighed before being transferred. Colored plastic bags could not be arranged because this will take time for manufacture and extra money needed for big quantity.
The containers and the plastic bags were distributed in the different departments. 500 containers of different sizes and 8000 plastic bags were used. A team of 3 environmental engineers, 10 trend workers, and two medical doctors who have had a previously training course in medical waste management in WHO program in Libya participated in the study.
3- The different components of the medical waste have been collected, segregated, sorted out, and weighed every 24 hours starting from 08:00 am up to the next day 08:00 am. This process has been done every week throughout the whole period of the study starting from Saturday to Saturday. This procedure has been carried out according to the sheet for assessment of waste generation. It has been done in each department of the hospital according to the classification of WHO. The waste generation rate has been calculated for per bed and per patient.
4- The Generation rate has been measured per day. The collected waste has been weighed to determine the total medical waste generated in kg/day.
Human Data:
All personnel in the study sample have been exposed to the following:
1- The manager engineer, the head of the nursing staff, and the different employees, concerned with the administration, have all been interviewed in order to collect information about inpatients and outpatients, waste collection, segregation, storage, insite treatment, out-door transportation, final disposal, and any other alternative methods that they have been applied in the management.
2- Interviewing questionnaire for HCWWs has included:
• Personal data, education, duration of work, history of personal habits, past medical history, history of previous infection or diseases, history of previous blood tests for HBV; HCV; and HIV, safety measures related to the medical waste management, immunization, training, knowledge about the mode of the transmission of infection, and personal protection devices (PPDs).
• General examination includes: general appearance for anemia, measuring of blood pressure examination of the hand and the exposed area of skin for any abnormal changes.
3- From each HCWWs and control group a blood sample has been taken and tested for HIV, HBV, and HCV in the central laboratory of the hospital. Every sample has got a separate code. All the tests were done by Enzyme Linked Immunosorbent Assays (ELISA/EIA).
Statistical Analysis:
Statistical analyses have been conducted by using PC with the software SPSS (Statistical Package for the Social Sciences) version 13.0. The 0.05 level has been used as the cut off value for statistical significance.
Results & Discussion
Segregation of Medical Waste:
Segregation is one of the most important procedures to successful management. It has been found that only 10-25 % of the HCW is hazardous. By segregation, the treatment and disposal costs can be reduced; and, according to the information given by WHO, segregating the hazardous from the none hazardous waste should reduce the risks of infecting the workers handling HCW. In Tripoli Medical Center, the segregation has not
taken place as it is recommended by WHO.
Waste Collection:
The collection of waste inside each department was done in wheeled container without differentiation between types of waste and without labeling. The container is leakand puncture-proof with fitted cover and it follows the WHO criteria for waste container specifications. The use of rigid containers such as a two-wheeled 240-litre container with a lid is recommended for temporary storage within or near these areas.
Labeling:
This precaution has not been accounted for in Tripoli Medical Center.
Period of Collection:
The schedules for collection is every 12 hours in two shifts in all the departments of the hospital and this is advised by the WHO (24 hours in hot climate and 48 hours in cold climate).
Treatment and Disposal
Each type of HCW needs specific treatment. However, in Tripoli Medical Center, there is the facility to manage at least the infectious waste but they do not do it because they do not have a policy for this purpose. Moreover, there is no infectious committee. The radioactive waste has a special program from the Local National Center for Energy Research.
Waste Generation
Waste generation in Tripoli Medical Center is 403.5 kg daily. Waste generation is (0.47kglbed/day) and (284.37 kglbed/year).The amount is calculated as daily production per patient and per bed and 0.1 kg/patient/day.
Distribution of the Studied HCWWs According to the Presence of Hepatitis Infection in Relation to Control
The result of serological test for HBV, HCV in HCWWs and control. It has been found that 2.3% of HCWWs are positive for HBV, 2.7% are positive for HCV and 95% are negative. The corresponding figures among the control group are 0.3 % , 0%, and 99.7%, respectively .The result of the test is significantly different in both groups. The HIV is negative in both groups.
Recommendations.
An HCWM plan should consist of a situation assessment and the identification of problems and needs. It should also include HCWM improvements, the allocation of human and financial resources, and arrangements for implementing the improvements to sustain the operation of the HCWM system. It is worth emphasizing that each health care establishment has to develop its own HCWM plan, depending on its size, type, and nature of medical activities. Thus, an HCWM plan for a cancer treatment hospital will differ from the plan for a maternity hospital, for example.
In many lower- and middle-income countries, shortage of funds discourages managers from preparing plans. When a bilateral or multilateral project is proposed, planning starts to get some attention.
This is unfortunate, because planning should be a regular and continuing activity. Therefore, it is recommended that health care establishments at least initiate the preparation of a plan, however simple (e.g., based on the WHO minimal programme), for the short or medium term that is in line with the available resources and then gradually improve it. A simple plan will be better than no plan.
Preparing and implementing a HCWM plan requires developing sequential steps as follows:
1- Review of policy.
2- Assessment (situation analysis). 3- Formula of recommendations. 4- Prioritizing of objectives.
5- Determination of resources needed 6- Elaboration of national action plan.
7- Set up strategy for NAP implementation. 8- Implementation of the NAP
9- Monitoring and evaluation of NAP.