Medical wastes characterisation in healthcare institutions in Mauritius

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Abstract

This study was initiated to characterize solid and liquid wastes generated in healthcare institutions and to provide a framework for the safe management of these wastes. The project was carried at three major medical institutions, namely, the Jeetoo Hospital, the Sir Seewoosagur Ramgoolam National (SSRN) Hospital and the Clinic Mauricienne.

A waste audit carried out at these sites revealed that approximately 10% of solid wastes was hazardous in nature, consisting mainly of infectious, pathological and chemical wastes. The average amount of hazardous wastes per patient per day was found to be 0.072 kg at Jeetoo hospital, 0.091 kg at SSRN hospital and 0.179 kg at the clinic. The amount of hazardous wastes generated as a function of the number of occupied beds was found to follow a relationship of type y = 0.0006x  0.19, where y was the amount of hazardous wastes generated per bed per day and x was the number of occupied beds. The waste quantifying process also revealed that at SSRN Hospital, 0.654 m3 of water was being consumed per patient per day and the amount of wastewater produced was 500 m3/day. Further analysis revealed that the wastewater was polluting with chemical oxygen demand (COD), biological oxygen demand (BOD5), total suspended solids (TSS) and coliform content well above permissible limits.

Introduction

Mauritius is a small island developing state of around 1800 km2, situated in the Indian Ocean at a longitude of 22°E and latitude of 60°S. It has a population of 1.12 million inhabitants and a GDP at basic prices of 5406 US$ in 2003 (National Accounts Estimates, 2003). The island is divided into five regions with one principal hospital, one district hospital and several area community health centres. Healthcare waste management falls under the responsibility of the Ministry of Health although the Department of Environment, Ministry of Environment through the Environmental Protection Act (EPA, 2002) controls activities such as disposal of wastes. Several other pieces of legislation such as the Public Health Act 1925 and the latest Standards for Hazardous wastes Regulations (Environment Standards, 2001) enacted in September 2001 require health care institutions to safely manage their wastes on the island. Furthermore, Mauritius signed the Basel Convention in 1993 and has the obligation to control transboundary movement of wastes.

Medical or healthcare wastes have witnessed an increase in the past ten years due to the increased number and size of healthcare facilities, medical services and use of medical disposable products. There are around twelve regional hospitals situated in the northern, southern, eastern and central parts of the island with a total bed capacity of around 3819 (MoH, 2000). The main hospitals with in-house patients in general medicine and surgery, obstetrics, gynaecology and paediatrics are shown in Table 1.

Medical wastes, if not properly handled and disposed of, carry high risks of infection and injury and may represent serious health hazards to health personnel. The management of healthcare wastes in many low to developed countries is often poor and fraught with difficulty (Rushbrook et al., 2000, UNEP, 1996, Pruess et al., 1999). In Mauritius, the infectious part of healthcare wastes has traditionally been burnt on site in incinerators while the non-infectious part is mixed with the domestic waste stream and disposed of at the sole sanitary landfill on the island.

Although Mauritius is currently implementing the Standards for Hazardous Wastes Regulations 2001, the framework for managing healthcare wastes in Mauritius is inadequate. Information on the amount of wastes generated in healthcare institutions is not available currently. In the absence of proper data, it is impossible to design treatment facilities or to establish a framework for managing the health care wastes.

This paper aims to characterise healthcare wastes in public and private institutions in Mauritius, in view of designing proper treatment facilities and developing a framework for managing healthcare wastes.

Section snippets

Methodology

Two hospitals, the Jeetoo Hospital and the Sir Seewoosagur Ramgoolam National (SSRN) Hospital, and one private healthcare centre, La Clinic Mauricienne, were selected as case studies in order to characterise and quantify healthcare wastes in the local context.

The Jeetoo Hospital is located in the capital and is the main healthcare institution in that region. This hospital comprises of many departments such as the wards, the casualty, the minor operating theatre, the major operating theatre, a

Waste audit

Healthcare wastes consisted namely of two types: Infectious wastes (cotton, gloves, syringes and others) and pathogenic wastes, sharps and pharmaceutical wastes, chemical wastes and pressurized containers. These were generated in wards, X-ray departments, operating theatres, pharmacy, casualty and laboratory. It was found from the audit that around 90% of hospital wastes was general wastes similar in properties to domestic wastes. The remaining 10% was infectious hazardous wastes. Pruess et al.

Conclusion

This study showed that waste generation rates would differ between public hospitals and private clinics. An average of 0.179 kg/bed day of hazardous wastes was generated at the private clinic which was higher than the average value of 0.072 kg/bed day generated at the Jeetoo hospital. The major portion of wastes from healthcare institutions was non-hazardous in nature with 162 kg/day of non-hazardous wastes produced at Jeetoo Hospital, and 215 kg/day at the SSRN Hospital. An estimate of total

Recommendations

Based on these findings, it can be noted that there is potential to improve the management of healthcare wastes in the local context. Apart from the technical measures proposed, a framework to manage the wastes generated in various institutions on the island should be developed, which would take into consideration the following:

  • Waste minimization.

  • Segregation of healthcare wastes from general wastes.

  • Establishment of internal rules for waste handling.

  • Important health and safety practices for

Acknowledgement

I thank Ms. Pamela Comaren, B. Eng (Hons) Chemical and Environmental Engineering student for undertaking the experimental work and staff at Jeetoo hospital, SSRN hospital and La Clinique Mauricienne for providing support to this study.

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