While playing in the neighborhood in Najran, in southwestern Saudi Arabia, a group of sixth-grade students found a highly infectious yellow bag of clinical waste on the roadside. A few days later, in the southeast of the country, Al-Ahsa Mayor Fahad Al-Qahtani received complaints from residents about medical waste buried in the local graveyard. Both incidents of dumping dangerous medical waste were publicized in local newspapers this April.
A 50-year-old Saudi surgeon, who worked for more than 23 years in several public and private hospitals in Madinah, shares the concerns of many over the state of local medical waste management. Preferring to remain anonymous, he says there are no clear and detailed standard policies and procedures covering all aspects of the handling and disposal of medical waste. This surgeon’s experience includes heading a quality management committee, a vascular surgery department and being involved in medical training.
“Most staff (medical, technical and administrative) are unaware of what is really meant by medical waste and how they should handle it,” he claims. “The management of medical waste differs in both who is responsible and who is capable of doing the job. Worse, it’s not generally handled under one clear heading with a separate unit or department whose job includes infection control.”
We are used to thinking that health care, covering immunization, diagnostic tests, medical treatments and laboratory examinations, protect and restore health and save lives. But what about the wastes and byproducts that are generated?
Medical waste is a major health hazard. Careless and indiscriminate disposal of such waste by health care establishments can contribute to the spread of serious diseases such as hepatitis and HIV-AIDS both among those who handle it and among the general public.
Mona Shatila, the infection control coordinator at the International Medical Center (IMC) in Jeddah, says it is very important to provide the patients and staff with a safe and healthy environment inside the hospital.
“Anything that comes out of the patient could infect others. We’re here to help the patient and the staff. Together we make a safe environment “ she says. Shatila took Arab News on a tour inside the IMC’s medical waste management facilities. She explained the process of managing waste material throughout the hospital starting with the patient’s room.
“Everything is color-coded. So it’s very important for the staff to know how the coding work,” says Shatila.
There are four colors for clinical waste units: Black for regular trash, white for paper, yellow for medical waste, and red for human tissue. These bags are placed inside covered, washable bins with the appropriate warning signs on them.
Another type of waste, she explains, comes from suction procedures of blood or fluids especially during surgery. A special type of powder is sprinkled inside the container for these fluids that transforms them into a semi-gel substance. “This makes it easier to dispose in the yellow biohazard bag.”
Sharp medical instruments are another waste hazard. Needles, broken ampoules and scalpels cannot be thrown into regular trash bins because they might cut someone and transfer blood-borne pathogens, diseases that could spread by blood contamination. Workers exposed to these pathogens risk death or serious illness. According to the IMC’s infection control guidelines, the chances of getting hepatitis B virus from an infected syringe are 30 percent. The chances of similarly contracting hepatitis C virus are three to five percent and of HIV 0.3 percent.
To contain the spread of such diseases, Shatila explains that sharp objects have to be thrown in special bins in both patients’ rooms and in all clinical units.
“They are wall-mounted and secured so no one can play with them,” she says. “Also, once the syringe gets inside the container, it cannot be taken out. All for safety purposes.”
Cleaning staff who collect the medical waste and deliver it to the waste area must wear the proper personal protective equipments: mask, goggles, gown and gloves.
“All bags have to be secured tightly and put in a covered trolley,” says Shatila. There is a special trolley for each type of wastes: Regular waste, biohazards and sharp containers and these are all carried through the waste trolley elevator.
Regular trash has its own disposal area from which it is collected regularly. Medical waste is held in a special area and collected by SEPCO Environment, a specialist company which burns the waste, including the sharp containers at very high temperatures in special furnaces.
Unfortunately, according to Shatila, waste managements regimes differ in effectiveness and rigor from hospital to hospital.
“Until recently, throughout the Middle East in particular, infection control was not a big deal. Now it is a given that every hospital ensures its environment is safe.”
Last year it was estimated that Saudi Arabia produces 25, 000 tons of medical waste annually.
The World Health Organization (WHO) has warned that waste management commonly fails through the absence of proper procedures, a lack of awareness about the health hazards involved, insufficient financial and human resources and poor implementation of the controls that do exist.
“Many countries do not have appropriate regulations or do not enforce them. An essential issue is the clear attribution of the responsibility for the appropriate handling and disposal of waste, ” claims WHO.