Professional Documents
Culture Documents
Jurnal Manajemen
Jurnal Manajemen
Jurnal Manajemen
research-article2015
WMR0010.1177/0734242X15616474Waste Management & ResearchAli et al.
Short Communication
Abstract
Proper management of hospital waste is a critical concern in many countries of the world. Pakistan is the sixth most populous country
in the world, with one of the highest urbanisation and population growth rates in South Asia. Data and analyses regarding hospital
waste management practices in Pakistan are scarce in scientific literature. This study was meant to determine waste management
practices at selected hospitals in a major city in Pakistan, Gujranwala. A total of 12 different hospitals were selected for the survey,
which involved quantification of waste generation rates and investigation of waste management practices. The results were analysed
using linear regression. The weighted average total, general and infectious hospital waste generation rates were found to be 0.667,
0.497 and 0.17kgbed-day1, respectively. Of the total, 73.85% consisted of general, 25.8% consisted of hazardous infectious and
0.87% consisted of sharps waste. The general waste consisted of 15.76% paper, 13.41% plastic, 21.77% textiles, 6.47% glass, 1.99%
rubber, 0.44% metal and 40.17% others. Linear regression showed that waste generation increased with occupancy and decreased
with number of beds. Small, private and specialised hospitals had relatively greater waste generation rates. Poor waste segregation,
storage and transportation practices were observed at all surveyed hospitals.
Keywords
Infectious waste, hazardous waste, regression, public health, waste generation
in August, 2005. Periodic assessments of healthcare facilities are Punjab, Lahore, Pakistan
necessary to evaluate compliance with these rules. Unfortunately Corresponding author:
data regarding HWM practices in Pakistan is scarce. Our objec- Mustafa Ali, Department of Management Science and Engineering,
tives in this study are: (i) determination of quantity and composi- School of Economics and Management Science, Southeast University,
Jiulonghu Campus, Jiangning District, Nanjing City, Jiangsu
tion of hospital waste in a major city of Pakistan; (ii) evaluation Province, P.R. China.
of HWM practices in selected hospitals in light of HWMR. Email: aliseunanjing@gmail.com
88 Waste Management & Research 34(1)
hospitals refer to those private hospitals that are operated by outdoor patients (OPD) apart from the paramedic and sanitary
charitable institutions. staff at each hospital.
Figure 1 highlights the change in hospital waste generation
rate with the variables of hospital size (number of beds), location,
Methodology
category (general vs. specialised) and type (public vs. trust vs.
The study was conducted across 12 public and private hospitals in private). It can be seen that, on average, waste generation was
the four predominantly urban townships of Gujranwala. These greatest in small hospitals (beds<50) followed by medium-sized
included the towns of Nandipur, Khiali Shahpur, Aroop and Qila hospitals (50<beds<100) and large hospitals (beds>100).
Dedar Singh as shown in Table 1. The hospitals were categorised Moreover, hospitals in Nandipur town generated the greatest
based on their respective location and bed size. The methodology amount of waste on average while those in Khiali Shahpur town
consisted of physical segregation and weighing of the hospital generated the largest amount of infectious waste. Similarly, waste
wastes for 7days each along with the determination of waste man- generation was greatest in private hospitals, followed by the trust
agement practices using a standard questionnaire. The question- hospitals and the public hospital, in that order. Specialised hospi-
naire was developed in accordance with HWMR. It consisted of tals generated more waste, on average, than general hospitals.
three parts, including seven questions to gather general informa- Of the total hospital waste, 73.85% consisted of general,
tion, 23 questions about waste management practices and five 25.8% consisted of hazardous infectious and 0.87% consisted of
questions about final disposal of the hospital waste. The questions sharps waste. Hazardous infectious waste usually comprised of
about waste management practices gathered information about empty plastic drips, used blood infusion bags, cotton swabs,
use of safety equipment, waste records, waste collection, handling dressings and plasters, syringes, used testing kits, laboratory
and storage, and waste transportation, among others. The ques- sample containers, Nasogastric tubes, etc. Sharps waste consisted
tionnaire was addressed to the hospital manager and it was usually of all sharp objects, including needles, broken vials, cut glass,
filled by a member of the hospital administration/waste manage- etc. The general waste consisted of all waste meant to be thrown
ment team. The responses were then compared with actual find- in the municipal container. On average, the percentage composi-
ings following a 7-day inspection of each hospital. tions of paper, plastic, textiles, glass, rubber, metals and others in
general waste stood at 15.76%, 13.41%, 21.77%, 6.47%, 1.99%,
Results and discussion 0.44% and 40.17%, respectively. Here others refers to non-risk
items, such as dirt, food waste, fruit peels, etc.
Waste generation The results shown in Table 2 were used to generate a regres-
The average generation rate for the general waste was found to be sion-based model of hospital waste generation using SPSS v.21.
0.497kgbed day1, while that for infectious waste was found to The independent variables included average occupancy, number
be 0.1702kgbed day1. Thus the average total waste generation of beds, number of out-patients and number of sanitary staff.
rate was 0.667kgbed day1. The results are similar to those in Table 3 highlights the results of linear regression. It can be seen
other findings, where it was 0.61kgbed day1 in Gansu, China that the occupancy and number of beds were the only significant
(Zhang et al., 2013), 0.62kgbed day1 in Lao PDR (Phengxay, (p<0.05) variables that could be used to predict waste generation
2005), 0.74kgbed day1 in Shandong, China (Gai et al., 2009) at the hospitals. The hospital waste was found to decrease with
and 0.63kgbed day1 in Istanbul, Turkey (Birpinar et al., 2009). the number of beds and increase with the average occupancy at a
Table 2 displays the waste generated at each hospital. The hospi- hospital. The results are consistent with findings in other studies
tal names have been replaced with abbreviations such as G for where clinical waste was found to decrease with an increase in
government, T for trust and P for private hospitals. The table also the total number of beds at a hospital (Patwary et al., 2009) and
displays the average number of in-patients (occupancy) and increase with the occupied beds (Mohee, 2005).
Ali et al. 89
ARP: Aroop; ENT: Ear Nose Throat; G: government; KPR: Khiali Shahpur; NPR: Nandipur; OPD: outdoor patients; P: private; QDS: Qila Dedar
Singh; T: trust.
Variable B T Significance of t
Occupancy 0.021 3.514 0.01
Beds 0.009 4.7 0.002
Out patients 0.001 1.468 0.186
Sanitary staff 0.012 0.639 0.543
Constant 1.507 9.717 0.000
R2 0.823
Adjusted R2 0.721
Sum of squares 2.399
Residual sum of squares 0.517
F 8.117
Significance of F 0.009
a biweekly basis. In the meantime, the waste remained in the Declaration of conflicting interests
storage area without the provision of refrigeration, in violation The authors declared no potential conflicts of interest with respect to
of HWMR. Offsite transportation of this waste was carried the research, authorship, and/or publication of this article.
out by a commercial firm contracted to incinerate this waste.
Transportation was carried out in a special vehicle that was Funding
labelled with warning signs. The transportation was carried The authors disclosed receipt of the following financial support for
out without any optimal routing system. Such a mechanism the research, authorship, and/or publication of this article: This
can be established using geographic information system work was funded by The China Specialized Research Fund
(Shanmugasundaram et al., 2012). for Doctoral Program of Higher Education [20120092110039];
The National Natural Science Foundation of China [71172044 and
71273047]; The National Social Science Foundation of China
Waste disposal and resale [12&ZD20].
HWMR recommend the treatment of hazardous infectious waste
and sharps by land-filling, incineration or any other method per- References
mitted by the law. In case of incineration, the residual ash is Arab M, Rouhollah Askari B, Tajvar M, et al. (2008) Report: The assess-
ment of hospital waste management: A case study in Tehran. Waste
required to be filled in land such that it does not intoxicate ground Management & Research 26: 304308.
water. Our survey revealed that, except P6, the hazardous infec- The World Bank (20102014a) Population growth (annual %). Available at:
tious waste and sharp boxes of all the hospitals were treated by http://data.worldbank.org/indicator/SP.POP.GROW (accessed 23 August
2015).
incineration. At P6, the waste was thrown directly into the munic-
The World Bank (20102014b). Urban population (% of total). Available
ipal containers without any pre-treatment. At the time of the sur- at: http://data.worldbank.org/indicator/SP.URB.TOTL.IN.ZS (accessed
vey, there was only one incineration plant in the city, which was 23 August 2015).
Bazrafshan E and Mostafapoor FK (2011) Survey of medical waste character-
situated at the Combined Military Hospital located in the Military
ization and management in Iran: A case study of Sistan and Baluchestan
Cantonment area. However, it was found to be non-operational Province. Waste Management & Research 29: 442450.
owing to a lack of technical staff for its operation and mainte- Birpinar ME, Bilgili MS and Erdogan T (2009) Medical waste manage-
nance. It was discovered that a commercial firm had been con- ment in Turkey: A case study of Istanbul. Waste Management 29:
445448.
tracted by the surveyed hospitals for incinerating the hospital Bureau of Statistics, GotP, Pakistan (2014) Punjab Development Statistics.
wastes. The incineration plant was located around 70km away in Available at: http://www.bos.gop.pk/publicationreports (accessed 23
another city. Transportation of the hospital waste at such a long August 2015).
Gai R, Kuroiwa C, Xu L, et al. (2009) Hospital medical waste manage-
distance represents significant costs, which are indirectly borne
ment in Shandong Province, China. Waste Management & Research
by the patients. Hence, there exists an urgent need to find an 27: 336342.
alternate solution to this challenge. Idowu I, Alo B, Atherton W, et al. (2013) Profile of medical waste manage-
ment in two healthcare facilities in Lagos, Nigeria: A case study. Waste
The disposal of general waste from the hospitals took place in an
Management & Research 31: 494501.
open dumping site at the outskirts of the city. Here scavengers Mayors C (2011) The worlds fastest growing cities and urban areas from
extracted different recyclable items from the waste, which eventu- 2006 to 2020. Available at: http://www.citymayors.com/statistics/urban_
ally reached a wholesale market in the nearby town of Muridke. growth1.html (accessed 23 August 2015).
Mohee R (2005) Medical wastes characterisation in healthcare institutions in
The prices of different articles sold here included 0.07 to Mauritius. Waste Management 25: 575581.
0.08US$kg1 for paper, 0.3US$kg1 for plastic, 0.08US$kg1 for Patwary MA, OHare WT, Street G, et al. (2009) Quantitative assessment
glass and 0.350.4US$kg1 for metal as per the exchange rate of medical waste generation in the capital city of Bangladesh. Waste
Management 29: 23922397.
between Pakistani Rupees and US dollars at the time of the survey. Phengxay S (2005) Health-care waste management in Lao PDR: A case
study. Waste Management & Research 23: 571581.
Conclusions Shanmugasundaram J, Soulalay V and Chettiyappan V (2012) Geographic
information system-based healthcare waste management planning
The generation of hospital waste in Gujranwala city was found to for treatment site location and optimal transportation routeing. Waste
Management & Research 30: 587595.
be 912.8kgday1 at the surveyed hospitals with a weighted aver-
Stankovic A, Nikic D and Nikolic M (2008) Report: Treatment of medical
age of 0.667kgbed day1. Average waste generation was found to waste in Nisava and Toplica districts, Serbia. Waste Management &
be relatively greater in smaller private hospitals. Specialised hos- Research 26: 309313.
Taghipour H and Mosaferi M (2009) The challenge of medical waste man-
pitals generated more waste than general hospitals. Regression
agement: A case study in northwest Iran-Tabriz. Waste Management &
analysis showed that waste generation increased with occupancy Research 27: 328335.
rate, but decreased with number of beds. It was also found that Thakur V and Ramesh A (2015) Healthcare waste management research:
the waste segregation, storage and transportation services at most A structured analysis and review (20052014). Waste Management &
Research 33: 855870.
of the surveyed hospitals did not meet the requirements of Yves Chartier, Jorge Emmanuel, Ute Pieper, Annette Prss, et al. (2013) Safe
HWMR. Moreover, infectious waste items found their way in Management of Wastes from Health Care Activities (2nd ed.). Geneva:
general waste, which was sorted by scavengers for onward sale. World Health Organization.
Zhang HJ, Zhang YH, Wang Y, et al. (2013) Investigation of medical waste
Hence, a stricter enforcement of HWMR is required at the hospi- management in Gansu Province, China. Waste Management & Research
tals, along with necessary support from the government. 31: 655659.