Available online at www.sciencedirect.

com

Waste Management 28 (2008) 450–458

www.elsevier.com/locate/wasman

Site investigation on medical waste management practices

in northern Jordan
a,*
Fayez Abdulla , Hani Abu Qdais a, Atallah Rabi b

a
Department of Civil Engineering, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
b
Department of Public Health, Medical School, Jordan University of Science and Technology, Irbid 22110, Jordan

Accepted 26 February 2007

Available online 15 May 2007

Abstract

This study investigated the medical waste management practices used by hospitals in northern Jordan. A comprehensive inspection
survey was conducted for all 21 hospitals located in the study area. Field visits were conducted to provide information on the different
medical waste management aspects. The results reported here focus on the level of medical waste segregation, treatment and disposal
options practiced in the study area hospitals.
The total number of beds in the hospitals was 2296, and the anticipated quantity of medical waste generated by these hospitals was
about 1400 kg/day. The most frequently used treatment practice for solid medical waste was incineration. Of these hospitals, only 48%
had incinerators, and none of these incinerators met the Ministry of Health (MoH) regulations. As for the liquid medical waste, the sur-
vey results indicated that 57% of surveyed hospitals were discharging it into the municipal sewer system, while the remaining hospitals
were collecting their liquid waste in septic tanks. The results indicated that the medical waste generation rate ranges from approximately
0.5 to 2.2 kg/bed day, which is comprised of 90% of infectious waste and 10% sharps. The results also showed that segregation of various
medical waste types in the hospitals has not been conducted properly. The study revealed the need for training and capacity building
programs of all employees involved in the medical waste management.
Ó 2007 Elsevier Ltd. All rights reserved.

1. Introduction tal pollution; unpleasant smell; and growth and multiplica-

It is well known, that hospitals, clinics, nursing homes,
laboratories, veterinary clinics and many more establish-
ments have to dispose of waste materials that have been
generated in the process of medical care and treatment.
Medical wastes constitute a larger portion of infectious
wastes, which are potentially dangerous since they may
contain pathogenic agents. Some of the pathogenic organ-
isms can be dangerous, because they may be resistant to
treatment and possess high pathogenicity or ability to
cause disease (Askarian et al., 2004). The production of
these wastes will continue to be an on-going phenomenon
as long as there are human activities (Mato and Kaseva,
1999). Improper waste management will cause environmen-
*
Corresponding author. Tel.: +962 795880016; fax: +962 27095123.
E-mail address: fabdulla@just.edu.jo (F. Abdulla).
tion of insects, rodents and worms, and may lead to
transmission of diseases like typhoid, cholera, and hepatitis
through injuries from sharps contaminated with human
blood (Henry and Heinke, 1996). The management of the
medical waste is an emerging issue that is magnified by a
lack of training, awareness, and financial resources to sup-
port solutions. The proper collection and disposal of this
waste is of great importance as it can directly and indirectly
impact the health risks to both public health and the
environment.
2. Medical waste management in Jordan
The generated medical waste from all Jordanian hospi-
tals is approximately 9.4 tons/day (Zghondi et al., 2005).
Outside of Jordan many studies have focused on the man-
agement of medical waste in countries such as the United

0956-053X/$ - see front matter Ó 2007 Elsevier Ltd. All rights reserved.
doi:10.1016/j.wasman.2007.02.035
 F. Abdulla et al. / Waste Management 28 (2008) 450–458
States of America (Lee et al., 2004; Klangsin and Harding,
1998), United Kingdom (Tudor et al., 2005), India (Patil
and Shekdar, 2001), Saudia Arabia (Almuneef and Mem-
ish, 2003), Tanzania (Mato and Kassenga, 1997), and Iran
(Askarian et al., 2004).
Recently, Jordan has witnessed a rapid development in
both public and private medical care establishments. In
1995 there were 7440 beds in public and private hospitals
(MoH, 1996), while it has increased to about 10,000 in
2002. The number of health care centres in the year 2000
was 383; additionally there were 262 rural clinics (DOS,
2002). Currently, there are 98 hospitals in Jordan, and
58% of them are private hospitals. There has been a corre-
sponding increase in the number of patients that are trea-
ted, adding to the already large quantity of medical waste
that institutions must dispose of appropriately.
Many developed countries have legal provisions with
regards to the proper management of medical waste. Jor-
dan, like many other developing countries, has historically
paid little attention to the proper handling and disposal of
medical wastes. By the end of 2001, the Ministry of Health
(MoH) had issued official regulations governing medical
waste. The MoH is the regulatory agency charged with
implementing these requirements, which are executed
through field visits to hospitals to determine compliance.
To develop an appropriate medical waste management
strategy for the northern region of Jordan, it is important
to understand current practices in hospitals. Thus, a key
objective of this paper is to assess and evaluate the current
management practices of medical waste in northern hospi-
tals. To achieve this, a comprehensive survey was con-
ducted in all 21 hospitals located in the northern region.
The northern region is divided into four governorates
including Irbid, Mafraq, Jerash and Ajlun. The vast major-
ity of these hospitals (15) are located in the Irbid governor-
ate, while Mafraq has four hospitals and Jerash and Ajlun
have one each. The Ministry of Health owned 57% (12) of
these hospitals, while the private sector owned 33% (7), one
hospital was owned by a university and one was owned by
the Royal Medical Services (Military). These hospitals can
be divided into four categories according to their type or
services provided, 57% (12) of those hospitals are general,
23.8% (5) are specialized, two are general and teaching,
and another two are specialized and teaching. In this study,
‘‘general hospitals’’ refers to hospitals that provide a large
array of medical services or typically the first patient con-
tact. ‘‘Specialized hospitals’’ refers to hospitals that provide
medical services for a particular group of patients, such as
a pediatric hospital or a limited set of services.
3. Methodology
The methodology for this study was based on collected
data and information from all hospitals through a ques-
tionnaire. This approach was based on the recommenda-
tions from the World Health Organization (WHO) for
evaluation of hospital waste management in developing
451
countries (Pruss et al., 1999). The questionnaire contained
questions about the generation of waste and practices
related to segregation, collection, internal and external
storage, transport, treatment and final disposal, and train-
ing and awareness. The questionnaire was reviewed and
edited by experts from Jordanian universities and the
MoH.
Each hospital was sent a letter by the MoH requesting
their participation in the study, which included a survey
interview and facility walk-through. Then, each hospital
was contacted by the survey team, which was composed
of the MoH staff who had experience in medical waste
management. The team met with hospital personnel
involved in the management of the medical wastes in each
hospital. The questionnaire was completed in each hospital
during an interview process that included a walk-through
survey of all medical departments and facilities in the hos-
pitals. Site visits were particularly helpful in obtaining
information and observing common practices with regards
to the management of the medical wastes.
A total of 21 hospitals in the northern region were
requested to complete the questionnaire. The data from
the completed questionnaires were stored and coded in a
database for further analysis. The data from the survey
was checked for consistency and completeness, and then
analyzed using SPSS 10 software. The response rate was
100%, with all hospitals being very cooperative with the
survey team.
4. Results and discussion
4.1. Background information on the hospitals
Summary statistics of the number of beds, bed occu-
pancy and medical staff for hospitals are shown in Table
1 (Figs. 1 and 2). The hospitals have a total of 2296 beds.
The size of these hospitals ranges from 15 to 299 beds, with
a mean, minimum and maximum bed occupancy of 58.3%,
20%, and 80%, respectively. The number of medical staff in
these hospitals ranges from 14 to 590 persons, with an aver-
age of 172. This variation is due to number of services and
type of hospital.
4.2. Waste generation rate
All wastes generated by hospitals are considered medical
waste. An estimated 10–15% of hospital wastes are consid-
ered ‘‘infectious’’ (USC, 1988). This study revealed that the
Table 1
Summary statistics of bed number, annual occupancy, and number of
medical staff
Minimum Maximum Mean
Number of bed 15 299 94.95
Annual occupancy (%) 20 86 58.34
Medical staff 14 590 171.95
452 F. Abdulla et al. / Waste Management 28 (2008) 450–458

350

300

Number of beds 250

200

150

100

50

0
Princes Bassma

Irbid Al-Takhasose

Al-Rahbat Al-Wardeyah

Peduatric & Guana

Princes Badeeah

Princes Raya

Jarash

Moaath ben Jabal

Princes Rahma

Yarmouk

Al-Ramtha

Ibn Al-Nafees

Al-Najah

Al-Eman

Annour Sanatourium

Al-Mafraq

King Abdullah

Abi-Obaydah
Prince Rashed

Al-Quasmee

Al-Room Al-Katholeek

Hospital name

Fig. 1. Number of beds in northern hospitals.

100

90

80
Occupancy rate %

70

60

50

40

30

20

10

0
Princes Bassma

Irbid Al-Takhasose

Al-Rahbat Al-Wardeyah

Peduatric & Guana

Princes Badeeah

Moaath ben Jabal

Princes Rahma

Yarmouk

Princes Raya

Jarash
Al-Ramtha

Ibn Al-Nafees

Al-Najah

Al-Eman

Annour Sanatourium

Al-Mafraq

King Abdullah

Abi-Obaydah
Prince Rashed

Al-Quasmee

Al-Room Al-Katholeek

Hospital name

Fig. 2. Average occupancy rate in northern hospitals.

generation rate ranges from 0.26 to 2.6 kg/bed day with a in these hospitals of 2296, the anticipated medical waste
weighted average of 0.83 kg/bed day (Fig. 3). The reported is about 1.4 tons/day. The composition of the generated
average is within the range of previous studies. A study waste was found to be 38% paper, 27% plastic, 10.5% glass,
conducted by Abu Qdais (2005) on some hospitals in the and 11% textile (Fig. 4).
northern region revealed that the weighted average genera-
tion rate is about 0.61 kg/bed day, with the maximum 4.3. Legislation on medical waste management
being generated by private hospitals and minimum by a
university hospital. Based on a weighted average genera- The survey results indicated that 29% of the hospitals
tion rate of 0.61 kg/bed day and the total number of beds have policies that deal with medical waste management;
 F. Abdulla et al. / Waste Management 28 (2008) 450–458 453

80000

70000

Generated medical waste (kg/year)

60000

50000

40000

30000

20000

10000

Jarash
Princes Bassma

Irbid Al-Takhasose

Al-Rahbat Al-Wardeyah

Peduatric & Guana

Princes Badeeah

Princes Raya

Moaath ben Jabal

Princes Rahma

Yarmouk

Al-Ramtha

Ibn Al-Nafees

Al-Najah

Al-Eman

Annour Sanatourium

Al-Mafraq

King Abdullah

Abi-Obaydah
Prince Rashed

Al-Quasmee

Al-Room Al-Katholeek
Hospital name

Fig. 3. Reported generation rate of medical waste in northern region.

Miscellaneous, 8.50% ness was the primary reason for non-compliance, and,
Metals, 5.00% finally, 12% of the hospitals indicated that their difficulty
in complying with regulations had to do with the complex-
ity that would be involved in implementation. Thus, a need
Textile, 11% Paper, 38% for technical assistance and simple solutions are needed in
meeting the MoH requirements.
The MoH has developed regulations aimed at ensuring
appropriate handling and processing of waste. However,
Glass, 10.50% there is still a need for a medical waste management strat-
egy that includes prevention, source segregation, handling
and transportation, and treatment and disposal compo-
nents. Such a strategy would then need to be supplemented
with the appropriate policy guidance and regulations at the
Plastic, 27% national and sub-national levels. To accomplish this work,
Fig. 4. Composition of waste generated in northern hospitals.
hospital administrators and policymakers require both
technical assistance and financial support in developing
and implementing an effective medical waste management
however, only 10% of the hospitals have formal guidelines strategy.
for medical waste management. More than one-third of the
hospitals (38%) indicated that they verbally informed per- 4.4. Healthcare waste segregation
sonnel about the national regulations, while another 38%
informed their staff about the regulation in a formal or Infectious and pathological wastes and sharps are segre-
written manner. The remaining 24% were not notifying gated from the main waste stream in all hospitals. All hos-
their staff about the regulations in any manner. All of the pitals used yellow colour bags for infectious waste, while
surveyed hospitals were aware of existing medical waste 29% of hospitals used red bags for highly infectious waste.
regulations, but only 67% of the hospitals had a copy of Sharps are segregated into yellow sharp containers in 10%
the regulatory requirements. of hospitals and the remaining 90% of hospitals used con-
The reasons for non-compliance of the surveyed hospi- tainers with different colours.
tals with the national regulations, which is shown in All hospitals send their expired pharmaceutical materi-
Fig. 5, varied. About 6% of the hospitals indicated that als back to the suppliers. About 43% of hospitals used spe-
the regulations were not clear, while 45% of the hospitals cific procedures in handling pharmaceutical waste, while
indicated that it was too costly to apply in their facilities. the remaining 57% dispose of it in the domestic waste
Further, 33% of the hospitals noted that a lack of aware- stream. Of the 43% hospitals with specific procedures,
454 F. Abdulla et al. / Waste Management 28 (2008) 450–458
100
90
80
70
Percent (%)
60
50
40
33
30
20
10
0
Lack of awarness
Fig. 5. Factors preventing sites from fully complying with the MoH regulations.
33% returned the waste back to the suppliers, while the
remaining 67% of hospitals disposed of the waste in yellow
bags with the rest of the medical waste.
The remaining generated waste types are listed below
along with the hospitals segregation methods:
 Genotoxic waste is generated in 10% (2) of the hospitals
and segregated using red colour bags in both hospitals.
 Radioactive waste is generated in only 5% of the hospi-
tals and segregated using red bags and a special
container.
 Chemical waste, which is generated in laboratories and
often in liquid form, is not segregated in 76% of the hos-
pitals and is disposed of through the public sewer sys-
tem. The remaining 24% of the hospitals collect the
chemical waste in special containers, then a pre-treat-
ment procedure is applied prior to disposal it in the
sewer system.
 Heavy metals (fixer from X-rays) – waste containing
heavy metals segregated into a plastic container prior
to treatment for 57% of hospitals, while the remaining
43% of the hospitals dispose of it through domestic
sewer the system.
 Pressurized containers are disposed of with domestic
waste in 81% of the hospitals that apparently have no
clear procedure for handling this type of waste. Only
19% of the hospitals segregate pressurized containers
by placing them in yellow bags, which are disposed of
as medical waste.
In general, this study indicated that segregation of all
wastes is not conducted according to any consistent rules
and standards; some quantity of medical waste is disposed
94
45
12
Simple means are needed Costly to apply Clear Regulation
of with domestic wastes; and no control measures exist for
the management of these wastes.
Approximately 81% of the hospitals reported having
methods for measuring the quantity of medical waste gen-
erated. About 38% of the hospitals applied some method of
source identification of the generated medical wastes. Only
10% of the hospitals recycle their waste. The recycling was
conducted primarily in the form of the reuse of thermom-
eters. Further, most of the hospitals reuse plastic contain-
ers of reagent as sharps containers. Most of the hospitals
(95%) used medical waste labelling to differentiate it from
domestic waste. Fig. 6 delineates some practices related
to medical waste handling.
4.5. Pre-treatment of medical waste
About 67% of the hospitals autoclave their highly infec-
tious medical waste prior to disposal, while chemical disin-
fection is used in 14% of the hospitals.
4.6. Storage and transportation of the healthcare waste
The status of the storage facilities and the internal and
external transportation of the generated medical waste
were investigated using the checklist in Table 2. Most of
the 15 elements of this checklist were based on the MoH
regulatory requirements (MoH, 2001). All of the elements
of the storage facilities and the transportation schemes
were given equal weight and the degree of compliance
was calculated accordingly. For example, King Abdullah
hospital had the highest degree of compliance (93%), which
meant it failed to meet only one of the requirements. Fig. 7
shows the degree of compliance of the hospitals with the
 F. Abdulla et al. / Waste Management 28 (2008) 450–458 455

100

90

80

70

60
Percent (%)

50

40

30

20

10

0
Estimation method Source identification & Recycling Labeling
segregation

Fig. 6. Some medical waste management practices in northern hospitals.

MoH storage and transportation requirements. As can be
seen, the hospitals vary in their degree of compliance. Less
than one-third of the hospitals (29%) failed to meet the
MoH requirements with a degree of compliance less than
50%. The study revealed the need for upgrading the inter-
nal and the external storage facilities to meet the MoH
requirements.
The number of carts assigned for medical waste trans-
port ranges from one to four carts in the hospitals. Most
Table 2
Status of storage facilities and internal and external transportation in
northern hospitals
Issues related to storage facilities and transportation scheme
Availability of temporary storage facility
Availability of central storage facility
Availability of refrigerated storage for pathological waste
Are storage facilities disinfected?
Daily disinfection for storage facility
Are the following attributes available at the storage facility?
(a) Connection to sewer system
(b) Water source
(c) Ventilation
(d) Safe and isolated
(e) Easy to clean
(f) Large container for storage
Is the area or the volume of the storage facility is sufficient?
Are there assigned carts for transporting medical waste within
the hospital?
Are there assigned vehicles for transporting medical waste off-
site?
Are medical waste and non-medical waste transported
separately for temporary storage and/or treatment?
Is healthcare waste transported by normal vehicles for disposal?
carts (95%) were yellow in colour with wheels and a lid.
The results obtained from the surveyed hospitals indicated
that the maximum time period for temporary storage is
12 h, while the maximum storage time in central storage
has been 2 days. Collection and internal transportation in
northern hospitals were carried out primarily by private
contractors with little experience and who have a signifi-
cant number of overturned containers. Typically, the pri-
vate sector workers did not wear sufficient protective gear
during waste handling activities, increasing the potential
risk of accidents and personal injury. Transportation of
medical waste outside hospitals was undertaken in vehicles
that did not meet the regulatory requirements for safety.
Yes One recommendation to improve this aspect of medical
(%) waste management in the northern region would be to
43 develop a regional transportation scheme. By this scheme,
71 medical waste will be collected from central storage areas
5
81
at each hospital and transported safely to regional inciner-
48 ation sites.
11
4.7. Disposal of healthcare waste
38
62 The disposal practices for different types of medical
71 waste generated in the hospitals were investigated in the
57 study. The survey results indicated that all hospitals incin-
57
erate their infectious and pathological medical wastes.
67 Chemical wastes that are generated in laboratories were
95
disposed of into the sewer system by 76% of hospitals.
43 The remaining 24% of hospitals pre-treated such waste
prior to disposing of it in the sewer system.
90 Sharps were incinerated by all hospitals. Empty pressur-
ized containers were disposed of by incineration in 19% of
33
hospitals, and by sending it to sanitary landfill in 81% of
456 F. Abdulla et al. / Waste Management 28 (2008) 450–458

100

Storage and transporation compliance (%)

80

60

40

20

0
Princes Badeeah
Princes Bassma

Moaath ben Jabal

Princes Rahma

Prince Rashed

Peduatric & Guana

Annour Sanatourium
Princes Raya

Al-Rahbat Al-Wardeyah
Irbid Al-Takhasose

Jarash
Al-Quasmee

Abi-Obaydah
Ibn Al-Nafees

Al-Room Al-Katholeek
Al-Ramtha
Yarmouk

King Abdullah
Al-Eman
Al-Najah

Al-Mafraq
Hospital name

Fig. 7. Degree of compliance of the hospitals with the MoH requirements.

hospitals. Body fluids including blood and other liquid a gas cleaning system or other air pollution deterrent. Only
healthcare wastes were disposed of by incineration in 5% of the hospitals conducted annual emission testing for
38% of hospitals, by discharging into domestic sewer lines some of the gases; while the remaining hospitals were not
in 48% of hospitals, and by putting them in a special tank conducting any emissions tests. The capacity of the hospi-
in 14% of hospitals. Radioactive wastes were stored for a tal incinerators ranges from 75 to 5600 kg/day. There was
long enough period to decay and then incinerated in one no regular maintenance program for these incinerators;
hospital. maintenance was only conducted when operational prob-
The disposal of medical waste was accomplished by hos- lems occurred. The maintenance was conducted by the pri-
pital staff in 19% of hospitals, by local authority staff in vate sector in 55% of the hospitals while the remaining
24% of hospitals, and by the private sector in 57% of hos- hospitals used their own staff to conduct maintenance
pitals. The monthly cost of incineration ranges from activities. The temperature in the first stage of incineration
70 US$/month to 1330 US$/month. ranges from 500 to 800 °C; only 40% of hospital incinera-
Almost all hospitals discharge mixed domestic and med- tors met the MoH requirement, which is 800 °C in the first
ical liquid waste into sewer networks or into septic tanks. chamber. The temperature in the second chamber ranges
In 43% of hospitals liquid waste is disposed of through from 500 to 1100 °C; none of these incinerators met the
the septic tank system. Then these hospitals transfer their MoH requirements. Generally, the condition of the inciner-
sewage outside the hospital by means of tankers. The ators design and operation regarding temperature control
remaining 57% of hospitals are connected directly to the and detention time were not suitable and did not meet
public sewage network. If this wastewater is not being trea- the MoH regulations. The location of the incinerators were
ted appropriately, the discharge may lead to contamination not appropriate in 80% of the hospitals, being within 8–
of drinking water supplies and/or environmental degrada- 400 m of densely populated areas or different hospital
tion. Given these potential risks, hospital administrators wings.
and government regulators have been very concerned and Due to poor performance of these incinerators, 67% of
interested in finding solutions that would eliminate the the hospitals indicated their willingness to send their med-
risks to public health and the environment that can come ical waste to a central facility once it exists. The remaining
from inappropriate disposal of liquid medical waste. 33% of the hospitals showed no interest in a centralized
facility because they have their own facilities. Regarding
4.8. Characteristics of incinerators the off-site transportation of medical waste from hospitals
to regional incinerators, 46% of the hospitals preferred to
Only 48% of the hospitals were equipped with an incin- hire a private contractor, 27% preferred the regional facil-
erator. More than one-third of these hospitals (38%) shared ity to take care of the transportation, and 27% would like
their incinerators with other hospitals that did not have an their own staff to transport the medical waste. Workers in
incinerator. None of these incinerators were equipped with these facilities were equipped with safety equipment. Masks
 F. Abdulla et al. / Waste Management 28 (2008) 450–458
and safety shoes were available for 80% of the workers,
while gloves and clothing were available for all workers.
In addition, the MoH incineration performance evalua-
tion is still restricted to parameters that can be visually
inspected and realized. This is due to a lack of monitor-
ing/testing equipment and qualified personnel to conduct
performance evaluations of the existing incineration plants.
This realisation should encourage regulators and adminis-
trators to work towards achieving highest standards in
medical waste management.
4.9. Staff responsibilities, training and awareness
Training programs about medical waste management
for doctors, nurses and technicians were limited; about
29% of the hospitals had not provided training to doctors
and other personnel about medical waste management
and their potential hazards. Some hospitals (57%) provided
limited training for support staff (maintenance engineers/
technicians, cleaning workers). Hospitals indicated that a
simple orientation programs for new employees about hos-
pital waste management was provided. The MoH regula-
tions require that each hospital should have medical
waste steering committee. Such committee was available
only in 71% of the hospitals.
All hospitals (100%) indicated their needs and willingness
to participate in future specialized training programs in med-
ical waste management. The majority of hospitals (90%) pre-
ferred attending annual training. In 71% of the surveyed
hospitals, training for top mangers was highly required. On
the other hand, training programs for medical staff (nurses
and doctors), waste handlers, operators and maintenance
engineers were requested by 81% of the hospitals.
One-third of the hospitals (33%) lack medical waste
management awareness material and 67% of the hospitals
have limited awareness material such as signs. The survey
indicated that 81% of the hospitals were satisfied with the
level of performance of their employees or private contrac-
tors in the collection, transport and disposal of the medical
waste generated at their hospitals. About 84% of the hospi-
tals indicated that medical waste management equipment
and facilities were available all of the time in the market
at a reasonable price.
5. Conclusions
The number of private and government hospitals and
medical centres throughout northern Jordan is constantly
increasing. This leads to an increase the quantity of medical
waste that is disposed of improperly. Although the MoH
has developed regulations aimed at ensuring appropriate
handling and processing of waste, there is still a need for
a medical waste management strategy that is based on inte-
grated waste management options. Such a strategy would
then need to be supplemented with the appropriate policy
guidance and enforcement at both national and regional
levels. To achieve this, policy makers and hospital admin-
457
istrators require both technical assistance and financial
support.
The main findings and recommendations of the study
are:
 The estimated quantity of medical waste from the hospi-
tals was about 1400 kg/day, with an average generation
rate of 0.61 kg/bed day.
 Liquid medical waste was being discharged into munici-
pal sewers in 57% of the hospitals or collected in septic
tanks (43%). There is a need to find proper procedure
for handling liquid medical waste.
 Segregation procedures of the different types of wastes
were not consistently followed. Source segregation of
medical waste, handling and transport, treatment and
disposal are basic elements of a management strategy
that need to be outlined and regulated.
 The most frequently used treatment for solid medical
waste was incineration; 48% of the hospitals were
equipped with an incinerator. All of the incinerators
failed to meet the MoH regulations. The efficiency of
incineration practices still is questionable which may be
adversely reflected on the public health of the surround-
ing communities. There is a need for upgrading medical
waste incinerators to meet the MoH requirements.
 The study indicated a need for training programs for dif-
ferent levels of hospital staff from administrators and
top managers to doctors and nurses, down to waste han-
dlers and maintenance and incinerator operations staff.
 Collection, internal transportation and operation of on-
site treatment facilities in the hospitals were conducted
in most of the time by a private company: with little
experience and lots of over turns.
 Most of the storage facilities in the hospitals failed to
meet the MoH requirements. There is a need for upgrad-
ing the storage facilities in the northern hospitals.
 Vehicles used for transportation of medical waste out-
side hospitals failed to meet the safety requirements.
There is a need for regional transportation facilities.
Acknowledgements
The authors acknowledge the support offered by the
USAID, International City/County Management Associa-
tion and the MoH during the course of this study.
References
Abu Qdais, H., 2005. Medical Waste Survey in Northern Region
Hospitals. Medical Waste Management Project for Northern Jordan
(Final Report). Irbid, Jordan.
Almuneef, M., Memish, Z.A., 2003. Effective medical waste management:
it can be done. American Journal of Infection Control 31 (3), 188–192.
Askarian, M., Mahmood, V., Gholamhosein, K., 2004. Results of a
hospital waste in private hospitals in Fars Province, Iran. Waste
Management 24, 347–352.
Department of Statistics (DOS), 2002. Annual Environmental Statistics.
Amman-Jordan.
458 F. Abdulla et al. / Waste Management 28 (2008) 450–458
Henry, G., Heinke, G.W., 1996. Environmental Science and Engineering,
second ed. Pretence-Hall, Englewood Cliffs, NJ.
Klangsin, P., Harding, A.K., 1998. Medical waste treatment and disposal
methods used by hospitals in Oregon, Washington, and Idaho. Journal
of Air and Waste Management Association 48, 516–526.
Lee, B., Ellenbecker, M.J., Moure-Esaso, R., 2004. Alternatives for
treatment and disposal cost reduction of regulated medical wastes.
Waste Management 24, 121–143.
Mato, R.R.A.M., Kaseva, M.E., 1999. Critical review of industrial and
medical waste practices in Dar es Salaam City. Resources, Conserva-
tion and Recycling 25, 271–287.
Mato, R.R.A.M., Kassenga, G.R., 1997. A study on problems of
management of medical waste in Dar es Salaam and their remedial
measures. Resources, Conservation and Recycling 21, 1–16.
Ministry of Health (MoH), 1996. Annual Statistical Book of Jordanian
Health Sector. Amman-Jordan.
Ministry of Health (MoH), 2001. Medical waste management regulations.
Official Journal of the Hashemite Kingdom of Jordan, Amman-Jordan
(4511).
Patil, A.D., Shekdar, A.V., 2001. Health-care waste management in India.
Journal of Environmental Management 63, 211–220.
Pruss, A., Giroult, E., Rushbrook, P., 1999. Safe Management of Waste
from Health Activities. World Health Organization, Geneva.
Tudor, T.L., Noonan, C.L., Jenkin, L.E.T., 2005. Healthcare waste
management: a case study from the National Health Service in
Cornwall, United Kingdom. Waste Management 25, 606–615.
United State Congress (USC), Office of Technology Assessment, 1988.
Issues in Medical Waste Management-Background Paper, OTA-Bfo-
49. United States Government Printing Office, Washington, DC.
Zghondi, R., Netcheh, B., Khasheshneh, M., 2005. WHO-CEHA/SDC-
Switzerland Rapid Assessment of Healthcare Waste Management in
the Kingdom of Jordan. Final Report. Amman-Jordan.