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hospitals in city of Tehran have been investigated in order to collect the general and specific information to indicate the current status of healthcare waste management. A questionnaire contained 72 questions addressing the main phases of the waste management process in 6 parts including segregation, collection, transportation, storage, disposal, as well as the hygiene status separately, were used to collect the data.
To convert the data into a quantitative measures, score 1 was assigned to answers which were complied with the law and score 0 was assigned to those which were not complied with the law. Then in each separate part of the questionnaire, indicating each phase of healthcare waste management, scores were converted in to 0–100 to be ranked as shown in Table 1. Subsequently, the mentioned ranked scores were scaled up in the expert group as shown in Table 2. The mentioned scaled up scores are used as the basis of descriptive statistical analysis.
Table 1
The ranges for ranking the hospital waste management
Table 2
The weighting factors for healthcare waste management status
The frequency tables and the central and dispersion index of descriptive statistics were used in order to analyze the available data including mean, median, and standard deviation. To indicate the normal description of healthcare waste management process, the non parametric test (1-sample k-s) was used. Considering the fact that p < 0.05, Kruskal–Wallis and Mann–Whitney tests were used to investigate that whether or not these parameters (hospital ownership, hospital ranking, hospital activity, involving environmental expert in hospital, and holding healthcare waste management training course in the hospitals) influence healthcare waste management.
The average waste generation in hospitals was 2.9 kg/bed per day. The density of healthcare waste rates ranged from 120 to 150 kg/m3, and the total average of healthcare waste generation was 65000 kg/day. It should be mentioned that pathological wastes were segregated and collected considering ratified regulations of Iran Health Ministry included healthcare wastes management issues.
Most of the selected hospitals (84.7%) have environmental health expert responsible for hospital’s healthcare waste management. But, there are few hospitals (15.3%) that have no experts to monitor the healthcare waste management status in the hospital.
Training course considering healthcare waste management was held in 52.78% of the hospitals, but 47.22% of the hospitals had no training courses on this issue.
Though the ratified low emphasis on having executive program for healthcare waste management, 75.69% of hospitals did not have such a program.
Considering segregation status, 51.4% were ranked medium, 27.1% were ranked good, and 10.4%, 9%, 2.1% were ranked poor, excellent, and very poor respectively.
Most of the hospitals were ranked excellent in collection stage (43.1%). In contrast, the study in India shows the worst collection status for healthcare wastes as wastes were collected in a mixed form, transported and then disposed of along with municipal solid wastes [15].
Most of the hospitals (39.6%) were in excellent status considering transportation process. 29.9%, 14.6%, 4.9%, and 11.1% were ranked good, medium, poor, and very poor respectively. The study investigated in Irbid city (a major city in the northern part of Jordan) showed that healthcare facilities in Irbid city have less appropriate practices when it comes to the handling, storage, and disposal of wastes generated in comparison to the developed world. There are no defined methods for handling and disposal of these wastes, starting from the personnel responsible for collection through those who transport the wastes to the disposal site. Moreover, there are no specific regulations or guidelines for segregation or classification of these wastes [16].
In the storage stage, 43.1% of hospitals were ranked excellent, 34% of hospitals good, 13.2% of hospitals medium, 2.1% of hospitals poor, and 7.6% of hospitals were ranked very poor. The research in UK showed that storage of clinical waste carts in areas accessible to members of the public and failure to lock individual waste carts was common. Waste segregation was poor. Many clinical waste carts and the areas dedicated to their storage were in a poor state of repair [17].
Most of the hospitals were in poor status considering disposal process. 24.3% of hospitals were in very poor situation. 8.3%, 5.6%, and 4.9% were ranked as excellent, good, and medium respectively. The waste disposal has the lowest average in comparison to the other process of healthcare waste management in this study due to not using appropriate technologies. Therefore, the hazard of healthcare waste could impacts the public negatively, though all efforts in the other healthcare waste management stages were satisfactory. The study in Egypt revealed that, the current situation of medical waste disposal in Alexandria is depending on incinerators. Some of these incinerators are not working anymore. Incinerations as a system is not accepted at the time being in most developed countries such as Iran due to the risks associated with it and suitable substitution management system for healthcare waste disposal is now taking its place [18].
The Kruskal –Wallis Test considering P < 0.05 and The Mann–Whitney Test considering P < 0.05 showed that there was a correlation between waste management different process and hospital rank. As the hospitals ranked excellent with 75.77 median are in better condition in healthcare waste management in comparison with other hospitals ranked as good, medium, poor, and very poor with 68.61, 62, 58.3, and 45.14 median respectively.
There was also a correlation between healthcare waste management and having environmental health expert. (p = 0.017). The waste management status in hospitals having such experts was in the better situation with 68.68 mean in comparison with other hospitals without mentioned experts with 58.58 mean. It should be mentioned that the waste management status in 53.3% of hospitals having environmental experts ranked good.
There was a correlation between healthcare waste management status and holding training course involved healthcare waste issues considering P < 0.001. The healthcare waste management was good in 69.1% of hospitals with trained staff.
The percentage of healthcare waste management ranks is shown in Figure 1. It can be seen that most of the hospitals were ranked good. The comparison between Tehran hospitals with Karachi hospitals showed that Tehran hospitals were in more appropriate situation. Out of eight hospitals visited 2 (25%) were segregating sharps, pathological waste, chemical, infectious, pharmaceutical and pressurized containers at source. For handling potentially dangerous waste, two (25%) hospitals provided essential protective gears to its waste handlers. Only one (12.5%) hospital arranged training sessions for its waste handling staff regularly. Five (62.5%) hospitals had storage areas but mostly it was not protected from access of scavengers. Five (62.5%) hospitals disposed off their hazardous waste by burning in incinerators, two (25%) disposed of by municipal landfills and one (12.5%) was burning waste in open air without any specific treatment. No record of waste was generally maintained. Only two (25%) hospitals had well documented guidelines for waste management and a proper waste management team [19].
The study conducted in 15 cities in Nanjing (a city in China) showed that the healthcare waste management in this city is rather similar to the mentioned management in Tehran city. As a case in point, the segregated collection of various types of healthcare waste has been conducted in 73% of hospitals. Furthermore, 93.3% of the hospitals have temporary storage areas [20].
The study conducted by Patil and Shekdar (2001) demonstrated that at many places, authorities are failing to install appropriate systems due to a variety of reasons, such as non-availability of appropriate technologies, inadequate financial resources and absence of professional training on waste management, while in Tehran at least in 27% of hospitals infectious wastes and sharps are disposed by using appropriate technologies.