Hospital Solid Waste Management Systems and Practices at University Teaching Hospital of Kigali (Chuk), Rwanda

ABSTRACT This study investigated hospital solid waste management systems and practices at University Teaching Hospital of Kigali (CHUK) for improving environmental management by promoting the safe and appropriate management of waste from hospitals. A combination of quantitative and qualitative methodologies was used to record necessary information. Data were analyzed with SPSS version 18.0 statistical software. Student t test and chi-squared tests were mainly applied to assess the data. The results of this study revealed that CHUK produced two types of waste: Infectious waste (Sharp &Non-Sharp) and Non-Infectious waste, which have been categorized into two classes by considering its bio-characteristics; Biodegradable waste and Non Biodegradable waste. Results gave an overall average weight of 429 kg/day of NonBiodegradable waste generated at CHUK. Our study showed that there was no clear policy and plan in place for managing hospital waste at CHUK. Segregation of hospital solid is not conducted according to definite rules and standards. The hospital does not label infectious waste with Biohazard symbol. The questionnaire survey revealed that there are two treatment and disposal options for treated HCW; the incineration was the main method for the On-site treatment of all combustible waste and off-site landfill is the remaining option for treatment of all Biodegradable waste. Survey had indicated that CHUK provides protective gears and training to all personnel who are engaged in HCW management. Despite of the provision of protective gear, some concerns were reported include injuries from needles stick, sickness and inappropriate bins and improper incineration practice. In the light of the above observations made, a number of recommendations are hereby made with the hope of improving the management of hospital waste in Rwandan hospitals in general and University Teaching Hospital of Kigali in particular.

TABLE OF CONTENTS

DECLARATION A II

DECLARATION B III

APPROVAL SHEET IV

ACKNOWLEDGEMENTS V

TABLE OF CONTENTS VI

LIST OF TABLES IX

LIST OF FIGURES X

LIST OF PLATES XI

ACRONYMS XII

ABSTRACT XIII

CHAPTER ONE: INTRODUCTION 1

1.1 BACKGROUND INFORMATION 1

1.2THESTUDYAREA 3

1.3 PROBLEM STATEMENT 3

1.4 GENERAL AND SPECIFIC OBJECTIVES 4

1.5 RESEARCH QUESTIONS 5

1.6 SCOPE OFTHE STUDY 5

1.7 SIGNIFICANCE OF THE STUDY 5

1.8 CLARIFICATION OF BASIC TERMS AND CONCEPTS 6

CHAPTER TWO: LITERATUREREVIEW 7

2.1 WASTE GENERATED FROM HOSPITALS 7

2.2 HOSPITAL WASTE CLASSIFICATION 7

2.3 HOSPITAL WASTE MANAGEMENT SYSTEMS AND PRACTICES 9

2.4 TECHNOLOGY FOR HOSPITAL WASTE TREATMENT AND DISPOSAL 11

2.4.1 THE TECHNOLOGY OF LANDFILLS 11

2.4.2 THE TECHNOLOGY OF INCINERATION 11

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2.4.3 AUTOCLAVING .12

2.4.4 CHEMICAL DISINFECTION 12

2.5 HEALTHCARE WASTE LEGISLATIONS, GUIDELINES AND REGULATIONS ASPECTS 12

2.5.1 NATIONAL REGULATIONS 12

2.5.2 INTERNATIONAL REGULATIONS 13

2.6 ENVIRONMENTAL PROBLEMS (RISKS) ASSOCIATED WITH HOSPITAL WASTE 14

2.6.1 INJURIES AND ACCIDENTS 14

2.6.2 HAZARDOUS HOSPITAL WASTE RISK 14

2.7 CONSEQUENCES OF IMPROPER DISPOSAL/NON-DISPOSAL OF MEDICAL WASTE. 15

CHAPTER THREE: METHODOLOGY 17

3.1 RESEARCH DESIGN 17

3.2 SAMPLING AND SAMPLING PROCEDURE 17

3.3 DATA COLLECTION 19

3.3.1 QUESTIONNAIRE SURVEY 19

3.3.2 INTERVIEW SURVEY 19

3.3.3 OBSERVATION AND PHOTOGRAPHY 20

3.4 MEASURING HEALTH-CARE WASTE AMOUNT AND WASTE COMPOSITION 20

3.5 DATA ANALYSIS 21

3.6 ETHICAL CONSIDERATION 21

3.7 LIMITATIONS OF THE STUDY 21

CHAPTER FOUR: PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA 22

4.1 REPARTITION OF RESEARCH RESPONDENTS 22

4.2 CHARACTERIZATION OF THE HCSW PRODUCTION AT CHUK 24

4.2.1 TYPE AND THE COMPOSITION OF HCSW GENERATED AT CHUK 24

4.2.2 CATEGORIES OF HEALTH CARE SOLID WASTE GENERATED AT CHUK 29

4.2.3 ESTIMATION OF THE HCSW QUANTITIES GENERATED AT CHUK 30

4.3 LEGISLATIVE, POLICY AND REGULATORY ASPECTS AT CHUK 35

4.3.1 REVIEW OF EXISTING HCWM MATERIALS AT CHUK 35

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4.3.2 CURRENT HCWM POLICY STATUS ATCHUK .37

4.3.2.1 TRAINING AND KNOWLEDGE ON HCWM 37

4.3.2.2 AVAILABILITY OF DOCUMENTS ON HCWM AT CHUK 39

4.4 CHARACTERIZATION OF THE HCSWM PRACTICES AT CHUK 41

4.4.1 SEGREGATION, PACKAGING, COLOR CODING AND LABELING 41

4.4.2 COLLECTION, ON-SITE TRANSPORTATION AND STORAGE ~47

4.4.3 OFF-SITE TRANSPORTATION 50

4.4.4 OPTIONS AVAILABLE FOR TREATMENT AND DISPOSAL OF HSCW AT CHUK 50

4.5 ENVIRONMENTAL PROBLEMS ASSOCIATED WITH HCW AT CHUK 55

CHAPTER FIVE: FINDINGS, CONCLUSION AND RECOMMENDATIONS 62

5.1. FINDINGS 62

5.2 CONCLUSION 65

5.3 RECOMMENDATIONS 65

5.4 DIRECTIONS FOR FUTURE RESEARCH 67

REFERENCES 68

APPENDICES 72

APPENDIX I: TRANSMITTAL LETTER 72

APPENDIX II: INFORMED CONSENT 73

APPENDIX III: RESEARCH INSTRUMENTS 74

APPENDIX IV: RESEARCHER’S CURRICULUM VITAE 82