Policy on healthcare waste management absent in Nigeria

A cross section of medical waste disposal containers

 …training of health workers on quality control imminent

The sustainable management of healthcare waste (HCW) has over the years continued to attract increasing public interest especially public health and environmental experts given the health problems associated with exposure of humans to potentially hazardous wastes arising from healthcare.

With these wastes said to contain materials considered harmful and can cause ill health to those exposed to it, often times, it has been shown that inappropriate handling and disposal of healthcare waste poses health risks to health workers who may be directly exposed and to people near health facilities, particularly children and scavengers who may become exposed to infectious wastes and a higher risk of diseases like hepatitis and HIV/AIDS.

Even as considerable gap exist with regards to assessment of healthcare waste management practices in Nigeria compared with international best practice elsewhere in developed countries of the work, health experts have called for the country to have a clear policy on medical waste management to be put in place at the institutional and national levels as well as train health workers to follow a simple but systematic procedure so as to develop the nation’s healthcare system centered on quality control.

Commenting on the issue, Obekpa Abah, a physician in the Department of Community Health, Faculty of Clinical Sciences, College of Medicine, Ambrose Ali University, Edo State, revealed that healthcare waste is the total waste stream from a healthcare or research facility that includes both potential risk waste and non-risk waste materials.

 While stating that sustainable healthcare waste management practice depends on the commitment of all healthcare facility staff, particularly commitment from the hospital leadership, Abah disclosed that lack of awareness about the health hazards related to health-care waste, inadequate training in proper waste management, absence of waste management and disposal systems, and the low priority given to the topic are the most common problems connected with health-care waste.

“The major sources of healthcare waste include hospitals and other health-care establishments,     laboratories and research centres, mortuary and autopsy centres, blood banks and collection services etc. Many countries in sub Saharan Africa including Nigeria don’t have appropriate regulations, or even enforce them. An essential issue is the clear attribution of responsibility for the handling and disposal of waste. According to the 'polluter pays' principle, the responsibility lie with the waste producer, usually the health-care provider, or the establishment involved in related activities.

“For instance, national legislation and policy specific to HCW management is yet to be implemented at any level despite the existence of Draft Nigeria National HCW (2007) and the fact that Nigeria is a signatory to several multilateral environmental agreements including the Basel convention,” Abah stated.

Lending his view, Elijah Ohimain, a biotechnologist at the Faculty of Science, Niger Delta University, Wilberforce Island, Bayelsa State, revealed that one major issue confronting the management of healthcare waste is perhaps the fact that it is generally viewed mainly from an environmental and less from a public health perspective.

While the World Health Organization estimating that annually, about 8 to 16 million new cases of Hepatitis B virus (HBV), 2.3 to 4.7 million cases of Hepatitis C virus (HCV) and 80,000 to 160,000 cases of human immune deficiency virus (HIV) are as a result of unsafe injections and very poor waste management systems in developing countries like Nigeria, where many health concerns are competing for limited resources, Ohimain stated that it is not surprising that the management of healthcare wastes has received less attention and the priority it deserves.

“The current management practice for healthcare wastes generated at the health facility in a recent study which was conducted is unsustainable and cannot be relied upon to protect human health and environmental integrity. There is no existing policy or plan and no systems in place for sustainable management of HCW. There is an urgent need to take practical steps aimed at ensuring ‘duty of care’ and safeguarding the environment for current and future generations,” he concluded.

Taking a careful look at healthcare wastes, of the total amount of waste generated by health-care activities, about 80 percent is general waste. However, the remaining 20 percent is considered hazardous material that may be infectious, toxic or radioactive. As a result of these shortcomings, these wastes contain potentially harmful microorganisms which can infect hospital patients, health-care workers and the general public.

With waste and by-products such as syringes, needles, disposable scalpels, blades, expired, unused, and contaminated drugs, vaccines and sera including, waste contaminated with blood and its by-products, cultures and stocks of infectious agents, patients in isolation wards, discarded diagnostic samples containing blood and body fluids, there is the need for stakeholders in the health sector to come together to develop a hospital waste management plan whereby such wastes can be segregated and disposed properly but excluding informing such plans to all hospital staff and patients in a bid to reduce occasions of people getting infected due to careless disposal of healthcare wastes by hospital personnel.

“Improving the standard of healthcare waste management in Nigeria will serve several useful public health purposes: Protect the health and safety of healthcare workers, patients and visitors at healthcare facilities; Improve occupational health and safety conditions of those responsible for handling healthcare waste; Improve environmental protection; Save costs through segregation, salvaging and re-use; and improve the service delivery of the healthcare sector, particularly in terms of compliance with the ‘duty of care’ principle (which requires that any person who generates, transports, treats or disposes of waste must ensure that there is no unauthorised transfer or escape of waste from her/his control. Such a person must retain documentation describing both the waste and any related transaction. In this way, he retains responsibility for the waste generated or handled),” Ohimain concluded.

FACTS

Type of HCW generated

Hospital unit                     Type of waste

Outpatient Ward             Waste paper, Hand gloves, Swabs, needle and syringes,  Used hand gloves, used i.v. fluid giving sets, Swabs, needle and syringes

Labour Ward                     Placenta, soiled clothes and materials, Papers,  empty medicine bottles and packaging, Empty drip containers, Needle and syringes, used I.V fluid giving sets,

Other Wards                      hand gloves, Swabs, soiled clothing, used infusion and blood giving sets,  soiled beddings, Used dressing materials, hand gloves

A&E unit                            Swabs, needle and syringes, soiled clothing,  used infusion and blood giving sets