PROJECT TOPIC AND MATERIAL FOR DEPARTMENT OF ENVIRONMENTA HEALTH SCIENCE

A STUDY OF THE HEALTH AND ENVIRONMENTAL IMPACTS OF BIOMEDICAL/HEALTH CARE WASTES IN IKOLE LOCAL GOVERNMENT AREA OF EKITI STATE

CHAPTER ONE

1.0      BACKGROUND OF THE STUDY

Biomedical/health care waste is a very serious global problem affecting mainly the developing nations. The medical waste tracking ACE [MWTA] USA of 1988 defined medical waste as any solid waste, which is generated in the diagnosis treatment or immunization of human beings or animals, in research pertaining to us in the production or testing of biological substances.

Biomedical/health care waste management has been a major source of concern to many people due to constant increase in hospital population and poor handling of instrument by health workers. Since ikole community is a developing community with various health institutions. one cannot deduce health hazard in fact biomedical waste is a major problem which needs attention before epidemics of infections manifested that includes gastro-intestinal infections, respiratory infections genital infections, skin diseases or infections. Anthrax, hemorrhagic fever, AIDS etc.

This research work spell out various means of managing biomedical/health care waste in our medical institutions in ikole EKITI  and more so, to know from various health or biomedical hazards already been found by various health personnel in their various field of work especially in ikole local government area.

1.2 STATEMENT OF THE PROBLEM

        The improper management of waste generated in health care facilities can severely affect the health care givers, patient and individual member of the community it also has the adverse impact on the environment. In addition to pollution from inadequate treatment of waste can indirectly affect the community, throughout the world and estimated of 16 billion injections are administered usually needles and syringes that are not disposed off properly pose on great hazard to public health due to the risk of injury and infection and of the opportunities for reuse.

        Additional health hazard occurring from scar engine on waste disposal sites and manual sorting of the waste of health care facilities, the waste handlers are at immediate risk of meedned-strick, another factor that contribute to health impact of biomedical/health care waste in ikole ekiti as a local government head quarter is that, the community people and the health workers have partial knowledge about biomedical waste management. Based upon observation the research involve to carry out research to find out factors responsible for biomedical waste and the health impact in the environment and human health in general.

1.3 SIGNIFICANCE OF THE STUDY

The world is generating more and more and hospital and health centre are not exception. Medical waste can be infectious, contain toxic chemicals and pose contamination risk to those people in the environment if patient are to receive health care and recover in safe surrounding, waste must be disposed off safely. Choosing the correct cause of action for the different types of waste and priority are not always straight forward particularly when there is a limit budget.

        This project work provide guardians and also serve as an eye opening on what is essential and what action required to ensure the good management of biomedical waste. Drawing on the most up to date professional practices the project provide practical recommendation for use in the different content where biomedical waste are to be management the guardians this work is applicable in resources poor countries such as Nigeria as well as country where there is more develop health infrastructure.

1.4 STUDY OBJECTIVES

The aim and objectives of this study is to;

1.  To enhance public enlightment and environmental education on biomedical/health care waste and their management.

2.  To facilitate development and implement action of health care waste management policy for the settlement

3.  To promote efficient collection and storage of biomedical waste and facilitate their prompt evaluation for treatment or disposal.

4.  To reduce biomedical waste generation in facility settlement.

5.  To evaluate the significance of the biomedical waste hazard.

1.5 RESEARCH QUESTIONS

1. Do people have an in-depth knowledge about bio-medical/health care waste?

2. Are biomedical waste common in residential environment?

3. How should individuals dispose biomedical waste?

4. Does improper management of health care waste have health implication?

1.6 DEFINITION OF TERMS

CONTAINER; vessels in which waste is placed for handling transportation, storage or eventual disposal [WIKIPEDIA]

        SEGREGATION; is a process of separating different types of waste at the point of generation in keeping them isolated from each other [State of the environment report 2003].

        TREATMENT; Is a process for altering the biomedical, chemical or physical characteristics of waste or reduced the hazard it present and facilitate or reduced that cost of disposal [manual on hospital waste management central pollution control board DELHI 2000].

        RADIOACTIVE; A nucleus of an atom that passes properties of spontaneous disintegration [Stanley and P wright [1993] the cytotoxic handbook fourth edition].

        RECYCLING; this is the act of reusing products rather than simply disposing of them after you use them. [San. Isiaku N.A [2004]; A lecture notes on hazardous and radioactive waste management].

INDICATOR; It is a facility in which solid waste is combusted under regulated temperature [medical dictionary]

DISINFECTANTS; Are antimicrobial agents that are applied to non living objects to destroy micro-organisms that are living on the objects. [Sandle T. [2012] the CDC handbook; A guide to cleaning and disinfecting clean rooms [1^st edition].

ENCAPSULATION; this produces a solid mass of material that is resistant to leaching. Waste can also be mixed with lime, fly ash and water to form a solid cement-like product [San Isiaku N.A [2004] a lecture notes on hazardous and radioactive waste management].

GEOTAXIS; A form of positive toxis in which there is a tendency to growth or movement towards or into the earth [Farlex partner medical dictionary 2012].

BIOLOGICAL; A medical product that is derived from biological sources [Random Hence Kernerman websters collage dictionary 2010]

EXPLOSIVE; these are reactive substance that contain great amount of potential energy that can

Produce an explosion if released suddenly. [San isiaku N.A [2014]; A lecture note on hazardous and radioactive waste management].

OPEN DUMP; this is a waste management facility characterized by indiscriminate dumping of

Waste in an uncontrolled, uncovered and unprotected. [Urban solid waste management India].

        PYROLYSIS; some hazardous waste type may be eliminated using pyrolysis in an ultra high temperature electrical are in inert condition to avoid combustion. This treatment method may be preferable to high temperature incineration of concentrated organic waste types including PcBs, pesticides and other persistent note on hazardous and radioactive waste management.

        LEACHATE; this is the liquid that comes out from a solid waste dump which is characterized by a larger chemical which can be highly hazardous to human life [India standard solid waste [1989]]

        MONITORING; The act of listening, carrying out surveillance on and or recording the emission of one’s own or allied forces for the purpose of maintaining and improving procedural standards and security or for references as applicable [WIKTIONARY].

        SANITATION; The control of the entire factor in the physical environment that exercise or can exercise a deleterious effect on human physical development, health and survival [The sanitarian and his work first edition by oni bamildele, Ayo mesuleya, Ayo bello olorunda] and others]

        SCAVENGER; A person who searches through and collects items from discarded material for reuse [dictionary com].

        SHARPS; These are sub-categories of infections health are waste characterized by sharp edges which can cause injuries, example includes, infusion sets, scalpels, blades and broken glass [san isiaku N.A [2014] A lecture note on hazardous and radioactive waste management].

                            CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 INTRODUCTION

        The inadequate and inefficient management of wastes has been regarded as one of the most serious environmental problem facing the cities of developing countries. The seriousness of this problem as well as the concern it drowns from citizens of the affected nations could be justified by the magnitude of publication available today. It is however ironical that health care waste have not been given much attention to the developing country like Nigeria.

        Health care waste as a problem comes into the lime light in the developed countries in the 1980s because of epidemiology and political reasons. For example increase in the incidence of viral blood infections such as Aids and hepatitis B and C was linked to discarded syringes in the disease transmission. This epidemiological scare was completed by public ontery arising from the usual insighthness of medical waste in open dumps, drains tidal water, leaches and recreational and other public places. Health care waste becomes a world problem and a global priority in the early 1990s WHO requested all member nations to develop safe and sound hazardous waste management policies with a special focus in biomedical wasted.

        Usually, the health care waste is understood to mean wastes coming from facilities and regulations [e.g medical practices, pharmacies etc.] available information confirm that about 85 percent of these wastes are actually non-hazardous about 10 percent are infectious waste and about 5 percent are non-infectious but hazardous. Thus they can be radioactive, toxic and hazardous therefore require proper handling to fore stall risks to human and damage to the ecosystem.

        There have been various reports on dangers posed by health care wastes to human health and well being. Waste generators and handlers at the health care facilities and scavengers at the waste dumping sites are at great risk. Used syringes or needles have been seriously used ignorantly as ear rings or simple colored and solid as hair rollers, fresh food crops are being grown and harvested near dumping sites while liquid waste coming from hospitals are used for irrigation. Some innocent people have unknowingly stepped on used syringes, needles, broken bottles of toxic chemical or exposed to poison fumes and gasses resulting in morality.

        There is a wide gap of information on the nature composition, generation, rates, storage, sorting, transportation, disposal and the legal frame work, for effective management of biomedical waste. Added to these are low literacy level and poor attitudes and practice of medical staff and the general public following from these observations, a comprehensive study was made in Ikole-Ekiti which is cited as a case study in this work during this study, the need for suitable biomedical waste management to be manual was defined, for any health care waste management to be meaningful and suitable there is need for proper planning of all stages in the process, which include human, material and financial resources.

        Health was firstly taken care by medicine man these medicine men were trained to know the different herbs and roots; how to prepare them, which ailments they carried and how to administer them. The health care system especially in Nigeria evolved over a period of time. Before the advent of the Europeans, when large highly organize financial and socio-political system with provisions made for solving environmental problem including health. The poor state of health of the populace is characterized by the rapidly decreasing immunization coverage, which is indicator of health care service utilization.

        Hospital waste, till recently was not being managed but it was disposed off, the disposed of health care waste can be very hazardous particularly when it gets mixed with municipal solid waste and its dumped in uncontrolled or illegal landfills such as vacant plots in neighboring residential areas and slums. This can lead to a higher degree of environmental pollution, apart from poison, serious health risks such as Aids, hepatitis, plaque, cholera etc.

        According to world health organization [WHO] estimates 85% of health care wastes is actually non hazardous and around 10% is  infectious while the remaining 5% is non infectious but consists of hazardous chemicals like methyl chloride and formaldehyde. In the total amount of municipal waste, a city generates only 1-5% which is hospital waste of which 10-15% is considered infectious. It was estimated; a city like New Delhi with about 40,000 beds generated about 60 metric tons of hospital waste per day. But whatever the amount of hospital waste there be, it proves to be harmful to the community. This need immediate treatment and effective disposal, the usual in effective waste consists of bandages, gauzes, cotton waste, placenta, amputated human parts and used analysis kits containing infectious materials as well as the reagent and solvent used for analytical purpose.

        Biological hazards are the discipline that aims at the prevention of biological hazards resulting from direct and indirect manipulation of the various biological agents. In the country this discipline has a comprehensive approach for not only limited to risks from the handling of genetically modified organisms but irrigation and exposure from the use of various biological agents on the premises of human, animal and better training and human resources development. This is true with the creation of the national bio safely centre in 1996 by the ministry of science technology and environment,  which prepares the country for the rise of emerging and re-emerging diseases which currently constitute major challenges to bio security as discipline.

       

2.2 MEANINIG OF BIOMEDICAL WASTE

        A series of definition have been ascribed to health care wastes. Biomedical waste includes all the waste generated by health care establishment, research facilities and laboratories in addition. It includes the waste originated from minor or scattered sources. Such as that produced in the course of health care undertaken in the home [dialysis, insulin injection etc]. The medical waste tracking act [MWTA] USA of 1988 defined medical waste as any solid waste, which is generated in the diagnosis, treatment or immunization of human beings or animals in research pertaining to the production of testing of biological substances.

        Health care waste was defined as the total waste stream from health care facilities, research facilities, veterinary clinics and laboratories. This waste stream can however be divided into municipal solid waste and special biomedical waste [sanitarian clinics and his work 2009]. It is also defined as all the waste generated by medical activities embrace the activities of diagnosis as well as preventive, curative and palliative treatments in the fields of human and veterinary medicine [biomedical health care waste 1^st edition].

Biomedical waste is a heterogeneous mixture, it often certain chlorine [from material containing polyrinyl chloride and other plastics], heavy metals [from broken thermometers], cytotoxin, radioactive  diagnostic materials infectious materials and pathogen in consequence, these organisms which can infect hospital patients, health care workers and the general public.

CLASSIFICATION OF BIOMEDICAL WASTE

1. Non-Risk Biomedical Waste

        This include all the waste that has not been infected like general office waste, packaging or leftover food. They are similar to normal municipal waste, they represent between 75% -90% of the total amount of waste into two [2].

i.            Recycle waste; this include paper, cardboard, non contaminated plastic or metal, cans or glass that can be recycle at any recycling industry exist in the country.

ii.          Biodegradable waste; this category of wastes comprises for instance leftover food or garden waste that can be composed

2. Waste Sharps

A. Human Anatomical Waste

This category of waste comprises of non-infections human body parts; organs and tissues and blood badge, example are tissue waste, removed organs, amputated body parts, placentas etc.

B. Pharmaceutical waste       

        The term pharmaceuticals embraces a multitudes of active ingredients and types of preparations. The spectrum ranges from tears through heavy metal containing disinfectants to highly specific medicines waste management therefore requires the use a differentiated approach to this category of waste comprises expired pharmaceuticals or pharmaceutical that are unusual for other reason e.g [call back campaing].

C. Cytotoxic Pharmaceutical Waste

        Cytotoxic pharmaceutical wastes are wastes that can arise by [administration to patients] manufacture and preparation of pharmaceuticals with a cytotoxic [antineoplastic] effect. The chemical substances can be sub divided into six main groups; anti-metabolites, hormones, antibodies and others, consequently, these wastes pose hazards and the measure to be taken.

D. Blood and Body Fluid Waste

        It includes waste that are not categorized as infectious waste but contaminated with human or animal blood, secretion and excretions. It is warranted to assume that these wastes might be contaminated with pathogens eg. Dressing materials such as swabs, syringes, without needles and bandages.

3. Infectious and Highly infectious waste

A.  Infectious waste       

        This comprises all biomedical waste clinically assessed by a medical practitioner transmitted or veterinary surgeon to the potential transmitted infectious agents to humans or animals. The waste include discarded materials contaminated with blood or its derivatives other body fluid or excreta from clinically confirmed infected patient or animals with hazards communicable diseases.

        Contaminated waste from patient after undergoing heamodialysis [e.g. equipment such as filter disposable sheets, aprons, gloves or laboratory courts contaminated with blood]

B. Highly infectious waste

        This include all microbiological cultures in which a multiplication pathogens of any kind has occurred laboratory wasted [cultures and stocks with any viable biological agents artificially controlled to significantly elevated numbers, including dishes and devices used to transfer, imoculate and mix cultures of infections agent and infected animals from laboratories e.g. sputum culture of TB laboratory, high concentrated microbiological cultures, glass ware material etc. generated from laboratories

C. Radioactive Wastes   

        These usually contain low level radioactivity [IMBa] radio nuclides with short half lives, which lose their activity relatively quickly. They are produce as a result of procedures such as invitro analysis of body tissue and fluid inviro organ imaging and tumor localization and various investigation and therapeutic practices. Certain therapeutics however require radio nuclide with larger half-lives in the form of pins, needles or seeds and may be raised on the patient after sterilization.

Some of the radioactive materials commonly used in health care facilities and the sources of radioactive wastes.

2.3 SOURCES OF BIOMEDICAL WASTE

        The sources of biomedical waste can be classified as major and minor according to the quantities of produced.

MAJOR SOURCES

        The major sources include;

a.   Hospital and other health care establishment

b.  Laboratories and research centre

c.   Mortuary and autopsy centre

d.  Animal research and testing

e.   Nursing home for the elderly

f.    Blood banks and blood collection centre

MINOR SOURCES  

        The minor sources include;

a.   Funeral homes

b.  Home treatment

c.   Small health care establishment

d.  Ambulance service

2.4 HEALTH RISK/IMPACT OF BIOMEDICAL WASTE

        Health risk associated with biomedical waste. A health risk cannot be assessed if the hazard or cause involved is uncertain to the environment. However, a precautionary principle has to be applied in managing than effectively. Some of the risk associated with biomedical waste is as follows;

A. Occupational Risk-   During handling of waste, the medical and auxiliary staff, and the sanitary laborers can be injured, if the waste has not been packed safely. Many injuries occur because syringes, needles or other sharps have not been collected in safely boxes or because they have been overfilled. Most of the needle injuries happened during recapping on dump sites scavengers are exposed to injuries during recycling activities.

        Epidemiological studies indicate that a person experiences one needle stick injury from a needle used on an infected source, patient has risks of 30% and 0.3% respectively of becoming infected with HBV, HCV or HIV. Occupational risk may be associated with the operation of certain disposal facilities such as incineration and unsanitary landfills.

B. Risks to population; the general public can be infected by biomedical waste either directly or indirectly through many ways reuse of syringes is a serious problem in most of the developing countries.

        The [WHO] estimates show that about 10 million infections of hepatitis B, C and HIV occur yearly from the reuse of discarded syringes and needles that were not disinfected or were improperly disinfected.

C. Risks to Environment; although treatment and disposal of biomedical wastes aims at reducing risks, indirect health risks may occur from reuse of toxic pollutants into the environment through treatment or disposal. Dumping of biomedical waste in uncontrolled areas can contaminate silage or gray water [sridhas 1995, 1999]

Land fill can potentially result in contamination of drinking water there is the risk of spillage of biomedical waste due to use of inappropriate containers, the attitude of hanlage vehicle drives during transportation from sources to the disposal facility, lack of access control to the storage areas, and uncontrolled movement of stray animals into the dump site.

        Inadequate incineration of incinerating of materials unsuitable for incineration can result in the release of pollution into the air, incineration emission includes conventioneer pollutant eg. Particulate matter; sulfur oxides, nitrogen oxides, volatile organic compounds, and carbon monoxides as well as dioxims, furams Arsenic, lead, cadmium, chromium, mercury and particulate pollution into the atmosphere [EPA 1996] and incinerators is a major source of wastes in small and poorly controlled. Incinerators is a major source of dioxins and furan which have proven carcinogenetic. Finally, the dumping  of biomedical in an uncontrolled areas can have a direct environmental effect by contaminating soils and underground waters. During incinerating, if no proper filtering is done, air can also be polluted causing illness to the nearby populations. This has to be taken into consideration when choosing a treatment or a disposal method of carrying out a rapid environmental impact assessment.

2.5 PLANNING IN BIOMEDICAL WASTE MANAGEMENT     

        Planning is very essential under biomedical waste management to any organization who are directly or indirectly involved in the management of health care waste, there is tendency of spared of diseases and exposure of the health of populace to potential hazard. Therefore, the chief environmental health officers is responsible for routine operation and monitoring of the waste management system for handling and disposing of pathological, pharmaceutical, chemical and radioactive waste.

The following are the steps to follow;

1. Control internal collection of waste containers and their transport to the central waste storage facilities of the hospital on a daily basis.

2. Ensure that hospital attendant and auxiliary staff replace use containers with the correct new containers

3. Directly supervise hospital attendants and auxiliary workers assigned to collect and transport health care waste.

4. Prevent all unsupervised dumping of waste containers on the hospital ground.

5. Coordinate and monitor all waste disposal operation of being injured or infected. They include;

A. Medical staff; doctors, Nurses, Sanitary staff and hospital maintenance personal.

B. In and out patient receiving treatment in health facilities as well their visitor.

C. Workers in waste disposal facilities including scavengers.

D. Workers in support service linked to health care facilities such as candies, waste handling and transportation services.

E. The general public is more specifically the children playing with the items they can find in waste outside the health care facilities when it is directly accessible to them.

2.6 HANDLING OF BIOMEDICAL WASTE

        This deal with generation, segregation, collection, storage and transportation of health care wastes. Health institution generally generates a wide variety of waste, some of them are similar in many respect to those produced by recreational, facilities hotels and restaurant. Such waste includes paper, rags, food remnant, glass, plastics, metals and the hazardous and infectious nature, appropriate handling practices and color coding are required.

        Generating rate; Generating of biomedical waste varies from country to country and also depends on the types of facilities biomedical waste is usually expressed in terms of ‘kg/bed/day’ or kg/patient/day. These waste generated at a specific health care waste generation, it should be stressed that there are inherent day to day variation which values even at the level of each facilities, which may not discard the same amount of waste every day.

2.7 WASTE SEGREGATION

        Health care waste generator must segregate their waste from trash because the segregation requirement raise institutional awareness of the types and quantity of medical waste generated and promote the development of appropriate management strategies for each medical waste categories [USEPA 1989] this is a vital implementing a cost of offensive disposal because it minimizes the quantity of regulated waste and reduce the disposal cost [EVISENSE 1995].

        Solid hospital wastes are directed as whole municipal collection systems without proper separation of the infectious fractions tissues is through proper creation in specifically designed units, burrial on the hospital grounds. Introduction to the sewage system with or without prior tribulation, direct incineration in metallic containers or shipment to local cemeteries [Mnreal 1991]. Infectious

waste must be placed in containers labeled with the universal biohazard symbol.   

COLOR CODE FOR WASTE SORTING AND SEGREGATION [CCWSSS]

COLOR	CATEGORY	COMPONENT OF WASTE
Black	Non infectious waste	All paper, packaging, materials including cartons, bottles food remnants and rays.
Yellow	Infectious waste	Gloves, dressings, blood body fluids, used specimen containers and similar wastes from both health care and research facilities
Red	Highly infected wastes	Anatomical waste, pathological waste
Brown	Chemical	For maldehyde, batteries, photographic chemicals, inorganic chemicals
Yellow with radioactive label	Radioactive waste	Any solid, liquid or pathological waste, contaminated with radioactive isotope of any kind
Green	Recyclable waste	Glass waste, metal, cans, plastic waste, plastic cans, polythene etc.
	Organic waste	organic waste including garden wastes, leagues, Serbs, tree trucks, weed, flower etc.

2.8 PACKING OF BIOMEDICAL WASTE

        Health care wastes with the exclusion of sharps must be packed impermeable, red color varies from curbing polyethylene or polypropylene plastic bags meeting the expected requirements. Most often red or red –orange bags are used, hence the term ‘red bag’ waste yellow color coded sacks are used throughout UK for disposal of chemical wastes with high density puncture resistant containers for sharps. In Nigeria, yellow color is being used for infectious waste in many facilities, waste from operating threats and these from patients infected with multiple antibiotic resistance bacteria, hepatitis B or other high risks agent including HIV re-related diseases are double wrapped for increased protection [Health care waste management 2009]

2.9 STORAGE OF BLOMEDICAL WASTE

        The storage of health care waste is the nucleus of the entire management process hence, as the waste is segregated into different streams at this stage an incorrect classification of waste can generate many problems at the subsequent levels of management.

        The maximum period for the storage of health care waste is 30 days although some authorities prefer that the waste is stored for not more than 4 days. The storage days containing commences when the first non-sharps items of biomedical waste is placed in red bags or sharp container or when the sharp container is fill or closed. However, in the USA, storage of regulated medical wastes does not exceed 5 days, point of generation [1 day] storage area [3 days] and transport vehicle [1 day] 

2.10 TRANSPORTATION IN BIOMEDICAL WASTE

        ‘transport is the movement of health care waste from the point of generation to any immediate point [including to movement of biomedical wastes from health care facility or agency to another for the purpose of testing and researching ] and finally to the part of treatment or disposal.’

A. ON-SITE TRANSPORTATION

            Health care waste should be transported within the hospital or other facilities by not used for any other purpose and meet the following specifications easy to load and unload there should be no sharp edges that could damage waste bags or containers during loading and unloading and easy to clean.

            Before transportation of all waste dispatch, documents should be completed, while all arrangement should be made between consignor and consignee and incase on exportation the consignee should have confirmed with the relevant competent authorities that the waste can be largely imported and that no delays will be incurred in the delivering of the consignment to its destination, proper identification is necessary during the transport of biomedical and health care wazstes. When medical waste is transported in reasonable containers, these containers must be sterilize before being redeployed.

            The vehicle should be cleaned and disinfected daily with an appropriate disinfectants. All waste bag seals should be in place and made intact at the end of transportation.

B. OFF-SITE TRANSPORTATION OF WASTE

            The health care waste producer is responsible for safe packaging and adequate labeling of waste to be transported off-site and for authorization of its destination. Labeling of biomedical waste is a very important area that should not be taken with levity.

            Accurate full and correct labeling allows the origin of the waste to be traced in addition, the hazard posses by container can be quickly identified incase of accident, enabling emergency service to take appropriate action. Each container is typically labeled with a barcode, the type of waste where the waste is coming from, the time of arrival, time consignment was offloaded and how much was generated.

            However, local authorities and relevant agencies should ensure that vehicle used to transport biomedical waste should fulfill the following design criteria;

i.            The body of the vehicle should be a suitable size commensurate with the design of the vehicle, with an internal body height of not less than 2.2 meter.

ii.          ii. There should be suitable system of arrangement for securing the lead during transport.

iii. The vehicle should be kept locked all the times, except when loading and unloading.

Iv. Open top container should never be allowed for the transportation of biomedical waste.

v. The vehicle should be marked with the name and address of the waste carrier labeling of

CATEGORY	LABELLING
B1	Danger, Anatomical waste to be incinerated and deeply buried
B2	Danger, contaminated sharps do not open
B4, B5, C1	Danger, hazardous infections waste
C2	Danger, highly infectious to be pretreated
B3, B33, D	Danger, to be discarded by authorized staff only
E	Danger, radioactive waste

                            

2.11 LABELLING AND COLOR CODING OF BLOMEDICAL WASTE

        Labeling of waste containers into various categories is crucial for easy identification pretreatment and disposal. The label should clearly indicate the contents, date of production, place of production [e.g. ward establishment], waste quantity, waste category, waste destination in case of offsite disposal.

Some of the advantage of labeling is;

1.It serves as warning to waste generation handlers and the general public of the hazardous nature of waste.

2. The nature of the hazardous posed by the waste in case of accident.

3. It facilitate easy tracing of the origin of the wastes.

The WHO recommended color-code schemes are;

COLOR CODING FOR STORAGE AND TRANSPORTATION

WASTE	DESCRIPTION	COLOR CODE
1	General waste	Black plastic bag of appropriate size
2	Infectious waste [A] sharps	Puncture resistance containers and yellow sharp cardboard boxes may be used but have no Color code
3	Photographic chemical waste photographic developer-fixer solution-x-ray photographic	Red/brown plastic container to be recycled/ reuse to be neutralized
	[C] Radioactive waste, solid combustible/compactable, liquid aqueous spent sealed sources.	Yellow containers with radioactive symbol [usually which headliners]. Durable plastic bag which can be sealed. Puncture resistant container central, thick walled polythene bottles or organic glass container but should have secondary container to prevent them from breaking. Container in which the source was.
	[D] laboratory waste - Acids - Alkalis - Solvents - Organic substance - Heavy metal [mercury]
	[E] Incinerator Ash, sludge	- yellow metal containers labeled ‘Ash’ - yellow metal containers labeled ‘sludge’

SAFETY PRECAUTION IN ‘BIOMEDICAL WASTE’

        The following measure should be considered to safe health care waste management to reduce possible hazard and infection arising from improper handling of the wastes.

i. WASTE MINIMIZATION AND SEGERATION

        Waste minimization through reduction, reuse and recycling method is an important first step in managing biomedical waste safety responsible and in a cost effective manner. Segregation of hazardous, non-hazardous and infectious waste is another measure towards safe and economic management of biomedical wastes.

ii. Storage

-         Segregation waste collected in color coded container must be stored safely.

-         Sharp must always be kept in puncture-proof containers

-         Plastic bags used for storage must be suspended inside a frame or be placed inside a stir by container and provide with a bid, the container should not be over filled, while needles should be bent, broken, cut, separated from syringes or replaced prior to disposal.

iii. TREATMENT

-         THEY SHOULD BE CARRIED OUT AT THE POINT OF WASTE GENERATION

-         Syringes and needles should be damage before being put into the containers.

-         Sharps should be disinfected at source by using chemical disinfection

iv. FINAL DISPOSAL

-         Care must be taken to reduce the waste as much as possible before final disposal.

-         Hazardous substances such as treated incineration ash, should be disposed off after retrieving the recycle portion.

-         Liquid waste should be disposed off in severs or septic tank and solid waste into sanitary landfills.

TRAINING ON BIOMEDICAL WAST EMANAGEMNET

    Training in biomedical waste management is expected to aspects such as sensitization, teaching, discussion and feedback. The training should be devoted to sensitizing the audience on the;

[A] Need to manage waste in the hospital, these include;

-         Danger to patients

-         Problems of inappropriate technologies

-         Spread of infections through recycling

-         Facts about sharps and their reuse

-         Danger to the community through biomedical waste

[B] Various ganger and risk faced by health care workers

[C] Legislation for biomedical waste etc.

    The entire hospital teams needs to know the provision of biomedical wastes rules [management and handling]. How and why they came into existence, their effect to make sure management programme succeeds, fires and other legal implication should also be thought. Trainee should be taught about waste management and related problems.

SAFETY PRACTICES FOR PERSONNEL

    Biomedical waste management policies or plans include provision for the continuous monitoring of workers health and safety to ensure that correct handling storage and disposal produces are being followed.

-         Proper training of workers

-         Provision of equipment and clothing for personal protection

-         Establishment of an effective occupational health programme that includes;

Immunization post-experience prophylactic treatment and medical surveillance.

 Training; training in health and safety should ensure that workers know and understand the potential risk associated with biomedical waste, the value of immunization against viral hepatitis and importance of consistent use of personal protection equipment.

    Workers at risk include health care providers hospital cleaners, maintenance workers, operators of waste treatment equipment and all operators involved in waste handling and disposal within and outside the establishment must be made aware of the risk involved in their occupation. The protective clothing used will depend to an extend upon the risk associated with the biomedical waste, but the following should be made available to all person who handle biomedical waste.

-         Helmets

-         Face marks

-         Overall

-         Industrial apron

-           Disposable glove

-         Industrial boots

A. Treatment of biomedical waste 

        Biomedical waste have to be treated before disposal, the term ‘treatment’ here refers to the process that modify the waste in some way before its final resting place [Load 1994]

Treatment may be required for specific reason;

a.   Disinfect or sterilize the waste, so that it is no longer the source of pathogenic organisms.

b.  Reduce the bulk volume of the waste in order to reduce requirement for storage and transportation.

c.   Make recycle items unusable

The systems of treating biomedical wastes generally are designed and operated in two basic requirements.

DECONTAMINATION- it deals with a requirement for rendering the biomedical waste biologically safe for ultimate disposal.

DISFIGUREMENT- it relates to the recognisability of the treated biomedical waste. It will go along way rendering share in the waste streams, non-hazards. This requirement could be achieved through shredding, combustion and sometimes through reaction with strong for achieving effective disinfection; certain vital factors should be given adequate consideration. These factors include the types of disinfectant concentration and quantity of disinfectant, temperature, PH, Mixing and contact time. WHO aims to promote effective non-burn technologies for the final disposal of biomedical waste to avoid both the disease burden from unsafe biomedical waste management and potential risk from dioxins and co-planar PCB [WHO 2006]

2.12 BIOMEDICAL WASTE DISPOSAL AND MANAGEMENT

        Biomedical waste disposal methods in various country and institution have different methods of biomedical disposal

1. SANITARY LANDFILL        

        According to wogrolly [1998] most critical waste should be allowed to be landfill after separation of the organic matter or even after treatment in an incinerator. Deep well draws the gas, which is filtered purified deodorized and then fed into the local gas supply. Sanitary landfills can be useful disposal techniques, especially for small town.

Some essential elements for design and operation of sanitary landfills.

i. access to sites and working areas possible for waste delivery and site vehicle.

ii. Division of the site into manageable phase appropriately prepared before landfills starts.

iii. Surface water collection trenches around site boundaries

 iv. Adequate mechanisms for leach ate collection and treatment system if necessary

2. INERTIZATION

        The process of ‘inertization’ involves mixing waste with cement and other substance before disposal in order to minimize the risk of toxic substances contained in the waste migrating into surface water of ground water.

3. BIOMEDICAL WASTE MANAGEMENT

        The management of health care waste requires diligences and care from a chain of people. Starting with the nurse or doctor who uses the equipment and supplies that become waste continuing through to the labour who provides clean sack or containers and carries away the wastes, on the mechanics and technicians who keep the vehicle and the equipment in good condition and finishing with the person responsible for ensuring that residence are disposed off in correct way [Coad 1994].

        Management styles that give room to upward contamination that is willingness on the subordinate to offer suggestion to their superiors usually go a long way in helping to encourage a feeling of team spirit or shared responsibility. All suggestion must be received positively if such an environment is to be contaminated [Coad 1994]. Various management options have been developed for the management of biomedical waste but only two [2] which are relevant for developing are given below;

1. The government is the regulation and facilities

        The government is the regulator. A major general as well as the manager, all generators will be required to review their current biomedical waste management practice and satisfy the applicable legislation, regulations, standard and criteria developed by the appropriate ministry. Hospitals currently operating incinerator would access the implication of upgrading, replacing the existing incinerators to meet the stipulated emission criteria.

Under this scenario, hospital and other generators considering their treatment/disposal facilities would be responsible for any environmental assessment and setting that may be required including any negotiations with regional local government of biomedical; and the public with regulations specific to the environment of biomedical waste in places, it is anticipated that private sectors would respond to market possibilities and provides services for collection, transportation, treatment and disposal.

2. Private ownership and operation

        In this management option, a private sector contractor would site permit, construct and operate a city wide system for the collection transportation, treatment and disposal of health care waste from as a minimum in the publicity founded health care institutions.

2.13 THE ROLE OF LEGISLATION IN BIOMEDICAL WASTE MANAGEMENT

        The formulation of policy for the management of biomedical waste should outline the rationale for the national goals and the key steps that are very essential to the achievement of an effective management at the national level.

This may include the following points;

1. Health and safety risks resulting from mismanagement of biomedical waste

 2. Approve method of treatment and disposal for each waste category.

3. Warning against unsafe practice such as disposing of hazardous biomedical waste in municipal landfills.

4. The responsibilities of the management within and outside biomedical health care establishment.

5. Assessment of the cost of management of biomedical waste

6. Record keeping and document

7. Training requirement

8. Rules governing the protection of workers health and safety.

9. Strategies for a gradual implementation of the policy especially when existing practices are inadequate

10. Definition of biomedical waste categories include in the policy.

LEGAL POLICY IMPLEMENTATION IN NIGERIA

        Nigeria has no well-defined health care waste legislation. The policy on environment and various decrees made reference to hazardous and toxic wastes which have relevance to health care facilities.

        During the year 2007, a draft policy was finalized and a stakeholders meeting was held to rectify the policy which was sent to the government for legislation [federal ministry of Environment 2007]. Prior at the establishment of the federal Environmental protection Agency [FEPA] in 1988 there were sectorial environmental regulations some of these include;

-  National Guideline and Standards for Environmental pollution Control in Nigeria [1990]

- The harmful waste [Special criminal provision] act cap 165 LFN 1990, the law provides that all activities relating to purchase, sale, importation, transit, transportation, deposit and storage of harmful wastes are prohibited and therefore unlawful and any person who contravenes is punishable by imprisonment.

- The pollution abatement in industries and facilities generating regulation 5.1.9 or 1991 which spell out restrictions on release of toxic substances into Nigeria’s ecosystem and the pollution monitoring requirement for industries the strategies for waste reduction requirement for environmental audits and penalties for contraventions.

- The environmental impact Assessment [EIA] Decree 86 of 1992 is to infuse environmental considerations into development project planning and execution.

- The management of solid and hazardous waste regulations S.1.1.5 of 1991 which give a comprehensive list of dangerous and hazardous waste and the environmentally sound technologies foe waste disposal.   

CHAPTER THREE

3.0 METHODOLOGY

        This study was designed to investigate the impact of biomedical or health care waste in Ikole local government of EKITI STATE.

3.1 DESCRIPTION OF THE AREA

        Ikole local government is a local government area of ekiti state, Nigeria. Its headquarters are in the town of ikole. It has an area of 321km² and a population of 168,436 at the 2006 census. Ikole is about 65km from Ado, the capital of ekiti state Nigeria.

The town is situated on a very plain and well drained land on the northern part of the state. About 40km from the boundary of Kwara-state. The town is gifted with good fertile farmlands which ensure future expansion of agriculture and allied industries as well as high swell in its population growth.

3.3 STUDY SETTING AND SAMPLING TECHNIQUE

        Sampling techniques should be adopted to ensure that sampling is unbiased. A sample of 50 subject of respondents were used for this study, the researcher used a random sampling technique to select the respondents in the study. The respondents includes; the medical officer or workers such as the Doctor, Nurses, Community health Extension Workers, Auxiliary Nursing, Medical Laboratory officer Health Labour and Environmental health officer.

3.4 INSTRUMENT DESIGN

        The research used different instrument in collecting the data, so that reliable and useful information can be obtained.

The instruments used questionnaire, interview and personal observation.

        The questionnaire contain 16  questions in all the questions deals with personal data of the respondents, elicit information on the significant of biomedical waste management on the environment, method of biomedical or health care waste management, environmental impact of biomedical waste management. Etc.

        Oral interview were conducted on the knowledgeable and intellectual member of the locality so that reliable information can be gathered on the study topic. The specialists on the chosen field were also interviewed in the area, so that they can give full professional supports to the question asked corresponding good responds.

3.5 METHOD OF DATA COLLECTION

        The major instrument used for data collection is questionnaire which is to be administered on each sampled facility. The questionnaires are specially designed to collect information on various aspect of health care waste management from the policy makers and policy making institutions. The specific institutions to be targeted are; Waste management Authority [WMA], federal environmental protection Agency [FEPA], National Environmental Standards Regulations Enforcement Agency [NESREA], State Environmental Protection Agency [SEPA], ministry of health and all other relevant local government in the study area.

3.6 PRETEST OF THE STUDY

        It is often expenditure to pre-test the questionnaires to ensure that the researcher have a good understanding of how the various components are stored, or recorded and also have similar technical terms in naming or categorizing wastes, and to ensure that the questionnaire are appropriate to the purpose and objective of the study.

3.7 METHOD OF DATA ANALYSIS

        The completed questionnaires were subjected to scoring, data collected were analyzed by the means of percentage, Cross tabulation percentage shall be used for presentation of data while tables will be employed to show the analysis of data collected in various area during the research work.

3.8 LIMITATION OF THE STUDY

        The problem anticipated by the researcher during the course of writing this project whereby a lot of challenges was faced such as lack of proper support from the respondents, financial constrain, limited time factors, stress, lack of adequate material on the topic, problem of electricity during printing of the project. Therefore, this project is limited to Ikole local government area of Ekiti State 

CHAPTER FOUR

4.0 DATA PRESENTATION AND ANALYSIS

4.1 INTRODUCTION

        The data generated through the questionnaires were presented and analyzed in this chapter. The method used for presentation and analysis of data frequently count and simple percentages, this was used to test the hypothesis in the study aimed towards investigating the significance of biomedical waste management. The analysis of data was based on the responses to questionnaires various respondents.

DISTRIBUTION OF DATA COLLECTED

[PRESENTATION OF FREQUENCY]

TABLE A: Categories of Respondents

Categories	Frequency	Percentage
Medical	30	60%
Health labourers	20	40%
Total	50	100%

Table A: shows that out of 5o respondents. 60% are medical officers while 40% are health labourers.

Research question: Does people have in-depth knowledge about biomedical waste?

TABLE B:

S/N	QUESTIONNAIRE	RESPONSE	PERCENTAGE%
1	Can you identify biomedical waste among other types of waste	[A] YES 36	72%
		[B] NO 14	28%
Total		50	100%

TABLE C:

S/N	Questionnaire	Response	Percentage
2	What are the compositions of biomedical waste? [A]Dust, paper, nylon/others [B] Garbage, rubbish, ashes [c] Broken glasses, concretes, blade hypodermic needle	[A] 16 [B] 6 [C] 28	32% 12% 56%
	Total	50	100%

Table B/C: Shows the percentage of those who have in-depth knowledge about biomedical wastes. Question i show that 72% Health workers can identify biomedical waste among other type of waste and 28% cannot identify health care waste among other type of waste.

Question ii shows the percentages that know the composition of biomedical waste is 56% while those identified household as health care waste is 12% and other is 32%, therefore this indicate that the respondents have depth knowledge of biomedical waste.

        Research question iii: Does biomedical waste much common in residential environment?

Table D/E

S/N	Questionnaire	Response	Percentage
1	Do biomedical many in large population?	[A]Yes 41 [B] No 9	82% 18%
	Total	50	100%
2	Why do medical waste much common in the environment? [A] increase in population [B] increase in health facility [C] increase in mortality rate [D] due to urban centre	[A] 5 [B] 24 [C] 11 [D] 10	10% 48% 22% 20%
	Total	50	100%

Table D: shows that 82% confirm that biomedical waste are much common in the environment while 18% disagree.

Table E: shows that 48%, 22%, 20% and 10% respectively indicate reason why biomedical waste much common in the environment.

Research iv: How should individual dispose biomedical waste?

Table F/G

S/N	Questionnaire	Response	Percentage
1	Which treatment method do you use before disposing your health care waste? [A] Incineration [B] Autoclaves [C] Mechanical/chemical disinfection	[A] 10 [B] 15 [C] 25	20% 30% 50%
	Total	50	100%
2	How do you dispose off your treated health care waste? [A] Landfill [B] Discharge in to the sewer-system	[A] 20 [B] 30	40% 60%
	Total		100%

Table F: shows that 20%, 30% and 50% respectively indicate the various method used in treating their health care waste before disposing it.

Table G: shows that 40% dispose off their treated health care waste into the sewer-system.

Research Question v: Does improper management of biomedical waste have health implication?

Table H/I

S/N	Questionnaire	Response	Percentage
1	Are you aware of any health risks associated with biomedical waste, if not properly manage?	[A] Yes 39 [B] No 11	78% 22%
	Total	50	100%
2	What are the natures of infection that workers exposed to? [A] Hepatitis [B] Plague [C] Cholera [D] AIDS/HIV [E] Injury [F] Others	[A] 4 [B] 5 [C] 8 [D] 12 [E] 12 [F] 9	8% 10% 16% 24% 24% 18%
	Total	50	100%

Table J/K

S/N	Questionnaire	Response	Percentage
3	Which categories of staff in the hospital are prone to such exposure? [A] Nurse [B] Doctor [C] Health labourer/other	[A] 12 [B] 13 [C] 25	24% 26% 50%
	Total	50	100%
4	What are the constraints you encounter during the management of biomedical waste? [A] Financial problem [B] Political attitudes [C] Time factor	[A] 24 [B] 10 [C] 16	48% 20% 32%
	Total	50	100%

Table H: shows that 18% are aware of health risk associated with biomedical/health care wastes, if not properly managed while 22% are not aware of the health risk.

Table I: shows the percentage of various nature of infection the workers are exposed to; Hepatitis 18%, Plague 10%, cholera 16%, HIV/AIDS 24%, Injury 24% and others 18%.

Table K: shows the various constraints they encounter during the management of health care waste 48%, 20% and 32% respectively.

CHAPTER FIVE

5.0   SUMMARY, CONCLUSION AND RECOMMENDATION

5.1   SUMMARY

        The communities [IKOLE] and health workers have knowledge of health care waste management and majority know the proper method to be using in disposing their waste but they were faced with financial problem, lack of management facility, insufficient of labourers and many others.

Due to those problems, majorities were using any method they wish in disposing their waste and because this has been no implication and enforcement of law on the health workers, the people of the communities in the local government and this disqualify and reduce the anesthetic be of the environment.

        The project highlight the background of the study, statement of the problems, significance of the study, study objectives, hypothesis or research question and definition of terms in the study and it review the relevant literature of the health and environmental impact of biomedical wastes, the source and the management of health care/biomedical waste e.g. handling of biomedical waste which include wastes segregation, waste treatment, waste disposal and wastes collection, transportation and storage.

        It further explains the research procedure and methodology. It shows the area of study i.e. the description of the study area, study design, method of data collection, critical issues protest/plot study and limitation of the study. It contain result and discussion, it presented the detailed discussion of result closed in the project.

5.2   CONCLUSION

        The research project entitled ‘A study of the health and Environmental impact of biomedical/health care wastes in Ikole local government area of Ekiti’ was based on formulation of four research question. Questionnaire was administered on 50 stratified randomly chosen samples in Ikole local government of Ekiti State. Findings revealed that people have in-depth knowledge about biomedical waste, causing ill-health/infection and limitating the ansthetic beauty of the environment thereby confirming that biomedical waste is a problem in the study and nuisance in the environment in general.

        The finding in the research shows that insufficient of labour [man power], financial problem, political priority and time factor contribute to environmental implication of biomedical waste management. This shows that governmental sanitation has not paid attention to provision of equipment [i.e.] environmental sanitation equipment as well as enough sanitary refuse deport through health workers having the idea of sanitary disposal of biomedical waste , but they were combated by inability to remove biomedical waste from the point of generation to the final disposal point passing appropriate and standard procedure to enhance health standard of the people, workers, and the general environment.

5.3   RECOMMENDATION

        It has been observed from the past experience that the success or failure of any programme in a country or community depends upon the dedication and commitment of the personal health workers involved technology back by government and non-governmental organization. Financial and moral support. In order to achieve a sound health care for the people of IKOLE local government of Ekiti State through good environmental sanitation and proper management of waste. The following recommendations are therefore made to ensure a success and effectiveness in aiming tidy and good environment.

        Therefore health care waste management required the following;

-         For the use of incinerator, training should be given to some number of people from staff to operate properly and safely.

Specific fund should be allocated for the use of incinerator for maintenance and servicing promptly.

-         Every health care facility should have special boxes use as dustbin for biomedical waste storage.

-         Bio-medical/health care wastes should not be mixed with other wastes of municipal corporation to avoid contamination to people handling health care waste.

-         Private health care facility should also be allowed to use incinerators which is installed in government health facility. For this purpose a specific fee can be charge from private health care facility to generate income for the government waste management board.

-         Specific vehicle i.e. health care waste vehicle should be started to collect waste from private hospitals and private medical clinics and carry it out the main incinerator for fast disposal.

-         As provided by bio-medical waste rules, the whole of the waste should be fragmented into colours due to their hazardous nature for easy identification.

-         Biomedical waste management board can be established in the local government to monitor and carried out proper management of health care waste.

-         Either judicial power should be given to the management board or special court should be established in the matters of environment pollution for imposing times and awarding damages for any health care institute that go against the rules of waste management board.

-         Housekeeping or health labourers staff should always wear protective devices such as gloves, face masks, gowned while handling the health care wastes to safeguard them against infections

-         There should be biomedical waste label on waste carry bags and wastes carry trolley and also poster should be put on wall adjacent to the bins [wastes] giving details about the type of waste that has to dispose in the baggage as per biomedical waste management rule. Carry bags should also have biohazard symbol on them for easy recognition.

REFERNCES

1. A report of the high power committee urban solid waste

Management,

India Planning Commission Government of India.

2. CEET: Biomedical waste management-Burgeoning

                        Issue [2008].

3. Federal ministry of health [2007]: National Policy on

Injection Safety and Health Care Waste Management in Nigeria.

4. Federal ministry of environment [2007] Health Practice

National Environmental Regulation of, Nigeria gazette NO 21 volume 94 of 9^th may 2007.

5. Implementation Hospital Waste and Management

6. Farlex Partner medical dictionary 2012

7. WHO 2010: Safe management of waste from health care

                                Activities.