Waste Control of Medical Supplies in the Health Care Industry - Research Paper Example

?Running head: Waste control in the health care industry Waste Control of Medical Supplies in the Health Care Industry Waste Controlof Medical Supplies in the Health Care Industry Introduction One of the most important aspects of health care management is the disposal of medical waste. The disposal of wastes is a delicate process because the materials involved are possible causes for infection which may bring harm to those who handle the waste and those who transport the waste. The process of disposal is therefore not in the same vein as other wastes from residential or business facilities because of the more tedious and regulatory processes involved. Various legal and clinical standards have been set forth in order to manage the disposal of hospital wastes. To some extent, these policies and standards have been relatively effective in managing hospital wastes. Improvements to these standards are still needed in order to ensure that hospital wastes are effectively managed and that risks to the general population in relation to such wastes are minimized. This paper shall discuss the current waste control of medical supplies in the health care industry. It shall also discuss the impact of ineffective waste management on hospitals and on disease management. It shall also consider the different possible improvements which can be made in the waste control and management of healthcare wastes. This paper is being conducted in the hope of establishing an academic and scholarly approach and answer to the topic on healthcare waste control. Discussion Most of the wastes from healthcare facilities can be considered regular solid municipal waste. However, some of these wastes need special attention – these are sharps (needles, razors, scalpels), pathological wastes, infectious wastes, pharmaceutical wastes, biological wastes, and hazardous chemical wastes (Johannessen, et.al., 2000). All in all, these wastes are referred to as special health care wastes. Wastes from isolation wards and microbiological laboratories also require special attention. The rest of the waste from healthcare facilities include packaging, reusable medical equipment, and secondary wastes created by disposal technologies (Johannessen, et.al., 2000). Inappropriate and inadequate management of these products exposes people and the environment to health risks. Various healthcare workers, patients, waste handlers, and the general public are exposed to various health risks from these infectious wastes (most especially, the sharps), chemicals, and other hospital wastes (Johannessen, et.al., 2000). And the exposure to these wastes is often seen with the improper handling by health workers. The WHO (1999) has successfully classified the different types of healthcare wastes and these include: communal waste and special wastes (infectious, anatomic, pharmaceutical, genotoxic, chemical, heavy metals, pressurized containers, and radioactive materials). Communal wastes are all solid wastes which are not infectious, chemical or radioactive. These can specifically include packaging materials and office supplies. These wastes can generally be disposed of in communal landfills or similar arrangements (WHO, 1999). Segregation and recycling applies to these wastes. Special wastes on the other hand are classified into various categories and are not in any way classified for communal landfills. Infectious wastes are wastes from humans or animals which can potentially transmit infectious diseases to humans (WHO, 1999). These wastes include those which are discarded from equipment during diagnosis, treatment, and prevention stage of the diseases or the assessment of the patient during which contact with blood, tissues, saliva and other patient derivatives may have been seen. Such wastes include: cultures and stocks, tissues, dressings, swabs, items soaked in blood, syringe needles, scalpels, diapers, blood bags, and similar items (WHO, 1999). All sharps regardless of usage by infected patient or not, is considered under infectious wastes. Other infectious wastes include: syringe needles, scalpels, infusion sets, knives, blades and broken glass (WHO, 1999). Anatomic wastes are recognizable body parts. Pharmaceutical wastes are those which consist of or which contain pharmaceuticals like those which are expired or are no longer needed; their containers and/or packaging, and other items which are contaminated or which contain pharmaceuticals (WHO, 1999). Genotoxic wastes are those which consist of or which contain substances with genotoxic elements like cytotoxic and antineoplastic drugs and chemicals. Chemical wastes are those which consist of or which contain laboratory chemicals. These also include film developers, disinfectants both expired or no longer needed, solvents, and cleaning agents (WHO, 1999). Heavy metal wastes are those which contain both materials and equipment with heavy metals and its components including batteries, thermometers, and manometers. Pressurized containers are those which consist of full or empty containers with pressurized liquids, gas, or powdered materials (gas containers and aerosol cans) (WHO, 1999). Finally, radioactive materials include unused liquids from radiotherapy or laboratory researches (contaminated glassware, packages or absorbent paper, urine and excreta from patients tested with unsealed radionuclides (WHO, 1999). There are special ways of disposing of such special wastes because their improper management can caused infection and contamination of handlers, of patients, and of the general population. Inefficient disposal of special hospital wastes, through open dumping and uncontrolled burning, has managed to exacerbate the risk of spreading infections and of being exposed to the toxic emissions from the incomplete burning of such wastes (Johannessen, et.al., 2000). Because of these concerns, occupational health and safety regulations have been set forth as an important aspect of healthcare waste management activities. The transmission of infectious diseases to the general population has mostly been seen with the mishandling of contaminated sharps. The infections which have been a major cause of concern are Hepatitis B (HBV), Hepatitis C (HCV), and HIV/AIDS. The Hepatitis B virus has been known to be infectious for up to a week, and even if there is drying at room temperature one needle stick prick has a 30% rate of sero2 conversion. For HIV/AIDS and Hepatitis C viruses, the rate of sero2 conversion is 0.3 to 0.5% and 2.5% respectively (WHO, 1997). The WHO estimates that on an annual scale, there are about 30,000 new HIV infections, 8 million HBV infections, and 1.2 million HCV infections caused by accidental needle pricks. With these considerations, much sensitivity has been needed in the handling of special healthcare wastes and in dealing with biological wastes. Different cultures have various views on the management and burial of body parts and for the most part, it is important to consider such cultural elements in the disposal of special healthcare wastes. Moreover, considerations of local community’s perception in the health care waste management plans have been made crucial to the implementation of a sustainable disposal plan (Rush, 2003). These perceptions must be taken into consideration in order to ensure the success of any health care waste management plans. Adequate management of healthcare wastes can minimize risks in and outside healthcare facilities. The foremost priority is on the segregation of wastes, most especially at the point of generation, covering reusable and non-reusable, hazardous and non-hazardous elements (Johannessen, et.al., 2000). Other essential elements include the implementation of the sharps management system, waste reduction, avoidance of hazardous elements, ensuring worker safety, providing adequate methods of waste collection and transport, and setting forth safe treatment and disposal processes (Johannessen, et.al., 2000). There are four main steps of managing healthcare wastes. First is the segregation into its various elements, including reusable storage in containers; second, is the transport to waste treatment and disposal sites; third is the treatment; and last is the final disposition (Johannessen, et.al., 2000). These steps ensure that the wastes would not cause further harm to the handlers and the general population. A paper by Shaner and McRae (1999) also discusses classifications and different steps in handling health care wastes wastes. And the first step in resolving waste management issues is to first define or identify the problem. In the United States, there are three major classifications of healthcare wastes, and these are: category A: hospital wastes (all waste from facilities – cafeteria, office, construction wastes); category B: medical wastes (waste from patient diagnosis, treatment, immunization); category C: potentially infectious wastes (has potential to transmit infections disease) (Shaner and McRae, 1999). Category B wastes are regulated to not be more than 15% of total hospital waste with some hospitals with adequate segregation measures managing to reduce this waste to 8% of their total hospital waste. In general, observations have revealed that about 10% on average represents potentially infectious hospital waste (Shaner and McRae, 1999). The second step in efficient waste management is to focus on segregation first. Some hospitals practice the act of mixing all together their wastes which may belong to different categories. Consequently, the wastes which are leaving the hospitals are all infectious and hazardous. The effect of one type of waste, especially the infectious wastes, now affects other types of wastes which may not at all be infectious (Shaner and McRae, 1999). Those who handle such wastes are in the greatest danger because they may not know that a sharp material or an infectious item is in a trash bin when they retrieve the garbage wastes. These workers may then be exposed to infectious items through accidental exposure or contact in municipal disposal bins; exposure to chemical or contaminants; and exposure to chemical pollutants from incineration of wastes (Shaner and McRae, 1999). Regardless of the final strategy in the treatment and disposal of wastes, it is important for wastes to be segregated before they are picked up, treated, and disposed. This can help safeguard the health of workers and of the general public. The third step is on the implementation of a sharps management system. Sharps are the most significant threat to humans in the waste stream (Shaner and McRae, 1999). Proper segregation of these sharps in rigid and puncture proof containers have to be monitored for safe treatment and disposal. Through these methods, risks of contamination can be prevented. The next step would be to focus on reduction. It has been noted that hospitals in third world nations produce less waste as compared to US hospitals (Shaner and McRae, 1999). This has been seen as a result of the reprocessing and reuse of hospital materials. Another strategy is on ensuring worker safety through education, training, and adequate personal protective equipment. Hospital workers who have inadequate knowledge on how to handle hospital waste and equipment have been at greatest risk for being infected through hospital wastes (Shaner and McRae, 1999). Health education therefore has to include the proper handling of hospital wastes, from the disposal of such wastes to the handling of garbage, its treatment, transport, and disposal. It is also important to provide secure collection and transport of hospital wastes. The collection and transport of hospital wastes must be undertaken with an equal amount of caution and precaution. The laborers and transporters must therefore not mix the wastes with the municipal wastes and they must secure hospital wastes in separate trucks and transport methods. Plans and policies in securing the continuity in the management of these wastes must be laid out properly (Shaner and McRae, 1999). Such policies must be incorporated into the training of employees, including those who dispose and transport the hospital trash. In the management of healthcare wastes, investment in training and equipment for reprocessing supplies; the management of hazardous materials; and the management of medical waste treatment must also be made. These investments help ensure that the equipment and materials would be reused in medical facilities and unnecessary wastage would be avoided (Lee, Ellenbecker, and Moore-Ersaso, 2004, p. 143). These are the standards in healthcare waste elimination and their management has been set forth as important aspects of special waste management. At present, medical waste incinerators are considered among the top four sources for dioxin and anthropogenic mercury emissions in the United States (Schaum, et.al., 1999). These wastes are particularly dangerous because they are able to travel long distances and be transferred between the air, lands, and our waters. Based on surveys in the 1990s, healthcare wastes have been generated at a rate of 3.5 million tons for each year (Medical Waste Committee, 1994). Moreover, home health care has also been known to produce about 50,000 tons of waste per year. Most hospitals have taken to treating their waste, and in some instances they have often turned to incineration to dispose of their wastes. In effect, no clear waste management options have been considered for these waste materials. Moreover, the process of waste disposal leaves much to be desired. One of the many dangers associated with healthcare wastes is its link to pollution. Although such link is not clear and apparent, there is a web of relationships and decisions which affect product suppliers and healthcare workers. “Pollutants with the potential to have harmful effects on human health have been identified with health care waste. Two of these substances, mercury and dioxin have been detected in significant amounts in air and ash emissions from medical waste incinerators” (Glasser and Chang, 1991, p. 1180). Health care facilities that do recognize the risks they impose to the environment have carried out precautionary measures in order to address these risks. These precautions have been taken with the recognition that when the degree of uncertainty is high and knowledge is limited, then risks should be avoided (Kaiser, Eagan, and Shaner, 2001). The American Hospital Association in 1998 agreed to work with the US EPA in order to understand the goals for waste volume and toxicity minimization. Important points set forth in this understanding have included the 50% reduction in the volume of wastes by 2010 and the elimination of mercury from health care facilities by 2005 (American Hospital Association, 2000). Toxicity reduction has been considered the more important remedy in healthcare waste reduction because of the impact of severe pollutants to the environment. Nevertheless, volume reduction of other wastes has also been focused on because of the impact of lower disposal costs and smaller amounts of waste to the goals of environmental protection (Kaiser, Eagan, and Shaner, 2001). Major tasks for health care professionals wanting to improve the environmental management of their facilities have included the review of by-products of waste disposal methods and the development of criteria in the environmental screening of products (Kaiser, Eagan, and Shaner, 2001). In the US, the important consideration in the purchasing of products has often included the cost, quality, and availability of these products. These considerations have not necessarily led to improved environmental waste management because many of these products created more waste products and toxic elements. Moreover, the personnel responsible for acquiring these health products and services come from various backgrounds and some of them have worked in health care fields or more technical fields of expertise. However, most of them have inadequate training in environmental management of healthcare wastes (Kaiser, Eagan, and Shaner, 2001). Experts suggest that the management of the hospital supply chain must consider the waste management of these healthcare products, as well as the training of the people who would manage such wastes. In some avenues, the energy demands, global impact, and the terms of resource use have also been set forth as important considerations for the acquisition of health care products. “Without this holistic perspective, the industry charged with promoting health and healing contributes to environmental problems, which in turn adversely impact human health” (Kaiser, Eagan, and Shaner, 2001, p. 206). This point further emphasizes the importance of setting forth a thorough review and understanding of the supply chain process and management. Environmental education has been set forth as one of the most important aspects of the health care waste management. For most health care practitioners, the gap between the knowledge and the environmental impact of such health care products has underscored the importance of understanding health professionals and environmental health. Most physicians do not undergo occupational health training during the medical school years (Levy, 1985). Most schools give minimal emphasis on environmental education and the same is true with nursing schools. This educational gap is a major cause of concern because inadequate waste management impacts significantly on the disease processes. Studies point out that on a worldwide scale, about 40% of deaths are attributed to environmental factors, including chemical and organic pollutants (Pimentel, et.al., 1998). In effect, these studies further emphasize the importance of education integration of environmental information among health professionals in order to increase consciousness during health care waste disposal. Various suggestions on the management of healthcare wastes have been made by different authors and analysts. One of these suggestions focus on the implementation of upstream tactics, which basically emphasizes on minimizing the environmental effects of products and services and their sources, instead of addressing their impact after they have already occurred (Kaiser, Eagan, and Shaner, 2001). These methods have included the purchase of non-mercury products and reducing the use of other toxic and chemical-based products. In order to effectively eliminate persistent contaminants, proactive activities between manufacturers and waste treatment processors must be made. Moreover, the shift in the purchase of more environmental friendly products can also prompt other health manufacturers to improve the environmental strength and impact of their products. Conclusion The above discussion sets forth the different types of wastes produced by health care facilities. These wastes may be generally classified into the communal wastes and special wastes. A major cause of concern for this study are the special wastes and the disposal of these wastes without them impacting negatively on the general population, on the health care workers, on the waste handlers, and on the patients. Various hospitals and health facilities have implemented management measures for these wastes; however, some of these methods have been ineffectual. Risks on healthcare workers have still been manifest according to surveys and assessments of the disease processes in some health institutions. Health education and training in waste disposal management has been pointed out as one of the most important remedies for health care waste management. It is productive and it is preventive, helping ensure that the health care workers would properly dispose of their wastes and the handlers of such waste would know how to efficiently manage said wastes. These health workers help contribute to adequate segregation, treatment, and disposal of health care wastes. Finally, the importance of purchasing health supplies which do not have dire environmental impacts are all part and parcel of effective health care waste management. Works Cited American Hospital Association. (2000) Memorandum of Understanding. Retrieved 26 February 2011 from http://www.aha.org/ Glasser H. & Chang, D. (1991) An analysis of biomedical waste incineration. J Air Waste Manag Assoc, volume 41: pp. 1180–1188 Johannessen, L., Dijkman, M., Bartone, C., Hanrahan, D., Boyer, G., & Chandra, C. (2000) Health Care Waste Management Guidance Note. Health, Nutrition, and Population Paper. World Bank. Retrieved 26 February 2011 from http://siteresources.worldbank.org/HEALTHNUTRITIONANDPOPULATION/Resources/281627-1095698140167/Johannssen-HealthCare-whole.pdf Kaiser, B., Eagan, P., & Shaner, H. (2001) Solutions to Health Care Waste: Life-Cycle Thinking and “Green” Purchasing. Environmental Health Perspectives, volume 109 (3), pp. 205-207 Lee, B., Ellenbecker, M., & Moure-Ersaso, R. 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