Assessment of management of health-care wastes in non-government health care facilities in Nairobi province

Abstract

Poor management of health care wastes exposes health care workers, waste handlers . and the community to infections, toxic effects and injuries. Despite this inherent hazardous nature of the health care wastes, their treatment and disposal remains neglected and unattended within the urban municipal waste systems in Kenya. The national healthcare waste management plan is yet to be implemented, consequently leaving the management of the health care facilities (HCFs) without a reference on how to manage their wastes. The goal of this study was to provide data that can be used to improve HCWM by analyzing the existing practices currently adopted by the health care facilities. The general objective was to carry out a situation analysis on the management of health care wastes in non- government health care facilities. This was a descriptive cross-sectional study that assessed health care waste management (HCWM) in 24 nongovernmental (12 mission and 12 private owned) HCFs in the Nairobi province. An observation checklist was used to document the various elements of HCWM practiced within the HCFs. It included the presence of a HCWM plan, a waste management team, provision of personal protective equipment for the waste handlers, waste segregation, waste colour coding, storage, safe transportation, treatment and disposal. Structured questionnaires were used to elicit information on the knowledge, attitudes and practices of the different cadres of health workers and waste handlers, and to determine the management's contribution towards safe HCWM. Sixty five health care workers, 24 waste handlers and 24 facility administrators were interviewed. The study found that no facility had a HCWM plan and only 3 HCFs (12.5%) had a waste management team headed by a waste management officer. Waste segregation was found to be inadequate as no facility had a general waste category hence all the wastes produced within these facilities are considered hazardous and have to be treated prior to disposal. Waste storage facilities were not adequate as they are easily accessible and not secure. Waste was transported manually in 21 facilities (88%), putting the waste handlers at risk of injuries and infections. The only treatment method found to be in use within the facilities is incineration and only 13 facilities (54%) were found to have functioning incinerators. The incinerators are the De Montfort type and there are no measures for emission control in place and can therefore be source of air pollution putting the community at risk of disease. Private collectors are used by two thirds of the facilities to dispose their wastes while the rest disposethem within their premises by means of a landfill or open pit. There was no specific budget allocation for HCWM except in the cases where the services of private waste collectors were used. The knowledge of the health workers on HCWM was found to be inadequate, but their attitude was found to be positive. Three quarters of the health workers re-cap used needles, they have low immunization rates against tetanus and hepatitis B virus andthe rate of needle prick injuries was low at 6% in the previous one month. Twenty one facilities (88%) provide personal protection equipment (P.P.E.) for their waste handlers and the waste handlers had high levels of compliance in the usage of the P.P.E. Immunization status and needle prick injuries among the waste handlers were also low. These findings show that there is need to implement the national policy on HCWM so as to improve and harmonize HCWM within the facilities.