CHARACTERIZATION, QUANTIFICATION AND MANAGEMENT SITUATION OF MEDICAL WASTE IN NEPAL

Waste management is always a serious problem in developing country like Nepal, Medical waste has become a matter of major concern at present with the growth of health facilities in both public and private sectors of Nepal, It is a serious concern, as most of its waste goes to municipal waste management system, There is no proper or separate waste handling, dumping or incinerating practice for hazardous or hospital waste in Nepal, This study aimed to evaluate the characterization, quantification and management situation of various health care centers in Nepal, A study on the waste characterization and quantification as well as existing waste management system was conducted in six different hospitals and nursing homes of Nepal during 2004 to 2007, These hospitals has been serving about 0,25 million patients in average every year, The methodology involved in the study is the collection of the waste from each ward, segregation, characterization into infectious, non-infectious waste groups and quantification. In each hospital investigation was conducted for 7-15 days, Existing management practice were directly observed and documented, Necessary infonnation was also collected through fonnal and infonnal consultations with different stakeholders of the concern hospitals, This study found that the average daily waste generation in surveyed hospitals is 69,35 kg, The average per capita waste generation in these hospitals is 0.66 kg in which infectious waste was 0, 13 kg/day/person and non-infectious waste was 0,53 kg/day/person, The average infectious waste was almost 22,07% and noninfectious waste was 77.93% in the surveyed hospitals, Application of strong policies and legislation measures for proper management of the medical waste is highly needed.

nurses, waste handlers, scavengers etc, Infectious waste may contain number of pathogens and these pathogens can enter into the body through various routes like puncture, abrasion, or cut in the skin, by inhalation or through the mucous membranes, Patient and visitors attending these establishment are also equally at risk [6],

Study area
The study on the waste characterization and quantification as well as existing

Methodology
This study is based on both primary and secondary data. The methodology involved in this study is the collection of the waste from each ward, segregation, characterization into infectious, non-infectious waste groups and quantification. In each hospital investigation was conducted for 7-15 days. Existing management practice were directly observed and documented, Necessary information was also collected through formal and informal consultations with different stakeholders of the concern hospitals, Primary data was collected from the field survey at different wards of selected hospitals, stores places inside hospital and final disposal area inside hospital and undefined dumping site of waste authority. A surface study of the waste management system of the hospital was done to make outline the statement of problem for the study. Various infonnation required for the study was retrieved through the administration of the questionnaires to the relevant authorities including the director, doctors, nurses, ward boys, executive officer, the supervisor of the housekeeping department, peoples around the hospitals and the workers involved in the waste handling activities. For the qualitative analysis, the waste generation points at various wards in the hospital were located and waste collection team were informed about the research study being carried out. The collection of the waste was done every day for seven to fifteen consecutive days to obtain the representative data. The collected waste from each wards were brought to the place nearby the area or room for storage and the waste from different wards were segregated separately, and characterized into sharps, hazardous and non-hazardous waste groups. The safety measures as gloves and masks were put on properly before the sorting was done to avoid any kind of accidents or injuries. After the characterization, each waste type and the items were weighed separately, and the weights obtained were noted down for the data processing, analysis and interpretations. The weighing was done by a spring balance of capacity 20 kg. At times, when certain item weighs more than 20 kg, they were divided into fractions, and weighed. Different items were weighed separately as far as possible, and later on during the data processing, the items were classified into three basic groups as per NHRC classification of Healthcare waste. All the data collected by the field survey were analyzed with the help of computer software, calculator conversion, MS-Word, MS-Excel for graphical analysis and presentation.

Total waste generation and its quantification
A clear scenario of medical waste generation, their category and present management system of some government and non-government hospitals in Nepal were produced by this study. Table I shows that the average capacity of the hospital is 112 which range 25 to 200.   Table 3 reveals that more than 77% waste is non-infectious and only less than 23% of waste is infectious in selected surveyed hospitals in Nepal. [8] reported that 85% of hospital waste in Asia are non-infectious, From the present study it is found that the amount of infectious waste is higher in Dhulikhel Hospital where it is found about 37.27% of the total waste. B&B Hospital and Scheer Memorial Hospital also generate more then 20% of the infectious waste. In Narayani Hospital, Shah Nursing Home and Shiva Hospital the generation of infectious waste is lower which is 17,0 I%, 15.10% and 14.47% of the total waste, respectively,

Categorization waste from selected surveyed hospitals in Nepal
The percentages of infectious waste in Nepal is higher than that of Netherlands (5%) and Sweden (8%), and lower than that of Denmark (25%) and USA (28%), and is near about close to the rate generated in Germany (14%). This indicated difference may be due to geographical location, living habits and standards, availability of different treatment facilities, and perhaps to the way in which solid waste are categorized in different countries [7],   Table 4 shows the generation rate of infectious and non-infectious waste were 0.13 kg/day/person and 0.52 kg/day/person, respectively and the total waste generation is about 0.65 kg/day/person.  Table 5 shows the projected yearly generation of total waste in selected six hospitals is 151,869 kg. This increasing amount of waste, if not managed properly will cause severe health and environmental problems. Though, the non-hazardous or non-infectious waste can be dumped in open place with other waste but the hazardous and infectious waste needs special treatment before dumping so that it cannot spread gem,s. Table 6 shows the existing waste management practice in selected surveyed hospitals in Nepal. It is observed that existing hospital waste collection, handling and disposal practices of all the hospitals involved transport of wastes by ward boys, maid nurses and other employees from the point of generation to initial storage points in each unit Hospital waste is seen to be dumped at various comer of the hospital owns boundary. Waste normally collected from small bowl or plastic bin, provided for each bed in a hospital or clinics and put them either in a large bucket These wastes from buckets are then put in a pushcart or directly carried to the nearest municipal bins for dumping. The municipal bins are normally placed either in hospital premises or outside the hospital. In most cases waste from Operation Theater, laboratory and hospital kitchen are also dumped into municipal bins, Municipality's trucks carry them to the landfill area for the final dumping,

CONCLUSIONS
This study concludes that the average daily waste generation in surveyed hospitals is 69.35 kg. The average per capita waste generation in these hospitals is 0.66 kg in which infectious waste was 0. 13 kg/day/person and non-infectious waste was 0.53 kg/day/person. The average infectious waste was almost 22.07% and non-infectious waste was 77.93% in the surveyed hospitals. Treated as medical waste as municipal waste in Nepal is one of major mistake in the hygienic point of view. Thus, only little proportion infectious and hazardous wastes from hospitals require special attention for their proper disposal. The remaining portion of waste can be disposed off into the municipal dustbins, This small portion of hazardous waste also mixed with general waste and disposed in municipal bin without any treatment and which is finally taken by municipality truck along with municipal waste, which makes the whole body of municipal waste as infectious. This is one of the parts of environmental hazard at present as well as in future. Out of six hospitals only three have incinerator but one is not working now. Application of strong policies and legislation measures related to the medical waste management for proper management of the medical waste is highly needed.

S RECOMMENDATIONS
• Application of strong policies and legislation measures related to the medical waste management for proper management of the medical waste is highly needed. • There should be a treatment facility in the city for medical waste. There must be accountability of the concerned authority. Incineration is a good method to destroy medical waste, but in recent it had gained bad reputation for its air pollution by dioxin, furan and heavy metal ash. There are other alternative methods like: chemical treatment, Microwave Technology, Bio-oxidation, Autoclaving etc. • However incinerator is considered as a best solution for safe disposal of medical waste since the amount hazardous waste is found very little in compare with other non hazardous waste in case of hospital waste in Nepal. There is bio-oxidation process also, which is better, Microwave system may be used. • This study also suggested making awareness among healthcare staffs and waste handlers about the varieties of waste categories and their potential impacts so as to prepare a desirable way in managing medical waste. • Intervention is required at all the stages of waste management-form the formulation of appropriate laws, segregation of waste, transportation of waste to the final disposal method. Among different treatment options, incinerator has been found as the most suitable one for city as it has capacity to burn the hazardous waste completely. All Health Care Institutions should be committed to waste management from generation to final disposal. • Every hospital and clinics must allot budget for medical waste disposal companies.
• The establishment of a waste management committee and the development of waste management plan are required.