الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
In the last years, there was a growing concern in the medical and environmental
protection communities regarding the current handling and disposal methods for PW and
other waste materials generated from hospitals. All hospitals are using pharmaceuticals in
the normal course of patient’s treatment services, and in this process PW is generated. It is
generated through a wide variety of activities, including but not limited to IV preparation,
spills/breakage, partially used vials, syringes, and IVs, discontinued, or unused
preparations, patients’ personal medications and outdated pharmaceuticals.
Pharmaceutical waste continuously enters the environment as trace pollutants. Human beings can be accidentally and chronically exposed to these trace residues of pharmaceuticals from the environment. In addition, unused pharmaceuticals may be discarded with general waste in landfill sites that are not appropriately engineered; they might leach and contaminate ground water and drinking water.
Safe management of PW could be achieved by ensuring management of waste in the
processes of safe handling, segregation, collection, storage, transport, treatment and final
disposal in order to mitigate and minimize health risks and prevent environmental
contamination as required in various international waste management and environmental
protection laws. PWM and other sanitation-related programs should receive more attention
in Palestine.
7.1 Aim of the study:
The present study aimed to assess PWM and to develop an integrated management system at Governmental Hospitals in GGs.
7.2 Target population and study sampling
The target population was employees at the selected hospitals (administrators,
pharmacists, nurses and waste workers).
Phase I: it included 90 administrators.
Phase II: it included 530 participants out of 1500. Phase III: it included 69 participants.
7.3 Study design
The study was conducted using a cross sectional approach followed by an intervention approach (one group pre-test post-test intervention design).
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Summary
7.4 Data collection
The required data were collected using the following tools:
7.4.1 Cross sectional study:
Predesigned interviewing questionnaires as well as an observation checklist were used to assess PWM at the five hospitals under study.
Interviewing questionnaire included the following items:
• Personal data including age, sex, years of experience, profession and whether there
is a training programs or not.
• Administrative management aspects included questions about legislative,
regulatory and policy aspects, training program, availability of required resources,
waste management committee, presence of PPE and availability of awareness
posters/ brochures.
The checklist included the following items:
• Management of unused pharmaceutical.
• Segregation of pharmaceutical waste.
• Using waste label and international symbol.
• Collection and transport process inside the hospital.
• Existence of central storage room and its condition.
• Transportation outside the hospital.
• Treatment and final disposal
7.4.2 Pretest and posttest study: Assessment of knowledge, attitude and
practice:
An interviewing questionnaire was used, it included the following items:
• KAP of hospital employees regarding PW waste definition, inventory of
pharmaceuticals in the pharmacy, pharmaceutical waste stream generation, waste
minimization options applied in the selected hospitals (prevention, reuse, recycle),
waste segregation practices, collection, transportation, treatment and final disposal.
• An intervention program was designed according to the results of initial assessment
of the pharmacists, nurses and sanitation workers knowledge, attitude, and practice
regarding PWM in the five selected hospitals.
• Assessment of knowledge, attitude and practice of intervention participants was
redone using the same questionnaire.
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Summary
7.5 Study results
The present study revealed the following results:
7.5.1 PW administrative aspects at selected hospitals
• Results revealed lack of written policy, plan and practical guidelines for PWM. In
addition, there is no definite waste management responsibility installed in
hospitals that was reflected on management of hospital waste.
• Regarding PWM committee or teams, only (20%) respondents’ revealed
availability of specific department “team” to deal with PWM.
• Inadequate resources were available in hospitals, these are required to ensure that
waste was managed in compliance with national legislation and international standards.
• All participants had insufficient knowledge about definition and reasons for
pharmaceutical waste generation. Only (22.5%) defined all management process
steps, from the point of generation of waste to its final treatment and disposal.
• PPE were available in all hospital under study, but with insufficient quantity.
However, healthcare staff and waste workers didn’t use PPE regularly.
7.5.2 Unused pharmaceutical management at selected hospitals
• Regarding On-Going Inventory Control, results revealed that 71.4% of
pharmacies and 30% of other hospital wards maintained an inventory as firstexpired/first-out and most pharmacies were doing periodic auditing for expired drugs. Most of hospital wards were using unit dose.
• All pharmacies were documenting expired drugs while other hospital wards didn’t
have any recording, and usually expired drugs were disposed off in sharp box or in waste containers without any documentation.
• Quarantine area was not available for accumulation of outdated pharmaceuticals
and it was accumulated in any empty space in the pharmacy.
7.5.3 Segregation, collection, temporary storage and on site
transportation of pharmaceutical waste
• Results revealed inadequate segregation for PW, no color-coding was used for
available container/ bags, and all containers available in the hospital were in black
color. Bad quality bags were used for waste collection, they were subjected to
tear, and they were without any identification by either waste labels or symbol for
PW.
• Segregation process was in adequate. However, only sharps were segregated in
safety box, while a few hospital wards (10.6%) segregate infectious waste.
Cytotoxic waste were segregated incorrectly without color code.
• Expired drugs were collected in carton boxes inside the pharmacy prior to return
to the central pharmacy without specific quarantine area.
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Summary
• 38.7% of bags that hold waste were sealed at the fullness while more than half of
these bags were over loaded, and only 20% of hospitals had temporary storage
room.
• There was inadequate number of transporting trolley, 70% of transporting
containers were not clean and some of them had bad smell and PW was collected and transported in the same trolley with general waste.
• All hospital didn’t have specific routes for waste transportation to storage room
and incinerators.
• All hospital departments were lacking spill management kits and only 19.6% of
participants indicated that spill was managed properly.
7.5.4 Central storage, offsite transportation, treatment and disposal of
pharmaceutical waste
• All hospitals haven’t had storage rooms and only two hospitals had operational
incinerators.
• There was accumulation of waste bags next to the incinerator or in the vicinity of
hospitals
• Designed vehicles used to transport medical waste were not available in hospitals
that didn’t have incinerators.
• Accumulated waste bags beside incinerators or in the vicinity of hospitals weren’t
tightly closed and sharp box weren’t put in bags. Also shipping label wasn’t used on the bags that hold waste and shipping document were not used.
• Incineration was the only treatment method used in all hospitals for treatment of
HCW. It was old fashioned and didn’t have air emission control system and both available incinerators were in need of proper maintenance.
7.5.5 Educational Intervention Program Results
• Study results showed inadequate knowledge regarding health care waste
management before the implementation of the educational training program; after which there was a significant improvement.
• Regarding attitude, the overall results indicated a significant improvement in the
attitude among participants handling and in charge of disposing cytotoxic anticancer drugs after applying educational intervention program and providing sufficient education and training as effective tools to improve the safety climate in a hospital providing chemotherapy actively.
• Concerning pre and post-test assessment results of healthcare and waste workers
practice in Oncology Department, study results showed significant improvement
in PWM. This result might be attributed to improvement of awareness, knowledge
regarding PWM and availability of resources needed for best management
practice.