الفهرس 
Introduction
Health hazardsOnly 14 pages are availabe for public view
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Abstract
Hospitals generate and reject material regularly, and improper management of these wastes leads to public health hazards, environmental pollution, and aesthetic appearance. The study and the results presented in this article were as a work carried out in two major private hospitals, namely, the Al-Hadi Hospital and Al-Salam Hospital. The results indicated that the waste generation rate is 1.306 kg/bed/day, which includes 0.251 kg/bed/day of toilette waste (19%), 0.468 kg/bed/day of office waste (36%),0.570 kg/bed/day of infection waste (44%) and 0.017 kg/bed/day (1%) of sharp waste. Segregation of the different types of waste is carried out in nearly all of the hospitals. With rapid population growth and industrialization, disposal of hospital solid wastes, which include a wide range of infectious hazardous wastes pollutants, has become one of the main environmental issues. Hospital waste is special in that it has a higher potential for infection and injury than other types of waste. It may include wastes like sharps, soiled waste, disposables, anatomical waste, cultures, discarded medicines, chemical wastes, etc. This waste is highly infectious and can be a serious threat to human health if not managed in a scientific and discriminate manner.
In The State of Kuwait healthcare waste management falls under the responsibility of the Ministry of Public Health although the Environmental Public Authority through the Environmental Protection Act controls activities such as disposal of wastes. Nearly 33,000 metric tons of medical wastes are generated by governmental and private hospitals in Kuwait every year with about 10% - 15% of all the waste classified as infectious waste. These quantities represent about 31% of the total hazardous solid waste generated in the country. The wet waste generated in the hospital kitchen and restaurant, and the soiled cloths sent to the laundry were not included in the study. An effective and efficient program for the management of healthcare wastes is a critical component of the facility’s infection control program and consequently plays an important role in the quality of care, as well as in the occupational health of the entire staff of the facility. This paper aims to characterize healthcare wastes in private hospitals in Kuwait, in view of designing proper treatment facilities and developing a framework for managing healthcare wastes.
Kuwait has a total of sixteen governmental hospitals with a total of approximately 4900 beds and nine private hospitals with a total of 771 beds. In this cross sectional study, two of the nine private hospitals of Kuwait (Al-Hadi and Al-Salam Hospitals), were assessed in a period of one year (November 2006-October 2007). Private hospitals were selected because they are less influenced by financial constraints than governmental hospitals. In addition governmental hospitals were assessed and examined by previous studies. Data were collected monthly from two privet hospitals; Al-Hadi and Al-Salam hospitals during the entire year. Monthly, 8 days for data collection (two days/week) were carried where 10 bags weighted including office waste, toilette, infection and sharp waste with counting the total amount of bags for each type of the waste. Five bags of office waste were sorted to see how much plastic, textile, glass, paper, yard and food products from two hospitals (monthly). Questionnaires were design for workers in the hospital; Hadi and Al Salam hospital to see their potential, scientific and practical skills in dealing with the different various wastes. This data is important to clarify and understand how the MSW system works nowadays. The results indicated that the waste generation rate is 1.306 kg/bed/day, which includes 0.251 kg/bed/day of toilette waste (19%), 0.468 kg/bed/day of office waste (36%),0.570 kg/bed/day of infection waste (44%) and 0.017 kg/bed/day (1%) of sharp waste. The total wastes varied between 1.145 kg/bed/day and 1.467 kg/bed/day, however, the amounts of non-hazardous waste varied between 0.733 kg/bed/day and 0.705 kg/bed/day for Al-Hadi and Al-Salam hospital respectively. A maximum amount of 164.42 kg/day of total solid waste was generated at the Al-Hadi hospital. The major components of the average office waste of Al-Hadi hospital were yard waste (29%), followed by paper (26%). Then plastic (19%), followed by food (15%) while glass make up the smallest amount (5%). The hazardous waste generation was 59.04 kg/ day. A minimum amount of 75.02 kg/day of total solid waste was generated at the Al-Salam hospital. The major component was yard wastes (27%), followed by paper and cardboard (25%). Also plastic constitute a good amount of the solid wastes generated (23%), while glass make up the smallest amount (3%). The hazardous waste generation was 39.01 kg/bed. A regression analysis is used to produce the best fitting equation for the set of values. The equation predicts a response (dependent) variable from a function of regression (explanatory) variables and parameters, adjusting the parameters such that a measure of fit is optimized. The stepwise regression (which is a regression procedure) with maximum R2 improvement option, was evaluated for the hazardous and nonhazardous waste generation models.
The choice of explanatory variables for the hazardous wastes model development included sharp waste (SHWS), infectious wastes (INWS) and number of beds (NMBD). However, for the nonhazardous wastes, the explanatory variables of the model included: toilet wastes (TOWS), office wastes (OFWS), and number of beds (NMBD). Analysis of the correlations indicated that these variables influenced the daily waste generation significantly. The mathematical relationship had the following forms: Hazardous wastes: TTHW = -0.06889 + 1.3944 SHWS + 3.72057 INWS + 0.18437 NMBD, (1) Nonhazardous wastes: TNHW = 0.11009 + 1.20379 TOWS + 3.99652 OFWS + 0.17729 NMBD, (2) The above models appear to provide a good fit for hazardous and nonhazardous waste generation. None of the statistics values are significant and the F distribution hypothesis testing is rejected, indicating that the model provides a good fit to the data. In addition, the R2 which measure the goodness of fit is 0.8705 and 0.8332 for hazardous and nonhazardous waste models respectively, indicating good fit of the models. Questionnaires were carried out on a sample of workers (25 workers in each hospital) in the private hospital; Al Hadi and Al-Salam Hospitals. Most of them were primary educated and they did not understand the nature of their work. Although, large number of hospital workers did not know the seriousness of materials that come out of the hospital; but they have strict instructions to wear the protective equipment such as gloves and masks. The administration is interested of medical checkup at the beginning of the contract, but there is no continuity to maintain the health of workers. Also, it is not interested in educating of the employees. Typically, handling of these wastes is assigned to poorly educated workers who perform all activities without proper training or guidance, and with insufficient protection. The total wastes generation rate is 1.306 kg/bed/day. However, the amounts of non-hazardous waste generation are 0.719 kg/bed/day. Moreover, the hazardous wastes generation are 0.587 kg/bed/day. A maximum amount of 164.42 kg/day of total solid waste was generated at the Al-Hadi hospital while a minimum amount of 75.02 kg/day was produced at Al-Salam Hospital. Based on these findings, it can be noted that there is potential to improve the management of healthcare wastes in the local context. A framework to manage the wastes generated in various medical institutions in Kuwait should be developed, which would take into consideration the following:
Waste minimization.
A comprehensive performance study throughout the country, compiling necessary rules and establishing standards in this field along with planning regular and effective training programs through lectures, posters and handouts for different personnel regarding hospital waste hazards, collection, segregation of different wastes, storage, preventive measures and control of accidents/injuries, and raising the knowledge on the importance of using protective measures should be considered an urgent matter in our Health Service Department.
Periodic meetings should be conducted involving administrative and maintenance staff who are directly or indirectly involved with waste management in order to share and discuss the technical or practical difficulties and provide suggestions that may be specific to a particular hospital and region. A compulsory introductory training program should be conducted for all new staff in the hospital to familiarize them with the operating procedures practiced in the hospital.
Searching for a new approach for medical waste treatment such as ’mobile chemical treatment of medical waste’. This system is the most up to date fully automated system for treating hazardous medical waste. It is available as a mobile unit for point of origin treatment or as a fixed site process.
There is a great need for establishing and implementing a proper medical waste management program to control and improve the existing situation in Kuwait. This study helped in establishing a database, information on the healthcare waste sources, generation, collection, transportation, treatment and disposal. Also, it has provided suggestions for policy makers and further information to facilitate policy development and improved medical waste management.