الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 201 |  |  |
| | | from | 201 | | |
Abstract
This investigation, study deals with integrated management of healthcare waste in Kuwait governmental health care sector. Get out the suitabili- ty of regulations and legalism set by (KEPA) with the practices dealing
healthcare waste in ministry of health and the conformity with emissions standards with the permissible limits by the (KEPA). Furthermore, to find suitable ways to reduce generation healthcare waste and to obtain suit- able alternative methods to dispose of generating such waste. A central incineration in Kuwait was selected in this study to be representing the level of (PCDD’s and PCDF’s), heavy metals, and particulate matter emissions. Finally, detect the system of removal bottom ash which is the remaining health-care waste materials.
Chapter 1 an introduction reviewing of the literature, about the impor- tance and methods of calculating health-care waste generation rate, main world organizations and (KEPA) classification of health-care waste, differ- ent ways of health-care waste treatment and disposal, risks associated with improper health care waste management and risks associated with in- cinerators, hospitals health-care waste management and review the Policy
.review health-care waste history in state of Kuwait.
Chapter 2 explains 5 sampling analytical methods used in this study.
Recording weights of health-care waste in kg then quantifies by mathe- matical equations, and observe collection, disposal methods to determine their classification to define health-care waste type and quantities in Ku- wait government hospitals. Use a questionnaire for health care staff in 6
Kuwait governmental hospitals then analyses questionnaire output data in SPSS application to identify the level of their knowledge and practices. Examine the efficiency of sterilization through biology test. Use a high resolution gas chromatographic Column coupled to a high resolution mass
spectrometer (HRGC/HRMS) using the instrumental parameters , The re- covered samples are digested, and appropriate fractions are Polychlori- nated Dibenzo-p-dioxins (PCDDs) and Polychlorinated Dibenzofurans (PCDFs was measured using USEPA Method 23a to determine level of gaseous emissions from incinerators (dioxins/furans).Use inductively cou- pled argon plasma-mass spectrometry to determine Hg, Cd and Pb metals.
Emissions testing was conducted in accordance with procedures set forth in US EPA Title 40 CFR 60, Appendix A, Reference Methods (RM). USEPA Method 1& 2 ,Moisture Contents was measured using USEPA Method 4.
Examine bottom ash samples from incinerators to measure heavy metal
using Inductivity couple plasma (ICPOES).test method SW-846-1311.
Chapter 3 (results)
(Part 1) Analyzes control methods data of health-care waste flow, genera- tion. from collected data this chapter concludes:
Main classification of (HCW) is a hazard and non-hazardous waste de- pending on the source of generating the waste. Non-hazardous waste col- lected and then transport outside of the hospital building under the super- vision of municipal of Kuwait.
Hazard healthcare waste fallow different process of handling, these pro- cesses are done by co-operating of KEPA by sitting regulation, law, and standards with Kuwait ministry of health of supervision, monitoring, and control.
The low set for segregation system from KEPA and ministry of health manager’s decisions regarding to the segregation system covering all as- pects of healthcare waste segregation processes, however, such laws were not applied seriously by handlers.
Some cleaners leave containers contain hazard healthcare waste in hospital corridors and public’s presence to transfer them later. In emergency suites at Mubarak Hospital, empty plastic juice cans were used to collect contam- inated needles by nurses. During field visits to Kuwait governmental hos- pitals; it was observed those open and non-covered garbage baskets were used. Cleaners use hospitals, public corridors to transfer (HCW). Off-site transport of hazard healthcare waste data is recorded manually and stored in files.
The second part in chapter 3 is to calculate generation hazard healthcare waste. Some calculation indicates that Mubarak AL-Kabeer hospital has the highest percent of generating waste.
(Part 2) analyzes survey data using the SPSS application to indicate healthcare waste handler knowledge and safety practice. Analyzed data indicate that:
· Cleaners and porters are at risk because of their poor knowledge about hospital hazard healthcare waste policy regulations, labeling system.
· The majority of all occupational groups, exclude nurses, did not
join training programs for healthcare waste handling.
· In general, 70.3 percent of the staffs that expose to the accident did not report it.
· The low level of health education for administrations and their lack of knowledge of appropriate health procedures for handling hazard- ous health –care waste present a risk management system for such waste.
· Although there is a high level of awareness among nurses for the segregation and disposal of healthcare waste, the lack of adequate tools leads to a defect in the waste disposal system.
(Part 3) presents the operating system of Shuaiba1, Kbd, and Shuaiba2 cen-
tral incinerators in Kuwait and their emotions concentrations of (PCDD’s
and PCDF’s) in ng/m3, heavy metal in mg/m3, and particulate matter in mg/ m3, as well as the recommended concentrations set by (KPEA). The second section of chapter 5 reviews the quantities of ash produced by the inciner- ators and the terminal method of disposal in landfill. As a consequence of the information submitted and the samples analyzed in this chapter is the following:
· The final disposal of health-care waste is carried out through three institutions, Kuwait ministry of health, (KPEA), and public author- ity for industry.
· The final disposal of health-care waste passes in two stages, the first is incarnation and the second buried the incineration products in land fill.
· There is no database where all data are recorded manually and saved in files.
· Factors that affect (PCDD’s and PCDF’s) emissions concentra- tions are:
- Healthcare waste generation, increasing the generation health-
care waste the concentration of (PCDD’s and PCDF’s) increase.
- Engineering, maintenance operations, good maintenance can in-
crease the efficiency of the incinerations and reduce emissions.
- Defining standards, setting emission limits with effective moni- toring can be a determining element for increased emissions.
· Bottom ash is collected manually from incinerators and sends to
landfill to dispose of.
This study concludes that proper health care waste management system must include: pollution prevention; waste minimization, correct classifi- cation and segregation, proper containment, color-coding, safe handling and collection of waste, labeling and signage, proper storage and transport, and safe disposal of treated waste. Pollution prevention and waste mini- mization entails environmentally preferable procurement practices, source
reduction, material substitution, safe reuse, recycling and composting of waste where possible. Other key aspects of a good health-care waste management system include: written policies, clear delineations of roles and responsibilities, the development of effective plans with stakehold- er participation, effective implementation, regular training at all levels; motivational programs to promote process change, monitoring, periodic evaluation, and continuous program improvements; and full consideration of occupational safety and personal protection.