Major Challenges of Clinical Waste Management in

Pakistan

Tabinda Salman*, Aftab Ahmad, Saqib Rafique Shaikh

National Academy of Young Scientists (NAYS®) - Pakistan*Email: ceap@nays.com.pk

INTRODUCTION

Clinical waste management is of great importance due to its

patients, practioners and public health risk and environmental hazards.

clinical waste is not properly managed and disposed in majority of

public and private hospitals of Pakistan and the situation is worst in small

cities, town and villages, where clinical waste is mixed with general

waste and is disposed.

The improper disposal is resulting in many infectious diseases and can

even result in an outbreak.

There are different health risks associated with each type of waste so

their management is necessary.

MAJOR CHALLENGES

According to one of the estimate Pakistan generates 2.0 kg of waste per bed

per day (20% is of risk-waste). This waste includes used syringes, blades, used

gloves, chemicals and drugs etc.

Hospitals produce around 250,000 tons of waste per year.

Only in Karachi City, 610 government and private hospitals generating 30

tones medical waste each day.

Workers dispose of infectious and non-infectious waste in open bins without

proper segregation of waste.

The disposal system in not efficient and workforce involved in its disposal is

ignorant of risk involved.

Landfills and incineration are being used to dispose- off the hospital waste in

Pakistan. In landfill method, hospital waste is buried underground but according

to health experts not a single landfill is constructed on scientific lines. Majority of

incinerators also do not have proper filters and scrubbers. Gases like dioxin and

chemicals are discharged in the air, when waste is burnt, which can be potential

carcinogen.

Sharps waste

34%

Infectious waste

17%

Pathological waste

21%

Pharmaceutical

waste

8%

Chemical waste

11%

Radiactive waste

9%

Types of Healthcare Waste generated

Poster presented at EBSA 20th Annual Conference ‘The Diverse World of Biosafety’ (April 25-28, 2017), Madrid, Spain

Fig: This data has been collected from 178 sources in major cities of Pakistan

SCENARIO IN PICTURES

REFERENCES

Pakistan Environment. Fact Sheet. http://www.wwfpak.org/ factsheets _hwf.php

S. Habibullah, A. Salahuddin, 2007, Waste disposal of government health care

facilities in urban area of Karachi. PJMR; 46: 1-4

MR Khan, F. Fareedi, B. Rashid, 2006, Techno-economic disposal of hospital

wastes in Pakistan. PJMR; 45: 41-45 .

Ather S. Hospital waste management . J Coll Physicians Surg Pak 2004;14:645-

6.

Hashmi SK, Shahab S. Hospital and biomedical waste management. In: Iliyas

M, Editor, Community medicine and public health. 4th ed. Karachi: Time

Publishers,2013, pp. 426-37.

RECOMMENDATIONS & CONCLUSION

Government and associated departments should step in to control the

situation. There is serious need of handling of waste specially sharps and

syringes, pathological waste and infectious waste.

There should be proper system for the segregation, collection, storage

and transportation of waste.

Workers should be given trainings for the awareness of health

hazardous of healthcare waste.

NAYS - Pakistan through its Biosafety Working Group and

collaboration of many national and international organization have

provided training to staff in different hospitals and will extend its

services in future.

Grants won from Health Security Partners (HSP)- US and CRDF-

Global for Biorisk management and biosafety trainings.

BRIGHT SIDE

Few Hospitals and organizations are

Following Hospital Waste Management Rules,

2005.

Shalamar Hospital, Lahore established

in 2000 as non-profit organization. They

have two incinerators, four special vehicles

and 222 collection points in towns nearby Lahore.

Ten incinerator plants are working in Karachi i.e.

Karachi Metropolitan corporation, Aga Khan

Hospital, Abbott & Brookes Pharma, Civil

Hospital, Kidney Center etc..

HEALTH RISKS

According to World Health Organization, in 2000, contaminated syringes

caused:

21 million population suffered from Hepatitis B virus (HBV) infections

2 million suffered from Hepatitis C virus (HCV) infections

Population of 260 000 suffered from HIV infections.

Type of waste Health Impact

Infectious waste (contaminated

needles, sharps etc)

Vomiting, eye and genital

secretions, pus, skin

secretions, cerebrospinal fluid, blood in

faeces.

Chemical & Pharmaceutical waste Skin, mucous membrane diseases

Genotoxic waste Dizziness, nausea, headache & dermatitis

Radio active waste Headache, dizziness, vomiting and genetic

alterations

Sources of Healthcare Waste

Hospitals 78

Clinics 32

Emergency

services16

Research

laboratories18

Animal research

laboratories 06

Blood banks 28