Waste Management

INTRODUCTION

Sri Lanka is a "throwaway society" with no proper waste management

system. The available system needs to be better planned and implemented, as
it has adversely affected humans and the ecological system over the past two
decades [1]. On average, a person generates between 0.4kg to 1.0kg of waste,
and local authorities or municipal councils collect only about half of the
generated waste. The current practice is collecting trash and dumping it in low
population-density areas, resulting in over 300 visible dumpsites in Sri Lanka. On
September 8, 2009, the garbage dump in Bloomandal erupted due to the
accumulation of methane gas. The mount subsequently collapsed, burying
dozens of houses. As a result, stop the Supreme Court ordered garbage
dumping in the Bloomingdale area in Colombo 13 on March 29th, 2009.
However, the solid waste collected from the Colombo MC began
accumulating in the Kolonnawa 13th area, spreading across 21 acres and
becoming another waste divisionOn April 14, 2017, the Meethotamulla-
Kolonnawa dumpsite collapsed, causing over 26 casualties and destroying
around 145 houses [5]. Therefore, a proper waste management system must be
introduced urgently to prevent such incidents from happening again. This
system must focus on improving waste management in all industries, not just one
or two. The apparel and healthcare industries are the most prominent waste-
generation trends in Sri Lanka, and a sound waste management system is
necessary. This waste is a significant problem, but it is also a valuable source
that can be converted into useful products. Throughout this research, we visited
many industries, hospitals, and healthcare centers to collect data on the
current waste management practices and identify potential suggestions to
improve waste management.
 WASTE MANAGEMENT IN HEALTHCARE
SECTOR IN SRI LANKA

Hear waste can categorize into many kinds to have an experience with more
categories of waste such as solid waste, liquid waste, bio degradable waste,
non-bio degradable waste, hazardous waste, biomedical waste, and E-waste.
Therefore, we have selected some General Hospitals as the organization in
which we do our study case. We have identified that there are many waste
categories as follows,

1. Clinical waste (Health care waste)

a. Hazardous waste
b. non-Hazardous waste

2. Liquid waste

3. Solid waste
a. Food waste
b. Plastics
c. Glass
d. Cardboard, paper
e. Polythene
f. Textile waste
 Waste Generation trends.

There are many waste generation trends. It will depend According to the
industry, the production, or a service that provides.

Clinical waste generation

The total waste stream generated from healthcare institutions is classified as
healthcare waste. These are generated from activities in different settings within
a healthcare institution, such as,
departments, emergency treatment units, intensive care units, wards or clinics
 Performing surgeries in theatres
 Deliveries in labor rooms
 Performing testing in laboratories
 Conducting immunization activities
 Conducting pathological and forensic autopsies etc.

Healthcare waste can be divided into two categories. They are,
1. Non–hazardous general waste
2. Hazardous waste or waste that is associated with health risks

Huge amount of waste produced by a healthcare institution is usually called

"non-hazardous" or "general healthcare waste". It comes mainly from healthcare
facilities' administrative, kitchen and housekeeping functions. It may include
waste from packing material and waste generated during the construction and
maintenance of healthcare buildings [10]. The remaining healthcare waste is
considered "hazardous" and can pose several health and environmental risks. It
includes waste and by-products and covers a diverse range of materials, such
as [10],
3. Infectious Waste – Waste contaminated with blood and other bodily fluids,
waste from patients with infections (swabs, bandages, disposable medical
devices)
4. Pathological Waste – Human tissues, Organs, Body Parts
5. Sharps Waste – Syringes, needles, blades
6. Chemical Waste – Heavy metal contained in medical devices (mercury in
broken thermometers)
7. Pharmaceutical waste – expired, unused and contaminated drugs and
vaccines
8. Genotoxic Waste – Highly hazardous substances (cytotoxic drugs, cancer
treatment and their metabolites)
9. Radioactive Waste – Radio therapeutic materials
10.E-Waste – Electronic and Electrical waste

CURRENT WASTE MANAGEMENT SYSTEM.

Special treatment procedures exist for each waste category, mainly

hazardous and Non-hazardous waste management.

Hazardous Waste Management

Infectious waste is also hazardous waste suspected to contain pathogens in

sufficient concentration. Infectious waste includes blood and blood
products, items contaminated with blood and bloody fluids, clinical
specimens etc.

Safe disposal of hazardous waste is essential. Waste generated from

healthcare institutions is treated using only the following methods; these are
two machines that are used to treat hazardous waste in these hospitals.
 Incinerator
 Using a meta Miser

Sri Lanka has experienced the spread of covid-19. Infectious waste

generated from suspected and confirmed covid-19 cases is collected in
yellow polythene bags (minimum gauge 300) and tied well. Then it is put into
another yellow bag, connected, and sealed with appropriate tape. Mark
the waste bag with a red star for easy identification and prioritized disposal.
Sharps should be placed in a puncture and leak- proof cardboard alert box.
Alert boxes are designed with a small inlet. So that item can be dropped in,
but no item can be removed.
Covid-19 waste should be transported separately in a trolley or cart, which
is easy to load, clean and disinfect and should be treated on a priority basis
on the same day. Staff transporting this waste must always wear proper
personal protective equipment such as gloves, masks, boots and overalls.
Infectious waste handling staff needs to be educated on how to protect
themselves. The ministry of health gives all these guidelines. However, at
present, some of them still need to be processed.

Separated Waste Collecting and Storage

An individual collects all the waste from each ward regularly with a cart
dedicated to garbage collection. So, not transport this waste across the
hallway to another location for storage. The waste cart should be
transported through the hospital using a designated route to the storage
area. Mainly there is a separate area for waste separation and treatment
process. The entire waste handler wears a protective gown, heavy-duty
gloves, boots etc. We observe all these things and all the techniques they
do to separate waste.

Some standard techniques include placing bins with color codes to collect
Non-Hazardous waste. Mainly they use this to collect food waste, plastic,
polythene, cardboard, papers, etc. Dumping other waste categories into
the infectious waste bin was discouraged because handling and disposal
of this waste are costly. So,

 There is a national color code for healthcare waste for which yellow
indicates infectious waste.
 Waste bags are placed inside waste bins according to the above
color code
 The size of the bags and the volume of the bins should be decided
according to the unit’s needs.
All the other hazardous waste like chemical, e-waste, radioactive waste and
some different types of waste are collected by following all the guidelines given
by the ministry of health. Those types of waste need to be placed or ordered near
where patients are moving. The storage place must be identified as an infectious
waste area by using the biohazard sign [11]. The accumulated waste should be
disposed of as early as possible and not be kept in the storage area for more than
48 hours. That is the primary method of storing. This hospital has a separate area
to manage the waste generated by the hospital area. There are some central
parts of this area, like,
 Waste separation area
 Waste storage area
 Incinerator and meta Miser machine area
 Hazardous waste category and storage area
 Expired medicine storage area
 Bio-degradable waste storage and treatment area
 Water treatment area

Non-Hazardous Waste Management
All food, plastic, polythene and paper waste are categorized as non-hazardous.
Therefore, this waste management does separate. The main objectives of the
waste management system include
 Reduce the infectious nature of the waste
 Reduce the volume of the waste
 Ensure safety and health
 Ensure proper recycling

Food Waste
Food waste is a significant issue in many healthcare institutions in Sri Lanka. In a
healthcare setting, food waste is mainly generated as follows,
 Preparation of food for patients/ staff
 Unserved food
 Leftovers from patients/ staff
Management of food waste
Waste avoidance and minimization is the primary process they follow. So, the
below steps are used for that process according to the staff and patient ideas.

 Possible measures that can be taken to reduce food waste,

 Changing the menus
 Improvement in the methods of serving food to patients
 Strict stock taking on the requirement of food for patients and staff
Waste segregation methods are also there. All the Food waste generated at the
hospitals is only disposed into waste bags placed inside green waste bins.
Municipal waste councils carry some for treatment and other activities like
feeding pigs. Once the volume of food waste is reduced and separated, it is
necessary to dispose of it environmentally sound and cost-effectively. In this
hospital, Food waste is managed as follows.

 Composting – Use as a fertilizer for food plants which are grown in the
garden at the hospital
 Turning into animal food – pig feeding process
 Biogas generation – Small biogas production unit near the kitchen for
cooking.
Other types of Non-Hazardous waste are,

Plastic waste is another type of non-hazardous waste generated in this hospital.

After generations, they collect them and separate them into categories of waste,
such as polythene, plastic bottles, and other plastic waste materials. Then, they
give separated plastic waste to the municipal waste management council for
further processes.
Paper waste – all the types of cardboard, papers and waste that include paper-
type materials are manually separated using labor and transported to other
processes.
Kitchen waste – coconut cups and other degradable waste are used to make
compost. Some of them are directly utilized for burning processes
 LIQUID WASTE MANAGEMENT

Liquid waste generated from places like operation theatres, labor rooms, labs,
laundry, canteen and toilets is first segregated and treated with disinfectant and
then poured into a standard drainage facility. This waste produced could lead to
infections, and it will be hazardous if the discard is done in local bodies like lakes
and rivers. Hospitals should make their Effluent treatment plant to avoid this
biomedical waste so that wastewater can be reused eventually. Disposal of the
infected and hazardous rubbish from the hospital, including laboratories, has
been a threat to the environment, leading to the spreading of the disease, putting
lthe environment at risk and the transmission of prone disease. So, it is the duty of
health care facilities which includes hospitals, nursing homes, clinics, dispensaries,
veterinary institutions, animal houses, pathology and biochemistry lab, blood
banks etc.; steps should be taken to reduce adverse effects on human health and
the environment. There is a separate area for the water treatment process in the
hospital. They treat all the wastewater generated in the hospital area and all
sludge waste. They transport all the wastewater to large storage tanks and fill them
using tubes. Mainly they get wastewater from sinks and Barth rooms. After storage,
they do basic filtration steps to separate water. Then separated water move to
another tank and pumped using the large pump. Then rotational primary filtration
process is done. Again, pump that treated water into another rotational type
primary filtration system and then pump in to the large water tank and let the
water overflow to dissolve oxygen with water. Then again, add some chemicals
like chlorine and remove the treated water.

Before releasing the treated water, they analyze some parameters like PH value,
nitrogen level, ammonia level and oxygen level of treated water. If parameters
are not in good condition, wastewater is treated several times. After the treatment
process, the remaining sludge is not used to make any product because of the
ministry of health guidelines.
Wastewater discharged from sewage systems and laboratories should comply
with the wastewater discharge standards stipulated by the Central Environmental
Authority. Wastewater management mainly, wastewater can be reused in several
methods. Hospitals focus on treatment methods and then discharge them to the
river. Below methods are some good suggestions,
  Reuse of treated black water from the treatment plant for gardening
 Reuse of treated grey-water from laundry for gardening
 Displaying posters & billboards
 Foot handle water taps
 Displaying instruction near all water taps & points
 Recycling technology at water ponds
 Mechanical sprinklers to garden
 Monthly analysis of water consumption of each unit by the energy
manager
 Awareness to all inward patients through health education on the use
of water


Hospital laundry waste management

Hospital Laundry aims to provide a regular and timely supply of clean clothes to
the patients and staff for the comfort and safety of the patient and the personal
appearance of the personnel. Laundry gives pleasure to patients. First, when a
patient comes to a ward, he looks at the bed and its neatness. If it is quality
enough, the patient gets satisfied. However, behind the scene is very difficult.
Cleaning staff collect these bed sheets, operating clothes and other washable
items and separate them. They do not mix and use chemicals to clean these
clothes and put them into the washing machine. Then the washing process goes
on, and the clothes are taken to the dry zone after washing. After drying it, send
it to the final step. It is an Ion process. Using a big Ion, it automatically gets Ion and
folds in a manner. After that, clothes are being collected and distributed to
relevant wards. If the capacity of the hospital laundry is fulfilled, then hospital
management tender calls to industries or people who wash clothes and allow
fulfilling the demand. The amount of textile waste generation depends on the
number of words and several patients who are in the hospital. This hospital has a
separate area to treat waste textiles, and there are large machines to do this
process. But it is easier to manage if more patients are in the hospital.
EFFECTS OF IMPROPER WASTE DISPOSAL
Improper management of healthcare waste poses a significant risk to patients,
visitors, healthcare workers, the community and the environment. It contaminates
the natural environment (air, water, soil, and flora) and the artificial environment,
affecting the health of humans and other living beings. Persons exposed to
hazardous healthcare waste are potentially at risk of being injured or developing
adverse health outcomes. Adverse outcomes associated with mismanaged
healthcare waste and by-products in the hospital include.
 Injuries inflicted by sharp objects
 Potential for spreading drug-resistant micro-organisms from
healthcare facilities into the environment
 Chemical burns arising the context of disinfection, waste treatment
activities or sterilization
 Adverse health outcomes due to environmental pollution
 Toxic exposures
 Thermal injuries
Proper management of healthcare waste is essential in ensuring the health and
safety of healthcare staff and all other categories of staff handling such waste.
Healthy healthcare staff is a prerequisite for providing quality healthcare services.
The improper management of healthcare waste causes environmental problems
such as,
 Air pollution
 Water pollution
 Soil pollution
Open burning of healthcare waste or incineration using substandard incinerators
adds a significant amount of particulate matter to the atmosphere causing air
pollution. Air pollution is a silent killer and a significant risk factor for non-
communicable diseases such as ischemic heart diseases, lung cancers, chronic
lung diseases, etc. Children, pregnant mothers, people with pre-existing chronic
conditions and outdoor workers are particularly at a higher risk of developing
adverse health effects due to air pollution. Improper segregation and disposal of
healthcare waste can cause soil and groundwater pollution, adversely affecting
human health. Therefore, mainly in the healthcare industry, they all pay more
consideration to their waste management and always try to minimize the effects
of both hazardous and non-hazardous waste.
Regulations Environmental licenses
 Environmental Protection License (EPL)
 Scheduled Waste Management License (SWML)
Environment Impact Assessment (EIA) Hospitals proposed to be established in
sensitive areas should carry out an Environmental Impact Assessment before
construction commences to mitigate anticipated adverse environmental impacts
due to pollution or construction activities.
Waste Management License - Industries engaged in managing healthcare waste
generated from healthcare institutions, including medical laboratories and
research centres, should obtain scheduled waste management licenses from the
CEA (central environmental authority) for the following activities.
 Waste collection, Waste transportation, Waste storage, waste recovering,
Waste disposal
According to the discussion with the hospital management and other staff
members, we propose some ideas for generated food waste management, they
are as follows.
 Build a biogas unit for food waste management,
 Limited polythene usage within hospital premises,
 encourage staff members to use reusable lunch boxes,
 Order food for only needy inward patients,
 Patients were advised to keep only amount of food for their consumption,
 Training of staff regarding waste segregation,
 Arrange farmer to collect the remaining small amount of food waste as
animal feed are some of them.
 SUGGESTED PLANS

 Further, increase the capacity of the wastewater management system

 Making additional products, such as rugs, pillows, etc., from fabric scraps
after the production of clothes.
 Earn extra income by handing raw fabric and thread containers to a paper
box recycling facility.
 Use of paper containers or bags made from fabric discarded during
garment manufacturing instead of polythene for packaging finished
garments
 Working with the waste management agency to collect the waste at least
once daily.
 Further expansion of waste disposal yard and further expansion of rain
cover.
 Construction of billboards with pictures in addition to the existing programs
for employees about waste disposal.
 Implement a program for the daily disposal of restaurant waste.
 Using a safe house for storing hazardous waste.
 Healthcare waste should be transported using dedicated, wheeled, leak-
proof containers or vehicles.
 Needle cutters should be provided for hospitals to separate needle sharps
from the waste stream at their generation points.
 All the hospitals in Sri Lanka should provide necessary training and education
for all staff concerning safety, health risks, and environmental issues in
healthcare waste handling.
 There should be a healthcare waste management plan for every hospital
suitable for their area considering population, area, environmental impacts
etc.
 It is recommended that the Central Environmental Authority, in coordination
with the Ministry of Health & introduce a manual of guidelines practically
applicable concerning healthcare waste management [14].
 Waste treatment places should be more significant according to an
increment of hospital wards
 because waste generation gradually increases with the increase of
patients.
 CONCLUSION

 Health effects of healthcare wastes, unaware of the environmental

damage or pollution that may result from the poor management of
healthcare wastes.
 Policies and regulations of healthcare waste management do not address
the lack of physical and financial facilities or the absence of responsible staff
in the hospital.
 In considering environmentally friendly healthcare waste management and
WHO guidelines in this regard, some healthcare waste practices were
unsatisfactory.
 Waste is not the only product that removes. It can convert into a valuable
product by adding value to the waste.
 Currently waste management system should be improved according to the
quantity of waste generated in the hospital.