In the UAE, tremendous progress and development in the health sector have been achieved in the last decade. However, medical waste is a growing problem with a prediction that it will become more complicated in the future. With more stringent environmental regulations, the expense of proper disposal of medical waste will probably be escalated in a manner that would increase the cost of health provision. These costs will possibly be passed onto the patient.
This audit report examines the state of medical waste management in the UAE following the WHO stipulations and provided government guidelines. It suggest that a management plan for medical waste should incorporate a cradle-to-grave approach (Meany and Pual, 1989). This includes the adoption of the standard operating procedure to address issues such as waste generation, waste segregation, handling, storage, transportation, treatment, and disposal. All these issues should be regulated to assure no occupational or environmental health impact. Moreover, medical waste management framework may include components such as offerings of training programs to individuals dealing with the waste in all stages from generation until disposal.
Aims and Objectives
The audit aimed to evaluate the practice of medical waste management in the UAE, according to the WHO provided standards and the guidelines provided by the UAE MoH. The objectives of the audit included the evaluation of quantity and rate of medical waste produced, as well as waste handling methods including segregation, use of color-coded bags, and labeling waste bags. Additionally, to ascertain the presence of on-site waste storage facility and modes of waste transportation, and to examine the techniques used for the treatment of waste. The existence of internal and government guidelines at the hospital, the presence of training programs for staff involved in waste handling, and use of radioisotopes and methods of handling/disposal of generated radioactive waste are taken into account.
Standards
The audit was based on the WHO (WHO, 1997) guidelines for assessing hospital waste management and the procedures suggested by UAE MoH.
Methods
The assessment of medical waste management in UAE was carried out through a survey and on-site visits to major hospitals in the country. Fourteen hospitals, distributed among the seven emirates, were selected for the survey. Five hospitals belonged to the Abu Dhabi Emirate, four in Dubai and one hospital each for the remaining emirates. The selection of the hospital was based on the number of beds available. Therefore, the total number of beds in all hospitals selected is 4032 and represents about 50% of the total number of beds in the country. Among the 14 selected hospitals, 12 are government hospitals, while the other two are privately owned.
The data was collected using a questionnaire based on the format prepared by the WHO (WHO, 1997) for assessing hospital waste management. It consisted of eleven major questions that covered different aspects of waste management, legislation, and information regarding medical waste handling, storage, pretreatment, treatment, and disposal. In addition, the questionnaire tackled issues such as staff training and awareness, availability of an incinerator within the hospital, and the presence of pollution control equipment.
Moreover, on-site visits were made to all selected hospitals to achieve direct communication with the facilities’ authority as well as to observe the actual management practices in comparison to the suggested UAE MoH suggested procedures.
Results and conclusion
The average rate of medical waste generated at the UAE hospitals is 1.95 kg/bed/d, with high variations (i.e., 0.2 to 4.5 kg/bed/d) among the surveyed hospitals. While the total quantity of medical waste generated at the UAE hospitals is known, most of the hospitals do not estimate the quantity of each type of medical waste generated. All surveyed hospitals apply segregation procedures for pathological, sharps, and infectious waste, but not all hospitals practice segregation of chemical, pharmaceutical, and pressurized containers. Hospitals in the Emirate of Abu Dhabi use red bags for disposal of medical waste, while hospitals in the other emirates use yellow bags. However, not all hospitals are practicing marking on the disposal bags and containers. There is a separate on-site storage room for medical waste in most hospitals in the UAE. On-site transportation of medical waste for incineration is conducted using special vehicles or trolleys. Off-site transportation for treatment or disposal is performed using specialized vehicles.
Nevertheless, not all hospitals employ a waste tracking system. Incineration is used by most hospitals in the UAE for the treatment of medical waste. But, some of the incinerators are old, poorly maintained with no proper equipment to control air pollution. Surveyed hospitals are using contractors for handling the generated waste. All hospitals have reported the presence of training programs for staff recruited by the contractors. Federal guidelines for the management of medical waste exist but are not strictly implemented by the hospitals. However, guidelines set by Dubai are strictly applied by the hospitals in the Emirate.
Recommendation
• Improve on estimates for radioactive waste generated
• Introduce legislation regarding radioactive waste management
• Train non-educated workers on the risk associated with the handling of medical waste.
• Employ chemical waste and pressurized containers segregation practice.
• Estimate the quantity of each type of medical waste
• Improve the method of marking the disposal bags and containers.
• Improve on waste tracking systems
• Install new incinerators
• Ensure strict implementations of federal guidelines.
Action Plan
The action plan comprises of points from 2018 to 2019. In July 2019, the Al-Qasini and Al-Ain hospitals should ensure the strict implementation of government guidelines. It should also be noted that medical waste in Al-Ain area will soon be treated in a newly-built centralized incinerator by December 2019. Moreover, Al-Baraha, Saqr, and Al-Qasimi should practice marking of disposal bags and containers by Dec 2019.
Also, all hospitals, except Tawam, Al- Baraha, and Saqr should employ the practice of segregation of chemical, pharmaceutical, and pressurized containers by Dec 2019.A re-audit will be carried out in January 2020, with the aim of ascertaining the implementation of the recommendations from this current audit.
References
Maryam, A. A.-D., Munjed, A. M., & Fouad, K. (2008). Medical waste management in the UAE. Kuwait: Kuwait Waste Management Conference.
Meany, J., & Pual, N. (1989). Medical wastes strategy, Pollution Engineering.
UAE MoH. (1999). Safe handling and disposal of medical waste (excluding radioactivewaste), . Abu Dhabi: A report of the Technical Committee,.
WHO. (1997). Action plan for the development of national programme for sound management of hospital wastes. An outcome of the Regional Consultation on Sound Management of Hospital Waste, Chiang Mai, Thailand, 28-29 November 1996. . World Health Organization Regional Office for South-East Asia.
