Hospitals struggle with waste management problems<\/p>\n
By Iwan Nefawan<\/p>\n
JAKARTA (JP): The economic crisis has affected most people in
\nthis country. A lot of people are suffering due to the soaring
\nprices of food and drugs. The turmoil has also hit health
\ninstitutions, particularly hospitals and laboratories.<\/p>\n
At Cipto Mangunkusumo General Hospital (RSCM), many patients
\ncannot afford the drugs and medical fees. And due to the
\nfinancial problems, many operational activities cannot be
\nimplemented normally. But tasks such as waste management cannot
\nbe stopped altogether even though the budget is limited.<\/p>\n
The number of patients during the first three month of the
\n1998\/1999 fiscal year (which started in April) was 25,567
\ncompared to 36,229 in the same period of the previous year. The
\nbed occupancy rate in that period this year was 60 percent, 1
\npercent down on last year.<\/p>\n
The figures show there has been no significant drop in the
\namount of waste produced by the hospital since the crisis began.<\/p>\n
In the past three months, the hospital produced more than 18
\ncubic metres of solid waste and 600 cubic metres of waste water
\nper day. Based on these characteristics, it can be categorized as
\nmedical and nonmedical waste. The medical waste, which comprises
\nmore than 20 percent of the total waste, includes infectious,
\npathological, laboratory and pharmaceutical substances.<\/p>\n
The cost of waste management is not cheap. For the solid waste
\nhandling, there are many plastic bags, containers, etc. that must
\nbe provided. These cost more than Rp 100 million (US$8,650) per
\nyear. Another Rp 150 million has to be allocated for liquid waste
\ntreatment. To process the liquid waste, the mechanical and
\nelectrical equipment must be switched on all the time.<\/p>\n
To survive the crisis, many hospitals are having to change
\ntheir waste management strategies, for example by reducing the
\noperating hours of the waste water treatment or even stopping the
\nprocess, and simplifying or even stopping the separation system.<\/p>\n
Those run the risk of affecting both the environment and human
\nhealth. The primary impact is the pollution caused by discharging
\nthe waste through the water, the ground or the air. As a result,
\nthe environmental quality inside the hospital and surrounding
\narea be deteriorated.<\/p>\n
Furthermore, the pollution can be harmful to human health. In
\nthis case, the main health damage is the spread of infectious
\ndiseases that can be transmitted rapidly from one person to
\nanother, and from one place to another. Of course, it will
\nadversely affect people's health and, as a consequence, damage
\npeople's ability to handle the crisis.<\/p>\n
In order to survive this crisis without damaging anyone, there
\nare three strategies that could be implemented to streamline
\nhospital waste management. These are: waste minimization
\nprograms, optimization of natural processes, and preventive
\nmaintenance programs.<\/p>\n
Waste minimization programs can reduce waste management
\nexpenses. Waste minimization refers to practices or processes
\nwhich reduce by the maximum possible amount the quantity of waste
\ngenerated and\/or the quantity of waste, which requires subsequent
\ntreatment, storage or disposal.<\/p>\n
Minimizing waste products without compromising infection
\ncontrol is always preferable to waste disposal. If possible,
\nhospitals should aim to reduce the quantity of waste requiring
\nfinal disposal through improved product design, reduced and
\nrecyclable packaging, and the introduction and promotion of
\nrecyclable products.<\/p>\n
The primary objective of a waste minimization policy is to
\nreduce potential hazards to human health and the environment by
\nminimizing the generation of waste which is hazardous.<\/p>\n
Secondary objectives are the efficient use and conservation of
\nresources, a reduction in the need for disposal facilities, a
\nreduction of waste disposal costs, and improved cost efficiency
\nthrough reduced waste disposal and raw material costs.<\/p>\n
Several hospitals in developed countries have demonstrated the
\nmany opportunities that exist for waste minimization. In the
\ndevelopment of this program, Cipto Mangunkusumo is assessing the
\npotential waste that can be minimized. It will be implemented in
\nlow-risk waste generations, such as by processing biodegradable
\nkitchen waste for compost, and by reusing or recycling
\nadministration papers.<\/p>\n
The optimization of natural processes is the way to minimize
\nthe use, and therefore cost, of fuel and electricity.<\/p>\n
This is not easy to develop in reality because many waste
\ntreatment systems depend on mechanical and electrical equipment.
\nTo this end, hospitals' management must reassess which parts can
\nbe operated naturally and the use of machines must be minimized.
\nIn the case of Cipto Mangunkusumo, the strategy is being applied
\nin the use of waste water pumps by turns and gravitation system
\nof piping maximally. This effort needs the monitoring program to
\nbe strictly enforced in order not to eliminate the quality of the
\nprocess.<\/p>\n
A preventive maintenance program can reduce the frequency with
\nwhich machines break down. Thus repair costs can be reduced and
\nmachines' lifetimes extended.<\/p>\n
However, this program needs to be supervised extremely
\ncarefully. It is difficult to change a strategy in a limited
\ntime. The key is developing a suitable monitoring system to
\nanticipate the machinery's condition. At Cipto Mangunkusumo
\nhospital, this is still being implemented.<\/p>\n
It is expected that the three efforts described above can help
\nthe hospital survive the crisis. Although the result has not been
\nproven yet, we are convinced that they can save some money,
\ncontrol the pollution and prevent the transmission of infectious
\ndiseases. In order to get the optimal result, the program must be
\nsupported by sound management policies. The government can help
\nthe hospital management by providing guidelines that are easy to
\nunderstand and have a suitable sense of crisis.<\/p>\n
The author is an environmental health officer at Cipto
\nMangunkusumo General Hospital.<\/p>",
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