Hospitals struggle with waste management problems

By Iwan Nefawan

JAKARTA (JP): The economic crisis has affected most people in this country. A lot of people are suffering due to the soaring prices of food and drugs. The turmoil has also hit health institutions, particularly hospitals and laboratories.

At Cipto Mangunkusumo General Hospital (RSCM), many patients cannot afford the drugs and medical fees. And due to the financial problems, many operational activities cannot be implemented normally. But tasks such as waste management cannot be stopped altogether even though the budget is limited.

The number of patients during the first three month of the 1998/1999 fiscal year (which started in April) was 25,567 compared to 36,229 in the same period of the previous year. The bed occupancy rate in that period this year was 60 percent, 1 percent down on last year.

The figures show there has been no significant drop in the amount of waste produced by the hospital since the crisis began.

In the past three months, the hospital produced more than 18 cubic metres of solid waste and 600 cubic metres of waste water per day. Based on these characteristics, it can be categorized as medical and nonmedical waste. The medical waste, which comprises more than 20 percent of the total waste, includes infectious, pathological, laboratory and pharmaceutical substances.

The cost of waste management is not cheap. For the solid waste handling, there are many plastic bags, containers, etc. that must be provided. These cost more than Rp 100 million (US$8,650) per year. Another Rp 150 million has to be allocated for liquid waste treatment. To process the liquid waste, the mechanical and electrical equipment must be switched on all the time.

To survive the crisis, many hospitals are having to change their waste management strategies, for example by reducing the operating hours of the waste water treatment or even stopping the process, and simplifying or even stopping the separation system.

Those run the risk of affecting both the environment and human health. The primary impact is the pollution caused by discharging the waste through the water, the ground or the air. As a result, the environmental quality inside the hospital and surrounding area be deteriorated.

Furthermore, the pollution can be harmful to human health. In this case, the main health damage is the spread of infectious diseases that can be transmitted rapidly from one person to another, and from one place to another. Of course, it will adversely affect people's health and, as a consequence, damage people's ability to handle the crisis.

In order to survive this crisis without damaging anyone, there are three strategies that could be implemented to streamline hospital waste management. These are: waste minimization programs, optimization of natural processes, and preventive maintenance programs.

Waste minimization programs can reduce waste management expenses. Waste minimization refers to practices or processes which reduce by the maximum possible amount the quantity of waste generated and/or the quantity of waste, which requires subsequent treatment, storage or disposal.

Minimizing waste products without compromising infection control is always preferable to waste disposal. If possible, hospitals should aim to reduce the quantity of waste requiring final disposal through improved product design, reduced and recyclable packaging, and the introduction and promotion of recyclable products.

The primary objective of a waste minimization policy is to reduce potential hazards to human health and the environment by minimizing the generation of waste which is hazardous.

Secondary objectives are the efficient use and conservation of resources, a reduction in the need for disposal facilities, a reduction of waste disposal costs, and improved cost efficiency through reduced waste disposal and raw material costs.

Several hospitals in developed countries have demonstrated the many opportunities that exist for waste minimization. In the development of this program, Cipto Mangunkusumo is assessing the potential waste that can be minimized. It will be implemented in low-risk waste generations, such as by processing biodegradable kitchen waste for compost, and by reusing or recycling administration papers.

The optimization of natural processes is the way to minimize the use, and therefore cost, of fuel and electricity.

This is not easy to develop in reality because many waste treatment systems depend on mechanical and electrical equipment. To this end, hospitals' management must reassess which parts can be operated naturally and the use of machines must be minimized. In the case of Cipto Mangunkusumo, the strategy is being applied in the use of waste water pumps by turns and gravitation system of piping maximally. This effort needs the monitoring program to be strictly enforced in order not to eliminate the quality of the process.

A preventive maintenance program can reduce the frequency with which machines break down. Thus repair costs can be reduced and machines' lifetimes extended.

However, this program needs to be supervised extremely carefully. It is difficult to change a strategy in a limited time. The key is developing a suitable monitoring system to anticipate the machinery's condition. At Cipto Mangunkusumo hospital, this is still being implemented.

It is expected that the three efforts described above can help the hospital survive the crisis. Although the result has not been proven yet, we are convinced that they can save some money, control the pollution and prevent the transmission of infectious diseases. In order to get the optimal result, the program must be supported by sound management policies. The government can help the hospital management by providing guidelines that are easy to understand and have a suitable sense of crisis.

The author is an environmental health officer at Cipto Mangunkusumo General Hospital.