Hospitals struggle with waste management problems

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.