Assessing sustainable healthcare waste management implementation in two large hospitals in Malaysia

Transcription

1 October 8 9, 2018 Assessing sustainable healthcare waste management implementation in two large hospitals in Malaysia Timothy Kurannen Baaki 1,a, Mohamad Rizal Baharum 1 and Azlan Shah Ali 1 1 Department of Building Surveying, Faculty of Built Environment, University of Malaya, Kuala Lumpur, Malaysia a kurannenbaaki@siswa.um.edu.my

2 study background Previous healthcare waste management (HCWM) research has focused primarily on management practices (see Prem Ananth, Prashanthini, & Visvanathan, 2010; Sawalem, Selic, & Herbell, 2009; Tudor, Noonan, & Jenkin, 2005). FM practice in Malaysia is still largely operational (Myeda & Pitt, 2014). FM function needs to continually express its strategic relevance by tangible value-adding performance output (Amaratunga & Baldry, 2002; Pitt & Tucker, 2008; Sapri & Pitt, 2005). Very little studies have addressed HCWM in Malaysia. Specific focus has been on clinical/biomedical and or hazardous wastes (Ambali, Bakar & Merican, 2013; Razali and Ishak, 2010; Chong, 2007; Zaimastura, I., 2005). infectious waste pathological waste sharps pharmaceutical waste genotoxic waste chemical waste heavy metals pressurized containers radioactive waste Hazardous 25% A dedicated sustainable approach to HCWM implementation has not been researched. This study therefore aims to examine sustainable HCWM in university teaching hospitals in Malaysia as well as determine a strategic performance assessment framework for safe and sustainable healthcare waste management (SSHCWM) implementation Non-risk 75% domestic-type recyclable HCW composition according to WHO (Chartier, 2014)

3 theoretical framework critical importance of factors Sustainability policy implementation of factors Critical success factors for SSHCWM implementation SSHCWM implementation success Theoretical framework for assessing strategic SSHCWM implementation using critical success factors methodology

4 data collection and analysis: interviews, observations, questionnaire survey Data collection techniques Semi-structured interview 5 key informant interviews with department heads responsible for HCWM and managers of waste management contractors Observation An observation checklist with ten (10) category of items used 8 visits to UTH A; 6 visits to UTH B; 1 visit to Kualiti Alam treatment and disposal site Questionnaire survey 243 respondents (doctors, nurses, admin staff) Qualitative (descriptive) Qualitative content analysis Analysis techniques Quantitative (descriptive; statistical) Mean ranking; correlation; multiple linear regression.

5 results: profile of healthcare facilities general characteristics of the healthcare facilities Both hospitals are public university teaching hospitals and provide secondary and tertiary healthcare services UTH A: 1643 UTH B: 1040 UTH A: 2805 UTH B: 1516 UTH A: 150 UTH B: 107 nature and quantity of waste generated Waste Category HCF General (paper, cardboard, plastic) Pathological (human tissues, body fluid, body parts) Chemical (expired disinfectants, lab reagents,) Infectious (cultures, stocks, swabs) Sharps (needles, scalpels, broken glass) Pharmaceutical (Expired pharmaceuticals ) Pressurized containers (gas cylinders, aerosol cans) Radioactive Estimated Qty. (kg/day) % of General waste % of Clinical waste UTH A 6,176kg/day 73% 27% UTH B 4,299kg/day 63% 37% both hospitals are large-quantity generators (LQG). Average of 2.1kg/person/day (UTH A) and 2.6kg/person/day (UTH B).

6 results: repondents profile Interviewees' profile Interviewee code Designation Experience Name of HCF UTH-A-R1 Head of Facilities Management Unit 16+ years UTH A UTH-A-R2 Procurement Officer 25 years UTH A UTH-A-R3 Site Manager (WMC) 6-10 years UTH A UTH-B-R1 Head of Building Management Department 16+ years UTH B WMC-R1 Head of Sales 6-10 years UTH A & UTH B Survey respondents profile Respondents Questionnaires distributed Valid response rate Percentag e Doctors, physicians, medical assistants, lab technicians, pharmacists Matrons/nurses Administrative staff Total

7 UTH A UTH B results: sustainable healthcare waste management practices definition and classification Healthcare waste definition All wastes generated from the hospital All wastes generated from the hospital General classification/ categorization Domestic (general) waste Chemical waste Clinical waste General waste Clinical waste color-coding/labeling, collection material/container practice Waste category General (paper, cardboard, plastic) Pathological (human tissues, body fluid, body parts) Chemical (expired disinfectant, lab reagents) Infectious (cultures, stocks, swabs) Sharps (needles, scalpels, broken glass) Healthcare facility Labeling/ color-coding Collection material/container UTH A Blue/Green/Orange/gra Waste bin y UTH B Blue Waste bin UTH A Yellow Pedal bin with leak-proof liner UTH B Yellow Pedal bin with leak-proof liner UTH A Yellow Pedal bin with leak-proof liner UTH B Yellow Pedal bin with leak-proof liner UTH A Yellow Pedal bin with leak-proof liner UTH B Yellow Pedal bin with leak-proof liner UTH A Yellow Puncture-proof sharps container UTH B Yellow Puncture-proof sharps container UTH A Yellow Pedal bin with liner UTH B Yellow Pedal bin with liner UTH A Waste bin UTH B Waste bin Pharmaceutical (Expired pharmaceuticals) Pressurized containers (gas cylinders, aerosol cans) Radioactive UTH A Yellow Lead canister with radioactive symbol UTH B Yellow Lead canister with radioactive symbol

8 results: waste management practices On-site transportation Segregation recycle bins Pedal bin with leakproof liner Trucks for onsite transportation (UTH A). Left to right: truck for general waste, truck for clinical waste Wheeled bins for onsite transport Left to right: general waste (UTH A); clinical waste (UTH B). Some yellow bins are overfilled radioactive symbol sharps container Treatment and disposal (clinical waste) Temporary storage Syringe caps improperly disposed Cold room for clinical waste storage (UTH B) Vertical secure landfill

9 results: sustainable healthcare waste management practices Item Mean [N=243] Std. Dev Proper segregation and sorting Purchasing supplies that generate less hazardous waste (e.g., purchase of non-mercury thermometers) Rank Education/awareness about material reuse and recycling Purchasing environmentally friendly products Encourage material reuse and recycling through reward Recycling Prudent use of materials Sourcing suppliers within close proximity Reuse of materials Purchasing of reprocessed sing use devices [SUDs] Preference for purchasing reusable items over disposable ones Purchasing recyclable products Selection of methods or supplies that generate less waste Sanitary landfills Incineration with air pollution control [APC] [CATEGORY NAME] [VALUE]% [CATEGORY NAME] [VALUE]% Recycling at UTH A achieved at 4% on average annual savings on HCWM costs since beginning active recycling initiatives in Sustainable HCWM is not a priority, however, at the observed hospitals Recycling at UTH B is not really active. No active waste minimization initiatives

10 results: waste management training Similar training approach (intake-based for new staff and students; periodic for existing) is practiced at both hospitals, although at UTH A, sustainable healthcare waste management practices are also actively introduced in the training curriculum. Item Scale Frequency Percentage Training on health/environmental risks of HCW No training Once a year Two times a year Three times a year Four times a year Total Training on waste prevention, minimization, segregation and handling No training Once a year Two times a year Three times a year Four times a year Total A Go Green sensitization campaign at UTH A

11 results: critical success factors (CSFs) for SSHCWM (Obj. 4) Item Mean [N=243] Std. Dev Rank a b a b a b Training and education Regulation, policies and technical guidelines Specific budget for healthcare waste management Manpower and onsite SHCWM infrastructure Behavior change Implementing an environmental management system [EMS] [e.g., ISO 14001] Implementing waste management hierarchy Perceptions, roles and interactions of stakeholder networks Implementing life cycle waste management a=importance; b=implementation

12 results: critical success factors (CSFs) for SSHCWM Relationship between importance of factors and overall implementation of factors RPTG a BC a PRISN a TE a SB a WMH a EMS a LCWM a MOI a SusPolicy SusPolicy Correlation Coefficient.260 **.215 **.206 ** **.247 **.217 **.241 **.235 ** Sig. (2-tailed) N SSHCWM_IS Correlation Coefficient.171 **.127 *.145 *.921 **.153 *.155 * Sig. (2-tailed) N **. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed). Regression coefficients Unstandardized Coefficients Standardized Coefficients Collinearity Statistics Model B Std. Error Beta t Sig. Tolerance VIF 7 (Constant) BC TE MOI SusPolicy Adjusted R 2 = 0.872; behavior change, training and education; manpower and onsite sustainable HCWM infrastructure account for 87.2% variance in SSHCWM implementation success

13 discussion and conclusion This study established that sustainable HCWM initiatives such as waste minimization, proper segregation waste recycling, material reuse, training and education are practiced in university teaching hospitals in Malaysia. However, there is no sustainable waste management priority by top hospital management. Disposal facilities utilize sustainable approaches such as microwaving and secure vertical landfilling to treat and dispose HCW Nine (9) critical success factors were identified as being of critical importance to SSHCWM. Behavior change; training and education; and manpower and onsite sustainable HCWM infrastructure were found to significantly influence SSHCWM implementation Sustainability policy was found not to have a significant mediating effect on critical importance of factors and implementation success of SSHCWM meaning SSHCWM can be successfully implemented without a formal sustainability policy To improve strategic performance of SSHCWM implementation, the study suggests that: more active efforts be directed towards encouraging all involved stakeholders to adopt sustainable practices conducting more frequent and comprehensive trainings and education campaigns providing onsite sustainable HCWM infrastructure such as composting facility

14 thank you any questions?