Risk Characterization and Quantification of Medical Waste in Qom Province

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 2, Pages: 634-638

J. Environ. Treat. Tech.

ISSN: 2309-1185

Journal web link: http://www.jett.dormaj.com

Risk Characterization and Quantification of

Medical Waste in Qom Province

Y. Ghafuri , R. Shiri , N. Jafari. Afzal , H. Izanloo

Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran

Received: 10/12/2019 Accepted: 14/03/2020 Published: 20/05/2020

Abstract

The term healthcare waste includes all the waste generated within healthcare facilities, research centers, and laboratories of

medical procedures. The purpose of this study was to determine the the quantities and composition of waste generation and evaluate

the hospital waste management and hazard analysis by preliminary risk analysis (PRA) in all hospitals in Qom province, Iran.

Results showed that the production of sharp, pharmaceutical, cytotoxic, chemical, pathological, and heavy metals wastes is

estimated to be 3.6%, 2.5%, 0.18%, 0.11%, 0.3%, and 0.01% of total wastes, respectively. Analysis and partitioning of heavy metal

and cytotoxic waste was reported in this study. Events such as segregation and color-coded containers for pharmaceutical waste,

especially cytotoxic waste and heavy metals, and unsupervised waste offsite transport in a hospital without safe facilities were

identified as high-risk events. In addition, other events were identified as medium risk. Administrative procedures, maintenance,

training treatment plant operators, and integrating training with public education on risks of healthcare waste are among the other

issues that should be considered in providing strategies in hospital waste management.

Keywords: Qom; Waste; Risk; Assessment; Hospital

Introduction¹

2 Materials and Methods

Public interest in emerging and developing countries to

The hospitals of Qom province include seven public

hospitals (i.e., Kamkar, Shahid Beheshti, Forghani, Hazrat

Masoomeh, ImamReza, and Izadi) and tree private hospitals

(i.e., Valiasr, Aliebn Abitaleb, andGolpaygani) that location

of study area was shown in the figure1. In the first phase of

the study, the quantities of waste generated in the hospitals

were determined through a 30-day monitoring of the related

data. For this purpose, waste records of eight categories of

hospital waste components (i.e., infection, sharps,

pharmaceutical, cytotoxic, chemical, heavy metals, and

pathological and compressed containers) were considered.

For all eight categories of waste, labeled sample bags were

provided separately. The samples were daily collected and

weighted using a digital mass balance. Considering the

importance of health impact and environmental hazards of

heavy metals and cytotoxic drugs in terms of fate and

environmental behavior as well as different treatment and

disposal methods depending on the physico-chemical

properties of each of these compounds, the composition of

cytotoxic waste and heavy metal is checked in this research.

The quantity and composition of cytotoxic waste includes

vials and cytotoxic drug residues as the most important part

of cytotoxic waste was assessed in oncology wards of

selected hospitals.

improve health services is growing. In this regard, poor

medical waste management within healthcare facilities have

been challenged increasingly by several interest groups and

communities (1). The term healthcare waste includes all the

waste generated within healthcare facilities, research

centers, and laboratories of medical procedures. Medical

waste is highly “hazardous” and may pose a variety of

environmental and health risks. Knowing the types and

quantities of waste produced in a healthcare facility is an

important first step in safe disposal (2, 3). Waste-generation

data are used in estimating the capacities required for

containers, storage areas, and transport and treatment

technologies. Waste-generation data can be used to establish

baseline data on rates of production in different medical

areas and for procurement specifications, planning,

budgeting, calculating revenues from recycling,

optimization of waste-management systems, and

environmental impact assessments (4). The aim of this study

is the risk characterization and quantification of medical

waste in public and private hospitals of Qom province (Iran)

by a specific method to evaluate the composition of hospital

waste and assess the health and environmental risks

associated with medical waste management

Corresponding author: H. Izanloo, Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom,

Iran. Tel: +9832536602040. E-mail: h-izanloo@muq.ac.ir.

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 2, Pages: 634-638

Figure 1: Location of Studied Area

Table 1: Risk Assessment Matrix

Hazard Severity

No effect(1)

Minor(2)

Major(3)

Fatal(4)

Catastrophic(5)

Likelihood

occurrence

Very likely (5)

Likely

(4)

(3)

(2)

Possible

Unlikely

Very unlikely (1)

Low risk 1-4

Medium risk 5-12

High risk 15-25

The rate of generation and Percentage of heavy metals

component (Cd, Cr, Cu, Hg, Zn and Pb) in the hospital’s

waste were determined, the composition analysis of waste

containing heavy metals segregated into a plastic container

and identification of heavy metals types was carried by the

survey team who had experience in medical waste

management.In the next stage, a questionnaire about medical

waste management was prepared. This data collection tool,

which was based on the order of the Iranian Ministry of

Health, includes the process of waste management in the

stage of segregation and storage, collection and

transportation, treatment, and final disposal (5,6,7).

Results and Discussion

Waste estimation of the hospitals was performed

according to eight types of medical waste. The average daily

medical waste generated in the hospitals of Qom province

are presented in Table 3. These data are shown according to

the number of each hospital from 1 to 10, in the order of the

hospital listed in the previous section. The results of waste

generation in hospitals show that about 2363 kg/day medical

waste is produced and, accordingly, the rate of hospital

waste generation per bed is 1.2 kg/bed/day. About 93% of

the province’s special medical waste is dedicated to the

production of infectious waste. Other results also showed

that the production of sharp, pharmaceutical, cytotoxic,

chemical, pathological, and heavy metal wastes is 3.6%,

Risk assessment

In the second phase of the study, hazard analysis and risk

.5%, 0.18%, 0.11%, 0.3%, and 0.01% of total wastes,

respectively. The findings of this study are like those of

Ghafuri and Naizadeh about the composition and quantity of

cytotoxic waste from oncology wards. They showed that the

mean production rate of medical waste in two hospitals of

Qom province was 1.73 kg/bed/d, including 92% infection

waste (1.67 kg/bed/d), 2.5% sharp, 5% pharmaceutical

waste, and cytotoxic waste was 293.5(gr/d), which is equal

to 0.07% of total medical waste generation (4). Compared

with these studies, other reports from Iran showed different

results. Farzadkia et al. reported hospital waste as 2.3

Kg/bed/day; Askarian et al. reported a medium rate of 8.025

Kg/bed/day at private hospitals of Shiraz, Iran; Alimohamad

et al. estimated a medium rate of 4.38Kg/bed/day at Shariati

Hospital of Tehran; Overall, these results show that medical

waste rates vary widely and must be estimated by local

measurements (10,11,12). Results about partitioning of

assessment by using the preliminary risk analysis (PRA)

were considered. This is a semi-quantitative technique for

risk assessment based on the identification and ranking of

potential hazards and risks related to all processes of medical

waste management. The level of risk is according to the

multiplication of severity and likelihood criteria, presented

in Tables 1 and 2 (8, 9).

Table 2: Severity of Consequence Criteria

No effect

Minor

Major

Has no effect on health

Minor injury

Injury

Hazardous

Catastrophic

Serious or fatal injury

Death

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 2, Pages: 634-638

heavy metals and cytotoxic drugs in hospital wastes is

indicated in Figure 1 and 2. Figure 1 demonestrated that the

highest percentages of ferrous metals in hospital wastes in

Qom province are related to Zn and Cu however, other

amounts of Hg and P are also not negligible.this results is

Comparable with study results of liu et al about

Characteristics and evalution of heavy metals concentration

in the Medical Waste Incinerator Fly Ash (13). Results of

Partitioning of cytotoxic drugs in figure 3 was show that

maximum percentage of drug cytotoxic wastes is related to

Cyclophosphamide. The results of the risk analysis of

hospital Waste Management in hospitals of Qom province

are shown in Table 4.

Table 3: Average Daily Generation (kg/day) of Hospitals Waste in Qom province

Pressurized

Container

Hospital

Beds

Number

Heavy

metals

Infection

Sharp

Pharmaceutical

Cytotoxic

Chemical

Pathological

234

540

245

158

110

100

110

158

118

233

2012

240

400

300

167

233

263

187

224

2200

5.5

1.7

2.5

0.16

1.7

0.18

1.5

0.2

0.006

0.0025

4.5

0.0026

1.33

1.26

0.12

8.4

8.5

5.8

5.6

7.5

4.3

8.68

6.7

7.5

4.1

3.6

9.15

4.41

0.012

0.27

0.09

0.02

0.035

0.5

0.2

total

4.36

2.63

0.282

9.55

0.255

other

partitioning of heavy metal(%)

Figure 2: Partitioning of heavy metals in hospital wastes (%)

IFOSFAM IDE

14.1

L-ASPAR AGIN ASE

M ETHOTER EXATE

DAC AR B AZIN

M ESNA

6.6

8.3

6.6

12.5

ER INOTEC AN

B LEOM YC IN

5.8

C YC LOPHOSPHAM IDE

C ISPLATIN

2.5

1.2

2.2

7.5

6.6

FLUOUR AC IL

OXALIP LATIN

C AR B OPLATIN

VINC R ISTINE

ETOPOSIDE

C YTAR AB INE

6.6

PARTITIONING OF CYTOTOXIC DRUGS %

Figure 3: Partitioning of cytotoxic drugs in cytotoxic wastes (%)

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 2, Pages: 634-638

Table 4: Risk Analysis of Hospital Waste Management

Stage of

Risk Analyze

waste

management

Events

Hazard Identification

Control of Risk

Likelihood

Severity

Risk

Segregation and color-

coded containers for

pharmaceutical waste

especially cytotoxic

waste and heavy metals metals

is not predicted

-pharmaceutical and cytotoxic

- Hazards from genotoxic waste should be separated and

and cytotoxic waste

- hazard from heavy

stored carefully away from

other waste

- Modification and

improvement of Interim storage

sites with the national

regulation

Segregation

and Storage

- Incidence of

contamination by

biohazards

Interim storage does

not comply with the

national regulation

Lack of planning and

forecasting of

collection routes in

hospital unit

- The spread of infection

in the sensitive area of

-Collection routs of waste must

be start from the most sensitive

Transport trolleys

Are not appropriately

sized according to the

volumes of waste

generated and

periodically

disinfected.

Unsupervised waste

offsite transport in

hospital without safe

facilities

hospital and increase risk areas and follow a fixed route

of disease

around other medical areas and

interim storage locations

-Waste containers, trolleys and

vehicles are maintained and

cleaned regularly.

Collection

and

Transport

- Unsupervised waste

management poses a

high risk of disease

transmission among

health-care workers,

waste workers and the

general public

Develop active monitoring

program for offsite transport of

waste

location and

surroundings of the

treatment site and

disposal facility is not

appropriate

Improper disposal of

sharps In hospitals

without disposal

facilities

-Spread of contamination Development of a hospital

and health threats

waste

Treatment

and Final

Disposal

-Survival of pathogenic

microorganisms and

increase of needle stick

for worker and public

management plan that should

comply with national

regulations

- Treatment plant operators

Cleaning staff

Lack of sufficient

knowledge in the

operators of disposal

facilities

Employees to be trained

The risk assessment process reported in this table relates

to each of the waste management processes including

segregation and storage, collection and transportation,

treatment, and disposal; however, the waste management

situation investigated in the hospital did not comply with

Iranian regulation. Based on the results, events including

segregation and color-coded containers for pharmaceutical

waste (especially, cytotoxic waste and heavy metals) and

unsupervised waste offsite transport in a hospital without

safe facilities were identified as high-risk events and other

events were identified as medium risk. According to the

results of Farzadkia et al. about Management of Hospital

Waste in Tehran, Iran, conditions of waste storage systems

and collection planning were unsuitable; also, the reported

results are consistent with the present study (11). Moreover,

the study of Mansouri on the preliminary hazard analysis as

a tool for risk assessment of sari hospital waste indicates the

high risks in the hospital waste management system [14,15].

In another study, Sefuhi conducted a risk assessment on the

healthcare waste in the Hospital of Batna City (Algeria).

According to the results of the preliminary hazard analysis

and Risk Assessment Matrix, this researcher reported that

sharps, infectious waste, and human anatomical waste are in

the area of high risks. This result is different from the results

of this study. However, it is consistent with the results of a

study of Alwabr with the subject of medical waste in

Journal of Environmental Treatment Techniques

2020, Volume 8, Issue 2, Pages: 634-638

hospitals of Yemen, where it was reported that the events of

waste handling processes were in high-risk levels by the

PRA analysis technique (8,9).

Tehran, Iran” Health Scope. 2018, 7(2), e61412, doi:

0.5812/jhealthscope.61412.

[

11] Farzadkia, M., Moradi, A., Shah Mohammadi, M., Jorfi, S.,

Hospital waste management status in Iran: a case study in the

teaching hospitals of Iran University of Medical Sciences.

Waste Management and Research,2009,27, 384–389,

https://doi.org/10.1177/0734242X09335703.

Conclusion

Based on the results of the present study, setting a plan

that involves a strategy for implementing improved waste

management and the allocation of roles, responsibilities, and

resources is of high necessity. Such a plan would lead to

developing a policy on regional and cooperative methods of

healthcare waste treatment with considering minimization,

separation, handling, transport, treatment, and final disposal

[12] Susi A Wilujeng, Enri Damanhuri and Mochammad Chaerul

medical waste management in private clinics in surabaya and

factors affecting it,International Journal of GEOMATE, 2019,

6(55), 34 – 39, DOI: ht tps://doi.org/10 .21660/201 9.55.4606.

[

13 ] Fang Liu, Han-Qiao Liu, Guo-Xia Wei, Rui Zhang, Tong-Tong

Zeng, Gui-Sheng Liu and Jian-Hua Zhou , Characteristics and

Treatment Methods of Medical Waste Incinerator Fly Ash: A

Review, Processes 2018, 6, 173, doi:10.3390/pr6100173

(

16). One of the important results of this study is the

composition of hospital waste and heavy metal content and

the genotoxicity of oncology wastes released into the

environment (17). Administrative procedures, maintenance,

training treatment plant operators, and integrating training

with public education on risks of healthcare waste are among

the other subjects that should be considered in providing

strategies in hospital waste management.

[14] Tayebeh Mansouri, Mahmood Alimohammadi,Ramin

Nabizadeh Nodehi,Kamyar Yaghmaeian, AliAzari, Risk

Assessment of Sari Fatemeh Zahra Hospital Using Failure

Mode Effect Analysis, Individualized Rapid Assessment Tool

and Preliminary Hazard Analysis, J Mazandaran Univ Med Sci

018, 28 (161), 89-107 (Persian).

[

15] C. Bokhoree,Y. Beeharry,T. Makoondlall-Chadee,T. Doobah

and N. Soomary ,Assessment of Environmental and Health

Risks Associated with the Management of Medical Waste in

Mauritius, APCBEE Procedia, 2014, 9 ,36 – 41.

Acknowledgment

[

16] I Gusti Ngurah Gede Putra, Sang Putu Kaler Surata, Gusti Ayu

Ari Agung , Medical waste management strategy in the

inpatient primary health care center with system approach: a

SWOT Analysis” 2017, Bali Medical Journal (Bali Med J) 3(3)

This project has been supported by the Qom University

of Medical Sciences Health Services. The authors would like

to thank environmental health engineering’s of Qom

hospitals.

017

[

17] Y. Ghafuria, M. Yunesian, R. Nabizadeh, A. Mesdaghinia,M.

H. Dehghani• M. Alimohammad ,Environmental risk

assessment of platinum cytotoxic drugs,a focus on toxicity

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