Audit report exposes haphazard disposal of clinical waste
Sri Lanka’s hazardous clinical waste management practices are exposing the people to danger with incinerators running below optimum temperatures, haphazard disposal of ash and sludge, inadequate storage facilities, untimely disposal and sanitary workers handling refuse without protective gear, the National Audit
Office has found.
The NAO examined 17 hospitals in ten districts across seven provinces. It studied the functions of the Central Environmental Authority (CEA), the Health Ministry, and Sisili Hanaro Encare (Pvt) Ltd, a private company.
Clinical waste includes laboratory cultures, waste from isolation wards, tissues (swabs), materials or equipment that have been in contact with infected patients, human tissues or fluids. There are sharps including needles and scalpels; biological and anatomical waste including tissues, organs, body parts, blood and body fluids. Also listed are outdated and discharged drugs; and materials and containers contaminated with such wastes.
The report highlighted instances of waste being set fire in the open (Peradeniya, Tissamaharama, Prison Hospital and Kataragama), blood discarded from laboratory tests going into gullies that overflowed out of the hospital premises (Tissamaharama), bags of waste being stacked in unsuitable places pending disposal (all hospitals) and black smoke emitting from the incinerator chimney indicating improperly combusted waste (Kurunegala).
It found that foreign-funded projects to improve the management of clinical waste in the country fell short of their objectives. For instance, Australian Export Finance and Insurance Corporation loaned the Government US$ 13.76 million in December 2015 for hospital waste treatment.
Incinerators were bought for five hospitals and MetaMizers for 20 hospitals at a total cost of US$ 15mn. MetaMizers use hybrid autoclave technology to shred and sterilize medical waste. The NAO inspected the equipment in selected hospitals and “observed that those machines were not in operation in an efficient and effective capacity as intended”.
Compared with the cost incurred, “the intended purpose of disposing clinical waste in an eco-friendly manner could not be efficiently and effectively achieved by this project”.
The NAO cited instances where, this year, there were even unidentified persons disposing of clinical waste in various places around Sri Lanka. It blamed inadequate supervision and monitoring as well as weaknesses in internal control.
Owing to the dire situation, the NAO has presented a lengthy list of recommendations. They apply to “mandatory” rules that already exist but are known to be widely violated. For instance, hospitals do not segregate and dispose of waste according to the national colour code. They do not use polythene bags of a minimum recommended thickness. They do not have standard bins stamped with warning symbols for safe disposal of sharps. The NAO calls for a uniform system on all counts.
Hospitals do not remove their sharps bins when they are threefourths full. They do not observe safe methods for on-site transportation of waste. And workers do not adopt protective measures. There was insufficient space to store clinical waste safely and refuse was often not gotten rid of quickly.
Outdated drugs were unsafely stored risking leakage out of hospital premises. Temperature was not maintained at optimum level of combustion of clinical waste. Cytotoxic empty bottles and syringes were dealt with haphazardly.
Ash was not buried safely in a manner that would not affect the surface, interior water bodies, earth or air. Air emissions from incinerators were not tested.
The NAO calls for a prohibition on burning infectious waste and premises in the open. It suggests a common incineration facility--at least a combination of several Provinces--instead of separate ones for each hospital. This could minimise negative environmental effects owing to negligence or ignorance, it says.
It recommends obtaining the performance reports of the Australian-funded project and corrective action; a national policy for an environmentally friendly disposal of hospital waste; Health Ministry action to strengthen clinical waste management, among other steps.
The report reveals that out of 1,521 hospitals and medical institutions in the country only 281 had the mandatory environmental protection licence from the Central Environmental Authority and just 50 State and private hospitals or other medical institutions had the compulsory scheduled waste management licence.