Date of Award

6-2010

Document Type

Thesis

Degree Name

Master of Science (MS)

Department

Environmental Science

First Advisor

Dr. Munjed Maraqa

Second Advisor

Abdulbari Bener

Third Advisor

Dr. Muhammed Al Hassan Al Malak

Abstract

During coastline cleaning campaign carried out in the UAE in 1993, various amounts of waste classified as medical waste were identified. As a result, public concern has been raised concerning the handling and disposal of medical waste in the country. Despite that, little work has been conducted to assess medical waste management in the UAE and no published work has been found that assesses the management of radioactive medical waste. The main objective of this research was to assess the process of implementation of medical waste management applied at major hospitals in the UAE in comparison with the guidelines established by the World Health Organization (WHO). Such assessment included the procedures for handling, collection, transportation, treatment and disposal of generated medical waste.

A questionnaire that accounts for all steps of waste management was distributed to 14 hospitals located in the different emirates within the UAE. Additionally, direct onsite visitation of selected hospitals was performed to collect information that would result in a better assessment of waste management and guideline implementation. On the applied side, ash samples were collected from hospitals with incinerators to measure its radioactive and metal content.

Results of this study revealed that the average rate of medical waste generated at UAE hospitals is 1.95 kg/bed/day, with high variations among the surveyed hospitals (i.e. 0.2 to 4.5 kg/bed/day). While the total quantity of medical waste generated at UAE hospitals is known, most of the hospitals do not estimate the quantity of each type of medical waste generated. Segregation procedure for generated medical waste at UAE hospitals is applied for pathological, sharps, and infections waste. However, not all the surveyed hospitals are practicing segregation for other types of medical waste including chemical, pharmaceutical, and pressurized containers. Collection of hospital waste is usually conducted using two types or color-coded bags: yellow for medical waste and black for domestic waste. It was found that not all hospitals practice marking on their disposed bags and containers neither are they employing waste tracking system during transportation. Separate on-site storage room for medical waste exists at many hospitals.

Most of the hospitals in the UAE do not have pretreatment capabilities for medical waste possibly due to budget constraints or due to the wide use of disposable items. Some hospitals, however, are using certain types of pretreatment methods including autoclave and chemical disinfection for pathological and infectious waste. Other types of pretreatment methods such as microwave, gas/vapor, and irradiation are not used by any of the surveyed hospitals. Among the treatment methods for medical waste, incineration is used by many hospitals in the UAE. However, most of the incinerators are old and poorly maintained with no proper equipment to control air pollution. Hospitals in the city of Abu Dhabi are using continuous feed technology for destruction of infectious pathogens in generated medical waste while hospitals in the city of Dubai are disposing their medical waste in a sanitary landfill.

Federal regulations that govern management or medical waste are not clearly developed in the country. Guidelines for medical waste management, excluding radioactive waste, have been developed in some emirates but they are not strictly implemented. Major hospitals have developed some guidelines for management of their own medical waste. While these guidelines are strictly followed at some hospitals, it is left to the hospital administrators to implement their established guidelines and procedures. Greatly lacking are federal or internal guidelines for the management of radioactive medical waste.

All radionuclides used at UAE hospitals have relatively short half-lives. Surveyed hospitals using radionuclides have special storage facilities for their radioactive waste with a decay storage period that varies from two to three weeks and could reach six months in certain cases, depending on the isotope present in the waste. Analysis of ash samples collected from incinerators of hospitals using radionuclides showed that the level of activity is below the limit recommended by the International Atomic Energy Agency. Furthermore, analysis of ash samples showed that toxic metals, with the exception of Chromium at certain locations, do not exceed the TCLP regulatory limits.

It is recommended that a competent authority coordinates with other sectors in the country to establish a federal policy for management of medical waste including the radioactive portion. It is further recommended that municipalities provide the necessary infrastructure for collection, transportation, and disposal of medical waste and enforce the provisions of the law for medical waste management.

Better management of medical waste can be achieved if a hospital coordinate activities among its different departments. Hospital managers should train their staff to become aware of the the hazards associated with infectious or toxic waste. Immunization against Hepatitis B should be given to all hospital workers at risk especially nurses, auxiliaries and porters. It is also recommended that hospitals document all cases of infection or poisoning result from exposure to or handling of medical waste.

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