The Effectiveness of Biomedical Wastes Handling and Disposal in Accra: The Case of the Korle-Bu Teaching and the La General Hospitals

Improper handling and disposal of biomedical wastes have the potential of causing environmental and public health problems. The purpose of the study was to investigate the effectiveness of biomedical wastes management by health care providers in Accra. The focus was on the Korle-Bu Teaching and the La General Hospitals. The research used the simple random sampling technique to select eighty healthcare personnel for the investigation. The study results indicated that the respondents were highly knowledgeable about the importance of disinfecting biomedical wastes before disposal and aware of the possibility of such wastes transmitting diseases if not properly managed. In addition, the research revealed that the hospitals have the necessary facilities and follow the requisite processes for disposal of biomedical wastes. This has resulted in very effective disposal of hospital wastes. The research conclusion is that the effectiveness of management and disposal of biomedical wastes in the two facilities is because of the extensive knowledge of the respondents about the issue, availability of the required equipment and the implementation of well-designed strategies for disposing of biomedical wastes. The study recommends that more logistical/financial support should be available to health facilities for effective management of biomedical wastes throughout the country [1,2].

The recent upsurge in the outbreak of emerging infectious diseases in Africa has resulted in waste management increasingly becoming a major issue for governments and policy makers. Urban waste management in particularly is of major concern to various stakeholders of waste management. The tremendous progress in medical science and technology and expansion in the number of health institutions globally, have resulted in large quantities of potentially hazardous medical wastes being generated by these institutions daily [3,4]. The scare is even more alarming because increasing numbers of the facilities are now set up in residential areas. In order to avoid serious outbreak of infectious diseases on an epidemic if not pandemic proportion, priority attention ought to be on the management of the wastes produced by these health facilities. This study was conceived with the aim of investigating the effectiveness of handling and disposing of biomedical waste so as to ascertain the level of preparedness of the country in preventing and/or controlling infectious diseases in the country. The aim is also to make recommendations for adequate and sustainable management of biomedical wastes in Accra and the country as a whole.

Waste management has become a big challenge to district, municipal and metropolitan authorities as well as the government of Ghana. Ineffective management of urban wastes in Ghana presupposes that the handling, management and disposal of biomedical wastes face similar challenges. There are different stakeholders who provide health care services in Ghana. Consequently, the way they handle, manage and dispose of their medical wastes vary from one provider to another. While differences in disposal may occur, there is the need to ensure that such processes are effective in minimising the health hazards and environmental impacts that these wastes may have on the society. Like other urban wastes, the management and disposal of biomedical wastes pose a major challenge to many health facilities. In some cases, the problems become complicated because of inadequate and inappropriate knowledge of handling and disposal of biomedical wastes by the caretakers of health care facilities. Knowledge and the capability to properly manage and dispose of biomedical wastes are necessary for avoiding infections from these sources. In addition, adequate knowledge among health care professionals about effective and efficient biomedical waste management and disposal is crucial for the success of any biomedical waste management programme initiated in the country. Nevertheless, there appears to be little or no empirical evidence on biomedical waste handling and disposal by health care institutions in Accra. In order to bridge this gap and provide baseline information for further research, this study sought to investigate the effectiveness of biomedical waste management and disposal by health facilities in Accra. In particular, the study concentrated on the processes of biomedical waste handling and disposal at the Korle-Bu Teaching Hospital and the La General Hospital. The questions to ask therefore are what are the categories of biomedical wastes generated by health care providers in Accra? What are the levels of knowledge and awareness of health professionals regarding biomedical wastes policies and practices? How do the health care providers manage and dispose of biomedical wastes in their facilities? In addition, How effective is the management and disposal of biomedical wastes among the health care providers?

In order to answer these questions, the following objectives have been set for the study.

1. To identify and analyse what types of biomedical wastes the selected healthcare facilities generate.
2. To evaluate the knowledge and awareness levels of health professionals/other stakeholders of the sample health facilities regarding biomedical wastes policies and practices.
3. To examine the efficiency of the methods, practices, procedures and processes adopted by the facilities in handling and disposing of biomedical wastes.
4. To assess the effectiveness of biomedical wastes management by the selected healthcare providers in Accra.

Biomedical waste is any solid and/or liquid waste generated in the process of diagnosis, treatment or immunisation of human beings or animals [5]. Biomedical wastes include all types of wastes produced by health facilities such as general hospitals, medical centres, and dispensaries. In particular, they includes liquid wastes such as blood, body fluids, solutions, unused drugs, expired drugs, and wastes from radiology, as well as solid wastes such as needles, syringes, blades, wastes from treatments, and parts of the human body i.e., organs, tissues, or placentas [6].

The risks of exposure to biomedical wastes include occupational exposure of health workers, waste-handlers, and environmental exposure of the public caused directly by illegal or careless management and disposal practices or indirectly through emissions and ash handling from medical waste incinerators [7]. Biomedical residues can potentially transmit diseases and present an additional risk to the staff of the healthcare facilities, patients and the community when the wastes are not managed properly [8].

Exposure to biomedical wastes tends to be more prevalence in the developing, compared with the developed countries. The World Health Organisation [9], reports that underdeveloped countries suffer the greatest burden of risk from medical waste due to the high costs of proper disposal procedures. Improper disposal of biomedical waste through open dumping and uncontrolled burning, for instance, increases the risk of spreading infections and of exposure to toxic emissions from incomplete combustion. The integration of infectious components of biomedical wastes with the general non-infectious waste leads to the potential infections of the entire population. Health care providers are thus, expected to ensure no adverse health and environmental consequences occur due to handling, treatment, and disposal activities [10]. This explains the motivation of the WHO in 2004 to call for the development of national policies, guidance, and plans for healthcare waste management [11]. The question to ask is do hospitals and other health care facilities in Ghana have these policies, guidelines etc.?

When such guidelines are adopted and effective management and disposal strategies implemented could potentially minimise the risk of exposure to biomedical wastes. Effective management of biomedical wastes must therefore take into account safe and scientific management procedures in handling, segregating, mutilating, disinfecting, storing, transporting, and final disposal of medical wastes. According to the US Army Centre for Health Promotion and Preventive Medicine [12], biomedical waste must first be segregated from regular wastes starting at the point of generation and continue during storage, in transportation and through to the point of treatment. Segregation and identification thus form the basis of minimising and effectively managing biomedical wastes. Biomedical wastes identification involves sorting the wastes into colour coded plastic bags or containers [13].

In the health care setting, such biomedical wastes have emanates from several sources including hospitals, nursing homes, dispensaries, primary health centres, medical colleges and research centres/paramedic services, veterinary colleges and animal research centres, blood banks/mortuaries/autopsy centres, and biotechnology institutions [14]. Irrespective of the source, the World Health Organisation [15] classifies biomedical wastes into eight categories: general waste, pathological, radioactive, chemical, and infectious to potentially infectious waste, sharps, pharmaceuticals, and pressurised containers. Further simplification of the categories is namely: communal waste or general waste and special waste. On the one hand, communal or general waste refers to solid waste not including infectious, chemical, or radioactive waste. They include items such as packaging materials, bedding, wastewater from laundries, office supplies and other substances that do not pose a special handling problem or hazard to human health or the environment [15]. On the other hand, special wastes consist of several different sub-classifications of infectious wastes, radioactive waste, pharmaceutical wastes, pathological wastes, sharps, genotoxic waste, chemical waste, and pressurised containers [15,16].

Biomedical wastes present two major kinds of risks: health risks and environmental risks. Public health issues arising from biomedical wastes are due to the risks posed by such wastes in terms of causing diseases and injuries not only to health professionals who are exposed to those wastes but also to the general public. Nemathaga, et al. [17] identify health impacts from exposure to biomedical wastes as mutagenic, tetragenogenic, and carcinogenic effects, respiratory damage, central nervous system effects, reproductive system damage and others. Furthermore, chemicals used during cleaning and disinfection may also cause headaches, fatigue, dizziness, respiratory infections, as well as injury to the skin, eyes, or mucous membranes [18]. Improper handling and disposal of biomedical wastes have the potential of causing environmental hazards. Environmental hazards include loss of aquatic life [19]; environmental nuisance and disease-causing vermin [17] as well as unpleasant smell; growth and multiplication of insects, rodents, and worms, and transmission of diseases like typhoid, cholera, and hepatitis through injuries from sharps contaminated with human blood if not properly treated and disposed [14].

Johannessen, et al. [20] opine that proper management of medical waste can minimise the risk both within and outside healthcare facilities. They outline four general steps for proper biomedical waste management. These are: (1) segregation into various components, including reusable and safe storage in appropriate containers; (2) transportation to waste treatment and disposal sites, (3) treatment and (4) final disposal [20]. Acharya and Singh [21] prescribe a similar waste management process. The process comprise of handling, segregation, mutilation, disinfection, storage, transportation, and final disposal. There are different technologies or methods for treating and disposing of biomedical wastes. These include incinerating, autoclaving; microwaving and shredding [22-24]. The question to ask is how effective have these processes and methods been applied in the management of biomedical waste in Ghana? The purpose of the present research is to unravel the state of biomedical waste management in the country in order to be in a position to prevent infections from them and recommend solutions for managing the challenges.

The study was conducted within the Accra Metropolis which is located on longitude 05 35’and on latitude 00 06’. The metropolis covers an area of 137sq km. The Accra Metropolitan Area is bordered on the eastern side by the La-Dadekotopon Municipal Assembly, on the south by the Gulf of Guinea, west by Ga South and Central Municipal Assemblies, and on north by the Ga West and La-Nkwatanang Municipal Assemblies. The metropolis comprised of eleven sub metros namely Ablekuma Central, Ablekuma North, Ablekuma South, Ashiedu Keteke, Ayawaso Central, Ayawaso East, Ayawaso West-Wuogon, La, Okaikoi North, Okaikoi South, and Osu Klottey (Figure 1).

Figure 1: Map of the Accra Metropolitan Area (AMA) Showing the Study Area.
Source: Modification of Accra Metropolitan Assembly Map, 2014.

The study sought to investigate the management of biomedical wastes in two health facilities in Ghana. The research used the case study approach to examine the issue within the targeted entities—that is, Korle-Bu Teaching Hospital and La General Hospital. The sample population comprised of all health care professionals working within the Korle-Bu Teaching Hospital and La General Hospital. The study sampled eighty health care professionals from the Korle-Bu Teaching Hospital and the La General Hospital for the exercise using the simple random sampling technique. The simple random sampling method ensures that every member of a target population has a probability of being included in the study. The questionnaire was the main research instrument used for the research. The questionnaire was pre-tested prior to the actual act of data collection. This is to get rid of unnecessary questions and ambiguous issues. The researchers and her assistants distributed the questionnaires. Thereafter, the data were analysed using the SPSS.

Out of the 80 questionnaires distributed to the sampled health workers of Korle-Bu Teaching and the La General Hospitals, 62 of them were completed and returned. This represents a response rate of 77.5% of the total administered. The results show that 32% of the respondents were males while females constitute 68% of the sample. The age distribution of the respondents indicates that 48% of them were between 18 and 29 years of age. Forty-two per cent (42%) of them have university degrees and the majority of them have been with the study hospitals for less than 3 years. The results also indicate that the respondents were mostly (57%) nurses. This indicates that the right people have been involved in the research since nurses are at the frontline when it comes to issues of infections and diseases.

The types of biomedical wastes generated by the selected health facilities are as outlined in table 1.

The research shows that about 84% of the respondents reported that the dominant biomedical wastes generated in the two health facilities comprised of sharps (Table 1). Sharps are categories of biomedical wastes, which include needles, infusion sets, scalpels, knives, and blades. The results imply that the sample health facilities use large quantities of these materials. In addition, over 66% of the respondents indicated that their facilities generated chemical wastes like laboratory regents, disinfectants, and solvents. The third highest biomedical wastes generated by the health facilities consist of pharmaceutical wastes (45.2%). The generation of these three categories of biomedical wastes—sharps, chemical, and pharmaceutical wastes, is not surprising because generally they are the most widely used materials in health facilities throughout the country. Other biomedical wastes generated by the health facilities were pathological wastes such as body parts, blood, human foetuses, and other fluids (43.5%) and infectious wastes such as laboratory cultures, waste from isolation wards, tissues etc. The responses indicate that infectious biomedical wastes form a large proportion of wastes generated by the two health facilities. Since they are among the largest and most patronised, there is a need to take uttermost care in managing their wastes in order not to create suitable conditions for an outbreak of epidemics as recently experienced in other West African countries.

Table 2 is a summary of the responses to questions about the levels of awareness and knowledge about the dangers of biomedical wastes and the need to handle and manage them properly. The results of the survey as presented in table 2 indicate that there is a very high level of awareness and knowledge about the issue among the respondents. It was not surprising that they linked this knowledge to the practice of disinfecting all of such wastes before final disposal. All of the respondents showed that they were knowledgeable and aware of the need to cautiously handle and disinfect biomedical wastes before disposal. They indicated that this is because of the infectious nature of such wastes and their likelihood to infect and transmit diseases if not properly managed (Table 2).

To exhibit and prove their levels of awareness and knowledge about biomedical wastes, 58% of the respondents indicate that it is to prevent the negative consequences of biomedical wastes mismanagement that is why the hospital authorities have established rules and procedures about how they should be managed. It is the same reason that underscores the periodic inductions, trainings and lectures done to upgrade their knowledge on proper management of such wastes. About 61% of the respondents said that the principle of colour coding of the hospitals’ waste containers is a constant reminder of the infectious nature of biomedical wastes. In addition, 53.2% of the respondents opined that their knowledge and awareness derived from the fact that they always have to segregate such wastes at source. A rather high percentage (72.6%) of the respondents claimed that the fact that their facilities are constantly disinfecting wastes before disposal, will automatically sensitise anyone who is close to their operations about the dangers posed by such wastes in terms of their capabilities to infect people and spread infectious diseases. Other respondents (66.1%) said they got such knowledge from incidences of infections suffered by some of their colleagues and other health workers in Ghana and other parts of the world.

The respondents mentioned elaborate processes followed in handling and final disposal of biomedical wastes in their health facilities. Their responses are as presented in table 3.

The results of the study indicate that the respondents were aware of facilities in their places of work designated for the management and disposal of biomedical wastes generated. About 63% of the respondents indicated that as part of the processes of managing and disposing of biomedical wastes, their health facilities have incineration equipment for safe disposal of very infectious biomedical wastes. Furthermore, 46.7% of the interviewees reported that they have burning sites within their premises for disposing of some general non-infectious categories of biomedical wastes. Another 46.7% of the respondents mentioned autoclave and chemical disinfection equipment as means of managing biomedical wastes (Table 3). The low level of awareness among some of those interviewed could be because their work schedules might be unrelated to waste management in the study health facilities. It is the waste management units or departments in the study hospitals who are largely responsible for managing such wastes.

The study also highlights well-defined strategies to ensure proper management and final disposal of biomedical wastes to safeguard the health of the hospitals’ workers, the environment and the general populace of Accra and beyond. It is gratifying to note that the majority of the respondents, that is 58 of the 62 respondents (93.5%) were able to outline the appropriate steps and procedures of waste management up to final disposal in the study hospitals. According to these 93.5% respondents, the management starts from first segregating the wastes into various components, transporting them to the treatment or disposal sites depending on the type of waste, That is, non-infectious wastes going to disposal sites immediately after sorting whiles the infectious types undergo treatment first before they are finally disposed of. According to the respondents, when health facilities follow these steps, there will be a minimum chance of infectious biomedical wastes materials returning into the environment in infectious states.

Table 4 shows that due to the strict compliance with the regulation of biomedical waste management by the study health facilities, 70.9% of the respondents said disposal of wastes in their hospitals depends on the categories of wastes generated. This high percentage of adequate management of wastes in the health facilities is encouraging. This gives the assurance to the populace that management of hazardous wastes is good and allays the fear of many concerned people about where such wastes end up. Furthermore, over 66% of the respondents asserted that the principle of zero-tolerance of exposing visitors and patients of their hospitals to the risk of infections has been paying off. In addition, about 60% of the respondents indicated that their practice of disposing of wastes in specified colour coded containers is effective and internationally endorsed as part of the best practices of biomedical wastes management. Similarly, as part of the best practices in biomedical waste management, 48.3% of the respondents said that they dispose of sharps in puncture proof containers. The survey results have demonstrated that the study health facilities have been using diverse but very effective methods [25] and practices in the management and disposal of biomedical wastes in their facilities. This is very commendable, as it will prevent the spread of infectious diseases and save the nation lots of revenue that would otherwise be used to control and treat such preventable ailments.

The study sought to establish the effectiveness of biomedical wastes handling and disposal in Accra. The study started by first identifying the types of biomedical wastes generated by the two selected health facilities in Accra. The results show that the main categories of wastes generated by the two health facilities were (a) sharps consisting of needles, infusion sets, scalpels, knives, and blades; (b) chemical wastes such as laboratory regents, disinfectants, and solvents; and (c) pharmaceutical wastes. Sharps and chemical wastes were the most frequently generated wastes among the biomedical wastes produced by the two health facilities.

The frequent generation of wastes from sharps and chemical origin by the study health facilities indicates that such materials are very much in demand for the treatment of patients by the various departments of the respective health facilities. This finding implies that any negligence on the part of the health professionals could expose patients, visitors, and the larger society to the risks of injury or infection through careless handling, managing and/or disposing of untreated biomedical wastes. Therefore, efforts to effectively manage and dispose of these wastes should be a priority for all stakeholders. The study results indicate that there is a need to adopt more efficient and effective management and disposal practices to ensure that such wastes do not have negative consequences on the health of the medical personnel, patients, society and the environment at large.

It is gratifying to note that there is a satisfactory level of awareness and knowledge among the health professionals regarding the need of managing biomedical wastes in their facilities by regularly disinfecting the wastes before final disposal. The knowledge of the respondents about biomedical waste management indicates that the health professionals of the hospitals would be acting professionally when handling, treating and disposing of biomedical wastes. The result also indicates that at the departmental/unit levels of the health facilities, the health professionals have the needed skills and knowledge regarding the management of biomedical wastes.

The two healthcare facilities have facilities like incinerators, burning sites, autoclave machines, and chemical disinfection equipment for the management and disposal of biomedical wastes. Furthermore, the fact that the health facilities use strategies such as segregation of wastes into various components and treatment of the wastes based on the particular types before disposal is consistent with best practices when it comes to the management and disposal of biomedical wastes [17,18]. The adoption of the best practices in managing biomedical wastes in the study health facilities is a clear demonstration that the health facilities are effectively managing their biomedical wastes. However, there is a need to ensure that their strategies are coordinated and properly linked to those of other health facilities for a sustainable management and disposal of biomedical wastes throughout the city of Accra and the country as a whole.

To conclude, the study provides empirical evidence on the effectiveness or otherwise of biomedical waste handling, management and disposal of two major hospitals in Accra. Taking the Korle-Bu Teaching Hospital and the La General Hospital as a case study, the research revealed that the management and disposal practices and strategies currently adopted by the hospitals are effective. The effectiveness of biomedical wastes management in the two facilities is because of the extensive knowledge and awareness among their workers about the consequences the mismanagement of such wastes could have on them, the public and the environment at large. The study also made it clear that the availability of the required equipment for treating wastes and the existence of well-designed strategies and practices for managing and disposing of biomedical wastes enhance the effectiveness of such waste management. The study recommends that more resources should be committed for proper management and disposal of wastes in order to safeguard the health of people, enhance their living conditions and protect the environment from pollution by hazardous wastes.

1. Wikipedia. Biomedical waste. 2013.
2. Baveja G, Muralidhar S, Aggarwal P. Hospital waste management: An overview. Hospital Today. 2000;5(9):485-486.
3. Matin K. Irvine Medical Waste Management Plan. California: University of California. 2006.
4. Visvanathan C1. Medical waste management issues in Asia. Paper presented at the Asia 3R Conference, Tokyo. 2006.
5. Ferraz A, Afonso SAV. Incineration of different types of medical wastes: Emission factors for gaseous emissions. Atmospheric Environment. 2003;37:5415-5422.
6. Eigenheer E, Zanon U. O que fazer com os residuos hospitaleres. Proposta para classificacao, embalagem, coleta e destinacao final. Arquivos Brasileiros de Medicina. 1991;65:3.
7. World Health Organisation. Wastes from Healthcare Activities. Geneva: WHO. 2000.
8. Da Silva CE, Hoppe AE, Ravanello MM, Mello N. Medical wastes management in the south of Brazil. Waste Manag. 2005;25(6):600-5. doi: 10.1016/j.wasman.2004.03.002. PMID: 15993344.
9. World Health Organisation. Basic Steps in the Preparation of Healthcare Waste Management Plans for Healthcare Establishments. Geneva: WHO. 2002.
10. Patil GV, Pokhrel K. Biomedical solid waste management in an Indian hospital: a case study. Waste Manag. 2005;25(6):592-9. doi: 10.1016/j.wasman.2004.07.011. PMID: 15993343.
11. Cheng YW, Sung FC, Yang Y, Lo YH, Chung YT, Li KC. Medical waste production at hospitals and associated factors. Waste Manag. 2009 Jan;29(1):440-4. doi: 10.1016/j.wasman.2008.01.014. Epub 2008 Mar 24. PMID: 18359619; PMCID: PMC7133359.
12. World Health Organisation. Management of Wastes from Hospitals and other Health Establishments. Copenhagen: WHO. 1985.
13. Rao S, Ranyal RK, Bhatia SS, Sharma VR. Biomedical Waste Management : An Infrastructural Survey of Hospitals. Med J Armed Forces India. 2004 Oct;60(4):379-82. doi: 10.1016/S0377-1237(04)80016-9. Epub 2011 Jul 21. PMID: 27407678; PMCID: PMC4923431.
14. Abdulla F, Abu-Qdais H, Rabi A. Site investigation on medical waste management practices in northern Jordan. Waste Management. 2008;28:450-458.
15. World Health Organisation. Handbook Safe Management of Wastes from Healthcare Activities. Geneva: WHO. 1999.
16. World Health Organisation. Management of Solid Healthcare Waste at Primary Healthcare Centres: A Decision-making Guide. Geneva: WHO. 2005.
17. Nemathaga F, Maringa S, Chimuka L. Hospital solid waste management practices in Limpopo Province, South Africa: a case study of two hospitals. Waste Manag. 2008;28(7):1236-45. doi: 10.1016/j.wasman.2007.03.033. Epub 2007 Dec 3. PMID: 18060760.
18. Pruss A, Giroult E, Rushbrook P. Safe Management of Wastes from Health-care Activities. Geneva: WHO. 1999.
19. Boadi K, Kuitunen M. Urban waste pollution in the Korle Lagoon, Accra Ghana. The Environmentalist. 2002;22:301-309.
20. Johannessen IM, Dijkman M, Bartone C, Hanraban D, Boyer G, Chandra C. Healthcare waste management guidance note. Health Nutrition, and Population Discussion Paper. 2000.
21. Acharya DB, Singh M. The Book of Hospital Waste Management. New Delhi: Minerva Press. 2000.
22. Pruthvish S, Gopinath D, Jayachandra RM, Girish N, Bineesha P, Shivaram C. Healthcare Waste Management Cell, Department of Community Medicine. Bangalore, India: Information Learning Units for HealthCare Waste. 1998.
23. Shah HK, Ganguli SK. Hospital waste management: A review. Indian Medical Journal of the Academy of Hospital Administration. 2001;25(3):56-69.
24. Rasheed S, Iqbal S, Baig LA, Mufti K. Hospital waste management in the teaching hospitals of Karachi. J Pak Med Assoc. 2005 May;55(5):192-5. PMID: 15960283.
25. Mugenda OL, Mugenda AG. Research Methods: Qualitative and Quantitative Approaches. Nairobi: African Centre for Technology Studies (ACTS) Press. 1999.