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					Hospital Waste Management in Kathmandu Valley

A Term Paper for the partial fulfillment of M. Sc. second year in
                    Environmental Science

                             Submitted by:
                            Nawraj Sapkota
                               Roll no. 25


                                              Supervisor: Mr. Ganesh Karki
Hospital Waste Management in Kathmandu Valley
Nawraj Sapkota CDES, TU

Executive summary:

Total wastes generated by hospitals and healthcare establishments are generally termed as
hospital wastes. In other word, Hospital waste means all wastes coming out of hospitals,
it may be biological or non-biological that is discarded, and is not intended for further use
in a hospital. Mainly there are two types of wastes generated from hospital. They are
classified as Risk Waste and Non-risk waste. The Non-risk waste covers 75-90% of total
waste generation whereas risk waste covers only 10-25% of total hospital waste.
(Visvanathan C. 2006) The Risk waste consists of chemical waste such as Lab reagents,
Disinfectants, Solvents, Pathological waste such as Body parts, Blood & other fluids,
Pressurized containers such as Gas cylinders, Cartridges & Aerosol cans, Infectious
waste such as Lab Cultures, waste from isolation wards, tissues, Pharmaceutical Waste
such as Expired or no longer needed pharmaceuticals, Used or damaged medicinal
material such as heavy metal content Batteries, broken thermometers, Blood pressure
gauges, Needles, infusions sets, Scalpels, knives, blades etc. (WHO, 1999).

The hospital wastes have high potential for hazards. So, hospital waste can cause
pollution and disease if it is not handled properly. Infectious waste, especially sharps,
poses a risk to anyone who comes into contact with it. The WHO estimates that 40% of
hepatitis cases and 12% of HIV cases worldwide are caused by occupational exposure.
Chemical, pharmaceutical and radioactive waste generated from hospital, which need
specialist handling. Added to this, there will be large amounts of more ordinary trash
including packaging, paper and food which can make up around 80% of the waste stream.
A large hospital can produce tons of waste every single day.

Hospital waste in Kathmandu valley:

Hospital and health care waste management poses a serious challenge in Nepal,
especially in the Kathmandu Valley. Hospital wastes, both hazardous and non-hazardous,
are scattered around the health facilities in the valley. Such improper management not
only poses a great risk to the service providers and patients, but also has an adverse
impact on the environment.

Some 80 percent of the total waste generated from health care activities is general waste
and is comparable to domestic waste. The remaining 20 percent is considered hazardous
materials that may be infectious, toxic or radioactive in nature. In the context of Nepal,
all wastes are turning hazardous because of improper management. Hence, the
management of health care waste is an integral part of the national health care system
(Baral B., 2008). Hospitals and nursing homes in the Kathmandu valley alone produce
over 250 kg of hazardous medical wastes each day (The Rising Nepal, 2005).

A number of surveys have been conducted in the Kathmandu Valley to establish an
overview of the health care waste management. Two of them include surveys of the
quantities of health care waste (HCW) and health care risk waste (HCRW).

The first survey was conducted in 1997 (ref. VII) and included measurements of the
quantities of waste generated at 11 hospitals in the Kathmandu Valley.

The average quantity of waste estimated for all 11 HCFs appear from table 2.3 below
(ENPHO 2001).

Category of waste                             Average amount of waste for all 11
                                              health care facilities
Health care waste (HCW)                       0.54 kg/patient/day (rounded figure)

Health care risk waste (HCRW)                 0.16 kg/patient/day (rounded figure)
Treatment of Hospital Waste in Kathmandu valley:

In most of the hospitals in Kathmandu valley, all of this trash is mixed together and
burned in low tech, highly polluting incinerators, or in the open with no controls
whatsoever. It is now well established that incinerating medical waste produces large
amounts of dioxin, mercury and other pollutants. These end up in the air, where they can
be transported thousands of miles to contaminate the global environment, or in the ash,
which is frequently dumped without thought for the load of persistent toxins that it
carries. If it is not burned, medical waste can end up dumped with municipal garbage.
Wherever this happens, rag pickers face a daily danger. There is some possibility to resell
some components of the waste, for example, syringes for illicit re-use.

More than 90% of healthcare institutions do not practice safe waste handling, storage and
disposal methods and most healthcare institutions rely on municipal services for their
ultimate disposal. In Kathmandu Valley, Tribhuvan University Teaching Hospital and
Patan Hospital have incinerators to treat their wastes. Other hospitals and health facilities,
however, rely on containers provided by Kathmandu Municipality. Bir Hospital, the
country's oldest hospital, has been in a peculiar position ever since local residents
destroyed its incinerator a few years ago. Teku Hospital treats patients affected by all
kinds of infectious diseases, including HIV/AIDS, Hepatitis B, C and cholera, the
absence of incinerators forces it to dump infectious waste in normal containers,
threatening the health of local residents (Poudel, 2002). In many hospital of Kathmandu
valley incinerators are operated more like a back-yard burner.

One of the difficulties with ensuring hospital waste is the lack of funding. Many donors
that conduct essential work to strengthen healthcare services, provide medical supplies or
organize immunization programs do not include any provision for medical waste
management (SWMRMC, 2004)

The feasible and modern strategic objectives for management of hospital waste are:

       Putout the broad information about hospital wastes and their management.

       Encourage hospital waste management and the maintenance of healthy
        environment in hospital and surroundings.

       To create awareness amongst the staff, patient and community.


   1. Desk study: to study the book, journal, lecture, term papers, research paper, thesis
        and literature review on other several relevant studies.

Result and Discussion:

Management of hospital waste in the hospital of Kathmandu valley is one of the most
important issues. Numerous hospitals have been established in the Kathmandu valley.
Many of these hospitals are situated especially at populated area. So there is high risk of
pollution contamination of hospital hazards to the surroundings. The method of waste
disposal in hospital of Kathmandu valley is very unsafe and ill-managed. In most of the
hospitals in Kathmandu valley, all of this trash is mixed together and burned in low tech,
highly polluting incinerators, or in the open with no controls whatsoever. The rarely
segregated hospital wastes are also mixed together in times of collection by municipality
due to the use of same transporter for both risk and non-risk wastes.

Management of hospital waste in Kathmandu Valley is confronted with a number of
issues. These include:
   The major fraction (75-90%) of the waste generated by hospitals is, in general,
    non-risk wastes and resembles residential and institutional wastes. The remaining
    fraction (10-25%) is hazardous (risk) and may pose a variety of health risks.
    Therefore there is a need to promote the concept of “source separation” as
    apriority action.

   The hazardous fraction of the hospital waste poses risk to individuals exposed to
    such wastes, both within and outside establishments, workers in waste disposal
    facilities and scavengers. It is therefore, necessary to examine such hazardous
    wastes from broader perspectives; from generation to collection, storage and

   Commonly used technologies are incineration, land filling, burning, autoclaving,
    chemical treatment, microwave disinfection and plasma touch technique. These
    treatment technologies are influenced by prevalent standards, policies and
    legislations. But in many hospital of Kathmandu valley incinerators are operated
    more like a back-yard burner. Hospital incinerators are the biggest dioxin

   In Kathmandu valley mushrooming clinics and health centers, often unregistered,
    are the major source for operational problems in healthcare waste management.

   Management of hospital waste is addressed in the national policies in Nepal but it
    is very weak in terms of enforcement of these regulations.

   Some of the potential source reduction practices in hospital could be:

    Segregation: Waste segregation can drastically reduce the volume and toxicity of
    the waste stream. The volume of the infected waste can be reduced after proper
    segregation and significant cost can be saved for its treatment.

    Material/device substitution: Proper procurement practices can help to reduce the
    harm. There are some viable substitutes for many products that contain PVC
       plastic, mercury etc. For example mercury based thermometer can be substituted
       by electronic sensing devices.

      The lack of information on hospital waste management in the Kathmandu valley
       is a serious weakness and hampers effective management of hospital waste.

      Mostly problem is in government hospitals where lack of budget is forwarded as
       the reason for not managing hospital wastes.

The major issue for management of hospital waste in the hospitals of Kathmandu valley
is the lack of budget and awareness. This is usually a direct result of the lack of
enforcement by government and subsidy or grants to the hospitals. Hospitals and public
health care units are supposed to safeguard the health of the community. However, the
waste produced by the medical care centers if disposed of improperly, can pose an even
greater threat than the original diseases themselves. So, it is very sensitive to community

Policies for more effective management of the hospital waste of Kathmandu valley will
have to better demonstrate, in economic terms, the contribution this management makes
to the Kathmandu’s overall environmental safeguard. Economic incentives, grants and
subsidy in the management of hospital waste are vital for those hospital and clinic which
have poor economic condition.

Action to manage hospital waste in the hospitals of Kathmandu valley has to ultimately
be done by the hospital and medical care centers that generate those wastes. Unless
hospitals and medical care center in the Kathmandu valley have the incentives, the
capabilities, and the opportunities to manage hospital waste safely, they are unlikely to do
so. Therefore policy reforms and awareness and training have to be taken to create
condition at the hospital level to manage the hospital waste in hospitals of Kathmandu
valley. National and international networks of hospital waste management must be
expanded and the advancement of existing management technique must be done.

Most of the hospitals and medical care centers of the Kathmandu valley are facing a great
and tragic situation if the hospital wastes of these establishments are not managed
properly. Along with hospital and surroundings area all valley and the sites where those
waste are dispose are also facing high risk to environment and community.

However, some works have been done to minimize the risk of hospital waste. The
policies, laws and regulations are found in Nepal for hospital waste management but due
to the weak enforcement this is dysfunctional. Some hospital and medical care centers
have some initiation to manage hospital waste. They are doing incineration and
segregation of waste to make easy to handle. But in many hospital of Kathmandu valley
incinerators are operated more like a back-yard burner and waste collectors from
municipality mix them with household waste and dispose in same disposal site as non-
risk waste. These constraints can be avoided with the modern technologies, awareness
and training.

Properly managed hospital waste in the hospitals of Kathmandu valley can continue to
provide better and safer health facilities to the communities. The management strategies
for hospital waste must aim to maintain the condition of the hospital environment and to
protect the environment from pollution. To achieve this goal it will be necessary to
design management strategies and programs that take into account the needs of the
hospitals as well as the aspirations of the communities and environment who share the
risk with hospitals. Developing such programs requires a much better understanding of
potential of hospital waste and generation process and amount. Thorough analysis of the
constraints for improving management of hospital waste and modifications in policies
and current approaches help to make better management. These actions are crucial for
managing the hospital waste and ensuring sustainable health facilities in the face of
growing threats from modernization and the greatly expanding human population.

Baral B. 2008, The Rising Nepal   (detail nai tha vayena)
Environment & Public Health Organization (ENPHO) 2001: Environmental Impact
Assessment of Medical Waste Management in Kathmandu.

Poudel, K. 2002: Hospital waste: Hidden Hazard, The National Newsmagazine, 21: No:

SWMRMC, 2004: A Diagnostic Report on State of Solid Waste Management in
Municipalities of Nepal, Solid Waste Management and Resource Mobilization Centre,

The Rising Nepal 2005: Medical wastes major threat to urbanites (July, 6).

Visvanathan C. 2006. Asia 3R Conference, 30 October – 1 November, 2006 Tokyo,

World Health Organization (WHO, 1999): Wastes from Healthcare Activities.

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