Comparison of performance of On-site and Off-site treating systems of medical waste in Iran and presenting some performance enhancing strategies

Abstract

Introduction: Undesirable managing, treating and disposal of medical waste play a major role in the spread of various communicable diseases among the people, and also creating environmental pollution. According to scientific principles the treating of medical waste can be carried out in onsite or offsite of health care facilities. Currently in Iran, the hospitals have selected onsite treating method (autoclaves, incinerators and etc) as the preferred treatment, which most of those systems have problems in financing, operation, maintenance and environmental, etc. Almost all of medical waste of minor producers is being sent to the municipal waste stream without any treatment for final disposal. Therefore, the primary objective of this study was to assess the current condition of onsite medical waste treatment facilities in the country, compare onsite medical waste treatment facilities with offsite systems and find the best location by employing Analytical Hierarchy Process (AHP). In addition, this study aimed to make some practical recommendations on medical waste treatment for improving the current situation. Materials and Methods: In the beginning of the study for assessing current onsite medical waste treatment facilities, 4 provinces in Iran were selected to participate in the survey. Then, 10 active hospitals with onsite medical waste treatment facilities were selected in each province (totally 40 hospitals) for assessing their current conditions. Site visits (observational method) with completing checklist were conducted in all selected hospitals to gather the basic information and assess current working conditions of onsite medical waste treatment facilities. Then, to compare onsite and offsite medical waste treatment facilities, based on the experts’ perspective Analytical Hierarchy Process (AHP) was employed. Results: The results of assessing of current condition indicated that desirable medical waste management system was not employed in the most of hospitals. Most of onsite medical waste treating systems have problems in reduction of waste, education of personnel, financing, planning, determining capacity of installations, operation and maintenance, etc. AHP synthesis (with inconsistency95 ratio of 0.01 <0.1) revealed that, in total, the offsite treatment of medical waste was in much higher priority than the onsite treatment (64.1% versus 35.9%). Also the AHP synthesis (with inconsistency ratio of 0.01 <0.1) revealed that, in total, the autoclave was in much higher priority than the incinerator (52.8% versus 48.2%). Conclusion: According to the current undesirable experience with onsite treating facilities and AHP result, it was concluded that offsite central should be instituted as an alternative. An amendment should be made to Iran’s current medical waste regulations to have infectious-hazardous waste sent to a central offsite installation for treatment. To begin and test this plan and also receive the official approval, a central offsite can be put into practice, at least as a pilot in one province. Then, if it was practically successful, it could be expanded to other provinces and cities. The benefits such as feasibility of treating medical waste of minor medical producers and also surrounding cities and villages, more cost-effectiveness, easy expansion and modification, efficient operation, etc. would be expected.