Close to a third (29 percent) of health facilities do not safely dispose of medical waste, exposing healthcare workers, patients, waste handlers, and communities to health risks, reveals a Nation Newsplex review of health service delivery data.

Even though waste management is an integral part of hospital hygiene and infection prevention and control, four in five facilities lack guidelines on healthcare waste management while two in three do not train health providers on managing refuse safely, according to the Kenya Health Service Delivery Indicator Survey (SDI) 2018 Report released recently. Of these facilities, just one in eight have both the guidelines and history of training.

The survey, by the World Bank and Ministry of Health, finds that 17 percent of facilities in urban areas and more than double the proportion in rural areas do not dispose of their waste properly. A higher share of public facilities (a third) compared to private ones (a fifth) do not manage their waste properly. More than a quarter of health centres, dispensaries and clinics and a fifth of first-level hospitals poorly dispose of their waste.

Due to poor medical waste segregation practices, it is common to find that up to half of waste in some facilities in Kenya is infectious, according to the Ministry of Health, but ordinarily less than a fifth of medical waste is considered infectious in parts of the world with good waste-segregation practices.

Medical waste, a product of healthcare activities, is a potential source of infection if not handled properly. Incorrect disposal of the waste can harm patients, health workers, local communities and the environment. Other workers involved in handling refuse and street children who scavenge on dumpsites are also at risk.

Healthcare settings produce infectious waste that may lead to hospital-acquired infections and HIV and AIDS among healthcare workers, waste handlers, and patients.

In Kenya, the actual burden of hospital-acquired infections has not been accurately quantified, but it is projected to account for about 10-25 percent of admissions in public health facilities, according to the Health Ministry’s Healthcare Waste Management Plan 2016-2021. Some of the risks to staff from patients through such waste include HIV and AIDS, TB, hepatitis B and C and viral haemorrhagic fever such as Ebola. World Health Organization figures attribute nearly five percent of new HIV infections, a third of new hepatitis B cases, and about 40 percent of new hepatitis C cases globally to injections with contaminated syringes.

Multidrug-resistant TB also poses a great threat to health providers and the public. The World Health Organization estimates that millions of healthcare workers are exposed to percutaneous (through the skin) injuries with infected sharp objects every year.

Due to poor medical waste segregation practices, it is common to find that up to half of waste in some facilities in Kenya is infectious, according to the Ministry of Health, but ordinarily less than a fifth of medical waste is considered infectious in parts of the world with good waste-segregation practices.

Similar to the SDI findings, health facilities scored poorly in waste management in the 2013 baseline survey report for the Health Sector Support Project funded by the World Bank. The study assessed performance in five thematic areas, including policies and procedures, management and oversight, logistics and budget, training and occupational health and treatment and infrastructure. All the facilities surveyed scored poorly in all the thematic areas and the overall average score was 14 percent based on a predetermined scoring criteria of poor (0 percent- 49 percent); fair (50 percent-74 percent) and good (above 75 percent).

Another study that assessed waste-disposal practices in 24 non-government facilities in Nairobi found that no facility had a medical waste management plan, and only one in eight had a waste management team headed by a waste management officer.

Healthcare waste consists of a broad range of materials, from used needles and syringes to medical devices, body parts, soiled dressings, diagnostic samples, blood, chemicals, pharmaceuticals, devices and radioactive materials. Medical waste includes all the waste produced within healthcare facilities, research centres and laboratories related to medical procedures.

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