Levels of Polycyclic Aromatic Hydrocarbons (PAHs) in Healthcare Waste Incinerators’ Bottom Ash from Five County Hospitals in Kenya

Health-care waste contains potentially harmful microorganisms and compounds which can infect and affect hospital patients, healthcare workers, the general public and environment. Therefore, management of health care waste requires safe handling, treatment and disposal procedures. While incineration reduces the volume and quantity of waste for final disposal, it leads to the production of fly and bottom ashes laden with toxic incomplete combustion products such as Polycyclic Aromatic Hydrocarbons (PAHs), dioxins, furans and heavy metals. This exposes workers who handle and dispose the bottom ashes, hospital patients, the general public and environment. The goal of this study was to determine the total and individual levels of 16 most prevalent and toxic PAHs. Bottom ash samples were collected from incinerators in five county hospitals in Kenya, namely;Moi-Voi, Narok, Kitale, Makindu and Isiolo. Bottom ash samples were collected over a period of six months from the five hospitals. The samples were then sieved, homogenised and stored at 4°C in amber coloured glass containers. The PAHs were extracted using 30 ml of a hexane-acetone solvent (1:1) mixture by ultrasonication at room temperature (23°C) for 45 minutes. The PAHs were then analyzed with a GC-MS spectrophotometer model (Shimadzu GCMS-QP2010 SE) connected to a computer work station was used for the PAHs analysis. The GC-MS was equipped with an SGE BPX5 GC capillary column (30 m × 0.25 mm × 0.25 μm) for the separation of compounds. Helium was used as the carrier gas at a flow rate of 15.5 ml/minute and 14.5 psi. 1 μl of the sample was injected at 280°C, split mode (10:1). The oven programming was set for a total runtime of 40 minutes, which included: 100°C (2-minute hold);10°C /min rise to 200°C;7°C /min rise to 249°C;3°C /min rise to 300°C (2-minute hold). The interface temperature was set at 290°C. Analysis was done in Selected Ion Monitoring (SIM) mode and the peak areas of each of the PAHs were collected from the chromatograph and used for quantification of the 16 PAHs listed by the U.S. Environmental Protection Agency (EPA) which included, BaA (benz[a]anthracene: 4 rings), BaP (benzo[a]pyrene: 5 rings), BbF (benzo [b]fluoranthene: 5 rings), BkF (benzo[k]fluoranthene: 5 rings), Chr (chrysene: 4 rings), DbA (dibenz[a,h]anthracene: 5 rings), InP (indeno[1,2,3 - cd] pyrene: 6 rings) and Acp (acenaphthene: 3 rings), Acpy (acenaphthylene: 3 rings), Ant (anthracene: 3 rings), BghiP (benzo[g,h,i]perylene: 6 rings), Flu (fluorene: 3 rings), FluA (fluoranthene: 4 rings), Nap (naphthalene: 2 rings), PhA (phenanthrene: 3 rings) and Pyr (pyrene: 4 rings). Ion source-interface temperature was set at 200°C - 250°C. Internal standards from Sigma Aldrich were used in the analysis and the acquired mass spectra data were then matched against the NIST 2014 library [1] [2]. The mean PAHs concentration in the bottom ashes of each hospital varied broadly from 0.001 mg/kg to 0.4845 mg/kg, and the mean total concentration levels of individual PAHs ranged from 0.0072 mg/kg to 1.171 mg/kg. Low molecular weight PAHs (Phenanthrene, Naphthalene and Fluorene) were predominant in all the hospital wastes whereas Kitale and Narok presented the lowest PAHs concentrations and the lowest number of individual PAHs. Moi/Voi recorded the highest total PAHs concentration at 1.3129 ± 0.0023 mg/kg from a total of 11 PAHs being detected from the bottom ash samples. Narok had only three PAHs being detected at very low concentrations of 0.0041 ± 0.00 mg/kg, 0.0076 ± 0.00 mg/kg and 0.012 ± 0.00 mg/kg for phenanthrene, anthracene and chrysene respectively. This study presents hospital incinerator bottom ash as containing detectable levels of both carcinogenic and non-carcinogenic PAHs. Continued unprotected exposure of hospital workers (waste handlers) to the bottom ash PAHs could be hazardous to their health because of their cumulative effect. Preventive measures e.g. the use of Personal protective equipment (PPE) should be prioritised to minimise direct contact with the bottom ash. The study recommends an upgrade on incinerator technology for efficient combustion processes thus for better pollution control.

Performance of Healthcare Facilities of Different Levels towards Safe Healthcare Waste Management as Linked to Infection Prevention and Control Standards in Tanzania

The aim of this study was to ascertain performance of Healthcare Facilities on safe healthcare waste management practices. To achieve this, a national assessment was conducted country wide to assess performance of various healthcare practices related to waste materials management, WASH, and Hygiene practices as linked to infection prevention and control. The assessment of healthcare waste management in the facilities was conducted in all the 26 regions of Tanzania Mainland for one month. A standardized checklist and tools were used to assess and monitor various aspects related to healthcare waste management using open source software for data collection (ODK). Data were analyzed using SPSS computer software. It was observed that most of permanent staff (88%) in the Healthcare facilities had knowledge on hand hygiene, but the gap was observed to the waste handlers (12%) who were not equipped with the hand hygiene knowledge. About 89% of the hand washing stations were available at mortuary units, followed by 75% at main entrance and the lowest was 3% at waste zone areas of the healthcare facilities. Hand washing materials like soap were mainly found at theaters (64%) followed by mortuary (60%) and last at waste zones. It was concluded that handling of HCW is not properly practiced to the expectations, necessitating strengthens of supervision. The findings provide evidence for those engaged in improving HCF conditions to develop evidence-based policies and efficient programs, enhance service delivery systems, and make better use of available resources.

Readiness of Healthcare Facilities to Implement Onsite Healthcare Waste Management Protocols and Incineration Guidelines in Tanzania

The aim of this study was to assess Readiness of Healthcare facilities to Implement onsite Healthcare Waste Management Protocols and Incineration Guidelines in Tanzania. To address this, a national assessment was conducted country wide to assess readiness of Healthcare Facilities (HCFs) to undertake various Healthcare Waste Management (HCWM) initiatives with particular focus to adherence to HCWM protocols and incineration guidelines. The assessment of healthcare waste management was conducted in facilities in the 26 regions of Tanzania mainland for one month. A standardized checklist and tools were used to assess and monitor various aspects related to healthcare waste management using open source software for data collection (ODK). Data were analyzed using SPSS computer software. It was observed that 46.2%, 33.3% and 25% of the health centres, district hospitals and regional hospitals did not have appointed supervisors, which makes it difficult for the HCFs to perform better in managing healthcare waste in their respective facilities. It was further revealed that healthcare facilities have made remarkable improvement in the overall healthcare waste management with evidence of ongoing common activity on purchasing injection safety boxes (69.2%) and purchasing of waste bins (53.8%) at all levels. On average, about 70% of the HCFs have plans and budget though inadequate to support HCWM activities. In a conclusion Healthcare Facilities must designate a better system to compressively address healthcare waste management issues. Again the findings provide evidence for those engaged in improving HCF conditions to develop evidence-based policies and efficient programs, enhance service delivery systems, and make better use of available resources.

An information fusion FMEA method to assess the risk of healthcare waste

Healthcare waste(HCW)management plays a vital role in the development of modern society.In HCW management,failure mode and effects analysis(FMEA)is a popular method to implement risk management for improving the quality of healthcare.However,the shortcomings of the traditional FMEA method have been widely discussed in literatures.This paper proposes an information fusion FMEA method based on 2-tuple linguistic information and interval probability.The 2-tuple linguistic set theory is adopted to change the heterogeneous information into interval numbers.Meanwhile,the interval probability comparison method is applied to analyze failure modes.Finally,a case study is presented to verify the reliability and effectiveness of the proposed method by comparing different FMEA methods.

Diagnostic Analysis of Mechanical Conditions of Small-Scale Incinerators in the Healthcare Facilities in Tanzania

This paper provides analytical diagnosis of mechanical conditions of medical waste incinerators used for healthcare waste (HCW) treatment in Tanzania. The main features assessed were types of incinerators, features of incinerators and incinerator house. The assessment was conducted in three levels of health care facilities (HCFs), that is, Regional, district hospitals and health centers, existed in 26 regions of Tanzania. Questionnaires, interview and checklists were used as tools for data collection. It was observed that High-Tech incinerators are mainly used in regional hospitals, while district hospital and health center use both High-Tech and De-Montfort incinerators. About 60% of the incinerators have defective doors. More than 55% of incinerators are corroded in regional and district hospitals. The chimney, top plates and grate which are good condition are 55.6% and 60% in regional hospitals and health centers, respectively. The situation is below 50% in district hospitals. The leakage of the roof and loose structures were observed in district hospitals and health center to be more than 50% of the incinerator houses. On other hand, the performance of burners and incinerator housing cleanliness are generally good. It was concluded that the incinerators in the HCFs are in bad conditions, necessitating maintenance.

Quantitative Assessment of Medical Waste Management in Hamad Medical Corporation—Qatar

A proper waste management system is very important in healthcare facilities because the overall benefit outweighs the cost. In the healthcare sector, hazardous health care waste (HHCW) consists of wastes that are potentially contaminated by dangerous agents. Identification and segregation of HHCW is harbinger for its proper management. The quantitative analysis study on HHCW had not been done in Qatar government hospitals. This study quantitatively analyzed the current practice for HHCW management in Hamad Medical Corporation (HMC), Qatar. The objective of this study is to provide a first comprehensive assessment of hazardous healthcare waste managements in Qatar and offers an opportunity to improve existing practice. This is a retrospective survey study carried out on secondary data collected from the department of occupational health and safety (OHS), HMC. OHS department collects and keeps records of hazardous wastes produced by HMC. Data on the HMC hospitals’ characteristics from 2017 to 2019 were retrieved from Planning and Statistics Authority’s website. World Health Organization (WHO) formula for calculating HHCW generation rate was used to calculate the rate for HMC. Data analysis results show a steady increase in HHCW generation rate in HMC, the generation rate was 2.6 Kg/patient bed/day, 2.8 Kg/patient bed/day and 3.1 Kg/patient bed/day for the years 2017, 2018 and 2019 respectively. There were also significant variations in HHCW generation rates between hospitals. The highest generation rate was 4.64 Kg/patient bed/day recorded for AWH and the lowest was 0.2 Kg/patient bed/day recorded for mental health and both hospitals contributing 23.18% and 0.29% respectively of HHCW in HMC.

Concentration of Copper, Zinc, Lead, Cadmium, and Nickel in the Incinerator Bottom Ash in Five County Hospitals in Kenya

Healthcare wastes contain potentially harmful microorganisms, inorganic and organic compounds that pose a risk to human health and the environment. Incineration is a common method employed in healthcare waste management to reduce volume, quantity, toxicity as well as elimination of microorganisms. However, some of the substances remain unchanged during incineration and become part of bottom ash, such as heavy metals and persistent organic pollutants. Monitoring of pollution by heavy metals is important since their concentrations in the environment affect public health. The goal of this study was to determine the levels of Copper (Cu), Zinc (Zn) Lead (Pb), Cadmium (Cd) and Nickel (Ni) in the incinerator bottom ash in five selected County hospitals in Kenya. Bottom ash samples were collected over a period of six months. Sample preparation and treatment were done using standard methods. Analysis of the heavy metals were done using atomic absorption spectrophotometer, model AA-6200. One-Way Analysis of Variance (ANOVA) was performed to determine whether there were significant differences on the mean levels of Cu, Zn, Pd, Cd and Ni in incinerator bottom ash from the five sampling locations. A post-hoc Tukey’s Test (HSD) was used to determine if there were significant differences between and within samples. The significant differences were accepted at p ≤ 0.05. To standardize the results, overall mean of each metal from each site was calculated. The metal mean concentration values were compared with existing permissible levels set by the WHO. The concentrations (mg/kg) were in the range of 102.27 - 192.53 for Cu, Zn (131.68 - 2840.85), Pb (41.06 - 303.96), Cd (1.92 - 20.49) whereas Ni was (13.83 - 38.27) with a mean of 150.76 ± 77.88 for Copper, 131.66 ± 1598.95 for Zinc, 234.60 ± 262.76 for Lead, 12.256 ± 10.86 for Cadmium and 29.45 ± 18.24 for Nickel across the five sampling locations. There were significant differences between levels determined by one-way ANOVA of Zn (F (4, 25) = 6.893, p = 0.001, p ≤ 0.05) and Cd (F (4, 25) = 5.641, p = 0.02) and none with Cu (F (4, 25) = 1.405, p = 0.261, p ≤ 0.05), Pb (F (4, 25) = 1.073, p = 0.391, p ≤ 0.05) and Ni (F (4, 25) = 2.492, p = 0.069). Results reveal that metal content in all samples exceed the WHO permissible levels for Cu (100 mg/kg), while those for Ni were below the WHO set standards of 50 mg/kg. Levels of Zn in three hospitals exceeded permissible level of 300 mg/kg while level of Pb exceeded WHO set standards of 100 mg/kg in two hospitals. Samples from four hospitals exceeded permissible level for Cd of 3 mg/kg. This study provides evidence that incinerator bottom ash is contaminated with toxic heavy metals to human health and the environment. This study recommends that hospitals should handle the bottom ash as hazardous wastes and there is need to train and provide appropriate personal protective equipment to healthcare workers, waste handlers, and incinerator operators and enforce compliance to existing regulation and guidelines on healthcare waste management to safeguard the environment and human health.