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RFMH hospital established 77 years ago by the Church of Nazarene

Sustainable medical waste management practices are a pipe dream for RFMH because of severe resource constraints. RFMH is a regional hospital situated 2 km away from Manzini city centre in the hub of Swaziland. It provides Medical, Surgical, Paediatrics, Obstetric, emergency and rehabilitative services

RFMH is a non-governmental and non-profit making hospital established 77 years ago by the Church of Nazarene. It is the second largest hospital in the country with a catchment population of 280 972 (CSO 1997 Vol. 1). It is a referral hospital for all regional clinics totalling to 110 (Emergency Preparedness and Response Plan for RFM Hospital 2001). Further, the hospital serves as a teaching hospital for the Nazarene College of Nursing and also host attachments for medical students from the local University and international students. Due to the HIV/AIDS epidemic, the hospital finds itself exceeding its carrying capacity of 340 beds thus exerting pressure on already limited resources. The hospital hosts the highest admissions of HIV/AIDS patients in the country (Ibid). 
 

Entrance to RFM Hospital

In view of the above, waste management issues become critical and are the biggest challenge for this resource-constrained hospital. A survey by two visiting officers from Yonge Nawe confirmed that RFMH urgently needs resources to avert a potentially

disastrous situation as a result of inadequate resources and capacity to manage medical waste. Generally, gloves, used gauze, papers, used intravenous fluids, and empty boxes of gloves are deposited into a 50-litre bin lined with a black refuse bag. When the bin is filled up the maintenance staff collect it for disposal at a nearby dumpsite where other general waste is disposed of. 
 

Dumpsite where medical waste is disposed of

The dumpsite is located within proximity to a stream, adjacent to Nazarene High School and Nazarene Teachers Training College. In view of this scenario, the stream is exposed to contamination by waste dumped at the site. There is no one responsible for managing the dumpsite. Waste disposed at the site included among others, ash from the incinerator, general waste,

used gloves and gauze.A make shift dumpsite is also developing next to this dumpsite. General domestic waste is dumped on this site. The first thing one to spot is plastic waste, which is littered all over the dumpsite. 

Sharps are disposed in an improvised 25-litre container or carton box, the sharps consist of used scalpel blades, needles and syringes. Once the container fills up the maintenance staff collect it for disposal. The sharps and expired drugs are burnt in an open space next to the incinerator and the ash is disposed of at the nearby dumpsite. 
 
 

Sharps in improvised 25-litre container or carton box is burnt in an open space next to the incinerator. These containers were thrown without being burnt

An Officer from the Pharmacy department is responsible for burning of all expired drugs and ensures that they are completely burnt. Further, the Pharmacy assists the Swaziland Hospice at Home for the disposal of expired drugs.  Expired intra venous fluids are drained in the wash sink and the

containers are thrown in the general waste bin. Body tissues such as foetuses are incinerated.  Placentas are disposed of in a 10 litre bucket lined with an ordinary plastic bag and are also incinerated. Ward Aides are responsible for collecting placentas for incineration and they wear protective clothing. 
 

Body tissues such as foetuses, Placentas and others are incinerated

In the operating room, used needles and scalpels are put in a separate container, which is collected by the Maintenance Department for disposal when it is full. Blood soaked linen is soaked in jik and then hand sluiced. Used instruments are soaked in jik, washed under running water, disinfected and sterilized by an autoclave.

There are no goggles for the staff, which could expose them to danger in case of accidental blood spills. The hospital has at the moment one sluicing machine and the greatest concern is about hand sluicing of blood soaked linen, which could expose staff to dangers. "We know that some diseases get transmitted through blood. We wished people would not sluice the linen before sending it for washing but we lack the necessary resources, " lamented the Operating Room Matron. The Matron stated that workers were aware of the dangers of hand sluicing and were also aware of the importance of using protective clothing. "But it is a pity that the protective clothing is not always available," she added.

Sluicing in the wards is done manually. The sluicing machine is only used for paediatric and maternity wards and unfortunately it broke down. 

A staff member in one of the departments said that, "Medical waste is hazardous; it needs to be properly disposed. If not, it can be a source of infection to us as staff and to the community at large. We decontaminate the waste and put it into the into the autoclave to destroy the pathogens after which we put it in the disposal plastic bags and send it for incineration."

The incinerator the hospital use was made in South Africa. It looks very old and is believed to be more than 20 years. Biomedical technicians maintain the incinerator. The incinerator sometimes breaks down and has never been upgraded to match the amount of waste generated. Ash from the incinerator is collected by the maintenance staff and is disposed of at the nearby dumpsite together with general waste. 
 

Wide view of the incinerator at RFM hospital

The incinerator operator has been running this unit for 2 years and has never received any training with regard to managing it. He stated that he wishes he could be provided with protective clothing to safeguard him from accidents such as blood spills. He is also responsible for burning the sharps at an open space, which is next to the incinerator cubicle.

The in-service training department is responsible for among others occupational health and safety training. Training has been limited to nursing staff. However, there are plans to include all support staff.
 

Segregation of waste at the point of generation to keep general waste from becoming infectious is critical to any waste management scheme. Further the training of all staff is key to any medical institution towards sustainable medical waste management.

The problem of medical waste will not disappear in one day, or even one year, if all stakeholders, medical practitioners, health care administrators, municipalities, regulatory bodies, industry, government, and civil society at large do not take ownership of their responsibility in it.  But the prime responsibility lies with the generator of the waste itself.  Yonge Nawe hopes to collaborate with RFMH in its efforts to improve medical waste management practices through training, awareness, resource mobilisation and information sharing.