Microbial and heavy metal contamination of treated hospital wastewater in Thailand

OBJECTIVES

To determine the microbial and heavy metal contamination of treated hospital wastewater

MATERIAL AND METHOD

Methods of treating wastewater were acquired by questionnaires. Chlorine concentration, pH, bacteria and parasites in treated wastewater were tested in the individual hospitals. Heavy metal concentrations were measured by atomic absorption spectrophotometry.

RESULTS

In 2002, 72 hospitals were included in the present study. The common methods of treating wastewater were activated sludge and oxidation ditch. Bacteria exceeded standard numbers, pathogenic bacteria and parasites were found in two-thirds of the hospitals. Heavy metals, namely lead, chromium and cadmium, in the hospital effluent did not exceed standard concentrations.

CONCLUSION

Micro-organisms exceeding standard levels were found in treated wastewater in two-thirds of the hospitals. Lead, chromium and cadmium levels in hospital effluent were in an acceptable range.

Problems in the management of medical waste in Thailand

OBJECTIVES

To identify problems in the management of medical waste in Thailand for future development.

MATERIAL AND METHOD

The study was done in 39 hospitals during June and July 2002 by interviewing medical personnel on knowledge and attitude in management of medical waste, observation of practice and checking the amount of medical waste in waste bags. Certain laboratory investigations were done in dustmen.

RESULTS

The amount of medical waste was 0.41 kilogram per bed per day. Problems identified were inadequate knowledge in management, improper practices, high incidence of sharp injury at work. Laboratory tests in dustmen showed evidence of pulmonary tuberculosis in 3.4%, parasites and intestinal pathogens in stools 5.1% and positive for HBsAg in 8.5%.

CONCLUSION

Improper management of medical waste was present in all hospitals. Risks of exposure and incidence of infection related to the management were at concerned levels. Education and practice guidelines are needed.

Trusts must exploit change opportunity

Alan Oliver, marketing director, Checkmate Fire Solutions, urges Trusts to view the forthcoming fire safety regulations as an opportunity for change, and examines the benefits of fire safety risk assessments tailored to a Trust's specific and individual needs.

Awareness needed of Legionella risk

A profile of the work of David Harper, global authority on Legionnaire's disease in engineering terms, whose investigations into new-build hospital water systems have uncovered a number of risk factors which could expose patients to the Legionella bacterium.

Hospital waste management in the teaching hospitals of Karachi

OBJECTIVE

To evaluate the current practices of segregation approaches, storage arrangements, collection and disposal systems in the teaching hospitals of Karachi.

METHODS

A cross-sectional survey was conducted in eight teaching hospitals of Karachi, using convenient sampling technique. The instrument of research was a self administered questionnaire, with four sections, relating to the general information of the institution, administrative information, information regarding Health Waste Management personnel and a check-list of Hospital Waste Management activities.

RESULTS

Out of eight hospitals visited 2 (25%) were segregating sharps, pathological waste, chemical, infectious, pharmaceutical and pressurized containers at source. For handling potentially dangerous waste, two (25%) hospitals provided essential protective gears to its waste handlers. Only one (12.5%) hospital arranged training sessions for its waste handling staff regularly. Five (62.5%) hospitals had storage areas but mostly it was not protected from access of scavengers. Five (62.5%) hospitals disposed off their hazardous waste by burning in incinerators, two (25%) disposed off by municipal landfills and one (12.5%) was burning waste in open air without any specific treatment. No record of waste was generally maintained. Only two (25%) hospitals had well documented guidelines for waste management and a proper waste management team.

CONCLUSION

There should be proper training and management regarding awareness and practices of waste disposal. Research must be undertaken to seal existing gaps in the knowledge about hospital waste management. The hospital waste management guidelines enacted on 7th June 2004 should be followed and regulated by law enforcement agencies rigorously.

Keeping hospitals clean: how nurses can reduce health-care-associated infection

From modern matrons to student nurses, everyone is responsible for the environment in which they work. All nurses should be aware of the cleaning system used in their organisation and be able to follow it when necessary. A clean ward or clinic will help prevent hospital-acquired infections and promote patient and visitor confidence.

Management map for tomorrow

The way forward for hospital services and facilities management is examined by Francisco Castella, Doctor of Engineering and a member of the International Federation of Hospital Engineering Council. In this article, which is based on a paper presented at the 18th IFHE Congress, he draws on his experience as facility manager and director of general services in the Teaching Hospital of Badalona, Spain, and on knowledge gained through attending IFHE Congresses - representing the Spanish Hospital Engineering Association.

Methods to much improve maintenance

The benefits to be gained from the application of both value engineering (VE) and quality systems--e.g. quality assurance (QA), and total quality management (TQM)--to the management of building services maintenance have yet to be realised by the building services industry. These concepts are particularly applicable to complex hospital engineering services.

Maintaining life-support and non-life-support equipment. What do JCAHO's new requirements mean?

As part of its new "Shared Visions--New Pathways" initiative, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) now requires accredited healthcare facilities to demonstrate that life-support equipment receives a high priority in their equipment-maintenance programs. JCAHO has also revised its overall accreditation scoring system. Some of our member hospitals have asked ECRI for advice on how to deal with these changes. JCAHO's intent, as we understand it, is not to impose burdensome new requirements on hospitals, but simply to ensure that life-support equipment receives the necessary equipment-maintenance priority. We believe that any facility that has been meeting JCAHO's requirements up to now won't need to significantly change its equipment-management program, though it will need to revise its documentation procedures. In this article, we describe the changes to JCAHO's requirements and outline the steps that hospitals need to take to meet the requirements--as well as the steps they don't need to take.

Meeting essential lighting criteria

Hospital lighting has to meet a variety of special requirements. Lighting performance, ease of maintenance and efficiency are all important, as is patient comfort--and, with the introduction of PFI schemes, there is new focus. Richard Holt, managing director of Trilux Lighting, provides an insight.

"Beyond 'broke'": three steps to improve how your hospital buys, uses, and repairs equipment

By approaching problems in the hospital as an observational researcher, biomeds can begin to think about the problems in a different way, which may point toward opportunities to solve these problems. Of all of the people in the hospital, biomeds are in the best position to address these issues because they see how the products are used and what goes wrong. These three steps are just a starting point for moving beyond product repair and maintenance so biomeds can improve product use in their hospitals.

[Bioactive effectiveness of selected disinfective agents on Gram-negative bacilli isolated from hospital environment]

In our study the susceptibility (MIC) of chosen 21 strains of Gram-negative bacilli isolated in hospitals to disinfectant agents (glucoprotamine, sodium dichloroisocyanurate, potassium persulfate), the effectiveness of these disinfectants against selected bacteria and their effectiveness to biofilm forming bacteria was determined. It was found that glucoprotamine showed the highest activity to Gram-negative bacteria. Obtained MIC values for glucoprotamine (except 1 strain of S. marcescens) were 16-64 times lower that MICs for sodium dichloroisocyanurate and 4-32 times lower that MICs for potassium persulfate. The effectiveness of disinfectants containing potassium persulfate or sodium dichloroisocyanurate was 100% tested by carrier method. Glucoprotamine was ineffective against 2 out of 9 strains (18%): E. cloacae and S. marcescens. It was found that disinfectants were more effective against Gram-negative bacteria in carrier methods than for biofilm forming bacteria. 86% of bacteria growing 5 days on a catheter were resistant to working solution of disinfectant containing glucoprotamine (5200 mg/L) or potassium persulfate (4300 mg/L); 66.6% of tested bacteria were resistant to working solution of sodium dichloroisocyanurate (1795.2 mg/L). In our study the highest effectiveness to biofilm forming bacteria showed disinfectant with sodium dichloroisocyanurate, the lowest--with glucoprotamine.

Comparison of infectious waste management in European hospitals

A research project sponsored by the EC-LIFE programme was conducted to compare waste management in five different European hospitals. A comparison of the regulations governing current waste management revealed different strategies for defining infectious hospital waste. The differences in the infrastructure were examined and the consequences for waste segregation and disposal were discussed under economic and ecological aspects. In this context the definition of infectious waste is very important.