By Eric Ojo
According to the World Health Organisation (WHO), about 85% of the total amount of waste generated by health care activities is general, non-hazardous waste. The remaining 15% is considered hazardous material that could be infectious, toxic or radioactive. Hazardous waste that is not managed properly presents a risk to hospital patients, health care personnel and the public.
Health-care waste contains potentially harmful microorganisms that can infect hospital patients, health workers and the public. Other potential hazards may include drug-resistant microorganisms which spread from health facilities into the environment. Adverse health outcomes associated with health care waste and by-products also include sharps-inflicted injuries; toxic exposure to pharmaceutical products, in particular, antibiotics and cytotoxic drugs released into the surrounding environment, and to substances such as mercury or dioxins, during the handling or incineration of health care wastes.
Waste management and evacuation remain a component of the infection prevention and control strategy in the response to COVID-19 in the Federal Capital Territory (FCT). However, this critical activity has snowballed into a daunting task for health workers and frontline responders involved in response activities.
This development stems from the volume of harmful medical waste generated daily in health facilities managing COVID-19 cases and the complex activities involved in managing and evacuating them. The SARS-CoV-2 virus which causes COVID-19 can potentially survive in the environment for several hours or days. Premises and areas potentially contaminated with the virus should be cleaned regularly and (or) before their re-use.
The standard method of evacuating waste in health facilities starts with waste identification at the point of generation, followed by segregation where the waste materials are categorised and separated using colour-coded waste bins. The infectious waste materials are put in the yellow containers, the highly infectious waste in the red containers, while non-infectious ones are collected in the black containers.
The waste materials are thereafter packaged, decontaminated and moved by trained and properly kitted waste handlers to the internal waste holding area within the health facility, from where they are taken to the final destruction point, which is the incinerator located within or outside health facilities in compliance with COVID-19 Infection, Prevention and Control (IPC) guidelines. These waste materials include those generated from government hospitals, laboratories and private hospitals that manage COVID-19 cases.
“At the FCT Department of Public Health, waste is properly managed. Everything used in managing patients in the hospitals, laboratories, isolation and treatment centres disposed of by incineration,” said Dr Josephine Okechukwu, the immediate past Director of Public Health at the FCT Health and Human Services Secretariat (HHSS).
Waste management and evacuation in the FCT is duly monitored by the IPC Pillar as well as the Health and Safety Pillar of the COVID-19 Emergency Operation Centre (EOC). The IPC Pillar monitors the hospitals, treatment centres, and laboratories, including the accredited, privately owned labs to ensure compliance with standards, while the Health and Safety Pillar goes round to assess the quality of services being rendered in all these facilities.
The Medical Director of Karu General Hospital and the Health and Safety Pillar Lead for the FCT EOC, Dr Osamuede Ojo said her pillar performs an oversight function in waste management to ensure that the level of IPC compliance in the health facilities and treatment centres in the FCT is top-notch.
“An IPC scorecard is used to find out how well different centres are doing in terms of IPC. On our regular visits to isolation and treatment centres, we ensure centres are in good condition and that waste is properly disposed of and incinerated. The incinerators are also checked to ensure that the waste is burnt and properly disposed of.” She added.
According to her, some hospitals own the incinerators, while some utilise the incinerators of nearby facilities. Dr Ojo further explained that after disinfection, the waste can be kept somewhere for a couple of hours, but we do not encourage waste to be kept for more than 24 hours, before being taken to the final point for incineration.
Waste Management in the Response to COVID-19
To prevent re-infection and safeguard the environment, proper waste management is important in the fight against COVID-19, therefore, caution and strict adherence to clinical precision in the evacuation of medical waste must be deployed. Ms Chioma Dan Nwanfor, an Epidemiologist of the Nigeria Centre for Disease Control (NCDC), deployed with the support of the African Centre for Disease Control (Africa CDC) to support FCT’s COVID-19 response, re-emphasised the critical importance of managing highly infectious disease wastes.
According to Ms Nwanfor, the NCDC has put a system in place to ensure that every state has an IPC-focal person. “We are not where we want to be, but we have improved. The only way to ensure that waste materials generated is well disposed off is by effectively monitoring the whole process end-to-end to ensure the waste does not go back into the community.”
Narrating her experience, the focal person for the Laboratory Pillar in FCT’s EOC, Mrs Abiola Ojo recounted some bottlenecks in the management of infectious disease waste in the COVID-19 response.
Mrs Ojo disclosed that the Public Health Department does not have its laboratory and that some of the sample collection centres are not directly located in the government hospitals.
“After every working day, the wastes generated from these centres need to be moved to the nearest facility or a laboratory with an incinerator. Since inception, we have used the National Reference Laboratory (NRL) at Gaduwa for the incineration of our waste,” she added.
Sumayya Hamza Maishanu, a Molecular Scientist and Laboratory Lead for COVID-19 at the DNA Labs Limited (one of the accredited, privately owned laboratories in Abuja) said the lab lacked its own incinerator but leveraged on the existing relationship with Foxgloves Multi-specialty Hospital, to manage wastes from the centre.
“Earlier, we worked with the National Hospital Abuja to manage our waste but the hospital soon exceeded its bandwidth. We swiftly reached an agreement with this private hospital. We take our waste after deactivating the pathogens weekly and we pay them for their services.”
Limitations to waste management
The Director of Disease Control, FCT Primary Health Board and Team Lead for the IPC Pillar at the EOC, Dr Yakubu Mohammed noted that the evacuation of waste to the incinerator points wasn’t regular and that the most worrisome, is that the majority of the health facilities in FCT lacked incinerators. There are only about three or four hospitals under the FCT Administration that have incinerators.
“Only 3 out of the 14 health facilities in Abuja which belong to the Federal Capital Territory Administration (FCTA), have incinerators. The remaining 15 secondary health facilities belong to other Ministries, Departments and Agencies (MDAs) and only about two or three of them have incinerators. Similarly, we have over 700 private healthcare facilities in Abuja, with only about five have incinerators. The three tertiary health facilities: Gwagwalada Teaching Hospital, National Hospital, and the Federal Medical Centre in Jabi, all have incinerators, but they are overwhelmed by these facilities dependent on their services.”
“We have seven isolation and treatment centres for COVID-19, only three out of the seven have incinerators. So, lack of incinerators is quite a challenge in waste management,” he further disclosed.
The foremost thing to do, according to the IPC Pillar Lead, is to procure and install good incinerators in the hospitals, both government-owned and private hospitals, train health care workers and institute a mechanism for maintenance that requires a lot of resources.
Dr Mohammed also noted that when the waste materials are transported from the health facility, there is much to be done to ensure that they are properly destroyed in time, to avoid the activities of scavengers.
“While that is in progress, the clearance of waste in health facilities should be regular, to avoid accumulation which can constitute an eyesore in health facilities and a potential source of infection within the health facility and the community.”
This narrative was done in November 2020 as part of the #COVID19NigeriaStories documentation project on state-level responses to COVID-19, implemented by the Nigeria Centre for Disease Control and Nigeria Health Watch with support from the Ford Foundation.