ASSESSMENT OF HOSPITAL WASTE MANAGEMENT OF SOME

SELECTED

FACILITIES IN BAUCHI METROPOLIS

Ph.D. CIVIL ENGINEERING (STRUCTURES)

RESEARCH PROPOSAL

BY
USMAN ABUBAKAR
(PGS/2014-2015/2/P/3083
DEPARTMENT OF CIVIL ENGINEERING
ABUBAKAR TAFAWA BALEWA UNIVERSITY, BAUCHI

SUPERVISORS:
PROF. A. U. ELINWA
(Chairman Supervisory Committee)
Engr. Dr. DUNA SAMSON
(Member Supervisory Committee)

APRIL, 2016

1.0

INTRODUCTION

1.1: Preamble
The Establishment of a healthcare system is a basic requirement
of every civilized society. Food, medicines, chemicals, equipment
and instruments are used while treating out patients cum patients
admitted into Hospital. Naturally, this leads to production of a
variety

of

medical

and

non

medical

wastes.

Appropriate

management and minimization efforts need to be put in place to

reduce the quantity and volume of these types of waste. The risk
associated with healthcare waste and its management has gain
attention across world in various events, local and international
forums and summits. The Agenda 21 of the United Nations
Conference on Environment and Development (UNCED) in Rio de
Jameiro, June 1992, also identified healthcare waste as being
amongst the environmental issues of great concern to the global
community. Cheng et al (2009) noted that although medical waste
presented a relatively small portion of the total waste in a
community, its management is considered an important issue
worldwide. The United Nations Environment Program (UNEP)
argues in their International Source Book on Environmentally
Sound Technologies for Solid waste management that among
these wastes, healthcare waste is one of the most problematic
types.
The growing affluence and increasing population concentrated
urban areas have increase the generation of all types of waste
including medical waste. Coker et al (2009) noted that as the
2

demand for more healthcare facilities increases there is also an

increase in medical waste generation in Nigeria. Babalola (2009)
added that in developing countries like Nigeria, high HIV/AIDS
prevalence, high morbidity among the general population has
resulted in high hospital admissions and as a result management
of the medical waste generated become a major challenge in
most

healthcare

facilities.

Poor

conduct

and

inappropriate

disposal methods applied during handling and disposal of medical

waste is increasing significant health hazards and environmental
pollution due to the infectious nature of the waste. Access to a
clean environment has been recognized as being essential to the
improvement of healthy and social environment. The Federal
Government of Nigeria (FGN) has rapidly embarked on programs
for delivery of good sanitation to most cities town and villages
Olubukola (2009).
In recognition of the significant of clinical waste management the
FGN through the Federal Ministries of Environment and Health
(FMOE and FMOH) undertook a study on the management of
medical waste in 1995, to assessing how critical waste could be
managed within referral and primary healthcare centers (Coker et
al, 2008). Consequently in 1996, the FGN adopted the clinical
waste management technical guidelines to address the concerns
that have been express by the study. The clinical waste
management technical guidelines set out the best practices for
identification, segregation, handling, storing, transporting and
disposal of clinical waste. Furthermore in 1988, the waste
management policy was formulated to have an over arching
3

vision to raise the environmental sustainability, human health and

natural resources, awareness to meet the needs of current and
future generations(Coker et al, 2007).
Despite all the effort to provide good sanitation and sound
medical management, Fadipe et al,(2009) noted that numerous
aspect of clinical or healthcare waste management are found to
be haphazard and challenging in most African Hospitals. Clinical
waste is increasingly becoming a problem particularly in Nigerian
healthcare facilities (Ndubisi et al, 2010). Indiscriminate dumping
of medical waste, clinical waste mixed with household waste and
this waste being conveyed using bare hands and transported in
open trucks from some health facilities have been observed
(Coker, 2011). Olubokola(2010) noted that environmental quality
in Nigeria has deteriorated due to improper medical waste
segregation, collection, transportation and disposal methods used
in healthcare facilities. Mongam( 2013) also added that improper
management practice are still evident from point of initial point of
generation, collection to final disposal. Although, significant
progresses have been made in healthcare waste management,
the existing healthcare waste management practices in Nigeria
still need a great deal of modification and improvement.
This

investigation

work

has

been

motivated

by

these

aforementioned challenges noted in medical waste management

practices in Nigerian healthcare facilities. It is hope that the
findings of this study will be used to bridge the knowledge gap

and improve on the medical waste management practice in

Bauchi metropolis being the study area.
1.2: Statement of the problem
The non sustainable management of Healthcare waste (HCW)
has increasingly continues to generate public interest due to the
health problems associated with exposure of human being to
potentially hazardous waste arising from healthcare. Presently,
considerable gaps exist with regards to the assessment of
healthcare waste management (HCWM) practices particularly in
Nigeria and in several other countries in sub-saharan Africa. The
nature and quantity of HCW generated cum institutional practices
with regards to sustainable methods of HCWM, including waste
identification, segregation, collections, transportation, treatment
and final disposal are often poorly observed and documented in
several developing countries like Nigeria, despite the risk posed
by the improper handling of the HCW ( Farzadika et al, 2009). It is
also of serious concern that the level of awareness, particularly of
health workers regarding HCW has never been adequately
documented. The practical information on this important aspect of
HCWM

is

inadequate

and

research

on

the

public

health

implications of inadequate management of HCW are few and

limited in scope.{Kocasay, 2007 and Ohimain, 2010) believed that
several hundred of tones of HCW are deposited openly in waste
dump sites and surrounding environment, often alongside with
non hazardous solid waste. A near total absence of institutional
arrangements for HCWin Nigeria has been by others (Coker et al,
5

1998). The poor segregation, handling and disposal practices of

many

hospitals,

clinics

and

health

centers

are

likely

representatives of practices throughout Nigeria and this poses

serious health hazards to people living in the vicinity of such
healthcare facilities (David et al, 2012). Previous studies reported
that handling of waste at some healthcare facilities is haphazard,
with used of unacceptable methods of transport such as mortuary
trolleys (Clementina, 2014). Stephen et al, (2011) also added that
clinical waste has the potential to cause damage to most aspect
of the environment, especially to land, water, air and wildlife. It is
therefore, requires that medical waste be managed in a safe
manner using suitable treatment and disposal methods (Oke,
2007). It is against this background that the researcher wishes to
assess the medical waste management practices in Bauchi
metropolis healthcare facilities.

1.3

Justification of the study

In quest for finding lasting solutions to human and environmental

problems and even eliminating the potential risk pose by
inappropriate healthcare waste management practice in Nigeria,
this study is considered significant for the following reasons:
It will provide insight into prevailing medical waste management
practices at the healthcare facilities in Nigerian cities like Bauchi.
6

The information and recommendations from the study could be

used to help in ensuring effective management of medical waste
in Bauchi metropolis healthcare facilities which could in turn help
to reduce risks to healthcare workers, the community at large and
the environment. It is hope that the research findings may help
Bauchi state Government, departments and local authorities in
improving the existing policies and planning measures in order to
mitigate risks of improper management of medical waste. The
findings of the study could also enable the State Government
through the ministries of health and environment to address
identified gaps and strengthen proper management of clinical
waste and could also help to supplement and complement the
existing knowledge on clinical waste management system used in
Bauchi metropolis healthcare facilities. With the site visits and indepth interviews to be conducted in the selected healthcare
facilities, sustainable medical waste management plan will be
proposed.

1.4:

Aim and Objectives

1.4.1:

Aim

The aim of this study is to conduct assessment of hospital

waste management practices and environment at some selected
healthcare facilities in Bauchi metropolis
7

1.4.2:

Objectives of the study

The study has the following objectives to achieved

1. To conduct assessment of the prevailing practice of hospital
waste

management

in

the

selected

hospitals

in

Bauchi

metropolitan.
2. Gather and evaluate information on hospital waste generation,
segregation, collection, storage, treatment, transporting and
disposal.
3 Determine the categories as well as generation rates of solid
medical wastes at the selected healthcare facilities.
4

Assess the level of implementation and compliance with the

recommended best practices for the sustainable management of

healthcare

waste

based

on

United

Nations

Environmental

Programs/World Health Organization (UNEP/WHO, 2005)

5 To evaluate the level of awareness of the health workers
regarding healthcare waste management.
6 Validate the results and developed models
7

Recommend a sustainable and economical medical waste

management plan
1.5: Scope of work
As the research is more of cross sectional descriptive study, all
field work will be carried out within a maximum period of five
months. Five healthcare facilities out of the thirty-two (32)
8

number in Bauchi metropolis that registered with Bauchi state

ministry of health headquarters, Bauchi would be selected based
on the modified methods of United Nations Environmental
Programs/World Health Organization (UNEP/WHO, 2005) and
Townend and Cheeseman (2005) guidelines.

CHAPTER TWO
2. O
2.1

Preambles
9

LITERATURE REVIEW

One of the long standing and most challenging task for human
being is to live on a piece of land without spoiling it. Hospitals are
health institutions providing patient care services, and the public
seem to be unaware of the adverse effects of the garbage and
filth they generate. Sharma (2007) added that it is ironic that
health facilities which provide succor to the ailing can also
generate various type of medical wastes. Moving to 20 th century,
the advert of complicated diseases and ailments led to more
complicated medical waste being generated, which required more
organized methods of waste management. Poor management of
medical waste exposes healthcare workers, waste handlers and
the community to infections, toxic effects and injuries in addition
to environmental damages (Pruss et al., 1999).
2.2

Healthcare waste

Healthcare waste can be defined as the total waste stream that is

generated

from

healthcare

establishments,

health

related

research facilities, laboratory and emergency relief donations.

Hospitals,

clinics,

laboratories,

medical

research

centers,

pharmaceutical manufacturing plants, pharmacies, blood banks,

veterinary healthcare centers and nursing home healthcare
activities are some the generators of healthcare waste.
Jang (2011) defines healthcare waste to include a number of
waste materials such as blood soaked bandages, culture dishes
and other glassware, discarded needles and lancets, cultures,
stocks and removal body organs.

10

Sharma et al.,(2010) defines healthcare waste as waste arising

from medical, nursing, dental, veterinary, pharmaceutical or
similar investigative, treatment care or research practice. Coker
(2009) added that healthcare waste may prove hazardous to
those that come in contact with it. The term healthcare waste has
often been used interchangeably with other terms such as
medical waste, hospital waste, clinical waste, biomedical waste or
biohazardous waste around the world (jang, 2011). In Nigeria, this
waste is generally known as healthcare, also World Health
Organization (WHO) and other International bodies refer this
waste as healthcare waste, recognizing that all waste generated
from healthcare facilities are by product of healthcare activities
(Clementina, 2014). Pruss et al., (2002) used the term medical
waste as to deal with all types of produced by healthcare
facilities.
Waste generation from healthcare activities can be broadly
categorized general waste and hazardous waste (Ogbonna et al.,
2012).The major portion of waste generated in healthcare
activities is composed of general waste that can be treated in the
same way as domestic waste. However, this remains true only
when proper segregation of waste is practiced according to the
type at source. There are different estimates regarding the share
of hazardous and non hazardous waste constituents of healthcare
waste. Obekpa et al., (2012) and Sharma (2013) estimated that
between 75% and 90% of the waste produced by healthcare
facilities is general waste comparable to domestic waste. In
addition Fadipe (2011) reported that 85% of the waste produced
11

in hospitals and clinics is non contaminated and pose no risk of

infection. According to the WHO, between 10%and 25%is
hazardous due to its composition. The remaining 75%to 90%
poses no risk of infection transmission as it is comparable to
domestic waste.This mainly comprise waste produced in the
administration

and

housekeeping

sections

of

the

facilities.

Healthcare waste was further classified into two major categories

by WHO(2005):
1 Healthcare general waste is the proportion of healthcare waste
that is not hazardous and comparable to household waste.
2 Healthcare risk waste is the proportion of healthcare waste that
is likely to contain pathogenic organism in sufficient quantities to
cause diseases. This waste is commonly referred to as clinical
waste or biomedical waste in certain quarters and falls under
general cluster known as hazardous waste.
Healthcare risk waste is further classified into various other
types according to specific composition (Ogbonna and Ubani,
2012).
Infectious waste refers to waste which is suspected to
contain pathogens such as excreta from patients and wound
dressing.
Pathological waste consist of tissue, body parts, human
fetuses, blood and body fluid
Sharps are category of healthcare waste comprising of items
which can cause cuts and injuries. These include needles,
scalpels and broken glass.
12

 Chemical waste contains residues of chemical used in

hospitals such as disinfectants and reagents used in
laboratories.
Pharmaceutical waste contains remains of pharmaceutical
products such as expired drugs.
The below figure shows how Hossain et al., (2011) classified
healthcare wastes which agreed with WHO (2005) healthcare
waste classification system.

N
W
H
P
S
C
IR
h
a
n
o
s
z
t
a
e
d
f
n
e
t
a
h
r
im
e
r
m
ip
o
c
h
ld
s
c
t
a
f
o
a
ic
z
a
r
u
e
g
lw
t
o
o
s
ia
u
r
m
t
c
v
s
d
io
a
t
e
H
r
lc
e
u
C
a
s
l
F
R
is
o
s
r
k
N
w
o
a
n
s
t
R
ie
s
k

Figure

2.1:

Classification

of

facilities (Hossain, 2011)

13

waste

from

healthcare

Plate 1: General waste: This is more of municipal waste

that consist of food remnants, used papers, soft drinks
cans etc.

14

Plate 2: Pathological waste: consist of human tissues

or fluids, e.g body parts, blood and other body fluids,
fetuses.

15

Plate 3: Pharmaceutical waste: waste containing

pharmaceuticals; e.g. drugs that are expired or no longer
needed,

items

contaminated

pharmaceuticals (bottles, boxes)

16

by

or

containing

Plate4: Infectious wastes: waste suspected

to contain, pathogens, e.g. laboratory cultures, swabs,
17

materials or equipment that have been in contact with

infected patients.

Plate 5: Sharp wastes: These are wastes that consist of

items like needles, infusion set, scalpels, knives, broken
glass, and blades.

18

Plate 6: Pressurized containers: This type of waste

consist of gas cylinder, gas cartridges, aerosol cans
etc.

19

Chemical waste:
This type of waste consists mainly of laboratory reagents, film
developer, expired disinfectants, solvents.
Radioactive waste:
These are wastes that contain radioactive substances like
unused

liquids

from

radiotherapy

or

laboratory

research,

contaminated glassware, packages or absorbent paper, urine and

excreta from patients treated.
2.3

Healthcare waste management

Waste management consists of various activities from the

generation of the waste to final disposal. It involves strategic
measures

taken

quantification,

in

storage,

the

generation,

handling,

collection,

characterization,
transportation,

treatment and final disposal of the waste. It also covers

managerial, technological and remediation measures involve in
the corrective action of existing waste practices as well as the
continuous plan towards ensuring sustainable waste management
within a locality (Toyobo, 2012). Stephen and Elijah (2011) define
healthcare waste management as an integral part of the hygiene
and infection control within a healthcare facility, which helps in
controlling nosocomial infection. According to Sharma (2013)
medical waste management include all the actions necessary for
20

collection, transportation and treatment of this waste to recover,

reuse recyclable or valuable fractions before its final disposal at a
landfill or before incineration.

The term waste management

usually relates to materials produced by human activities and the

process is generally undertaken to reduce their effect on health,
the environment or aesthetics. According to Coker (2012) the
process of waste management comprises of key stages which all
are very important and interrelated and the stages include
segregation,

collection,

storage,

handling,

transportation,

treatment and disposal.

Healthcare waste management has become a critical issue and
has taken a central place in national health policies of many
countries (Bassey et al., 2006). Unless medical waste is properly
segregated, handled, transported and disposed, it can present
risk to the health and safety of people at work, members of the
public and the environment (Coker et al., 2009). All individuals
expose to improper management of healthcare waste are
potentially at risk of being injured or infected. The must
vulnerable groups include medical staff namely doctors , nurses,
sanitary staff and

hospital maintenance personnel.

Patient

receiving treatment in healthcare facilities, their visitors and the

general public are also at risk of being injured through healthcare
waste ( Pruss et al., 1999 and Hossain et al., 2011).
Improper waste management can lead to environmental
pollution (water, air, soil), unpleasant smells can foster the growth
and multiplication of insects, rodents, cockroaches, vermin and
21

may lead to transmission of diseases like typhoid, cholera, human

immunodeficiency virus and hepatitis B and C as well as
contamination of of underground water table by untreated
medical waste landfills (Pruss et al., 2000, Mahasa et al., 2014).
In order to minimize impacts of clinical waste, a proper and
workable waste management plan is a pre- requisite in Nigerian
healthcare establishments. The safe management of healthcare
waste may be achieved by ensuring care in dealing with
healthcare risk waste. Hence it is the ethical responsibility of
management of hospitals and healthcare establishment to ensure
proper medical waste management. This involves determination
of

sources,

waste characterization,

generation

rate,

safety

handling practices, segregation, storage, transportation and final

disposal (Olubukola, 2009). According to Ogbonna (2012) and
Clementina (2014), effective medical waste management should
also include clear definitions of medical waste and the scope of
legislation concerning it, basic principles promote the reduction of
the amount of waste generated at source and homogeneous
classification of waste and the implementation of environmentally
friendly waste management technologies.
2.4 Medical Waste generation
Medical waste is generated from various activities performed in
healthcare

facilities

and

these

include

infectious

and

non

infectious waste. Generation of healthcare waste differs not only

from country to country but also within a country. Tables 2.1 and
2.2 showed the generation rate of medical waste in different
22

countries of the world and some cities in Nigeria. Waste

generation depends on many factors such as established waste
management methods, type of healthcare facility, hospital
specialization, occupancy rate, proportion of patients treated on
daily basis and the degree of regulation enforcement at national
and local levels, definition of medical waste, and training of
medical waste personnel, medical treatment and disposal policy
type (Coker and Oke, 2009, Jang, 2011).

Table2.1: Medical waste generation rate in some countries

of the world.
S/no

Country

Generation
1

Per Capita MW
America

1.45Ibs/patient/day
2

United Kingdom

1.12Ibs/patient/day
3

China

0.31Kg/patient/day

23

Palestine

0.50Kg/patient/day
5
Ethiopia
0.60Kg/patient/day
6

Tanzania

0.13Kg/patient/day
7

Senegal

0.25/patient/day
8

Nigeria

0.62

Kg/patient/day
Source: WHO 2005 Report.

Table2.2: Average Medical waste generation rate in some

cities of Nigeria
24

S/No

Cities

Generation rate

References
1

Abuja

2.78kg/bed/day

Bassey et al, (2006)

2

Ibadan

1.75 kg/bed/day

Toyobo et al, (2012)

3

Jalingo

0.68kg/patient/day

Razack et al, (2013)

4

Kano

1.68Kg/bed/day

Umar

et al, (2009)
5

Port Harcourt

2.07Kg/bed/day

Ogbonna

David (2013)

Fadipe et al., (2008) also noted that quantities of medical waste

generated also depends on level of instrumentation at the
healthcare facilities, number of beds, types of health services
provided, economic ,social and cultural status of patients and the
general condition of the area where the facility is situated.

25

Generation rate in Kg/bed/day

7

0
Brazil

India

Iran

Italy

Japan

N/Korea Taiwan Thailand U S A Vietnam

Fig2.1: Generation rate of medical waste in different

countries (Jang, 2011)

26

Generation rate in developed countries such as Italy, U S A and

Japan is greater than the rates found in developing countries such
as Thailand, Vietnam, India and Iran (Coker et al., 2008). The
generation rate of medical waste is also dependent on the
regulations and economic status of a country with large variation
when expressed as the amount of waste per bed/day or per capita
/day. Also, the number of daycare patients has significant effect
on waste generation rate (Babatola, 2008). For example Babatola
et al., (2008) reported that due to higher number of daycare
patients, public healthcare facilities produce larger amount of
healthcare waste than private healthcare facilities.
2.5 Medical waste management practices
The best waste management practice is to prevent and minimize
the generation of waste (Hossain et al., 2013). The management
of waste must be consistent from the point of generation
(Cradle) to the point of final disposal (grave).
2.5.1 Segregation
The United Nation Environmental Programme (UNEP) has that
only 10% of the healthcare waste is considered to be potentially
infectious. The proportion can be further reduced to 1-5% with
proper segregation practiced at the source (UNEP). According to
Coker et al., (2009), segregation refers to separation of waste into
designated categories.

Babalola (2009) also defined waste

27

segregation as a process of dividing garbage and waste products

in an effort to reuse and recycle material. In the con text of
healthcare facilities it is the first important process in medical
waste management. The safe management of healthcare waste
requires that clinical waste should be separated from general at
source of generation for example from all patient care activity
areas, diagnostic service areas, operation theatres, labor rooms
and treatment rooms. Segregation of waste happens at the point
of generation so that it can be sent through the appropriate route
for disposal (Fadipe et al., 2009). The reason being that clinical
waste presents greater risks and needs to be handled with care.
The risk waste is separated from non risk waste which account for
20% of medical waste (Sharma, 2013). The responsibility of
segregation should be with the generators of biomedical waste for
example doctors, nurses, medical and paramedical personnel.
Segregation ensures that the correct pathways are adopted for
storage, transportation and ultimate disposal of medical waste.
Moreover, medical waste is also segregated from each other
because certain medical wastes need to be handled, treated and
disposed

of

differently

and

appropriately.

For

instance,

sharps/syringes, needles, cartridges, broken glasses and any

other contaminated disposal of sharps instruments items are to
be handled differently.
According to Wahab (2011) if segregation does not take place
properly, two scenarios which arise have far reaching implications
on both public and environment health. The scenarios are:
28

1. Healthcare risk waste gets mixed up with non risk waste. This
results in a situation where the former ends up at landfills and
cause injuries to scavengers, municipal workers, children and
general population.
2. Healthcare general waste is subjected to special treatment to
disinfect it such as incineration or autoclaving thereby imposing
unnecessary cost on the health system. Infectious waste requires
very expensive treatment before disposal. By all means it should
only be infectious waste that is subject to such treatment.
2.5.2 Handling
Handling procedures of medical waste follows after waste has
been segregated and placed in plastic bag or rigid containers.
According to Faribah and Kazim (2014), handling of medical waste
takes place in all the stages and it is through handling that
different groups get into direct contact with medical waste. In
order

to

prevent

injuries

from

sharps,

porters

and

other

operatives are to wear personnel protective equipment (PPE) for

incineration.

Healthcare

workers,

operatives

and

all

other

personnel involved in handling clinical waste are to be given

Hepatitis B vaccination as means of protection from viral hepatitis
B infection.
2.5.3 Storage
Medical waste has to be stored before collection and final
disposal, and should not accumulate in corridors, wards or places
that are accessible to the general public. There is a wide range of
29

containers designated to stored different types of waste. These

include plastic bags and rigid containers in a variety of sizes.
When containers are full to the required capacity, the waste is
removed from the collection points on a 24 hourly basis of its
generation. Waste is not supposed to be stored for more than 48
hours (WHO, 2010). According to Pruss et al., (1999), the following
are the characteristics of an appropriate area for storage of
medical waste:

Identified as being for only medical waste.

Well lit and ventilated area.
Away from food preparation or storage area.
Vermin free.
Away from pedestrian and private or public transportation

routes.
Totally enclosed and secured spaced with only authorized
access.
Clearly marked with warning signs.
Has access to first aid washing facilities.
Should allow for any spillage of contents.
2.5.4

Transportation

As noted by Oke et al., (2010) medical waste must be

transferred from the place it is generated to the installations
where it will be treated and disposed of. Collection and
transportation of medical waste must be carried out by trained
personnel

from

authorized

waste

collection

area.

Transportation of medical waste depends on the category of

the waste. Altin et al., (2009) reported that at all times
transportation of medical waste should be controlled via a
30

document that shows at least the amount and type of waste,

place of origin of waste and waste collection date, and place of
destination. Where waste is transported within the facility,
Sharma, (2013) established that all containers should be
covered and labeled as being bio-hazard according to WHO
specifications. Purposed designated vehicles are to be used
solely for the transportation of such waste.
2.5.5

Treatment and disposal

There are varieties of technologies available for treating

medical waste. Waste treatment leads to a decrease in
volume, weight, risk of infectivity and organic compounds in
the waste ( Pruss et al., 1999). Treatment methods include
incineration, autoclaving, microwave and disinfection systems
(Coker et al., 2009). It has been found from literature that the
most common disposal methods of solid clinical waste,
particularly in developing countries, are dumpsites, controlled
landfill, sanitary landfill and pits (Sharma, 2007). Healthcare
waste treatment technologies, especially for infectious waste
are often classified into burn and non burn technologies and
have their inherent merits, demerits and application criteria
(Fadipe

et

al.,

2011).

The

most

commonly

proclaimed

treatment technology for healthcare waste is incineration. The

WHO (2010) suggested that incineration as a viable interim
solution especially for developing countries where options for
waste treatment such as autoclaves, shredders, or microwaves
are limited. A properly designated and constructed incinerator
31

should completely burn the waste leaving a minimum amount

of residuals in the form of ashes and it should be equipped
with scrubber to trap toxic air pollutants emitted (Ngouakam et
al., 2012). These emissions are claimed to have serious
consequences on workers safety, public health and the
environment (Oke et al., 2012). Non burn technology appears
to emit fewer pollutants, is cost effective, compact and
reliable, and avoids secondary pollutants (Muduli et al., 2012).
Open pit dumping is the most common method of clinical
waste disposal in developing countries like Nigeria (Coker et
al., 2009). This is because it is less expensive and no other
alternative methods are available at reasonable costs. Though,
it is the least cost option, open dumping has long been
recognized as a potential infection source of public health and
environmental pollution hazard (Omar et al., 2012). It is an
uncontrolled and inadequate disposal option for clinical waste,
since the waste is accessible to scavengers and animals (Coker
et al., 2009).

Also wind easily blows over the dumped waste,

dispersing air pollutants into nearby communities (Coker et al.,

2009).
In general, landfilling is also an easy and low cost waste
disposal method. However, if landfill is improperly managed, it
raises human health risk and environmental pollution concern
(Babalola et al., 2011). Landfilling is however considered an
unsophisticated

disposal

method,

which

requires

careful

segregation of waste so that it does not pose significant health

32

effect on public health and environment (Gidarakos et al.,

2010}. In developing countries like Nigeria, landfills are
operated like an open dump sites. The clinical waste is dumped
in the landfill mixed with non clinical waste, and later burned.
Landfills produce waste products in three phases during the
waste degradation process. These are solid (degraded waste),
liquid (leachate, which is polluted with waste), and gas (usually
referred to as landfill gas) (Coker, et al 2008).
It can be seen therefore, that Landfilling is not a safe solution
to the treatment of the medical waste. This is because landfills
can produce harmful gases and contaminate underground
water bodies, cum wind- blown litter and dust. Landfills also
attract vermin.
2.5.6

Training and education

A smooth running of any medical waste management system

requires regular training programmes. Proper training must be
carried out with hospital employees to developing awareness of
health, safety and environmental issues (kumari et al., 2012).
Staff members who are involved in handling waste should be
provided with training in handling, segregation, storage and
disposal procedures. This type of people should be provided with
protective

equipment

and

should

receive

certificates

of

proficiency after successful completion of appropriate training

(Pruss et al., 1999).
Staff should be trained in the following:
33

 Checking that the storage bags are effectively sealed before

and after they handle them.

Handling bags by neck and never throwing or drop them
Knowing what to do if there is an accidental spillage.
Reporting accidents and incidents.
Marking sure that the source and origin of the waste are

clearly marked on the bag.

Understanding the risks associated with disposal.
2.6 Medical waste management practices in developed
countries.
Medical waste management practices differ from developed to
developing nations, from urban to rural areas. It is the ethical
responsibility of the management of hospitals and healthcare
establishments to have concern for public health. In a study at
King George Hospital in England, Longs et al., (2006) observed
that staff were handling medical waste with appropriate health
and safety measures using impervious gloves and mouth masks
although they were not aware of potential hazards of the material
they

were

handling

as

prescribed

in

Biomedical

Waste

Management and Handling rules, 1988. In USA medical facilities,

it was found out that medical waste items were generally
segregated according to respective color coded bags and storage
of segregated healthcare waste was away from the patients and
nursing station (Sharma, 2009). Altin et al., (2005) also reported
that in New York State health facilities, there were effective
training programs educational plans related to medical waste
management.
34

In developed countries legislation and good practice guidelines

define medical waste and state the various possible ways for
collection, transportation, storage and disposal of such waste.
Also the best available technologies are used for the development
of alternatives for proper disposal of medical waste with minimum
risks to human health and the environment (Bassey et al., 2011).
2.7 Medical waste management practices in developing
countries
In developing countries medical waste management has not
received sufficient attention yet. Healthcare waste typically drives
from two sources in developing countries: emergency relief
donations (leftover from international donor response to either a
humanitarian

crisis

or

natural

disaster)

and

long

term

healthcare services (Coker et al., 2011). In less developed and

transitional countries, medical waste disposal options are limited,
and small scale incinerators have been used as an interim
solution. Incinerators emit a variety of harmful pollutants,
including particulate matter, mercury, dioxin and furans (Sharma,
2010). In developing countries, solid waste have not received
sufficient attention, hazardous and medical wastes are still
handled and disposed together with domestic waste, thus
creating a great risk to municipal workers, the public and the
environment (David et al., 2013). The most common method of
land disposal medical waste used is the open dump. This method
of waste disposal poses severe negative public and environmental
health effects, and must be discontinued. The following main
35

problems facing the hospitals in developing countries in terms of

medical waste management were identified:
Lack of necessary rules, regulations and instructions on
different aspect of collection and disposal of waste.
Mixing of hazardous waste with domestic waste of the
hospital.
Failure to quantify the waste generated in a reliable records.
Failure to use appropriate color bags thereby limiting the
bags used to one color for all waste.
Absence of dedicated waste manager and committees
responsible for monitoring medical waste management
practices.
Lack of education

and

training

on

medical

waste

management.
Assessment studies on medical waste management in developing
countries have detected several problems and defaults such as
segregation, handling and storage not appropriately conducted.
Practices for waste minimization are poor, hazardous and
common waste are mingled and disposed in the open dumps or
landfills, waste incinerators are not equipped with an emission
control apparatus, chemical waste is disposed through the public
sewage system and there are no staff training programs (Babalola
et al., 2013). He added that some cleaners were found to salvage
used sharps, saline bags, blood bags and test tubes for resale or
reuse.
In a study by Coker et al., (2009) in Ibadan, Nigeria, it was
observed that the secondary and primary healthcare centers do
36

not practice any scientific disposal of clinical waste. Hospital

waste is often thrown in open garbage dumps or in nearby
dumps. Where waste is segregated by hospital staff, it is done for
the purpose of retrieving useful items. This gives way to
malpractices as waste recycling by rags pickers and possible
reuse of used syringes has become accepted way of life. Hospitals
are currently burning waste or dumping in bins which are
transported to unsecured dumps.
Rag pickers in the hospital, sorting out the garbage are at a risk of
getting tetanus and HIV infections.

37

Plate7: Rag pickers in a hospital dumped waste

site.

Plate8:

Rag

picker

handling

highly

directly with his hand without PPE.

38

infectious

waste

Plate 9: Transporting medical waste in a wheelchair.

39

2.8

Hospital Waste Management Plan

Biomedical waste management strategies include planning

and

organization

development

of

characterization
waste

of

minimization

waste
option,

and

losses,

technical

and

regulatory, and economic feasibility, implementation, monitoring

and optimization continued and outgoing evaluation of reaching
zero generation status.
Implementing

effective

biomedical

waste

management

programmes require multi sectional cooperation and interaction

at all levels. Establishment of national policy and a legal
framework, training of personnel, and raising public awareness as
essential elements of successful healthcare waste management.
Management of healthcare waste should thus be put into a
systematic, multifaceted framework, and should become an
integral feature of healthcare services.
Each hospital is required to develop a waste management
plan that provides for a thorough segregation and treatment of
waste. The main aims of biomedical waste management are
Minimizing

risk

of

personnel,

general

public

and

environment.
Minimizing the amount of waste generated.
Segregation and separation of wastes
Designation of deposit areas in the wards.
Establishment of safety routes for the transportation of
the waste.
40

 Establishment of a safe and proper area for the

temporary storage.
Proper waste treatment and disposal.
3.0

Materials and Methodology

The methodology for this research will be determined by the aim

and objectives. The chapter will outlined in details how the
research would be conducted. It describes the research design,
subject data collection process and instruments. It also proposes
the

data

analysis

method

and

presentation

plan.

The

methodology for conducting this work is illustrated in figure 3.1

41

DSQMR
sarutecx
Vtceuaimd
tausdplin
etyuIi/h
pAdiPrmgtbq
MnIoePat
satnpdrv
lrnuAoitp
yialcvn
swiatevh
irtvde
seoiu
nyr
e

ti e a i t
u oe
o
tai
t ie e rl os
nn O
vn
su
n
r
e ap
iv r o
el
c
i
i
t

s t
l

ns

c a n
s
ei
e
o

au
l

i/

n
d

d R
r /
lr

c D
o u
t
e

t
t

a e
h

Fig 3.1 Flow chart for the research work methodology.

3.1 Research Design
Fadipe (2011) define a research design as a master plan
specifying the methods and procedures which are used to guide
and conduct a research. It strategic plan for a research project,
setting out the broad outline and key features of the work to be
undertaken, including the method of data collection and analysis
42

to be employed and showing how the research strategy addresses

specific aim and objective of the study(Babu et al, 2009).
research

focuses

on

an

assessment

of

medical

The

waste

management at five selected healthcare facilities in Bauchi

metropolis. The research designs to be adopted by the study are
quantitative and qualitative (mixed method approach).
The mixed method approach involves both collecting and
analyzing qualitative and quantitative data and is practical in the
sense that the researcher is free to use all method possible to
address a problem(David and Ogbonna, 2013). The method also
helps

the

researcher

to

lay

out

researcher

questions,

methodologies, data collection and analysis needed to conduct a

research.
3.2

Study setting

The setting for this study would be one referral (Teaching

Hospital), one Special Hospital, Two Clinics and one Health Center.
The healthcare facilities are few, they operate under different
conditions and are located in different areas of Bauchi metropolis.
Purposive sampling technique would be used by this study. This
type of sampling technique is a non probability one, where the
researcher chooses a sample with a purpose to predetermined
category of healthcare facility of interest (Umar and Yahaya,
2014). Since the purposive sampling technique is non probability
approach, it is subject to bias and error.
3.3 Sample and Sampling Procedure
43

Five healthcare facilities in Bauchi Metropolis would be selected

as a representative of the healthcare institutions in the area.
Samples for the study would include three Government and two
private owned healthcare facilities. The samples would be made
up of one referral or tertiary hospital, one secondary or specialist
hospital and primary health center owned by Government, while
the remaining two are to be private clinics. By virtue of their
numbers,
Bauchi

ATBU,Teaching

(secondary)

and

hospital(tertiary)
Underfive

Specialist

primary

health

hospital
center

automatically will be included into the samples. For the purpose of

location and patronage, Reemee and Amsad clinics would be
selected.
3.3.1

Study Population

A study population comprises the entire aggregation of cases that

a researcher is interested in (Bassey et al, 2009).The population
in this study would be the health workers and ancillary staff in
the five healthcare facilities to be sampled. The health workers
are to be the doctors, nursing staff, laboratory scientists and
pharmacists, while the ancillary staff to consist of cleaners,
porters operatives for handling waste.. Probability Proportional to
Size (PPS) would be used to select the study population as
indicated in fig 3.2 below. The PPS method allows each and every
category of population to equally represent and the larger the
sample size the more samples to be taken.

44

Po p u la tio n
S iz e = N = (x +
y)
A n c illa r y
S ta ff = y

H e a lth
W o rke rs
=x

Sam p
le = 0 .
1y

Sam p
le = 0 .
1x
To ta l
S a m p le =
0 .1 N

Fig.

3.2: Stratified random sampling plan (Tayobo and Oyeniyi,

2012)

3.4

Data Collection and Research Instruments

Various research instruments would be used to ensure reliability

and validity of data that could be collected. Care would be taken
to ensure that the research procedures are same at each
healthcare facility included in the study sample. The use of
45

various research instruments may likely improve the quality of the

research findings and hence the enhancement of validity of data.

3.4.1

Questionnaires

Questionnaire would be used to collect primary data from

sampled healthcare workers and ancillary staff of the selected
healthcare facilities. Questionnaires are to be used mostly to
gather information from key respondent on their views concerning
the types of medical waste generated, segregation at source,
collection pattern, storage and transporting style, treatment and
disposal

methods

and

risks

relating

to

medical

waste

management practices. A survey questionnaire is to be adopted

because it allows participants to give their views anonymously
and this reduces bias from the researchers owned opinion and
also with no verbal or visual clues to influence the respondents
(Sharma, 2009).
3.4.2

Structured Interview Guide

According to Babalola (2008), interview involves direct interaction

between an investigator and research subjects. The researcher
spoke directly with respondent asking questions related to a
specific area. Structured interview allows for more freedom of
discussion with subjects and aim for a greater understanding of
the subjects(Longs and Williams, 2006). Questions will be
prepared prompt typical areas of dialogue. This allows the subject
to expand upon the questions and revealed answered information
46

that could not be achieved with a questionnaire. Interview would

be conducted based on a written list questions. The following
subjects are to be interviewed, personnel involved in the
collection and disposal of medical waste, facility waste managers,
facility waste management committee and the environmental
officers. Prior consent and appointment are to be made with key
informants who are to be interviewed in their designated offices.
3.4.3

Field Observation and Measurement

Observation involves the physical examination of research

subjects in a natural social environment with particular attention
paid the subjects behaviors and actions (Altin A. Altin, 2003). The
observation would be made first hand by the researcher. The
research is to use unobtrusive observation where he would not
directly be involved in the observation activities. This will prevent
the researcher from influencing the subjects behavior. The field
observation to be made would be of cradle to the grave type.
Types of clinical waste to be generated, segregation from source,
designated collection points, places to be stored, treatment
method to be adopted and final disposal pattern will all be
observed. Continuous monitoring and spot checking will the
observation technique to be adopted. Places such as inpatients
rooms, nursing stations, laboratories, treatment rooms among
others are to be the observation points. It is intended to spent
maximum of a week at each sample healthcare facilities for the
exercise. Incinerators and landfills will be parts of the places to
visit. The reasons for the observation is see the practical practice
47

of segregation, handling, collection and storage are being done

accordingly and if clinical waste receptacles would be provided,
wastes are deposited in appropriate containers, transported
correctly and incinerated according to UNEP/WHO(2005) technical
guidelines on medical waste management.
Measurements would be used to express observations numerically
in order to investigate casual relationship. Items to be measured
are to be quantity of waste generated and number of patients
who visit the facilities per day. The generated waste would be
measured by ensuring that the waste type generated is put into
pre-weight separate container labeled for specific type of waste. A
digital weighing scale would be used to measured the waste. An
average weight of seven days measurement will be used to
calculate the daily generated waste type per patient and per bed.
A camera would also be used in collecting data from the field
observations. A measurement/observation sheet would be used to
record data to be obtained.
3.5

Pilot Study and questionnaire Validation

To ensure validity and reliability of the questionnaire, the

researcher will conduct a pilot testing of the questionnaire to a
small group of healthcare workers and ancillary staff at Zango
primary health center situated in Bauchi metropolis actual data
collection. Sampling procedure and other technique would be
same for pilot test and the main work. The pilot test result is to
develop, adopt and check feasibility of the questionnaire and after
which amendments will be made.
48

3.6

Data Presentation and Analysis Tools

Data analysis is a practice in which raw data is ordered and

organized so that useful information can be extracted from it
(Mahasa and Ruhigo, 2014). The types raw data of this research
to be measurements, questionnaire responses and observation to
be made. Charts, graphs and textural write-ups of data are to be
used to analyze the data. These method are meant to refine and
distill the data so that readers can glean interesting information
without needing to sort through all the data on their own.
Statistical Package for Social Science(SPSS) will be used to
present and analyze the data that would be collected. Services of
a statistician may be employed during this phase of the research
process. The raw data will be presented in tables, bar chart graph
and pie chart. Microsoft excel would be used to produce these
tables and graphs. Plates will also be used to present the
collected data. Comments will be made on each finding.
Correlation coefficients for the amount of waste generated versus
the number of patients who visits the healthcare facilities survey
would calculated. The method of data presentation to be used will
help to clarify data and draw new conclusions.

49

INTERVIEW GUIDE: FOR ENVIRONMENTAL OFFICER

1 To what extent do healthcare facilities implement and comply
with the 1996 Nigerian Technical Guidelines on medical waste
management
2 Has the above document being evaluated to assess if it is
addressing all clinical waste issues
3 Is the Nigerian Technical Guidelines commensurable with
International Standard on Environmental issues?

50

What

are

the

risks

that

inappropriate

clinical

waste

management poses to the environment and human health?

5 How often does BASEPA monitor the management of clinical
waste in healthcare facilities?
6 Is clinical waste disposing same as municipal waste at landfill?

INTERVIEW GUIDE: FACILITY WASTE MANAGER/ HEALTH

SAFETY OFFICER.
1 How many people visit your healthcare facility (HCF) per day
2 What is the daily generation quantity of clinical waste in your
HCF
3 How many injuries related to clinical waste have been reported
in the past 12 months
4 How many health workers in your HCF have received Hepatitis B
vaccination?
51

5 How often is clinical waste collected?

6 If the clinical waste is not collected as scheduled, what do you
do with it.
7 Is clinical waste storage accessible to any person or scavenger?
8 Do you record any clinical waste management information?
9 How often is in-service training on clinical waste management
for health workers done?
10 Who is responsible for providing a continuous clinical waste
training for for the health workers?
11 How do you manage risk associated with clinical waste?
12 Do you check if clinical waste collected is properly incinerated
before final landfill disposal?
13 What are the problems that you encounter in managing clinical
waste?
14 What are the initiatives taken for effective managing clinical
waste?
INTERVIEW

GUIDE:

PERSONNEL

RESPONSIBLE

CLINICAL WASTE COLLECTION AND DISPOSAL\

1 How often do you collect clinical waste in this HCF?
2 How much waste do you collect in Kg/day?
3 Is the clinical waste you collect, segregated at source?
52

FOR

4 Where is clinical waste store, waiting for collection and disposal

5 How secure are the clinical waste storage facilities
6 What do you used in transporting the clinical waste?
7 is the transportation of clinical to designated
8 Where is clinical waste treated?
9

Did

clinical

waste

handlers

received

any

training

in

management of clinical waste?

10 Are waste handlers provided with protective clothing when
handling clinical waste?
11 Do waste handlers receive any vaccination against hepatitis B
12 What are the risks associated with clinical waste that have
been encountered by the past 12 months.
13 What are the problems that you encountered in collection and
disposal of clinical waste.
14 What recommendations would you give for the improvement
of medical waste management?
OBSERVATION/MEASUREMENT SHEET
PLACE OF OBSERVATION---------------------------------------------DAY
DATE
Quantity
waste

1
of

clinical

generated

per
53

day
Number of outpatient
per day
Sources

of

clinical

waste
Segregation of waste at
source: YES or NO
Bags Containing waste
-secured fastened
-not securely fastened
-Placed

at

the

right

place
-left for too long
Supply of receptacles
Adequate/inadequate
-red plastic
-sharp container
Pedal bins
Others specify
Used of color

coded

and labeled receptacles

Mode of transport to
storage place
-use of hand
-pedal bins
-other specify
Used
of
protective
clothes when handling
waste
Types

of

protective
54

clothing used
Clinical storage room
-secure/insecure
-ventilated/not
ventilated
-present of scavengers
-present of worms, flies
and animals
-Present of leachates
-waste spilling
State of waste
-rotten
-smelling
-dry
Collection
-collected/not collected
Storage
room,
bins/trolleys

cleaned

after collection
Waste
transportation
offsite
-used

designated

vehicle
-used any vehicle
Presence of incinerator
-incineration procedure
followed/not followed
-residues

collected

to

landfill/not collected
55

References

56

Abdelkarim, E. and Mohammed, B. (2013). Medical

Waste Management: A case study of the Souss
Massa - Draa Region, Morocco.
Journal of
Environmental Protection, 2013, 4, 914-919.
Adoga, et al. (2014). Knowledge and Practice of
Medical Waste Management among Health Workers in
Nigeria General Hospitals. Asian Journal of Science
and Technology, VOL. 5, issue 12 PP 833-838, 2014.
Ahmad, N., O. and Musa, A., E. (2014). Assessment of
Medical Solid waste Management in Khartoum State
Hospital. Journal of Applied and Industrial Sciences,
2014, 2(4): 201-205.
Altin, A., Altin (2003). Determination of Hospital
Waste Composition and Disposal Methods: A case
study. Polish Journal of Environmental Studies, VOL
12, No. 2, (2003), 251-255.
Anita, R. and Kumal. (2011). Bio-Medical Waste
incineration Ash: A Review with Special Focus on its
Characterization, Utilization and Leachate Analysis.
International
Journal
of
Geology,
Earth
and
Environmental Sciences, 2011 Vol. 1, September
December, PP 48-58.
Asante, O., B. and Yaokumah, E.,B. (2014).
Healthcare waste Management, its Impact: A case
study of the Greater Accra, Region, Ghana.
International Journal of Scientific and Technology
Research, VOL. 3, issue 3, March, 2014.
Bazrafshan, E. and Mostafapoor, F., K. (2010).
Survey of Medical Waste Characterization and
Management in Iran: a case study of sistan and
Baluchistan Province. Journal of Waste Management
and Research 29(4)442-460.
Bassey, et al. (2006). Characterization and
Management of Solid medical wastes in the Federal
Capital Territory, Abuja Nigeria.
African Health
Sciences, March 2006, 6(1):58-63.
57

Blenkharn, J., I. (2006). Standards of Clinical waste

Management in UK Hospitals. Journal of Hospital
infection (2006) 62,300-303.
Babanyara, Y., Y. et al. (2013). Poor Medical Waste
Management Practices and its Risks to Human Health
and the Environment.
International Journal of
Environmental, Ecological, Geological and Geophysical
Engineering. Vol. 7, No 11, 2013.
Babatola, J., O. (2008). A Study of Hospital Waste
Generation and Management Practices in Akure,
Nigeria. An International Multidisciplinary Journal,
Ethiopia, Vol. 2 (3), 2008.
Babu, et al. (2009). Management of Biomedical
Waste in Indian and other Countries: A Review.
International Journal of Environmental application and
Science, Vol., 4 (1), 65-74 (2009).
Christopoulos,
K.
and
Gidarakos,
E.
(2010).
Solidification/ Stabilization of Fly and Bottom Ash
from
Medical
waste
incineration
Facility.
Department of Environmental Engineering, Technical
University of Crete, University Campus, 73100,
Chnria, Greece.
Clementina, U. U. (2014). Assessment of Healthcare
Waste Management Practices in Enugu Metropolis,
Nigeria. International Journal of Environmental
Science and Development, Vol. 5, No 4 August 2014.
Coker, et al., (2009). Medical Waste Management in
Ibadan, Nigeria: Obstacles and Prospects, Journal of
Waste Management 29, 804-811.
David, N., Ogbonna. (2013). Characteristics and
Waste Management Practices of Medical Wastes in
Healthcare Institutions in Port Harcourt, Nigeria.
African
Journal
of
Environmental
and
Waste
Management, Vol. 1 (1) PP. 013-021.
Elijah and Savange (2005). An Alternative for the
Treatment and Disposal of Healthcare Waste in
58

Developing Countries. Journal of Waste Management,

25, 625-637.
Etusim, P., E., et al. (2013). A study on Solid waste
Generation and Characterization in some selected
Hospitals in Okigwe, Imo State, Nigeria. Journal of
Educational and Social Research. Vol. 3(4) 2013.
Fadipe, K., T. and Ogedengbe, T., O. (2011).
Characterization and Analysis of Medical Solid Waste
in Osun State, Nigeria.
African Journal of
Environmental Science and Technology, Vol. 5 (12),
PP. 1027-1038, 2011.
Fariba, M. and Kazim, N. (2014). Analysis of the
Healthcare waste Management Status in Tehran
Hospitals. Journal of Environment Health Science
and Engineering 2014, 12:116.
Hassan,
T.
and
Mohammed,
M.
(2009).
Characterization of Medical Waste from Hospitals in
Tabriz, Iran. Science of the Total Environment 407
(2009), 1527-1535.
Hossain
et al.,
(2011).
Clinical
Solid
Waste
Management Practices and its Impact on Human
Health and Environment: A Review, Journal of Waste
Management, 31, 754-766.
Jang, Y. C. (2011). Infectious Medical Hospital Waste:
General Characteristics in South Korea. Earth System
and
Environmental
Sciences,
Encyclopedia
of
Environmental Health, pp 227-231.
Kumari et al., (2012). Establishing Biomedical Waste
Management System in Medical University of India. A
Successful Practical Approach, 20 November, 2012.
Longs, E., O. and Williams, A. (2006). A Preliminary
Study of Medical Waste Management in Lagos
Metropolis, Nigeria. Iran Journal of Environmental,
Health Science Engineering. Vol. 3, No. 2, PP. 133139.
59

Mahasa, P., S. and Ruhiiga T., M. (2014). Medical

Waste Management Practices in North Eastern Free
State, South Africa J. Hum Ecol, 439-450 (2014).
Meman,S., A. and Paracha, M., B. (2013). Utilization
of Hospital Waste Ash in Concrete.
Mehran
University Research, Journal of Engineering and
Technology, Vol. 32.No 1, January, 2013.
Muduli, K. and Barve, A. (2012). Challenges to Waste
Management Practices in Indian Healthcare Sector.
2012 International Conference on Environmental
Science and Engineering IPCBEE, Vol. 32, (2012),
Press, Singapoore.
Martin, et al. (2012). Properties of Concrete with
Municipal Solid waste Incinerator Bottom Ash. 2012
IACSIT Coimbatore Conferences IPCSI,T Vol. 28,
(2012), Press, Singapore.
Narasimhan, J. and Fu, J. (1994). Medical Waste
Characterization,. Journal of Environmental Health,
Vol. 57, No. 1.
Ngouakam, M. (2012). Generation and Disposal of
Solid, Clinical waste in General Hospital and
Infectious Disease Hospital, Ikot Ekpene, Akwa Ibom
State, Nigeria:
Olukanni, D., O. and Okorie, M. (2014).
Medical
Waste
Management
Practices
among
selected
Healthcare Facilities in Nigeria: A case study.
Academic Journals Vol. 9 (10), PP 431-439.
Omar, D. and Siti, N.,N., (2012).
Clinical Waste
Management in District Hospital of Tumpat, Batu
Pahat and Taiping.
Asia Pacific International
Conference on Environment Behavior Studies
Mercurele Sphinx Cairo Hotel, Giza Egypt 31, October
2 November, 2012.
Pruss et al., (1999). Safe Management of Waste from
Health Activities, Geneva. World Health Organization.
60

Sharma, D. (2013) Generation of Hospital Waste: An

Awareness impact of Health and Environmental
Protection. National Journal of Community Medicine
VOL. 4, issue 1, January March, 2013.
Toyobo, A., E and Oyeniyi, A.,B. (2012). Appraisal of
University
Teaching
Hospital
Medical
Waste
Management in Nigeria: Case studies of University,
College Hospital (UCH) Ibadan and Obafemi Awolowo
University,
Teaching
Hospital
(OAUTH)
Ile-Ife.
Universal Journal of Education and General Studies,
Vol. 1 (9), PP. 290-297.
Tabashi, R. and Marthandan, G.
(2013). Clinical
Waste Management: A Review on Important Factory in
Clinical Waste Generation Rate.
International
Journal of Science and Technology, Vol. 3, No. 3, 2013.
Umar, A., B. and Yahaya, M., N. (2014). Hospital
Waste Manage Practices: A case study of Primary
Healthcare centers, in Fagge Local Government Area,
Kano State. 105R Journal of Nursing and Health
Science Vol. 3, issue 6 Ver. II, PP. 26-33, 2014.
Wahab, A., E. and Adesanya, D., A. (2011). Medical
Waste Generation in Hospitals and Associated Factors
in Ibadan Metropolis, Nigeria. Research Journal of
Applied Sciences, Engineering and Technology 3 (8):
746-751, 2011.
Yanful, S. (2010) Characterization and Management
Strategies.
Journal of Emerging Trends in
Engineering and Applied Sciences, (JETEAS,) 3 (1),
165-169.

61

Anita and Kumal. (2011). Bio-Medical Waste incineration Ash: A

Review with Special Focus on its Characterization, Utilization and
Leachate Analysis.

International Journal of Geology, Earth and

Environmental Sciences, 2011 Vol. 1, September December, PP

48-58.

62

Ahmad, N., O. and Musa, A., E. (2014). Assessment of Medical

Solid waste Management in Khartoum State Hospital. Journal of
Applied and Industrial Sciences, 2014, 2(4): 201-205.
Adoga, et al. (2014). Knowledge and Practice of Medical
Waste Management among Health Workers in Nigeria General
Hospitals. Asian Journal of Science and Technology, VOL. 5, issue
12 PP 833-838, 2014.
Abdelkarim, E. and Mohammed, B. (2013). Medical Waste
Management: A case study of the Souss Massa - Draa Region,
Morocco. Journal of Environmental Protection, 2013, 4, 914-919.
Altin, A., Altin

(2003).

Determination of Hospital Waste

Composition and Disposal Methods: A case study. Polish Journal

of Environmental Studies, VOL 12, No. 2, (2003), 251-255.
Asante, O., B. and Yaokumah, E.,B. (2014). Healthcare waste
Management, its Impact: A case study of the Greater Accra,
Region, Ghana. International Journal of Scientific and Technology
Research, VOL. 3, issue 3, March, 2014.
Bazrafshan, E. and Mostafapoor, F., K. (2010).

Survey of

Medical Waste Characterization and Management in Iran: a case

study of sistan and Baluchistan Province.

Journal of Waste

Management and Research 29(4)442-460.

Bassey, et al. (2006). Characterization and Management of
Solid medical wastes in the Federal Capital Territory, Abuja
Nigeria. African Health Sciences, March 2006, 6(1):58-63.
63

Blenkharn, J., I. (2006).

Standards of Clinical waste

Management in UK Hospitals. Journal of Hospital infection (2006)

62,300-303.
Babanyara, Y., Y. et al. (2013).

Poor Medical Waste

Management Practices and its Risks to Human Health and the

Environment. International Journal of Environmental, Ecological,
Geological and Geophysical Engineering. Vol. 7, No 11, 2013.
Babatola, J., O. (2008). A Study of Hospital Waste Generation
and Management Practices in Akure, Nigeria.

An International

Multidisciplinary Journal, Ethiopia, Vol. 2 (3), 2008.

Babu, et al. (2009). Management of Biomedical Waste in
Indian and other Countries: A Review.

International Journal of

Environmental application and Science, Vol., 4 (1), 65-74 (2009).

Christopoulos, K. and Gidarakos, E. (2010).
Stabilization

of

Fly

and

Bottom

Ash

from

Solidification/
Medical

waste

incineration Facility. Department of Environmental Engineering,

Technical University of Crete, University Campus, 73100, Chnria,
Greece.
Characterization in some selected Hospitals in Okigwe, Imo
State, Nigeria. Journal of Educational and Social Research. Vol.
3(4) 2013.
David, N., Ogbonna. (2013). Characteristics and Waste
Management

Practices

of

Medical

Wastes

Institutions in Port Harcourt, Nigeria.

in

Healthcare

African Journal of

Environmental and Waste Management, Vol. 1 (1) PP. 013-021.

64

Etusim, P., E., et al. (2013). A study on Solid waste Generation

and Characterization in some selected Hospitals in Okigwe, Imo
State, Nigeria. Journal of Educational and Social Research. Vol.
3(4) 2013.
Fadipe, K., T. and Ogedengbe, T., O. (2011). Characterization
and Analysis of Medical Solid Waste in Osun State, Nigeria.
African Journal of Environmental Science and Technology, Vol. 5
(12), PP. 1027-1038, 2011.
Fariba, M. and Kazim, N. (2014). Analysis of the Healthcare
waste Management Status in Tehran Hospitals.

Journal of

Environment Health Science and Engineering 2014, 12:116.

Hassan, T. and Mohammed, M. (2009). Characterization of
Medical Waste from Hospitals in Tabriz, Iran. Science of the Total
Environment 407 (2009), 1527-1535.
Longs, E., O. and Williams, A. (2006). A Preliminary Study of
Medical Waste Management in Lagos Metropolis, Nigeria.

Iran

Journal of Environmental, Health Science Engineering. Vol. 3, No.

2, PP. 133-139.
Mahasa, P., S. and Ruhiiga T., M. (2014). Medical Waste
Management Practices in North Eastern Free State, South Africa
J. Hum Ecol, 439-450 (2014).
Meman,S., A. and Paracha, M., B. (2013). Utilization of Hospital
Waste Ash in Concrete. Mehran University Research, Journal of
Engineering and Technology, Vol. 32.No 1, January, 2013.
65

Muduli, K. and Barve, A. (2012). Challenges to Waste

Management Practices in Indian Healthcare Sector.
International

Conference

on

Environmental

Science

2012
and

Engineering IPCBEE, Vol. 32, (2012), Press, Singapoore.

Martin, et al. (2012). Properties of Concrete with Municipal
Solid waste Incinerator Bottom Ash. 2012 IACSIT Coimbatore
Conferences IPCSI,T Vol. 28, (2012), Press, Singapore.
Narasimhan, J. and Fu, J. (1994).

Medical Waste

Characterization,. Journal of Environmental Health, Vol. 57, No.

1.
Ngouakam, M. (2012).

Generation and Disposal of Solid,

Clinical waste in General Hospital and Infectious Disease Hospital,

Ikot Ekpene, Akwa Ibom State, Nigeria:
Olukanni, D., O. and Okorie, M. (2014).

Medical Waste

Management Practices among selected Healthcare Facilities in

Nigeria: A case study. Academic Journals Vol. 9 (10), PP 431-439.
Omar, D. and Siti, N.,N., (2012). Clinical Waste Management
in District Hospital of Tumpat, Batu Pahat and Taiping.

Asia

Pacific International Conference on Environment Behavior

Studies Mercurele Sphinx Cairo Hotel, Giza Egypt 31, October 2
November, 2012.
Sharma, D. (2013) Generation of Hospital Waste: An
Awareness impact of Health and Environmental Protection.
National Journal of Community Medicine VOL. 4, issue 1, January
March, 2013.
66

Toyobo, A., E and Oyeniyi, A.,B. (2012). Appraisal of University

Teaching Hospital Medical Waste Management in Nigeria: Case
studies of University, College Hospital (UCH) Ibadan and Obafemi
Awolowo University, Teaching Hospital (OAUTH) Ile-Ife. Universal
Journal of Education and General Studies, Vol. 1 (9), PP. 290-297.
Tabashi, R. and Marthandan, G.

(2013). Clinical Waste

Management: A Review on Important Factory in Clinical Waste

Generation

Rate.

International

Journal

of

Science

and

Technology, Vol. 3, No. 3, 2013.

Umar, A., B. and Yahaya, M., N. (2014).

Hospital Waste

Manage Practices: A case study of Primary Healthcare centers, in

Fagge Local Government Area, Kano State.

105R Journal of

Nursing and Health Science Vol. 3, issue 6 Ver. II, PP. 26-33, 2014.
Wahab, A., E. and Adesanya, D., A. (2011). Medical Waste
Generation

in

Hospitals

Metropolis, Nigeria.

and

Associated

Factors

in

Ibadan

Research Journal of Applied Sciences,

Engineering and Technology 3 (8): 746-751, 2011.

Yanful, S. (2010) Characterization and Management
Strategies.

Journal of Emerging Trends in Engineering and

Applied Sciences, (JETEAS,) 3 (1), 165-169.

67

MATERIALS
The materials along with specifications which to be used
for this study are summarized as
3.1.1

Cement: Ordinary Portland cement from Ashaka

cement factory will be used. All tests to be conducted are

to conforming to BS 812 minimum requirements.
3.1.2

Fine Aggregate:

Dry

River

sharp

sand

from

Bayara River in Bauchi LGA of Bauchi State will be used as

fine

aggregate.

All

tests

to

be

conducted

conforming to BS 1881 minimum requirement.

68

are

to

3.1.3

Course Aggregate:

Engine crusted stone from

Triacta Nigeria Limited quarry in Bauchi LGA of Bauchi

State will be used as course aggregate of maximum
nominal size of 19mm.

All tests to be conducted are to

conforming to BS 1881 minimum requirement.

3.1.4

Hospital Waste Ash: Hospital waste ash from

Abubakar Tafawa Balewa University, Teaching Hospital

Bauchi final disposal site will be used. The ash will be a
mixture of fine and coarse particles (broken glasses and
bottles, metallic pieces including syringes and other
surgical items).
3.1.5

Mixing Water: Portable water will be used for the

entire experimental programme.

3.2.5 Laboratory Tests:

Laboratory experiments will be

conducted on materials to be used in this study, and these

include cement, fine and coarse aggregates and Hospital
waste ash.

Test for the cement will be performed in

accordance with the procedure outlined in BS 4550 (1978)

and the aggregates will be conducted in accordance with
test procedures outlined in BS 812 (1985 and 1986).
Concrete

samples

will

be

prepared

and

tested

in

accordance with the procedures outlined in BS 1881

(1983).

The following laboratory investigations will be

carried out to be used for the characterization of the

Hospital ash.

69

Particle Size distribution through sieve 63um and

75um.
Chemical

composition

by

X-ray

fluorescence

spectrometer.
Morphology and Mineralogy determination by X-ray
diffraction.
Leaching test of heavy metals.
Compressive Strength test of the Cement/ash matrix.

The third expected benefit is to use medical waste ash in

concrete matrices with the view to disposing them safety
at ordinary landfills or even to reuse these materials in
the construction industry.
The fourth expected benefit is to use the solidified matrix
in reducing underground water pollution with heavy
metals in the medical waste ash.

70

2.1

Preamble

Hospitals

are

health

institutions

providing

various

healthcare services to the community. Their activities may

include curative, rehabilitation, prevention, patient care
services

and

promoting

health

education.

It

is

the

responsibility of the hospitals and health care centers or

establishment to look after the health of the public. This
may be directly through patient care, or indirectly by
ensuring a clean, healthy environment for their workers
and the community (Patil et al., 2005). The management
of hospital waste is of the utmost important due to its
potential environmental hazards and public health risks.
To realize sustainable development in hospitals, it is
necessary that the need to maintain a balance between
effective

infection

control

and

good

ecological

environment is recognized by health care workers and

hospital

management

undertaking
generate

these

(Daschner

activities,

wastes both

from

et

the

al.,

1997).

hospital

clinical and

may

non

In
also

clinical

activities. The infectious component of the hospital waste

could pose a potential risk to patients, hospital staff,
visitors,

neighboring

communities

surrounding environment.

and

even

the

Waste production depends on

the hospitals capacity, the number of clinical staff and the

applied practices (Tsakona et al., 2006). Despite the fact
that current medical waste management practices differ
from hospital to hospital, the problematic areas are
71

approximately the same for all hospitals or health care

units and at all stages of waste management, including
segregation, collection, packaging, storage, treatment,
transportation
management

and
is

disposal.
subject

of

Thus,
major

hospital
concern

waste
to

any

regulatory agency (Giroult et al., 1999).

2.2

Definitions and Classification of hospital waste

In this case, the bottom ash must be examined for
its toxicity and all the necessary measures must be
taken in order to minimize leaching of its hazardous
components in to the environment (Woolley et al.,
2001). Concrete is the most important material used
in constructing structures all over the world because
of its low cost, ease of construction, good durability
and availability of its ingredients. The role of cement
past in concrete is essential to achieve safe and
durable structures. Therefore, it is useful to improve
cement paste characteristic especially strength and
durability at low cost (Kiat, 1990 and Targan et al.,
2003).
The effect of the waste material on the properties
of concrete such as compressive strength, durability,
pozzolanic reactivity, dry shrinkage and setting time
were investigated by many researchers (Beddar and
Belagra, 2003, Camei leri et al., 2006, Juric et al.,
2006 Kula et al., 2002, Stonys et al., 2008).
72

In addition to improving concrete properties using

waste materials, other advantages can be achieved,
including reducing environmental pollution because
waste

materials

can

cause

Water,

Air

and

Soil

pollution during decay and reducing the high cost of

waste disposal on land fill (Pacewska et al., 2002).
Other benefits of using waste materials in concrete
mixtures

include

reducing

the

cost

of

cement

production and the consumption of raw materials (AlKhaja, 1997).

incinerated

Bottom ash and fly ash, produced from

hospital

waste,

are

used

for

the

production of concrete and bricks, after mixing (5050) with the reminder materials (Tay, 1987).

In

several European countries high quantities of ash are

reused for the manufacture of pavements, bridges
and structural stones but also as sub-layer in the
manufacture
landfills.

of

motorways

and

as

daily

cover

On the contrary, in USA and Canada, a

general interest exists without constituting common

practice to use ash as a construction material.
In Germany 50% of the ash produced from incinerated
waste

is

used

for

the

manufacturing

of

sound

insulation walls at national roads, as well as, sublayers on the streets.

In Netherlands, 60% of the

bottom ash is used for the construction of asphalt and

as a sub-layer of roads. In Denmark above 72% of ash
is reused for the manufacture of parking spaces,
73

cycling tracks and other roads (Reihnders, 2005).

Characterization of the nature of fly ash and bottom
ash took place through the determination of heavy
metals, particle size distribution, morphology and
mineralogy of several samples (Petrantonki et al.,
2009).

Shazim and Muhammad, (2011) conducted

research on Utilization of Hospital Waste Ash in

Concrete.
using

The research evaluated the feasibility of

Hospital

waste

Ash

(HWA)

as

replacement of Cement in Concrete.

partial

The result

revealed that density decreased with introduction of

HWA as Cement replacement, and higher the HWA
Contents lower is the density.
containing

higher

amount

of

Also, for the mix

Cement,

higher

compressive strength can be expected, and setting

time

increased

while

water

absorption

of

mixes

decreased with increase in the percentage of HWA in

the mix. It was concluded that Utilization of HWA as
partial replacement of cement in concrete solves the
problem of disposal thus keeping the environment
free from pollution.
Nabil and Al-Akhras (2010) investigated the effect of
medical waste ash (MWA) resulting from the Jordan
University of Science and Technology incinerator on
mortar properties. The investigation revealed that
medical waste Ash may be stabilized in the mortar
mixes with insignificant leaching of the heavy metals
74

and the incorporation of MWA in the cement paste

decreases the setting time, it was concluded that
stabilization of Medical waste Ash in mortar mixtures
reduces the underground water and environmental
pollution by the insignificant leaching of its heavy
metals.

75