Management Systems in Production Engineering

2012,No4(8),pp811

CHANGESINTHESYSTEMSOFMEDICALWASTEMANAGEMENTINPUBLICHEALTHPROTECTIONIN STITUTIONSOFLUBUSKIEVOIVODSHIP20072011RESEARCHRESULTS
MaciejGAWRON,JagodaZBOROWSKA UniversityofZielonaGra

Abstract: Thepaperdiscussestheproblemofopera onofmedicalwastemanagementsystemsinthelubuskievoivodshiplocal governmenthealthprotec onins tu ons20072011.Basedontheconductedresearch,65%oftheexis nghealthpro tec onins tu onsubordinatedtotheMarshalOceoflubuskievoivodshippresentsendogenicchangesofwastema nagementsystemsmainlyaectedbythenancialstandingofthemedicalservicessector. Keywords:medicalwaste,wastemanagement,healthcareunits

INTRODUCTION Observedwithinrecentyearsdicultnancialsitua on inthesectorofpublichealthprotec onins tu onrequires seekingra onalac onsinthemanagementsectorfocusing mainlyoneconomicsavings.Inthelogicalwaythesetasks should refer to all aspects of opera on of the health pro tec on ins tu on and aect the evolu on of the waste managementsystems.Itshouldbemadebyminimizingthe waste produc on through decreased consump on of raw materials and energy and reduced costs related to their recycling. Therefore the paper presents the problem of opera on of medical waste management systems in the voivodship local government health protec on ins tu ons of lubuskie region 20072011. It focuses on endogenic changeswithinthemaectedbythenancialcondi onof themedicalsector.Addi onallythepaperspeciesfactors which inuence the eciency of the medical waste man agementsystemanddenesdierenttypesofthem.More overthemostimportantthreatsresul ngfromthemwere determined. 65% of the exis ng public medical health ins tu ons subordinatedtotheMarshalOceofLubuskievoivodship 20072011 were analyzed as well as materials available in the sta s calbase of theRegionalResearch Center of the MainSta s calOceinZielonaGra THEPROBLEMOFMEDICALWASTEMANAGEMENTIN MODERNHEALTHPROTECTIONINSTITUTIONS Medicalwasteinthemodernhealthprotec onins tu on is a crucial problem. This is because many risks con cerningthem.Thesubjectliteraturedenesmedicalwaste as solid, liquid and gas products occurring at treatment, diagnosis and preven on in medical prac ce of hospitals and other medical ins tu ons as well as research ins tu ons.Pursuantto2oftheRegula onsoftheMinisterof Health of 23.08.2007 on the specic procedure of dealing withmedicalwasteisclassiedasfollows[4]:

medicalwastewithcodes180102*,180103*,1801 80* and 18 01 82* means infec ous waste [5], is haz ardouswastewhichcontainlivingmicroorganismsortheir toxinswhichareknownorwhichprovidereasonableback ground to believe that they cause infec ous diseases of otherpeopleorlivingorganisms, medicalwastewithcodes180106*,180108*and 180110*,isspecial[6],hazardouswastewhichcon tainchemicalsubstancescausingnoninfec ousdis eases of people or other living organisms or which couldbethesourceofenvironmentcontamina on, medicalwastewithcodes180101,180104,1801 07,180109and180181refersto"remaining[7], nothazardousmedicalwaste. Poland produces about 200 thousand tons of medical waste, including 80% of municipal waste which does not posesanitaryrisk.Theother20%ofthetotalmassofpro duced waste is specic waste which require appropriate disposal.[2]Thereforethemedicalins tu onsarerequired toappropriatelycollectandthendisposeittoavoidbiologi cal contamina on which could be caused by such waste. Otherwise there could be a very diverse mixture of dier enttypesofwaste,beginningfromtypicalmunicipalwaste (e.g. food, packaging) through toxic chemicals (e.g. medi cines) and furthermore biologically infected (e.g. tools, dressings). THEORGANIZATIONOFMEDICALWASTEMANAGEMENT SYSTEMSINHEALTHSERVICESINSTITUTIONS Wastemanagementcoversallac onsintendedtomini mize, use or dispose medical and veterinary waste as well astotaladcomprehensivesourcesoftheirorigin,methods of collec ng them, iden ca on and transporta on con trol,technologiesofprocessingthemwithdegrada onand assessment of environment contamina on, measurement ofliquidandgasemissionincludingtheanalysisoftheac vi escost[1].

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M.GAWRON,J.ZBOROWSKAChangesinthesystemsofmedicalwastemanagementinpublichealthprotec onins tu ons...

Hospital infec ons mean currently a signicant chal lenge for the world and Polish medicine and management sciences.Ahospitalasanimportanthealthprotec onins tu onisacompanywhichproduceswasteincludingwaste producedinourhomesaswellasthosewhichareriskyfor people and environment. Therefore relevant management and in par cular supervision of processing waste in terms of epidemiology and work safety is an important factor in preven ngfrom infec ons and requiresdevelopingappro priateecientsystem. Wastemanagementapartfromthepreven onofepide miologicalandenvironmentalinfec onsisalsoeconomical ly important. This is because, waste management and dis posal creates a signicant nancial burden. Depending on thetypeoftheins tu onitmaybefromseveraltoseveral hundredthousandannuallyormore. In the prac cal opera on of Polish health protec on ins tu ons it is possible to observe a defec ve methodof waste management system including among others inap propriatewastesegrega on,qualifyingtoomanywasteas hazardous, sending waste which could be recycled to the dumpingsite.Allthoseactsgenerateaddi onalcosts. Itislogicalthattheproblemofgenera ngwastecannot beavoidedinsuchins tu onsbuttheeconomicra onality together with care for epidemiological safety creates the necessity to develop in health protec on ins tu ons rele vantprocedures,opera onstandardswhichleadtodimin ishing their quan ty and at the same me contribute to ecient waste handling procedures. It seems that the key toecientwastemanagementis: 1. Segrega on into respec ve categories of place and meoftheirorigin. 2. Appropriatewastedivision,dependingonthelevelof riskandtypeofmaterialtostandardisethem. 3. Knowingthecontentandtypeofdierentwastegro ups and which lead to the improvement of waste recyclingordisposal. 4. Ac ons taken to maximise ecient selec ve collec on which depend on knowing rules of waste selec onandquan ty,loca onandmarkingcontainers. 5. Adop ngofrelevantsegrega onproceduresdirectly contributestothecostandmethodoffurtherwaste processing. Knowledgeandcorrectclassica onofproducedwaste is required to plan the waste management. Appropriate and ecient planning and then implementa on brings si gnicantbenetsfortheins tu on.Table1presentssome ofthem.
Table1 Selectedbenetsofwastemanagementsegrega oninhealth protec onins tu on
Internal elimina onoffeesandnesforincorrecthan dlingofwaste, raisingpersonnelawarenessintermsofenvi ronmentsafetyandwastedisposalcosts, developingnewforwasterecycling(asseconda ryrawmaterials)savingrawmaterialsand energy facilita ngtheprepara onofthehealthservice ins tu ontoimplemente.g.qualitymanage mentsysteminlinewithISO9001,environment managementsystemaccordingtoISO14001 and/orhealthandsafetyatworkPNN18001. External increasingposi ve rela onswiththe environment decreasinginuence onenvironment improvingcompe veadvantageon themarketofmedi calservices diusionofgood prac cesofwaste managementtothe environment

THELOCALGOVERNMENTHEALTHPROTECTIONINSTITU TIONSOPERATINGINLUBUSKIEVOIVODSHIPDESCRIP TIONOFTHERESEARCHAREA There are 15 voivodship local government health pro tec onins tu ons,14outofthemareIndependentPublic Healthcare Ins tu ons and only oneLubuskie Specialist Pulmonology and Cardiology Hospital in Torzymsince 3.09.2010operatesasSp.zo.o.(Ltd)withLubuskievoivod shipac ngastheonlyshareholder.Thenextins tu onto be transformed is also Independent Public Hospital for Mental Diseases in Midzyrzecz which is to operate based on similar rules to Torzym. Despite signicant problems withdebts(thetotaldebtsofalllubuskievoivodshiphospi talsasat16April2012isPLN350M)[3]within20072011 noins tu onmaderestructuretoreducethem. The local government of the voivodship as the ins tu on establishing health protec on ins tu ons controls them pursuant to the act of medical ac vity of 15 April 2011[8]andtheRegula onoftheMinisterofHealthof18 November 1999 on detailed rules of supervision of public healthcareins tu ons[9].Thecouncilisexclusivelyrespon sible for crea on, transforma on and closing as well as providing equipment par. 18(19)(f) of the act of 5 June 1998onlocalgovernmentofvoivodship[10],includingthe approvalofchartersandamendmentsmadetothecharters ofsuchins tu ons. The tasks of the Management Board of the voivodship covermanagement,coordina onandcontrolofthehealth servicesins tu onsincludingtheappointmentanddismis sal of managers and appointment of Social Councils and SupervisoryBoards(asinTorzym),conven onofmee ngs and adop on of charters of Social Councils and Company SupervisoryBoards. Asat1April201215healthprotec onins tu onswere subordinatedtothelocalgovernmentofthevoivodshipi.e.: 1. RegionalHospitalSPZOZinZielonaGra. 2. RegionalHospitalforMentallyIllSPZOZinCibrz. 3. LubuskieSpecialistPulmonologyandCardiologyHos pitalSPZOZinTorzym. 4. The Lech Wierusz Lubuski Rehabilita on and Ortho pedicCenterinwiebodzinSPZOZ. 5. Independent Public Health Care Ins tu on Children andYouthTreatmentCenterinZabr. 6. CenterforAddictedPeopleSPZOZ"'NowyDworek". 7. Independent County Public Hospital in Gorzw Wielkopolski. 8. Independent Public Hospital for Mentally Ill in Midzyrzecz. 9. RegionalEmergencySta onSPZOZinZielonaGra 10.IndependentPublicHealthCareIns tu on'MEDKOL' inZielonaGra. 11.RegionalCenterofAddic onandCoaddic onthera pyinZielonaGra. 12.Independent Public Health Care Ins tu on Obwd LecznictwaKolejowegoinGorzwWielkopolski. 13.Independent Public Regional Emergency Sta on in GorzwWielkopolski. 14.RegionalIndustrialMedicineCenterinZielonaGra. 15.Regional Industrial Medicine Center in Gorzw Wielkopolski.

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M.GAWRON,J.ZBOROWSKAChangesinthesystemsofmedicalwastemanagementinpublichealthprotec onins tu ons...

THEANALYSISOFWASTEMANAGEMENTSYSTEMSOF INDEPENDENTHEALTHPROTECTIONINSTITUTIONSSUB ORDINATEDTOTHELOCALGOVERNMENTOFLUBUSKIE VOIVODSHIP20072011RESEARCHRESULTS TheresearchwasmadeinQ12012among65%ofPublic HealthCareIns tu onssubordinatedtotheMarshallOce of Lubuskie Vovodship 20072011. A ques onnaire was applied. Theresearchshowsthatinjec onsincludingbloodsam ples, analy cal tests of biological materials and nally dressings mainly contributed to medical waste among dierenttypesofmedicalservicesoeredinpublichealth care ins tu ons subordinated to the local government in lubuskie voivodship. Next in terms of the number of pro ducedwasteweresurgicalprocedures,cytosta ctreatment and microbiological tests. 20% of the analysed medical in s tu onsdeclaredthepossessionofownwastetreatment plants (mainly biological waste treatment plants), 40% of them disposed waste directly to the municipal sewerage system without any form of waste treatment or pre treatment.Thiscouldlogicallycreateapoten alepidemio logicalrisk.Otherins tu onsdisposedwastetoownhospi talcesspools. Theresearchalsodisclosedthattheglobalamountofall wasteintheanalysedlocalgovernmenthealthcareins tu ons regularly increases However the dynamics of such increasesignicantlydeclined20092010.Therela onsare presentedindiagram(g.1).

recyclingcostof1tonofmedicalwastegraduallydecreases (diagramg.2).

Fig.2.Averagewastemanagementcosts,perunit,per1tonof wastemanagement20072011(inPLN)

Observedin20072010decreaseoftheaveragecostsof management of 1 ton of waste may prove the improve mentoftheeconomiceciencyofexis ngintheanalysed ins tu ons waste management systems. This can be con rmedbythedecreaseoftheaveragecostof"service"of1 tonofwastecomparingtotheirgrowingquan ty. Howeverthesuddenobservedonthediagramno.2in creaseoftheaverageunitcostin2011couldbetheresult of ina on pressure observed in the economy, due to the increaseofindirectcostsi.e.energyortransporta on.This can also prove dispropor onate increase of the average unit cost of waste management comparing to their in creasedquan ty.

CONCLUSIONS The problem of waste management in lubuskie health protec on ins tu ons (and not only there) is constantly importantand uptodate due to the related risks and will evengrowinimportanceinthefuture.Itcanbeprovedby theconstantly growing produc on volume in the analysed periodwhichspeciedcertainlongtermtrendsandgradu allyincreasingin20072011globalcostsofitsrecycling.All theseaspectscombinedwiththedicultnancialsitua on Fig.1.Dynamicsofmedicalwasteincrease of the Polish health protec on system would be a signi Atthesame meglobalcostsofwastemanagementof cantchallengetheyhavetofaceinthenextyears.There the en re analysed group 20072011 proved regular search made clear that the analysed Independent Public Health Protec on Ins tu ons opera ng in the dicult growth.Thisrela onispresentedintable2. nancialsitua onofthehealthsectorin20072010gradual Table2 Approximatecost(global)ofallwastemanagementsystemsin ly increased the eciency of waste management systems healthprotec onins tu onssubordinatedtotheMarshallOce so the average cost of 1 ton of waste management recy ofLubuskieVoivodship20072011 cling gradually decreased in that period. This could be ex pressedbyseekingimprovementsinthatareafocusingon Costsperyears(inPLN) nancial savings for growing quan ty of produced waste 20072010. Interes ngly enough the research showed as 2007 2008 2009 2010 2011 well that the external ina on pressure related probably withtheobservedpricesincreaseinthena onaleconomy 299853.3 288676.7 657108 676612.5 894255 in 2011couldaect the decrease of this eciency. There fore public authori es who specify the areas of opera on Howevertheanalysisofcostvaria onperunitcostof1 of such ins tu ons should be responsible for considering ton of medical waste management from A, B, C group fo those issues when developing waste management pro cusingtospecifytheeconomiceciencyofthesystempro grams and instruments suppor ng restructure and im vides very interes ng informa on. 20072010 the average provement of waste management systems of the ins tu onsofthePolishmedicalservicessector.

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REFERENCES [1] Wandrasz J.: Sanitacja i termiczne unieszkodliwianie odpadwwobowizujcychprzepisach(Sanita onand thermalwasterecyclingaccordingtoregula ons).Ab rys.Pozna2004,s.6 [2] Wyrbek H.: Zarzdzanie gospodark odpadami medycznymiwPolsce.ZeszytyNaukoweUniwersytetu PrzyrodniczoHumanistycznegowSiedlcach.2010. [3] h p://www.zachod.pl/2012/04/dlugiszpitali/ [4] Regula onoftheMinisterofHealthof23.08.2007on detailedprocedureofhandlingmedicalwasteJ.o.L.of 2007No.162(1153)1153.

[5] Regula onoftheMinisterofHealthof23.08.2007on detailedprocedureofhandlingmedicalwasteJ.o.L.of 2007No.162(1153)1153. [6] Regula onoftheMinisterofHealthof23.08.2007on detailedprocedureofhandlingmedicalwasteJ.o.L.of 2007No.162(1153)1153. [7] Regula onoftheMinisterofHealthof23.08.2007on detailedprocedureofhandlingmedicalwasteJ.o.L.of 2007No.162(1153)1153. [8] Act of 15.04.2011 on medical ac vi es. J.o.L. No. 112 (654)645asamended. [9] Regula onoftheMinisterofHealthof18.11.1999on detailed rules of supervision of independent public health care ins tu ons and sanitary transport J.o.L. No.94(1097)1097.

MaciejGawron JagodaZborowska UniversityofZielonaGra Scien cGroupofEcoManagement ul.Podgrna50,65246ZielonaGra,POLAND email:mgwr.gawron@gmail.com;j.jagoda@poczta.fm

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