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Waste Management 25 (2005) 622–625

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Medical waste management in Jordan: A study at the


King Hussein Medical Center
a,* b,1 a,1
Rami Oweis , Mohamad Al-Widyan , Ohood Al-Limoon
a
Biomedical Engineering Department, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan
b
Biosystems Engineering Department, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan

Accepted 25 March 2005


Available online 8 June 2005

Abstract

As in many other developing countries, the generation of regulated medical waste (RMW) in Jordan has increased significantly
over the last few decades. Despite the serious impacts of RMW on humans and the environment, only minor attention has been
directed to its proper handling and disposal. This study was conducted in the form of a case study at one of JordanÕs leading medical
centers, namely, the King Hussein Medical Center (KHMC). Its purpose was to report on the current status of medical waste man-
agement at KHMC and propose possible measures to improve it. In general, it was found that the centerÕs administration was rea-
sonably aware of the importance of medical waste management and practiced some of the measures to adequately handle waste
generated at the center. However, it was also found that significant voids were present that need to be addressed in the future includ-
ing efficient segregation, the use of coded and colored bags, better handling and transfer means, and better monitoring and tracking
techniques, as well as the need for training and awareness programs for the personnel.
Ó 2005 Elsevier Ltd. All rights reserved.

1. Introduction However, it seems that the fraction of waste generated


at medical institutions, known as special or regulated
In the last few decades, human activities and changes medical waste (Lee et al., 2004) or otherwise known as
associated with lifestyles and consumption patterns have clinical waste (WHO, 1994), has not attracted the same
resulted in the generation of huge volumes of different level of attention as other types of wastes, particularly in
types of wastes. The wastes have threatened the survival developing countries, despite the fact that medical waste
of humans and other living things, as well as all natural is labeled as hazardous because it poses serious and di-
resources that are necessary to human existence (Henry rect threat to human health (Coad, 1992; WHO,
and Heinke, 1996). Consequently, waste management 1999). Throughout this study, the term Ômedical wasteÕ
and the pollution problems associated with waste gener- is used to mean the special (regulated) or clinical portion
ation have attracted significant attention and a great of waste generated in medical institutions, unless other-
deal of research has been conducted on these topics (La- wise specified.
Grega et al., 1994). Jordan enjoys one of the most advanced and compre-
Throughout most of the world, medicine is one of the hensive medical care and service systems compared to
sectors that has witnessed significant improvement. the whole region of the Middle East. The Ministry of
Health (MoH) estimated the number of beds in the
*
country in 2002 at 10,000, compared to about 7400 in
Corresponding author. Tel.: +96227201000; fax: +96227095018.
E-mail addresses: oweis@just.edu.jo (R. Oweis, O. Al-Limoon),
1995. This number keeps on rising with the active partic-
widyan@just.edu.jo (M. Al-Widyan). ipation of the private sector that owns some of the larg-
1
Tel.: +96227201000; fax: +96227095018. est and most sophisticated medical centers in the

0956-053X/$ - see front matter Ó 2005 Elsevier Ltd. All rights reserved.
doi:10.1016/j.wasman.2005.03.011
R. Oweis et al. / Waste Management 25 (2005) 622–625 623

country. Yet, in Jordan, like in many other developing In addition, the KHMC complex includes a Joint Ser-
countries, little emphasis has been placed on the proper vices Department for management and administration
handling and disposal of medical waste (Mato and Kas- and other supporting general services required to run
eva, 1999). and serve the facility, including but not limited to sup-
A report published by the MoH along with the Gen- ply, nutrition, maintenance, patient wards, staff resi-
eral Organization for Environmental Protection and dences, etc.
Jordan Environment Society, indicated that medical In this study, special attention was given to radio-
waste in Jordan suffers from serious mismanagement active waste produced in the Nuclear Medicine
practices that, generally, deviate substantially from the Department, which contains the so-called hot lab
standard acceptable practices established by relevant where radioactive material is prepared, radioactive
international bodies (WHO, 1999). It was also reported waste is managed, and radioactivity and radioactive
that medical waste is mixed with the municipal waste doses are monitored (by a dose calibrator). About
and that medical liquid waste is disposed of in the public 30 patients visit the department daily for diagnosis
drainage network (Jaffal, 2003; Al-Qudah, 2000). Such and therapy.
practices create potential public health risks to humans
and a burden on the environment.
In light of all the above, this study was initiated and 3. Methodology
intended as a case study in Jordan. It was conducted in
the King Hussein Medical Center in Amman, which is The KHMC was selected because it is one of Jor-
one of the leading medical centers in Jordan and the re- danÕs oldest, largest, most advanced, sophisticated,
gion. The goal was to report on current status of regula- and comprehensive medical compounds. Consequently,
tions and practices regarding medical waste management it is believed that in this center, the level of awareness
in the KHMC in order to identify the areas of good and of the significance of the proper handling of medical
acceptable medical waste handling procedures, indicate waste is higher than anywhere else in the country.
mismanagement practices, and propose potential reme- The methodology of this particular study was a two-
dies and solutions. Special emphasis was placed on radio- stage strategy:
active waste, which refers to materials contaminated with
radionuclides beyond a given threshold level established 1. Becoming familiar with the rules, procedures, and
by the IAEA (Sztanyik, 1993). regulations set forth by the centerÕs Directory to be
followed by the concerned personnel regarding the
management of medical waste generated at the cen-
2. Description of the KHMC ter. The centerÕs Directory may be accessed via the
website: www.jrms.gov.jo.
The KHMC complex lies on a total area of 650 acres 2. Spending enough time in the different departments of
and includes three major centers: the center recording observations and writing notes in
a critical manner about the practices of the medical
1. King Hussein Hospital (KHH): this is a 56000-m2 waste management by the concerned personnel.
building with a total capacity of 583 beds. Each year,
about 458,000 patients visit this center with about These two steps were carried out with the help and
25,000 admissions. This hospital is equipped with 11 guidance of a specialized officer and were meant to re-
operating theaters and 1830 employees. The KHH port reliable results and conclusions regarding the extent
consists of 12 departments in most medical specialties. to which the medical waste is handled at the KHMC in
2. Farah Royal Jordanian Rehabilitation Center light of written policies and established international
(FRJRC): this is a five-story building with a total standards in this regard (WHO, 1999).
capacity of 150 beds equipped with 4 operating Being aware of its serious impacts on humans (Al-
rooms and with 404 employees. This center consists Qudah, 2000; Sztanyik, 1993), special emphasis was
of 13 departments with 7 specialized clinics and is placed on the handling and management of the radioac-
provided with a Mayo Clinic satellite link. tive waste generated in the Nuclear Medicine Depart-
3. Queen Alia Heart Institute (QAHI): this is a 13000-m2 ment at the KHMC.
four-story building with a total capacity of 108 beds.
It consists of four departments mainly for cardiac
care and an outpatient clinic. 4. Medical waste management in the KHMC

The three centers are served by a nursing department The management of medical waste in the KHMC is
that provides all nursing services by professional and directed by a seven-member committee appointed for
highly trained personnel. the purpose of administering medical waste handling
624 R. Oweis et al. / Waste Management 25 (2005) 622–625

in the compound. The committee meets on a monthly to check the activity level in the department.
basis and issues recommendations to all the centerÕs The ÔSurveyor 50Õ is a portable detector (sur-
departments and oversees the implementation of the vey meter) for c-and X-ray exposure rate
management rules by the concerned personnel. Observa- measurement or a-, b-, c-, and X-ray count
tions during carrying out this study indicated that, in rate measurements. The ÔMonitor 5Õ is a
general, good management practices of medical waste device that allows full view of the meter in
do exist in the KHMC including: a large window for good reproducibility
and extra ray sensitivity.
1. Establishing procedures for the collection, separa- B. Personal monitoring: instruments such as a
tion, transfer and disposal of medical waste such as: thermo luminescent dosimeter (TLD) are used
(i) identifying waste type, mainly to monitor the radiation dose that
(ii) separating non-medical (general) waste from reaches the medical staff due to their exposure
medical waste, to radiation.
(iii) using appropriate labeled bags based on a color (ii) Radioactive waste management: for both solid
guideline, and liquid radioactive wastes.
(iv) placing waste in transparent labeled bags in case A. Solid radioactive waste (0.5 m3/d): includes
of shortage of an appropriate bag type, contaminated syringes (with Tcm99), gloves
(v) transferring all waste bags on wheeled containers and capsule containers (for I131). These
and using utility gloves when dealing with broken waste materials are stored in special lead
bags and waste and then decontaminating them. containers lined with yellow bags and kept
2. Enforcing strict rules when dealing with sharps and in to decay to safe levels of radiation (less than
case of injuries caused by sharps. 5 lSv/h) at which point they are sent to the
3. Applying specific procedures for the decontamination incinerator.
of contaminated instruments. B. Liquid radioactive waste (40–50 l/d):
4. Using high-level disinfection (solution) and applying includes contaminated hand washing water
different sterilization techniques (steam, hot-air, and patients liquid waste. This waste is
chemical, and gas) for surgical and other instruments. passed to the delay region where it is stored
5. Establishing disposal subcommittees in different to reach a safe level of activity (1–5 lSv/h)
departments to monitor the disposal of medical and then released to the public drainage
waste. Upon separation of waste into medical and system.
general (non-medical) fractions, the major disposal
and predisposal (IAEA, 2000) practices of medical
waste in the KHMC include: 5. Conclusions and recommendations
(i) collection of certain waste items in yellow bags
and then transferring them to the incinerator. Based on the findings of this study, the following con-
Such items include syringes, gloves, contami- clusions may be drawn:
nated paper, and contaminated disposable medi-
cal tools, 1. The staff at the KHMC is aware of the significance
(ii) storing sharps in sharps containers, of managing medical waste generated at the
(iii) washing surgical tools and storing them in bags compound.
prior to transferring them to sterilization, 2. Separation of waste generated into medical and
(iv) placing body parts in labeled bags prior to send- non-medical waste is practiced to a satisfactory
ing them to the dead refrigerator. extent.
6. Adopting strict measures for the management of 3. Radioactive waste is managed and treated according
radioactive waste including appointing a radiation to high international standards (WHO, 1999).
protection committee that consists of specialists in 4. Shortcomings in the medical waste handling system
nuclear medicine and nuclear physics to oversee the at the KHMC do exist most notably of which are:
disposal of radioactive waste. The management of (i) failure to quantify the waste generated in reliable
radioactive waste at the KHMC includes the follow- records,
ing procedures: (ii) lack of the use of colored bags by limiting
(i) Radioactivity monitoring: includes both environ- the bags to only one color (yellow) for all
mental and personal monitoring. wastes,
A. Environmental monitoring: instruments such (iii) the need for training the staff on how to deal with
as ÔMonitor 5Õ and ÔSurveyor 50Õ are used to hazardous waste,
make sure that solid radioactive waste (iv) the need for establishing national standards, par-
reaches safe levels before final disposal and ticularly for medical waste packaging.
R. Oweis et al. / Waste Management 25 (2005) 622–625 625

5. Overall, it may be stated that, at the local level, the Henry, G., Heinke, G., 1996. Environmental Science and Engineering.
KHMC may be considered a good example for other Prentice-Hall, Englewood, NJ, USA.
IAEA, Predisposal management of radioactive waste, including
medical centers as far as medical waste management decommissioning, Safety Standards Series No. WS-R-2 2000.
is concerned. Jaffal, G., 2003. Biomedical waste management problems and strategic
solutions. Unpublished Report Supervised by Dr. Yaseen Hayaj-
neh, College of Medicine, Jordan University of Science and
Technology, Jordan.
LaGrega, M., Buckinham, P., Evans, J., 1994. Hazardouss Waste
Acknowledgements Management. McGraw-Hill, New York, USA.
Lee, B.-K., Ellenbecker, M., Moure-Ersaso, R., 2004. Alternatives for
The authors are indebted to the KHMC for provid- treatment and disposal cost reduction of regulated medical wastes.
ing all the necessary support. Thanks are due to Dr. Waste Management 24, 143–151.
Ibraheem Habashneh for his invaluable assistance. Mato, R., Kaseva, M., 1999. Critical review of industrial and medical
waste practices in Dar es Salaam City. Resources, Conservation
and Recycling 25, 271–287.
Sztanyik, L., 1993. A review of the management of radioactive wastes
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