The Study on Hospital Waste Management Practices Among the Different Hospitals of Bheemdatta Municipality of Kanchanpur District, Far-Western Region, Nepal

Background : Hospital waste refers to the wastes generated by healthcare facilities, from their departments like laboratories, pathology, nursing, surgical, mortuary & autopsy & various other units in either solid or liquid form which can be either general non-hazardous waste, hazardous waste, infectious waste toxic or radioactive waste. The proper management of healthcare waste is essential to prevent from the adverse outcomes that the improper waste can cause to deteriorate the health of human beings, animals, hospital patients etc. It also forbids the possibility of infectious disease spreading, & greatly reduces the risk to public health. Hospital wastes are dangerous for each & every life in the earth thus, they need to be managed safely with proper plan, policy that helps to make environment hygienic, infection free & clean. Objectives : The overall objective of this study is to identify the hospital waste management practices among the different hospitals. Methodology: A cross sectional study was conducted in the hospitals of Bheem dutta municipality of Kanchanpur district where the convenience hospital staffs were selected & used to collect the data. The total sample size of 81 is taken which by using non-probability convenience sampling by considering limited time, resources & accessibility. Structured questionnaire was used as a major tool for this study. Result : According to the data analyzed, it is found that all the hospitals have proper HCW management plan & each of


Introduction
Hospital waste are generated by healthcare facilities, from their departments like laboratories, pathology, nursing, surgical operation, mortuary & autopsy, blood bank & various other units in either solid or liquid form. The waste generated is either a general, non-hazardous waste or an infectious, toxic, or radioactive waste. Healthcare activities are performed to save-guard, cover & restore the life of people but the wastes generated from such activities are becoming the leading cause for ensuring the adverse health and environmental impacts on our mother Earth & human lives along with animals, microorganism, & hospital patients. But, what about the waste generated by hospitals & their by-products? It's management is becoming a hurdle in all around the globe but has caused more challenge in developing countries like ours Nepal too. Globally, proper waste management practices are still lacking in implementation all over the areas although the regulations and plans have been made. (3) As latest data, 1 in 3 healthcare facilities in a world is still not safely managing the hospital waste. (1) There are still deficiencies in practices and solutions to reduce the healthcare waste and its impact on health of human and environment. Especially, after the COVID-19 pandemic the hospital waste generation load has increased tremendously which generated 143 tons of additional waste only in a form of syringes, needles & safety boxes. (4) In context of Asia, issue regarding the proper management of healthcare waste exists due to large population of Asian developing countries, high rates of urbanization and high financial need to manage it in a proper way & their failing to implement the proper waste management practice. (1) Although the rules and regulations are formulated by government of Nepal but still they are not being implemented in accordance to the guidelines by all the hospitals for management of their wastes which is again creating the pathetic environment for us to live due to our own deeds.(2) So, there should be proper and strict implementation, evaluation of the policies and plans formulated & the monitoring should be done by authorized body regularly and identify the areas for improvement that are creating the hindrances on proper implementation of the plan. (6)

Objectives
The objectives can be discussed as:-

General objectives
The general objective of this study was to identify the hospital waste management practices among the different hospitals in Kanchanpur district.

Specific objectives
1. To identify the practices pattern adopted by the hospital regarding the hospital waste management. 2. To inspect whether the management is being done as recommended by WHO and concerned guidelines or not 3. To find out the awareness on hospital staff about the hazard of improper waste management 4IJFMR23045320 Volume 5, Issue 4, July-August 2023 3 4. To find out the best way that can be adopted by hospital for proper waste management in accordance to their need & feasibility Research questions a) Are the hospitals following the healthcare waste management practices as recommended by WHO or national authority not? b) What is level of knowledge and awareness regarding the proper waste segregation, storage and disposal to the hospitals? Methodology Study type: It was a Quantitative research methodology was used for this study.
Research design: Cross-sectional study design was used for this study.

Study area:
The study area was kanchanpur district of farwest Nepal.

Findings
In this chapter different data was calculated and finding or the results was calculated out. The finding should have the direct linkage with the specific objectives of the study. Disposal of the plastic and saline bottles in the hospital:        The above data is about the use of different color coded containers in the hospitals to segregate the various hospital wastes, where it is found that all (100%) hospitals uses it to segregate their waste.

Indicators Frequency Percentage
Yes 81 100.0 Table 9: HCW management plan The above data shows that, all the hospitals have proper healthcare waste management plan of theirs for wastes proper collection, segregation, and disposal of a waste to reduce the unnecessary wastage.  The above data shows about the hospitals having the proper healthcare waste management plan where it can be seen that all the hospitals in the Bheem dutta municipality have proper HCW management plan.

barriers in proper HCW management
The above data shows that lack of knowledge and awareness is the main barrier creator in managing the healthcare waste properly i.e.(44.44%), followed by lack of proper policy and guidelines & others like lack of government support, lack of strict municipality policy.

Discussion
Despite being a severe problem and having very hazardous nature, causing a lot of negative consequences there is still lacking the proper measures for healthcare waste management in Bheemdatta municipality hospitals which needs to be major concern for all related sectors but, sadly it has not been anything like that. The data analyzed above clearly shows that, still there is lack of proper awareness among the staffs, management for proper handling of waste and managing the wastes in an appropriate manner. Only having a proper healthcare waste management plan isn't being okay for the hospitals where they are being unable to strictly implement the plan in the practicality and that is leading to the problem. All the hospitals have proper HCW management plan & they follow it up to certain extend but still they have inability in owning the autoclaves within their hospitals as only 77.8 percentages of have it and rest lacks. On practice of hospitals for encouraging hospital waste minimization, mostly the hospitals are seen to use separation of waste properly in color coded containers as according to data i.e.(45.7%), followed by segregating waste as according to the government set guidelines i.e. (18.5%) creating awareness about waste handling (13.6%), reducing the use of plastic bags, practical teaching to the staff about proper handling & others. Although majority of hospital staff i.e. (93.8%) have proper knowledge regarding the safe handling of waste materials still they aren't following it in practicality. Only (40.7%) of hospitals are using the separate route for waste transportation from hospital to avoid passage of waste through patient area which can cause the infection to patients & visitors. (8) All the hospitals in the Bheemdatta municipality uses municipality vehicle to carry the wastes from hospital to disposal area i.e.(100%). The rate of vaccination to staff working in the hospitals along with waste handling is also seen low as only (60.5%) of staff are vaccinated against tetanus, Hepatitis B & other infectious disease from which we can conclude that the staff working on handling the wastes aren't fully secured & safe. For the disposal of sharp wastes majority of the hospitals are using needle destroyer i.e. (45.7%), followed by disinfecting technique i.e. (18.5%) & other like dumping in proper places. Only about half percentages i.e.(56.8%) of hospitals are following the recommendation and guidelines of WHO in healthcare waste management process & rest of (43.2%) are managing wastes in their own way without any standard guidelines. From the data above, the main barriers enlisted for not creating proper healthcare waste management is lack of proper knowledge to the staff and lack of proper policies & guidelines i.e. (19.8%) followed by lack of awareness of hazards being created by the improper handling of the wastes i.e. (14.8%) along with other measures like lack of government strict policies, lack of government support, low finances with hospitals etc. Moreover, the municipality has also no proper standard guidelines, policies created that needs to be maintained by the hospitals for waste management, waste segregation process. On analyzing the data of minimizing the problem of improper HCW management and creating the well organized and systemized process for waste handling and managing the waste properly to decline or minimize the consequences of improper management, mostly there is need of creating awareness on the hospital staff for proper waste handling & providing them knowledge about the hazardous consequences of wastes i.e. (19.8%), followed by legislating strict municipality policies and guidelines for hospitals in which they can adhere & follow to minimize mismanagement of wastes i.e. (17.3%) from municipality, & others like providing training to all the staff about handling wastes, applying 3R technique to reduce the quantity of waste generated, government aids etc. Major factors contributing for the improper healthcare waste management is lack of proper implementation of policies, lack of formulation of the policies specific to hospitals that are suitable for the implementing them practicality & no strict guidelines regarding the waste management by government & municipalities.

Conclusion and recommendations Conclusion
Hospital waste management is a significant environment and social obligation, & hence requires a proper plan along with practical implementation in reality to reduce the negative consequences of the improper waste management. The plans should be made in a standard protocol in order to do effective waste disposal. From above study and data analysis, we can conclude that, even though all the healthcare facilities are having a healthcare waste management plan but still they are unable to implement it properly which results as a critical problem. The proper healthcare waste management is still not being able to be practiced and the positive results are not achieved. There is scarcity of enough finance with the hospitals to own the incinerators, & other machines for proper waste management. The staffs are still not able to differentiate the wastes properly and are handling the wastes without any safety guidelines and measures. There is still no separate route for transmission of hospital waste from avoiding the patient and visitors area which creates a high risk of infection. All the hospitals are using the municipal vehicle to carry the hospital waste and don't have their own personal vehicle to transport the waste. Municipality also lacks the concern for proper waste management in the Bheemdatta municipality as it hasn't formulated any specific guidelines for waste segregation, collection and disposal, and lacks the proper management. The hospital staffs are also not fully vaccinated against the tetanus, Hep.B and other diseases that may be transmitted from the mishandling of infectious waste. There seems to have bottlenecks in proper handling and management of hospital wastes like lack of standard guidelines that are strictly adhered to follow, lack of awareness among the waste handling staff, lack of adequate finances and no use of recycling, reusing, and reducing techniques to minimize the wastes which needs to be addressed by the government and municipality by formulating the strict policies and providing awareness & education among all the waste handling staff for making them know an efficient way of handling the hospital wastes.

Recommendation
Hospital waste management is a significant environmental and social obligation, that needs to be achieved for making the hospitals clean, hygienic, and infection free along with meeting the criteria and standard set by WHO to be recognized as a having the hospitals providing qualitiable services and meeting the international standard by competing in global service market. The findings of the present study addresses the need for the effective policies, awareness and education along with training the staffs on proper waste handling to solve the problem arising from improper healthcare waste management. As per the findings following recommendations are given: • Proper policies should be made by government regarding healthcare waste management • Municipality should undertake strict actions for implementing the guidelines set by it • Awareness should be provided to hospital staffs, visitors, and the community people regarding the consequences of improper waste management • Hospital waste handling staffs should be given training for proper handling of the wastes • Emphasis should be given on reuse, reduce and recycling of wastes • Government should provide aid to the hospitals for installing the incinerators • Passage route of waste and patient & visitors should be separated • All the hospitals should strictly follow their plan in practicality too • All the hospital staff should be vaccinated compulsorily