Submitted in accordance with the requirements for the Doctors Degree of Technology: Business Administration, Durban University of Technology, 2009. / Although there is an abundance of health care waste information in South Africa, not enough studies have been done in public district hospitals particularly in rural areas. Hospitals find it difficult to comply with the minimum requirements of health care waste management guidelines, such as segregation of waste. If hazardous waste gets mixed with non-hazardous waste, waste disposal and treatment become costly. Furthermore, there has been a sharp increase in the amount of waste generated from health facilities. However, there seem to be uncoordinated efforts in each province in dealing with waste problems. The purpose of this study was to evaluate the process of operational and administrative procedures of health care waste management in hospitals. The study was conducted to facilitate the optimisation of waste management. A quantitative approach was chosen for this study because cause and effect relationships can more easily be identified, and the research is more structured and controlled. The project involved an enquiry into the perception of respondents on the procedures used in managing health care waste. Data was collected from 270 respondents out of 27 hospitals in nine provinces of South Africa. The informants were health care waste workers who were either directly or indirectly involved in waste management. A questionnaire was used as a research instrument. Results were analysed statistically using a special package for scientific studies. It has been found that in the midst of financial challenges, hospitals are unable to prioritise and rank absolutely important activities that are necessary to be undertaken to meet minimum requirements of health care waste management as laid out in the health care waste guidelines and directives. Shortages of waste equipment such as trolleys, waste containers, and temporary storage areas were the main challenges facing hospitals. The recommendations set the tone and provide a blueprint that health care managers may consider in facilitating improvement in the management of health care waste.

Thesis (MTech (Environmental Health))--Cape Peninsula University of Technology, 2007 / This study examined the medical waste management practices of Tygerberg Hospital. The researcher made use of both primary and secondaiy data. Since this was a is study, the analysis is essentially descriptive.The results of this study revealed that both general and medical wastes are generated in the hospital. Tygerberg Hospital does not quantify medical waste. Segregation of medical wastes into infectious medical waste and non-infectious medical waste is not conducted according to definite rules and standards. The hospital does not label infectious waste with Biohazard symbol. Separation of medical waste and municipal waste is however practiced to a satisfactory extent. Wheeled trolleys are used for on-site transportation of waste from the points of production (different wards) to the temporary storage area. Staff responsible for collecting medical waste use almost complete personal protective equipment. The results of this study indicated that off-site transportation of the hospital waste is undertaken by a private waste management company. Waste is transported daily and small pickups are mainly used by the waste management company for transporting the waste to an off-site area for treatment and disposal. The final disposal of the medical waste is done by the private waste management company. The main treatment method used in the final disposal of infectious waste is incineration. Non-infectious waste is disposed of using land disposal method. The hospital does not recycle medical waste materials except white office paper and mixed office paper and the use of empty containers of antiseptics for the collection and temporary storage of sharps.The hospital does not provide training for staff members on the health and environmental effects of infectious waste. The waste management company's workers have also not received any formal training with regards to medical waste management. The study showed that Tygerberg Hospital does not have a policy and plan in place for managing medical waste. There is no definite policy or plan for purchasing the necessary equipment and for providing the facilities for the correct management of medical waste in the hospital. There are also no policies and guidelines regarding the recycling of medical waste products. There are a number of problems the hospital faces in terms of medical waste management, including; lack of necessary rules, regulations and instructions on the different aspects of collection and disposal of waste, intermingling of hazardous wastes with domestic waste in the hospital sometimes, failure to quantify the waste generated in reliable records, lack of use of coloured bags by limiting the bags to only one colour for all waste, the absence of a dedicated waste manager, the supervisor in charge of general services has waste management as part of his job schedule, and there is no committee responsible for monitoring the management of medical waste. From the results of this study, it is obvious that medical waste management is not practiced according to the World Health Organisation's (WHO's) recommended standards. There are some areas where medical wastes are not properly managed. It is imperative for significant investment in the proper management of medical waste in order to reduce the health risk it poses.

Thesis (MPH.) -- University of Limpopo, 2016. / Background: Health care workers produce various types of waste in the course of rendering health care services. Each classification of waste must be disposed according to the prescribed guidelines. Improper disposal of waste may pose a danger to employees, patients and the environment. Health care workers must have adequate knowledge on disposal of medical waste. This study was therefore done to determine the knowledge and practices of health care workers on medical waste disposal. Objectives: This study aims to determine the knowledge and practices of health care workers on medical waste disposal at a hospital in the Mpumalanga Province in South Africa. Methods: A quantitative cross-sectional research approach was used at a regional hospital for the Mpumalanga Province in the Bushbuckridge Municipality under the Ehlanzeni District. The study respondents included professional nurses, enrolled nurses, enrolled nursing assistants, medical doctors, dental health and allied health staff. Data were collected through self-administered questionnaires analysed using International Business Management Statistical Package for Social Sciences 22 (IBM SPSS 22). Results: The results show that a high percentage of health care workers did not have adequate knowledge regarding disposal of medical waste but disposed medical waste appropriately. The results further show that knowledge and practice of health care workers had no association with age, gender and years of experience. There is an association between professional category and knowledge and practice of healthcare workers. Conclusion: Disposal of medical waste is the responsibility of all health care workers. There should be regular training of all categories of health care workers to improve their knowledge on disposal of medical waste and minimise the risks associated with improper waste management. This will further increase compliance with the guidelines of disposal of medical waste. Key words: Health care workers, medical waste, knowledge, practice, disposal

Thesis (MTech (Environmental Health))--Cape Peninsula University of Technology, 2011. / Pharmaceuticals have been formulated to influence physiological systems in humans, animals, and microbes but have never been considered as potential environmental pollutants by healthcare professionals. The human body is not a barrier to chemicals, but is permeable to it. Thus after performing their in-vivo functions, pharmaceutical compound introduced into the body, exit mainly via urine and faeces. Sewage therefore contains highly complex mixtures of chemicals in various degrees of biological potency. Sewage treatment works including those in South Africa, on the other hand, are known to be inefficient in removing drugs from sewage and consequently either the unmetabolised pharmaceutical compounds or their metabolites emerge in the environment as pollutants via several trajectories. In the environment, the excreted metabolites may even undergo regeneration to the original parent molecule under bacterial influence, resulting in "trans-vivo-pharmaceutical-pollution-cycles". Although all incinerators are known to generate toxins such dioxins and furans from the drugs they incinerate, all the medicines disposed by the hospitals under research, were incinerated, as the preferred option of disposal. The incineration process employed was found to be environmentally unsafe. Expired and unused medicines which the general public discard as municipal solid waste become landfilled. Because many landfill sites are not appropriately engineered, the unwanted drugs landfilled therein, leach into the surrounding ground water, which is the influent source of water treatment plants. Water treatment plants, including those in South Africa, are also inefficient in eliminating pharmaceutical compounds, releasing them in sub-therapeutic concentrations into potable tap water as pollutants, the full effects of which are yet to be determined.

Thesis (MPH.) -- University of Limpopo, 2016 / Introduction The aim of the study was to determine the knowledge and practices of health care workers on medical waste disposal at George Masebe Hospital, Waterberg District, Limpopo Province, South Africa. Method A cross sectional study was conducted and simple random sampling was used to select participants. Data was collected using self-administered questionnaire which where total of 141 participants were sampled using the Slovin formula. Data were analyzed using the IBM SPSS Version 22 and both descriptive and inferential statistics were used to answer the study objectives. Results The study shows that 43% of the respondents had good knowledge on medical waste disposal, 13% were not sure and 44% had insufficient knowledge. Forty nine percent (49%) of the respondents practiced safe medical waste disposal, 4, 3% were moderate in practice and 46, 1% had insufficient practice in place. There was no statistical significant relationship between knowledge and practice of medical waste disposal control measures of health care workers. Conclusion The study concluded that knowledge of the respondents on medical waste disposal was insufficient, there were satisfactory medical waste practices and there was no relationship between knowledge and practice.

The South African Waste Information System (SAWIS) was developed by the Department of Environmental Affairs and Tourism (DEAT) in 2005. This is a system used by government and industry to capture routine data on the tonnages of waste generated, recycled and disposed of in South Africa on a monthly and annual basis. All waste producers and waste management organisations should contribute to this national waste database and should accurately monitor the types and quantities of waste produced and handled. According to DEAT (2006) the need for Data verification is important. DEAT (2006:59) defined the term Data Verification as: "assessing data accuracy, completeness, consistency, availability and internal control practices that serve to determine the overall reliability of the data collected." The aim of the study is to determine a procedure, as well as the nature and extent of internal and external source documents, which could be used in the reconciliation of medical waste quantities from generation to disposal. The key objectives are to determine whether the selected hospitals keep internal records of the quantities of medical waste generated; to reconcile the waste quantities on the internal records with the external records, such as the collection certificates, invoices and waste incineration certificates; to ascertain whether the quantity of medical waste generated is equal to the quantity of waste incinerated and disposed of to determine the ratio factor between the quantity of medical waste before incineration and the quantity of the residue (ashes) after incineration, and to make recommendations on the reconciliation of waste quantities from the point of generation to the point of disposal. The results of the study indicate that the destruction certificate is the proof that the waste that was on-site collected by the service provider has been disposed /treated. Especially as an internal control measure. The health care risk waste (HCRW) management record keeping of quantities of weight as per Hospital A, Hospital B and Hospital C allows the opportunity to analyse the weight per month and per Hospital and per category and to make comparisons. The weakness or the gap however still exist that the waste is not weighed at the point of origin, but at the point where the waste service provider collects the waste onsite. It is from this point onwards that the service level agreement between the hospital and the waste service provider and the document management system and the tracking receipt and the waste collection documents (WCD) becomes relevant and where the quantities of waste per category are for the first time recorded. The hypothesis as stated in Chapter 1 was proven valid. The study concludes that reconciliation and comparison between the collection certificate and the destruction certificate and the monthly invoice is therefore possible, but the risk of mixing of waste and the understating or overstating of waste quantities is still not overcome. / Environmental Sciences / M. Sc. (Environmental management)

Thesis (MTech(Environmental Health))--Cape Peninsula University of Technology, 2011. / Pharmaceuticals have been formulated to influence physiological systems in humans, animals, and microbes but have never been considered as potential environmental pollutants by healthcare professionals. The human body is not a barrier to chemicals, but is permeable to it. Thus after performing their in-vivo functions, pharmaceutical compound introduced into the body, exit mainly via urine and faeces. Sewage therefore contains highly complex mixtures of chemicals in various degrees of biological potency. Sewage treatment works including those in South Africa, on the other hand, are known to be inefficient in removing drugs from sewage and consequently either the unmetabolised pharmaceutical compounds or their metabolites emerge in the environment as pollutants via several trajectories. In the environment, the excreted metabolites may even undergo regeneration to the original parent molecule under bacterial influence, resulting in “trans-vivo-pharmaceutical-pol ution-cycles”. Although all incinerators are known to generate toxins such dioxins and furans from the drugs they incinerate, all the medicines disposed by the hospitals under research, were incinerated, as the preferred option of disposal. The incineration process employed was found to be environmentally unsafe. Expired and unused medicines which the general public discard as municipal solid waste become landfilled. Because many landfill sites are not appropriately engineered, the unwanted drugs landfilled therein, leach into the surrounding ground water, which is the influent source of water treatment plants. Water treatment plants, including those in South Africa, are also inefficient in eliminating pharmaceutical compounds, releasing them in sub-therapeutic concentrations into potable tap water as pollutants, the full effects of which are yet to be determined.

MPH / Department of Public Health / See the attached abstract below

PhD (Public Health) / Department of Public Health / Medical waste is a special type of hazardous waste generated from healthcare facilities. Mismanagement of this waste has a negative impact on healthcare workers, patients and their relatives, medical waste handlers and the community. South Africa, like many other developing countries, is resource-constrained in the management of medical waste and poor practices have been reported across the country, especially in the urban health facilities that have received more attention from researchers. This study was conducted to explore the practices and challenges of medical waste management in Vhembe District, a largely rural district in Limpopo province and develop intervention strategies for better management of the waste in the District. A convergent parallel approach of mixed method design was adopted to achieve the objectives of this study. The target population included the main stakeholders of medical waste management in the district: the Department of Health, healthcare facilities and the waste management company responsible for the treatment and disposal of medical waste in Limpopo Province. The study population from the Department of Health included representatives from the medical waste management section while the waste management company was represented by the manager of the company in Limpopo Province. The samples for the healthcare facilities were drawn from fifteen randomly selected healthcare facilities in the district and included the administrative heads, medical waste generators and medical waste handlers. The study was conducted in three phases. Phase 1 was a qualitative study during which the administrative heads of the selected healthcare facilities, personnel directly involved in medical waste management at the healthcare facilities as well as the representatives from the Department of Health and waste management company were engaged in in-depth interviews. This phase also involved voice recording, observations, field documentation and taking of relevant pictures. Thematic content analysis was used to analyze the data obtained. During phase 2 (quantitative study), a semi-structured questionnaire was employed for data collection from medical waste generators and handlers at the healthcare facilities. A total of 229 questionnaires were retrieved from the participants and were analyzed with the Statistical Package for Social Sciences version 25.0. Descriptive statistical analyses were performed; Chi-square and Cramer’s V tests were used to determine the associations between dependent and independent variables, as well as the strength of association where significant relationships exist. Statistical significant level was set at p<0.05 and the results are presented in tables and graphs. The results from both phases were interpreted and discussed simultaneously. Respondents and participants were assured of anonymity of their identities and confidentiality of the information they provided. They were given adequate information about the study and only those who volunteered participated in the study after appending their signatures on the informed consent form. In phase 3, the Medical Research Council Framework was used to develop intervention strategies for improved medical waste management in Vhembe District based on the Strength, Weakness, Opportunity and Threat (SWOT) and Political, Economic, Social, Technological, Environmental and Legal (PESTEL) analysis techniques. The study revealed inefficient practices of medical waste management in all the healthcare facilities. Rate of medical waste generation was 338.15kg/day, 19.2kg/day and 15.5kg/day of HCRW from the hospitals, community health centers and clinics respectively. Segregation practices were poor, and only 28.4% of respondents rated their healthcare institutions as being excellent with medical waste segregation. The type of occupation was found to be significantly associated with exposure to training (p=0.000) and the level of knowledge about medical waste management (p=0.000). Also, the use of personal protective equipment was found to be significantly associated with training (p=0.011). Transportation and temporary storage were not done according to the recommendation in the guidelines and incineration was the main means of treatment of the waste. The final product of waste treatment is being disposed into an hazardous waste landfill. The challenges encountered in the process of managing medical waste include lack of adequate funding and budget for medical waste management, ineffective and irregular training of healthcare workers, non-compliance to medical waste management guidelines, insufficient bins, substandard central storage rooms, insufficient personal protective equipment and unavailability of Hepatitis B vaccine. The strength, weakness, opportunities and threats of medical waste management in Vhembe District were analyzed and specific intervention strategies were developed to improve on the strength, minimize the weakness, take advantage of the opportunity and combat the threats. The developed strategies were validated. This study provides the evidences of poor management of medical waste in Vhembe District, and shows the need for urgent intervention measures to be put in place. We therefore recommend that the intervention strategies proposed here be evaluated and implemented to mitigate the untoward effects of poor medical waste management among healthcare workers and the community as a whole. / NRF