Infectious waste surveys in a Saudi Arabian hospital: An important quality improvement tool

Objectives: To analyze the composition by weight of the infectious waste stream, better segregate waste, reduce disposal costs, reduce the load on the hospital incinerator, identify inappropriate items having signficant cost or safety implications, and provide a safer work environment for housekeepers, Methods: Four infectious waste surveys were conducted between 1991 and 1999 that involved opening a total of 7364 bags of infectious waste. The contents of each infectious waste bag were separated into 20 different components and weighed. Inappropriately discarded items were removed and tagged with the date and hospital unit of origin. Setting: Dhahran Health Center, a 410-bed hospital operated by the Saudi Arabian Oil Company (Saudi Aramco) in Dhahran, Saudi Arabia. Results: The surveys show a continuing trend in a higher percentage of plastics and a decrease in paper due to increased use of disposables. Much of the infectious waste consisted of plastic intravenous bottles, intravenous lines, and paper wrappers for sterile instrument sets that were not infectious. Dhahran Health Center was producing a total of 1163 kg of infectious waste per day before the first survey. This was reduced to 407 kg per day after implementation of a waste segregation program in 1991 (a reduction of 65%). Incineration operation was reduced from daily to 3 days per week, with a corresponding reduction in incinerator emissions. Infectious waste from inpatient, surgical, and obstetric areas was reduced by a total of 70% between 1991 and 1999, from 2.8 kg (6.1 lb) to 0.85 kg (1.9 lb) per patient per day. This is in the rang of 2 to 4 lb per patient per day that is generally reported. Numerous inappropriately discarded items were discovered during the surveys with cost or safety implications. Each survey, including the latest one of November-December 1999, has shown that further improvements are possible in the hospital's waste management program. Specific educational efforts and changes in procedures are described. Conclusions: We believe this is the first report of such an extensive analysis of a hospital's infectious waste. Many hospitals do not have the resources to conduct such detailed surveys of their waste streams. However, regardless of the method of treatment and disposal, such surveys are valuable quality improvement tools because all health care facilities want to reduce disposal costs, identify high-value items mistakenly discarded, and improve safety.