Hospital waste, a complex challenge
By Agnes Winarti
Stacks of Sanglah hospital waste, in yellow- and black-colored bags, were piled up at the entrance of Sanglah General Hospital’s incinerator on Monday. However, one particular black bag stood out, as it double-wrapped a yellow bag stuffed with medical waste.
“This waste must not be wrapped like this, because yellow bags are for infectious waste, while the black bags are for general waste. But some staff still forget. Maybe they were in a rush,” said sanitary worker Nyoman Widnya, as he quickly separated the bulging yellow bag from its black wrap.
One year after a memorandum of understanding (MoU) was signed by seven hospitals with the aim of phasing out mercury-based medical equipment and improving the waste-management systems in the capital Denpasar, Sanglah General Hospital is still struggling to turn the agreement into concrete results.
Behavioral change and budget allocation remain the biggest hurdles at Sanglah, which serves as the top referral hospital not only for Bali but also the entire eastern region of the archipelago.
Everyday, Sanglah General hospital produces some 350 kilograms of medical waste, while it sees around 1,000 kilograms of medical waste a day arrive at its incinerator from 93 private hospitals, clinics and medical institutions throughout Denpasar, Klungkung, Bangli and Gianyar.
Most of the waste comes in a mixture of infectious medical items, such as needles, transfusion containers and hoses, blood-stained items, protective gear and even body parts or human organs.
The hospital undertook more scrupulous efforts in disposing of its internal waste at the end of last year. From the previous system of two types of containers for medical and non-medical waste, now Sanglah employs three such containers: one for sharp waste, such as needles; one for medical waste (yellow); and one for non-medical waste (black). Implementing the color-coded system, however, is not as simple as it may sound.
“The Health Ministry stipulates yellow bags for medical waste, red for radiology waste, purple for infectious waste and brown for chemicals. However, it’s difficult to find red, purple and brown ones; not to mention that they cost more. So, we mostly use yellow and black,” Sanglah General Hospital’s sanitation coordinator, Ketut Gede Surata, told the Bali Daily.
“We previously had our own color system, while regulations by the health and environment ministries stipulated different color systems. To make it more complicated, the very definition of medical waste differs from one source to another,” said Surata.
Another headache that the medical workers, nurses and doctors have to deal with is the phasing out of mercury-based equipment, such as thermometers for measuring body temperatures and sphygmomanometers for taking blood pressure.
“There have been complaints that digital and aneroid equipment are sometimes inaccurate compared to the mercury tools,” said Surata, citing a few incidents at the hospital, where patients’ blood pressure had been recorded as abnormally high with digital sphygmomanometers, while the mercury alternative obtained normal results.
Due to the highly sensitive nature of digital tools, patients usually have to wait up to 20 minutes after their arrival to have their blood pressure measured. “That disrupts our goal to provide fast medical services to patients,” Surata added.
Despite these problems, Surata confirmed that Sanglah remained committed to phasing out their mercury tools, targeting a slow-but-sure 10 percent progress annually. “We also plan to better manage our mercury waste, which includes setting standard operating procedures [SOPs] when there’s a mercury spill at the hospital,” he added.
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