KARACHI: Despite being the largest public sector hospital in the city and among the few that have an incinerator, the Jinnah Postgraduate Medical Centre (JMPC) at present doesn’t have a proper system to dispose of its medical waste, a major potential threat to the safety of its staff, patients as well as the community at large, it emerged on Sunday.

During a recent visit to the JPMC’s incinerator located on its premises, feral cats and birds were found scavenging among the piles of waste, which included hazardous medical refuse such as empty bottles, used needles, syringes, IV bags, blood bags and soiled dressings.

The incinerator was found non-operational.

Upon contact, deputy director of administration at the JPMC Dr Javed Jamali said the incinerator was operated only when sufficient waste was collected.

“It is operated daily but only for two to three hours. There are many healthcare facilities in the city which don’t even have this mechanism,” he said, admitting that hospital waste shouldn’t have been thrown out in the open.

The hospital incinerator, he said, was too old but couldn’t be replaced owing to a shortage of funds.

To a question whether the hospital has a system to segregate hazardous and non-hazardous refuse at source, he said: “This protocol is adopted only for high-risk patients, for instance, those who are diagnosed with hepatitis and Congo virus infection.”

Endorsing the opinion that most healthcare facilities in the city are operating without a waste disposal system, executive member of the Medical Microbiology and Infectious Diseases Society of Pakistan, Dr Altaf Ahmed said that such a mechanism existed at a few private hospitals only.

“The Abbasi Shaheed Hospital and the Civil Hospital Karachi, the two major government hospitals in the city, had also bought incinerators a long time back but I don’t know whether they are still being used,” he said.

“Waste from hospitals including the Indus Hospital is lifted by the Karachi Metropolitan Corporation, which, I am told, incinerates the refuse at its two facilities.”

However, there were hundreds of laboratories and clinics operating in the city without any regulatory mechanism, he pointed out, questioning their waste disposal practices.

“There are millions of germs in a single bottle used for any microbiological test, which is just thrown away in the open. This reflects our apathy towards our environment.”

Spread of disease

Hospital waste, he said, may lead to the spread of various diseases including those caused by antibiotic resistant bacteria, many of which evolve at health facilities.

“Scavengers get the disease first and become carriers of infections for diseases like hepatitis, diarrhea, food-borne illnesses, skin infections, tuberculosis, cancer etc.

“Besides, waste dumped in the open is a breeding site for mosquitoes as well as for flies. Liquid waste is routinely discharged into sewerage drains in hospitals that can contaminate drinking water in areas with a faulty sewerage system,” he added.

Hospital waste categorised as hazardous waste should be separated at source and treated in large “green autoclaves” that don’t cause air pollution.

“These not only sterilise the waste but also greatly reduce the size of the solid waste, which is then mixed with other material and disposed of at landfill sites,” he said, suggesting that the government should set-up such facilities and charge health facilities for the service.

Concerns over poor medical waste disposal practices have recently been highlighted by experts in a study carried out on food being sold in and outside 10 public sector hospitals of the city.

The Karachi University study has shown that the food was unfit for human consumption and that the germs contaminating it had resistance against a number of commonly used antibiotics.

The samples were picked up from the Civil Hospital Karachi, Landhi Medical Complex, Abbasi Shaheed Hospital, Sindh government hospital, Liaquatabad, Qatar Hospital, Sindh government hospital (UP Mor), Lyari General Hospital, JPMC, Dow University of Health Sciences (Ojha campus), and Sindh Social Security Hospital.

The study identified dumping of waste (especially medical waste) in the open, lack of infection control measures at healthcare settings, mixing of sewerage lines with water mains, and poor hygiene practices of food handlers as major contributors to the evolution of these germs and their spread.

Published in Dawn, September 5th, 2016