Objectives: To analyze the composition by weight of the infectious waste st
ream, 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 housekeepe
rs,
Methods: Four infectious waste surveys were conducted between 1991 and 1999
that involved opening a total of 7364 bags of infectious waste. The conten
ts 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 Ar
abian Oil Company (Saudi Aramco) in Dhahran, Saudi Arabia.
Results: The surveys show a continuing trend in a higher percentage of plas
tics and a decrease in paper due to increased use of disposables. Much of t
he infectious waste consisted of plastic intravenous bottles, intravenous l
ines, and paper wrappers for sterile instrument sets that were not infectio
us. Dhahran Health Center was producing a total of 1163 kg of infectious wa
ste per day before the first survey. This was reduced to 407 kg per day aft
er 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 i
npatient, surgical, and obstetric areas was reduced by a total of 70% betwe
en 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 la
test 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 analy
sis of a hospital's infectious waste. Many hospitals do not have the resour
ces to conduct such detailed surveys of their waste streams. However, regar
dless of the method of treatment and disposal, such surveys are valuable qu
ality improvement tools because all health care facilities want to reduce d
isposal costs, identify high-value items mistakenly discarded, and improve
safety.