The challenge of medical waste management: a case study in northwest Iran-Tabriz.

This article presents the results of a descriptive cross-sectional study on medical waste management in Tabriz (Iran's fourth largest city). The study was conducted in 10 of 25 active hospitals of the city in the summer of 2007. The methodology of the present study was based on data collected from hospitals through a checklist, site visits (observation), and quantity analysis by weight. The results indicated that more than 13.59 tonnes day(-1) of total medical waste and 4.06 tonnes day(-1) of hazardous-infectious medical waste are generated by the active hospitals of the city. Currently, there are no practical instructions, or suitable supervision on different levels of waste management. The health authorities and hospital managers do not accept sufficient responsibility for the medical waste due to financial problems and the lack of awareness regarding the hazards of medical waste. Segregation and minimization of waste are not carried out correctly in any of the hospitals. The use of protective measures by staff and temporary storage areas was not in agreement with standards in 70 and 60% of the hospitals in the present study, respectively. About 50% of the hospitals had been equipped with an incinerator, but all but one (10%) of them had been phased out due to operation and maintenance problems, air pollution, etc. Almost all of the hospitals have a waste management officer, but there is not an effective training programme for the staff. Infectious-hazardous medical waste is mixed with general waste, and it is disposed of in a municipal waste landfill, which is an unsanitary dumpsite. Illegal segregation and recycling of medical waste is carried out at the final disposal site; therefore, there are concerns about environmental pollution and the transmission of infectious diseases. It is proposed that, through the allocation of increased budgets, implementation of integrated segregation, minimization of waste, and creation of a training programme in the hospitals, the quantity of medical waste would be decreased (by about 70.11%). Considering the previous unsuccessful experience of on-site incineration in Tabriz (and in Iran's other large cites), an amendment should be made to Iran's current hazardous waste regulations to have infectious-hazardous waste sent to a central off-site autoclave or incinerator for treatment. The off-site autoclave would have some advantages, such as decreased air pollution. Of course, some health officials oppose this plan. To test this plan and receive the official's approval, a central off-site autoclave can be put into practice as a pilot.