Medical waste: DA calls upon Motsoaledi to ensure hospitals comply with Health Act 

17 November 2015

I will today write to the Minister of Health, Aaron Motsoaledi, to request a meeting with him to discuss the failure by hospitals in the Free State, and possibly elsewhere, to properly manage their medical waste in terms of the National Health Act. 

On an oversight visit to Mangaung on Friday 13 November, interviews with industry insiders in the medical waste removal business in the Province and an on-site inspection at National Hospital in Bloemfontein’, revealed that when it comes to medical waste management, hospitals routinely violate best-practise norms.

On my visit to the National Hospital, for example, it was horrifying to see a number of bags ripped open in the medical waste storage area. We were told by the hospital that this had been done by rats. Furthermore, the possibly infectious waste was strewn about on the floor.

There are six categories, defined by law, in terms of which medical waste must be “segregated” – or separated into separate waste bins or containers. These categories are: anatomical waste; sharps (eg needles); pharmaceutical waste; infectious waste; cytotoxic and general waste.

It is essential that every healthcare facility has at least one dedicated central healthcare risk waste storage area, serving as an interface from where service providers collect healthcare risk waste for offsite treatment and disposal:

1. The area must be clearly demarcated and a sign posted indicating that the area is a healthcare risk waste storage area (National Hospital had no sign);

2. The central storage area (CSA) must be locked and access controlled at all times, and must not accessible to unauthorized personnel, animals, rodents and birds (Storage bags were ripped open ‘by rats’ management told us);

3. The CSA must have, as a minimum, the following:

- An impenetrable, hard standing floor with good drainage connected to the sewerage system (evidenced by stench, there was no drainage system);

- Water supply for cleaning and disinfecting purposes, as well as a hand basin, hand soap and hand towel (none of this is evident at National Hospital). The CSA must be cleaned and disinfected every time the waste is collected (not done and the stench overwhelming as a result);

- Be undercover and provide protection from the elements i.e. sun wind and rain (complies);

- Have good lighting and have at least good ventilation (no light and little ventilation);

- Be lockable and secure (minimal barely compliant); and

- Be equipped with a fire extinguisher and a spill kit (none in evidence).

4. The storage area must:

- Be equipped with the necessary personal protective equipment or PPE (gumboots, work uniform, elbow length gloves, mask, and protective eye goggles) and emergency equipment to deal with spillages (none in evidence);

- A space separate from the healthcare general waste storage area (the waste was not segregated strictly enough so that 40% of it was general garbage but its removal charged at a much higher hazardous waste disposal rate);

- Not be close to fresh food stores or kitchens (complies);

- At a distant from normal human traffic (complies);

- Easily accessible to waste removal vehicles (complies);

- Contain normal and sudden increases in waste volumes (does not comply).

Failure to adhere to national norms poses a threat to public health. The presence of rats at National Hospital’s medical waste storage area is evidence of a complete breakdown of the required system and needs to remedied immediately. While the regulations are best practice, enforcement is happenstance and unacceptable.

National’s hospital management said they had no funds to upgrade the medical waste disposal system, that the hospital is ‘broke’ and indeed ‘always broke’ this time of the year. They would have to wait until the next financial year to do anything about the situation. This cannot be allowed to continue. 

Minister Motsoaledi must explain how he will make hospitals nationwide compliant with the law when it comes to management, “segregation” and disposal of medical waste. 

Issued by Dr Wilmot James, DA Shadow Minister of Health, 17 November 2015