Pengelolaan Sampah RS Masih Carut-Marut

Sabtu, 17 April 2004

Bandung, Kompas – Pengelolaan sampah medis rumah sakit di Jawa Barat, khususnya rumah sakit milik pemerintah-termasuk puskesmas-sejauh ini masih carut-marut. Padahal, sampah medis merupakan limbah B3 (bahan beracun berbahaya) yang sangat berpotensi menularkan berbagai penyakit infeksi. Di Indonesia memang belum ada model manajemen sampah medis yang terpadu. Proyek percontohan model itu kini tengah dijalankan di Bandung.

Hal itu diungkapkan Kepala Bidang Pengendalian Kerusakan Lingkungan Badan Pengendalian Lingkungan Hidup Daerah Jawa Barat Setiawan Wangsaatmaja, Jumat (16/4) di Bandung. “Setelah studi kelayakannya selesai, diharapkan akan ada investor yang tertarik untuk terlibat di bidang ini,” kata Setiawan. Pengembangan model itu melibatkan Bank Dunia sebagai konsultan.

Setiawan juga tidak menjamin dokter-dokter yang praktik di rumah atau klinik secara bertanggung jawab menitipkan sampah medisnya ke RS yang dapat mengelola dengan cukup baik. “Masih banyak RS yang bahkan mencampur sampah medisnya dengan yang nonmedis, lalu membuangnya ke tempat pembuangan akhir sampah pada umumnya. Jelas ini berbahaya,” katanya.

Menurut Setiawan, estimasi rata-rata produksi limbah medis di seluruh RS di Jabar tahun 2004 adalah sekitar 3.500 kilogram per hari. Rata-rata tempat tidur di RS setiap hari menghasilkan 0,3 kg sampah medis. Limbah medis padat harus dibakar dalam insinerator dua bilik dengan panas lebih dari 1.000 derajat Celcius. Sementara itu, limbah cair diolah dengan instalasi pengelola air limbah (IPAL).

Limbah medis itu misalnya sisa jaringan tubuh bekas operasi, jarum suntik, perban, bahan-bahan reagen, hingga sisa radioaktif. Jarum suntik bekas jika tertusuk pada petugas sampah dapat menularkan berbagai penyakit infeksi serius, seperti hepatitis dan HIV/AIDS.

Koordinator Sanitasi Rumah Sakit Hasan Sadikin (RSHS) Maudy Dirgahayu mengungkapkan, sejak akhir tahun 2003 insinerator di RSHS sudah tidak dapat digunakan karena rusak. Hingga kini mereka terpaksa mengirim sampah medis padatnya pada sebuah perusahaan swasta yang khusus mengelola sampah. Sementara, sampah cair masih dikelola di IPAL milik sendiri.

“Saat insinerator kami masih berjalan pun sebenarnya tidak sempurna. Banyak mengundang protes dari lingkungan sekitar karena gangguan asap dan debunya,” kata Maudy.

Menurut Maudy, lokasi RS di kawasan padat memang menyulitkan jika harus mengelola limbah di lokasi yang sama dengan RS. RSHS saat ini memproduksi sekitar 150 kg sampah medis padat setiap hari.

Setiawan mengatakan, pengelolaan sampah medis yang ideal memang seharusnya tersentral di satu lokasi yang jauh dari kawasan padat penduduk agar memudahkan pengawasan, prosedur standar operasional lebih mudah diterapkan.

Sejauh ini, menurut Setiawan, di Indonesia belum ada satu perusahaan pun yang khusus bergerak mengelola limbah medis. (SF)

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Penangan Limbah Medis Tajam harus segera dibenahi

Jakarta, 2 Juli 2003.

Pada tahun 1999 WHO melaporkan bahwa di Perancis pernah terjadi 8 kasus pekerja kesehatan terinfeksi HIV melalui luka, 2 kasus diantaranya menimpa petugas yang menangani limbah medis. Di Indonesia dalam satu laporan diketahui bahwa setiap bulan pemakaian alat suntik untuk pengobatan mencapai 10 juta pelayanan. Padahal selain untuk pengobatan, alat suntik juga digunakan dalam program imunisasi bagi bayi dan anak-anak yang  setiap tahunnya  mencapai  4,9 juta anak dan setiap anak memerlukan 8 suntikan. Dengan demikian jumlah limbah medis tajam di Indonesia menjadi sangat tinggi.

 

Oleh karena itu, penanganan limbah medis tajam harus segera dibenahi, karena limbah ini sangat berbahaya bukan hanya bagi pengunjung rumah sakit atau pelayanan kesehatan lainnya, namun juga bagi petugas kesehatan serta masyarakat umum. Hal itu penting karena, limbah alat suntik dan limbah medis lainnya dapat menjadi faktor risiko penularan berbagai penyakit seperti HIV/AIDS, Hepatitis B dan C serta penyakit lain yang ditularkan melalui darah.           

            Demikian penegasan Menkes Dr. Achmad Sujudi ketika membuka Lokakarya Penanganan Limbah Medis Tajam pada Pelayanan Kesehatan Dasar (PKD) di Yogyakarta tanggal 1 Juli 2003. Lokakarya yang berlangsung selama 3 hari diikuti 105 peserta dari Depkes Pusat, Kepala Dinas Kesehatan Provinsi, Wakil dari Kantor Meneg Lingkungan Hidup, pemerhati masalah limbah, produsen pengolah limbah lokal dan PATH (Programme for Appropriate Technology in Health).

            Kendati Departemen Kesehatan telah menyusun Standar Pelayanan Minimal (SPM) untuk mengukur kualitas pelayanan kesehatan dasar yang salah satunya adalah kewajiban rumah sakit dan Puskesmas untuk mengolah limbahnya. Namun Menkes mengakui bahwa penerapannya masih belum baik. Berdasarkan hasil assesment tahun 2002, diketahui bahwa baru 49 % dari 1.176  rumah sakit (526 rumah sakit pemerintah dan 652 rumah sakit milik swasta) di 30 provinsi, baru 648 RS  yang memiliki incinerator dan 36% memiliki IPAL (Instalasi Pengolah Air Limbah) dengan kondisi sebagian diantaranya tidak berfungsi.       

Lebih lanjut ditegaskan, Depkes yang secara teknis memiliki kewenangan dalam penatapan standar-standar pelayanan kesehatan telah mengeluarkan berbagai ketentuan tentang penanganan limbah, terutama melalui Kepmenkes No. 876/2001 tentang Pedoman Teknis Analisis Dampak Kesehatan Lingkungan serta Permenkes No. 986/1992 tentang Persyaratan Kesehatan Lingkungan. 

Limbah medis sebagaimana limbah lainnya berkaitan dengan masalah lingkungan. Karena itu dalam penanganan limbah medis ini dilakukan bersama dengan Kementerian Lingkungan Hidup yang memiliki otoritas dalam penerbitan produk hukum di bidang lingkungan hidup. Koordinasi juga dilakukan dengan Badan Pengkajian dan Pengembangan Teknologi (BPPT) yang memiliki otoritas dalam pengembangan teknologi tepat guna dalam pembuangan limbah medis. Selain itu, Depkes juga mengajak BKKBN yang dalam pelayanannya juga menghasilkan limbah medis tajam.                

Menkes menegaskan, di masa lalu penggunaan alat suntik baik untuk pengobatan maupun imunisasi masih mengandalkan semprit atau syrenge yang disterilkan melalui perebusan berulang-ulang sehingga hampir tidak ditemui limbah alat suntik. Tetapi sesuai perkembangan ilmu pengetahuan dan teknologi, para dokter dan petugas kesehatan harus menggunakan alat suntik disposable (sekali pakai) dan bahkan memakai autodisable syringe (alat suntik sekali pakai yang betul-betul tidak dapat dipakai kembali), mengakibatkan adanya limbah alat suntik yang dikategorikan limbah medis tajam dan berbahaya.

            Sementara itu Prof. Dr. Umar Fahmi Achmadi dalam keterangannya kepada wartawan menjelaskan bahwa lokakarya yang diselenggarakan ini merupakan bagian dari paket safe injection (suntikan yang aman). Dengan lokakarya ini diharapkan penerapan safe injection dapat berkembang secara sistematik di seluruh Indonesia melalui para peserta yang hadir.

            Program imunisasi merupakan bagian dari upaya kesehatan dasar yang wajib tersedia bagi masyarakat dengan mutu yang baik. Hal ini seirama dengan prinsip hidup sehat dimana masyarakat memperoleh pelayanan kesehatan dengan mutu baik dalam lingkungan fisik yang sehat sehingga dapat memotivasi masyarakat untuk berperilaku hidup bersih dan sehat.

            Menkes menyambut baik lokakarya ini dan berharap menjadi forum untuk mempertemukan para pakar dari berbagai ilmu serta para praktisi baik dalam maupun luar negeri. Dengan demikian hasilnya akan menjadi acuan Depkes untuk menyusun konsep manajemen penanganan limbah medis yang komprehensif di Indonesia.

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Health-care waste management

Biohazard

To reduce the burden of disease, health-care waste needs sound management, including alternatives to incineration

Related fact sheet
Wastes from health-care activities

In the last few years there has been growing controversy over the incineration of health-care waste. Under some circumstances, including when wastes are incinerated at low temperatures or when plastics that contain polyvinyl chloride (PVC) are incinerated, dioxins and furans and other toxic air pollutants may be produced as emissions and/or in bottom or fly ash (ash that is carried by air and exhaust gases up the incinerator stack). Exposure to dioxins, furans and co-planar PCBs may lead to adverse health effects.

What are dioxins, furans and co-planar PCBs?

Dioxins, furans and co-planar PCBs are toxic substances produced as by-products of various industrial processes, including the combustion of wastes containing polyvinyl chloride (e.g., some plastics, some blood bags and fluid bags). This happens particularly when wastes are incinerated at temperatures lower than 800 degrees Celsius or when the wastes are not completely incinerated. Dioxins, furans, co-planar PCBs and other toxic air pollutants may then be produced as emissions and/or in bottom or fly ash. In some circumstances dioxins and furans can be produced under natural conditions (e.g. volcanic activity and forest fires).

Polychlorinated dibenzo-para-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and polychlorinated biphenyls (PCBs) are called dioxins, furans and co-planar PCBs, respectively. Amongst the different dioxins and furans, not all have the same toxicity; some are even harmless. Dioxins, furans and co-planar PCBs are persistent substances that do not readily break down in the environment and that bio-accumulate in the food chain. Most human exposure to dioxins, furans and co-planar PCBs is through the intake of food.

Health concerns and intake limits

Long-term, low-level exposure of humans to dioxins and furans may lead to the impairment of the immune system, the impairment of the development of the nervous system, the endocrine system and the reproductive functions. Short-term, high-level exposure may result in skin lesions and altered liver function. Exposure of animals to dioxins has resulted in several types of cancer.

The International Agency for Research on Cancer (IARC) classifies dioxins as a “known human carcinogen”. However, most of the evidence documenting the toxicity of dioxins and furans is based on studies of populations that have been exposed to high concentrations of dioxins either occupationally or through industrial accidents. There is insufficient evidence to prove that chronic low-level exposures to dioxins and furans causes cancer in humans.

WHO has established a Provisional Tolerable Monthly Intake (PTMI) for dioxins, furans, and polychlorinated biphenyls (PCBs) of 70 picograms (10-12 g) per kilogram of body weight. The PTMI is an estimate of the amount of chemical per month that can be ingested over a lifetime without appreciable health risk. Almost all exposure to dioxins and furans is through the food chain and the PTMI represents the cumulative exposure to dioxins and furans from all sources including food and water.

It has not yet been possible to estimate the worldwide burden of mortality and morbidity from exposure to dioxins and furans: the exposure and risk assessment has many uncertainties; data gaps are very large.

Additionally, the types of health effects that may result (e.g. cancer, impaired immune function) would only show up after long exposure periods and would be difficult to measure.

Health-care waste and the creation of dioxins and furans

WHO has established tolerable intake limits for dioxins and furans, but not for emissions. The latter must be set within the national context.

A number of countries have defined emission limits that range from 0.1 ng TEQ/m3 (Toxicity Equivalence) in Europe to 0.1 ng to 5 ng TEQ/m3 in Japan, according to incinerator capacity.

Even in high temperature incinerators (>800 °C), temperatures are not uniform and dioxins and furans can form in cooler pockets or during start-up or shut-down periods. Optimization of the incineration process can reduce the formation of these substances by, for example, ensuring that incineration takes place only at temperatures above 800°C, and that flue gas temperatures in the range of 250°C to 450°C are avoided.

In the last 10 years, stricter emission standards for dioxins and furans in many countries have significantly reduced the release of these substances into the environment. In several European countries where tight emissions restrictions were adopted in the late 1980s, dioxin and furan concentrations in many types of food (including mother’s milk) have decreased sharply.

The amount of health-care waste produced can be substantial

The safe disposal of health-care waste generated at smaller rural clinics or larger facilities is feasible where adequate, well-operated infrastructure exists. However, the volume of waste generated within large facilities and during immunization campaigns may be difficult to dispose of safely when resources are limited. In 2001, during a measles mass immunization campaign in West Africa (covering all or part of six countries), 17 million children were vaccinated, resulting in the generation of nearly 300 metric tonnes of injection waste. Without adequate waste disposal options at both local and regional levels, this volume of waste would have been difficult to eliminate safely.

Incorrect disposal of health-care waste creates other health risks

The unsafe disposal of health-care waste (for example, contaminated syringes and needles) poses public health risks. Contaminated needles and syringes represent a particular threat as the failure to dispose of them safely may lead to dangerous recycling and repackaging which lead to unsafe reuse. Contaminated injection equipment may be scavenged from waste areas and dumpsites and either be reused or sold to be used again. WHO estimated that, in 2000, contaminated injections with contaminated syringes caused:

  • 21 million hepatitis B virus (HBV) infections (32% of all new infections);
  • two million hepatitis C virus (HCV) infections (40% of all new infections); and
  • at least 260 000 HIV infections (5% of all new infections).

In 2002, the results of a WHO assessment conducted in 22 developing countries showed that the proportion of health-care facilities that do not use proper waste disposal methods ranges from 18% to 64%.

In addition to the public health risks, if not managed, direct reuse of contaminated injection equipment results in occupational hazards to health workers, waste handlers and scavengers. Where waste is dumped into areas without restricted access, children may come into contact with contaminated waste and play with used needles and syringes. Epidemiological studies indicate that a person who experiences one needle stick injury from a needle used on an infected source patient has risks of 30%, 1.8%, and 0.3% respectively of becoming infected with HBV, HCV and HIV.

The way forward

The management of health-care waste requires increased attention and diligence to avoid the substantial disease burden associated with poor practice, including exposure to infectious agents and toxic substances. Incinerators provide an interim solution especially for developing countries where options for waste disposal such as autoclave, shredder or microwave are limited.

Whatever the technology used, best practice must be promoted to ensure optimal operation of the system. To reduce exposure to toxic pollutants associated with the combustion process such as dioxins, furans, co-planar PCBs, nitrogen and sulphur oxides as well as particulate matter and to minimize occupational and public health risks, “best practices” for incineration must be promoted, and must include the following elements:

  • Effective waste reduction and waste segregation, ensuring that only appropriate wastes are incinerated;
  • Siting incinerators away from populated areas or areas where food is grown, thus minimizing exposures and thereby risks;
  • A properly engineered design, ensuring that combustion conditions are appropriate, e.g., sufficient residence time and temperatures to minimize products of incomplete combustion;
  • Construction following detailed dimensional plans, thus avoiding flaws that can lead to incomplete destruction of waste, higher emissions, and premature failure of the incinerator;
  • Proper operation, critical to achieving the desired combustion conditions and emissions. In summary, operation must: utilize appropriate start-up and cool-down procedures; achieve (and maintain) a minimum temperature before waste is burned; use appropriate loading/charging rates (both fuel and waste) to maintain appropriate temperatures; ensure proper disposal of ash; and ensure use of protective equipment to safeguard workers;
  • Periodic maintenance to replace or repair defective components, including inspection, spare parts inventory, record keeping, and so forth;
  • Enhanced training and management, possibly promoted by certification and inspection programmes for operators, the availability of an operating and maintenance manual, management oversight, and maintenance programmes.

Management and operational problems with incinerators, including inadequate training of operators, waste segregation problems, and poor maintenance, are recognized as critical issues that should be addressed in assessment and waste management plans.

How to address unsafe incineration

To better understand the problem of health-care waste management, WHO guidance recommends that countries conduct assessments prior to any decision as to which health-care waste-management methods be chosen. Tools are available to assist with the assessment and decision-making process so that appropriate policies lead to the choice of adapted technologies. In support of sound health-care waste management, WHO proposes to work in collaboration with countries through the following strategy:

In the short-term

  • Until countries have access to proven, environmentally safe options for the management of health-care waste, incineration may still be seen as an appropriate response. Incineration should comply with the following recommendations:
    • good practices in incinerator design, construction, operation (e.g., pre-heating and not overloading the incinerator, incinerating only at temperatures above 800°C), maintenance and lowest emissions;
    • The use of waste segregation and waste minimization practices to restrict incineration to appropriate infectious wastes;
    • availability of good practices tools, including dimensional construction plans, clear operational guidelines, etc.;
    • correction of current deficiencies in operator training and management support, which lead to poor operation of incinerators;
    • materials containing chlorine such as polyvinyl chloride products (e.g., some blood bags, IV bags, IV tubes, etc.) or heavy metals such as mercury (e.g., broken thermometers) should never be incinerated.
  • Research and production by manufacturers of all syringe components made of the same plastic to facilitate recycling;
  • Selection of PVC-free medical devices;
  • Identification and development of safe recycling options wherever possible (for plastic, glass, etc.);
  • Research and promotion of new waste management technologies or alternatives to incineration;
  • Promotion of the principles of environmentally sound management of health-care waste as set out in the Basel Convention.

In the mid-term

  • Further efforts to eliminate unnecessary injections to reduce the amount of hazardous health-care waste that needs to be treated;
  • Research into the health effects of chronic exposure to low levels of dioxin, furan and co-planar PCBs;
  • Risk assessment to compare the health risks associated with first incineration and secondly exposure to health-care waste.

In the long-term

  • Support of countries in the development of national guidance manuals for the sound management of health-care waste;
  • Effective, scaled-up promotion of non-incineration technologies for the final disposal of health-care wastes to prevent the disease burden from (a) unsafe health-care waste management and (b) exposure to dioxins and furans;
  • Allocation of human and financial resources to safely manage health-care waste in countries
  • Support of countries in the development and implementation of a national plan, policies and legislation on health-care waste.

WHO aims to promote effective non-burn technologies for the final disposal of medical wastes to avoid both the disease burden from unsafe health-care waste management and potential risks from dioxins, furans and co-planar PCBs. WHO will:

  • Prevent the health risks associated with exposure to health-care waste for both health workers and the public by promoting environmentally sound management policies for health-care waste;
  • Support global efforts to reduce the amount of noxious emissions released into the atmosphere to reduce disease and defer the onset of global climate change;
  • Support the Stockholm convention on Persistent Organic Pollutants (POPs);
  • Support the Basel Convention (1989) on hazardous wastes and other wastes;
  • Reduce the exposure to toxic pollutants associated with the combustion process through the promotion of appropriate practices for high temperature incineration.
For more information contact:

WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

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Wastes From Health-Care Activities

WHO

Health-care activities – for instance, immunizations, diagnostic tests, medical treatments, and laboratory examinations – protect and restore health and save lives. But what about the wastes and by-products they generate?

From the total of wastes generated by health-care activities, almost 80% are general waste comparable to domestic waste. The remaining approximate 20% of wastes are considered hazardous materials that may be infectious, toxic or radioactive. The wastes and by-products cover a diverse range of materials, as the following list illustrates (percentages are approximate values):

  • Infectious wastes — cultures and stocks of infectious agents, wastes from infected patients, wastes contaminated with blood and its derivatives, discarded diagnostic samples, infected animals from laboratories, and contaminated materials (swabs, bandages) and equipment (disposable medical devices etc.); and
  • Anatomic – recognizable body parts and animal carcasses.

Infectious and anatomic wastes together represent the majority of the hazardous waste, up to 15% of the total waste from health-care activities.

  • Sharps — syringes, disposable scalpels and blades etc.

Sharps represent about 1% of the total waste from health-care activities.

  • Chemicals — for example solvents and disinfectants; and
  • Pharmaceuticals — expired, unused, and contaminated; whether the drugs themselves (sometimes toxic and powerful chemicals) or their metabolites, vaccines and sera .

Chemicals and pharmaceuticals amount to about 3% of waste from health-care activities.

  • Genotoxic waste — highly hazardous, mutagenic, teratogenic1 or carcinogenic, such as cytotoxic drugs used in cancer treatment and their metabolites; and
  • Radioactive matter, such as glassware contaminated with radioactive diagnostic material or radiotherapeutic materials;
  • Wastes with high heavy metal content, such as broken mercury thermometers.

Genotoxic waste, radioactive matter and heavy metal content represent about 1% of the total waste from health-care activities.

The major sources of health-care waste are hospitals and other health-care establishments, laboratories and research centres, mortuary and autopsy centres, animal research and testing laboratories, blood banks and collection services, and nursing homes for the elderly.

High-income countries can generate up to 6 kg of hazardous waste per person per year. In the majority of low-income countries, health-care waste is usually not separated into hazardous or non-hazardous waste. In these countries, the total health-care waste per person per year is anywhere from 0.5 to 3 kg.

Health impacts

Health-care waste is a reservoir of potentially harmful micro-organisms which can infect hospital patients, health-care workers and the general public. Other potential infectious risks include the spread of, sometimes resistant, micro-organisms from health-care establishments into the environment. These risks have so far been only poorly investigated. Wastes and by-products can also cause injuries, for example radiation burns or sharps-inflicted injuries; poisoning and pollution, whether through the release of pharmaceutical products, in particular, antibiotics and cytotoxic drugs, through the waste water or by toxic elements or compounds such as mercury or dioxins.

Sharps

Throughout the world every year an estimated 12 000 million injections are administered. And not all needles and syringes are properly disposed of, generating a considerable risk for injury and infection and opportunities for re-use.

  • Worldwide, 8-16 million hepatitis B, 2.3 to 4.7 million hepatitis C and 80 000 to 160 000 HIV infections are estimated to occur yearly from re-use of  syringe needles without sterilization2.  Many of these infections could be avoided if syringes were disposed of safely. The re-use of disposable syringes and needles for injections is particularly common in certain African, Asian and Central and Eastern European countries.
  • Regarding injection practices, public health authorities in West Bengal, India, have recommended a shift to re-usable glass syringes, as the disposal requirements for disposable syringes could not be enforced.
  • In developing countries, additional hazards occur from scavenging on waste disposal sites and manual sorting of the waste recuperated at the back doors of health-care establishments. These practices are common in many regions of the world. The waste handlers are at immediate risk of needle-stick injuries and other exposures to toxic or infectious materials.

Vaccine waste

In June 2000, six children were diagnosed with a mild form of smallpox (vaccinia virus) after having played with glass ampoules containing expired smallpox vaccine at a garbage dump in Vladivostok (Russia). Although the infections were not life-threatening, the vaccine ampoules should have been treated before being discarded.

Radioactive wastes

The use of radiation sources in medical and other applications is widespread throughout the world. Occasionally, the public is exposed to radioactive waste, usually originating from radiotherapy treatments, that has not been properly disposed of. Serious accidents have been documented in Goiânia, Brazil in 1988 in which four people died from acute radiation syndrome and 28 suffered serious radiation burns. Similar accidents happened in Mexico City in 1962, Algeria in 1978, Morocco in 1983 and Ciudad Juárez in Mexico in 1983.

Risks associated with other fractions of health-care wastes, in particular blood waste and chemicals, have been relatively poorly assessed, and need to be strengthened. In the meantime, precautionary measures need to be taken.

Risks associated with waste disposal

Although treatment and disposal of health-care wastes aim at reducing risks, indirect health risks may occur through the release of toxic pollutants into the environment through treatment or disposal.

  • Landfilling can potentially result in contamination of drinking water. Occupational risks may be associated with the operation of certain disposal facilities. Inadequate incineration, or incineration of materials unsuitable for incineration can result in the release of pollutants into the air. The incineration of materials containing chlorine can generate dioxins and furans3, which are classified as possible human carcinogens and have been associated with a range of adverse effects. Incineration of heavy metals or materials with high metal contents (in particular lead, mercury and cadmium) can lead to the spread of heavy metals in the environment. Dioxins, furans and metals are persistent and accumulate in the environment. Materials containing chlorine or metal should therefore not be incinerated.
  • Only modern incinerators are able to work at 800-1000 °C, with special emission-cleaning equipment, can ensure that no dioxins and furans (or only insignificant amounts) are produced. Smaller devices built with local materials and capable of operating at these high temperatures are currently being field-tested and implemented in a number of countries.
  • At present, there are practically no environmentally-friendly, low-cost options for safe disposal of infectious wastes. Incineration of wastes has been widely practised, but alternatives are becoming available, such as autoclaving, chemical treatment and microwaving, and may be preferable under certain circumstances. Landfilling may also be a viable solution for parts of the waste stream if practised safely. However, action is necessary to prevent the important disease burden currently created by these wastes.

In addition, perceived risks related to health-care waste management may be significant. In most cultures, disposal of health-care wastes is a sensitive issue and also has ethical dimensions.

Waste management — reasons for failure

The absence of waste management, lack of awareness about the health hazards, insufficient financial and human resources and poor control of waste disposal are the most common problems connected with health-care wastes. Many countries do not have appropriate regulations, or do not enforce them. An essential issue is the clear attribution of responsibility of appropriate handling and disposal of waste. According to the ‘polluter pays’ principle, this responsibility lies with the waste producer, usually being the health-care provider, or the establishment involved in related activities.

Steps towards improvement

Improvements in health-care waste management rely on the following key elements:

  • The build-up of a comprehensive system, addressing responsibilities, resource allocation, handling and disposal. This is a long-term process, sustained by gradual improvements;
  • Awareness raising and training about risks related to health-care waste, and safe and sound practices;
  • Selection of safe and environmentally-friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing of waste.

Government commitment and support is needed to reach an overall and long-term improvement of the situation, although immediate action can be taken locally.

Health-care waste management is an integral part of health-care, and creating harm through inadequate waste management reduces the overall benefits of health-care.

WHO’s response

The first global and comprehensive guidance document, Safe Management of Wastes from Health-Care Activities, released by WHO in 1999, addresses aspects such as regulatory framework, planning issues, waste minimization and recycling, handling, storage and transportation, treatment and disposal options, and training.

It is aimed at managers of hospitals and other health-care establishments, policy makers, public health professionals and managers involved in waste management. It is accompanied by a Teacher’s Guide, which contains material for a three-day workshop aimed at the same audience.

The Interagency Guidelines for the Safe Disposal of Unwanted Pharmaceuticals in and after Emergencies provide practical guidance on the disposal of drugs in difficult situations in or after emergencies are also available.

The full text of these publications is available on the WHO water, sanitation and health web site

Planned WHO products and activities include:

  • The publication of a decision-maker’s guide for health-care waste management in primary health care centres;
  • The implementation of health-care waste systems at country level;
  • The development of a database on practical options for health-care waste management, mainly targeted at developing country situations;
  • Testing of low-cost options for health-care waste management;
  • The development of guidance for the disposal of blood and blood bags;
  • An approach for promoting the use of products in health-care activities leading to reduced production of wastes or less harmful wastes.

For more information contact:

WHO Media centre
Telephone: +41 22 791 2222
E-mail: mediainquiries@who.int

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Pengelolaan Limbah Medis Rumah Sakit

Incinerator With Air Polution Control Technology

Perusahaan dan industri yang memperhatikan pengolahan limbah medis memiliki konsekuensi dan tanggung jawab besar.

Satu pertanyaan yang sering muncul adalah : Apakah limbah anda telah dikelola dengan cara yang terbaik ?.

Limbah sudah selayaknya dikelola dengan baik, karena memiliki konsekuensi yang besar terhadap lingkungan dan usaha anda, apalagi jika peraturan tentang lingkungan sudah ditetapkan.

Di PT. JasaMedivest, kami membantu pemecahan dalam mengelola limbah yang efisien dan paling ramah lingkungan. Sebagai Perusahaan yang sudah berpengalaman dalam pengelolaan limbah berbahaya, kami melakukan pemerisaan yang stringent dan investasi yang besar dalam produk pelayanan yang menjamin keamanan lingkungan.

Layanan kami meliputi :

1. Pelatihan dalam menangani pengelolaan limbah medis di dalam internal RS.

2. menetapkan semua bahan yang diperlukan untuk dipisahkan dan disimpan.

3. Mengumpulkan dan mengangkut ke tempat pemusnahan akhir.

4. Pembakaran akhir dengan insinerator, limbah yang aman yang sudah dipisah-pisahkan menurut jenis limbah medis tertentu.

Semua layanan kami, sesuai dengan petunjuk dan peraturan Pemerintah Indonesia. Semua limbah medis yang dikelola oleh PT. JasaMedivest ditujukan untuk dimusnahkan di tempat pemusnahan modern di Cikampek, Jawa Barat dan merupakan pengolah limbah medis pertama di Indonesia yang dipantau langsung oleh Departemen Lingkungan Hidup yang memiliki standar emisi yang kuat.

Semua proses pemusnahan kami lakukan dengan standar tinggi untuk melindungi lingkungan dan keamanan. Setiap tahap pemusnahan diawasi tingkat polusinya dan selalu dilakukan monitoring sistem secara komputerisasi untuk menyimpan data, monitor alarm tanda bahaya, analisis penelitian emisi gas buang, effulent test dan zat residu. Kami juga memiliki tim ahli untuk membantu memastikan efisiensi dan keamanan secara maksimal.

Apabila RS atau Perusahaan anda memerlukan bantuan pengelolaan limbah medis, silahkan hubungi kami :

PT. JasaMedivest

 Jl. Pajajaran No. 72 Bandung 40173

CP : Faisal Ramdhan (Marketing Executive)

Ph No : 022-6004588 / 022-6003768.

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Penangan Limbah Medis Tajam Harus Segera Dibenahi

Bahaya Limbah Jarum Suntik

Pada tahun 1999 WHO melaporkan bahwa di Perancis pernah terjadi 8 kasus pekerja kesehatan terinfeksi HIV melalui luka, 2 kasus diantaranya menimpa petugas yang menangani limbah medis. Di Indonesia dalam satu laporan diketahui bahwa setiap bulan pemakaian alat suntik untuk pengobatan mencapai 10 juta pelayanan. Padahal selain untuk pengobatan, alat suntik juga digunakan dalam program imunisasi bagi bayi dan anak-anak yang  setiap tahunnya  mencapai  4,9 juta anak dan setiap anak memerlukan 8 suntikan. Dengan demikian jumlah limbah medis tajam di Indonesia menjadi sangat tinggi.

Oleh karena itu, penanganan limbah medis tajam harus segera dibenahi, karena limbah ini sangat berbahaya bukan hanya bagi pengunjung rumah sakit atau pelayanan kesehatan lainnya, namun juga bagi petugas kesehatan serta masyarakat umum. Hal itu penting karena, limbah alat suntik dan limbah medis lainnya dapat menjadi faktor risiko penularan berbagai penyakit seperti HIV/AIDS, Hepatitis B dan C serta penyakit lain yang ditularkan melalui darah.           

Demikian penegasan Menkes Dr. Achmad Sujudi ketika membuka Lokakarya Penanganan Limbah Medis Tajam pada Pelayanan Kesehatan Dasar (PKD) di Yogyakarta tanggal 1 Juli 2003. Lokakarya yang berlangsung selama 3 hari diikuti 105 peserta dari Depkes Pusat, Kepala Dinas Kesehatan Provinsi, Wakil dari Kantor Meneg Lingkungan Hidup, pemerhati masalah limbah, produsen pengolah limbah lokal dan PATH (Programme for Appropriate Technology in Health).

Kendati Departemen Kesehatan telah menyusun Standar Pelayanan Minimal (SPM) untuk mengukur kualitas pelayanan kesehatan dasar yang salah satunya adalah kewajiban rumah sakit dan Puskesmas untuk mengolah limbahnya. Namun Menkes mengakui bahwa penerapannya masih belum baik. Berdasarkan hasil assesment tahun 2002, diketahui bahwa baru 49 % dari 1.176  rumah sakit (526 rumah sakit pemerintah dan 652 rumah sakit milik swasta) di 30 provinsi, baru 648 RS  yang memiliki incinerator dan 36% memiliki IPAL (Instalasi Pengolah Air Limbah) dengan kondisi sebagian diantaranya tidak berfungsi.       Lebih lanjut ditegaskan, Depkes yang secara teknis memiliki kewenangan dalam penatapan standar-standar pelayanan kesehatan telah mengeluarkan berbagai ketentuan tentang penanganan limbah, terutama melalui Kepmenkes No. 876/2001 tentang Pedoman Teknis Analisis Dampak Kesehatan Lingkungan serta Permenkes No. 986/1992 tentang Persyaratan Kesehatan Lingkungan. 

Limbah medis sebagaimana limbah lainnya berkaitan dengan masalah lingkungan. Karena itu dalam penanganan limbah medis ini dilakukan bersama dengan Kementerian Lingkungan Hidup yang memiliki otoritas dalam penerbitan produk hukum di bidang lingkungan hidup. Koordinasi juga dilakukan dengan Badan Pengkajian dan Pengembangan Teknologi (BPPT) yang memiliki otoritas dalam pengembangan teknologi tepat guna dalam pembuangan limbah medis. Selain itu, Depkes juga mengajak BKKBN yang dalam pelayanannya juga menghasilkan limbah medis tajam.                

Menkes menegaskan, di masa lalu penggunaan alat suntik baik untuk pengobatan maupun imunisasi masih mengandalkan semprit atau syrenge yang disterilkan melalui perebusan berulang-ulang sehingga hampir tidak ditemui limbah alat suntik. Tetapi sesuai perkembangan ilmu pengetahuan dan teknologi, para dokter dan petugas kesehatan harus menggunakan alat suntik disposable (sekali pakai) dan bahkan memakai autodisable syringe (alat suntik sekali pakai yang betul-betul tidak dapat dipakai kembali), mengakibatkan adanya limbah alat suntik yang dikategorikan limbah medis tajam dan berbahaya.

Sementara itu Prof. Dr. Umar Fahmi Achmadi dalam keterangannya kepada wartawan menjelaskan bahwa lokakarya yang diselenggarakan ini merupakan bagian dari paket safe injection (suntikan yang aman). Dengan lokakarya ini diharapkan penerapan safe injection dapat berkembang secara sistematik di seluruh Indonesia melalui para peserta yang hadir.

Program imunisasi merupakan bagian dari upaya kesehatan dasar yang wajib tersedia bagi masyarakat dengan mutu yang baik. Hal ini seirama dengan prinsip hidup sehat dimana masyarakat memperoleh pelayanan kesehatan dengan mutu baik dalam lingkungan fisik yang sehat sehingga dapat memotivasi masyarakat untuk berperilaku hidup bersih dan sehat.

Menkes menyambut baik lokakarya ini dan berharap menjadi forum untuk mempertemukan para pakar dari berbagai ilmu serta para praktisi baik dalam maupun luar negeri. Dengan demikian hasilnya akan menjadi acuan Depkes untuk menyusun konsep manajemen penanganan limbah medis yang komprehensif di Indonesia. (sumber : Depkes)

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Pengelolaan Limbah Medis Jauh di Bawah Standar

Open Dumping

BANDUNG, (PR).-
Pengelolaan limbah medis (medical waste) dari rumah sakit, puskesmas, dan laboratorium di cekungan Bandung, masih jauh di bawah standar kesehatan lingkungan karena umumnya dibuang begitu saja ke tempat pembuangan akhir (TPA) sampah dengan sistem open dumping (tempat sampah terbuka). Padahal, limbah medis semestinya dibakar menjadi abu di incinerator (tempat pembakaran) yang bersuhu minimal 1.200 derajat celcius.

 

Pernyataaan itu diungkapkan Kepala Dinas Lingkungan Hidup (DLH) Kab. Bandung Mulyaningrum, Rabu (1/12). “Kalau pun ada rumah sakit yang memiliki incinerator, paling hanya berfungsi sebagai pembakar (burner), karena suhunya jauh di bawah 1.200 derajat celcius. Akhirnya, limbah yang dibakar pun masih berbentuk seperti arang, bukan abu,” kata Mulyaningrum.

 

Dijelaskan Mulyaningrum, begitu keluar dari incinerator, limbah medis itu semestinya sudah berbentuk abu sehingga tinggal dibuang ke TPA bahan berbahaya dan beracun (B3) dengan sistem sanitary landfill (limbah diuruk tanah). “Karena sudah berbentuk abu, areal TPA pun tidak terlalu banyak terpakai sehingga umurnya bisa lebih panjang. Selain itu, tidak terlalu memerlukan banyak tanah untuk menguruknya,” katanya.

 

Dicontohkan Mulyaningrum, buruknya penanganan limbah medis sempat memakan korban seperti ada pemulung yang harus diamputasi kakinya gara-gara tertusuk jarum suntik di TPA. “Untuk mengatasi itu semua, Kementerian Lingkungan Hidup (KLH) sedang mengkaji kemungkinan pembangunan incinerator di Kec. Cipatat, Kab. Bandung yang dapat menampung limbah dari seluruh rumah sakit, laboratorium, dan berbagai fasilitas kesehatan lainnya di cekungan Bandung,” katanya.

 

Mulyaningrum mengatakan, rencana pemilihan tempat di Cipatat karena incinerator tidak cocok dibangun di dalam cekungan yang padat penduduk seperti Kota Bandung. “Jika dipaksakan, incinerator di tengah kota bakal mencemari udara sehingga mengganggu bagi masyarakat di sekitarnya,” katanya.

 

Bakal selaras

Dijelaskan Mulyaningrum, rencana pembangunan incinerator di Cipatat bakal lebih selaras jika dipadukan dengan pendirian TPA limbah B3 di dekatnya. Setelah limbah rumah sakit dibakar di incinerator, abunya tinggal dibuang ke TPA limbah B3 yang berada di dekatnya. Pasalnya, limbah B3 saat ini masih harus dibuang ke TPA limbah B3 di Kec. Cileungsi Kab. Bogor sehingga memakan biaya besar.

 

Apalagi, Mulayaningrum mengatakan, pembangunan TPA limbah B3 di Kec. Cipatat sudah direkomendasikan oleh ITB yang bekerja sama dengan DLH. “Namun, secara informal, KLH mengatakan daya serap air di lahan itu tidak sesuai dengan persyaratan karena hanya 0,0001 m/detik sedangkan semestinya 0,000001 m/detik. Walau begitu, kendala tersebut sebenarnya bisa diatasi dengan rekayasa teknologi seperti menggunakan dua lapisan sehingga daya serap airnya bisa menjadi 0,000001 m/detik,” katanya.

 

Pakar lingkungan dari Badan Pengendalian Lingkungan Hidup Daerah (BPLHD) Jabar Dr. Setiawan Wangsaatmaja, mengakui, penanganan limbah medis di cekungan Bandung masih buruk. “Anda bayangkan, kalau tumor atau kanker hasil operasi dikorek-korek oleh pemulung di TPA, jelas sangat membahayakan kesehatan manusia,” katanya.

 

Sementara itu, Kepala Dinas Kesehatan Kab. Bandung dr. Sukmahadi Thawaf mengakui rumah sakit lama umumnya belum memiliki fasilitas pengolahan limbah sesuai standar kesehatan lingkungan. Walau begitu, berbagai fasilitas itu akan terus dilengkapi secara bertahap. Namun, untuk rumah sakit baru atau yang akan didirikan, berbagai fasilitas pengolahan limbah sesuai standar tersebut harus sudah dimiliki.

 

Sukmahadi mengatakan, rumah sakit lama belum memiliki fasilitas yang memadai karena standar kesehatan lingkungan pada masa lalu tidak seketat sekarang. “Karena itu, kami sangat mendukung upaya pengolektifan penanganan limbah medis seperti yang direncanakan di Cipatat,” katanya.(A-129)***

 

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