Biomedical waste management in the Regional Hospital Center of Ziguinchor

To make the hospital environment healthier for those it serves, the management of biomedical waste (BMW) was studied in the Ziguinchor Regional Hospital Center (RHC) in Senegal from 1 March through 15 March, 2000. The RHC incinerator had stopped operating in 1993. Problems in BMW management were observed at all levels. Neither identification nor sorting took place during collection. Waste bins were exposed everywhere. Workers, rather than carrying waste bins on their back or head, used rolling tables. BMW ended up in a shallow open pit where they were periodically burned. Workers collected, stored, and transported BMW without any type of protection (gloves, boots, masks, aprons, etc.). The principal determinants of this poor management appear to be inadequate funding and training for the cleaning staff, the staff's failure to realize the dangers, and their use of non-standardized practices, due to the absence of BMW policies. BMW management at Ziguinchor RHC must be corrected. Protective equipment must be used systematically. Similarly, standardized practices must be applied to the decontamination of used objects, the identification and sorting at the source, the recovery and recycling of all objects with any remaining value, and the correct storage of BMW. This waste must be transported under high security from its place of storage to its final disposal site. Deep burial has been selected as the most feasible method of disposal under current conditions. A year-long program has been proposed towards this end. Strategies include training, information, motivation, equipment, supervision and evaluation. The budget to implement this program is CFA 5,423,454 francs, distributed between training (22%), equipment (40%), construction of the pit, and follow-up (38%). The tasks are distributed between a public health doctor, department supervisors, and cleaning staff. The follow-up will include three quarterly inspections, at 3, 6, and 9 months and an evaluation at the end of the program. The effect of the program will be judged by the disappearance of unlawful dumping due to the disposal of all BMW in the RHS's deep burial pit.