Do you have any Medical Waste Management Programme in the hospital that regulates the generation, handling, storage, treatment, and disposal of medical waste?
Yes, we do have a Medical Waste Programme. In fact, we follow the EPSS - Environmental Protection & Safety Section Code of Practice and Regulations, as enforced by the Dubai Municipality. The EPSS is our guideline for our practices, methodologies and procedures. One of the practices outlined is the selection and the monitoring of the transportation service contractor, who in this case is Dulsco. We did a competitive tender exercise asking applicants to meet the requirements of EPSS. Dulsco met all our parameters of cost and quality, and we have had a very excellent relationship since then.

What constitutes medical waste and how knowledgeable and responsible is the medical fraternity in this part of the world in terms of handling medical waste?
It is essentially a moral and ethical responsibility and everyone is aware of it. The entire medical fraternity comes under the law and has to follow it in terms of disposing their waste. The hazards are exactly the same for everyone. We have chemicals that don’t break down over time and have to be carefully disposed. We have sharps, which are basically like needles that can puncture the skin and have mucus membrane on it. It could even be something from the laboratory on which skin testing has been done or any of the potentially infectious waste generated in a healthcare environment.

How do you rate the medical waste handling and disposal facilities in the UAE in comparison to other countries and are they environmentally friendly?
There are three major ways of Medical waste disposal. Firstly, there is incineration, or burning the waste in a furnace. Secondly, there is chemical disposal where you spread the waste, or cut into small pieces while adding chemicals to neutralize or equalize the waste. And thirdly, there is radioactive disposal, used mainly in Europe. Of these three, the most popular by far is incineration. However, this method often proves difficult, especially when you consider the amount of plastic, rubber and vinyl waste that is generated. In spite of this problem, it is still the most popular method.

How confident are you that the waste is handled the way it needs to be after it leaves your premises?
We follow the EPSS guidelines to the book as a waste generator. After this, it is Dulsco’s responsibility to meet the requirements of Dubai Municipality as the transporter. I’m confident that Dulsco meets every requirement too. Finally the responsibility lies with the actual disposer, Dubai Municipality. They too work according to the guidelines, using the right facilities for different types of waste disposal.

How is the waste generation history maintained with the hospital?
Without doubt, we have a very effective record maintenance system that meets the requirements of the EPSS codes. We take the compliance requirements very seriously.

The waste is collected in colour coded plastic bags depending on the type of waste (example: Black - general domestic & office type waste, Red - radiotherapy waste, Yellow - all other medical waste, Purple - cytotoxic waste). The gauge of the plastic bags in microns is also specified and special bag ties are used. Dedicated transport trolleys with sealed lids and steam cleaning capability are used for transporting from the internal hospital collection points to the main external storage collection facility. This is a chilled cold room, which maintains the waste at 4?C until collection by Dulsco. Finally, all bags of waste are weighed, labelled and a master record log is completed as the bags are transported to the Dubai Municipality disposal site in Jebel Ali.

What training programmes have been introduced to educate people in this specialised field?
The American Hospital is the first hospital in the Middle East to be accredited under the Joint Commission International Accreditation (JCIA). To maintain this accreditation, we take training very seriously. We have an awareness campaign for all our housekeepers using posters to explain the whole sequence of waste management. We also train them on the EPSS procedures and the type of protective clothing they must wear. Apart from this, we hold regular tests and have an annual performance review, when the team is also educated on not just medical waste management, but also on subjects related to prevention and control of infection, fire prevention, safety, quality improvement and disaster management.

What improvements would you recommend apart from what is existing?
Dubai already has a very good code of practice, a knowledgeable government department doing checks and an excellent central disposal system. However, I believe the enforcement of the codes and standards requires increased resources to better control the situation. The negative impact on the environment from negligence, ignorance or malpractice should healthcare waste generators and transporters not adhere to the codes is a very “scary” alternative.

Note: This interview is based on questions developed by Dulsco, to gather client feedback on partnering with Dulsco to transport medical waste.