How Jordan Disposes of Hazardous Coronavirus Medical Waste

Diagram showing movement of covid waste

Ahmed Bani Hani
Monday, June 29, 2020

“If we do this, others will, at the end of the day, we must wear protective clothing and masks, and God shall protect us”. This is how Rakan Abbasi, (20s), the environmental worker at the founder King Abdullah University Hospital (KAUH), describes the risk of his work in collecting medical waste for Covid-19 patients.

Rakan and his 11 colleagues working in Coronavirus isolation section work from 8 am – 4 pm, except for Friday and Saturday, according to strict health regulations and standards related to wearing special isolation section clothing, masks, gloves, and eyeglasses, in addition to head and shoe protectors, as per his description.

“We wear protective clothing and rounds start on the sections, we collect medical waste from the isolation section of people with coronavirus carefully. We were told they are contagious wastes and the virus can be transmitted quickly,” says Rakan, adding that this waste is collected in special red bags to indicate seriousness.

Rakan continues, “At work, containers are divided into categories, some of which is for hazardous Coronavirus wastes. We sterilize the container before and after we work. Upon completion, we move the bags to the warehouse, and then they are transported with special vehicles from there to incinerators”.

“Fear is great for our families and those we love. Yet, this is what we do for a living and we abide by instructions. Also, we do not mingle, we just do our jobs”.

After completing the work, Rakan and his companions remove the protective clothing in a place designated for that, according to methods previously determined for them, so that the infection does not spread to them if they come into contact with the virus. Then, they completely sterilize themselves before leaving for their homes. Rakan continues: “Fear is great for our families and those we love. Yet, this is what we do for a living and we abide by instructions. Also, we do not mingle, we just do our jobs”.

“7ibr” traced the mechanism of dealing with medical waste in the Coronavirus health isolation sections, and how they are collected by the competent cadres in hospitals and quarantine places, up to the incinerators and waste dumps, until their danger to the environment and people is disposed of.

At the beginning of the crisis, the Jordanian government approved the Prince Hamzah Hospital for quarantine in the capital, Amman, the KAUH for in northern Jordan, Queen Alia Hospital and the quarantine area in the Dead Sea, in addition to hotels rented in Amman for quarantine, according to the head of the Covid-19 dossier at the Ministry of Health, Dr. Adnan Ishaq.

What are medical wastes and how are they disposed of?
Hazardous medical wastes are defined as “any materials that cannot be disposed of in public waste disposal sites or sewage networks, due to their hazardous properties, their harmful effects on the environment and the safety of living creatures, as they need special means to deal with and dispose of them,” according to the second report on the state of the environment for the year 2016.

The report indicates that non-hazardous waste constitutes 75-90% of the total waste generated by hospitals, which is general (household) waste that results from administrative departments and various housekeeping activities such as paper, cardboard, plastic, food residue, and others. While hazardous waste constitutes 10-25%, and infectious waste constitutes the largest percentage of it, which is considered by a source in the Ministry of Environment close to the current figures, noting an increase in natural population growth by 5-10%. The same source confirmed that the ministry is working on issuing the third report on the state of the environment in Jordan in 2020, and there are no new figures or statistics yet.

The Ministry of Environment burned 171 tons of medical waste before April 10, after ending the contract with one of the companies that the Ministry of Environment granted a tender to, to dispose of dangerous medical waste generated by quarantine places, hospitals and hotels for those infected with Coronavirus at the beginning of the crisis, according to the director of the Directorate of Inspection and Environmental Control In the Ministry of Environment, Eng. Muhammad Al-Rialat

Rialat told “7ibr” that at the beginning of the crisis, a private company was contracted based on the recommendations of the technical authorities in the Coronavirus Crisis Management Cell. After reviewing the global practices in this regard, guidelines were developed by the Ministry of Environment to deal with the waste generated by the quarantine sites, approved by the Crisis Cell at the National Center for Security and Crisis Management, and accordingly, the waste is buried after its sterilization in the landfills of the Services Council in the governorates and the Amman Municipality, in addition to burning waste in the designated incinerators.

There are no official statistics available until the publication of this report on the amount of waste that has been dealt with since the beginning of the Coronavirus pandemic in Jordan, but Prince Hamzah Hospital deals daily with around 5 kilograms of waste per infected person, according to Abdul Razzaq Khashman, the hospital’s director. The KAUH handled more than 45 tons of waste until mid-June, according to the hospital’s management. The Greater Amman Municipality also handled 1,648 tons of waste from isolation places and hotels designated for isolation since the beginning of the crisis, according to media spokesperson for the Amman Municipality, Nasser Al-Rahamnah.

The Ministry of Local Administration is working on preparing a statistic about the volume of waste that it dealt with, and its results have not been released yet, according to the director of the Solid Waste Directorate in the Ministry, Engineer Hussein Muhidat. However, the ministry received about 4000 bags of waste from the quarantine areas in the Dead Sea as of May 16, 2020, according to the ministry.

Coronavirus’ wastes are highly contagious and dangerous
The spokesperson for the National Epidemiological Committee, Dr. Nazir Obaidat, confirms that the medical waste that comes out of the quarantine for people with coronavirus is highly contagious and dangerous and that it may transmit the virus.

Obaidat pointed out to «7ibr» that it is necessary to adhere to the health conditions in order not to transmit the infection to doctors, nurses and environmental workers who deal with this medical waste, pointing at the same time to the absence of any infection to medical personnel and cleaners, except for three cases of a nurse, a doctor and a cleaner, as they were infected after contacting people outside the hospital.

The Prince Hamzah Hospital administration treats all medical waste that comes out of the departments as hazardous waste, whether it is the waste of safety and protection tools, food, clothing waste, or any other form of waste, according to the hospital director, Abdul Razzaq Al-Khashman.

Khashman told «7ibr» that the hospital has been emptied since the beginning of the crisis to only receive Coronavirus cases, and that all medical and non-medical cadres inside it are trained at the highest level to deal with those infected with the virus and waste that comes out of the isolation departments.

He continues that medical waste is placed inside red bags prepared in advance, as it is collected by a special machine and then wrapped and sterilized, and transported to the place of waste collection until it is burned at high temperatures up to more than 1000 degrees Celsius, in the incinerators of the Jordan University of Science and Technology in the city of Irbid, north The kingdom. This comes after decommissioning the contract with the private company and providing the burning process as an aid from the university to the efforts of the Ministry of Health in combating the virus, without financial compensation, according to Director of the Services Department at Prince Hamza Hospital, Souad Nayef.

Regarding the medical liquid waste in the isolation sections, Khashman explains that large quantities of chloride are poured into the wastewater lines and on their exits, then mixed to it to ensure that they are not transmitting the infection, as the infected fluids, whether saliva or bathing water, may pose a danger and spread the virus in case not sterilized.

Ali Bani Issa, a doctor at the KAUH, describes the medical staff’s getting close to wastes while inspecting the infected people as dangerous. He said that direct dealing with patients with safety and protection tools such as masks, examination devices, gloves and a protective suit that are used only once, increases the volume of waste and its seriousness, which was confirmed by the Director-General of the Founding King Abdullah University Hospital Dr. Muhammad Al-Ghazou, as he said that the hospital produces about 600-800 kg of medical waste per day during the Coronavirus crisis, which is three times what is produced in the normal situation.

Al-Ghazou considered in his interview with “7ibr” that the safety of the cadres working in the hospital is no less important than fighting the virus, especially in light of their dealing with more than 175 confirmed Coronavirus cases since March, noting that all the medical wastes that come out of the isolation departments were collected and burnt daily inside the JUST incinerator near the hospital, so that it does not pose any risk to human health, “We treated it as a very dangerous waste. Thank God there was no infection, as we burnt more than 45 tons of wastes”.

Medical waste increased with the spread of the Coronavirus
At the beginning of the crisis, Dr. Hani Abu Qudais, from the JUST University, conducted a study that showed an increase in the quantities of medical waste in Jordan due to the spread of the Coronavirus.

Abu Qudais tells «7ibr» that his study prepared from March 2 through April 4 concluded that the amount of waste per hospital bed has increased to 10 times in some cases, as a result of the procedures followed when treating Covid-19 patients, compared to normal cases in other parts of the hospital.

The rate of medical waste production in Jordan ranges between 400-500 grams of medical waste per bed a day. There are about 11 thousand beds, which means the production of about 5.5 tons per day of medical waste.

Abu Qudais notes that the study was applied to KAUH dedicated to isolating and treating cases of coronavirus infection in the northern governorates, and its results represent this period and cannot be generalized. The amount of waste reaches 650 kg in the event of the presence of those infected with the virus. The increase is explained by the presence of large quantities of disposable medical safety and protection devices.

He adds that the rate of medical waste production in Jordan ranges between 400-500 grams of medical waste per bed a day. There are about 11 thousand beds, which means the production of about 5.5 tons per day of medical waste.* However, if this waste is not sorted correctly, this would lead to mixing it with non-medical waste, and therefore the mixture is considered as a whole harmful and contagious waste. This leads to an increase in the quantities of this waste, and therefore must be treated as contagious, according to Dr. Abu Qudais.

Dealing with Coronavirus waste requires caution
Several doctors, environmental workers, and vehicle drivers working in Prince Hamzah Hospital, the KAUH and quarantine areas tell their experiences while dealing with this waste, as they indicated that their work involves great psychological and nervous pressure due to the rapid spread of the virus on the one hand and their fear for their families and those they contact in the event of accidental transmission, on the other.

Workers are aware of the size of the risk they may be exposed to while dealing with this infectious waste, confirming that those infected with the virus may cough while they are inspected or checked during inspection tours. This may transmit the infection if it comes into contact with the protective clothing or part of it, so these clothes are considered hazardous medical waste, which should be disposed of and incinerated after one-time use.

“It is forbidden to get close to any bag,” says Abu Yusef (40s) *, who works as a special vehicle driver for transporting hazardous medical waste at Prince Hamza Hospital, noting that drivers do not interfere with work but rather transport waste from the hospital to the incinerators of JUST University.

The task starts after the cleaners transport the waste bags from the warehouses to the vehicle, without any interference from anyone, especially the drivers. There are strict instructions that obligate them not to approach the bags, he said, adding, “After loading the bags, we head towards our destination accompanied by another cleaning worker, not the one who transported the waste earlier. He is to wear the entire protective dress to unload the vehicle from the bags when we arrived at the incinerator and then back to the hospital again”.

Abu Yusef describes the seriousness of his work and the pressures they were exposed to at the start of the crisis. “We do this every day and our supervisors follow up on our work step by step. They did not leave us since the beginning of the crisis as if they say we are all in this together”.

What types of medical waste result from the management of the Coronavirus pandemic?
For his part, Dr. Mutasim Saidan, the Coronavirus spread statistics researcher, stresses the importance of dealing with waste resulting from cases of infection with the virus per the correct scientific methods, to ensure that the infection does not transmit later. He pointed out the importance of differentiating between waste that comes out of hospitals, places to isolate infected people and waste in precautionary quarantine places.

Saidan shows that the first type of waste results from confirmed cases of people infected with the virus, which makes them dangerous and contagious and must be dealt with by burning, which is now happening in the JUST university incinerator. As for the waste that comes out of precautionary quarantine places, it is “municipal” household waste, which is not contagious unless any infection is proven in those areas, whether it is inside the governorates or quarantine hotels.

“Infectious waste is collected and burned at high temperatures to dispose of its danger before it is buried. As for household waste, it is sterilized by using special sterilization materials before it is buried”. Saidan refers to the autoclave steam sterilization technique, which is used to sterilize the metal parts of ordinary medical waste, while it has not yet been proven to be effective with infectious waste, as bacteria and viruses remain, and therefore must be incinerated to eliminate its severity.

Saidan points out that there should be special transport vehicles to transport the waste generated by Coronavirus, and to check public safety procedures during their transportation, especially for long distances between the governorates, indicating that if any fluids leak or any parts of this waste fall, this may be a reason for the virus spread and transmission.

The former Minister of Environment, Dr. Taher Al Shakhsheer, stresses the importance of dealing with hazardous medical waste correctly, to ensure the safety of the environment and the people who deal with it and the population. He noted the importance of preparing incinerators and waste dumps to absorb these wastes and their gravity, and maintaining them periodically, for the resulting toxic gases from these wastes cause various cancers and diseases if released abroad.

Coronavirus waste journey to the incinerator
The head of the Environmental Health Division at the KAUH, Engineer Saeed Al Momani, described the journey of medical waste from the infecting people rooms, to containers, warehouses, incinerator, and turning it into ashes after disposing of its gravity.

Momani explained that waste bag colors are of significance; black indicates regular (household) waste, yellow indicates medical waste and red means that these waste are contagious and very dangerous. Momani also confirmed that all the waste bags that leave the fifth floor of isolating those infected with the virus are hazardous medical waste bags (red).

“Priority is for hazardous waste, then, medical waste. When transportation vehicle comes after bags are collected in the warehouse, we start with loading the res bags to the incinerator”.

Al-Momani adds that environmental workers are highly trained to deal with these situations, and they have long experiences and are committed to preventive guidelines, in addition to providing sterilization tools with each worker, a special elevator that is used only to transport coronavirus waste under great precautionary measures, where the elevator is sterilized after each process. There is one clear path from the patient rooms to the warehouse, as the first round begins at 10 am and the second at 13:30, with emergency rounds as needed. “Priority is for hazardous waste, then, medical waste. When transportation vehicle comes after bags are collected in the warehouse, we start with loading the res bags to the incinerator”. According to Momani, the bags are not packed completely, but only 9-10 kg, that is, two-thirds of them, and then tightly tied.

The burning process is carried out in two phases in ovens designated for this purpose. The first is at a temperature of 800 ° C, while the second reaches 1000 ° C and more, to ensure that it is not dangerous to public health and safety. In the first stage, toxic and dangerous gases are generated that the second stage aims to eliminate and convert the waste into non-hazardous ash, then bury it underground like any ordinary waste, according to Momani, who stressed that more than 45 tons of waste have been burned since the beginning of the crisis.

Environment and the most important file
The Director of the Inspection Directorate at the Ministry of Environment, Eng. Muhammad Al-Rialat, talks about the disposal of medical waste that comes out of the places of quarantine and sanitary isolation. He says that the ministry formed an emergency cell for this purpose that includes some official agencies in cooperation with the Ministry of Health, the Ministry of Local Administration, and the Greater Amman Municipality.

Rialat indicates that medical waste from the quarantine area in the Dead Sea is sterilized in the Der Alla landfill near the Dead Sea. The bags are left on cells lined with a plastic layer from the bottom, and they have sterilized again with materials approved by the Food and Drug Corporation, then they are lined from above with another plastic layer, while ensuring that animals do not approach them by placing a fence or a barrier, where they are left for ten days, to be treated later using the sanitary landfill method.

According to the Rialat, studies have shown that the virus may remain on the surfaces for up to 3-4 days, while waste bags are sterilized and exposed to sunlight for ten days on these cells to ensure that the virus does not remain and cause infection. He also mentioned that the ministry takes into account the global criteria in dealing with coronavirus waste, as no cases of environmental or health personnel have been recorded in dealing with this waste. Also, environmental inspectors deployed in all governorates of the Kingdom are constantly monitoring the mechanism of waste disposal.

The Secretary-General of the Ministry of the Environment, Muhammad Khashashneh, expected an increase in the rate of medical waste from the last report on the state of the environment in Jordan, which was published in 2016, due to taking into account the natural population growth that ranges between 5-10%, adding that the Coronavirus crisis generated a new type of medical waste, which is caused by people infected with the virus, as it is treated as highly dangerous infectious waste, confirming that the Ministry is currently working on completing a new report on the state of the environment.

The Minister of Environment, Dr. Saleh Al-Kharabsheh, said in a March press statement, that the Ministry is around the clock monitoring the implementation of integrated waste management resulting from medical care for people infected with the Coronavirus in quarantine places, to preserve the health and safety of citizens.

This report is in cooperation with JHR.
* An error was mentioned in an earlier version of this report that Jordan produces about 50 tons per day of medical waste. The correct number is about 5.5 tons. We apologize for the error.

Originally posted by 7iber here:

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