Practice and enforcement of national Hospital Waste Management 2005 rules in Pakistan

Hospital waste management (HWM) rules in Pakistan were issued in 2005. Despite a decade of enactment, adherence to HWM 2005 rules has been inconsistent and systematic assessment of adherence using a World Health Organization (WHO)-recommended questionnaire has not been done in all teaching hospitals of Peshawar District. This study assessed the adherence to HWM 2005 rules by tertiary care teaching hospitals of Peshawar District with respect to HWM personnel, policy and practices. Pretested structured questionnaires based on WHO recommendations were used to survey all teaching hospitals of Peshawar District from January to March 2015. Data were also collected on HWM infrastructure and processes from 1 randomly selected medical, surgical, paediatric, and obstetrics/gynaecology unit in each hospital. Besides descriptive statistics, public and private hospitals were compared using Fisher's exact and Wilcoxon rank-sum tests. Most surveyed hospitals lacked formal HWM plans (70%), written procedures (80%), related job descriptions (80%) or records (90%). Many hospitals neither had trained HWM supervisors (56%) nor did they organize formal HWM trainings for new staff (40%). None of the hospitals followed waste segregation and colour coding. When compared to national HWM 2005 rules, multiple gaps in appropriate transportation, storage and disposal were found with no statistically significant difference between public and private hospitals. Serious gaps in adherence to HWM 2005 rules exist in surveyed hospitals. With recent devolution of environmental function, the Government of Khyber Pakhtunkhwa should enact provincial HWM rules (and ensure their implementation) to facilitate effective HWM practice across provincial healthcare facilities.