Healthcare waste (HCW), the primary source of hospital-borne infections worldwide, harbours potentially harmful microorganisms, posing a risk of infection to patients, health workers and the public. It is estimated that 15 percent of the total HCW produced can be infectious, toxic or radioactive. Drug-resistant microorganisms can emanate from health facilities and spread into the environment, exacerbating the challenge of antimicrobial resistance.

There is a pressing concern about the management of HCW due to Nepal’s rapid growth of medical facilities. Proper disposal of medical waste is crucial not only for environmental sustainability but also for safeguarding public health. Contaminated sharps, infectious materials and hazardous chemicals result in the spread of infections and diseases. In a country where access to healthcare resources is limited in some areas, preventing disease transmission through safe waste management cannot be overstated.

Additionally, the environmental repercussions of inadequate medical waste management are alarming. Dumping untreated hospital waste contaminates air, soil and water resources, affecting local ecosystems and agricultural lands. Given Nepal's rich biodiversity and dependence on agriculture, HCW has a detrimental impact on food safety and water quality. So, segregating waste in hospitals and healthcare facilities is essential for our long-standing safety.

Cross-contamination of HCW also elevates the risk of hospital-acquired infections, exacerbating the effect of infectious disease outbreaks. Ensuring adequate waste segregation becomes pivotal in preventing cross-contamination, especially in healthcare settings. Separating waste types at the source to diminish the spread of infections within the hospital premises shouldn’t be overlooked.

Government initiatives

The Ministry of Health and Population (MoHP) has enacted regulations to oversee the appropriate disposal of medical waste. Healthcare facilities must adhere to the Health Care Waste Management Guideline to safeguard public health and the environment. Rigorous monitoring and enforcement of these guidelines are essential to instil a culture of responsibility among healthcare providers.

Compliance with proper waste segregation practices is not just an ethical obligation but also a legal mandate. Hospitals must align with national and international regulations dictating the disposal of medical waste, as it can otherwise leave healthcare institutions vulnerable to legal consequences. Guaranteeing proper waste segregation not only shields local residents from potential health hazards but also contributes to the overall well-being of the community. This commitment to proper waste management becomes an integral component of corporate social responsibility for healthcare institutions.

Public awareness of the potential risks associated with improper waste disposal through educating healthcare professionals, waste handlers, and the general public is of utmost importance. Moreover, community engagement can be a catalyst to promote responsible waste disposal practices, ultimately minimising the adverse effects on public health and the environment. By fostering awareness and encouraging responsible behaviour, healthcare institutions can play a vital role in creating a healthier and more sustainable environment for their immediate communities and broader society.

Innovative solutions

To address the unique challenges of HCW management, exploring innovative waste management solutions is essential. Implementing advanced technologies for waste treatment, such as autoclaving and incineration, can help reduce the volume and hazardous nature of medical waste. Additionally, promoting the recycling of certain materials can contribute to sustainability efforts.

In this context, I had the privilege of observing the innovative HCW management initiatives undertaken by the non-governmental organisation (NGO) Health Environment and Climate Action Foundation (HECAF360) at Tribhuvan University Teaching Hospital (TUTH). Supported and endorsed by national and international healthcare agencies, HECAF360 has pioneered the development of clean, green and climate-smart technology solutions tailored to environmentally sustainable HCW systems in Nepal and other low-resource nations.

There are colour-coded waste segregation containers in all departments and wards at TUTH. Healthcare professionals, patients and visitors are mandated to discard their waste—whether biological, contaminated, or plastic—into the containers. This meticulous segregation ensures that each type of waste is channelled to the right treatment process. The collected waste undergoes specialised treatment procedures based on its nature. Contaminated waste is subjected to sterilisation through autoclaving, while pathological and biological waste find their way into a custom-designed biodigester. This innovative system facilitates the decomposition of waste, yielding biogas as a sustainable byproduct.

The comprehensive approach adopted by TUTH and developed by HECAF360 suggests a commitment to effective waste management and environmentally friendly practices in the healthcare setting. It was a positive surprise to observe the significant improvement in the overall cleanliness of TUTH, especially when compared to the unsanitary conditions of the wards and external premises just a few years ago.

HECAF360 is actively revolutionising HCW management by implementing innovative zero-waste principles in many hospitals in and outside Kathmandu. Their efforts not only showcase a commitment to environmental responsibility but also serve as a model for addressing HCW challenges in resource-constrained settings. A similar approach is imperative across all hospitals and healthcare facilities nationwide. The government and other concerned authorities should actively endorse and champion organisations like HECAF360, which are at the forefront of implementing innovative zero-waste management systems in hospitals.

A comprehensive approach involving legal compliance, community awareness and innovative solutions is crucial to mitigating the potential risks of improper waste disposal. Prioritising responsible waste management practices will contribute to a healthier and more sustainable future as Nepal advances its healthcare infrastructure. Implementing robust waste segregation and proper disposal practices in hospitals, akin to what has been achieved in TUTH, will foster a healthier, safer and more sustainable future for the nation.