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Ramazanova Ayazhan Darkhanovna
1st year master's student,
A.E. Buketov Karaganda University
Bodeeva Rahat Tleuovna
Candidate of Biological Sciences, Associate Professor
Currently, much attention is paid to the issues of sanitary and epidemiological welfare of the population of Kazakhstan. There is a difficult situation with the medical waste management system in the country. This category of waste belongs to the category of hazardous, as it is a source of violation of epidemiological and environmental safety in waste. The system of medical waste management in modern medical institutions is criticized from the point of view of environmental safety. The process of medical waste disposal is imperfect, requires significant economic and organizational efforts. This problem can be solved by analyzing the existing waste management system in medical organizations and developing a program for effective management of medical waste in medical institutions.
Key words:
Medical waste, epidemiologically hazardous, waste management, environmental safety.
In Kazakhstan today, there is a situation when for the treatment of dangerous medical waste of classes B and C does not need permits, does not require mandatory environmental assessment, compliance with sanitary zones, development of permits and even obtaining a license for waste management.  It turns out that any organization of any form of ownership can engage in activities in the field of medical waste disposal. There is no proper control and a clear procedure for selecting technologies, while the use of the best available technologies, the most efficient, environmentally friendly, resource-saving and least expensive from an economic point of view is provided for the treatment of solid household waste and other waste [1].
Medical waste is all waste generated in medical institutions, medical laboratories, and biomedical institutions, as well as waste from small or scattered sources. The main part of medical waste hospitals. Estimates of the level of waste generation around the world show that hospitals produce about 0.5 kg per bed per day. Improper use of medical waste and its disposal pose a serious threat to the spread of the disease infectious agents, waste recycling workers, medical workers, patients and society. Open incineration and incineration of waste without proper control over environmental pollution poses a risk to waste recycling workers as well as contact with toxic atmospheric pollutants and ash.
Currently, the formation and accumulation of production and consumption waste is one of the main environmental problems. The production of waste worldwide is growing, outpacing the pace of its processing and disposal. Over the past century, the complex problems associated with waste generation have become more acute around the world. Not only does the annual increase in the amount of waste contribute to increasing environmental tension, but also the lack of a developed system for their processing and environmentally safe disposal. At the same time, the degree of waste involvement in economic activities is extremely low, and international experience in the field of waste management and regulation of their turnover is not sufficiently used. In our society, the culture of waste management is at a low level. A lot of social work is being done to convince people to sort waste, but if it does not start to work and bring results, then we need to think about revising the legislation in the field of waste management.
This collection contains basic information about medical waste, including the composition of the material, the amount of moisture, chemical composition and bulk density. Classification of medical waste it is described in the WHO reference guide in accordance with the World Health Organization classification system for safe handling of medical service waste. Total balance from 75% to 90% non-hazardous (non-infectious, non-hazardous) general waste produced by medical institutions household waste. Only a small part of medical waste is considered dangerous and can pose a health hazard. [2]
Quality factors and evaluation parameters are indicated in the compendium medical waste recycling technologies are an integral part of the medical waste management system, which includes the best available technologies, as well as the best environmental practices. Distribution is the key to efficiency medical waste management. Other elements of medical waste management: waste classification, waste reduction, containerization, color coding, labeling, processing, transportation, storage, processing and final processing. Planning and implementation of a medical waste management system should depend on storage, defines the role and responsibilities of medical personnel, specific procedures and training. Process institutionalization of an effective medical waste management system includes waste assessment and evaluation of waste management options from current practice, development of a waste management plan, adoption of organizational strategies and guidelines, creation of a waste management organization, terms of implementation of plans for the allocation of human and financial resources, accumulation of funds, program periodic Professional Development, Monitoring, Analysis and continuous improvement.
Burning heavy metals or materials with a high metal content (especially lead, mercury, and cadmium) can lead to the spread of toxic metals into the environment, resulting in negative impacts. Modern incinerators, operating only at a temperature of 850-1100 ° C and equipped with special equipment for gas purification, meet international standards for emissions of dioxins and furans. In accordance with the Code of the Republic of Kazakhstan on Human Health and the Healthcare System, central and local executive authorities, within their competence, carry out state regulation in the field of healthcare. However, the most common problems associated with medical waste are lack of awareness of the health risks associated with medical waste, lack of preparation for the proper processing of medical waste, and lack of attention to this problem.
Meanwhile, in the world practice, incineration or autoclaving (microwave and steam-thermal treatment) is used for the disposal of such medical waste. In Kazakhstan, too, the method of incineration is mainly used. However, according to the our city , the lack of uniform requirements and tariffs for this activity is alarming. For example, only in medical institutions controlled by the Akimat of Karaganda, and there are more than 30 of them, more than 400 tons of epidemiologically dangerous, especially dangerous and toxicologically dangerous medical waste are normally generated. According to the World Wide Fund for Nature (WWF), even 1% of improperly disposed masks can turn into 40 tons of plastic in nature.  And in the current situation, their volumes are likely to have increased significantly.
As I said, in order to properly dispose of medical waste, it is necessary to solve the problem by analyzing the existing waste management system in medical organizations and developing a program for effective management of medical waste in medical institutions.As an example , I chose the Multidisciplinary Hospital No. 1 of the city of Karaganda.
Multidisciplinary hospital №1 is equipped with modern medical equipment necessary for carrying out diagnostic and therapeutic measures.In accordance of the Charter of the Multidisciplinary Hospital №1, the subject of activity is the implementation of medical activities in accordance with the legislative and other regulatory legal acts of the Republic of Kazakhstan, including the procedures for providing medical care and standards of medical care. The purpose of the institution is to ensure the rights of citizens to medical care in accordance with the territorial program of state guarantees of free provision of medical care to the population of the Karaganda region.[3]
Analysis of the medical waste management system in the Multidisciplinary Hospital №1. In accordance with the requirements of regulatory documents, the system of medical waste management in the Multidisciplinary Hospital №1 includes the following components:
1. Appointment of responsible persons for the management of medical waste
2. Submission of statistical reports to the Ministry of Health of the Karaganda region
3. Primary accounting of medical waste
4. Waste collection and disposal scheme in Multidisciplinary hospital №1
5. Training of medical personnel on medical waste management
6. Conclusion of contracts with organizations, and transportation of medical waste
Qualitative and quantitative composition of medical waste in the Multidisciplinary Hospital №1. Every year, about 4 tons of medical waste are in circulation on the territory of the hospital.Table 1 provides information on the treatment of medical waste for 3 years (2017-2019) in the Multidisciplinary Hospital №1.
 Different classes of medical waste in different volumes can be generated in different departments of the hospital.
According to the sanitary regulations, hospital waste is divided into two categories: infected and other, uninfected components, the disposal of which is carried out through common channels for municipal waste.
Infected persons are transported in double-lined containers, under strict supervision, and must be incinerated within 48 hours.
Table 3. Information on medical waste management for 2017-2019
Amount of accumulated medical waste (tons / year)
Note-based on the author
In three years, Hospital №1 accumulated a total of 12,366 tons of medical waste. The decrease in the amount of accumulated medical waste is associated with a reduction in the bed stock in 2017. In the Multidisciplinary Hospital №1.  medical waste is formed, which differs in its qualitative, quantitative and morphological composition. Data on the quantitative composition of medical waste by waste class for 2017 are presented in Figure 1 in the form of a diagram.
Since the Multidisciplinary Hospital №1 uses a hardware method of neutralization, epidemiological hazardous waste of class B is not decontaminated in the hospital departments. Used syringes in the unassembled form are placed in solid non-piercing containers, after separating the needles with the help of puller needles.Yellow bags, as well as containers, are filled to three-quarters and the employee responsible for collecting waste closes it with a special screed to exclude the spillage of waste.
They move Class B waste outside the hospital units in closed containers. Disposable containers must be marked with the inscription "Waste. Class B".
After analyzing the data on waste collection, we can say that Class A waste accounts for 56% of all hospital medical waste. Recently, the amount of Class G waste has increased, accounting for 13% of the total waste structure. The remaining types of Class B waste account for 31%.
Organization of decontamination of medical waste, transportation.  After collecting medical waste in the departments in disposable soft yellow bags marked class B waste, which are fixed in special containers, they are moved to the room with the installation of hardware neutralization and destruction of medical waste. Since the Multidisciplinary Hospital №1 uses a hardware method of neutralization, epidemiological hazardous waste of class B is not decontaminated in the hospital departments. Used syringes in the unassembled form are placed in solid non-piercing containers, after separating the needles with the help of puller needles. Yellow bags, as well as containers, are filled to three-quarters and the employee responsible for collecting waste closes it with a special screed to exclude the spillage of waste.
They move Class B waste outside the hospital units in closed containers. Disposable containers must be marked with the inscription "Waste. Class B". Specify the name of the organization, division, date and surname of the responsible person. From February 2017 to December 2017, 1,189 tons of Class B medical waste were subjected to hardware neutralization. The «SAMot» - 01 unit and the SAMot-01/200 disinfectant-destructor were purchased at the hospital relatively recently, however, the situation with the handling of class B waste has significantly improved.
Methodology for designing a system for effective management of medical waste management. Some authors consider management as "a purposeful, planned, coordinated and consciously organized process that contributes to achieving maximum effect with minimal resources, effort and time" [4]. Methods of designing organizational systems are based on different approaches. One of them is a systematic approach based on a holistic view of the system. The effectiveness of the designed control system can be evaluated according to the main criteria: efficiency, manageability, stability and adaptability [5]. The system of effective management of medical waste management is based on compliance with the requirements of regulatory documentation in this area, the development of an in-hospital system of treatment with medical waste. From the point of view of Japanese management, the system should be simple, clear and controlled. Based on the above, we can offer a whole program for the treatment of MO, which includes clear instructions, clear algorithms and schemes for further use in a medical organization. The solution to the problem of effective management of medical waste management is associated with the development of new methodological approaches and technologies that are based on the latest achievements of the hygienic sciences, sociology, economics and ecology as a science. When evaluating the management system of medical waste management, it is necessary to consider the economic efficiency, reliability and safety of disposal technologies, and environmental safety.
Development of a hospital-based medical waste management system.  To introduce an in-hospital system of medical waste management, it is necessary to identify responsible persons for the planning and disposal of waste within the medical organization. Responsible persons are appointed by the order of the head of the institution. Different levels of responsibility are defined for designated officials. So, for the treatment of various types of medical waste, different specialists will be appointed responsible.
My recommendations for improving information support and technical infrastructure, developing the industry and solving current problems.
Proper sorting at the stage of formation of all types of waste by nature users will contribute to the rapid development of the industry, since the pace of movement is very low compared to other countries. In this regard, the state needs to create all conditions for all participants engaged in this direction. For entrepreneurs engaged in sorting, processing, recycling, processing, and neutralization of waste, it is necessary to create a special tax regime with favorable tax conditions, as well as to support entrepreneurs of this category in terms of state orders and orders of large national companies for goods produced because of waste processing. Any producing and consuming industry needs to be accounted for.
To achieve positive results, it is recommended to simplify the reporting system by completely switching to an electronic format. According to the Order of the Minister of Energy of the Republic of Kazakhstan dated July 11, 2016 No. 312, persons engaged in waste management and producers of hazardous waste keep records of production and consumption waste by their types, quantity and properties in the "journal of production and consumption waste accounting" in the approved form. To date, the logs are filled in and maintained in paper format, according to which the waste inventory reports are submitted. [28] To improve the information support of the EIS of the OOS, a digital form of the" waste accounting log should be developed and implemented. The purpose of the Aarhus Convention is to promote the protection of the right of every person of present and future generations to live in an environment conducive to their health and well-being, each Party guarantees the rights to access to environmental information, to public participation in decision-making, to access to justice in environmental matters, in accordance with the provisions of the Convention. As defined by the Convention, environmental information means any information in written, audio-visual, electronic or any other material form about: the state of the elements of the environment, such as air and atmosphere, water, soil, land, landscape and natural objects, biological diversity and its components, including genetically modified organisms, and the interaction between these elements. In the future, the implementation of information on all the above elements and components should be considered in the EIS system of the OOS.Proposals for improving the work of the state cadaster of production and consumption waste To improve the EIS of the Environmental Protection Organization, it is proposed to carry out the following activities: to finalize the mobile version of the portal; provide for the modification of the "Cartography" section with the addition of a tool for building maps using various indicators; expand the analytics subsystem in terms of adding infographics that show the dynamics of the main indicators of the waste inventory in the republic as a whole, in the context of regions, enterprises; develop and implement a digital form of the " journal of production and consumption waste accounting»; - add a feature for automatically sending notifications to users about the timely submission of waste inventory reports; consider holding practical seminars on waste management, including waste inventory issues; develop a web page for an information overview of the results of waste inventory management using infographics and cartography; provide for the possibility of overlaying images from the geoportal of JSC " NC "Kazakhstan Garysh Sapary" for space monitoring of waste disposal sites, monitoring the reduction of the formation of spontaneous unauthorized landfills in large cities
When transporting dangerous goods and waste, there is a risk of accidents, and there is no way to insure against this. Therefore, tracking the movement of hazardous waste in the territory of the Republic of Kazakhstan soon should become a priority. Since January 1, 2019, the state automated information system for emergency calls incase of accidents and catastrophes – EVAC-has been put into commercial operation in the Republic of Kazakhstan. The system operates using signals and data from the GPS and GLONASS navigation satellite systems. The main purpose of creating the EVAC system is to improve the safety of cargo and passenger transportation on the roads of the Republic of Kazakhstan. This is achieved by reducing the response time to accidents and emergencies of emergency services. The EVAC system informs the emergency response services in emergency situations within 20 seconds and generates the address of the accident within 10 seconds. Vehicles involved in the transport of hazardous waste and cargo must be equipped with this system to quickly respond to emergencies related to dangerous goods to prevent environmental disasters. The EVAC information system will ensure safer management of production and consumption waste and will allow receiving, processing and transmitting navigation information during the transportation of hazardous waste and cargo.
The article describes the methodology for designing an effective management system, an in-hospital waste management system, a program for effective management of medical waste management, which provides an economic justification for the design version of the device for the disposal of medical waste, provides instructions for the management of medical waste, a program for production control and a training program for personnel on the effective management of medical waste. The result of the proposed study was the developed program for the effective management of biological medical waste in the Multidisciplinary Hospital №1. As a social effect, we can mention the observance of environmental and epidemiological safety in the treatment of medical waste of class B, Multidisciplinary Hospital №1.
This thesis can serve as a good basis for further study of medical waste in Karaganda, where all the described knowledge can be used. This work will always be relevant, and in general, in our country and in Karaganda, the issue of separate collection, disposal and processing of medical waste is acute.
1 Electronic resource: http://ecogosfond.kz/wp-content/uploads/2020/09/Informacionnyj-obzor-za-2019-god.pdf
2 JORGE EMMANUEL Compendium of Technologies for Treatment / Destruction of Healthcare Waste // Health and Environment. 2018.
3Electronic resource:   http://www.karhospital.kz/
4  Rusakov N. V. Problems of waste management in medical and preventive institutions / N. V. Rusakova. M., 2009. 1
5Omron Q., Etabi F., Sadeghi M., Banaei B. The comparison of technical, environmental and economic aspects of autoclaving, incineration and landfilling in medical wastes disposal // Environ. Sci. Technol. 2007. N 2. p. 47-58.
6 Abramov V. N. Waste disposal of medical and preventive institutions. Moscow: Mainland, 1998.


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