Audit Proposal-Healthcare Waste Management

Effective disposal of healthcare waste products is a key element in ensuring that waste products from the industry do not result in environmental pollution. According to Johannessen, Dijkman, Bartone, Hanrahan, Boyer &Chandra, 2000, p.22), health care waste refers to all the waste which results from various healthcare establishments, laboratories, emergency relief donations and research facilities. The industry’s aim is to reduce health problems while at the same time preventing potential health risks (Dolk, 1998, p.78). Numerous waste products result in the course of providing healthcare services. Therefore it is paramount for the management of healthcare firms to ensure that the waste is properly managed.

Mismanagement of the various healthcare waste products poses a risk to both the environment and society. For instance, healthcare workers, waste pickers and handlers and the public are exposed to a high degree of risk from the chemical wastes and other infectious healthcare waste are at a risk. Improper or poor healthcare waste disposal relates to uncontrolled burning and open dumping. Uncontrolled burning exposes the public to the risk of toxic emissions resulting from incomplete combustion. On the other hand, sharp objects form the basis through which diseases are transmitted. Some of the diseases which can be transmitted through sharp objects include Human Immunodeficiency Virus (HIV), Hepatitis C (HCV) and Hepatitis B (HBV). According to a report by World Health Organization (WHO), approximately 21 million people were infected with the Hepatitis B virus in 2000 globally as a result of being injected by contaminated syringes. In addition, 2 million and 260,000 others were infected with hepatitis C and HIV viruses respectively resulting from the same cause (Best practices in healthcare waste management, 2007, p2). Most of the waste which is generated by healthcare institutions can be treated just like a regular solid waste. However some of the healthcare waste products require special attention. Some of these waste products include sharp objects (such as needles, scalpels, and razors), biological waste, and pharmaceutical waste and hazardous chemical waste products. In the healthcare industry, these types of waste products are commonly referred to as ‘special healthcare waste. In addition, some of the waste products which are generated under certain circumstances such as microbiological laboratories and isolation wards require special attention. All the departments involved in healthcare provision should ensure that they adopt good healthcare management practices. The discussion of this paper is aimed at presenting an audit proposal in relation to healthcare waste management in healthcare institutions. The audit is based on The Basel Convention which is a global agreement approved by 160 countries with the objective of addressing the challenges and problems which result from hazardous waste (Healthcare Waste Management, 2010, Para. 3). The writer works in a health institution where healthcare waste management has been adopted in but not all departments adhere to The Basel Convention standards. The convention is aimed at ensuring proper waste management in relation to health care institutions (Origin of the convention, 2010, para.2).

Importance of Evaluation, Measurement and Research in Healthcare

Healthcare institutions play a significant role in the economic growth of every country. However, their operation poses a health risk if the Healthcare Waste (HCW) is not properly managed. This is due to the fact that an efficient healthcare system enhances the productivity of the population. Various governments are increasingly getting concerned about the quality of their country’s healthcare facilities and the effects that they have on society in relation to waste disposal. As a result, governments are placing more emphasis on efficient healthcare management. This is being attained through the incorporation of evaluation, measurement and research concepts.

Evaluation in healthcare refers to the process of determining the worth or value of the issue under consideration by comparing it against a set of generally accepted standards. For an evaluation process to be effective, a number of elements should be integrated. These include the context of evaluation such as what to evaluate, frequency of evaluation and who is to undertake the evaluation (National Health Service Executive, 1996, para. 5). In addition, healthcare evaluation should also integrate the output, outcome and impact assessment. Through evaluation, it becomes possible to identify ways through which the healthcare system can be improved to enhance service delivery (Bond, 1996, p. 45). In addition, evaluation enables healthcare personnel to integrate a high degree of safety in the provision of healthcare services to the patients. The evaluation should be based on the standards set by The Basel Convention. The ultimate result is that the healthcare institutions do not affect society negatively (Walker, Pan, Johnston & Adler-Milstein, 2005, Para. 6).

Currently, performance measurement is one of the elements currently being considered by numerous governments in an effort to transform their healthcare institutions (Young & Kristoffersen, 2006, Para. 3).

According to Davida and colleagues (2008, p.33), performance measurement acts as a powerful instrument in improving the operations of healthcare institutions. Management teams of healthcare institutions must identify key variables to be measured in relation to healthcare waste management. In addition, the right method should be used to ensure that the findings are correct and hence the decision made. Measurement relates to the establishment of well defined yardsticks or units used in scaling various aspects of healthcare waste management. The units used in measuring the performance of a healthcare institution must be quantifiable in order to determine the effectiveness of healthcare institutions in disposing of the various wastes which result from their operation. Through measurement, it becomes possible for management teams of healthcare institutions to evaluate the performance of the institution (Bruce & Walter, 2007, p.32).

According to Koop (n.d, p.1), monitoring the effectiveness of healthcare institutions in disposing of waste products has become a complicated process. Nonetheless, health outcomes, efficiency, cost effectiveness and patient-centered concepts have to be integrated into the provision of healthcare services (National Health Service Executive, 1996, Para. 5). To ensure effectiveness in the monitoring process, management teams of healthcare institutions should integrate performance indicators. Koot (n.d, p.1) defines performance indicators as instruments used in monitoring the quality of healthcare programs. The performance indicators implemented must be relevant, reliable and valid for the audit process to be effective. Davida et al (2008, p. 34) assert that performance indicators should be easy to use by the relevant parties. In addition, performance indicators should be integrated by all the departments in relation to healthcare waste management. On the other hand, performance indicators must be verifiable so as to determine the efficiency of healthcare institutions in disposing of the various wastes (Brailer, 2008, p.34). It is important for healthcare facilities to be able to adjust the performance indicators if a problem in relation to health care waste is revealed. Research in healthcare audit is defined as an original and systematic process of exploring issues related to provision of healthcare. Research entails creation of a set of ideas and generating knowledge which results in development of new insights (Garish & Mawson, 2005, p. 35). Research in healthcare provision is a paramount concept due to the sensitive nature of the industry. According to Øvretveit and Gustafson (2003, p. 759) the healthcare industry is characterized by a high degree of innovation. New healthcare products are emerging from time to time. The new innovations pose diverse health risks and hence the importance of determining the most effective ways of their disposal. To ensure that healthcare waste products are properly managed, it is important for healthcare institutions to integrate the concept of research. This will enable the institutions to determine the best way to dispose of the waste.

Ovretveit and Gustafson (2003, p. 759) assert that research enables healthcare institutions to derive useful knowledge regarding the best practices to improve the quality of service provision. The findings of the research should be relevant and based on strong evidence. This can be attained through the incorporation of scientific research methods such as research designs. One of the designs that these firms can integrate includes audit design. This design entails a description of the activities to be undertaken and comparing it with the outcome. This means that research aids in the development of relevant solutions to the problems identified during evaluation and measurement. During implementation of waste disposal methods, it is important for healthcare institutions to determine the potential effects of the method to the health workers, waste product handlers and society in general.

Rationale for the audit

Effective and efficient delivery of healthcare services is not only dependent on the time of service delivery but also on how effective the healthcare institutions are at disposing of their waste. This is due to the fact that it will aid in preventing further infections resulting from the waste products. In addition, healthcare practitioners are increasingly being concerned with how they can eliminate affecting society negatively. This results from the fact that the current revolution in healthcare provision is not only being more patient-centered but has also integrated the concept of corporate social responsibility. As a result, every country is considering how to develop a national strategy focusing on healthcare waste management (Johannessen, Dijkman, Bartone, Hanrahan, Boyer &Chandra, 2000, p.22).The audit is based on the rationale that effective healthcare waste management plays a significant role in enhancing the operations of the firm within the society. In addition, the healthcare audit reports enable the practitioners to adjust their healthcare waste management practices. This arises from a low rate of standard compliance by firms that deal with healthcare service provision. Considering the volume of healthcare waste from both the large and small healthcare institutions and the risk that they pose to society, the incorporation of healthcare waste management is paramount.

Currently, a large number of healthcare institutions do not have unified healthcare waste disposal practices. This is due to a lack of common standards which have been integrated within the healthcare system. In addition, there has been increased public concern that healthcare institutions do not manage their waste optimally.

Some public reports claim that some of the healthcare waste products end up in open dumpsites. In addition, some healthcare institutions have been managing their waste products through incineration which results into toxic air pollution posing a threat to the environment and human health (Connett, 1996, p.65.).

Best practices in healthcare waste management

In order for healthcare institutions to operate in a socially responsible manner, it is paramount for the management of these firms to integrate ethical practices in disposing their waste products. This will ensure that the industry’s operation protects both the society and the environment (Daschner, 2001, P.564). There are various methods that are used in disposing healthcare waste products. One of these methods is through incineration. In conducting incineration, it is paramount for healthcare institutes to either minimize or eliminate the amount of toxicity resulting from the various waste products. This can be achieved by incorporating other waste disposal mechanisms such as source reduction, segregation, recycling and resource recovery. By adopting these methods, healthcare institutions do not only prevent or minimize the risk posed by these products but also help in preventing spread of diseases. In addition, good healthcare waste management aid in saving the cost that could result from managing the resulting risks.

In managing their healthcare waste products, healthcare institutions should adopt emerging technologies. In the 21st century, there has been an increment in the rate of technological invention and innovation. As a result, alternative and cost effective waste disposal technologies have emerged. These technologies are cleaner and safer compared to incineration and are effective in rendering healthcare waste products harmless. To ensure good healthcare waste management practices, healthcare institutions should adopt these technologies (Best practices in waste management, 2007, p.5).

For waste disposal to be effective, a considerable amount of cost is involved. Therefore, it is important for health institutions to set a certain amount of money in their annual budget to cater for healthcare waste disposal. In addition, these institutions should have a waste management committee whose role is to foresee all the activities related to waste disposal. The committee should also conduct research on the best method to dispose of the waste products (Best practices in waste management, 2007, p.5). The management team of healthcare institutions should ensure that they incorporate the concept of waste segregation. This entails the separation of various types of wastes other than disposing of them together. Through segregation, the institutions will be able to determine which waste to recycle and which to dispose of. This will contribute towards ensuring that the respective waste materials are well managed.

Healthcare institutions should also formulate and implement comprehensive healthcare waste management policies. The policy should define the best mechanisms through the various healthcare establishments should dispose of their waste. The policy should also entail a checklist on how best to manage the wastes products ( Johannessen et al, 2000, p.22). The institutions should continuously review the set standards in relation to healthcare wastes. This will enable these institutions to establish whether they are managing their wastes as per the laid down standards.

Overall objectives and audit objectives

The overall objective of the audit is to ensure that the management teams of healthcare institutions conform to good health care waste disposal practices. This will serve in either minimizing or completely the risks posed by these waste products to the environment and human beings. To attain this, it is paramount for healthcare establishments to consider integrating effective healthcare waste disposal practices. By adopting these practices, healthcare establishments will be able to operate social responsibly. Through the audit, various healthcare institutions will be able to gain insight on how to improve healthcare waste disposal practices (CGH Environmental Strategies, Incorporation, 1997, Para. 5).

The first objective of the audit is to determine the amount of healthcare waste that results from daily operation of the various departments within healthcare institutions. This will be achieved by adopting a common scale through which the quantity of waste is measured. The various wastes will be segregated into various categories such as plastics, pathological wastes, sweepings and cotton materials. This will aid in the process of determining the best waste treatment methods (Johannessen, et al, 2000, p.25).

The audit is also aimed at determining the form of treatment that is done to waste products before they are disposed of. Treatment of healthcare waste products is effective to ensure that the waste does not harm the individuals handling it in the process of its disposal. For instance, some of the waste is disposed off the institutions while others are disposed within the institution. The audit will focus on establishing how the waste is handled in the course of its transportation such as how the waste products are packaged and the transportation method used. The treatment and disposal objective will help in determining the location where the waste is disposed such as a landfill or a dump site. The audit will also establish whether the waste products are buried immediately or they are left on the dumpsite for some time. The audit will also assess the extent to which children, waste pickers and other individuals access the healthcare waste.

The third objective of the audit proposal is to determine a number of management issues in relation to individuals who are responsible for the management of healthcare waste in healthcare institutions. This will aid in evaluating the extent to which these parties are at complying with the laid down standards and stipulations. For instance, the audit will seek to evaluate the safety measures which the management teams have put in place in the course of handling the waste. In addition, the audit will evaluate whether those charged with the responsibility of managing the waste have the necessary skills to handle the waste. In relation to management issues, the audit will also seek at determining the daily waste product collection routines such as waste packaging (Heather & Edward, 2010, Para. 5).

The fourth objective of the audit is to evaluate the risk posed by the current management practices adopted by the health institutions. This will be achieved by evaluating whether the management teams of healthcare institutions assess the efficiency of health care waste product management practices from time to time. The nature of risk posed to various parties such as healthcare workers, visitors and the patients will be assessed. For instance, the audit will enable healthcare personnel in gaining insight into the nature of risk related to spillage or scavenging of waste products in the course of its transportation (Safe practices for better healthcare management, 2003, Para. 5).


The audit process will aid in the identification of the various risks posed by healthcare waste products to both the environment and human beings. As a result, the management teams of healthcare institutions will gain knowledge on how to mitigate the risk posed by adopting best practices in the process of managing healthcare waste products. The efficiency and effectiveness with which healthcare institutions provide healthcare services do not only rest on customer satisfaction but also on how the institutions manage their waste. This contributes towards the firm attaining a positive public image in its operation. The audit will give an insight to the parties involved on how to improve their waste disposal practices. This will be attained by evaluating the extent to which they have incorporated the concepts of evaluation, measurement and research in relation to healthcare waste disposal. Evaluation will ensure that what is being audited is of value to the institution’s success. On the other hand, the concept of measurement will aid in determining how the institution can improve health care waste management practices. This will be attained by identifying key performance indicators which are reliable, relevant and valid. Through research, healthcare institutions will gain new knowledge on the best methods to use in disposing of their wastes. For instance, the management team will be able to identify the emerging waste disposal technologies.


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Action plan

Objectives Activities to be Undertaken Resources Required Target Date Review Date & Method Evaluation
To determine the amount of healthcare waste products resulting from various departments Measuring the quantity of waste from all the departments Three experts from the waste management committee By 25thFebruary 2010 26thFebruary 2010.
The scale used in determining the quantity of date will be assessed by conducting a quantitative analysis to determine the volume of waste.
Rating the degree of volume of healthcare waste products. The healthcare wastes products will be compared amongst the departments
To determine form of treatments given to waste products before their disposal. Determining the chemicals used in treating the waste to ensure safe handling. 5 specialists from the drugs and poisons department By 28thFebruary 2010. 30thFebruary 2010. Reviewing the extent to which healthcare personnel comply with laid down safety standards in treating the waste products Testing whether the risk of handling the waste is eliminated.
To evaluate the management issues related to healthcare waste disposal. Identifying the various types of management issues necessary for effective waste disposal. 3 individuals from the waste management committee. 2 February 2010 4thFebruary 2010
Analyzing whether the all the management issues such as budget allocation have been met
Evaluating the efficiency with which departments within the institution are in ensuring compliance with management issues.
To determine the control mechanism adopted by the management teams in ensuring effective waste disposal. Evaluating the consistency of monitoring in the waste management practices. Waste management committee. 6th February 2010 8thFebruary 2010. An assessment of the waste management committee managerial skills Evaluating the degree of validity in the various control mechanisms put in place.