HOSPITAL SOLID WASTE MANAGEMENT DURING COVID-19 PANDEMIC IN NEPAL

A newly discovered Novel Coronavirus is spreading across the world and is transforming the way, we sustain every day. COVID-19 pandemic has created challenges for international and national or ganizational level. Additionally, healthcare institution has many challenges to deal with COVID-19, especially in developing countries. Among the various challenges faced by healthcare institution, management of waste generated from treatment of COVID-19 patients is essential to prevent fur - ther impact on environment. Improper management of COVID-19 waste can lead to adverse public health ramification. Thus, good nationwide protocol and policies of waste management can play a vital role in protecting the health of nation and community.


INTRODUCTION
The current situation of the COVID-19 pandemic has made hospitals across the world the centers of attention. Since the hospitals are directly involved in the treatment of patients in such a health emergency, they should be more cautious about COVID-19 waste management so as to avoid any waste disaster. As the world adapts to unprecedented behavioral and societal changes in response to the threat posed by COVID-19 pandemic, day to day operations of waste management must also be update. These essential services such as waste segregation, handling, collection and waste treatment are routine and indispensable activities of healthcare operations. Thus, appropriate waste management plays a key role in mitigating further spread of infection during this COVID-19 Pandemic, especially in developing countries that have poor waste management stratergies. 1,10,14

Composition of Hospital Waste
One of the main functions of the health care system is efficient functioning of the hospital waste management system. The hospital waste simply refers to any waste that comes out of a hospital in the course of diagnosis, treatment, medication, and surgical procedures of patients. It also includes chemical wastes, expired drugs, sharp objects like needles, anatomical wastes that come from surgeries or delivery of an offspring, radioactive wastes, food wastes that come out of hospital cafeteria, paper wastes that come out of record files and even technological and biomedical equipment waste that is generated once the technology is no longer in the condition to serve its purpose. Generally, hospital waste comprises 80% general wastes. But what is more important is how the hazardous wastes are being disposed of. 2

COVID-19 Pandemic and Waste Management
However, if planned properly, all healthcare institutions can adopt the best possible practices in hospital waste management. Still more this COVID-19 pandemic will continue and will have enormous impact on economy of nation and human health. Hence, it has put a burden on government and healthcare providers to manage this issue to assure health and safety of our citizens and to prevent this crisis into disaster. 5,7 During this COVID-19 pandemic many types of infected waste is generated with large volume of non-infected waste. The use of personal protective equipment's and single use plas-tics also increases the quantity and density of medical waste and improper management of PPEs can significantly increase the spread of COVID-19. Thus, it is essential that proper waste segregation, collection, storage and treatment are followed in all healthcare settings. To achieve this, healthcare workers and waste collection workers need to be protected because they are the most vulnerable part of population who are exposed to infection. Therefore, safe handling and final disposal of waste are the vital element in COVID-19 crisis. 5,12,14 Due to the COVID-19 pandemic, the unusual generation of medical waste and spread of virus is increased, which requires modern or alternative treatment options to prevent the potential threat or risk to healthcare workers, waste handlers and other people dealing with contagious waste. In china, due to this global pandemic there was surge in usage of personal protective equipment's which leads to sixfold increase in medical waste than usual and which urges the nation to deployed 46 mobile treatment facilities across china. In Brazil, medical waste increased twofold due to increase use of personal protective equipment such as facemask and gloves, where improper waste management is a major concern. Thus, Ministry of health of Brazil and Brazilian Health Regulatory Agency recommended sustainable measures by use of disposal mask only by health professionals and reusable mask by general people. 15,18 According to waste management guidelines issued in 2014, all healthcare facility in Nepal need to follow safe waste management practices efficiently within healthcare settings. Apart from this healthcare institution having isolation wards for COVID-19 patients, need to have separate color-coded bags/ containers for proper segregation and treatment of COVID-19 Waste. Along with this, healthcare personnel and waste collection workers need to wear personal protective equipment's while handling COVID-19 Waste. 3

Waste Segregation
Use separate color-coded container/bins to discard generated waste. Use double layered waste bags Dispose sharps in puncture proof container

Waste Collection and labeling
Seal the bag before transporting Spray the bag with 1 % sodium hypochlorite solution before transporting to treatment zone or temporary storage point Waste Transportation Place the waste bag in close trolley while transporting to treatment zone or temporary storage point. Disinfect the trolley and waste containers with 1% hypochlorite solution daily and after each use.

Waste Storage
Waste should not be stored more than 24 hours in temporary storage area.

Waste Treatment
Treat the waste with Autoclave, stored separately in temporary storage area not more than 24 hours and it should be transported to waste disposal provider as early as possible. If treatment zone is available within healthcare facility, the COVID-19 waste must be treated immediately.

6-Waste Treatment:
The method of treatment of COVID-19 waste is done based on the treatment technology available in healthcare facility. The treatment method which can be used for treating COVID-19 waste are autoclaves and friction heat systems, where the waste can treat for 60 minutes at 121 to 135 degree Celsius. Alternative option could be chemical disinfection depending upon local context and resource available.

7-Waste Disposal:
COVID-19 waste which are properly treated with autoclaves and friction heat systems are sterilized and have fewer micro-organisms or practically no microorganisms compared to household waste. Thus, after treatment it can be discarded as regular waste in a landfill.

COVID 19 Waste Handlers and Personal Protective Equipment
Based on available evidence COVID-19 is transmitted from human to human by close contact and droplet infection. The people who are in close contact with COVID-19 patients and those