Approximately 44 tons of medical waste is generated in Poland every year (about 40 thousand entities produced about 133 thousand tons of medical waste from 2011 to 2013). As much as 90 percent is hazardous waste, mainly infectious. That is why, it is very important to observe all safety procedures when storing, collecting, transporting and utilising medical waste. As much as 20% of medical waste has become produced in Śląskie and Mazowieckie Provinces.
Waste sorting
In 10 of 12 audited hospitals NIK identified a range of mistakes in medical waste treatment. Serious irregularities concerned mainly waste sorting. The waste was not sorted at all or different waste types were mixed. The waste bags and containers did not have necessary codes defining their type. It happened that the bags were overfilled which made it impossible to close them safely. Besides, the waste was stored in bags of improper colour, the bags often lacked details enabling the waste identification in case of emergency: no information was provided on who produced it or the bag closing date was missing.
Five hospitals did not store medical waste in required conditions (including the acceptable period and required temperature of storage). The stores were not protected against access of unauthorised persons, as well as insects, rodents and other animals which may spread germs. Besides, the stores had no ventilation or isolated boxes for medical waste of different types. Three hospitals also did not observe the conditions for in-house transport of medical waste..
According to NIK all irregularities related to sorting and storage of medical waste posed a threat to human health and the environment. NIK notified the Chief Inspector of Environment Protection, as well as the Province Inspectors of Environment Protection in Warsaw and in Rzeszów of the key irregularities.
Record-keeping
Hospitals are obliged to keep records of medical waste produced and transferred for utilisation. Half of audited hospitals kept obligatory records of waste against the effective catalogue and the hazardous waste list. Moreover, the auditors detected contradictions between the recorded quantities of waste and the quantities of waste handed over for utilisation - the waste quantity was underestimated by nearly 4 tons.
According to NIK improper record-keeping may result in overestimation of waste weight by waste disposal companies, and therefore increase the costs of their disposal, incurred by hospitals. Such behaviours may give rise to corruption. On the other hand, providing incomplete data to the Province Marshalls makes it impossible for them to keep the records in a way ensuring proper supervision of waste movement, particularly in case of infectious and hazardous waste.
The Supreme Audit Office found out that the Province Marshalls had no information about utilisation of nearly 7 thousand tons of infectious medical waste. Nearly 121 thousand tons of hazardous medical waste was produced and almost 114 thousand tons was utilised in Poland from 2011 to 2013. It means that plenty of waste dangerous for people’s lives disappeared from the system. Its fate remains a mystery - if it was really utilised or it was disposed of in another way.
The great majority of hospitals (10 of 12) did not address the companies which utilised infectious medical waste asking for a document confirming the waste utilisation. Hospitals explained there were no executive provisions, defining the template of such a confirmation.
Though, according to NIK, hospitals should make sure they can prove that their waste has been properly utilised, both for their own safety and for the safety of people and the environment. NIK states that no matter if the law provides for the document template the hospitals should demand from the incineration plant a written confirmation of the waste utilisation.
Utilisation
The number of medical waste incineration plants in Poland is going down every year. In 2011, there were 54 of them, 2 years ago - only 42. Less competition in the market makes the incineration plants set prices for waste collection from hospitals. The prices varied depending on the time and region and ranged from PLN 1.22/kg to PLN 3.24/kg.
In order to limit the practice of transporting waste all over the country in search of the cheapest recipient, the proximity principle was introduced which was to put a ban on medical waste utilisation outside a province where it was produced. However, the location of medical waste incineration plants in Poland does not always make it possible to utilise the waste in the province where it was produced. Sometimes it was the money which made a hospitals choose the given incineration plant.
NIK auditors found out that in case of Provincial Specialist Hospital in Włocławek, waste was transported to incineration plants distant about 200 km from the hospital because they were cheaper that the nearest plant (85 km far from the hospital).
At the request of NIK the Inspection of Environment Protection audited 29 incineration plants for infectious medical waste. Irregularities were identified in 18 of them:
- in every third incineration plant air pollution emissions were not measured or the measurements were made less frequently than required by the law;
- measurement results were provided to province inspectors of environment protection and province marshals with delays;
- five incineration plants utilised more waste than allowed;
- four incineration plants stored infectious medical waste improperly;
- waste records were not kept or were kept improperly in four incineration plants.
NIK’s recommendations
In view of the safety of people and the environment NIK has addressed the Minister of Environment to take effective measures to improve the compliance with the proximity principle with regard to infectious medical waste. NIK stands in a position that compliance with that principle should be a condition under which hospitals select a company to collect and utilise medical waste.
The Minister of Health should immediately regulate the issue of acceptable ways of utilising infectious medical waste by making sure the new ordinance accepts (in line with the new law) exclusively incineration of infectious medical waste.
7 of 10 hospitals which received post-audit recommendations concerning waste transport and storage, frequency of changing waste containers and marking waste bags, have already eliminated their irregularities. 5 of the audited hospitals have carried out NIK’s recommendations concerning proper record-keeping and providing reliable data on the type and quantity of waste to the Province Marshals
