At least 194 health professionals at Princess Marina Hospital, Nyangabwe Referral Hospital and Lobatse Mental Hospital were exposed to Hepatitis B infection last year after being injured by needles at work ÔÇô and the figures are believed to be much higher.
Although the Botswana Clinical Waste Management Code of Practice (BCWMCP) requires that “all Health Care Workers and Operatives be offered vaccination against Hepatitis B as and when they start work,” an investigation by the Auditor General on Clinical waste disposal has revealed that the health workers were not vaccinated at the time of the accident.
According to the report, 81 health care workers at Princess Marina Hospital, 112 at Nyangabwe Referral Hospital and one at Lobatse Mental Hospital were only given Hepatitis B vaccinations after the needle stick accidents.
According to the report, the number of accidents is believed to be under-reported because some of those who had been exposed feared that “they might be positive” and decided to hide their status. Besides, “there was no compensation for such cases as motivational incentives for reporting.”
The underreporting is also associated with an increase in HIV\AIDS.
It also emerged in the report that medical staff at the three health facilities is sometimes expected to work without protective clothing in the event of needle stick and other accidents.
“For instance, the orthopedic thick gloves were said to have been out of stock for six months at Princess Marina Hospital Main Theatre, different sizes of gloves were out of stock at Marina and Lobatse Mental Hospital for periods ranging between three days to six months and face masks were also out of stock at the mental hospital for periods ranging between 14 days to one year,” states the report.
These workers run the risk of “inhaling organic solvents that can injure lungs, the liver and other internal organs” warns the report.
The team of Auditor General Investigators also found wards at the three hospitals did not have enough containers to stash away clinical waste.
For example, at the Nyangabwe Referral Hospital Theatre Ward “needles were not appropriately disposed of. The containers were overflowing and needles had spilt on the floor and sticking out of containers. This posed great dangers to operatives who ultimately picked them up.” At Princess Marina Hospital the team from the Auditor General’s office “observed instances where sharp needles were overflowing (in Orthopedic Ward Male) and thoratic needles protruding from small sharp containers (surgical Ward Female).
It also emerged in the report that amid the guidance and policy documents safe disposal of clinical waste is not a high priority at government health facilities. For example, staff is not properly trained on how to handle clinical waste.
“The training was informal as it would be peer orientation, inadequate in that at times it was just a mini lecture/ a day’s workshop and lacked continuity in that it would be conducted once in a while or no training at all. In addition, the training did not include doctors, who were noticed to segregate clinical waste haphazardly and facilities’ management who was to ensure that waste produced by hospitals within their jurisdictions was appropriately managed,” stated the report.
BCWMCP requires that clinical waste be “separated from household waste at source because clinical waste presents greater risks and needs to be handled with caution.” The Auditor General however “observed that clinical waste was mixed with household waste.
Syringes, needles, cannulas, gloves and swabs smeared with blood were observed deposited with other types of waste.”
The report warns that “ inappropriate segregation of clinical waste does not only pose a serious threat to the general public, operatives and the environment but mostly to refuse collectors for both contractors and local authorities employees, who are not equipped with appropriate protective facilities to handle such waste.”