Environmental Impacts associated with solid waste management practices at Alberto Sabogal Sologuren National Hospital , Callao

Today, a large amount of solid waste is generated worldwide, of which only 10% is reused. The amount of solid waste reused is reduced if the waste has some characteristics that make it hazardous, as is the case of hospital solid waste (HSW). To this are added the environmental impacts that the waste and its inadequate handling entails. This research shows the association of solid waste management practices with environmental impacts in the Alberto Sabogal Sologuren National Hospital. For this, segregation, internal transport of solid waste, cleaning and disinfection of the equipment and the availability of personal protective equipment were taken into account. To achieve this, an evaluation of its management was carried out, which was carried out by visiting each of the services and / or environments of the Hospital, a physical characterization of solid waste for seven days where solid waste was identified and quantified. areas and services, an interview with staff working in the hospital center and an identification of environmental factors that are impacted as a result of waste management practices.


Introduction
Pollution by the waste produced by the human being directly affects our environment and the health of the population.Institutions of different nature seek to reduce the generation of domestic waste and high dangerousness for humans and the environment.This is because there is a lack of knowledge about the management of waste generated in hospitals, clinics, clinics and even more about the impacts caused by them.Many entities in the health sector have realized the importance of proper management of solid waste and are concerned with implementing increasingly effective control measures.In the Alberto Sabogal Sologuren National Hospital, around 88000 kg / month are generated, causing high costs of external collection and disposal, these are collected by a Service Provider Entity (EPS) and also by the municipality of Bellavista.Among the main problems presented by the Hospital regarding the management of hospital solid waste (HSW) are: lack of equipment and tools for the stages of conditioning, segregation and internal collection, inadequate infrastructure for intermediate storage, accumulated waste in corridors or passages what causes the dissatisfaction of the personnel that works in the center, cross contamination when common waste comes in contact with biocontaminated or special waste, there have been cases of work accidents by sharp objects (hypodermic needles).There are laws that regulate the environmental management of solid waste in Peru.These are: the General Law of the Environment, General Law of Solid Waste, the Technical Health Standard No. 096-MINSA / DIGESA: Management and Management of Solid Waste in Health Establishments and Medical Support Services at a National level.The modified Leopold matrix uses evaluation criteria assigning scores to the impacts.These are: (1) Direction, (2) Geographical extension, (3) Duration, (4) Magnitude, (5) Frequency, (6) Probability of occurrence; and (7) Reversibility.

Classification of Hospital Waste
According to the Technical Health Standard N ° 096-MINSA / DIGESA, hospital waste is classified as:

Materials and Methods
The present investigation is of non-experimental design since there is no manipulation of any variable.It is correlational in nature, because it studies the relationship between both variables.The research was carried out at the Alberto Sabogal Sologuren National Hospital for seven days (from May 06 to May 13, 2016).This hospital is located in the district of Bellavista, Province of Callao, Department of Lima, Peru.

Stages of the investigation:
• Identification and quantification of hospital solid waste.
• Evaluation of the management of HSW.
• Determination of environmental impacts.
The modified Leopold matrix with its respective evaluation criteria was used.

Geographical extension
Local (1) Confined to the area directly disturbed by the project Sub-regional (2) It surpasses the areas but it is within the limits of the study area of the evaluation Regional (3) It extends beyond the regional limits

Identification and Quantification of Hospital Solid Wastes
Hospital Solid Waste was identified and quantified.The bags of solid waste generated in each service were identified, these were collected through internal collection to the point of collection, which was the place chosen for the operation, where they proceeded to inspect the inside of each bag.First of all, the waste bags were weighed at the collection point, then the waste volume was determined with the help of a container of known volume, the waste was introduced into the container, ensuring that no empty spaces remained. .When the volume and weight data of the waste were obtained, the waste was classified, the garbage was separated manually according to its type and they were weighed again.Subsequently, the weights of each component were added together and a comparison was made with the total weight of the waste generated.In this way, the percentage by weight of each type of waste was calculated.

Evaluation of the management of Hospital Solid Waste
Table 6.Assessment of the handling of solid waste Hospital

Determination of Environmental Impacts
Table 7. Modified Leopold Matrix of Environmental Impacts Table 7 refers to the environmental impacts that are generated from hospital solid waste management practices.From the segregation of common and biocontaminated waste there are slightly negative impacts on the quality of the soil and water, as it has scores between -1.2 and -0.9, due to the fact that the waste is deposited in public spaces and gardens, as well It presents a slight direct affection to the safety and health of the operators with a score ranging from -2.5 to -1.5 since events related to punctures have occurred during the direct handling of the waste.During internal transport practices there are slightly negative impacts on the quality of soil, air and health and security of workers with scores of -3.2, -2.4,-2.5.During the practices of cleaning and disinfection of the equipment there is a critical point with a moderate impact (score of -5.6) towards the quality of the water since this activity is carried out frequently 2 or 3 times a day and making use of aggressive disinfectants in order to eliminate or reduce pathogens, these waters are finally poured down gutters to the drain without any previous treatment or in some cases part of these waters reach the fertile soil causing it to lose its quality.During the storage stage and the temporary collection of waste, there are slight negative impacts on the quality of soil, water and air, as well as the infrastructure and the safety and health of the workers.
The environmental factors that receive the greatest impact are the quality of water and the safety and health and security of workers with scores of -17.5 and -27.9 respectively.With respect to water quality, it is mainly impacted during the cleaning and disinfection stage and the equipment used in the management of hospital solid waste and the lack of use of personal protective equipment makes this also an environmental factor that is strongly impacted.Within the stage of management of HSW that causes greater impact is the storage and collection of solid waste since at a given time the waste has contact with environmental components such as soil quality, water, air, obtaining a negative value of -15.82, -17.5 and -8.6 respectively.However, there are also moderately positive impacts on the stages and practices of solid waste management, since these activities necessarily require an operator to execute them, promoting the generation of employment, their score ranges from 4.9 to 7. It should be noted that It has a total value of 72.8 for the generation of employment as a single environmental factor.

Table 1 .
Evaluation Criteria of the Modified Leopold Matrix.

Table 2 .
Evaluation criteria for the stages of hospital solid waste management ReversibilityShort term (0)It can be reversed in a year or less Medium term (1)It can be reversed in more than a year, but less than ten.Long term (2)It can be reversed in more than ten years Irreversible (3) Permanent effects Source: Technical Health Standard, N° 096-MINSA/DIGESA, 2012

Table 5 .
Generation of solid waste by type in each area of the Alberto Sabogal Sologuren National Hospital.