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Variations in Hospital Waste Quantities and Generation

Rates
a a a
H. M. Hamoda , H. N. El-Tomi & Q. Y. Bahman
a
College of Medicine, Kuwait University , Safat, Kuwait
Published online: 06 Feb 2007.

To cite this article: H. M. Hamoda , H. N. El-Tomi & Q. Y. Bahman (2005) Variations in Hospital Waste Quantities and
Generation Rates, Journal of Environmental Science and Health, Part A: Toxic/Hazardous Substances and Environmental
Engineering, 40:2, 467-476, DOI: 10.1081/ESE-200045650

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ISSN: 1093-4529 (Print); 1532-4117 (Online)
DOI: 10.1081/ESE-200045650

Variations in Hospital Waste

Quantities and Generation
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Rates
H. M. Hamoda, H. N. El-Tomi, and Q. Y. Bahman
College of Medicine, Kuwait University, Safat, Kuwait
The relationship between public health and improper collection, handling, and disposal
of solid wastes in general, and hospital wastes in particular, is quite clear. Hazardous
and nonhazardous wastes generated from different divisions of two of the largest pub-
lic hospitals (capacity of approximately 400 beds each) in Kuwait were quantified and
generation rates were determined. The generation rates were related to some impor-
tant factors such as the number of patients, number of beds, and the type of activity
conducted in different sections of the hospitals. The relationship between the waste
generation rate and the number of patients was more applicable than that expressed
in terms of the number of beds. The rates observed were in the range of 4.89 to 5.4 kg/
patient/day, which corresponds to 3.65 to 3.97 kg/bed/day, respectively. These genera-
tion rates were comparable with those reported in the literature for similar hospitals.
Minimal waste quantities were collected in the weekends. The study indicated that the
hospitals surveyed provide some segregation of hazardous and nonhazardous wastes.
Hazardous wastes contributed about 53% of the total quantity of wastes generated at
the hospitals.

Key Words: Hospital wastes; Generation rates; Solid waste quantities; Waste
composition.

INTRODUCTION
There has recently been a worldwide public health concern with the wastes
generated from hospitals. Such wastes contain, besides the normal household
wastes, a considerable amount of “medical” wastes. Hospital wastes pose a
serious public health problem.[1] It is commonly acknowledged that certain
categories of medical wastes are among the most hazardous and potentially
dangerous of all wastes generated in the community. As the quantity and com-
plexity of health care waste increase, the risk of transmitting disease through
inadequate management of waste also increases. Possible infection to hospital

Address correspondence to H. M. Hamoda, College of Medicine, Kuwait University,

Safat, Kuwait; E-mail: hamoda@hsc.edu.kw
 468 Hamoda, El-Tomi, and Bahman

employees and those handling wastes were from hepatitis B or C, tetanus, local-
ized or general infection, and AIDS. According to the American Hospital Asso-
ciation, about 15% of hospital waste is classified as infectious and its disposal is
regulated.[2] Processing contaminated waste has also resulted in transmission
of mycobacterium tuberculosis to workers handling such wastes.[3] Moreover,
the widespread, unlawful use of drugs in some countries makes the need for
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proper disposal of used hypodermics and syringes imperative. This has led the
World Health Organization to advocate that hospital wastes should be regarded
as a class of wastes requiring “special” management.[4]
Hazardous wastes have been defined as wastes or a combination of
wastes that pose a substantial or potential hazard to humans or other living
organisms.[5] Such wastes may have health-related properties such as infectiv-
ity, toxicity, radioactivity, carcinogenicity, mutagenicity, or teratogenicity. Med-
ical wastes are among those hazardous wastes of major concern. Handling and
disposal of medical wastes are associated with great health and environmental
risks.[6] The dangers from health care wastes may be significantly increased in
situations where the wastes are disposed of in conjunction with other municipal
solid waste and not either sterilized or incinerated at source. The health haz-
ard potential rises with secondary handling of the waste. For example, when
a recycling process such as composting, refuse-derived fuel, or sorting for the
reclamation of glass, plastics, metal, paper, fabrics, etc., is used within the com-
munity, there will always be a risk of infection if medical wastes are not dis-
posed of separately.[7] Moreover, evaluation of medical waste generation rates
and quantities is essential for the establishment of a waste management system
for hospitals. Such data are not available for hospitals in the state of Kuwait to
be compared with hospitals in other countries.
This study was conducted in order to: (i) determine the waste generation
rates in hospitals in Kuwait, and (ii) develop sound and representative rela-
tionships that describe the quantity of waste generated from different activities
within hospitals and the effective factors such as number of beds, patients, and
type of activity.

MATERIALS AND METHODS

This investigation considered two large public hospitals in Kuwait, namely
Mubarak Al-Kabeer and Amiri hospitals, representing two socioeconomic
classes of patients served, the middle class and the upper class, respectively.
All the solid wastes generated at these hospitals were collected daily (three
shifts/day) from each department within the hospital for two periods of time.
The first period extended for two weeks in February/March (spring) and two
weeks in July/August (summer) of the same year. As practiced in these hos-
pitals, the solid wastes are collected from each department in four color-coded
white plastic bags indicating different types of wastes. These are: (i) blue-coded
 Variations in Hospital Waste Quantities 469
bags for garbage wastes; (ii) yellow-coded bags for infected wastes; (iii) red-
coded bags for toilet wastes; and (iv) black-coded bags for toxic/radioactive
wastes. Meanwhile, the wastes generated by the kitchens are collected sep-
arately in black plastic bags.
The solid wastes collected in each bag were weighed using a balance with
capacity of 30 kg and divisions of 10 g. Moisture content was determined for
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each component by placing a sample weighing 500 g in an oven and gradually

increasing the temperature to 100◦ C. The difference in weight divided by the
wet weight (100%) was taken as the moisture content. By weighing the plastic
bag and then placing the contents of the plastic bag in a graduated container for
volume reading, density of each plastic bag is determined as well. The data ob-
tained were analyzed to determine generation rates (kg/unit) and characteris-
tics of each class of wastes in the studied hospitals. In addition to the field study,
a survey was conducted by distributing a questionnaire to employees working
in each hospital to determine an approximate percentage for hazardous and
nonhazardous wastes generated from each department. Statistical analysis of
data was performed using SPSS (version 11.5, Chicago, IL).

DESCRIPTION OF FACILITIES
Mubarak Al-Kabeer Hospital is located in Jabriya, district of Hawalli Gover-
norate in Kuwait. It contains 400 beds and has 293 doctors, 616 nurses, and 739
others working as personnel in the hospital. The average number for patients’
residence in the hospital is seven days. The medical wastes collected from this
hospital are treated as follows: infected and hazardous wastes are burned in
the hospital’s incinerator, whereas nonhazardous wastes (disposal wastes) are
transported and discharged to the seventh ring road landfill site, which receives
municipal solid wastes.
Amiri Hospital of the Capital Governorate is located in Kuwait City. It con-
tains 368 beds and has 282 doctors, 550, nurses, and 591 others working as
personnel in the hospital. The average number for patients’ residence in the
hospital is seven days. The medical wastes that are collected from Amiri Hospi-
tal are treated as follows: infected wastes are transported to the incinerator at
Mubarak Al-Kabeer Hospital for burning, whereas nonhazardous wastes (dis-
posal wastes) are transported and discharged to the seventh ring road landfill
site, which receives municipal solid wastes.
Both hospitals are operated by the Ministry of Health and are also used for
teaching medical students at Kuwait University. Each hospital contains sev-
eral departments covering almost all medical specialities (except obstetrics and
gynecology) categorized under casualties, outpatient clinics, inpatient wards,
laboratories, pharmacies, kitchens, as well as administrative offices and hotel
services.
 470 Hamoda, El-Tomi, and Bahman

RESULTS AND DISCUSSION

Solid Waste Quantities and Generation Rates

A summary of quantities and generation rates of different types of wastes at
the two hospitals (Mubarak and Amiri) is shown in Table 1. Four types of wastes
were identified as garbage, infected wastes, toilet wastes, and toxic/radioactive
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wastes. In addition, kitchen wastes are collected separately in both hospitals.

Generation rate of medical waste at the two Hospitals was found to be 5.4 kg/
pat/d (3.97 kg/bed/d) at Amiri Hospital and 4.89 kg/pat/d (3.65 kg/bed/d) at
Mubarak Hospital.
The higher generation rate at Amiri Hospital is due to the fact that the hos-
pital serves a large number of upper-class patients. On the other hand, Mubarak
Hospital accommodates a slightly larger number of patients compared to Amiri
Hospital, which could also affect the unit generation rate. The generation rate of
kitchen waste is 1.38 kg/pat/d (2.21 kg/bed/d) at Amiri Hospital and 1.2 kg/pat/d
(2.12 kg/bed/d) at Mubarak Hospital. Each hospital generated over two tons of
waste daily.
Minimal differences were observed between generation rates in summer
and spring, especially when the unit rate is expressed in terms of the “number
of patients” rather than the “number of beds” (Table 1). The number of patients
in hospitals in the state of Kuwait is usually larger in spring than in sum-
mer, since a considerable number of the inhabitants leave Kuwait for vacation
abroad to escape the very hot summer. However, when the unit waste genera-
tion rate is expressed in terms of the “number of patients,” comparable values
are obtained in both spring and summer. This clearly demonstrates the advan-
tage of expressing generation rate of hospital wastes in terms of the “number
of patients.” However, for design purposes, the estimates are usually based on
the number of beds, since hospital occupancy rates expected are difficult to
predict.

Table 1: Summary of waste quantities and generation rates at Amiri and Mubarak
Al-Kabeer hospitals.

Amiri Hospital Mubarak Hospital

Waste Spring Summer Spring Summer
Garbage (kg/d) 573.97 595.18 718.25 460.64
Infected wastes (kg/d) 669.34 744.25 1025.75 900.12
Toilet wastes (kg/d) 89.52 122.47 129.17 99.80
Toxic/radioactive wastes (kg/d) 816.24 827.25 849.10 826.50
Total wastes (kg/d) 2149.07 2289.15 2722.27 2287.06
Avg. medical waste (kg/bed/d) 3.62 3.97 4.68 3.65
Avg. medical waste (kg/patient/d) 5.40 5.40 4.80 4.89
Avg. kitchen waste (kg/bed/d) 2.21 2.25 2.12 2.07
Avg. kitchen waste (kg/patient/d) 1.38 1.35 1.2 1.2
 Variations in Hospital Waste Quantities 471
Table 2: Comparison of waste generation rates at hospitals in other countries.

Region Country Generation rate kg/bed/d

Middle East Kuwait (this study) (3.6–4.7)
Jordan[8] 4.3
UAE[9] 3.9
Saudi Arabia[10] 1.1
Europe[7]
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France 3.3
Norway 3.9
Spain 4.4
United Kingdom 3.3
North America[11] Canada 4.1
USA 4.4

Table 2 presents a comparison of waste generation rates reported in dif-

ferent countries in the Middle East, Europe, and North America. It is noted
that the waste generation rates observed in hospitals under study lie within
the range of values reported in the literature. Such values, however, may vary
depending on the size of hospital, i.e., number of beds.

Variations in Waste Generation Rates

Some factors that affect the quantity of wastes generated from the hospitals
were identified in this study. Table 3 presents the waste generation rates found
in different departments within the hospital. Since each department differs
from others in terms of operational characteristics and medical services pro-
vided, it is expected that the waste quantities and generation rates will differ.
It is noted from Table 3 that the wards (surgery, internal, pediatric), the main
operating theaters (MOTs), the laboratories, and the causalities departments
have the highest generation rate of infected wastes (yellow-coded bags). Mean-
while, both the wards, the operating theaters, and the administrative offices
produce the highest wastes of disposable wastes (blue-coded bags). The haz-
ardous wastes such as toxic/radioactive, are mainly contributed by the X-ray
units and the pharmacies, which is a result of the nature of activities in these
facilities. The lowest generation rates of all types of wastes was observed in the
outpatient departments (OPDs) of the studied hospitals, as the patients remain
for a very limited period of time in these departments and few procedures are
performed there compared to other areas such as operation theatres.
Seasonal and daily variations in waste generation rates were also exam-
ined. Tables 1 and 3 indicate that the generation rates were slightly higher in
spring than in summer, as more patients are admitted to hospitals in Kuwait
during the spring months when the residing population is highest. On the other
hand, daily variations in waste generation rates were more remarkable. It is to
be mentioned that Friday is a holiday in Kuwait, being the weekend. Fridays
recorded the lowest rates, followed by Thursdays, whereas Saturdays showed
generally higher rates compared with other days being the first day of the week.
 472 Hamoda, El-Tomi, and Bahman

Table 3: Generation rates of medical solid wastes at Amiri and Mubarak

Al-Kabeer hospitals.

Amiri Hospital Mubarak Hospital

Avg S.W./unit Avg S.W./unit
Department Spring Summer Range of values Spring Summer Range of values
Wards (kg/patient/day):
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Blue1 2.60 2.10 0.45–5 1.40 1.33 0.35–2.7

Yellow2 3.70 1.50 0.09–8 1.80 2.01 0.49–3.6
Red3 0.58 0.45 0.08–0.9 0.40 0.35 0.05–0.75
Black4 NA5 NA NA NA NA NA
MOT (kg/patient/day):
Blue 1.20 1.10 NA 0.55 0.70 NA
Yellow 4.10 4.90 NA 4.60 4.20 NA
Red 0.47 0.03 NA 0.25 0.25 NA
Black NA NA NA NA NA NA
Casualties (kg/patient/day):
Blue 0.07 0.12 0.062–0.159 0.08 NA 0.073–0.088
Yellow 0.41 0.41 0.15–0.65 0.26 0.21 0.07–0.44
Red 0.04 0.04 0.01–0.065 0.03 0.02 0.012–0.043
Black NA NA NA NA NA NA
X-ray (kg/test/day):
Blue 0.02 0.03 0.018–0.049 0.02 0.02 0.018–0.024
Yellow 0.04 NA NA NA NA NA
Red 0.02 0.012 NA 0.01 0.013 NA
Black 0.20 0.018 0.025–0.39 0.12 0.10 0.05–0.188
Pharmacy (kg/prescription/day):
Blue 0.013 NA 0.004–0.025 NA NA NA
Yellow NA NA NA NA NA NA
Red 0.002 0.003 0.001–0.005 0.0002 0.001 NA
Black 0.017 0.049 0.0054–0.085 0.1 0.1 0.006–0.01
Administrative (kg/employee/day):
Blue 0.128 0.172 0.09–0.187 0.33 0.4 0.02–0.75
Yellow NA NA NA NA NA NA
Red 0.0223 0.041 0.015–0.051 0.095 0.063 0.01–0.179
Black NA NA NA NA NA NA
OPD (kg/patient/day):
Blue 0.026 0.058 0.018–0.09 0.24 0.23 0.025–0.49
Yellow 0.056 0.078 0.022–0.118 0.22 0.29 0.021–0.55
Red 0.0033 0.0075 0.0025–0.009 NA NA NA
Black NA NA NA NA NA NA
Laboratories (kg/sample/day):
Blue 0.038 0.062 NA 0.035 0.041 NA
Yellow 0.29 0.46 0.03–0.90 0.67 0.73 0.08–1.37
Red 0.01 0.015 NA 0.007 0.005 NA
Black NA NA NA NA NA NA
1 Garbage.
2 Infected waste.
3 Toilet wastes.
4 Toxic/radioactive waste.
5 Not available.
 Variations in Hospital Waste Quantities 473
Table 4: Variations in waste quantities in (kg/d) in Amiri and Mubarak Al-Kabeer
hospitals during the week.

Avg. % increase in waste quantities over the weekdays

compared with Friday (weekend)
Type of waste Saturday Sunday Monday Tuesday Wednesday Thursday
Garbage
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Spring (Amiri) 44.2 40.9 46.3 38 49.8 26.2

(Mubarak) 63.2 59.3 57.2 61.3 51.4 49.4
Summer (Amiri) 53.3 81.7 63 89.8 68.4 68.9
(Mubarak) 52.4 60.8 42.8 50.2 71.3 69.8
Infected:
Spring (Amiri) 43.1 37.1 44.1 49.6 47.9 48
(Mubarak) 54.3 59.3 58.6 57.8 66.2 52.6
Summer (Amiri) 24.2 51.3 23.2 33.7 53.7 30.3
(Mubarak) 40.2 50.8 37.5 36.6 34.5 45.8
Toilet:
Spring (Amiri) 73.4 56.3 64.2 72.2 57.6 60.8
(Mubarak) 61.8 52.2 72.1 75 76.8 65.1
Summer (Amiri) 79.5 82.3 69.4 75.3 65.7 73.5
(Mubarak) 58.3 56.7 61.6 63.6 60.5 59.7
Toxic/radioactive:
Spring (Amiri) 47.6 48.8 61.6 42.2 48 30
(Mubarak) 19.3 50 20 39.9 40 28
Summer (Amiri) 32.7 14.2 23.1 19 39.9 28.8
(Mubarak) 20 19.8 25.2 20 29 27.5

Table 4 presents the percentage difference in generation rates obtained during

the weekdays as compared to those recorded on Fridays.

Composition and Characteristics of Hospital Wastes

This study also examined the composition of the wastes generated in the
two hospitals and determined the moisture content and density of the solid
wastes.
The wastes generated at the two hospitals were categorized into: (i) haz-
ardous wastes (infected and toxic/radioactive wastes); (ii) nonhazardous wastes
(garbage and toilet wastes); and (iii) kitchen wastes. Figure 1 shows the percent-
age contribution of each type to the total solid wastes generated at both hospi-
tals. It is to be noted that the organs and other parts of the human body disposed
by the operating theaters at all hospitals in Kuwait are collected separately and
buried in special tombs separate from the solid waste disposal system; such
wastes were not considered in this study. For other hospital wastes, the kitchen
waste constitutes about 25% of the total waste, while the hazardous and the
nonhazardous wastes contributed 53% and 22%, respectively. The composition
of the wastes produced by the two hospitals was comparable as shown in Table 5.
For the garbage waste, the composition found in this study is shown in
Table 6. It can be seen that the paper and cardboard component was the highest,
 474 Hamoda, El-Tomi, and Bahman
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Figure 1: Distribution of wastes generated at Amiri and Mubarak Al-Kabeer hospitals.

followed by plastics and food. It is more or less similar to the composition of

household wastes.
Moisture content of the waste as collected ranged between 30% to 57%,
whereas the density of the waste varied from 192 to 251 kg/m3 , which are lower
than that reported in the literature for municipal waste.[5] As incineration of
waste is practiced in the studied hospitals, the relatively high moisture content
of the waste may lead to a decrease in the efficiency of incinerators. Moreover,
the low density of the waste implies that the waste needs compaction prior to its
incineration in order to achieve optimal utilization of the incinerator’s capacity.
Such parameters must be carefully considered in the operation of incinerators.

Management of Hospital Wastes

This study indicated that considerable quantities of both hazardous and
nonhazardous wastes are generated daily by the hospitals and exceed the design
figures. Proper management calls for the separation of both types of wastes
during collection and the redesign of the waste disposal facilities based on actual
figures. The study has also shown that the majority of hospital wastes are

Table 5: Classification of wastes generated at Amiri and Mubarak Al-Kabeer

hospitals.

Amiri Mubarak Amiri Mubarak

Category Hospital Hospital Type of waste Hospital Hospital
Nonhazardous (%) 22.8 20.9 Garbage (%) 19.3 17.5
Toilet waste (%) 3.5 3.4
Hazardous (%) 51.5 53.8 Infected waste (%) 24.3 28.6
Toxic waste (%) 27.2 25.2
Kitchen (%) 25.7 25.3 Kitchen (%) 25.7 25.3
Total (%) 100 100 Total (%) 100 100
 Variations in Hospital Waste Quantities 475
Table 6: Average composition of garbage collected at Amiri and Mubarak
Al-Kabeer Hospitals.

Component Percentage (%)

Paper 24
Cardboard 8
Food 12
Plastics 18
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Textiles 11
Glass 10
Metals 9
Others 8
Total 100

hazardous in nature and the potential infection to hospital workers is great.

Therefore, handling and disposal of such wastes have to be properly controlled.
On the other hand, incineration of wastes as practiced in the studied hospitals
is associated with many problems related to air pollution and high heavy metal
content of the resulting ash. There is no coordination between the collection and
disposal of the wastes generated at the studied hospitals. An integrated waste
management system is required in order to achieve safe disposal of wastes
generated in the hospitals.

CONCLUSIONS
Based on the results obtained in this study, the following conclusions can be
made:

(i) The average generation rate of medical wastes in the two hospitals ranged
between 4.89 and 5.4 kg/patient/day. These rates are comparable to those
reported in the literature.
(ii) The hazardous waste component of the wastes generated at the hospitals
constitutes 53%, whereas the nonhazardous component accounts for 22%
only. The remaining 25% is contributed by the kitchen waste, which is non-
hazardous in nature but was collected separately in the studied hospitals.
(iii) A definite trend of minimal quantities of wastes was observed on Friday,
which is a weekend in the state of Kuwait. On the other hand, seasonal
variations were not significant.
(iv) The characteristics of the garbage and toilet wastes collected in the hospi-
tals were similar to those reported for the household wastes of municipal
origin.
 476 Hamoda, El-Tomi, and Bahman

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