TESIS SUMMARY

ANALYSIS OF OCCUPATIONAL SAFETY AND HEALTH IN THE

TREATMENT OF MEDICAL SOLID WASTE IN
SELE BE SOLU REGIONAL GENERAL HOSPITAL
SORONG CITY, WEST PAPUA , 2022

Occupational Safety and Health Interests

Public Health Science Study Program

Submitted By:

Yoneta Wamea
NIM: 20/466238/PKU/18865
PROGRAM PASCASARJANA FAKULTAS KEDOKTERAN
KESEHATAN MASYARAKAT DAN KEPERAWATAN
UNIVERSITAS GADJAH MADA
YOGYAKARTA
2022

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TABLE OF CONTENTS

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INTRODUCTION

Hospitals as one of the health service facilities that are part of health
resources that are indispensable in supporting the implementation of health
efforts. In addition to bringing positive impacts to the community, hospitals also
have the potential to have a negative impact on the environment and human health
in the form of pollution from an activity process, namely if the waste produced is
not managed properly.
Hospital solid medical waste contains hazardous materials (infectious, toxic
and radioactive) if not managed properly, it can pollute the environment and is
considered a link in the chain of spread of infectious diseases (Yunizar, et al,
2014). The World Health Organization (WHO), explained that the average
production of hospital waste in developing countries is around 1-3 kg / TT per
day, while in developed countries (Europe, America) it reaches 5-8 kg / TT per
day (Saghita, et al, 2017).
Hospital waste is a form of activity process that occurs in a hospital
environment that has the potential to transmit various disease seeds, in Indonesia
it is estimated to produce hospital solid medical waste of 376,089 tons / day and
liquid waste production of 48,985.70 tons / day. The management of medical and
non-medical waste in hospitals is very much needed for the comfort and
cleanliness of hospitals because it can break the chain of spread of infectious
diseases, especially nosocomial infections (Law of the Republic of Indonesia No.
44, 2009).
In 2021, Indonesia has 3,211 hospitals. In permenkes no. 44 of 2010
concerning hospitals, there is a quality of hospital accreditation. Hospitals should
focus on patients and the standards group of hospital management.
During the COVID-19 pandemic, the amount of medical waste production
in health care facilities (fasyankes) increased sharply. Based on data from the
Ministry of National Development Planning/Bappenas, the potential for an
increase in medical waste stockpiles due to the use of personal protective
equipment (PPE) reaches 3-4 times the previous amount (Kemenko PMK, 2021).

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 RSUD Sele Be Solu is a type C hospital, based on the Decree of the
Indonesian Minister of Health Number 1247 / Menkes / SK / XII / 2009 dated
December 22, 2009 concerning the Determination of the Class of Sele Be Solu
Hospital owned by the Sorong City Government. Based on the Sorong City
Regional Regulation Number: 24 of 2008 concerning The Job Description of
Subdivisions, Sub-Divisions, and Sections at the Inspectorate, Bappeda and
Sorong City Regional Technical Institutions in Chapter IX is a supporting element
of the City Government and is in charge of assisting the Mayor in the
implementation of the Government in the field of health services efficiently and
successfully by prioritizing healing efforts, recovery that is carried out optimally,
integrated with efforts to improve and prevent and carry out referral services.
The types of waste contained in Sele Be Solu Hospital, Sorong City include
syringes with needles, disposable gloves, disposable masks, infusion flabots,
alcohol cotton, contaminated gauze/cotton, contaminated bandages, infusion
hoses, bottles and blood-used pads. In determining the category of disposable
gloves, disposable masks, infusion flabots, alcohol cotton, contaminated
gauze/cotton, contaminated bandages, infusion hoses, drug bottles, and blood-
used pads fall into the category of general B3 waste. As for syringes and syringes,
they enter the B3 waste section sharply.
Hospital waste management efforts can be carried out by preparing
software in the form of regulations, guidelines and policies that regulate how to
sort, rent, transport, store and final destruction and improve health in the hospital
environment.
The solid medical waste produced by Sele Be Solu Hospital from January –
December 2021, amounted to 688.9 Kg and in January 2021 to December 2022,
as much as 212.1 Kg.
The reason why researchers conducted research at Sele Be Solu Hospital,
Sorong City, based on an initial survey at Sele Be Solu Hospital, Sorong City in
January - March 2022. Researchers know that medical waste management is not
yet appropriate and meets sanitation requirements, medical and non-medical waste

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has not been separated as a whole, so there is an increase in medical waste that can
affect the environment, hospitals and surrounding communities so that researchers
are interested in making the title of the proposal "Analysis of Occupational Safety
and Health in the management of Solid medical waste at Sele Be Solu Hospital,
Sorong City, West Papua Province in 2022".

LITELATURE RIVIEW
Understanding K3 Before entering the K3 philosophy, it is necessary to
understand the meaning of occupational health and safety or often abbreviated as
K3. The definition of K3 that will be discussed is according to the World Health
Organization (WHO) and the International Labour Organization (ILO). Human
work safety in detail according to (Daryanto, 2010) includes prevention of
accidents, preventing and reducing the occurrence of occupational diseases,
preventing and reducing permanent disability, preventing or reducing deaths,
securing materials, and maintenance that tests on improving the standard of living
and welfare of mankind. Circulatory in maintaining occupational health and
safety, telutu while working and working in accordance with the correct
procedures. Occupational Health (Sum'mur, 2013) is defined as a specialization in
health sciences or medicine and its practice, the employment community that
obtains the highest degree of health, in physical or mental must have a preventive
and curative social spirit against diseases or health disorders caused by
occupational factors and the work environment as well as common diseases.
According to the Minister of Health of the Republic of Indonesia No.1204
of 2004 concerning Hospital Environmental Health Requirements, waste is all
waste generated from an activity in solid, liquid, and gaseous forms. Waste is the
result of waste from an activity which is also a form of material that according to
its type and category has destructive power benefits for humans and the
environment. According to Baird (2016) waste is a substance that can take shape
in substances and can cause negative effects to the environment if not handled
properly.

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 Medical Solid Waste is waste that is directly generated from the act of
diagnosis and medical action against the patient. Included in these activities are
also medical activities in the polyclinic room, treatment, surgery, obstetrics,
autopsy, and laboratory room. Medical solid waste is often also referred to as
biological waste. Based on the potential hazards contained in clinical / medical
waste, the type of waste can be classified according to Adisasmito (2014).
According to Supraptini (2002) and Habibi (2018) that the influence of toxic
waste on the environment will worsen environmental conditions and will increase
disease in humans and damage to other environmental components. Handling
waste, of course, is not just processing it or recycling it without paying attention
to the type of waste and how it is handled because from one of the existing waste
has different characteristics on the impact it causes The influence of hospital
waste on environmental quality and health can cause various problems such as
comfort and aesthetic disturbances. These are colors derived from sediments,
solutions, phenol odors, eutrophication, and flavors from organic chemicals.

RESEARCH METHODS
This type of research uses qualitative methods, the data of which is sourced
from observations from checklist sheets. Researchers made observations at The
Selebesolu Hospital in Sorong City for one week after the Clearance Ethics were
issued using a checklist sheet. Researchers also conducted in-depth interviews with
the Director, Coordinator of environmental health sanitarians, and medical waste
treatment officers at Selebesolu Hospital.

RESEARCH RESULTS

Overview of Research Locations

In 2009 RSUD Sele Be Solu Kota Sorong was designated as a

HospitaltypeC, based on the Decree of the Minister of Health of the Republic of
Indonesia Number 1247 / Menkes / SK / XII / 2009 dated December 22,

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2009about the Determination of the Class of Rsud Sele Be Solumilik, Sorong City
Government. Has the task of carrying out health efforts efficiently and
successfully by prioritizing healing, recovery efforts with efforts to improve and
prevent as well as carrying out referral efforts and implementing quality services
according to hospital service standards. The types of medical services available at
Rsud Sele Be Solu Kota Sorong are outpatient services, inpatient and main
inpatient care, emergency services, intensive services (ICU), surgical services
(acute surgery and elective surgery) and oral dental services.
Rsud Sele Be Solu Kota Sorong has 9 (nine) inpatient rooms and 1 (one)
bourding room in the Emergency Installation and 1 Action room in the PONEK
(VK) room with a total of 158 beds. In 2020 the total inpatient visits were 6,816
patients. RSUD Sele Be Solu has 16 (sixteen) Polyclinics that are open every
Monday to Friday from 08.00 WIT until the end.
Specialist Services at the Outpatient Polyclinic consist of Internal Medicine
Specialists, Pediatricians, Surgical Specialists, Ophthalmologists, Mental Health
Specialists, Neuroscientists, Heart Specialists, Obstetricians, ENT Specialists,
Skin and Venereal Specialists, Clinical Nutrition Specialists and Medical Rehab
Specialists.

Tabel 5. Karakteristik Petugas

Variabel (N=17) Total Persentase (%)

Jenis Tugas Cleaning Service 5 27
Pengelola Limbah 7 38
Sanitarian 5 29
Umur 20– 24 Tahun 2 11
25 – 44 Tahun 9 52
45 – 54 Tahun 6 35
Jenis Kelamin Perempuan 3 17
Laki-laki 14 82
Lama Kerja 1 – 4 Tahun 10 58
> 5 Tahun 7 41

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 Tugas Rangkap 1 Tugas 9 52
> 1 Tugas 8 47
Tabel 5 menunjukkan bahwa 38% petugas yang terlibat di dalam
pengelolaan limbah padat medis adalah pengelola limbah, didominasi dengan
umur rentang 25 sampai 44 tahun (52%), berjenis kelamin laki-laki (14%),
memiliki lama kerja 1 sampai 4 tahun (58%) dan memiliki lebih dari satu tugas
rangkap (47%).
Operational Policies and Standards
The implementation of medical solid waste management at Rsud Sele Be
Solu, has a policy that is guided by the laws and regulations in thedecree of the
Minister of Health of the Republic of Indonesia Number 1204 / MENKES / SK /
X / 2004 concerning Hospital Environmental Health Requirements. SOP
(Standard Operating Procedure) on B3 waste management. The SOP used refers
to the decision of the head of the investment and one-stop integrated service office
of Koto Sorong Number: 060/003/DPMPTDP/VII/2019 concerning standard
operating procedures (SOP).
Sources and Types of Waste
The characteristics of the type of Medical Solid Waste based on the source
of waste generation at Sele Be Solu Hospital are as follows:

Table 1. Sources and Types of Waste

Waste Sources Waste Type

Laboratory Pipettes, reagents, body fluids, slide specimens, glasses,
needles, gloves and masks
Emergency Installation Blood sacs, body tissues, underpads/sanders, drainage
(IGD) sets, plasters, catheters, catheter veins, infusion tubes,
vials, vials, ampoules, maskes, sidposable gloves, swebs,
kassa, syringes.
Children's Poly Syringe, umblicak catheter, infuse set, vial, ampoule
Intensive Center Unit Blood sacs, body tissues, underpads/sanders, drainage
sets, plasters, catheters, catheter veins, infusion tubes,
used vials, vials, ampoules, masks, sidposable gloves,
swebs, kassa, syringes.

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Eagle, Pigeon, Parrot,
Asoka and Crane Infusion tubes, catheter veins, catheters, urine sacs, pads,
Treatment Room plasters, drainage sets, underpads, body tissues, syringes,
cassae, swebs, disposable gloves, masks

Operating Room
Blood bags, body tissues, underpads/ sanders, drainage
sets, plasters, catheters, catheter veins, infusion tubes,
infusion bottles, vials, ampoules, masks, sidposable
gloves, web, kassa, syringes.

Pharmacy
Expired drugs, masks, gloves, contaminated drugs.

The following are the types of medical solid waste produced by

hospitals according to their nature:
1. Medical/infectious solid waste
Infectious waste at Rsud Selebesolu comes from medical services
such as treatment rooms, polyclinics, operating rooms, maternity rooms,
ICUs and emergency rooms. The infectious waste produced is the residue
of medicines, gloves, masks, urine bags, infusion tubes, blood bags, body
tissues, syringes, cotton swabs, and scarred gauze.
2. Waste of sharp objects and needles
Sharp and pointed objects produced by Sele Be Solu Regional
Hospital and can cause dangers such as stab wounds, cuts such as broken
glasses, ampoules, knives and injections.
3. Pharmaceutical waste
The waste generated by Sele Be Solu Hospital in pharmaceutical
installations comes from drugs that are toxic, have passed the date limit,
and are dangerous to health (expired).
4. Cytotoxic waste
RSUD Sele Be Solu is a hospital with type C, so it does not handle
patients with cancer. Cytotoxic waste is a hazardous waste because it is
contaminated from chemotherapy drugs that can kill living cells.
5. Chemical waste
The chemical waste produced by Sele Be Solu Hospital is

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 laboratory and sanitary chemical waste, but none of it is in solid form.
6. Radioactive waste
Sele Be Solu Hospital does not produce radioactive waste.
7. Waste with a high content of heavy metals
Heavy metals that are high in various kinds, one of which is
mercury found in thermometers and tensions. Sele Be Solu Hospital is
free of tools and materials containing mercury.
Waste Management Process
Hospital waste management has been orred in the Ministry of Health
Number 1204 / MENKES / SK / X / 2004 concerning hospital environmental
health requirements. Solid medical waste is solid waste consisting of infectious
waste, pathology waste, sharp object waste, pharmaceutical waste, toxic waste,
chemical waste, radioactive waste, pressure conteiner waste, and waste containing
a high content of heavy metals. The following is the waste management process at
Sele Be Solu Hospital, Sorong City:
1. Container
Rsud Sele Be Solu has met the waste storage requirements in accordance
with the Ministry of Health Number 1204/MENKES/SK/X/2004. The hospital's
monitoring phase provides leak-proof bins by providing plastic bags at the bottom
of the trash can. Garbage bags are in accordance with the type of garbage, black
bags are used for non-medical waste and yellow bags are used for plastic with
medical waste, sharp object libags are separated in separate containers, which are
not easily punctured and hollow. For sharp type waste, Sele Be Solu Hospital uses
a sterile biohazard box in each service room. The needles and syringes in the
sterile contact of the biohazard are separated from other medical waste so that
they cannot be reused or directly destroyed.
The residence at Rsud Sele Be Solu is not easy for people to reach, it is
located in the service room not disturbed by a crowded street or place, it is located
in a corner or corner of the room. And every garbage that has been in the
container is labeled, the label as a marker of where the waste comes from. The
label is written on a small white sticker affixed inside a plastic bag like a bag from

36
 the emergency room.
As for the shortcomings in the reconstitution process found by researchers at
Sele Be Solu Regional Hospital, there are still some garbage containers that have
not been coated with plastic bags, and some labels of the source of origin of the
waste are not installed properly. Some observations also found that they were not
well covered, and they were still in a crowded location.
1. Collection
Waste collection at Sele Be Solu Regional Hospital in each service room is
included in a closed trolley transported by cleaners. The medical solid waste
trolley is 500 L in size and wheeled, the trolley is iron and very flexible for
cutting. As for the use of containers as waste collection containers, they are
collected in separate places, do not leak and do not spill. At the stage of collection
medical personnel use personal protective equipment consisting of gloves, aprons,
boots and masks.
The shortcomings of this collection stage are that when observing some
cleaners still do not use complete PPE such as masks that are not covered
properly, and also not all officers use boots.
1. Transport
Medical solid waste at Sele Be Solu Regional Hospital is scheduled for two
stages, transportation every 06.00 WIB in the morning and 17.00 WIB every
afternoon. The transportation process uses a closed trolley and separate
transportation does not go through a health care road that is not traversed by
patients, officers and visitors. The transportation process according to the results
of the study is very neat and orderly. After successfully collecting data on the
types of waste produced from Selebisolo Hospital are pharmaceutical waste,
general waste, infectious waste and sharp objects. The amount of medical waste
produced by Selebisolo Hospital per day ranges from 10.7 Kg, 70.5 Kg per week
and 280.2 Kg per month.
1. Shelter
From the results of the transportation of waste, the waste is then
accommodated in a temporary shelter or what is called (TPS). The TPS at Sele

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 Be Solu Hospital is a simen walled building, the TPS at Sele Be Solu Hospital is
separated by the main building 200 m of distance between the two. inside the
TPS itself is separated between B3 waste and non-medical waste which is
partitioned by the simen wall. Medical, non-medical and B3 waste have different
doors. But the TPS became a unit with the same roof.
1. Destruction
Sele Be Solu Hospital has one incinerator. The incinerator has a funnel
height of 2 meters with plate material, the dimensions of the incinerator room at
Sele Be Solu Hospital are 50x50x80 cm with a combustion capacity of 5-9 Kg /
hour. The incinerator at Sele Be Solu Hospital is fueled by diesel fuel.
Non-medical waste stored in the TPS is then forwarded to the landfill
located on Jl. Makbon KM 12 in Sorong City, West Papua.

Figure 3. Spatial Map of The Distance between TPA and TPS RSUD
Sele Be Solu

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Interview Results
Pertanyaan Penelitian
1. Are there guidelines for medical
solid waste management at Sele Be
Solu Hospital, Sorong City?
1. Are the guidelines well
executed?
1. Are there any occupational safety
and health problems experienced
in the management of medical
waste at Sele Be Solu Regional
Hospital?
Is it in the process stage of the
process of linking and storage
the container used is not leaky,
anti-puncture with a lid and not
easy to open?
Hasil Wawancara
“The domicile is there, the SOP is there and we do not run
alone because because our hospital is under the auspices
of the Government So we are running in accordance with
the rules of the Sorong City Government"
" there is an SOP but it refers to the Sorong City
government."
"No Course SOP, adjusting to DPMPTSP SOP"
"To carry out the hospital waste treatment process is
appropriate for those of us who have just started this, to
achieve the SOP target yet and we are in the process of
more firmly carrying out our duties in accordance with the
applicable SOP"
"So far it's been appropriate, going according to the
existing items"
"Yes, we are running according to the SOP"
"For the problems we face, there have been, have been
punctured, stepped on, if there is no exposure yet"
" I was once pierced by an ivory needle that has not been
separated"
"Heard someone had been stepped on, but maybe a non-
medical scum"
"For leak-proof medical solid waste containers, anti-
puncture with a lid, "Yes" because we have recommended
to the klining service officer that if the medical solid waste
is full, it must be transported or transferred to the TPS"
"Yes, we have a hermetically sealed shelter that is not
easy to leak, there is a plastic bag to hold it in the
container, it is well organized"
"yes, it has been tried not to leak, there is a container, there
39

What is the coloring and labeling
code on solid medical waste at Sele
Be Solu Hospital?
2. Have waste management
officers received training? What
was the training like and what
was the last year ?
How is PPE provided in the
implementation of waste
management and what are the
types of it?
is plastic too, the more here the better the quality"
"Here we can separate 3 containers of medical solid waste that ar
resistant/ Safety books infectious containers or sealed containers coate
infusion bottles plastic infusion bottles or closed containers covered wit
"black for non medical and yellow for medical waste"
" yellow color , and the label is written on plastic use marker the name o
"Yes, we conduct training for medical solid waste
management officers, we teach how to provide containers,
such as infectious waste (Yellow), infectious waste sharp
objects (Yellow), chemical waste containers (brown) and
Cytosic Waste Containers (Purple), for training every 3
months if and we also usually prepare with contract
personnel officers so as to notify contract officers"
"Yes, there was a special training brought in by hospital
waste management trainers from Jakarta in the last 2018
before the pandemic, at that time teaching about housing"
"Every 3 months there is training from management, how
to manage properly and correctly, labeling, starting from
collection, dedication, to destruction. All officers to
cleaning services have been given training related to this
and have a good understanding”
"The PPE that we use in handling waste management is
boots, gloves, katel pak, helem and Masks, we can do it
according to the SOP in our hospital, when we do the
processing, renting, sorting and destruction we use the
PPE provided from Selebesolu Hospital"
"There are types of protective helmets, special masks,
thick gloves, catepers with aprons, boots, yesterday there
was a face shiled too but now the helmet is equipped with
a face shield as well"
"Provided by the hospital, complete everything as can be
seen this I use a special shirt, complete with a mask
helmet and shoes. For technically, this outfit is only used
when the management process is carried out. And the
collection in the morning and evening, all have been hung
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 neatly in the room. There may be a 3rd party that washes
so every day it is always fragrant. But if this special
clothes are cloth, there are disposable ones."

1. Have waste management "We've given the officers anyway"

officers been given tetanus
and Hepatitis B " already but only a few people are rich"
immunizations? " I haven't gotten myself"

1. Is there a special TPS for
medical waste in Sele Be
Solu? Is the TPS in
accordance with the
standards?
"For TPS specifically for medical solid waste there, to
achieve good standards we are working, if for now we are
still using the existing temporary buildings."
" The TPS is in the form of a house- well it is partitioned,
some are for non-medical medical waste so, but it is
separated so it is not mixed. Then the ventilation is not
there so animals like mice should not be able to enter, but
yes the name is also an animal. Maybe you can dig a hole,
I think the wall is a bit fragile. Indeed, the TPS should
have a slight improvement."

“Oiya TPS di balakang RS , iya ada , jauh mungkin

sekitar 200 meter dari sini. Itu tembok belakangnya mau
roboh pernah saya sudah bilang direktur untuk buat yang
lebih baik, tapi mungkin covid-19 jadi tidak terlalu
penting. Tapi masih sangat layak, ruangan nya ada “

DISCUSSION
Solid Medical Waste Management Standards
The regulation and management of media solid waste are in accordance with
government regulations, and each item has gone well. Each stage of medical solid
waste management starts from the selection. The sorting of medical waste is
carried out starting from the source of producing waste. It is very good to see the
way from writing the name label of the room of origin of the waste on the waste
plastic. SOPs made by hospitals themselves are not available, only in accordance
with the regulation of the Ministry of Health of the Republic of Indonesia number
7 of 2019 concerning environmental health, namely that in the management of

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medical waste there are several stages, namely sorting, housing, transportation,
management, storage, final disposal and destruction.

In the interview results, the compliance of officers related to SOPs has been
carried out properly according to the Sele Be Solu Regional Hospital. However,
according to Saiti, the compliance of officers in implementing the SOP for
hospital waste management is still below the standard, which is < 100%. The
compliance rate of officers in the disposal of medical waste is still low below
29%-56%. The compliance rate for sharp object waste on average officers have
complied a lot even though they have not reached 100% (Saiti, 2017). This study
did not measure further related to officer compliance, in this study it only
describes the waste management process at Sele Be Solu Regional Hospital.
However, researchers believe that the compliance of officers at Sele Be Solu
Regional Hospital is still low considering that there are several incidents of being
stepped on and punctured during the implementation of waste management.
Sops that exist and are used at Sele Be Solu Regional Hospital must be
socialized to officers, such as medical waste management, nausea from the stages
of the process, the use of good and correct PPE, management if pierced by needles
or exposed to human body tissues. Even if the SOP used does not come from the
hospital.
The Process of Collecting Medical Solid Waste at Sele Be Solu Hospital
The transportation of medical solid waste at Sele Be Solu Regional Hospital
is in accordance with Kepmenkes 1204 / Menkes / SK / 2004 concerning hospital
environmental health requirements, where the types and categories are
appropriate, namely infectious waste and yellow pathology.
Medical solid waste at Sele Be Soludik Hospital is collected in a container
that is not subject to contamination conditions. The container used is anti-leakage,
it is not easy to puncture because it is made of hard plastic, and the cover is very
tight, it is not easy to open. So that it cannot be contaminated from insects or
rodents and unauthorized people. For infectious medical solid containers the color

42
is yellow while for non-infectious solids it is black.
This is in line with the same research at RSU GARUT in 2019, at the time
of the evacuation of medical solid waste, the containers used were quite uniform.
The entire room more or less uses a trash can of the same volume of 17 depending
on the condition of the room. For the storage of medical solid waste, a 50L
container with green color is used and the garbage is wrapped in a black plastic
bag, while for non-sharp / Infectious medical solid waste, a yellow 50L container
is used with waste from producers who have been wrapped in yellow plastic bags
(Yonik, 2019). However, it is not in line with the research conducted at Alfatah
Ambon Hospital. Medically densely packed people do not use plastic bags so they
are not eligible.
The weakness of the existing housing at sele be solu hospital is that the
shelter does not consider contamination that may stick to the container. Medical
solid containers should be disinfected after use, however the containers used are
not cleaned when reused. Even if it is a plastic bag, covered with a plastic bag, the
risk of contamination is possible.
Medical Solid Waste Collection Process at Sele Be Solu Hospital
The collection of medical solid waste at Sele Be Solu Regional Hospital is
carried out in each room, and each room has a container, and uses a closed course
trolley and is in accordance with the standards. Trolleys are used to be able to
keep officers away from direct contact waste. At the time of collection officers
use PPE that complies with the standards, ranging from head to toe. The
collection at Sele Be Solu Regional Hospital also uses scheduling, so it is not
carried out continuously, the hours set are the hours where there are fewer
visitors, so that the risk of disease transmission caused when opening containers
to visitors is reduced.
This is also in accordance with research at RSIA RK in 2020, officers
collect waste from each room with a plastic coating carrier, then tied it firmly, the
trolley used is the same as the Sele Be Solu Hospital, which is 240 liters in size
and uses Complete PPE (Rendi, 2020).
However, the weaknesses found during direct observation at the study site,

43
some officers did not use ppe completely, many of whom did not use mask-
material boots. The main danger of medical waste is the risk of infection from
microorganisms or viruses present in the waste, infection usually occurs due to
exposure to punctures of sharp objects or needle injuries (Sarwening, 2022).
Therefore, officers, be it cleaning services or waste officers, are required to use
personal protective equipment to minimize work accidents.
The Process of Transporting Medical Solid Waste at Sele Be Solu Hospital
Rsud Sele Be Solu made two shifts of change hours for the transportation of
waste from each room to the TPS. The resulting medical solid waste is transported
using a special troly and the path is made differently not passing through the
service room. Rsud Sele Be Solu is in accordance with permenkes number 1204
of 2004 concerning environmental requirements, dumana is recommended to
transport waste less than 24 hours. The transportation schedule is divided into
morning and evening. However, this transportation process requires special
training in practice, it requires the ability to transport waste properly. Since in the
process of transporting exposure to direct contamination between waste and
attendants is very likely to occur . This is different from the research at Ulin
Hospital, Banjarmasin City, at the transportation stage, the transportation stage is
not in accordance with Permenkes Number 7 of 2019, the transportation stage at
Permenkes Number 7 of 2019 is that transportation is carried out during non-peak
hours in the morning and evening and not through routes / corridors that are
crowded with patients or hospital visitors. Meanwhile, transportation at Ulin
Hospital, Banjarmasin City, is carried out during peak hours and does not have a
special route for transportation and still passes through the transportation of routes
/ corridors that are crowded with patients and hospital visitors.
According to the interview results, it turned out that some claimed that there
had been accidents such as stepping on and being pierced by needles. This is a
phenomenon that makes sense if according to the observations the use of PPE is
still very minimally used. However, training is needed even though it has been
done before. Development aims to improve the professional quality and skills of
employees and carry out their duties and functions optimally (Edi Sutrisno, 2011:

44
71). In addition to socialization of how to handle waste properly, there needs to be
socialization related to washing hands properly before the dam after transportation
is carried out, to prevent contamination.
The use of PPE is indeed some uncomfortable when working, as for those
who feel allergic if they use a closed apron in the very hot weather of Sorong
City. However, the use of complete PPE can prevent officers from health and
safety hazards while working, both from the physical side and contamination with
diseases that may come from medical solid waste produced by Sele Be Solu
Hospital. In addition to use, ppe hygiene is also an important issue. According to
the observation results, the PPE used by waste officers is a reuse, so it requires
good maintenance and storage so that waste management becomes more
standardized.
Medical Solid Waste Storage Process at Sele Be Solu Hospital
Before being burned or destroyed, Sele Be Solu Regional Hospital stores
medical solid waste in temporary shelters (TPS). The polling station at Sele Be
Solu Regional Hospital is in the form of a building that is partitioned. The
requirements for waste storage buildings and procedures and technical
requirements of TPS must meet the first criterion, namely having a design that is
in accordance with the characteristics and amount of waste produced. The first
requirement of Sele Be Solu Hospital has been met.
Second, protect from entering rainwater either directly or indirectly, because
the TPS building uses a wall with a roof, rain is not easy to enter the building.
However, according to the interview results, the TPS building is not feasible and
there needs to be a renovation of the khsusunya on the back wall. The TPS also
needs to be refurbished because there are several mouse holes that can make the
floor hollow. If the walls are walled and unventilated then the process of decay
will be noticeably faster, since the rapid process of decay will give rise to gases
and odors. So that gives rise to many rodents who may be looking for a way to get
in.
The Process of Destroying Medical Solid Waste at Sele Be Solu Hospital

45
 The storage stage is in accordance with Permenkes Number 7 of 2019,
namely the time of stay of waste in the TPS should not exceed 2x24 hours, solid
waste placed in the TPS remains wrapped in black plastic bags and is not
demolished, the final handling of waste is carried out by the hospital or in
collaboration with outside parties.
The destruction of medical waste at the hospital through a party that
provides an international standard incinerator, the waste from the next fertilization
is buried in the grave in the ground.
Impact of Occupational Safety and Health on Waste Management at Sele Be
Solu Hospital, Sorong City.
The hospital is an agency that is very clearly full of contamination of
various microorganisms of inorganic and organic materials so that the impact of
the risk of danger in it must be managed properly. The potential for infection with
germs with diseases in officers is very likely to occur, if it cannot be managed
properly, it will cause serious problems in the safety of workers and visitors and
the community, both officers, patients, visitors and the community living around
the hospital.
More than 24-hour garbage storage at the polling station will cause decay
and invite insect and rodent vectors that can transmit diseases from place to place,
resulting in health problems and infectious diseases. The incidence of diseases
such as dengue hemorrhagic fever that multiplies on objects that can hold water
such as cans, used bottles.
Another potential besides infectious diseases caused by vectors is the direct
contamination of waste with officers such as waste body fluids or human blood
due to the lack of wearing of personal protective equipment and hygiene applied
by waste officers. Accidents to officers and visitors may continue to occur due to
the splattering of syringes and sharp materials because placing waste is not in
accordance with existing regulations. As for the risk of falling, slipping,
stumbling, bumping, being hit, hit, burning by moving equipment such as trolleys
or other machines may occur at Sele Be Solu Hospital but the incident is minimal,
but it has been experienced.

46
CONCLUSIONS AND SUGGESTIONS

Based on the results of research conducted at Sele Be Solu Hospital, the

description of medical solid waste management at the hospital is as follows:
Overall, every detail in the management of medical solid waste at Sele Be Solu
Regional Hospital is in accordance with each item with the SOP that has been
adjusted to the Ministry of Health No. 1204 / SK / X / 2004 concerning
environmental health requirements in the Hospital.
The process of reserving medical solid waste at Sele Be Solu Regional
Hospital is separated according to the type of waste, the solid is given plastic with
yellow for infectious medical waste, black color for non-infectious sweet solid
waste, and labeled and the name of origin of the waste comes from. The
registration process at Sele Be Solu Regional Hospital has been good and follows
the SOP. The process of collecting medical solid waste at Sele Be Solu Regional
Hospital is carried out properly, in each room of the container, the collection
process is carried out at two times, namely in the morning at 06.00 WIT and in the
afternoon at 17.00 WIT. The time was chosen because at that time there were not
too many patients and visitors at sele be solu hospital. There is a weakness in the
collection process, namely, some officers still do not use complete PPE.
The process of transporting medical solid waste at Sele Be Solu Hospital
has a special line that does not pass through the service room, the troly used is
made of iron with a capacity of 250 L. Disadvantages of the processing process

47
even though it is tightly closed, the troly used looks unclean. The temporary
storage process (TPS) at Sele Be Solu Regional Hospital has not met the
requirements, the wall building is no longer solid, there is no air regulation and
ventilation system, waste stored in the TPS is more than the standard time, which
is more than 48 hours.
The process of destroying medical waste, sharp objects at Sele Be Solu
Hospital uses an incinerator that has good standards, the incinerator is provided by
a third party. Not all officers have received Hematitis B and Tetanus immunity at
Sele Be Solu Regional Hospital.
In order not to occur events related to safety and safety and further improve
the work performance of officers in waste management, the researcher's advice to
the Sele Be Solu Regional Hospital, Sorong City, West Papua, is
m. implement the SOP and provide directions according to the SOP to the officers
to understand the waste management measures properly and correctly. Tidak
store waste for more than 48 hours in the TPS. The TPS needs to be repaired its
wall lining and needs to be installed ventilation and good air system arrangement.
Increase evaluation related to the use of PPE in carrying out tasks in the field.
Providing vaccinations to waste officers.

DAFTAR PUSTAKA

Asmarhany, Chandra Dewi, (2014). Pengelolaan Limbah Medis Padat Di Rumah

Sakit Umum Daerah Kelet Kabupaten Jepara Jurusan Ilmu Kesehatan
Masyarakat Fakultas Ilmu Keolahragaan.
http://lib.unnes.ac.id/20215/1/6450408063.pdf (diakses tgl 8 jam 13.15)
Keputusan Menteri Kesehatan RI, (2019_. Profil Kesehatan Indonesia, Jakarta.
www.depkes.go.id/.../profil-kesehatan-indonesia/Profil
KesehatanIndonesia2019.pdf (diakses tgl 8 jam 13.15)
Kementerian Kesehatan Republik Indonesia (2016) Kesehatan dan Keselamatan
Kerja. Edited by S. Rejeki. Jakarta: Pusat Pendidikan Sumber Daya Manusia
Kesehatan, Badan Pengembangan dan Pemberdayaan Sumber Daya
Manusia Kesehatan.
Laporan Triwulan Limbah Medis Padat Rumah Sakit Ernaldi Bahar Provinsi
Sumatera Selatan Januari-Maret 2021
Reno John (2021). What is Waste?. Worldwide Waste: Journal of

48
 Interdisciplinary Studies.
Saghita, El Novrian Purnama, Thamrin, Dedi Afandi, (2017). Analisis minimasi
limbah medis padat RS PB. Jurnal Photon, vol. 7 No 2. Universitas Riau,
Pekanbaru http://lib.unnes.ac.id/202151/1/6450408063.pdf (diakses tgl 8 maret
jam 13:15)
Sugiyono (2017). Statistik untuk Penelitian. Bandung: Alfabeta. Hal 61,62.
UU RI No. 44 tahun 2009 Tentang Rumah Sakit
Yulinto Beny, Elmia Kursani, Risk Indra Aristi, (2017). Manajemen pengolahan
limbah medis padat di rumah sakit umum daerah kota dumai. Jurnal bahan
kesehatan masyarakat. Vol 1 No 2.
www.journal.poltekkesjambi.ac.id/index.php/JBKM/article/download/3/1
(diakses tgl 22 maret jam 14.00)

LAMPIRAN

Lampiran 1. Dokumentasi Observasi Lapangan

Gambar Keteranngan

49
Petugas sedang mengumpulkan
dan menimbang limbah medis
padat jarum yang bersifat
infeksius. Sebelum dibakar
didalam incenerator.

Hasil pembaharan incenerator

selanjutnya di kubur di tanah.

Proses pembukaan kotak

hazard

50
Proses penyimpanan limbah
padat medis didalam TPS

Incenerator

Pengumpulan limbah padat

medis infeksius

51
52
Lampiran 2. Lembar Penjelasan Menjadi Informan Penelitian

Kepada Yth,
Bapak/Ibu/Saudara/i
di Rumah Sakit Selebesolu

Dengan hormat,
Mohon berkenan, perkenalkan nama Yoneta Wamea mahasiswi Program Pascasarjana
Ilmu Kesehatan Masyarakat minat Keselamatan dan Kesehatan Kerja (K3) Fakultas
Kedokteran, Kesehatan Masyarakat dan Keperawatan (FKKMK) Universitas Gadjah
Mada Yogyakarta melakukan penelitian yang berjudul “ANALISIS
KESELAMATAN DAN KESEHATAN KERJA DALAM PENGOLAHAN
LIMBAH MEDIS PADAT DI RUMAH SAKIT SELEBESOLU KOTA SORONG
PAPUA BARAT TAHUN 2022”. Penelitian ini bertujuan untuk mendapat informasi
secara mendalam mengenai pengelolaan limbah keselamatan dan kesehatan kerja di
Rumah Sakit Selebesolu Kota Sorong Papua Barat.
Peneliti memohon kepada Bapak/Ibu untuk bersedia menjadi informan pada penelitian
Saya ini melalui wawancara yang memerlukan waktu kurang lebih 30 – 60 menit.
Seluruh jawaban Bapak/Ibu semata-mata hanya untuk keperluan penelitian atau
kepentingan ilmiah serta saya bersedia menjamin kerahasiaannya.
Beberapa prinsip yang perlu saya jelaskan adalah sebagai berikut :

a. Kesukarelaan
Bahwa penelitian ini dilakukan atas dasar kerelaan, artinya dalam pelaksanaannya
informan tidak dipaksa serta tidak dikenakan sanksi maupun denda jika tidak
mengikutinya atau mengundurkan diri di tengah jalannya penelitian.
b. Kejujuran
Diharapkan informan menjawab secara jujur apa adanya terkait dengan pertanyaan
yang diajukan peneliti tanpa ada yang ragu atau ditutupi/ disembunyikan.

1. Cara Pelaksanaan Informan menjawab pertanyaan terkait pengelolaan limbah di

Rumah Sakit Selebesolu secara jujur dan berdasarkan pengalaman,data dan
kejadian nyata yang ada di lapangan,

53
 2. Peneliti mengajukan beberapa pertanyaan untuk dijawab informan, peneliti
mencatat, merekam, dan atau memotret pelaksanaan wawancara,
3. Peneliti melakukan observasi di Rumah Sakit serta mengambil foto untuk
dokumentasi penelitian.
c. Kewajiban Subjek atau Informan Penelitian
Informan penelitian wajib menjawab pertanyaan yang diberikan dan sangat
diharapkan memiliki komitmen mengikuti penelitian dari awal hingga akhir.
d. Manfaat atau Kegunaan Penelitian
Manfaat penelitian ini adalah untuk memberikan masukkan mengenai pengelolaan
limbah di Rumah Sakit Selebesolu Kota Sorong Papua Barat tahun 2022.
e. Risiko dan Efek Samping
Penelitian ini tidak memiliki efek samping karena tidak ada perlakuan/
tindakan/penanganan medis yang diberikan. Adapun jawaban-jawaban atas
pertanyaan yang diajukan juga tidak menimbulkan kerugian bagi informan.
Penelitian akan memiliki risiko ketidaknyamaan saat diwawancara terkait
pertanyaan dan akan memakan waktu Anda dalam menjawab pertanyaan penelitian.
f. Kompensasi
Peneliti akan membayar kompensasi atas hilangnya waktu kerja saat dilakukannya
wawancara dengan pemberian penghargaan berupa ucapan terima kasih dan
bingkisan berupa susu, roti dan buah-buahan.
g. Pembiayaan
Penelitian ini sifatnya mandiri dari peneliti yang tidak bekerja sama atau terikat
dengan pihak maupun proyek manapun.
h. Kerahasiaan
Semua data penelitian dijamin kerahasiaannya oleh peneliti dan dipublikasi dalam
kerangka penelitian ilmiah tanpa data identitas informan penelitian.
i. Informasi Tambahan dan Konfirmasi Ulang

Jika ada sesuatu yang perlu ditanyakan, ada informasi tambahan atau konfirmasi
ulang dapat menghubungi saya peneliti utama Yoneta Wamea dengan Nomor
telepon dan WA : 082398834731

Bapak/Ibu juga dapat menanyakan tentang penelitian kepada Komisi Etik Penelitian
Kedokteran dan Kesehatan Fakultas Kedokteran UGM (Telp.0274- 588688 ext
54
 17225 atau +62811-2666-869; email: mhrec_fmugm@ugm.ac.id .
j. Pengunduran Diri dan Alasan
Pengunduran diri dapat dilakukan oleh informan sebagai subjek penelitian dengan
menjelaskan alasan pengunduran dirinya kepada peneliti. Alasan bersifat logis dan
tidak karena tekanan atau bujukan dari pihak lain.
k. Saran dan Masukan
Saran dan kritik yang membangun untuk penelitian ini dapat disampaikan secara
langsung atau dapat menghubungi Yoneta nomor whatsapp : 082398834731

Hormat Saya Peneliti

Yoneta Wamea
NIM .20/466238/PKU/18865

55
 Lampiran 3. Informed Consent

FORMULIR INFORMED CONSENT (KESEDIAAN MENGIKUTI

PENELITIAN)

Yang bertanda tangan di bawah ini :

Nama : ……………………….
Alamat : ……………………….

Menyatakan bahwa saya bersedia menjadi responden penelitian tesis yang dilakukan oleh
mahasiswa Ilmu Kesehatan Masyarakat peminatan Keselamatan dan Kesehatan Kerja (K3)
Fakultas Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan, Universitas Gadjah
Mada :

Nama : Yoneta Wamea

NIM : 20/466238/PKU//18865
Dengan judul “ANALISIS KESELAMATAN DAN KESEHATAN KERJA DALAM
PENGOLAHAN LIMBAH MEDIS DI RUMAH SAKIT SELEBISOLO KOTA
SORONG PAPUA BARAT TAHUN 2022”.

Saya telah mempelajari dan menyetujui hal-hal yang sudah dijelaskan terkait dengan cara
pemberian data dan informasi saya untuk penelitian ini, sehingga Saya menyatakan bersedia
berpartisipasi menjadi informan dalam penelitian ini.

Saya menjadi responden penelitian tanpa paksaan dari pihak manapun karena saya
mengetahui bahwa keterangan yang saya berikan sangat bermanfaat bagi kelanjutan
penelitian.

Yogyakarta, Oktober 2021

Responden

56
 Lampiran 4. Pedoman Wawancara

PEDOMAN WAWANCARA PENGOLAHAN LIMBAH MEDIS DI RUMAH SAKIT

SELEBISOLO KOTA SORONG PAPUA BARAT SELAMA PANDEMI COVID-19

Pertanyaan Pilihan Jawaban

Limbah Padat Domestik Covid-19
1. Apakah menyediakan tiga wadah limbah A. Iya
domestik (organik, non organic dan limbah padat) B. Tidak
di lokasi yang mudah dijangkau orang ?
Jika tidak berikan
alasan, Alasan:
2. Apakah menyediakan tiga wadah limbah padat A. Iya
untuk masker sekali pakai, sarung tangan bekas, B. Tidak
tisu/kain yang mengandung cairan/droplet hidung
dan mulut ? di lokasi yang mudah dijangkau orang ? Jika tidak berikan
alasan, Alasan:
3. Apakah pengumpulan limbah dari wadah A. Iya
dilakukan bila sudah 3/ 4 penuh atau kurang sekali B. Tidak
dalam 24 jam ? dilokasi yang mudah dijangkau
orang ? Jika tidak berikan
alasan, Alasan:
4. Apakah pengumpulan limbah padat pada wadah A. Iya
khusus dilakukaan 3/4 atau krang sekali dalam 6 B. Tidak
jam? dilokasi yang mudah dijangkau orang ?
Jika tidak berikan
alasan, Alasan:

5. Apakah pada saat pengumpulan limbah petuga A. Iya

menggunakan masker,sarung tangan’ sepatu boot’ B. Tidak
dan apron? dilokasi yang mudah di jangkau orang?
Jika tidak berikan
alasan, Alasan:
6. Apakah pengumpulan sampah khusus A. Iya

57
harus dilengkapi dengan masker, sarung tangan, B. Tidak
sepatu boot, apron, kacamata pelindung (goggle),
dan penutup kepala di lokasih yang mudah Jika tidak berikan
dijangkau orang ? alasan, Alasan:
7. Apakah Pengumpulan dilakukan dengan A. Iya
langkah-langkah: B. Tidak
a. Buka tutup tempat sampah?
b. Ikat kantong pelapis dengan membuat satu Jika tidak berikan
simpul? alasan, Alasan:
c. Masukkan kantong tersebut ke wadah untuk
diangkut?
d. di lokasih yang mudah dijangkau orang?
8. Apakah Setelah melakukan pengumpulan, petugas A. Iya
dapat membersihkan seluruh badan atau mencuci B. Tidak
tangan dengan sabun dan air mengalir? di lokasi
yang mudah dijangkau orang ? Jika tidak berikan
alasan, Alasan:

9. Apakah semua peralatan pelindung diri yaitu A. Iya

google, boots, dan apron yang digunakan larutan B. Tidak
disinfektan, sedangkan masker dan sarung tangan
dibuang ke wadah limbah padat khusus? Dilokasih Jika tidak berikan
yang mudah dijangkau orang? alasan, Alasan:
10. Apakah Limbah padat organik dan anorganik A. Iya
disimpan di tempat penyimpanan Sementara? B. Tidak
Limbah Padat Domestik paling lama 1 x 24 jam
kemudian berkoordinasi dengan instansi yang Jika tidak berikan
membidangi pengelolaan limbah domestic alasan, Alasan:
dikabupaten/kota? Di
lokasi yang mudah dijangkau orang?
11. Apakah ada tempat penyimpanan Sementara A. Iya
limbah padat domestic ? dilokasih yang dijangkau B. Tidak
orang?
Jika tidak berikan
alasan, Alasan:

58
59
28
Lampiran 2. Lembar Penjelasan Menjadi Informan Penelitian

29
Kepada Yth,
Bapak/Ibu/Saudara/i
di Rumah Sakit Selebesolu

Dengan hormat,
Mohon berkenan, perkenalkan nama Yoneta Wamea mahasiswi Program
Pascasarjana Ilmu Kesehatan Masyarakat minat Keselamatan dan Kesehatan Kerja
(K3) Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan (FKKMK)
Universitas Gadjah Mada Yogyakarta melakukan penelitian yang berjudul
“ANALISIS KESELAMATAN DAN KESEHATAN KERJA DALAM PENGOLAHAN
LIMBAH MEDIS PADAT DI RUMAH SAKIT SELEBESOLU KOTA SORONG
PAPUA BARAT TAHUN 2022”. Penelitian ini bertujuan untuk mendapat informasi
secara mendalam mengenai pengelolaan limbah keselamatan dan kesehatan kerja
di Rumah Sakit Selebesolu Kota Sorong Papua Barat.
Peneliti memohon kepada Bapak/Ibu untuk bersedia menjadi informan pada
penelitian Saya ini melalui wawancara yang memerlukan waktu kurang lebih 30 – 60
menit. Seluruh jawaban Bapak/Ibu semata-mata hanya untuk keperluan penelitian
atau kepentingan ilmiah serta saya bersedia menjamin kerahasiaannya.
Beberapa prinsip yang perlu saya jelaskan adalah sebagai berikut :

a. Kesukarelaan
Bahwa penelitian ini dilakukan atas dasar kerelaan, artinya dalam
pelaksanaannya informan tidak dipaksa serta tidak dikenakan sanksi maupun
denda jika tidak mengikutinya atau mengundurkan diri di tengah jalannya
penelitian.
b. Kejujuran
Diharapkan informan menjawab secara jujur apa adanya terkait dengan

30