Management of medical radioactive wastes

Assessment of Medical Radioactive Waste Management in Hospitals: | Richard Okot

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ASSESSMENT OF MEDICAL RADIOACTIVE WASTE

MANAGEMENT IN HOSPITALS

Richard Okot

BSc- Environmental Science, Management and Technology

P/O BOX 1, Kyambogo University

Kampala Uganda

[email protected]

+256-784848542

+256-754267894

Supervisor

Mrs. Pamela Lawino Okori

Lecturer Kyambogo university

Chemistry Department Faculty of Science

MSc – environmental science & technology

PGDS – Environmental Impact Assessment; Limnology & Wetland Ecology

BSc – Botany & Zoology;

BST – Chemistry

[email protected]


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DEDICATION

This research report is dedicated to my parents Mr. and Ms. Obita, who supported me financially,

morally and spiritually. Your advice, solidarity and relentless efforts to this course made me reach

this academic level.

MAY GOD BLESS YOU.


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ACKNOWLEDGEMENT

I would like to first give and praise to the Almighty God, without Him this truly would not have

been. Thanks for Your love and abundant gift of life.

I thank Mrs. Pamela .L. Okori for her invaluable academic supervision and enthusiasm throughout

this report, as well as for the support and confidence she gave me from every meeting and point of

contact that occurred from start to finish.

My gratitude goes to my dad Mr. Valeriano Obita and my mum Mrs. Leorina Obita, and all my

family members (Margret, Scovia, Nancy and Jane: brothers David, Ivan and Kenneth) without

whose love, financial support and wisdom I could not have been where I am today.

Thanks must also go to the people who agreed to undertake the surveys, without which the study

would have seriously been compromised.

I am grateful to all my former lectures of Chemistry Department, Kyambogo University, for their

academic guidance and guidance that facilitated me through my study.

Finally, thanks must go to all my course mates (Angela Nsaali, Helen brain, Auma Charoline, Lagu

Richard, and Ogwang Norbert) and friends (Opio Kenneth, Wampande Mika, Namanya Ernest,

Kibikyabo Festo, Discharch Musa) for their continual support and enthusiasm towards this study.

May the almighty God bless you all.


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ABSTRACT

The high generation rate of medical radioactive waste in Uganda is a proof that medical waste

management in Uganda is problematic. Based on a case study undertaken at Hospitals within

Kampala, this research looked in to the various issues in the field of medical radioactive waste

management. It explores the staff‘s perception towards the medical radioactive waste management

and aims to examine the knowledge level, attitude and role of health care workers towards the

medical radioactive waste management. The study looks in to the various medical radioactive

waste treatment technologies available and chooses the best available technology for the on-site

treatment of the waste.

In Uganda, there has been an emerging concern regarding medical radioactive waste management

and the enforcement of international and national regulations requiring health care establishment

to ensure that such waste is handled without any adverse effects to the human health and the

environment (Ugandan Ministry of Environment and Forests, 1998). According to the Ministry of

Health (2009), the current medical radioactive waste management system in Uganda is inadequate

both at public and private level. The actual amount of medical radioactive wastes generated in

Ugandan hospitals is not known and even trying to estimate it would be problematic (Wekoy,

2005). In addition, there is insufficient capacity and research data on medical radioactive waste

generation, separation, storage, treatment and final disposal mechanisms in Uganda. Therefore,

this study tried to provide a glimpse of how radioactive wastes are being handled at various

hospitals.

The study used 10 respondents and simple random sampling was used for the study. Data sources

were both primary and secondary. The data collection methods included; interviews,

questionnaires, secondary data, observation and photography. The captured data was presented in

graphic form like pie-chats, bar graph and percentages were generated. The research study found

out that, much of the wastes collected consisted of solid radioactive wastes followed by liquid and

lastly gaseous wastes and they were of low level according to their categorization. The radioactive

wastes generated were mostly used gloves, syringes, items used by hospitalised patients after

radiation therapy, protective clothing, masks, filters, overshoes, towels, hand tools, contaminated

water and effluent, body fluids, discarded liquid radiopharmaceuticals, and liquid-patient


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excretion. These wastes are collected from the different departments of hospitals into one place,

separated to different categories, some treated and others transported to the KCCA treatment plant

after they have piled up. Much of the wastes after segregation are stored on the KCCA containers

awaiting transportation to the Municipal treatment plant and the remaining, mostly with highly

radioactive materials are incinerated or treated from within the hospitals.

In conclusion, it was established that much of the radioactive wastes produced by hospitals were

in forms which included; solids, liquids and gases. These wastes are segregated and then deposited

at either the KCCA container or incinerated or in temporary plastic dustbins within the hospitals

which were then further transferred to the Municipal waste treatment plant at Kiteezi in Wakiso

district. Much of the radioactive wastes produced are low level waste. Some high level wastes

produced were incinerated at the hospital premises to reduce their effect to the environment and

the staff involved in the garbage collection process.


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TABLE OF CONTENTS

DEDICATION ................................................................................................................................ ii

ACKNOWLEDGEMENT ............................................................................................................. iii

ABSTRACT ................................................................................................................................... iv

TABLE OF CONTENTS ............................................................................................................... vi

LIST OF FIGURES ....................................................................................................................... ix

ABBREVIATION AND ACCRONYMS ..................................................................................... xi

OPERATIONAL DEFINITION OF TERMS .............................................................................. xii

CHAPTER ONE: INTRODUCTION ......................................................................................... 1

1.1 Global perspective of radioactive waste generation and management ..................................... 1

1.1.1 Radioactive waste generation in developed countries........................................................ 1

1.1.2 Radioactive waste generation in developing countries ...................................................... 1

1.1.3 Strategies for radioactive waste management .................................................................... 2

1.2 The application of nuclear medicine in hospitals ..................................................................... 3

1.3 Effects of mismanaging medical radioactive wastes in the environment ................................. 5

1.4 Statement of the Problem .......................................................................................................... 5

1.5 Significance of the study ........................................................................................................... 6

1.6 Objectives of the study.............................................................................................................. 7

1.6.1 General objective................................................................................................................ 7

1.6.2 Specific objectives.............................................................................................................. 7

1.7 Research questions .................................................................................................................... 7

1.8 Expected outcome ..................................................................................................................... 8

1.9 Scope of the study ..................................................................................................................... 8

1.9.1 Time scope ......................................................................................................................... 8

1.9.2 Geographical scope ............................................................................................................ 8

CHAPTER TWO: LITERATURE REVIEW .......................................................................... 10

2.1 Introduction ............................................................................................................................. 10

2.2 Definitions of terms and concepts ........................................................................................... 10

2.3 The main health care wastes generated in health care establishments .................................... 11

2.4 Classification of radioactive wastes ........................................................................................ 12

2.5 Management options for medical radioactive wastes ............................................................. 13

2.5.1 Segregation, temporal storage and transportation ............................................................ 13


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2.5.2 Dilute and Disperse .......................................................................................................... 14

2.5.3 Delay and Decay .............................................................................................................. 14

2.5.4 Concentrate and Contain .................................................................................................. 14

2.5.5 Incineration....................................................................................................................... 15

2.6 Policy and legal frameworks for radioactive waste management ........................................... 16

2.6.1 The Basel Convention ...................................................................................................... 16

2.6.2 Convention on Nuclear Safety ......................................................................................... 17

2.6.3 International Commission on Radiological Protection (ICRP) ........................................ 17

2.6.4 OECD Nuclear Energy Agency (OECD NEA)................................................................ 17

2.6.5 The Constitution of the Republic of Uganda (1995) ........................................................ 17

2.6.6 The National Environment Act CAP 153 ........................................................................ 17

2.7 Institutional frameworks for radioactive wastes management................................................ 18

2.7.1 Ministry of Water Lands and Environment...................................................................... 18

CHAPTER THREE: METHODOLOGY ................................................................................ 19

3.1 Introduction ............................................................................................................................. 19

3.2 Description of study area ........................................................................................................ 19

3.2.1 Climate of the study area .................................................................................................. 19

3.2.2 Population of the study area ............................................................................................. 20

3.2.3 Geology of the study Area ............................................................................................... 20

3.2.4 Soils of the study Area ..................................................................................................... 20

3.3 Research design ...................................................................................................................... 20

3.3.1 Methods of Data collection .............................................................................................. 20

3.3.1.1 Key informant interviews ....................................................................................... 20

3.3.1.2 Questionnaires......................................................................................................... 21

3.3.1.3 Secondary data ........................................................................................................... 21

3.3.1.4 Observation ............................................................................................................. 21

3.3.1.5 Photography. .............................................................................................................. 21

3.4 Sample size and Selection criteria .......................................................................................... 21

3.5 Data Analysis and interpretation ............................................................................................. 22

3.6 Dissemination of the results .................................................................................................... 22

3.7 Ethical consideration ............................................................................................................... 22

3.8 Limitations of the study .......................................................................................................... 22


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CHAPTER FOUR: DATA ANALYSIS AND RESULTS ....................................................... 24

4.1 INTRODUCTION .................................................................................................................. 24

4.2 Demographic characteristics of the respondents..................................................................... 24

4.2.1 Age distribution of the respondents ................................................................................. 24

4.2.2 Education level of respondents ........................................................................................ 25

4.2.3 Working experience of the respondents ........................................................................... 25

4.3 Information on radioactive waste in Hospitals ....................................................................... 26

4.3.1 Amount of radioactive wastes generated from different departments of hospitals .......... 26

4.3.2 The types of medical radioactive wastes generated by hospitals ..................................... 27

4.3.3 The categories of radioactive wastes generated from hospitals ....................................... 27

4.4 Radioactive waste management in Hospitals .......................................................................... 28

4.4.1 Segregation of the radioactive wastes .............................................................................. 28

4.4.2 Storage of the radioactive wastes ..................................................................................... 28

4.4.3 Radioactive waste disposal............................................................................................... 29

4.4.4 Whether there are various method available for radioactive waste management ............ 29

4.4.5 Whether there is a special department handling waste management activity .................. 29

4.4.6 Whether there is any alternative method/ idea of disposing waste other than the one

practiced. ................................................................................................................................... 30

4.5 Personnel involved in the management of hospital wastes ..................................................... 30

4.5.1 Number of personnel involved in the management of radioactive wastes in hospitals ... 30

4.5.2 Level of knowledge of the dangers of radioactive wastes on the environment ............... 30

4.5.3 Training given to the waste management staff ................................................................. 31

CHAPTER 5: DISCUSSION ..................................................................................................... 32

5.1 Introduction ............................................................................................................................. 32

5.2 Kinds of medical radioactive wastes generated from hospitals .............................................. 32

5.3 Current radioactive waste management practice within hospitals .......................................... 32

5.4 Knowledge and awareness of the dangers of radioactive wastes on the environment by the

workers .......................................................................................................................................... 34

5.5 Alternatives for radioactive waste disposal and selection of best available Technology ....... 35

CHAPTER SIX: CONCLUSIONS AND RECOMMENDATIONS ...................................... 38

6.1 Introduction ............................................................................................................................. 38

6.2 Conclusion .............................................................................................................................. 38

6.3 Recommendations ................................................................................................................... 39


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REFERENCES ............................................................................................................................. 41

APPENDIX I: QUESTIONAIRE ................................................................................................. 43

LIST OF FIGURES

Figure 4.1: Age of the respondents………………………………………………………………22

Figure 4.2: Educational Level……………………………………………………………………23

Figure 4.3: Working experience of the respondents…….……………………………………….23

Figure 4.4: Amount of radioactive wastes generated from different Department……………….24

Figure 4.5: Types of radioactive wastes generated………………………………………………25

Figure 4.6: The categories of the radioactive wastes generated………………………………….26

Figure 4.7: Whether there are other better materials to dispose waste other than those made out of

plastic…………………………………………………………………………………………….27

Figure 4.8: Number pf personnel involved in waste management…….………………………….28

LIST OF TABLE

Table 1.1: shows the list of commonly used radionuclide in nuclear medicine…..........................3

LIST OF PLATES

Plate 1.1 showing radioactive waste disposal facility at El Cabril……………………….……….3

Plate 2.1 showing vial wastes generated by hospitals……………………….……….…………..11

Plate 2.2 showing empty plastics generated by hospitals………………………………………..11

Plate 2.3 showing containers used for temporal storage of the wastes………..…………………14

Plate 2.4 showing storage facility for low level radioactive wastes.......................................…...15

Plate 2.5 showing an incinerator being operated within hospitals establishment…….………….16

Plate 5.1 showing personal wearing PPEs……………………………………………………….36


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ABBREVIATION AND ACCRONYMS

DNA : Deoxyribonucleic Acid

EPA : Environment Protection Agency

EPA : Environmental Protection Agency

HCW : Health Care Waste

HCW : Health Care Wastes

HCWM : Health Care Wastes Management

IAEA : International Atomic Energy Agency

ICRP : International Commission on Radiological Protection

KBq : Kilo Becquerel

KCCA : Kampala City Council Authority

LDC : Low Developed Countries

LDCs : Least developed countries

LLW : Low Level Wastes

MOH : Ministry Of Health

NASA : National Aeronautics and Space Administration

NEMA : National Environment Management Authority

NHMRC : National Health and Medical Research Council

OECD : Organisation for Economic Co-Operation and Development

PVC : Polyvinyl Chloride

Sv : Sievert

UK : United Kingdom

WHO : World Health Organisation

WMR : Waste Management Report


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OPERATIONAL DEFINITION OF TERMS

Alpha particle. This is a particle consisting of two protons plus two neutrons and is emitted by a

radionuclide. Alpha particles can be stopped by a piece of paper and are only a concern when

alpha-emitting isotopes are taken into the body.

Becquerel. Unit of radioactivity (Standard International unit). One Becquerel equals one

radioactive disintegration per second.

Beta particle. An electron emitted by the nucleus of a radionuclide. The electric charge may be

positive, in which case the beta particle is called a positron. Beta particles have a short range in air

and even shorter range in more dense material.

Gamma ray. A very high frequency form of electromagnetic radiation that consists of photons

emitted by radioactive elements. Gamma rays can injure and destroy body cells and tissue,

especially cell nuclei.

Gray. One gray is the absorption of one joule of radiation energy by one kilogram of matter, and

is a physical measure of radiation energy absorbed only.

Half-life (T½). This is the time it takes for the amount of a material to be reduced by half. In the

case of radioactive materials, the physical half-life is the time for the isotope to decay to half its

activity.

Hypothyroidism. An underactive thyroid gland; a glandular disorder resulting from insufficient

production of thyroid hormones

Iodine. The radioisotope 131I is often used in nuclear medicine for both imaging and treatment.

Photomultiplier tubes. These are devices used extensively in nuclear medicine to detect gamma

rays (although other devices may also be used).

Radioactivity. This is the spontaneous emission of radiation from unstable atoms. Radionuclides

lose particles for example alpha or beta and energy through radioactive decay.

http://www.rah.sa.gov.au/nucmed/nucmed/ncmd_docguide.htm#endocrinology

http://www.rah.sa.gov.au/nucmed/nucmed/ncmd_docguide.htm#therapy


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Radioisotope/Radionuclide. These are atoms with an unstable number of neutrons that

disintegrate, releasing rays of subatomic particles.

Radiopharmaceutical. These are pharmaceuticals consisting of radioactive compounds used in

radiation therapy. They are also used to examine the function of specific body organs.

Sievert (Sv). This is the unit of measure for the radiation dose equivalent for biological tissues,

and allows for the biological effect on different tissues – as sensitivity will vary with the type of

particle and the tissue.

Technetium. A chemical element with atomic number 43. Technetium was discovered in 1937 at

the University of California at Berkeley by Enrico Fermi and Carlo Perrier. Its chemistry allows

easy labelling of many pharmaceuticals.

X-ray. Photons or electromagnetic radiation produced by the de-excitation of bound atomic

electrons. The energy of an x-ray is equivalent to the difference in energy of the initial and final

atomic state minus the binding energy of the electron.

http://www.rah.sa.gov.au/nucmed/radpharm/rph_info.htm


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CHAPTER ONE: INTRODUCTION

1.1 Global perspective of radioactive waste generation and management

1.1.1 Radioactive waste generation in developed countries

Annually, nuclear power generation facilities worldwide produce about 200,000 m3 of low- and

intermediate-level radioactive waste, and about 10,000 m3 of high-level waste including used fuel

designated as waste (INSC, 2002). In the OECD countries, some 300 million tonnes of toxic wastes

are produced each year, but conditioned radioactive wastes amount to only 81,000 m3 per year this

imply that only 1% is treated. In the UK for instance, the total amount of radioactive waste

generated is about 4.7 million m3 with 1 million m3 already disposed of these radioactive wastes,

94% falls into the low-level radioactive waste category and 6% (290,000 m3) is in the intermediate-

level radioactive waste category, and less than 0.1% is classed as high-level waste. Although the

volume of High Level Waste is relatively small, it contains about 95% of the total inventory of

radioactivity.

Since the 1960s, more than 200,000 tons of spent fuel have been produced by 400 reactors in 30

countries, and every year 10,000 tons are added with the debate over the management of

radioactive wastes continues with no satisfactory solutions. In 1998, evidence emerged that

radioactive waste from 80 scrapped nuclear submarines in the area of the northern Russian naval

port of Murmansk had begun leaking into the sea (Edwards, 1998). Further quantities of wastes

were generated by the dismantling old weapons, including 50 tonnes of plutonium in United States,

(Curtis, 1994). The global plutonium stockpile is estimated at 1,100 tonnes and growing rapidly

(Panofsky et al., 1994). According to the European Union, at the end of 2004, there was 647,000

m3 of radioactive waste of which 26% was classified as very low-level waste and about 1% as

highly active waste. However estimates of additional radioactive waste and spent fuel likely to be

generated by Member States between 2004 and 2020 were made in 2008. The figure for

radioactive waste being 1,772,300 m3, of which approximately 25% was to be very low-level

waste and 0.1% was to be high level waste.

1.1.2 Radioactive waste management in developing countries

Medical radioactive waste management is one of the leading problems facing African countries

and other developing countries of the world (Glenn and Garwal, 1999). Waste generated in the

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course of the health care activities carries higher potential for infection and injury than any other

type of waste (Virenter, 2007). The medical waste problem is increasing mainly because of the

rapid demographic development, urban expansion coupled with inadequate resources and

insufficient management capacity.

In most developing countries, nuclear power plants are not the focal point of radioactive waste

generation because only about 7% of the world's installed nuclear power capacity exist in

developing countries which include in Asia, Latin America, and the Mediterranean region. At the

present time, developing countries are mostly concerned with the management of nuclear wastes

generated from medical centres, research institutes, industrial facilities, and mining operations. In

certain instances, management of such wastes has lapsed causing serious accidents due to radiation

source mismanagement resulting in fatalities to the public in Mexico (1962), Algeria (1978), and

Morocco (1984) (K.T. Thomas, 2002).

1.1.3 Strategies for radioactive waste management

Radioactive wastes are a potential risk to health and the environment due to their radiological and

chemical properties. Although there are different categories and types of radioactive waste and

accordingly different kinds of risks, there is a common basic principle for their management:

radioactive waste shall be managed in a manner that protects human health and the environment,

now and in the future without imposing undue burdens on future generations, (IAEA, 2006). Due

to the long timescales involved, the implementation of this principle is especially relevant when

considering HLW.

Disposal in near-surface facilities

Radioactive wastes that decay to harmless levels within time spans ranging from some decades to

a few centuries8 are typically disposed of in engineered near-surface structures that can be

designed to remain stable and intact as long as the wastes remain a hazard. (IAEA, 1999; IAEA,

2002c). Near surface disposal of wastes in trenches is generally applied to wastes that contain

mainly short-lived radioisotopes and, potentially, low concentrations of long-lived radioisotopes.

The use of trenches may be especially cost effective when disposing of large volumes of low

activity wastes and/or large items of decommissioning waste. Long-term safety may be provided


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largely by a combination of natural site conditions, the engineered disposal system and the waste

form. Designs to minimize plant and animal intrusion may also be employed.

Deep disposal in geological formations

Deep geological disposal of radioactive waste is generally considered the most appropriate

approach for high-level waste and spent nuclear fuel where it is necessary to isolate them from the

biosphere for many thousands years. The overall objective of deep disposal is thus to isolate the

wastes from the biosphere until such time as natural processes of decay and dilution prevent any

radionuclide from returning in concentrations sufficient to pose an unacceptable hazard. Clearly,

many processes of mobilization, transport, retardation, retention, dilution, re-concentration,

etcetera, need to be accounted for in evaluating whether this aim can be met, for a range of possible

scenarios of future evolution of the disposal system. Geological disposal is based on the multi-

barrier approach, whereby the engineered barriers and geological environment around the solid

waste act together to provide a variety of “safety functions” that control any eventual releases of

radioactivity from the repository and their movement through the rock.

Plate 1.1 Showing radioactive waste disposal facility at El Cabril

1.2 The application of nuclear medicine in hospitals

The incorporation of radionuclides in a chemical compound provides it with unique properties

such as specific biological affinity. When used in medicine these compounds are referred to as


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radiopharmaceuticals and its use in life science is extensive (Gregory choppin et al, 2001).

Radionuclides used in medicine include the radioisotopes of iodine, gallium, thallium and

technetium, amongst others. The physical characteristics of each are different and the selection of

a particular radionuclide relates directly with its intended clinical use, that is, whether a diagnostic

or therapeutic result is desired and it’s used to gain information that aids in a patient's diagnosis,

therapy and prognosis (AIM, 2007).

Clinical diagnostic imaging is a general term applied to non-destructive photographic techniques

of investigating the gross internal structure of any object (McGraw-Hill Encyclopaedia, 2005).

The procedures are diverse and span a wide spectrum ranging from X-ray based examinations to

sound, radionuclide and magnet based investigations (AIM, 2007). It is used to exclude disease,

to prove the existence of a pathological process, to assist in the planning of treatment or to follow

the course of a disease already diagnosed and/or treated. WHO estimates that simple X-ray and

ultrasound examination either singly or in combination, are all that is necessary to confirm a

diagnosis in approximately two thirds of patients who need diagnostic imaging (WHO, 2007).

Element Radionuclide Chemical

form

Half-life Energy

gamma

(KeV)

Energy

beta

(KeV)

Phosphorous 32-P Sodium

phosphate

14.3 d 1700

Chromium 51-Cr Sodium

chromate

27.7 d 320

Gallium 67-Ga Gallium

citrate

78.3 h 91,185,200

Strontium 89-Sr Strontium

chloride

50.5 d 140

Yttrium 90-Y Yttrium

silicate

64.1 h 2280

Indium 111-In Indium

chloride

2.8 d 171,245


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Iodine 131-I Sodium

iodide

8.0 d 364 606

Table 1: shows the list of commonly used radionuclide in nuclear medicine Source:

© 2007 Austin Hospital, Austin Health, Melbourne Australia

1.3 Effects of mismanaging medical radioactive wastes in the environment

Ionized radiation that occurs from nuclear material may result in weakening of seeds and frequent

mutations (Environmental Literacy Council, 2010). For instance, a nuclear plant, called Chernobyl

in Russia leaked in 1986 that caused excessive amounts of radiation pollution in that region. A

huge cloud of radiation was formed which resulted in a massive amount of destroyed plant life;

particularly pine trees in that area therefore high doses of radiation can be devastating to the

environment.

US Department of Energy, (2010), stated that the effect of radiation in the environment can be

dangerous and fatal to humans and animals. The damage it causes depends on the level of radiation

and the resiliency of the organism. Radiation causes molecules to lose electrons thus destroying it.

However, once radiation damages DNA the body may not be able to repair itself. For example

after two nuclear explosions in Hiroshima and Nagasaki, survivors experienced higher cases of

cancer and child deformities. The nuclear explosions are examples of high levels of radiation.

However, low doses of radiation can kill germs and decrease the number of food poisoning cases.

NASA, (2010) stated that radiation can reduce the amount of food and oxygen that plankton

produces. Plankton can respond to excessive amount of Ultraviolet-B light by sinking deeper into

the water. This decreases the amount of visible light required for photosynthesis, which reduces

growth and reproduction. An increased amount of UV-B can also increase the amount of ozone

produced at the lower atmosphere. While some plants can use this extra layer as a protective shield,

other plants are highly sensitive to photochemical smog.

1.4 Statement of the Problem

To date no low-cost, environmentally friendly and safe disposal option for medical radioactive

wastes are available. Low-cost options are often polluting and are therefore indirectly potentially

harmful to human health. The absence of management however also puts human health at risk.


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Significant improvements can however be achieved by management options such as purchase

policies, and isolation and proper treatment of key segments of the waste. According to the

Ministry of Health (2009), the current medical radioactive waste management system in Uganda

is inadequate both at public and private level. The actual amount of medical radioactive wastes

generated in Ugandan hospitals is not known and even trying to estimate it would be problematic

(Wekoy, 2005) and this is mainly attributed to insufficient capacity and research data on medical

radioactive waste generation, separation, storage, treatment and final disposal mechanisms.

In Uganda, the percentage of public health facilities equipped with diagnostic imaging machines

was 73.6% in 2004 (MOH Uganda, 2004) and the national coverage with x-ray and ultrasound

machines among private health providers was 8% and 11% respectively (Mandelli et al., 2005).

Despite this relatively high national coverage with imaging services, patients continue to flock for

imaging care in Kampala. However, the influx leads to congestion of the diagnostic imaging

departments in the national referral hospital at Mulago. Congestion affects the quality of care, the

timeliness of releasing results, and the rate of radioactive generation in hospitals and as a result

there is a likelihood that all the radioactive wastes generated will end up in the environment.

Therefore, this study will try to provide a glimpse of how much radioactive wastes is being

generated, the dangers it causes in the environment. The data to be gathered in this study will

provide technocrats with information relating to how medical radioactive wastes should be

managed.

1.5 Significance of the study

Health care institutions are responsible for delivery of patient care services and in the process of

delivering this, wastes comprising radioactive nuclides are generated. Poor handling of the medical

radioactive materials potentially exposes health care workers, waste handlers and the community

at large to radiation effects. Once these wastes are not properly managed, they end up into the

environment. Once in the environment, they can remain active for hours or several months and if

the radionuclides get into air, water supplies, and soil, they enter into food chains thus causing

various illnesses which include among others hypothyroidism in newly borne babies which is a

consequence of exposure to iodine, alteration of an organisms’ DNA thus leading to mutations,

cancer which is considered a primary health effect from radiation exposure, changes in blood


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chemistry and also cause some adverse effects to other living organisms (plants and animals) thus

reducing biodiversity.

The conclusions generated from the study will help generate more information to the already

existing body of knowledge in the area of medical radioactive waste management and to Hospitals

in particular. Also the research findings will enlighten the decision makers like NEMA,

Environment Officers, and KCCA of the gaps existing in the radioactive waste management. These

findings will help in drafting appropriate guidelines on the management of the wastes and create

awareness to the people concerned of the dangers of poor radioactive waste management so that

there would be a joint effort to solve the problem at hand.

1.6 Objectives of the study

1.6.1 General objective

To investigate the current use of medical radionuclides and generation, collection, storage,

transportation and disposal of the medical radioactive wastes generated from the different

departments of hospitals.

1.6.2 Specific objectives

1. To determine the kinds of medical radioactive wastes generated from different departments

of hospitals.

2. To determine information on the current collection, storage, transportation, treatment and

disposal of the medical radioactive wastes from hospitals.

3. To assess knowledge and awareness of the dangers of radioactive wastes on the

environment.

4. To identify the possible recommendations to archive proper medical radioactive waste

management.

1.7 Research questions

1. What are the kinds of medical radioactive wastes generated from the various departments

of hospitals?

2. How are the medical radioactive wastes collected, stored, transported, treated, and disposed

of?


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3. Are the people involved in the radioactive wastes management have knowledge and

awareness about the dangers of radioactive wastes to the environment?

4. What are the possible recommendations for medical radioactive waste management in

hospitals?

1.8 Expected outcome

1. The types and categories of the medical radioactive wastes generated from the various

departments of hospitals would have been determined.

2. The current method used in collection, storage, transportation, treatment and disposal of

the medical radioactive wastes would have been assessed.

3. The level of knowledge and awareness of the dangers of medical radioactive wastes on the

environment would have been evaluated.

4. Possible recommendations for proper medical radioactive waste management would have

been identified.

1.9 Scope of the study

The focus of this research was to assess the management of medical radioactive wastes emanating

from various hospitals within Kampala Uganda. The study will focused on 10 hospitals in a bid to

assess the management of medical radioactive wastes and the study was both quantitative and

qualitative in nature.

The study reviewed documents, reports and collected data from hospitals. The data collected were

used to estimate the extent of the medical radioactive waste management.

1.9.1 Time scope

The study took four months starting from April to July 2014. This period was sufficiently enough

to carry out baseline survey, collect relevant literature and carry out data collection for six weeks.

Sampling and analysis of assessment of the medical radioactive waste management in the hospital,

submission and approval of the study report.

Geographical scope

The study was conducted in 10 Hospitals located in Kampala District, the capital of Uganda and

the largest city in the country. The district is bordered by Wakiso District to the south, the west


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and the north and by Kira Municipality to the east. The coordinates of the district are: 00 19N, 32

35E.


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CHAPTER TWO: LITERATURE REVIEW

2.1 Introduction

This chapter presents a review of available literature to assess the objectives of the study. It consists

definitions of terms, classification of radioactive wastes, management options for radioactive

wastes, policy and legal frameworks on radioactive waste management and institution

arrangements concerning the radioactive waste management

2.2 Definitions of terms and concepts

Waste is a man-made substance in a given time and places which in its actual structure and state

is not useful to the owner or is an output without an owner and purpose. In other words, waste is

anything that we no longer need. It is also commonly referred to as rubbish, trash, garbage, refuse,

effluents and “unwanted, or unusable materials”. (Zake J: 2007). Medical waste is the waste

generated by hospitals, healthcare establishments, medical laboratories and research facilities

during the process of diagnosis, treatment, and associated medical research. Medical radioactive

wastes may be in the form of liquid, solid and gaseous which may be comprising of sharps, tissues,

cytotoxic drugs, genotoxic chemicals, pharmaceutical, heavy stained bandages, and other

discarded materials during the provision of healthcare, (Visvanathan, 2006). According to NHMRC

(1999), radioactive wastes are materials contaminated with radio-isotopes, which arises from the medical

or research use of radionuclides. It is produced, for example during nuclear medicine, radio-immune assay

and bacteriological procedures, and may be in a solid, liquid or gaseous form.

In the past few years, the world concern over the disposal and management of medical radioactive

waste has markedly increased. Medical waste newsletter (2005) cited improper handling, transport

and disposal of medical waste removed during surgery, autopsy and other medical procedures

along California beaches which violate the state laws regarding potentially infectious medical

wastes. A report by the ministry of territory development, water and environment, (www.

arabicnews.com) showed that morocco generates over 38000 tons of medical waste per year;

12000 of which is hazardous. The report indicates that hardly this kind of waste is getting more

complex because it contains biologically non degradable substances.


11

2.3 The main health care wastes generated in health care establishments

Health Care Wastes refer to wastes produced in health facilities or research institution during

diagnosis, treatment or immunization of human beings and animals (WMR, 2006). It includes all

the waste generated within health-care facilities, research centres and laboratories related to

medical procedures. World Health Organisation considers HCW as by product of healthcare that

includes sharps, non- sharps, blood, body parts chemicals, pharmaceuticals, medical devices and

radioactive materials (WHO, 2005).

Main HCW generated in the hospitals can be categorized based on the risk of causing injury and/or

infection during handling and disposal. Wastes targeted for precautions during handling and

disposal include sharps (needles or scalpel blades), pathological wastes (anatomical body parts,

microbiology cultures and blood samples) and infectious wastes (items contaminated with body

fluids and discharges such as dressing, catheters and Intravenous lines). Other wastes generated in

healthcare settings include radioactive wastes, mercury containing instruments and polyvinyl

chloride plastics. These are among the most environmentally sensitive by-products of healthcare

(Remy, 2001). Others that also form part include pharmaceuticals, pressurized containers,

chemical wastes. Glenn and Garwal (1999) reported that according to world health organization,

about 85% of hospital wastes are actually non- hazardous, around 10% are infectious and around

5% are non-infectious but hazardous wastes.

Plate 2.1 showing vials wastes generated Plate 2.2 showing empty plastics generated by

the hospital


12

2.4 Classification of radioactive wastes

Several classifications are possible when describing radioactive waste. These include physical

state (since radioactive waste can be solid, liquid or gaseous) as well as isotopic content and

concentration. The types of radiation (alpha, beta and gamma) emitted by the prevailing

radioisotopes in the waste is another basis for classification that defines the necessary degree of

shielding. Another form of classification relates to the half-life of the predominant radionuclides

of a given waste.

The system adopted by IAEA, which is the most internationally accepted, combines the type of

radiation emitted, the activity of the waste and its half-life to present an easy method of

classification based on the main following categories: (IAEA, 1994).

i. Exempt waste (EW): excluded from regulatory controls because radiological hazards are

negligible.

ii. Low- and intermediate-level waste (LILW): radioactivity levels are above those for exempt

waste and thermal power below about 2 kW/m3; IAEA recognizes two sub-categories of

LILW:

Short-lived waste (LILW-SL): primarily contains short-lived radionuclides, with long lived

radionuclide (including long-lived alpha emitter) concentrations restricted to an overall

average of 400 Bq/g per waste package;

Long-lived waste (LILW-LL): contains long-lived radionuclide concentrations that exceed

limits for short-lived waste.

iii. High-level waste (HLW): contains sufficient concentration of radionuclides to produce

heat generation greater than 2 kW/m3; the typical activity levels are in the range of 5x104

to 5x 105 TBq/m3.

There are three exceptions to some radioactive waste classification schemes that correspond to the

following materials:

Mining and milling wastes: residues left from mining and extraction of uranium and other

raw materials that contain naturally occurring radionuclides;


13

Environmental contamination: radioactively contaminated environmental media, such as

soil and groundwater;

Spent nuclear fuel (fuel that is removed from a reactor when its irradiation and energy

output has reached its designed level) is considered as either a resource (as it still contains

unused uranium and usable plutonium) or a waste depending on which management

strategy a country is using.

2.5 Management options for medical radioactive wastes

Literature reviews on waste disposal/ waste treatment technologies are rather contradictory. Some

of the most common technologies for the management of radioactive wastes include segregation,

temporal storage, dilute and disperse, delay and decay, incineration, and transportation to a secured

landfill. According to previous studies (Park and Jeong, 2001; Lee et al., 2004), about 49–60% of

medical waste is treated by various incinerations, 20–37% by autoclave sterilization, and 4–5% by

other methods.

2.5.1 Segregation, temporal storage and transportation

Handling, segregation, storage, transportation and final disposal are vital steps for safe and

scientific management of medical radioactive wastes in any establishment (Acharya and Singh

Meeta, 2000). Peter Ikome Kuwoh Muchungong, (2011), reported in his PhD research on

environmental exposure and public health impacts of clinical waste treatment and disposal in

Cameroon that thorough segregation and temporal storage of clinical waste in to its infectious and

non- infectious components is an important process in any efficient HCWM. According to peter,

the process guarantees reduction in the amount of radioactive waste requiring special treatment

and curbs potential occupational and operational risks to health care employees and by extension,

the general public. Peter further stressed that, despite these merits, the process of segregation is

overwhelmed with challenges that are pretty obvious in health care settings in the developing

world.

Temporal storage refers to the interim period between generation and transportation either to an

on-site treatment facility or to an off-site location (Luttrell et al, 2003). There is not yet a

universally accepted standard period of time that the waste can be stored prior to treatment and

disposal, but the U.S.EPA, 1986 recommends this time be kept as short as possible. Transportation


14

of clinical waste involves an on-site treatment or disposal facility or removal from a source of

generation to an on-site temporal storage facility before eventual transportation to an off-site

treatment and disposal facility.

Plate2.3 showing containers sed for temporal starge of the wastes

2.5.2 Dilute and Disperse

Low activity solid particle may be disposed of as ordinary hospital waste provided the activity of

the article does not exceed 1.35 microcuries or the overall package concentration does not exceed

135 microcuries / m3. Coker et al, (2009) stated that liquid radioactive waste with activity less

than microcuries level can be disposed of into the sanitary sewerage system with adequate flushing

with water following the disposal (Patil and Shekdar,2001). However, the maximum limit of total

discharge of liquid radioactive material into sanitary sewerage system should not exceed the

prescribed limits.

2.5.3 Delay and Decay

Radioactive wastes from the medical sector does not present a significant long term waste

management problem when compared to wastes generated from nuclear fuel cycle operations

(Remy, 2001). The storage room should be properly ventilated with an exhaust system conducted

through a duct line to a roof top exit. Biomedical radioactive wastes typically contain low energy

and emitters and is generally of low total and specific activity.

2.5.4 Concentrate and Contain

Diaz et al (2005) reported that this technique of radioactive waste management is sometimes used

for radioactive materials with very high activity levels and for those with long half-lives (longer


15

than a month). Their disposal by delay and decay method is impractical because of longer storage

period, particularly if space availability is limited. Radioactive waste is collected in suitably

designed and labelled containers and then buried in exclusive burial sites approved by the

competent authority (Glenn and Garwal, 1999). In day-to-day work of a hospital, we do not come

across radioactive waste of this nature and as such, this method of radioactive waste disposal is

rarely used.

Plate 2.4 Storage of low level waste (LLW) at ANSTO

2.5.5 Incineration

Incineration which is a method that utilizes thermal energy to decline waste materials to non-

combustible residue or ash and exhaust gases (Dursun et al, 2011). The Fly and bottom residues

produced after medical waste incineration contain high level of heavy metal like Pb, Cd, Ni, Cr,

Cu and Zn. Medical waste with high values of metal leachability prohibit the land filling of these

ashes as imposed by EU directives (Gotsis 2008). Medical waste is the 3rd largest sources of dioxin

air emission. However, despite of public concerns about incinerators, it is the most frequently used

option, due to its advantages regarding the sterilization of pathological and anatomic waste,

volume and mass reduction, and energy recovery (Zhao et al 2008).


16

Plate 2.5 showing an incinerator being operated within the hospital establishment

The criteria used in evaluating technological options considers environmental, health and

economic factors (Batterman 2004). The best technology for the medical waste treatment can be

different for different hospitals. It may depend on the local conditions and the requirement of the

hospital. However WHO gives a list of factors to guide the selection of best technology for treating

medical waste (Pruss 1999). They are; disinfection efficiency, volume and mass reduction,

quantity of wastes for treatment, infrastructure requirements, options available for final disposal,

operation and maintenance consideration, location and surroundings of the treatment site and

disposal facility, and public acceptability hence, it can be interpreted from the literature that,

medical waste management is an area of high concern due to the high generation of medical waste,

improper segregation and also due contradictory views about the various technologies. Medical

waste management is an area which needs more research and study to gear it towards sustainability.

2.6 Policy and legal frameworks for radioactive waste management

2.6.1 The Basel Convention

Basel Convention is an international treaty that was designed to reduce the movements of

hazardous waste between nations, and specifically to prevent transfer of hazardous waste from

developed to less developed countries. The Convention is also intended to minimize the amount

and toxicity of wastes generated, to ensure their environmentally sound management as closely as

http://en.wikipedia.org/wiki/Treaty

http://en.wikipedia.org/wiki/Hazardous_waste

http://en.wikipedia.org/wiki/Developed_countries

http://en.wikipedia.org/wiki/Less_Developed_Countries

http://en.wikipedia.org/wiki/Toxicity


17

possible to the source of generation, and to assist LDCs in environmentally sound management of

the hazardous and other wastes they generate.

2.6.2 Convention on Nuclear Safety

The Convention on Nuclear Safety was designed to create awareness on the importance to the

international community of ensuring that the use of nuclear energy is safe, well regulated and

environmentally sound. It was adopted on 17 June 1994 by a Diplomatic Conference convened by

the IAEA at its Headquarters from 14 to 17 June 1994 and was opened for signature on 20

September 1994.

2.6.3 International Commission on Radiological Protection (ICRP)

This body was founded in 1928, under the then name of “International X-ray and Radium

Protection Committee.” ICRP is an international advisory body providing recommendations and

guidance on radiation protection. The secretariat of this body is located in Sweden.

2.6.4 OECD Nuclear Energy Agency (OECD NEA)

The NEA is an agency of the OECD. Membership currently consists of all European Union

member countries as well as Australia, Canada, Japan, Republic of Korea, Mexico and the US.

The primary objective of NEA is to promote co-operation among the governments of its

participating countries in furthering the development of nuclear power as a safe, environmentally

acceptable and economic energy source.

2.6.5 The Constitution of the Republic of Uganda (1995)

The Uganda Constitution of 1995, Articles 39 and 41 provide that everyone has a duty to maintain

and enjoy a sound environment. Every person in Uganda has a right to a clean and healthy

environment and as such can bring action for any pollution or disposal of wastes. It states that

government will promote development, utilization and public awareness of the need to manage

land, air and water resources in a balanced and sustainable manner for present and future

generations.

2.6.6 The National Environment Act CAP 153

Section 5 provides for a person who owns or controls a facility or premises, which generate waste,

to minimize the waste generated by adopting cleaner production methods. Subsection l (b) (i):


18

identifying and eliminating potential negative impacts of the product/waste, (c): incorporating

environmental concerns in the design and disposal of a product.

2.6.7 The Local Governments Act, 1997

This act provides for a district-based system of local governments. This system provides for elected

councils that have both legislative and executive powers. Thus the district councils play an

important role in land administration, land surveying, physical planning, and management of

forests, wetlands, environment and sanitation services that are not the responsibility of the central

government.

2.7 Institutional frameworks for radioactive wastes management

2.7.1 Ministry of Water Lands and Environment

The ministry is the institution responsible for the formulation of policies that govern environmental

management in Uganda hence responsible for environmental issues in the country.

2.7.2 National Environment Management Authority

This is the principal agency in Uganda responsible for the management of environment and is

charged with the coordination, supervision and monitoring of all activities related to environmental

management.

2.7.3 Kampala City Council Authority

Though NEMA is charged with the coordination of sectoral environmental issues, KCCA ensures

that the collection, transportation and disposal of radioactive wastes are done in line with the legal

guidelines provided.


19

CHAPTER THREE: METHODOLOGY

3.1 Introduction

This chapter covered the description of study area, research design, sample size and selection

criteria, data analysis and presentation, dissemination of results, ethical consideration and

limitations the study.

3.2 Description of study area

Kampala District lies within the Kingdom of Buganda, in Central Uganda. The district is bordered

by Wakiso District to the south, the west and the north and by Kira Municipality to the east. The

coordinates of the district are: 00 19N, 32 35E.

Fig 3.1 map of Uganda showing the study area

3.2.1 Climate of the study area

The meteorological data for Kampala City is characterized by comparatively small seasonal

variations in temperature. Due to a high rate of evaporation from the lake surface and to regular

winds, which drift across the lake from east to west all seasons, the average rainfall is high 1,558

millimetres (61.3 in). There is a tendency of the rainfall to decrease as one moves northwards from

http://en.wikipedia.org/wiki/Kingdom_of_Buganda

http://en.wikipedia.org/wiki/Central_Region,_Uganda

http://en.wikipedia.org/wiki/Wakiso_District

http://en.wikipedia.org/wiki/Kira_Town


20

the lake shores. The rain falls in 160 to 170 days each year, with two peaks from March to May

and from October to November.

3.2.2 Population of the study area

The 2002 census put the population of Kampala at 1,189,100 people, the Uganda Bureau of

Statistics estimated the population of Kampala at 1,597,900 in 2010. In 2011, the city’s population

was estimated at approximately 1,659,600.

3.2.3 Geology of the study Area

The general geology of the landfill area consists of Basement complex system of rocks of the

Precambrian age. The lithology is mainly undifferentiated gneiss and migmitites (geological map

of central Uganda, 1974). Characteristic to these rocks in the tropical environment, insitu

weathering generally results in the development of a layer of weathered material referred to as

regolith. In general the regolith is the potential aquifer and the permeability varies according to the

clay content.

3.2.5 Soils of the study Area

The area has alluvial soil consisting of top black loamy soil underlain by the reddish brown ferrate

soils. Close to the valley, there exist alluvial sediments consisting of coarse quartz grains that grade

into fine grains. Granite gneiss is completely weathered sometimes with relict foliation observed

at a depth of 6.0m. In some places, the gneisses has become kaolinite. Pneumatisation of the

gneisses is notable in the north of the project area.

3.3 Research design

3.3.1 Methods of Data collection

During the study, both qualitative and quantitative methods of data collection were used because

qualitative methods involve the use of words rather than numbers; while quantitative methods

involve the collection of numerical data in order to explain, predict and control phenomena of

interest. These methods included, administering questionnaire, interviewing and observation.

3.3.1.1 Key informant interviews

The purpose of the interview with the waste management officer at Hospitals was to collect the

primary data and background information about the waste management practices at the hospital.

The data and information collected formed the basis for this research. An interview protocol was


21

initially developed to cover qualitative data collection that included interview technique, sampling,

ethical issues and data analysis.

3.3.1.2 Questionnaires

The questionnaires were designed for the study and it comprised of sections like; the demography

were the respondent’s working experience, educational level, among others will be asked. The

questionnaire also consisted of questions both open and closed in which exhausted the research

objectives and question. The method gave the respondents enough time to reflect, concentrate and

at times consult.

3.3.1.3 Secondary data

The researcher will get information from the study of documents about waste management; these

documents will include the publications, annual reports of the ministry of health, periodicals,

journals, magazines and other literature written by different knowledgeable scholars. This data

could be government or non-governmental / private statistics. The data will help the researcher

with the starting point for additional research.

3.3.1.4 Observation

An initial walk over the site was undertaken to become familiar with the layout and internal

activities in hospitals. The observation were carried out two times during the month of June to

July. The observations were carried along with the waste management team while they were

collecting medical waste from the wards. The following were some of the activities observed

during the research study;

3.3.1.5 Photography.

This was employed in collection of data aspects including facilities such as the waste bins, and the

disposal sites and incineration facilities available at hospitals.

3.4 Sample size and Selection criteria

The sample size comprised of 10 hospitals from different divisions in Kampala. During the study,

non-probability sampling procedure where purposive and quota sampling techniques was

employed. This is because, in purposive/judgmental sampling, the researcher purposively chooses

respondents who, in his opinion, are thought to be relevant to the research topic. Whereas in quota

sampling instead of dividing the population into strata and randomly choosing of respondents, the


22

researcher sets a ‘quota’ of respondents to be chosen in specific population groups, by defining the

basis of choice ( gender, education, status, etc.) and this still be used in determining size.

3.5 Data Analysis and interpretation

Data analysis was done manually and where possible using Microsoft Excel Spreadsheets

identifying areas of emphasis according to themes and the responses summarized in a narrative

form as a presentation of the major findings of the study. The data was presented in graphic forms

like pie-chats, bar graph and percentages were be generated. At the end of it all, it was from the

results of analysis that the data was interpreted and discussions obtained in relation to phenomenon

of medical radioactive waste management.

3.6 Dissemination of the results

After the researcher was done with analysing the data, he distributed the findings to the areas /

offices that were helpful during data collection exercise. For instance, NEMA and Nakawa

Division Health inspectors to enable them update their information and to discover the gaps

existing in radioactive waste management. The university retained a copy of the approved research

report for academic reference and the researcher retained his copy.

3.7 Ethical consideration

An introduction letter from the university was obtained prior to the study and it was presented to

respective authorities at Hospital to be allowed to carry out research in the area. The names of the

respondents were not included in the report and at the same time explanations were given in regards

to the purpose of research to the respondents.

3.8 Limitations of the study

Availability of data was a real issue for the research due to which certain areas of waste

management like emissions from the incinerators were not considered.

The results are subjected to the reliability on the response of health care workers on the

questions in the survey

The researcher was not allowed to conduct the waste audit due to health and safety risk

associated with the medical waste.


23

The cost benefit analysis of the on-site incineration is not done as the feasibility study of

the on-site incinerator is expected as the follow up of this research.


24

CHAPTER FOUR: DATA ANALYSIS AND RESULTS

4.1 INTRODUCTION

This chapter reveals the analysis and results on the investigation of the current generation,

collection, storage, transportation and disposal of the medical radioactive wastes generated from

the different departments in hospitals.

4.2 Demographic characteristics of the respondents

The first aspect of the study deals with the personal information of the respondents which includes;

age, level of education, and working experience of the respondents

4.2.1 Age distribution of the respondents

Figure 4.1 showing age of the respondents.

From the figure above, it was found out that 20% of the respondents were in the age bracket of 21-

30, 30% in the range of 31-40, 40% within the range 41-50 and lastly 10% were above 50. Figure

4.1 reveals that the proportion of respondents above than 40years of age is 50% percent of the total

population interviewed. Higher age groups has an advantage in that they are seen keener about

improving the waste management practices whereas most of the employees among younger age

group had the “I don‘t care” attitude towards waste management.

0

5

10

15

20

25

30

35

40

21-30 31-40 41-50 Above 50

Per

cen

tag

e

Age Group

Percentage age distribution of respondents


25

4.2.2 Education level of respondents

From the study, it was found out that all the respondents had attained some level of education. Of

this, 10% were of secondary level, 20% were of diploma level, 40% were bachelor holders and

30% were certificate holders as shown in figure 4.2. From the study it was found that respondents

who had attained higher level of education had more knowledge on better ways managing the

radioactive wastes than their counterparts who had attained low levels of education. Education is

very paramount for the development of any waste management strategy for an organisation

because attainment of education is strongly associated with decision-making and promotes

development.

Figure 4.2: Educational Level

4.2.3 Working experience of the respondents

It was found out from the study that 30% of the respondents had worked for less than 3years, 20%

between 4-10years, 40% between 11-15years and 10% had worked at the hospitals for more than

15years as shown in figure 4.3 above. The following data revealed from the data presented 40%

of the respondents had a working experience of 11-15 years which shows a higher number of

experienced people working on the department of the waste management which promotes proper

radioactive waste management.

10

30

20

40

0

5

10

15

20

25

30

35

40

45

Secondary. Certificate Diploma B.Sc. degree

Per

cen

tag

e

Education Levels

Education Levels of Respondents


26

Fig.4.3 showing working experience of the workers

4.3 Information on radioactive waste in Hospitals

4.3.1 Amount of radioactive wastes generated from different departments in hospitals

From the research study, it was found out that 17% of the radioactive wastes came from the

laboratory department, 11% of from the Dental department, 22% generated from the surgical

department and 50% of the radioactive wastes was generated from Radiological department. The

data shows that there are more radioactive wastes generated from the radiology department than

any other department. This is mainly attributed to increase in cancer cases within the country

making patients continue to flock for imaging care in the Hospitals for radiotherapy.

Fig 4.4 showing amount of radioactive wastes generated from different departments

0 10 20 30 40

1 to 3

4 to 10

11 to 15

Above 15

Number of respondents in %

Tim

e p

erio

d i

n Y

rs.

Working experience of the respondents

Laboratory

17%

Dental department

11%

Surgical

22%

Radiology

50%

Amount of radioactive wastes generated from

different departments

Laboratory Dental department Surgical Radiology


27

4.3.2 The types of medical radioactive wastes generated by hospitals

From the study, 75% of the radioactive wastes collected were solid, 15% of the liquid and lastly

10% were gaseous in nature as shown in figure 4.5. This implies that much of the wastes collected

consisted of solid wastes followed by liquid wastes and lastly gaseous wastes. The reason for the

high percentage of solid radioactive wastes is because most of the wastes are mixed together during

segregation and storage. Solid wastes are typically classified as combustible/noncombustible and

compactable/non-compactable waste.

Fig. 4.5 showing types of radioactive wastes generated

4.3.3 The categories of radioactive wastes generated from the hospital

60% of the respondents commented that radioactive wastes generated are of low levels, 20% raised

medium level wastes and lastly 20% raised high level wastes. The majority of the respondents

agreed that much of the wastes collected hospitals were low level wastes as shown in figure 4.6.

This is because hospitals generally use radionuclides that do not exhibit a high level of

radioactivity.

0

10

20

30

40

50

60

70

80

Solid Liquid Gaseous

75

1510

Qu

anti

ty i

n %

Types of medical radioactive wastes

Types of radioactive wastes generated


28

Figure 4.6 showing categories of radioactive wastes generated

4.4 Radioactive waste management in Hospital

4.4.1 Segregation of the radioactive wastes

From the study, it was found out that the radioactive wastes generated in Hospital includes, gloves,

syringes, items used by hospitalised patients after radionuclide therapy, protective clothing,

masks, filters, overshoes, towels, hand tools, contaminated water and effluent, body fluids,

discarded liquid radiopharmaceuticals, urine, gas from patients in nuclear medicine. These wastes

were collected from different departments of the hospitals into one place, separated to different

categories, some treated and others transported to the KCCA treatment plant after they have piled

up. Depending on the final handling or disposal, the wastes were usually separated into different

categories which includes; high level, low level and very low level wastes and stored in containers.

From the study it was found out that 80% of the segregated radioactive wastes were stored in

KCCA containers while 20% incinerated.

4.4.2 Storage of the radioactive wastes

During the site visits, it was observed that much of the radioactive generated from Hospitals after

segregation were stored in suitably designed and labelled containers provided by KCCA awaiting

further treatment, transportation to the Municipal plant and the remaining, mostly with highly

radioactive materials are incinerated.

60%20%

20%

The categories of radioactive wastes

generated

Low level waste

Medium level

High level waste


29

4.4.3 Radioactive waste disposal

From the study, is was found out that incineration was one of the methods used for disposal of the

radioactive wastes. Incineration involves burning wastes at high temperatures to reduce waste

volumes since a large proportion consists of bulky items such as contaminated clothes, lumber,

and plastic. It also reduces the total chemical toxicity of the waste. Also some of the wastes were

transported to the Land fill in Kiteezi and from there the wastes are buried under the soil to reduce

its effects to people and increase the level of radioactive decay, and this was done by KCCA.

4.4.4 Whether there are various method available for radioactive waste management

From the study, 60% of respondents agreed that there are other better materials used to dispose

waste other than the ones made out of plastic, 30% disagreed with the idea and lastly 10% did not

know. The majority of the respondents agreed that there are other methods like use of metallic

containers, directly bullying the wastes. This implies that hospitals should acquire better

radioactive waste disposal materials other than the ones in existence.

Figure 4.7 showing whether there are other better materials to dispose waste other than those made out of

plastic

4.4.5 Whether there is a special department handling waste management activity

During the study, 70% of the respondents agreed that there was a special department handling

waste management activities and 30% disagreed with the idea. The majority of the respondents

agreed with the idea because there are separate departments for handling wastes which is

independent of the other administrative activities carried out within hospitals and therefore they

have their own budget plans which enables them run their activities smoothly.

60%30%

10%

Whether there are other better materials to dispose

waste other than those made of plastic

Yes

No

Do not know


30

4.4.6 Whether there is any alternative method/ idea of disposing waste other than the one

practiced.

From the study, 60% of the respondents disagreed that there is no any alternative method/ idea of

disposing waste other than the one practiced whereas 40% agreed with the idea. The majority of

the respondents commented that the methods used at various hospitals were the common ones used

by other hospitals. This implies that there is need for hospitals to invest much effort in putting up

better disposal mechanisms for the radioactive wastes since these wastes hazardous nature and can

contaminate the environment when not properly managed.

4.5 Personnel involved in the management of hospital wastes

4.5.1 Number of personnel involved in the management of radioactive wastes in hospitals

From the study, 10% of the respondents commented that the number of persons involved in the

collection, handling and storage of hospital wastes were less than 5, 30% gave between 5 to 10

people and lastly 60% gave between 10 to 20 people. The majority of the respondents commented

that the number of people involved in waste handling ranges between 10 and 20 and that most of

these were waste collectors, cleaners, segregators and very few administrators.

Fig 4.8 showing number of persons involved in the collection, handling, and storage of hospital Waste

4.5.2 Level of knowledge of the dangers of radioactive wastes on the environment

80% of the respondents agreed that waste management staff were aware of the dangers of

radioactive wastes on the environment whereas 20% commented that they were not aware. The

0%

20%

40%

60%

Less than 5 Between 5 to 10 Between 10 to20

10%

30%

60%

Pe

rce

nta

ge

Number of people

The number of people involved in the collection, handling and storage of hospital waste


31

majority of the respondents agreed with the idea because the staff members were informed about

the challenges involved during the training period after recruitment.

4.5.3 Training given to the waste management staff

It was found out that 90% of the waste management staff had received whereas 10% disagreed

with the idea. The majority of the respondents agreed with the idea and it was found out that formal

training was provided for the duration mostly ranging between 3 to 5 days depending on the level

of understanding of the people being trained.


32

CHAPTER 5: DISCUSSION

5.1 Introduction

This chapter presents a discussion of results obtained as present in chapter four. The presentation

of the discussions is in line with the study objectives.

5.2 Kinds of medical radioactive wastes generated from the hospital

Different radionuclides were found to be in use in hospitals to exclude disease, prove the existence

of a pathological process, assist in the planning of treatment or to follow the course of a disease

already diagnosed and/or treated and these included the radioisotopes of iodine, gallium, thallium

and technetium, amongst others as shown in Table 1.1. The increased use of radionuclides were

mainly attributed to increase in cancer cases within the country making patients flock for imaging

care. However, this influx lead to congestion of the diagnostic imaging departments leading to an

increase in the rate of radioactive wastes generation. It was established from the study that the

radioactive wastes produced from the Hospitals were in forms which included; solids (75%),

liquids (15%) and gases (10%) as shown in figure 4.5

Once these wastes are exposed to the environment, they can remain active for hours or several

months and if the radionuclides are to get into air, soil and water supplies accessible by both

animals and humans, these resources can become contaminated. In human exposure to radiations

that are 5 Sievert are usually fatal. Newly borne babies exposed to iodine may suffer from

hypothyroidism. Other living organisms may also experience adverse effects of radiation thus

causing alteration in DNA sequence which can subsequently lead to both low crop and animal

productivity. Although the dose produced through this indirect exposure is much smaller than a

direct exposure dose, there is a greater potential for a larger population to be exposed henceforth

proper disposal is essential to ensure protection of health and safety of the public and the quality

of the environment including, air, water supplies, and soil.

5.3 Current radioactive waste management practice within the hospitals

The management of the radioactive wastes in the various hospitals were mainly divided into six

different steps: pre-treatment (collection and handling), conditioning, storage, treatment,

transportation and disposal. For practical reasons the wastes were divided into solid, liquid and


33

gaseous form to enable easy handling. The solid radioactive waste generated by the hospitals

included cover papers, gloves, empty vials and syringes, radionuclide generators, items used by

hospitalised patients after radionuclide therapy, sealed sources used in therapy, sealed sources used

for the calibration of instruments, and other biological waste. In the liquid waste category residues

of radionuclides, patient excreta, liquid scintillation solutions, and in the gaseous waste exhausted

gas from patients in in the radiology department were found out.

Depending on the final handling or disposal, the wastes were divided into different categories. One

category where the wastes would end up in a public waste treatment system with or without

incineration, the next where would be poured out in the public sewage system, and the third where

it was disposed of in a national disposal plant (Kiteezi). The following were some of the special

situations of radioactive waste management in the Hospitals observed during the course of the

study.

Pre-treatment. The thorough pre-treatment of the waste the most important step towards

a rational (both practical and economical) and safe handling of the waste. It includes steps

such as collection, segregation, chemical adjustment and decontamination. The segregation

is crucial and it was done taking into account the different aspects of the waste with a clear

view of the final treatment and/or disposal. The segregation of wastes into appropriate

categories took place during the waste collection.

Conditioning. This includes those operations that produce a waste package suitable for

handling, transportation, storage and/or disposal. It may include the conversion of the waste

to a solid waste form, enclosure of the waste in containers and, if necessary, providing an

over pack.

Storage. Interim storage of radioactive waste may be needed in different stages of the

waste management process. For many of the wastes generated in hospitals, storage for

decay is a useful option because the radionuclides have short half-lives. This can be done

in hospitals and may include some treatment of the wastes to ensure safe storage. After a

sufficient storage time, the final step, disposal as exempt waste, can also be performed at

the hospitals. Other types of waste containing radionuclides with longer half-lives must be

transferred to a special waste treatment, storage and disposal facility outside the hospitals.


34

Transportation. During transportation, safety management included appropriate

packaging, labelling, transportation of documents including sender, retriever, content of

the waste, categorisation, and information to possible rescue personnel. The packages and

containers were strong enough to ensure a safe, sometimes rough, handling.

Disposal. There were mainly two approaches to the disposal of radioactive waste from the

hospitals. One was "dilute and disperse" and the other was "confine and contain". By the

"dilute and disperse" concept, radioactive material, in aqueous or gaseous form, were

released into the environment in such a way that the material was diluted and distributed

over a large volume so that the final concentration of radionuclides is acceptably low. In

the "confine and contain" approach, the waste was collected and converted into a form such

that, when placed in a repository, it will retain the radionuclides until the activity was

decayed, or at least will ensure that the leakage of radionuclides from the repository does

not give rise to unacceptable concentrations anywhere in the environment. This approach

was used for longer-lived solid radioactive waste.

The radioactive wastes generated were safely managed because of the hazardous nature it possess

to human health and the environment. Through good practices in the production and use of

radionuclides, the amount of wastes were significantly reduced but not fully eliminated. It was

noted during the study that full compliance with all relevant regulations were considered and

planned for in the early stages of radioactive waste management.

5.4 Knowledge and awareness of the dangers of radioactive wastes on the

environment by the workers

Due to hazardous nature of the medical radioactive wastes, poor disposal practices have sparked

concern regarding the impact it possess on public health and the environment. Lack of sufficient

knowledge of the associated risks is a strong factor contributing to inadequate disposal practices.

From the study, knowledge, and awareness status concerning the dangers radioactive wastes on

the environment by the workers was examined. More than 95% of the workers were found out to

have proper knowledge about the hazardous components of medical waste which is an essential

component in radioactive waste management therefore it was easy for them to segregate the wastes

into various medical waste categories which made handling easier. A positive attitude was also

shown by Hospital employees towards the training on proper medical waste management and


35

improving the current waste management practice and this enabled them acquire the action

competences or skills of environment- in order to be able to identify and anticipate environmental

problems and work with others to resolve, minimize and prevent them. However from the study,

it was found out that about 55% of the workers surveyed had not attended training in past 12

months and this affected the the level of consistency in the managerial practice of radioactive waste

management since they lacked skills, knowledge and values concerning current management of

the waste and this impacts on practices of appropriate waste disposal.

On the aspect of personal protection, workers were observed using protective equipments such as

overalls and mouth masks during the handling of the wastes which showed a level of awareness

towards the hazardous nature of the wastes being handled but the hospital administrations should

provide the workers with complete protective ware in order to limit the chances of them being

exposed to radiations during the management process.

Plate 5.1 showing personnel wearing PPEs (overalls and mouth masks)

5.5 Alternatives for radioactive waste disposal and selection of best available

Technology

The use of radioactive materials for medical uses, brings with it the question of waste management

policy. Most countries using nuclear power have well developed strategies for radioactive wastes

and there are many similarities between the programmes of different countries. The study shows

that the incinerator is the best available technology for the on-site treatment of medical radioactive.


36

As discussed in the literature none of the above mentioned technologies seemed to be

environmental friendly or pollution free. But the study shows that a modern incinerator seems to

be the best available option for the hospitals. Incinerator seem to be the most favourable treatment

technology due to the advantages like waste reduction and can be used for all types of waste.

Incinerator will continue to be the favourable treatment technology unless and until we develop a

technology which can treat all types of medical waste so in the meantime alternatives for

radioactive waste management that can be taken up by the institution include; dilute and disperse,

concentrate and contain, Delay and decay. The first two methods are advantageous in that they can

be used in the treatment of non-radioactive wastes whereas delay and decay is unique to radioactive

wastes management.

Vitrification. This involves stabilisation of the wastes into a form which will neither react

nor degrade for extended periods of time. The waste is mixed with sugar and the calcined.

Calcination involves passing the waste through a heated rotating tube so that water is

evaporated from the waste and de-nitrate the fission products to assist the stability of the

glass produced.

Ion exchange. Here ferric hydroxide is used to remove radioactive metals from aqueos

mixtures. After the radioisotopes are absorbed onto the ferric hydroxide, the resulting

sludge can be placed in a metal drum being mixed cement to form a solid waste form.

Space Disposal. Of all disposal methods of radioactive wastes, this method has the greatest

potential to isolate the wastes permanently from the biosphere. Although it is technically

possible, its costs would be very high. Studies have indicated that the number of flights

required to transport high volume of radioactive waste would be impractical; space disposal

could be feasible only for very small volume of reprocessed high-level wastes. The risk of

catastrophic accidents is estimated to be about one per cent per flight, and thus that the

radiological risk of disposal in space is higher than for geological disposal.

Ice Sheet Disposal. Disposal of radioactive wastes in ice sheets has also been suggested in

the past and at first sight appears to be feasible, however, it has not been extensively

researched. The idea has the advantage of placing the waste in a slowly changing

environment devoid of living organisms. Canadian glaciers are too small for this method,

so ice sheets in Greenland or the Antarctic would have to be employed. Correspondingly,


37

the wastes would have to be transported over great distances. Moreover, treaty obligations

preclude disposal in the Antarctic.


38

CHAPTER SIX: CONCLUSIONS AND RECOMMENDATIONS

6.1 Introduction

This chapter presents the conclusions and the recommendation of the study.

6.2 Conclusion

The overall goal of this research was to investigate the current use of medical radionuclides and

generation, collection, storage, transportation and disposal of the medical radioactive wastes

generated from the different departments in Hospitals. The four general objectives of this research

were to:

1. To determine the kinds of medical radioactive wastes generated from different departments

of the hospitals.

2. To determine information on the current collection, storage, transportation, treatment and

disposal of the medical radioactive wastes from the hospitals.

3. To assess knowledge and awareness of the dangers of radioactive wastes on the

environment.

4. To identify the possible recommendations to archive proper medical radioactive waste

management

From the study, it was established that much of the radioactive wastes produced at Hospitals were

in forms which included; solids (75%), liquids (15%) and gases (10%) as shown in figure 4.5.

These wastes were segregated and then stored in the KCCA container or in temporary plastic

dustbins around the hospitals. The wastes were further transferred once in a day and usually in the

morning hours to the Municipal waste disposal plant at Kiteezi in Wakiso district. Much of the

radioactive wastes produced were low level waste of these some were incinerated at the hospital

premises as a means of disposal to reduce their effect to the environment and the staff involved in

the garbage collection process. It was also discovered that most of the staff involved in waste

handling had knowledge concerning the dangers of radioactive wastes and trained in the different

ways of protecting themselves.


39

This study by no means provides a synthesis of all the available information on the radioactive

waste management system in hospitals and proscribing detailed plans for appropriate waste

reduction projects is beyond the scope of this study. Further research should be done to address

specific issues within the sector, and requirements for appropriate waste reduction technologies;

and further work should be conducted to develop targets and objectives for long-term waste

reduction strategies.

The value of the present research exists in its utility to the hospital authorities involved in waste

management. The findings can be used to facilitate more effective and appropriate radioactive

waste management programs like waste reduction initiatives, by capitalizing on the incentives

while strategically reducing the barriers or taking action to transform them into incentives.

6.3 Recommendations

In response to the conclusions presented, the following recommendations are provided for

improving the management of medical radioactive wastes in hospitals. The recommendations are

specific to each stakeholder that should be involved in the strategic planning of the specific

interventions. The recommendations are based on the synthesis of information gathered in the

research findings, in-depth interviews, available literature, as well as on the author’s experience

while carrying out site visits.

Similar studies should be conducted in other hospitals in Uganda in order to develop unique

solutions based on the prevailing radioactive waste management.

Review of the waste management policies should be done so that it focuses not only on the

waste minimization strategies but should also contain strategies to encourage greater

engagement and to change the intended behaviour to a more sustainable behaviour.

The waste manager should consult with the staffs and a consensus should be made on the

location of waste bins.

The employees should be highly encouraged to inform the waste management team

whenever they have put wrong waste in wrong bin.

Proper consideration of record, track and monitoring for the waste generation pattern for

each wards.


40

The management of hospitals should allocate enough funds to the department responsible

for handling radioactive wastes so as to purchase modern gadgets for use.

The staff members involved in handling wastes should be provided with protective wears

such as overalls, gloves and gumboots.

Hospitals should provide periodic training to its staff members involved in handling

radioactive wastes.

Specific designs and engineering courses should be developed and introduced in higher

institutions of learning so as to enhance the science of radioactive waste management.

Responsible authorities like the KCCA, NEMA should ensure the sustainability of

radioactive wastes management systems by improving the effectiveness of collection and

recycling system.

Enforcement of rules and regulations regarding waste disposal should be taken as a serious

issue by the government.


41

REFERENCES

1. AERB Safety Code for Nuclear Medicine Laboratories (SC/MED 4) Appendix 511. 1989.

pp. 47–49.

2. Cherry SR, Sorenson JA, Phelps ME. Physics on Nuclear Medicine. 3rd Edition. Saunders;

Philadelphia, Pennsylvania: 1980.

3. Classification of Radioactive Waste, a Safety Guide. A Publication in the Radioactive

wastes Programme. Safety Series No. 111-G-1.1, IAEA 1994.

4. CoRWM Implementation Working Group, Draft Discussion Paper on Implementation,

CoRWM Document Number 1703.1, 2006.

5. CoRWM, Managing our Radioactive Waste Safely: CoRWM's Recommendations to

Government, CoRWM Document Number 700, 2006.

6. Defra News Release, Government Welcomes CoRWM's Package of Measures for Long

Term Management of Radioactive Waste, July 2006.

7. Department of Environment, Office of the Deputy Prime Minister, Scottish Executive and

Welsh Assembly Government, a Practical Guide to the Strategic Environmental

Assessment Directive, 2005.

8. Department of the Environment, Department for Environment, Food and Rural Affairs, the

National Assembly of Wales, and the Scottish Executive, Managing Radioactive Waste

Safely: Proposals for Developing a Policy for Managing Radioactive Waste in the UK,

2001.

9. Establishing and National System for Radioactive Waste Management, Safety Series No.

111-S-1, Vienna 1995.

10. Govida Rajan KN. BARC; Mumbai: 2002. Basic Safety Standards. Accredition

Programme for Nuclear Medicine Technologists in Radiation Safety; pp. 8.1–8.9.

11. ICRP Recommendations of the International Commission on Radiological Protection. Brit

J Radiol. 1995 ;( Suppl 6)

12. Kinni KS. Planning of Nuclear Medicine Laboratories for Diagnostic and Therapeutic

Procedures. Indian J Nuclear Med. 1998; 13(4):165–192.

13. Kishore J, Goel P, Sagar B, Joshi TK. Awareness about biomedical waste management and

infection control among dentists of a teaching hospital in New Delhi. Indian


42

14. Murthy BKS. BARC; Mumbai: 2000. Operational limits. Training workshop on Radiation

Safety in Nuclear Medicine and RSO Certification Examination; pp. 6.1–6.6.

15. Nagalakshmi B. BARC; Mumbai: 2000. Radioactive waste disposal with special reference

to Nuclear Medicine Laboratories; pp. 16.1–16.4. Training workshop on Radiation Safety

in Nuclear Medicine and RSO Certification Examination.

16. Narang RS, Manchanda A, Singh S, Verma N, Padda S. Awareness of biomedical waste

management among dental professionals and auxiliary staff in Amritsar, India. Oral Health

and Dental Management. 2012; 11: 162-168.

17. ODPM, Sustainability Appraisal of Regional Spatial Strategies and Local Development

Documents, 2005.

18. Radiation Protection for Medical and Allied Health Personnel 1989. NCRP Report No 105.

19. Rao PH. Report: Hospital waste management-awareness and practices: A study of three

states in India. Waste Management and Research. 2008; 26: 297-303.

20. Sharma S. Awareness about bio-medical waste management among health care personnel

of some important medical centers in Agra. International Journal of Environmental.

21. Sudhakar V, Chandrashekhar J. Dental health care waste disposal among private dental

practices in Bangalore.

22. Tabish SA. Hospital Infection Control: Conceptual Framework. Academia Publishers;

2005. Ecohealth: Management of Biomedical Waste; pp. 139–145.

23. The Nuclear Decommissioning Authority, Managing Radioactive Waste Safely: A Review

of International Experience of Partnerships, 2007.

24. The Principles of Radioactive Waste Management, Safety Series No. 111-F, IAEA, Vienna

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25. The Radiation protection Rules (RPR) 1971, under Section 30 of The Atomic Energy Act,

1962.


43

APPENDIX I: QUESTIONAIRE

This questionnaire has been designed to assess the medical radioactive wastes management in

Hospitals, Kampala city. Therefore it seeks to request for your assistance in answering questions.

Your response will provide data for research and will be highly confidential and will strictly be

used for this study only.

Dear respondents,

Instructions

Please put a tick in the appropriate box in every question or give your own opinion in the spaces

provided.

PART ONE: BIO-DATA

Typology Category

Typology Characteristics

Response.

Age (Years)

21-30

31-40

41-50

50+

Education level.

Secondary

Diploma

B.Sc. degree

Graduate studies

Working experience (Years)

1-3

4-10

11-15

15+


44

PART 2: INFORMATION ON RADIOACTIVE WASTE IN HOSPITAL

a) Amount of radioactive wastes generated in different departments of the hospital.

Department. Average waste collected per

day (approximately in kg)

Material used for collection of

waste for disposal

(approximately in kg)

Laboratory.

Radiology department

Dental.

Surgical ward

b) Pleases let me know on the quantities of the types of medical radioactive wastes

generated by your hospital

Type of radioactive wastes

generated.

Average waste collected

per day (approximately in

kg)

Solid

Liquid

Gaseous

c) Categories of the radioactive wastes generated.

Category. Response.

Low level waste

Medium level

High level waste


45

PART 3: RADIOACTIVE WASTE MANAGEMENT IN HOSPITAL

i. Describe briefly what happens between segregation (if any) and final disposal of Medical

Radioactive waste

................................................................................................................................................

....................................................................................................................................

ii. Where is the segregated waste stored while awaiting removal from the hospital or disposal?

Describe

................................................................................................................................................

................................................................................................................................................

............

iii. Describe briefly the final disposal of segregated waste (taken to municipal landfill, buried

on hospital grounds, incinerated, open burned, etc.).

................................................................................................................................................

................................................................................................................................................

............

iv. Where do you dispose the waste? Please mention the location

................................................................................................................................................

................................................................................................................................................

............

v. Do you think there are other better materials to dispose waste other than those made out of

plastic?

................................................................................................................................................

................................................................................................................................................

............

vi. Is there any special department handling waste management activity?

Yes No

vii. Do you suggest any alternative method/ idea of disposing waste other than that is practiced

now?

................................................................................................................................................

...........................................................................................................................


46

PART 4: PERSONNEL INVOLVED IN THE MANAGEMENT OF HOSPITAL

WASTES.

i. Indicate the number of persons involved in the collection, handling, and storage of hospital

Waste

................................................................................................................................................

.........................................................................................................................

ii. Are the waste management staff aware of the dangers of radioactive wastes on the

environment?

Yes No

iii. Are instructions/training given to newly hired waste management staff?

Yes No

iv. If yes, what type of training and of what duration?

................................................................................................................................................

....................................................................................................................................

***THANK YOU ***