Aveneu Park, Starling, Australia

1.0 on handling and disposal method. As

of Research

Healthcare waste management

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of Research Proposal

First Aid Kit Management System in Tertiary


order to comply to Occupational Health and Safety Act (OSHA) 1994, provision of
first aid kit become a mandatory as part of employer responsibility as stated
in Section 15 of Occupational Safety and Health Act 1994 (OSHA 1994) and
Section 25 of the Factories and Machinery Act 1967 (Occupational Safety and Health Act 1994); (Factories and Machinery Act,
1974).  As the provision of First Aid must be consistent
and efficient as part of employee’s welfare, Department of Safety and Health
(DOSH) with collaboration with few other contributors had come out with the Guidelines
on First-Aid In The Workplace up to Second Edition revised version in 2004. The
main objective of the Guidelines is to assists employers, occupiers and Occupational Safety and Health
practitioner to plan and implement proper first-aid facilities in the workplaces
(Guidelines on First-Aid In The Workplace
(2nd Edition), 2004). However, the contents of the
Guideline is not covering a holistic idea of first aid management as it is too
focusing on the requirements without expanding the guidance on handling and disposal
method. As part of health care products, the need of proper disposal of unused
or expired first aid items become important to reduce the burden on domestic waste
treatment. Typical component of first aid items vary with different type of
products such as paper, wood, consumable products, solvent based items and drug
contained materials. Some of the contents of first aid items are
categorized as hazardous waste. Even
though the quantity of first aid wastes produced is in small quantity, there is
still some risks and potential dangers for environment related to mishandling
of wastes. To start of the Nowadays
university communities can be considered as ”mini cities” with large area
coverage and variety of human activities. These having different degrees of
effect on the environment. Due
to this, it is justifiable for the need of proper first aid kit management
based on ‘cradle to grave’ concept to be introduced and implemented in the

Nubi, & Adelopo, 2017)


4.0   Literature Review

4.1   Definition of Health Care and First Aid

As stated in
Guidelines on The Handling and Management of Clinical Wastes in Malaysia,
health care is defined as any medical activities such as diagnosis, monitoring,
treatment prevention of disease of handicap in humans or animals performed
under the supervision of any person authorized by their professional
qualifications (Guidelines on The Handling and
Management of Clinical Wastes in Malaysia (3rd Edition), 2009 ). While referring to the
Guidelines on First Aid in the Workplace by DOSH, first aid is defined as the
assessment and interventions performed by a first aider for the injury with
minimal equipment until qualified medical or health personnel arrive to provide
treatment. First aid provision is including all appropriate facilities,
services and personnel required for the immediate treatment of injury or
illness at a workplace (Guidelines on First-Aid In The
Workplace (2nd Edition)). First aid emphasized on
early treatment once casualty occurred while health care is covering all phases
of casualty treatment. By comparing both definition, first aid also can be
categorized as a subset of health care elements.

4.2   Requirement of first aid provision

First aid
provision in any premise is including first-aiders, first-aid box, first-aid
room and first-aid equipment. The number of all first aid provision typically
is based on type of industry, number of workers, number of work shifts and
location of workplace and status of infrastructure in relation to the nearest
medical clinic or hospital (Guidelines on First-Aid In The
Workplace (2nd Edition), 2004). Considering the large
headcount of employees in large premise, the provision of first aid items can
be as many as health care facilities.

4.3   Maintenance and replenishment of first aid

As part of OSHA
1994, all injuries in the premises must be recorded and reported to Department
of Safety and Health (DOSH) (Occupational Safety and Health Act 1994). This is parallel in what
stated in Guideline on First Aid in the Workplace as the record of the
treatment given by the first-aider should be made and kept for a period of five
years by the employer. The main responsibility for maintaining first aid
facilities including replenishment and regular inspection is belong to
employers. For this case, employers need to ensure that appointed first aiders
must able to maintain perform the responsibility as to ensure the services are
adequate at all times (Guidelines on First-Aid In The
Workplace (2nd Edition), 2004).

4.4   First Aid waste Categorization

The World Health
Organization (WHO) stated that all waste generated by health care establishment
including waste originating from ‘minor’ or ‘scattered’ source is defined as
health care waste (World Health Organization,
Definition and Characterization of health-care waste) .As first aid is part of
health and medical services, hence the waste can be categorized based on their components.
First aid products potentially end up to produce several categories of waste
such as infectious waste, sharps, pharmaceutical waste and chemical waste as
stated in WHO. In Guidelines on The Handling and Management of Clinical Wastes
in Malaysia, the categorization of first aid is almost as similar as WHO
categorization on health care waste. Table 1 is the list of first aid waste

1: First Aid Waste Categories


First Aid Products

Waste Category

Materials or equipment that have been in contact
with blood or other body parts of injured person suspected to contain

Tissues (swabs, gauze pads and dressings)
Bandages (triangular, elastic and roller)
Eye pads
Adhesive tape
Alcohol prep pads
Cotton buds
Barrier device for CPR (pocket mask, face shield

infectious waste,
(clinical waste)

Clinical waste

Any health care equipment with sharps or pointed
parts able to cause an injury to human.

Safety pin
Cervical collar
plastic apron

(clinical waste)

Waste containing pharmaceuticals that are expired
or no longer needed and items contaminated by pharmaceuticals product

Bottles and boxes of pharmaceuticals products
such as

pharmaceutical waste (clinical waste)

Waste containing chemical substances
or disinfectants that are expired or no longer

Burn aid cream
Yellow lotion

chemical waste

Products or items in the solid state that are
expired or no longer needed

Cold pack compress gel
Unused absorbent paper
Unused swabs

Solid waste

Any products or tools that contained high
densities of poisonous metal.


Heavy metals

As first aid facilities and items are mainly used for early treatment of
casualty, most of the study do not really focusing much on the hazardous waste
elements in first aid items. There are no previous published studies assessing
and categorized first aid elements particularly in hazardous elements. The
assessment and categorization was always conducted in bigger scale of health
care waste focusing in large health care services such as hospitals, clinics,
pharmacies and university clinics (Hossain, Santhanam, Nik Norulaini, & Omar, 2011); (Ananth, Prashanthini, & Visvanathan, 2010).

4.5 Factors of health
care waste mismanagement

In developing
countries such as in Africa and Asia, continent health care waste amount
generation is lower. However the proportion of health care waste among total
waste is higher than developed countries such as in Europe. The reason behind
it is just because advanced legislation and guidelines are followed by
developed nations during waste collection by practicing various possible ways
during waste handling, storage and transportation. This effort was obviously
helpful in minimizing the health care waste generation and which it was not
followed by other developing countries (Alagoz & Kocasoy, 2008); (Almuneef & Memish, 2003); (Tudor, 2007).
Health care waste in developing countries have not yet fully appreciated as
they are still handled and disposed together with domestic and municipal waste (Alagoz & Kocasoy, 2008). At the initial stage of
waste disposing, only small proportion of the total waste may be considered and
being treated as health care waste. Mishandling by mixing the waste together
may lead to cross-contamination due to mixing with other non-health care waste.
This situation may end up to have entire waste load to be part of health care
waste which required intense treatment (Blenkharn, 1995); (Patwary et al., 2009).

management practice of health care waste can be identified from the point of
initial collection to the final disposal. Other than lack of appropriate
legislation and guidelines, lack of specialized clinical staffs, lack of
awareness and effective control also may lead to ineffective of health care
waste management. In addition to this, developing countries that may having
financial difficulties might therefore looking for cost effective disposal
methods of health care waste. (Hossain et al., 2011). Through the effort to
accomplish cost effective methods, the mismanagement of waste is likely to
occur as there is no other way to secure cost allocated for facilities

had been conducted and found out to be 85% of healthcare facilities (hospital)
including managers, cleaning staff, and environmental workers were not trained
on waste management and did not provided with detailed description of waste
handling in their job scope. From the same study, 55% of doctors and nurses
were also unsure about hospital waste management policies and procedures and
showed insufficient knowledge of the potential hazard while 90% of municipal
workers who perform the job on transportation of hospital waste to final
disposal sites had not been informed and educated on the hazards associated
with hospital waste.

care waste management such as in hospital and clinics required enforcement on
regulations. In addition, there is no reference or any declaration in the job
description documents of hospital staff on hospital waste management. This
phenomena will create ineffective of health care waste handling. (Sawalem, Selic, & Herbell, 2009).

6.0 Overview of
health, safety and environmental impact

A lot of study had been conducted to identify the impact
of health care waste towards the human and environment if the waste is not
manage properly. As developing country, the management of health care wastes
still disorganized as most of wastes are still handled and disposed together
with domestic wastes. Thus it creating a great health risk to the public and
the environment (Bdour, Altrabsheh, Hadadin, & Al-Shareif, 2007); (Coker et al., 2009); (Sawalem et al., 2009). The waste generated from
health care facilities and services ultimately pose the danger and risk to
health and to the environment even though the percentage of health care waste
is relatively small compare to the total waste (Bos & Izadpanah, 2002).  Due to infectious nature of health care
waste, it can also being harmful to human health and environment during
handling and disposal of health care solid waste (Hossain et al., 2011); (Bokhoree, Beeharry, Makoondlall-Chadee, Doobah, & Soomary, 2014).

According to WHO, health care waste potentially expose
infection risk, toxic effects and injuries towards community in the health care
facilities including workers, waste handlers, patients and the community (WHO,
2017). Besides it can lead to the risks of environmental pollution and
degradation, poor management of health care waste management can lead to
workplace injuries and diseases regardless of infectious and non-infectious.(Al-Habash & Al-Zu’bi, 2012);  (Nwachukwu, Orji, & Ugbogu, 2013); (Hossain et al., 2011). Some studies emphasizing
that anyone who work in the health care facilities that potentially in contact
with generated health care waste are in danger as the waste are likely to have
hazardous components.  It is including
any waste that consists of human tissue, blood or other body fluids, excretions,
drugs or other pharmaceutical products, swabs or dressings or syringes, needles
or other sharp instruments.

water effluents that contained pharmaceuticals elements from health care waste
proven to have a great effect towards wild aquatic animals. 2012). Study
conduct showed that fish exposed to 50% or 100% wastewater effluent had higher
tissue concentrated with pharmaceuticals in their brain and plasma. This
phenomena indirectly may potentially change the behavior of the affected fish (McCallum et al., 2017). As the effect of the health
care to wastewater-exposed fish is known, it was obvious that inappropriate health
care waste management is posing both health hazards and environmental
pollution, facing many health care centers in modern world.

of health care solid waste management practice also can exposed health care
staffs, patients and hospitals environment with diseases such as cholera,
dysentery, skin infection, and infectious hepatitis (Patwary et al., 2009; Tamplin, Davidson, Powis, & O’Leary, 2005).
These diseases able to spread through epidemic way if the waste is not manage
appropriately (Coker et al., 2009) .Thus, appropriate methods for the safe
management of health care waste must be practicing urgently.

5.0   Objective of Study

The aim of this
research is to ensure proper disposal of first aid waste through holistic
management approach. The first objective of this research is to identify a current first aid kit management
in tertiary institutions. Besides, another objective to be achieved in this
study is to propose effective first aid
kit management system.

6.0   Methodology of Study

6.1   Data Collection

This project
will be involved 2 stages of data collection. First stage is baseline survey through
at least 20 institutions to get a baseline data for current first aid kit
management practice in Malaysia. The survey will answered by 1 responder to represent
the organization at which population associated with it.  Sampling method to be used in this research is
nonrandom approach of purposive sample as the sample selected (individual to
answer the questionnaire) must be the person who are very well known of
handling the management of first aid provision and maintenance in the selected
institutions. Subject completed instruments for the stage 1 of this research
will be questionnaires. Second stage will be case study approach at which two
institutions are chosen to demonstrate the current practice in depth.

6.2   Benchmark

To introduce new
concept of first aid kit management, benchmarking from guidelines, policies and
procedures will be conducted to acquire the best approach.

6.3   Gap Analysis

The first aid
kit management practice will be clustered in few categories to complete the
cycle of ‘cradle to grave’ concept. The holistic management practice as to be
introduced from the benchmarking will be compared to current practice to
understand the gap of current first aid kit management practice in tertiary
















Figure 2: 
Flow chart of first aid kit management methodology

7.0   Work Schedule of Study











Topic selection









Literature review









Survey preparation









Survey distribution









Case study









Data analysis


















Report writing










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