The coronavirus pandemic has become a kind of test, revealing many problems in the field of healthcare.
Medicine has long been a source of corruption schemes, and the budgets of district hospitals are coveted money for dubious companies. In our analytical material, we will tell you how medical waste is stored and disposed of, especially from infectious disease departments, which remains the source of mass coronavirus infection.
Since the beginning of 2020, Moldovans have learned about the fact that COVID-19 is extremely contagious, and the preventive measures established by the Exceptional Commission provide for a series of very strict sanitary measures. However, for many residents of our country, it will be a shock to see how COVID waste is stored in close proximity of regular hospital visitors or at a tuberculosis dispensary, where coronavirus patients are also located.
More detail deserves to decipher what medical waste is and what kind of danger it can present. Disposable medical masks worn by medical staff in coronavirus patient departments, disposable gowns, shoe covers, are the items on which the virus most likely remained. Add to this a huge number of disposable syringes used for procedures, plus the used drip syringes that patients place on the wound after an injection. Also, ordinary household waste that is dumped from the covid patient wards, which most likely contain coronavirus on their surface.
From our observations, we noticed four COVID waste collection points – near mortuary in Bălți, in the maternity ward, in the emergency department and at the entrance to the TB dispensary sections. To collect such hazardous waste, special containers are used with a sign warning of the danger of contamination. Many residents of Balti could see these containers, and many Balti residents could be in the immediate vicinity of these containers, for example, at the emergency department of the Balti Clinical Hospital.
The rules regarding the storage and disposal of medical waste in Moldova are specified in “DECISION no. 696” of 11-07-2018 regarding the approval of the Sanitary Regulation for medical waste management, signed by the former Prime Minister P.Filip. Here are clearly specified the rules for storage of medical waste, which, as we can say, are not observed by the management of Balti Hospital. First, let’s look at how hazardous medical waste is stored in the city mortuary area:
In order to understand the violations, it is necessary to get acquainted with the Clauses of “Decision no. 696 ”, which will help you understand, for a start, why special plastic storage bags, made in several colors, are used.
Chapter III SEPARATE COLLECTION AND PACKAGING OF MEDICAL WASTE, art. 24. The color codes of the bags, in which medical waste is collected separately, are as follows:
1) yellow – for hazardous waste: stabbing, cutting, pathological and infectious, identified by codes 18 01 01, 18 01 02 and 18 01 03 * in the List of wastes and the annex to this sanitary regulation;
2) brown – for waste: chemical, medicinal, including cytotoxic / cytostatic, amalgam, identified by codes 18 01 06 *, 18 01 08 *, 18 01 09, 18 01 10 * in the list of wastes and in the Annex to this Sanitary Regulation;
3) green – for non-hazardous recyclable waste identified by codes 20 01 01, 20 01 02, 20 01 39, 20 01 40 from the List of wastes;
4) black – for non-hazardous waste (municipal waste) identified by code 20 03 01 of the Waste List.
From the explanation we see in Article 24 of “Decision no. 696 ”, it can be understood that the yellow packaging is an indicator of the collection of hazardous medical waste. COVID waste, which retains the danger of infecting others, is also packaged in yellow packaging. And, as we can see in the photographic evidence, yellow bags containing disposable stamps, protective equipment and more that have been in contact with coronavirus patients can simply lie on the ground, waiting for disposal time:
When filming, at different times at the disposal site, we can see half-open bags of hazardous medical waste. The yellow bags are marked with a biohazard symbol for their contents:
And even after the removal of dangerous bags from the territory of the Clinical Hospital, a large number of napkins, shoe covers and disposable masks from the infectious disease departments of the hospital remain on the ground. This can be seen in the photo taken after removing the above pile of covid-infected waste bags:
A place for the storage of waste generated by covid with high biological risk is located a few meters from the garages of special emergency ambulances, as well as the official vehicles of doctors. If there is asphalt under the plastic containers, then the bags that did not have enough containers are stored on empty ground, without canopy or protection from the sun or rain.
According to “Decision no. 696 ”dated 11-07-2018, there is a regulation for the storage of hazardous medical waste. Here is what is written in Chapter IV “TEMPORARY STORAGE”:
65. Each health facility should have a centralized temporary storage facility for medical waste.
67. The uncontrolled accumulation, disposal, discharge or disposal of hazardous medical waste is prohibited.
69. For sharp objects, pathological and anatomical and infectious waste identified by codes 18 01 01, 18 01 02 and 18 01 03 * in the List of wastes and in the Annex to this Health Regulation, the duration of temporary storage in a care unit shall exceed 48 hours, unless the waste is stored in a room equipped with a cooling system that maintains a constant temperature of + 4 ° C – + 8 ° C, provided that the storage time is a maximum of 7 days.
70. The room referred to in point 69 of this Sanitary Regulation must have an automatic temperature monitoring and recording system, which must be checked periodically.
75. The requirements for temporary centralized storage of medical waste include:
1) a floor with a surface resistant to mechanical interventions, waterproof, smooth and complete, easy to disinfect;
2) an adequate drainage system / floor drain for the elimination of wastewater from the cleaning in the sewerage network. In the absence of a floor siphon, cleaning is carried out with a minimum amount of water with disposable cleaning articles, which after cleaning will be considered infectious waste;
3) conditions for limiting the access of insects, rodents, animals and birds;
4) screens to protect against exposure to sunlight;
85. In temporary centralized waste storage areas, disinfection and rodent control are carried out to prevent the occurrence of vectors of infectious diseases (insects, rodents).
As we can all see, the current legislation is quite competent in prescribing methods of landfilling bio-waste, prohibiting the establishment of places in an open space, accessible to the sun, rain, as well as rodents and stray dogs, at a controlled external temperature, which must not rise above + 10 ° C.
The TB dispensary also does not comply with “Decision no. 696 ”dated 11-07-2018, having equipped a bio-waste collection site near one of the emergency exits, located in a crowded place right next to the path that leads to the popular Bălți Store” Terminal “:
As you can see, some of the containers that contain hazardous waste for people are ajar. The distance between the containers and the path along which there is a very active flow of people is about 5-7 meters. No protection against solar heat and rain. And one can only guess how many people can become infected by crossing this dangerous route.
In the emergency room, medical waste is stored near the central doors.
Who is responsible for waste disposal?
Since 2017, contracts for the collection and disposal of medical waste have been monopolized by Ecostat Ltd, which is closely linked to the former Minister of Labor, former head of the Social Security Offices, member of the Democratic Party Valentina Buliga.
Until 2017, few people had heard about the company “Ecostat” Ltd, then with the arrival of Valentina Buliga’s husband, Alexei, at the head of this company, it began to receive contracts of hundreds of thousands lei:
Thus, under the patronage of the Democratic Party at the head of the then government, in 2019 the company “Ecostat” had an annual turnover of over six million lei.
Valentina Buliga’s income statement for 2018 proves her family’s connections with Ecostat Ltd:
According to www.idno.md , you can see that, from 2016 to 2018, at the head of the company Ecostat was the husband of the honorary democrat Valentina Buliga, Alexei Buliga:
Balti Clinical Hospital was one of the first clients of this private company, connecting to its services as a municipal hospital since 2017. A high-quality investigation was conducted on this subject by the portal “www.moldovacurata.md”, some of which we also used in our material.
The value of contracts for the disposal of medical waste from the Balti Hospital for 2017
Although the management of Balti City Hall loves to speak in public about the “fight against the garbage mafia”, the documents show that since 2017, when the hospital had the status of a municipality, the money was directed to a structure controlled by the Democratic Party.
In 2017, the Balti Municipal Hospital signed a contract with Ecostat worth 227,520 lei.
In 2018, Bălți Municipal Hospital signed a contract with Ecostat worth 341,280 lei.
On March 1, 2019, Bălți Municipal Hospital became a Republican Hospital. Being in the first half of the year in the status of municipal hospital, the management signed a contract of 486,791 lei for services. Moreover, in July 2019, when the Hospital changed its status and became a republican, it was signed a new contract with Ecostat worth 324,000 lei.
In 2020, the Balti Clinical Hospital signed a contract with Ecostat worth 342,000 lei.
For 2021, Bălți Clinical Hospital signed a contract with Ecostat worth 469,800 lei.
Despite fairly solid government contracts and the sole owner, in the absence of competition, of winning tenders, Ecostat has a very modest website:
What is wrong with disposing of medical waste in the Balti Clinical Hospital?
It was filmed the moment when a minibus of the “Ecostat” company without identification traces went to the storage area on the territory of the TB dispensary. After that, the driver, without putting on his gloves, began to load in the bus biologically dangerous yellow bags:
All this takes place a few meters away from the path along which people go to the Terminal store. As you can see, ordinary minibuses are used to transport hazardous waste, which do not have a special control of the temperature inside it.
The right of reply and the opinion of the expert
To understand why the Balti Clinical Hospital stores medical waste generated by covid, biologically – hazardous, outdoors, we called the deputy director of this medical institution, Ala Condrea. To our call, which was registered, Ala Condrea replied that all the provisions, standards and regulations, according to which the Balti Clinical Hospital operates, are on the hospital’s website. And she will not give information other than those on the site. When asked about the safety of waste storage, Ala Condrea answered that these questions are available only to specialists in infectious diseases, refusing to comment on it.
However, in order to obtain an authoritative opinion, we contacted the head of the Center for Public Health Veaceslav Chișlari. When asked if there were any violations in the storage of hazardous medical waste, he replied that he did not see any violations here. Then we asked according to which legislation the storage and disposal of medical waste is carried out, to which the head of the Public Health Center gave a clear answer “Decision no. 696 of 11-07-2018 on the approval of the Sanitary Regulations for medical waste management. “
From the monitoring of the current situation, it can be concluded that “Decision no. 696 of 11-07-2018 on the approval of the Sanitary Regulation for medical waste management” exists only on paper, and no one is following the process of implementing this resolution. Due to the indifference of the local services, which have to monitor this situation, we have places with hazardous medical waste, generated by covid, in the immediate vicinity of people.
This analytical material was developed within the project “Medicine in Balti and Drochia in terms of civic activists”, funded by the European Union and the Konrad Adenauer Foundation under the grant program “Development of local civil society in the Republic of Moldova”. Its content is the sole responsibility of the project and does not necessarily reflect the views of the European Union.