The Covid-19 outbreak also had an impact on increased generation of hazardous medical B3 waste. Based on preliminary results of a joint study of the Indonesian Hospital Association with the Indonesian Association of Environmental Experts as of 5 May 2020, it is known from temporary data from 44 hospitals spread across several regions in Indonesia including RSDC Wisma Atlet, the amount of B3 medical solid waste during the Covid-19 era increased from an average of 344.2 kg / day to 5991.46 kg / day.
The increase of B3 Medical Waste from covid referral hospitals other than Wisma Athlete is around 47%. The most improvement is the Covid-19 Emergency Hospital for Athletes where the waste generation reaches more than 100 bags which, if converted into units of weight can reach 3500kg / day. This increase was due to the classification of B3 medical solid waste during the Covid-19 era, where all the remaining activities of patients treated in hospitals were classified as B3 Medical Solid Waste, including PPE and food scraps of patients infected with Covid-19.
According to data published by the Ministry of Health of the Republic of Indonesia, the number of hospitals in the DKI Jakarta Province is 190 units, most of which are public hospitals managed by the private sector with a total of 19,996 units of beds. From these data there are 28 regional general hospital units managed by the DKI Jakarta Provincial Government with a total of 3,252 beds.
Under normal conditions, based on the survey results, the generation of hazardous medical B3 solid waste is 1.08 kg per bed. Referring to the average occupancy rate of 58%, the estimated amount of normal medical waste reaches 12,525.5 kg / day or 12.5 tons / day. This number does not include clinics and primary health services. So it is predicted that the average total generation of B3 medical solid waste in DKI Jakarta is approximately 13.5 to 15 tons / day.
Based on the Decree of the Minister of Health of the Republic of Indonesia Number HK.01.07 / MENKES / 169/2020 concerning the Designation of Certain Emerging Infection Disease Referral Hospitals there are 8 hospitals in the DKI Jakarta Province and added 3 emergency hospitals to handle Covid 19. From the data there are 6 hospitals that manage waste using Incinerator and the rest is transported by third parties. The list of referral hospitals and their waste treatment can be seen in the following table.
| DECREE OF THE MINISTER OF HEALTH, REPUBLIC OF INDONESIA
NOMOR HK.01.07/MENKES/169/2020 ABOUT DETERMINATION OF HOSPITAL REFERENCES OF CERTAIN EMERGING INFECTION DISEASE |
|||
| No | Hospital Name | Treatment | Amount of Waste (kg/hari) |
| 1 | RSPI Sulianti Saroso | Diolah di incinerator | 150 |
| 2 | RSUP Persahabatan | Diolah di incinerator | 300 |
| 3 | RSUP Fatmawati | Diangkut oleh Pihak Ketiga | 466 |
| 4 | RSPAD Gatot Soebroto | Diolah di incinerator | 1100 |
| 5 | RSUD Cengkareng | Diangkut oleh Pihak Ketiga | 603 |
| 6 | RSUD Pasar Minggu | Diangkut oleh Pihak Ketiga | 425 |
| 7 | RS Umum Bhayangkara Tk. I R.Said Sukanto | Diolah di incinerator | 355 |
| 8 | RS TNI AL Mintohardjo | Diolah di incinerator | 100 |
| RS Darurat Covid19 | |||
| No | Hospital Name | Treatment | Amount of Waste (kg/hari) |
| 1 | RSD Wisma Atlet | Diolah di incinerator | 1000 ~ 2500 |
| 2 | RS Siloam Mampang | Diangkut oleh Pihak Ketiga | 30 ~ 40 |
| 3 | RS Pertamina Jaya | Diangkut oleh Pihak Ketiga | 250 |
Source: DLH DKI Jakarta
Referring to the Waste Management Guidelines for Referral Hospitals, Emergency Hospitals and Health Centers that handle Covid 19 Patients (Kemenkes), medical B3 waste treatment can use an Incinerator / Autoclave / Micro Waves. Incinerator is a waste treatment device with a combustion process above 800 ° C, while an autoclave is a device used to treat waste with a high pressure evaporation process. Each technology certainly has advantages and disadvantages of each. Autoclaves use thermal evaporation technology that does not produce harmful emissions, is free of pathogens and is safe to be discharged to landfills, but requires pre-treatment such as proper waste sorting and requires treatment of treatment discharges. Incinerators can reduce or clean up bacterial content in wastes that have the potential to pollute the environment, the processing process requires fast time, does not require sorting and the results of combustion can be used for steam generation or electricity generation.
The ability of hospitals to treat B3 waste is still very limited. Especially in the current Pandemic era, waste processing technology is very much needed to destroy B3 waste dumps produced from hospitals or households infected with Covid-19. Referring to the data that has been presented in the initial paragraph, the amount of B3 medical waste in the Covid-19 era increased very sharply to reach 1132%. If it is not dealt with quickly, it will cause new problems in the community and regional governments in particular. Therefore the DKI Jakarta Provincial Government in particular the DKI Jakarta Environment Agency needs to move quickly to manage the generation of B3 waste by using appropriate and environmentally friendly technology.
References :
http://sirs.yankes.kemkes.go.id/fo/
Keputusan Menteri Kesehatan Republik Indonesia Nomor Hk.01.07/Menkes/169/2020 Tentang Penetapan Rumah Sakit Rujukan Penanggulangan Penyakit Infeksi Emerging Tertentu
Implementasi Pengelolaan Limbah B3 Medis Covid-19 di Provinsi DKI Jakarta oleh Dinas Lingkungan Hidup Provinsi DKI Jakarta Disampaikan pada Acara Webinar yang diselenggarakan oleh Kementerian PPN/Bappenas Dan Ikatan Alumni Teknik Lingkungan – ITB Jakarta, 28 April 2020
https://mediaindonesia.com/read/detail/306644-autoclave-solusi-pengolahan-limbah-medis-covid-19
Trisaksono Bagus P. Pengelolaan Dan Pemanfaatan Sampah Menggunakan Teknologi Incenerator. ejurnal.bppt.go.i
List of B3 Medical Waste Managers in Indonesia :
- Arah Environmental Indonesia
- Wastec International
- Jasa Medivest
- Tenang Jaya Sejahtera
