CHINA: Rural Health Project
Medical Waste Management Plan (MWMP)
Background
The Project will be implemented in forty counties in eight provinces. Six of them
have been selected to prepare proposals for piloting when the project is effective.
Subsequently, more will be selected according to agreed criteria between the Bank
and the Government.
The project is rated as Category B in terms of environmental effects. Its primary
focus is on testing the viability of certain institutional innovations—cost control
measures, improved insurance mechanisms, new ways of organizing public health
services, etc. Thus, unlike most traditional health projects, it will not fund the
delivery of a broad spectrum of clinical health services although it is, of course, hoped
that such services may be indirectly affected for the better by the innovations tested.
The government has requested for support for village clinics. The support will involve
supply of quite basic medical equipment, renovation of existing village clinics,
building a very few new village clinics, and training of village health workers in
support of the implementation of various innovations. Such interventions raise
issues of medical waste disposal, albeit quite limited quantities at this level.
Objectives for the Plan
The plan should be implemented by the village clinics in the project areas, to mange
medical waste in a safe manner, hence prevent the spread of infection, reduce
exposure of health workers and patients to the risk from medical waste, and ensure
sustainable environmental development. The plan was developed according to the
relevant laws, stipulations and requirements such as Law on the Prevention and
Treatment of Infectious Diseases of the PRC, Provisions on Nosocomial Infection
Control, and Regulations on Medical Wastes Management.
Strategy and Measures
1. Establishment of A Comprehensive Nosocomial Infection Control System
a) Relevant national laws, stipulations and regulations such as : Regulations on
Medical Waste Management(Order No.380, State Council, PRC), Provisions
on Medical Waste Management by Medical Facilities (Order No.36, Ministry
of Health, PRC) , Categorization of Medical Wastes (Ministry of Health and
Ministry of Environmental Protection 1 ), Administrative Punishment
Measures for Medical Waste Management (Order No.21, Ministry of
Environmental ,Ministry of Health), Standards For Packaging Bags,
1
In March 2008, the State Environmental Protection Administration was upgraded and renamed as Ministry of
Environment Protection.
1
Containers and Warning Symbols for Medical Wastes (Order No.188,
Ministry of Health), etc .
b) Each village clinic should develop and implement its own plan for medical
waste management by taking into consideration the local conditions for the
disposal of medical waste, and Regulations on Medical Waste Management
issued by the State Council and the Provisions on Medical Waste
Management by Medical Facilities issued by the Ministry of Health.
2. Training Village Health Workers on Medical Waste Management and Raising
Awareness of Risks related to Medical Waste Among Villagers
The staff in village clinics should
a) Attend regularly training courses on laws, stipulations, regulations and other
legal bases relevant to safe management of medical waste organized by
relevant government authorities and technical agencies;
b) Be trained on collection, disinfection storage, transportation and disposal of
medical waste, personal protection measures such as hand hygiene, mask
wearing and apply principles and practices learnt in their daily practice;
Villagers and patients
a) Villagers and patients will be introduced on risks related to medical wastes,
avoidance of medical waste and where to report malpractices in medical
waste management.
3. Strengthening Personal Protection
a) The staff in village clinics should take such preventative measures such as
wearing work clothes, cap, mask and gloves, and clean or change them
regularly;
b) Hand hygiene and respiratory etiquette should become a norm.
c) Used sharps should be stored in prick-proof container and handle them with
care.
4. Specific Technical Measures for Medical Waste Management
Medical waste in village clinics mainly falls into two categories, namely, general
waste, and waste with infection potential. In most of cases, chemical and
pharmaceutical wastes are in small amount. In case of a small amount of
pharmaceutical waste, it can be disposed together with infectious waste. In the
event that there is a large amount of pharmaceutical waste, it shall be returned to
suppliers or relevant agencies for proper disposal.
a) Principle for Medical Waste Disposal
Disposal should not create harm to environment including water, air, soil, plants,
animals and human beings in the neighborhood. For instance, it can be deeply
buried but must be in line with the construction planning of local authorities.
Village clinics should choose different disposal measures according to their local
2
conditions. Where conditions permit, village clinics can have centralized
disposal of medical waste. For those village clinics that cannot handle their
medical waste in a centralized manner due to geographic or economic constraints,
they should dispose their waste in line with the requirements of the health and
environmental protection authorities at the county level.
b) Medical waste should be assorted, and separated into different groups.
Different groups of medical waste disposed separately in an appropriate
manner.
i.
A three-bin system with proper color coding (different containers for
general waste, waste with infection potential and sharps) is the basis of a
safer medical waste management system;
ii.
According to national regulations, medical waste is only allowed to be
kept in village clinics for 2 days at most;
iii.
For medical waste suitable for incineration, this should be done so as
soon as possible. They should be burned in a deep pit in a fenced off
place far away from water source to avoid the negative impact on the
environment. For medical waste not suitable for incineration, they
should be disinfected first before they are land filled together. The
responsible officials shall supervise the whole process;
iv.
Packages of syringes, drug bottles and infusion bottles shall be disposed
as domestic waste;
v.
Particular attention should be given to the sterilization of repeatedly used
instruments in village clinics. This can be done with high-pressure steam
as the first choice, or disinfectant as optional;
vi.
Supply, storage and management of pharmaceuticals should be
strengthened to reduce drug waste.
c) In the event of lost medical waste, the staff in village clinics should be
responsible for retrieving immediately and disposing the recovered waste in a
safe manner like burying deeply or burning. Causes for such a loss should
be analyzed, lessons reviewed, and the accountable person be educated to
avoid similar accident in the future.
5. Monitoring and Evaluation
Village clinics should be supervised by County Health Bureau, or Health Inspection
Center and Township Health Center authorized by the County Health Bureau
regularly.
Progress in implementation of the MWMP should be reported by the project
implementation agencies and reviewed by the Ministry of Health. The findings and
remedial actions will be communicated to the World Bank.
3