Demonstrating and Promoting Best Techniques and Practices for

Demonstrating and Promoting Best Techniques and
Practices for Reducing Health Care Waste to Avoid
Environmental Releases of Dioxins and Mercury
Pilot Facilities Application Guidelines
1. Project Objectives
The overall goal of this project is to protect public health and the global
environment from the impacts of dioxin and mercury releases. To achieve this,
the project is demonstrating best environmental practices and best available
technologies at healthcare facilities that have been selected to serve as models.
The project focuses primarily on activities such as promoting the use of non-burn
waste treatment technologies, improved waste segregation practices and the use
of appropriate alternatives to mercury-containing devices. These activities are
reflected in the following seven project objectives:
1. Establish model facilities and programs to exemplify best practices in
healthcare waste management.
2. Deploy and evaluate commercially available, non-incineration healthcare
waste treatment technologies appropriate to the needs of each country.
3. Introduce and evaluate the use of mercury-free devices in model facilities.
4. Establish or enhance training programs to build capacity for the
implementation of best practices and technologies both within and
beyond the model facilities and programs.
5. Review and update relevant policies.
6. Disseminate project results and materials to stakeholders and hold
conferences or workshops to encourage replication.
7. Make project results on demonstrated best techniques and practices
available for dissemination and scaling-up regionally and globally.
The project's ultimate benefit is the protection of the global environment and
public health, as well as patients, healthcare workers, and communities, from the
impacts of dioxin and mercury releases.
2. What is required from pilot facilities?
To participate, health care facilities must agree to conduct the following
1. Review and develop a baseline of waste management practices and
policies, including purchase and product utilization policies;
2. Prepare an estimate of total releases of dioxins and mercury into the
environment that result from the health care practices at the facility or as a
result of facility practices (e.g., offsite treatment and disposal) at the start
of the Project; and then prepare a good estimate of release reduction
achieved at the end of the Project, so that the efficacy and cost
effectiveness of the Project at each site can be properly assessed;
3. Establish waste minimization and waste management objectives;
4. Propose and adopt modifications in current practices and policies aimed
at achieving objectives;
5. Establish management structures and management techniques to assure
new policies and practices will be properly carried out;
6. Review product selection policies and procurement procedures, and
revise them as needed;
7. Train both managers and staff to carry out the new policies and practices;
8. Select and deploy appropriate waste treatment approaches;
9. Monitor and review progress; provide ongoing support and assistance
during Project implementation to assure objectives are being met; revise
approaches as needed;
10. Serve as a site host for future training programs, and allow the
documentation of the system change process to be used as a case study as
part of a national curriculum;
11. Allocate needed space to implement best practices in waste management
(space for sharps containers, waste collection containers, waste storage,
12. Share the cost of implementation of waste management best practices by
paying at least 10% of the amount funded by the project as in-kind
13. Ensure technical and financial sustainability of the implemented waste
management best practices after the end of the project.
3. Eligibility criteria
The pilot facilities will consist of 2 hospitals, 1 medical laboratory and 1 dental
clinic. Eligibility of healthcare institutions will be as follows:
Large Urban Hospitals
Number of beds
Medium Rural Hospitals
Number of beds
Medical Laboratories
Dental Clinics
Number of dental chairs
> 250
Passed the latest Ministry of Public Health
A or B
Public or private for profit or private not-for-profit
100 - 150
Passed the latest Ministry of Public Health
Public or private for profit or private not-for-profit
General with or without additional specialization
(e.g. pathology, etc…)
Outside hospitals
The operator of the clinic should be licensed
At least 3 dental chairs
4. Application documents
Applicants must submit the following documents:
1. Application form (Individualized rapid assessment form- I-RAT).
2. Letter of commitment from the healthcare facility’s administration to
participate in the project. The letter should include the following:
a. Commitment to contribute financially (at least 10% of the amount
funded by the project as in-kind contribution) to project
implementation in its premises.
b. A Full agreement to be a “showcase” Project.
c. Nomination of a contact person to act as a coordinator of the project
in the healthcare facility.
d. Explanation on how the waste management system will be
sustained after the end of the project.
3. Copies of the healthcare facility’s license/accreditation.
5. Evaluation of Applications
The first evaluation step consists of checking if:
1- The healthcare facility complies with the eligibility criteria.
2- The application file contains all the requested documents.
If both criteria are satisfied then the application will be evaluated against:
1- The location and accessibility of the facility (aiming to include the largest
number of beneficiaries).
2- The score on the I-RAT (application). The higher the score the lower the
3- The level of co-financing (the higher the level, the higher the grade).
4- Sustainability of the waste management system.
5- Affiliation with an academic institution is a plus.
The evaluation committee will consist of representatives from:
- The Ministry of Environment
- The Ministry of Public Health
- The syndicate of private hospitals
- The syndicate of medical laboratories
- The order of Dentists
- The Order of Nurses
- Arcenciel
- POPs project