Healthcare Waste Management at
Hammoud University Hospital
06 June, 2012
Waste Management Plan
√
1-Baseline Assessment
• Onsite survey conducted at both
model facilities
Policies
ProceduresProgram
Update
2-Wasteand
Management
•
•
•
•
Organizational structure and
resources’ allocation
Policies & Procedures
Waste Handling
Capacity Building
3-Mercury Phaseout
• Policies and Procedures
• Replacement of thermometers
Baseline Assessment
Organizational
structure
Policies &
Procedures
Practices
Infrastructure
Equipment
Capacitybuilding
Occupational
Health & Safety
Environmental
Financial
Legal
Baseline Assessment Findings
96% Improper waste Segregation
Baseline Assessment Findings
Organizational
structure
Policies &
Procedures
Practices
•The organizational structure includes a waste
management supervisor and the operations’ manager but
this position is not filled.
•There is not waste management committee at the hospital
level.
•Policies and procedures related to healthcare waste
management exist but are not comprehensive.
•Some waste-related policies and procedures are
inapplicable.
•Some waste-related policies and procedures are not
applied.
•96% of improper segregation practices.
•No monitoring and corrective actions are taken in
relation to waste management.
•Some recycling is taking place (cartons, IV bags…).
•Waste is mixed all together during external transport
and final storage.
Baseline Assessment Findings
Infrastructure
Equipment
• Waste is transported through service elevator, except
for 3 floors where main elevator is used.
• Dirty rooms are available except on the 1st , 3rd and
B1.
• Waste storage areas on some floors are not compliant
with international requirements.
• Location, size and conditions of the Central waste
storage area are not consistent with international
recommendations.
• Overuse of waste bins (namely for GW), especially in
admin. offices → Encourage exaggerated GW
generation rates.
• Inappropriate assignment of waste bins based on the
waste type to be contained → Negatively affect good
segregation practices
• Deficiency of waste bins in some wards (i.e.: Need to
place general waste bins in dialysis main treatment area)
→ Negatively affect good segregation practices
Baseline Assessment
Baseline Assessment Findings
Capacity-building
Occupational Health
& Safety
•No training curriculum specifically for healthcare
waste. HCW management is given as part of the
infection control orientation.
•The housekeeping department trains its employees on
waste collection and internal transportation.
• Health workers are only provided with Hepatitis B
Vaccines.
• None of the hospital staff is vaccinated against Tetanus.
• Health workers are trained on the use of PPEs as part of
the occupational health and safety training .
• Waste workers use mainly latex gloves during duty hours.
• PPEs are available in stock in adequate quantities and
quality.
• 45% of needle stick injuries are due to needle recapping.
Baseline Assessment Findings
Distribution of
Occupational Injuries
Distribution of Needle Stick Injuries by
Affected Population
Needle Stick
36%
40%
50%
Sharps
Injury
47%
45%
Causes of Needle Stick
Injuries
Percent Injuries
40%
35%
30%
24%
25%
19%
20%
15%
10%
10%
5%
Needle Recapping
55%
45%
Other
0%
Nursing staff
Physicians
students
Affected Population
ancillary staff
Baseline Assessment Findings
Environmental
• The quantity of waste generated is on the
high end of the benchmark.
• The percentage of infectious waste is high
constituting around 40% of the total waste.
• No proper segregation of different types of
hazardous and special waste which causes
public health and environmental hazards.
• Different types of wastes are combined
together for final disposal at Saida sea dump
without prior treatment which causes
environmental pollution and releases of
dioxins.
• No policies/procedures related to mercury
containing waste management and disposal
are available.
• Broken thermometers are disposed of in
sharps boxes.
• Wastewater is disposed of without
treatment.
Baseline Assessment Findings
Results of the 22 days waste assessment
Indicator
Result
Average daily occupancy rate (%)
58
Average outpatients per day
462
Average total waste generation rate in kg per bed per day
Bench Mark
Values
3
0.8- 61
Average total waste generation rate in kg per occupied bed per day
5.3
Average total waste generation rate in kg per total patient per day
1.5
Average infectious waste generation rate in kg per bed per day
1.15
0.3-0.41
37
16%2
Average percentage of infectious waste from total waste (%) 37.3
1
References: WHO, 1999; Chen et al., 2009 (for middle income countries)
pathological, infectious and sharp wastes (WHO, 1999)
2 Including
Baseline Assessment Findings
Financial
Legal
• Only monthly operating cost was estimated (including
Costs of sharp boxes, waste plastic bags, disposable
PPEs, nursing staff training, and Wages of the waste
management team)
• The average monthly operating cost amounts to 11
USD/in‐patient.
• 4.5% of the mercury thermometers are broken or
overused.
• Inconsistency with national laws & regulations
specifically:
• Law 64/1988 (The law of conservation of the
environment against pollution from hazardous waste
and hazardous materials).
• Law 444/2002 (Law of protection of the environment).
• Decree 13389/2004 (Determining the types of waste
from healthcare facilities and their disposal).
Waste Management Plan
1-Baseline Assessment
• Onsite survey conducted at both
model facilities
√
Policies
ProceduresProgram
Update
2-Wasteand
Management
•
•
•
•
Organizational structure and
resources’ allocation
Policies & Procedures
Waste Handling
Capacity Building
3-Mercury Phaseout
• Policies and Procedures
• Replacement of thermometers
Steps Of Proper Waste Management
Waste
minimization
Segregation
Handling
Treatment
Transportatio
n
Disposal
Waste Management Program –
Organizational Structure
Organizational Structure
1-Drafting the TORs of the waste management committee
2-Drafting the TORs of the waste management
coordinators in each department
3-Creation of a coordination
mechanism between departments
(Setting responsibilities of different
staff groups)
Waste Management Program –
Resources’ Allocation
Specification of Waste Containers
Waste Management Program –
Resources’ Allocation
Specification of Sharp Containers
Waste Management Program –
Resources’ Allocation
Color Coding & Specification of Waste Bags
Waste Management Program –
Resources’ Allocation
Placement of Waste Containers & Sharp Boxes
Waste Management Program –
Resources’ Allocation
Number of Staff Needed for HCWM
Waste Management Program –
Resources’ Allocation
Requirements for Storage Areas
Waste Management Program –
Policies & Procedures
Policies and Procedures
Drafted Policies:
1-Healthcare Waste Management Policy
2-Classification and Definitions
3-Waste Segregation Procedure
4-Waste Collection, Transport and storage Procedure
5-Cytotoxic Waste Management Procedure
6-Pathological Waste Management Procedure
7-Laboratory Waste Management Procedure
8-Spills Management Procedures
Waste Management Program –
Policies & Procedures
9-Pharmaceutical waste management
10-Management of mercury contaminated waste and
mercury containing devices
11-Waste minimization
12-Cleaning and disinfection
13-Environmentally preferable purchasing
14-Training management
15-Monitoring, inspection forms
16-Audit procedures (Plastic bags, bins, PPEs,
segregation, containment, Training coverage,
Competencies & Compliance)
Waste Management Program –
Monitoring & Reporting
Development of Performance Indicators, including:
•
•
•
•
•
•
•
•
•
Segregation efficiency
Training effectiveness
Stock control
Compliance to OHS
Compliance to reporting procedures
Compliance to collection, transport and storage procedures
Minimization effectiveness
Respect to green purchasing policy
Control of financial aspects
HCW Segregation Chart
Type
-Paper
- Plastic
- Metal
-Organic material
Category of Waste
- Blades
- Needles
- Ampoules
- Blood or body
Fluids
-Items contaminated
with blood and body fluids
- Chemicals
- Pharmaceuticals
Municipal
Sharps
Infectious
Hazardous
Labeling & color coding
HCW Segregation Chart
Type
Category of Waste
- Items contaminated
with chemotherapy
Drugs
Cytotoxic
- Sharps
contaminated
with chemotherapy
Drugs
Cytotoxic
Sharps
- Body parts & organs
Pathological
- Items
Contaminated with
Radioactive material
Radioactive
Labeling & color coding
Waste Management Program – Handling:
Segregation
Recyclable
Recycling Bin
Recycling
facilities
Non-recyclable
Black Bag
Municipal waste
Sanitary Landfill
Non-Sharps
Yellow Bag
Treatment by
sterilization
Sharps
Sharp Containers
Non-Infectious
Red Bag
Temporary
Storage
Export under
Basel Convention
Expired
Pharmaceuticals
Red Bag
Temporary
Storage
Export under
Basel Convention
Sharps
Sharp containers
with purple lid
Non-sharps
Purple Bag
Silver Bag
Burial
Non-Hazardous
Infectious
Hazardous
Healthcare waste
Special Waste
Cytotoxic waste
Pathological
Temporary
storage
Export under
Basel Convention
Waste Management Program –
Handling
Collection
Waste Management Program –
Handling
Routing for Waste Transport (Floor to Temporary Storage)
Transport
Waste Management Program – Handling:
Final Disposal
Recyclable
Recycling Bin
Recycling
facilities
Non-recyclable
Black Bag
Municipal waste
Sanitary Landfill
Non-Sharps
Yellow Bag
Treatment by
sterilization
Sharps
Sharp Containers
Non-Infectious
Red Bag
Temporary
Storage
Export under
Basel Convention
Expired
Pharmaceuticals
Red Bag
Temporary
Storage
Export under
Basel Convention
Sharps
Sharp containers
with purple lid
Non-sharps
Purple Bag
Silver Bag
Burial
Non-Hazardous
Infectious
Hazardous
Healthcare waste
Special Waste
Cytotoxic waste
Pathological
Temporary
storage
Export under
Basel Convention
Waste Management Program –
Handling
Routing for
Auditing
HCWM
Waste Transport (Floor to Temporary Storage)
Training of
Staff
Storage &
Treatment
Collection
&
Transport
Visual
aids
Segregation
Waste Management Program –
Handling
Routing for
Auditing
HCWM
Waste Transport (Floor to Temporary Storage)
Waste Management Program –
Handling
Routing for
Auditing
HCWM
Waste Transport (Floor to Temporary Storage)
Waste Management Program –
Capacity Building
1.
2.
3.
EXAMPLE TEXT
Go ahead and replace
it with your own text.
1
Training Needs
Assessment:
-Six target groups
- TNA = Desired
competencies – Existing
Competencies
2
Training Material
Development
3
ToT & Training
workshops
Waste Management Plan
1- Baseline Assessment
• Onsite survey conducted at both
model facilities
Policies
ProceduresProgram
Update
2-Wasteand
Management
•
•
•
•
Organizational structure and
resources’ allocation
Policies & Procedures
Waste Handling
Capacity Building
3-Mercury Phase-out
√
• Replacement
thermometers
of
mercury
Mercury Phase-out
Comparative
Comparative Evaluation
Evaluation
of Non-Mercury
of Non-Mercury
Thermometers
Thermometers
and Healthcare
and Healthcare
Staff Preferences
Staff Preferences
The Infrared temporal thermometer was chosen to
replace mercury thermometers.