Health Care Waste Management Policy Formulation & Implementation

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1 Health Care Waste Management Policy Formulation & Implementation Ruth Stringer International Science and Policy Coordinator Health Care Without Harm National Meeting on Health Care Waste Management and Mercury Free Health Care Kathmandu January 2011

2 POLICY ISSUES Laws/guidelines Implementation Compliance All three needed for an effective system Need to reflect the situation in the country including variations within it

3 Hospital level implementation plans Policy commitment Signed by director, made widely known Budget line Focal point Waste management committee May be linked to the injection safety committee Implementation/Expert support

4 Waste Management Committee Administration Finance Purchasing Medical representative Housekeeping/waste management section Maintenance Regular meetings, annual policy review Report to Director

5 Everybody is involved

6 Baseline assessment Needed to work out precise specifications and costs for the facility in question Work out amounts of waste produced How much waste of each type? Either segregate and weigh during the assessment or estimate from data on similar facilities What equipment will be needed? How many bins, what size autoclave etc

7 Reducing waste volume and hazardousness Procurement policies Certification of all injection equipment Mercury-free equipment Alternatives to PVC, glutaraldehyde etc Low waste products Take-back for unwanted and out of date pharmaceuticals Changing prescription practices Reducing injections to reduce sharps waste

8 Substituting mercury Thermometers and blood pressure meters Highly toxic to nervous system, environment 1200 mercury thermometers broke in Bir every year Secure mercury waste until there is a safe disposal route

9 Technology needs Varies from facility to facility May be dictated by National policy, international policy, eg WHO Facility size and location Climate, other factors On-site or offsite Needle cutters/sharps bins Incineration/autoclave/burial/other

10 Autoclaves of all sizes Autoclaves Very small autoclaves 4 L pressure cooker $25 -$50 40 L sterilizer $125-$600 Small to medium-size autoclaves 100 L autoclave $ $ L waste autoclave $25,000 - $35,000 Large centralized autoclaves Optional Shedders $20,000 - $150,000 14,000 L waste autoclave $200,000 - $250,000

11 Tanzania

12 Philippines

13 Advantages of autoclaves for medical waste disinfection Familiar technology in hospitals Reliable and economical Available in many sizes and levels of sophistication Can easily test them, prove they are working effectively

14 Segregation system Varies from country to country Most basic: sharps, infectious/risk, other May be dictated by policy or decided by the hospital Disposal route the most important factor 75% of waste is not hazardous Large proportion can be recycled

15 Segregation system

16 Segregate and destroy needles 36% HIV in South Asia from unsafe injections (WHO) 12% of needle stick injuries happen during waste disposal Uncut syringes can be illegally repackaged and resold Never recap needles Cut syringes immediately Disinfected syringes can be recycled Link with Safe Injection Global Network, WHO

17 Transportation and storage Dedicated, well designed trolleys Collect at least once/day Storage Secure from public and pests Easy to clean Water available Spill management and protective equipment etc Storage time limits Separate routes for clean and dirty materials

18 Training and implementation General training for all at start Appropriate training for different levels Administration Medical Housekeeping and waste handlers Waste treatment technicians Pilot practices in model wards Replicate across hospital, more training on the ward

19 New training paradigm The usual way 2-3 day lecture course A few practical demonstrations or site visits No testing or followup Return to a hospital with poor system A new way Centres of excellence Core of experienced staff to train others Allow placements Train administration too- even directors! Testing and follow-up Integrate training with implementation

20 Monitoring and compliance Monitor regularly Reward good practice, correct bad practice Record important information Waste amounts, segregation practices, accidents and injuries, staff views and ideas, costs and income, operation of waste treatment technology Waste management Committee review progress Make changes as necessary

21 Log for feedback

22 Biological indicators Internationally accepted as the best test of efficacy Contain heat resistant bacterial spores Incubate for 24 hours Any surviving spores will grow and turn the solution yellow

23 Waste and income data summary

24 Thank you More information from

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