Management Assessment October

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Percival Horace Wilcox
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1 National Health Care Waste Management Assessment October November 2007 By Ibrahim Longolomoi, Ministry of Public health and Sanitation, 9 th July 2009

2 Outline of the presentation Introduction of HCWM Objectives of the assessment Methodology of the assessment Findings Recommendations Way Forward 2

3 Introduction of the assessment of HCWM Problems associated with HCW are enormous Different efforts/initiatives are inadequate Need to understand dthe existing i structures, logistics and systems for management Develop national plans of action 3

inadequate Need to understand dthe existing i structures,

4 Poor management of HCW 4

5 Poor Waste Management Systems 5

6 Malfunctioning De Montfort Incinerator 6

7 Specific Objectives To conduct a national inventory of Healthcare Waste Management (HCWM) facilities in hospitals. To determine the waste management practices To develop a plan for adaptation in the AOP4 7

8 Methodology for Assessment 24 facilities were included Selection of facilities Selected four provinces Provincial hospitals were included Other facilities stratified for ownership and both random and purposive sampling methods used. 8

hospitals were included Other facilities stratified for

9 Results of National Inventory for hospitals No. Ownership Number 1. GoK Hospitals Sub District Hospitals Faith Based Hospitals /NGO Private 74 5 Nursing Homes 191 Total 497 9

10 Hospital Categories Selected Type of Hospital Number Public Hospitals 15 Mission Hospitals 5 Private Hospitals 4 Total Hospitals 24 10

11 Assessment Data Collection Questionnaire for Hospital Superintendent or Matron. Observational Checklist. Waste in all study hospitals was recorded dil daily for one week. 11

12 Findings

13 Waste containment Provision for sharps waste receptacles showed 95% adequacy Adequacy of waste receptacles for infectious & non infectious waste was at about 75% and 65%. Commonly used waste disposal containers 10 litre metal and 30 litre plastic bins in hospital clinics. High waste production areas; 30 and 70 litre plastic bins used. Provision of liner bags in bins was in 73% of hospitals. Improvisation 20 litre bucket was used for infectious and non infectious waste, while carton boxes was used for non infectious waste. 13

Commonly used waste disposal containers 10 litre metal and 30 litre plastic bins in hospital clinics.

14 Waste segregation practice Waste categories recorded were; sharps, infectious, non infectious, highly infectious, glass and food waste. Practice of colour coding was at 61%. Practice of segregation was in 27% for all waste, 55% did partial segregation while 18% did not segregate waste apart from sharps. 77.3% of Health Managers believed that they practised segregation of waste. Labelling of waste receptacles was 30.4% 8.7% partial labelling and 60.9% did not label at. 14

Practice of segregation was in 27% for all waste, 55% did partial segregation while 18% did not segregate waste apart

15 Waste segregation practice Common observations made; 1. Recommended colour codes for waste bins and bin liners not followed. 2. Matching of bins and bin liners of same colour is poor. 3. Complains of non availability of right colour bins and bin liners was expressed. 4. Facilities had inadequate numbers of bins to realize full segregation. Best practice: 15

Matching of bins and bin liners of same colour is poor. 3.

16 Colour of bins used for non infectious wastes Color codes for non-infectious waste White Blue 14.3 Grey 14.3 Black Percent Note: : HCF should provide bin liners in the 3 colours black, red, and yellow as defined in the national regulation, and they are inserted in waste bins of the same colour. 16

3 0 20 40 60 80 Percent Note: : HCF should provide bin liners in the 3 colours

17 Waste segregation practice Best practice: facility segregates into the following categories: Sharps Infectious Non infectious Highly infectious Glass Minimal practice: Sharps Infectious Non infectious 17

Infectious Non infectious Highly infectious Glass

18 Training of technical staff on HCWM 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% Whether technical staff were trained on HCWM Training of staff members had influence on practices observed in; Private GOK Mission Colour coding Use of bin liners Segregation practices. 10.0% 0.0% Yes No No response 18

members had influence on practices observed in; Private GOK Mission

19 Waste Transportation Labels or markings on tractor, trolleys, and wheelbarrows for waste transport not seen. Transport vessels used were not covered from rainy whether. Most hospitals had hdusable transport equipment. Provided waste transport equipment within hospitals were inappropriate. 19

Transport vessels used were not covered from rainy whether.

20 Waste storage 71% of the health managers interviewed said they had refuse transfer station Assed 53% of hospitals had onsite storage areas. Of those storage areas, 83% are well kept. 61% of storage areas had hdrestricted tit entry. 63% of the hospitals visited had signs of waste spillage or scattering within the hospitals. 20

Of those storage areas, 83% are well kept.

21 Waste Quantification Average daily waste(kg)/patient in KG/Patie ent Waste Private GOK SD GOK D GOK R 21

22 The data below are average values obtained from 23 hospitals of different levels over a period of one week in October Overall Average waste per patient Material per day (Kg/day) Sharps Infectious waste Non infectious waste Food waste Total waste produced Per person per day 22

23 No of all Patients Bed capacity Sharps (Kgs) Waste quantities generated in selected hospitals. Nairobi Hospital Infectious Non Infectious Highly infectious Food waste Mbagathi D.Hosp. Pumwani Mat. Hosp. Gertrude Children s Hosp. Matter Hospital KNH Food Total waste

24 Waste Treatment Treatment of waste includes incineration, crushing, or shredding of waste to reduce the hazard and/or the volume of waste prior to final disposal. Most facilities 83.3% provided incinerators for waste treatment. Of the 83.3% of hospitals with incinerators, 80% of them were functional. 24

25 De Montfort Incinerator 25

26 Waste treatment technologies. Waste Treatment Number of Percentage. Method. hospitals. Crashing go of Glass Shredding of medical waste Incineration

27 Functioning of incinerators 65% of incinerator operators were trained % 100.0% 80.0% 60.0% 40.0% 20.0% 0.0% Functional Incinerators in hospital Private GOK Mission Yes No In hospitals with no functional incinerators; 8.3% were contracting waste out. One hospital used no other method but open burning. 27

28 Final Waste Disposal General Observations; Evidence of overfilled ash pits Evidence of dug up area still with dangerous debris Non restricted placenta pits Non restricted waste dump areas Dug up shallow waste pits commonly in use Open dumps Few facilities partially contract out some waste. Reports of waste (general) collection by municipal authorities. 28

29 Recommendations

30 Key Recommendations 1. Segregation Introduce segregation code of practice to be followed in each hospital. 2. Training Continuous training of staff Rif Reinforce on jbt job training ii and supervision. ii 30

31 Key Recommendations cont d Waste Storage Provide secured storage with adequate chambers for infectious, non infectious, and food waste.. Waste Transport Provide dedicated trolleys/ trolley bins for on site transport. Provide securely designed transport vessel for off site transport. 31

32 Key Recommendations cont d Waste Treatment Consider centralized waste treatment for many facilities. i Recommend choice of technology affordable to facility. Final Disposal Provide secured pits for final disposal of ash and Transportation of waste to engineered designated land fill sites 32

33 Way Forward Support the development of the AOP 4 Support the development of strategic plans of action based on the findings Strengthen stakeholders coordination Support implementation of planned activities in both public and private health care settings. 33

34 Thank You Ahsante

11. The key for waste management Waste segregation

11. The key for waste management Waste segregation 11.1 Segregation at the place of origin The background idea Segregation means the separation of the entire waste generated in a hospital in defined, different