Copy of RAT-v2-en

7/30/2019 Copy of RAT-v2-en

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Section Scope Content

1. Introduction Provides basic information on this Rapid assessment tool

2. Checklist for chronological preparation of the assessment.

3. Guide Guidance on how to get prepared - how to train the interviewer and on what results can be expected.

4. Glossary + abbrev Terminology Listing of all specific terms used

5. Questions sum Summary of all questions used in the tool.

6. Tool A National

have had relevant activities in HCWM in different settings of the country.7. Tool B National Questionnaire to collect data at Ministerial level

B-1 Questionnaire for the Ministry of Health

B-2 Questionnaire for the Ministry of Environment

8. Tool C Local Questionnaire to collect data at Municipal Authority level

9. Tools D Local Questionnaire to collect data regarding different areas in healthcare facilities

D-1 Area: Management, Finance, Legal Regulations

D-2 Area: Application of Healthcare Waste Management

D-3 Area: Occupational Safety

D-4 Area: Training & Monitoring

D-5 Personal private observations made during visits of healthcare facilities (filled by the interviewer)

10. Input Quest D HCF Local The results of the questionnaires D1 to D5 are gathered by the interviewer in one table

11.esu s ues

HCF Locale resu s o e a e npu ues are summar se an evaua e ex o e nser e manua y.

Other results are generated automatically)

12. Tool E (D1 - D5) Local Rating system for the HCWM situation assessed at the HCF

Contact: World Health Organization: http://www.healthcarewaste.org / E-mail: [email protected]

Healthcare waste management Rapid assessment tool

Content

Contacts

We are interested in your data

Thanks to send to WHO a software copy of the spreadsheets containing the data you will have collected with this tool

for country level

Preparation

Version - 2011

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1 Introduction

In many (mainly low income) countries, improper management of wastes generated in healthcare facilities causes direct health impacts on the community, the personnelworking in healthcare facili ties, and on the environment. In addition, pollution due to inadequate treatment of waste can cause indirect health effects to the community.

healthcare wastes (HCW) include sharps (syringes, disposable scalpels, blades, etc.), non-sharps (swabs, bandages, disposable medical devices, etc.), blood and anatomicwaste (blood bags, diagnostic samples, body parts, etc.), chemicals (solvents, disinfectants, etc.), pharmaceuticals, and others, and may be infectious, toxic, create injuries or

This rapid assessment tool is a part of an overall strategy developed by WHO which aims at reducing the disease burden caused by poor healthcare waste management(HCWM) through the promotion of best practices and the development of safety standards.

2 Basic assumptions and objectives

The basic assumption is that it is possible - in a short period of time (7-15 days), by questioning main stakeholders and by selecting a number of healthcare facilit iesrepresentative of the country - to gather the essential data necessary to have a sufficient understanding of the situation regarding HCWM at a national level.

By analysing the role of each stakeholder along the HCWM stream it should be possible to identify where problems remain and what simple, practical actions should beundertaken to solve them.

The aim of this tool is to gather sufficient relevant information so as to provide decision makers/experts, etc. with the necessary data to help them elaborate a national actionplan. An example of such a plan can be found at the following address: www.healthcarewaste.org

3 Who can/should use this rapid assessment questionnaire ?

Senior management personnel (or other trained personnel) responsible for the design, implementation, evaluation and update of national policy and plans for healthcare waste

management constitute the primary audience of this rapid assessment toolbox. Assistance from appropriate national or international persons or group should be sought before

conducting the proposed assessment if senior management staff do not have the required expertise and experience. International experts will find this toolbox useful when being asked for assistance to conduct assessments or evaluations of waste management systems in countries where poor

healthcare waste management is suspected.

National policy makers may find this rapid assessment tool useful to better understand data for decision-making requirements in safe and appropriate waste management.

4 How to use this rapid assessment questionnaire ?

Assessment of healthcare waste management practices should follow 4 steps to ensure that the procedure will be useful, feasible, ethical and accurate.

1) Engaging all relevant stakeholders by using tools A, B 1-2, C, D 1-5

2) Describing the situation by the interviewer using Results Quest D.

3) Gathering credible evidence of defined quality and quantity by filling in as precisely and completely as possible all questions in each tool.

4) Justifying conclusions in your final report by giving access to readers of field data collected with each tool.

To ensure that information collection is a process conducted and analysed appropriately, this toolbox has been organised in several parts which follow a logical and

chronological frame which you are invited to follow. This frame goes from national (organisations, ministries) to local (the health facilities) and from the start of the HCWMstream (waste generation) to the end (final disposal).

It is recommended that you start by going through each tool to make sure you understand the questions. Data collected should be as complete, short and precise as possible. Itcan be of several types: [C] multiple choice; [N] numerical (quantitative); [Q] qualitative (ranking from 1-5); Boolean [B] (yes/no) or [T] text.

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5 Description of the tools

The tools are all structured in the same way and the numbering of topics and questions are made in such a way that data can be easily retrieved and analysed.

Each tool is described shortly below with its main stakeholder and the kind of information which it is hoped they can provide you.

A Associations, NGOs, Universities: these actors can provide interesting elements which can help you to complete your understanding of how the system works linked to their

practice of how HCWM is practised in places they have visited/worked in. This tool is text based, aiming to insert them into the national assessment report in order to provide anoverview of the activities others than on authority or facility level.

B Ministries (Health, Environment): these key interlocutors should assist you and provide you with a complete picture of how the system (should) function on both a practical,

technical, financial and legislative level. This tool is text based, aiming to merge the answers and insert them into the national assessment report.

C Municipal/local political authorities: confronted on a daily basis with general waste management issues, they can provide good information about waste collection, transport and

final disposal as well as eventual recycling habits, etc.

D1 Area: Management, Financing, Legal Regulations : Those questions can be answered e.g. by the Hospital managers like the director, accountancy, administration. They are in

a good position to give you an overall view of the healthcare facility structure and data.

D2 Area: Application of Healthcare Waste Management. Those questions can be answered by the person(s) responsible for waste management, the waste handlers , medical staff

or logistic staff. Persons answering these questions should have deep and detailed knowledge about waste management processes in the facility.

D3 Area: Occupational safety. The occupation safety of ficer, infection control committee, head nurses or the responsible person for healthcare waste management can answer

these uestions.D4 Area: Training & Monitoring. The responsible person for training, the responsible person for healthcare waste management, infection safety committee can answer these

question.

D5 The questioner: the questioner can rate by himself what he has seen during the onsite visit in each facility. The questioner can rate areas like the status of awareness,

segregation, equipment, transport & storage, treatment, disposal etc. This to influence the final result in order to reflect a situation analysis as close as possible to reality.

Input

Quest D

All questions of the Tools D (D1-D5) answered by the participating healthcare facilities / interviewer can be filled into this form, in order to receive all results automatically.

Results

Quest DSummarised Results of the Tools D: This tool is displaying all results of the Tools D.

E Rating system: this last tool is displaying summarised and rated results by topic automatically, if the "Input Quest D" form is filled.

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6 Identifying & engaging relevant stakeholders

Most problems and solutions are found at a human level. It is therefore essential to identify all relevant stakeholders, consult them and engage them by convincing them of the

importance/interest of having a simple and efficient HCWM system.

The existing tools deal with the major stakeholders. Nevertheless it may be possible that, for example other important injection providers outside healthcare establishmentsshould be included in the analysis, etc. In such cases, we recommend you use the listing of all questions and choose those you believe are the most relevant.

In certain (especially small) facilities, you may find out that the same person will have to be interviewed for several tools !

7 Selection of healthcare facilities

So as to be able to extrapolate collected data, a sufficient number of healthcare facilities representative of the country must be visited.

To keep things simple, choose between one and two healthcare facilities per size and category of structure (private, public, religious), type of area (urban, peri-urban, rural) and

by distinct ethnical and/or geographical area (topographic or climatic zone). This should normally lead you to visit between 6 and 12 health establishments.

Specialised healthcare facilities such as psychiatric, geriatric institutes, etc. are not considered as important HCW producers and are therefore left out of this study.

8 Information & Contacts

To comment on this tool, please contact WHO: [email protected]

Potential partners with international or regional outreach who are interested in advancing the agenda of safe HCWM and wish to cooperate in the further development andimplementation of activities can contact WHO [E-mail: [email protected]]. Visit our web site www.healthcarewaste.org or www.who.int/peh for additional information

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ealthcare waste management Rapid assessment tool

weeks time needed action done remarks

efore

count about 15-20hours in total

8 3 hours Go through the entire Rapid Assessment Tool (RAT) to make sure both its structure and content are clear

for you.

If you have any questions don't

hesitate to contact us !8 - 7 6 x 30 min. Get in touch with the Ministry of Health (if not already done), so check when is the most appropriate period

to perform the field assessment. Ask for their support in the preparation of this assessment: can theysuggest a list of HCF (Healthcare facilities) that you could visit

7 2 - 5 hours Try and find a local counterpart both for the organisation of the logistics (driver, hotel, etc), assistance

during the mission and follow up once it is finished (there are always some bits of information one wouldneed and can only get if someone is on the spot.

7 2 hours Once you have a fair amount of information about where you will be going, try to make up a realistic planaccording to distances to be driven, road status, size of HCF to be visited, etc.

6 2 hours Make a list of all the key interlocutors you should/must meet. Enter their coordinates in the contact sheet soas to have it at all times with you.

6 2 hours Request from the Ministry of Health that they provide you with a document giving you full access to alldocumentation you may need.

1 1 hour According to the number of HCFs you intend to visit, make the corresponding number of paper copies of the tools you will need (D1-D4), unless you are sure to be able to make photocopies on site.

uring

1-2 hours per dayto sum up andprepare the next

At the end of each day, make a summary of the day and check your field notes. Prepare the plan of the

next day according to data collected, planned meetingsConfirm the meetings for the next day

Enter data collected on your computer on a daily basis. Sending this information on regularly by e-mailensures data to be stored in an other place than your computer only (for security reasons).

2 days before the end of your f ield mission, go through the entire documentation you have managed tocollect. Think about any information you believe would be important to have and try and get hold of it whileyou are in the country.

After

count about 2-3weeks of full timework

1 Go through the entire documentation.

1 - 2 Write the report. An example of such a report can be found at: www.healthcarewaste.org or http://www.who.int/water_sanitation_health/en/ under healthcare wasteEnvisage organising a workshop 3-6 months after your field assessment so as to implement it. People

convened to this reunion are both local (Ministry of Health + Environment; resp. of medical staff training;representatives of the medical staff) and foreign (potential donors, cooperation agencies already workingin the country)

The success of your field assessment will depend greatly on how well it has been prepared beforehand. Having all logistical aspects settled;

meetings with key interlocutors agreed upon and authorisations from the ministry of Health provided or promised in a written form will save you lots

of time and energy. The following points are not exhaustive, but give most of the main points.

The success of your field assessment will depend greatly on how well it has been prepared. Having all logistical aspects settled, meetings with key

interlocutors agreed upon and authorisations from the ministry of Health will save you lots of time and energy.

The quality of your report and proposals depends on both the quality and amount of representative data you managed to collect during your field

visits as well as the possibility to get, via a local counter part, any further data needed.

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Rapid Assessment Tool RAT


1. Getting started

Duration

30 min

45 min

45 min

45 min

45 min

30 min

30 min

120 min

Some presentations on the topics above are available at WHO (3 day basic training on healthcare waste management).

In this module it is recommended to go through all tables of the tools and to outline the meaning and usage of all tables. At this point of introductionthe schedule of conducting the assessment and the procedure should be discussed in detail. Highlight the table "preparation" and "glossary + abbrev"in order to ensure that all interviewers are aware about the terminology of the tool and preparation needed also during the assessment.

A workshop will help the interviewers to understand the procedure completely and to identify problems and questions. In this workshop the use of the

questionnaires is played through. The following set up could be used during the workshop: For each area of concern of the questionnaires D1 to D4

one participant sits at a desk for answering the questions of the questionnaires (they present the healthcare facility). Other participants take one ofthe questionnaires D1, D2, D3 or D4 and are interviewing the participants at the desks. The interviewers are filling out the questionnaire. Afterfinalising the first questionnaire, the position of each participant is shifting one position to the right in order to ensure that all participants haveexperienced each position. At the end all participants are filing "Quest D5". Afterward the gained experiences are discussed and questions answered.

After clarification the team leader supports the participants how to fill the "INPUT Quest D" table.

Introduction RAT Tool

Workshop RAT

In this "guide" table you find some examples how to get started, the tasks and duties of the team leader and interviewers, how the interviewers can be prepared on the job and which results can

be received from the gathered data. Furthermore it highlights also gaps and difficulties which may be faced.

This module should include information about basic principles and practical instructions for safe waste collection, storage and transport.

To ensure the trainees understand the need for effective waste segregation and are able to implement this key component of waste management,this module includes the principles for segregation and the associated measures such as colour coding, labelling, packaging and collection supportedby practical samples.

This module should outline international regulation as well as relevant national laws, regulations and guidelines.

This module should educate the participants about the potential risks inside an outside of their sphere of action and about the principle of disease

transmission cycle.

Content / Description

Furthermore the team should received a short training on the topic "healthcare waste management" in order to receive relevant background information for the visits during the assessmenttour. It is recommended to conduct an introducing training on background and the use of the tool. The following topics should be targeted:

Topic

Risks of healthcare waste

Legal Background

This module should build awareness and capacity in safe and environmental friendly on-site treatment methods including definition of relevant terms(incineration, autoclaving, microwaving etc.).

This module should outline the importance of Personal Protective Equipment (PPE), which safety measures are needed during waste handlingprocedures and how to use it.

Segregation

Logistics

Treatment of Waste

Occupational Safety

The identification of the participating authorities and healthcare facilities is an important factor for the quality of the results of this assessment tool. Key persons from relevant authorities whohave the position and knowledge to answer your questions have to be identified.

It is recommended that the assessment team meet at least the day before the assessment starts, in order to go through the interview schedule together. A master copy of the assessment toolis printed out for detailed discussion. For every day in the week, a precise schedule should be available. The questionnaire is explained in detail by the team leader and each interviewer receivea complete set of the tool.

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2. Results receiving from the Questionnaire A, B and C

Results Quest D and Tool E: From the data summarised by the team leader in a table "Input Quest D" from all interviewers, the table "Result Quest D" will be generated automatically. The

results apply in text form or quantitative (by numbers or percentages). Also Tool E is generated automatically by the input of the table "Input Quest D". This summarising rating system is to giveyou a set of indicators of how good/bad is the situation regarding HCWM per topic. It can be decided how to the influence of the results from the staff of the hospital and the personal evaluation

of the interviewers by changing the weighted percentages of E15 and F15 of Tool E . Out of this results also graphical accounts can be generated like outlined below (3.).

After the interviewers are briefed the following RAT tables are to be copied for the interviewer (Quest A to D5)

Questionnaire A : Number of printed table "Quest A" in accordance with the number of visiting relevant NGO, associations etc. . The results are gathered by the team leader and summarised

in the final report.

Questionnaire B1: Number of printed table "Quest B1" in accordance with the planned interviewed persons in the Ministry of Health. The results are gathered by the team leader and

summarised in the final report.

Questionnaire B2: Number of printed table "Quest B2" in accordance with the planned interviewed persons in the Ministry of Environment or other relevant ministries. The results are gathered

by the team leader and summarised in the final report.

Questionnaire D1-D5: Number of printed tables "Quest D1 to Quest D 5" in accordance with the planned interviewed healthcare facili ties. D1- D4 will be answered by the staff of the

healthcare facility and D5 will be filled by the interviewer in order to enable the interviewer to have an effect on the results of the assessment, the received training will help to fill out this table.The results of these questionnaires are filled by the interviewer into the table "Input Quest D".

Input Quest D: All results of D1-D5 of all healthcare facilities are summarised. First the questions which is answered in text form are summarised - the other questions can be summarised in a

numeric way. The interviewer is filling this form every day - or after each visit in a healthcare facility by taking the answers of the questionnaires D1-D5 and transfer the results into the templateof the table "Input Quest D". This filled table is handed over to the team leader regularly - or at the latest at the end of the interview tour. It is possible to enter the results of 100 healthcarefacilities. The rows 110 to 122 are analysing the results automatically and should not be manipulated.

Input Quest D : The team leader is gathering all results from the Quest A, Quest B1, Quest, B2, Quest C and "Input Quest D" from all interviewers every day or at the end of the interviews. Theresults of the table "Input Quest D" from all interviewers are assembled in a summarised Input Quest D table. Furthermore the questions which are answered in text form are gathered andassembled. In case of malfunction of the calculations please contact: www.healthcarewaste.org

The "Input Quest D" table will be filled by each interviewer directly into the excel sheet:

Gathering of data by the team leader

Automatically generated results

In questionnaires A, B and C the data which are collected are either quantitative [N] (number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (one or

several numbers which correspond to the answer) or text [T]. As there are only one or two questionnaires filled of each questionnaire type (A, B or C) the evaluation can be done manually. Theresults can directly be summarised in the report by the team leader.

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3. Exemplary Results received from the Questionnaires D (trial test Uzbekistan)

Example of result for question 400: Which waste kinds are generated in the healthcare facility (%)

GeneralWaste Recyclables Radioactive Infectious Sharps Chemicals

Pharmaceutical Anatomical

large 100% 67% 0% 100% 100% 33% 67% 100%medium 100% 0% 0% 100% 100% 100% 100% 100%

small 100% 0% 0% 33% 100% 0% 33% 0%

average 100% 22% 0% 78% 100% 44% 67% 67%

Example of result for question 501: How many needle stick cases reported in the past 12 months (average per person)?

large medium small average big = large hospitalsneedle

sticks 0.33 0.00 3.00 1.43 medium = (sub-)district hospitals

small = ambulant servicesThe results on this example clearly indicates urgent mitigation measurements regarding injection safety, especially in small scale healthcare facilities. Injection safety should be targeted by MoH.

Example of result for questions 1301 and 1302: Dedicated budget available for healthcare waste management

No. Question large medium small

1301

Budget forhealthcare

wastemanagement

is available

3 3 2

1302Budget perbed and year

$0.77 $0.00 $0.00

In this example a contradictory result is shown. At question 1301 it was answered that budget for healthcare waste management is available and partly used. On the other hand at question

1302 only the large healthcare facilities indicated to have in average 0,77 US$ available. The medium and small facilities do not have a budget available. It is important to cross check thequestions on reliability and to decide if these questions should be excluded - or the contradictions should be explained.

Explanation

[0] not identified;[1] planned;

[2] available but not used;[3] available and used

US $ per bed and year

0%

20%

40%

60%

80%

100%

Quest 400: Generated waste kinds

large

medium

small

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4. Result Tool E (trial test in Uzbekistan)

Results

Questionnair

es D1-D4

esu

Personal

Observation

D5

Weighted

Result Verbal result

Weight 50% 50% 0-10% equivalent "critical situation"

44% 18% 31% satisfactory 11-30% equivalent "problematic situation

67% 45% 56% satisfactory 31-60% equivalent "satisfactory situation"

0% 10% 5% critical 61-80% equivalent "good situation"

67% 0% 33% satisfactory >81% equivalent "excellent situation"

Results

Questionnair

es D1-D4

Result

Personal

Observation

D5

Weighted

Result Verbal result

Weight 50% 50%

56% 50% 53% satisfactory

63% 62% 63% good



For a better understanding please try to change the percentages of E78 to E80 and F78 to F80. Also change the weights 50%:50% to e.g. 100 % to 0% (if you do not want influence by theinterviewers).

Example: All over result on national

level

Example: Healthcare waste final

disposal

All over average

big = large hospitals

medium = (sub-)district hospitals

small = ambulant services

big = large hospitalsmedium = (sub-)district hospitals

small = ambulant services

In Tool E 12 different areas of healthcare waste are summarised: staff (and training), HCW segregation & handling, HCW waste handling equipment, HCW storage area,

HCW collection & on-site transport, HCW treatment, HCW final disposal, HCWM regulations (code of conduct; management plan, policy), personal opinion. Thesummarised results are outlining the results of questionnaires D1- D4 gathered from the staff of the healthcare facilities and the personal observation of the interviewer.Below the weighted results are applied with a weight of 50 % to 50 % - the weight can be adapted by the team leader to the situation in the country. In the table below allresults of all answers are applied. The all over average of this example is "satisfactory". The results are differentiated in big, medium and small facilities, as there can be

found very different healthcare waste management situations.

Possible verbal results:

All over average

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5. Drawbacks and gaps that render its use difficult

This tool needs a knowledgeable team leader / team and furthermore a dedicated budget for implementation (daily rates, transport, accommodation, per diems).

The assessed results generated by this tool are comprehensive and need rating and explanation to the relevant stakeholder like authorities. It is important to find incoherent data and to identifyand highlight the most important data.

After the assessment phase, the next step is the planning and implementation of a national strategy on healthcare waste management or specific measures aiming to improve the situation. The

RAT can be repeated after some years or if a national strategy on healthcare waste management was implemented the "Monitoring Tool (MT)" on healthcare waste management developed byWHO can be used in order to evaluate the improvements.

A crucial point of the RAT tool is its complexity. As the objectives of healthcare waste management are intersectoral and touching topics like occupational safety, hygiene, public health,environment and economics, an assessment of the current situation in a country is multilayered. Furthermore a critical number of information has to be gathered in order to receive a reliable

Furthermore the interviewer should provide sufficient self confident to persuade higher positions in the hierarchy in order to be taken serious and to receive high quality answers.

While visiting healthcare facilities the interviewers should be able to weight the situation correctly, in order to evaluate if the interviewed persons are hiding information or do not have theawareness to provide high quality answers and to be able to fill out "Quest D5".

Therefore the collection of data should be well prepared. A team of interviewers should be well chosen and should have a fundamental knowledge about healthcare waste management or betrained on the relevant topics. Information which are gathered by interviewers who know exactly what's the meaning of the questions in order to explain the questions accordingly aiming to

receive the correct and realistic answer of the interviewee.

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Glossary and abbreviations

n Term Definition & [includes]

1 Anatomic waste

2 Auto-disable Syringe

3 Bloodborne pathogens

4 Burden of disease

5 Chemical waste

6 Colour coding

7 Container

8 Cytotoxic waste

9 Disinfectant

10 Disposable syringe

11 Disposal

12 Handling

13 healthcare wastes withhigh content of heavymetals

14 Hepatitis B

15 Hepatitis C

16 HIV / AIDS

17 Incineration

18 Infection control

19 Infectious healthcarewaste

20 Open dump

21 Pharmaceutical waste

22 Pathogen

23 Pressurized containers

24 Radioactive healthcarewaste

25 Recycling

26 Risk

27 Safe injection

28 Safety (sharps) box

29 Safety syringe

30 Sanitary landfill

31 Segregation

32 Sharps

33 Sterilisable syringe

34 Storage

35 Treatment

36 Waste management

Abbreviations

n abbreviation definition

1 HCW healthcare waste

2 HCWM healthcare waste management

3 HCF healthcare facility

Consists of recognizable body parts.

A specially modified disposable syringe with a fixed needle which is automatically disabled by plunger blocking after a single use.

Infectious agents transmitted through exposure to blood or blood products.

The health and socio-economic cost of a given medical condition on a society.

Consists of/or containing chemical substances.[Includes: laboratory chemicals; film developer; disinfectants expired or no longer needed; solvents, cleaning agents and other].Designates the use of different colours for the storage of various categories of HCW.

Vessel in which waste is placed for handling, transportation, storage and/or eventual disposal. The waste container is a component of thewaste package.

Drugs possessing a specific destructive action on certain cells.

Chemical agent that is able to reduce the viability of microorganisms.

An all-plastic syringe designed for a single use, with a separate, steel needle. Because there is no mechanism to prevent re-use, this type ofsyringe may be used more than once.Intentional burial, deposit, discharge, dumping, placing or release of any waste material into or on any air, land or water.

The functions associated with the movement of waste materials.

Consists of materials and equipment which include heavy metals and derivatives in their structure.[Includes: batteries; broken thermometers; manometers].

Hepatitis caused by a virus and transmitted by exposure to blood or blood products or during sexual intercourse. It causes acute and chronichepatitis. Chronic hepatitis B can cause liver disease, cirrhosis, and liver cancer.

Hepatitis caused by a virus and transmitted by exposure to blood or blood products. Hepatitis C is usually chronic and can cause cirrhosisand primary liver cancer.Human Immunodeficiency Virus, a virus transmitted through exposure to blood or blood products or during sexual intercourse. HIV causesthe Acquired Immunodeficiency Syndrome (AIDS).The controlled burning of solid, liquid or gaseous wastes to produce gases and residues containing little or no combustible material.

The activities aiming at the prevention of the spread of pathogens between patients, from healthcare workers to patients, and from patientsto healthcare workers in the healthcare setting.

Discarded materials from healthcare activities on humans or animals which have the potential of transmitting infectious agents to humans.These include discarded materials or equipment from the diagnosis, treatment and prevention of disease, assessment of health status oridentification purposes, that have been in contact with blood and its derivatives, tissues, tissue fluids, or wastes from infection isolationwards.[Includes: cultures and stocks; tissues; dressings, swabs or other items soaked with blood; blood bags. Sharps, whether contaminated orCharacterized by the uncontrolled and scattered deposit of wastes.

Consisting of/or containing pharmaceuticals.[Includes: pharmaceuticals expired, no longer needed; their containers, items contaminated by or containing pharmaceuticals (bottles,

A microorganism capable of causing disease.

Consists of containers (full or empty) with pressurized liquid, gas or powdered materials.[Includes: gas cylinders and cartridges; aerosol cans].Consisting of/or containing radioactive substances.[Includes: unused liquids from radiotherapy or laboratory research; contaminated glassware, packages or absorbent paper; urine andexcreta from patients treated or tested with unsealed radionuclides; sealed sources].

A term embracing the recovery and reuse of scrap or waste material for manufacturing or other purposes.

Probability that a hazard will cause harm and the severity of that harm.

Either all plastic or all glass syringe with steel needle. This type of syringe is designed for re-use after proper cleaning and sterilisation in asteam sterilizer or autoclave.

The placement of waste in a suitable location where isolation, environmental and health protection and human control (e.g. radiation control,limitation of access) are provided. This is done with the intention that the waste will be subsequently retrieved for treatment and conditioningand/or disposal (or clearance of radioactive waste).

Any method, technique or process for altering the biological, chemical or physical characteristics or waste to reduce the hazards it presentsand facilitate, or reduce the costs of, disposal. The basic treatment objective include volume reduction, disinfection, neutralization or otherchange of composition to reduce hazards, including removal or radionuclides from radioactive waste.

All the activities - administrative and operational - involved in the handling, treatment, conditioning, storage, transportation and disposal of

An injection that does not harm recipients neither exposes health workers to risks or results in waste that puts communities at risk.

A puncture proof/liquid proof container designed to hold used sharps safely during disposal and destruction.

Modified, disposable plastic syringe designed for the HC worker to disable it in a way that the needle is protected & cannot be re-used.

Characterized by the controlled and organized deposit of wastes which is then covered regularly (daily) by the staff present on site.Appropriate engineering preparations of the site and a favourable geological setting (providing an isolation of wastes from the environment)The systematic separation of waste into designated categories.

Sharps are a subcategory of infectious healthcare waste and include objects that are sharp and can cause injuries.[Includes: syringe needles, scalpels, infusion sets, knives, blades, broken glass].

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Healthcare waste management data collection

Inventory of all B, C and D questions

n topic question type data comments / multiple choice

1 geographical situation & population

100 area type in which area is the facility located ? C [1] urban, [2] peri-urban, [3] rural

101 area geography in which area is the facility located ? T climatic, topographical specifications if relevant

102 cultural practices are there any that must be taken in consideration? T

103 population how many people live in your locality ? N

104 population could I get detailed demographic data / country? N

2 healthcare facility (HCF)

200 HCF which category is it (are they) ? C

[1] small (ambulant service); [2] medium ((sub-)district

hospital); [3] large hospital201 HCF which type is it (are they) ? C [1] public; [2] private

202 HCFs could I obtain a list of all HCFs in the country ? T if possible by category & type (Nbr. bed), by locality / district

203 services which services do you have in your HCF C[1] medicine; [2] gynaecology; [3] surgery; [4] children services[5] emergencies; [6] radiology; [7] laboratory; [8] other (specify

204 bed capacity how many beds do you have in total ? N

205 occupancy what is the average bed occupancy ? N

206 outpatients how many outpatients come each day on average? N

3 staff

300 medical staf f training is training of med. staf f avai lable regarding HCWM ? B if yes, what kind of training is given?

301 staff for HCWM a responsible person for HCWM is identified and ope C

no en e ; p anne ; en e u no opera ona ;[3] operational

302 training responsible of HCWM what kind of training has this person followed ? T

303 staff for HCW awareness awareness of risks of person(s) handling HCW ? Q

304 hepatitis B and tetanus do you vaccinate your personnel against them ? B

305 medical staff numbers could I have a break down of the medical staff ? T please provide numbers, diagrams.

306 medical staff training Is the participation in the trainings documented? B Please provide participation sheets

307 staff training on monitoring staff is trained on monitoring and supervising of HC B

4 HCW generation

400 HCW kinds which kind of waste is generated in the HCF C

[1] general, [2] recyclables, [3] radioactive, [4] infectious, [5]sharps; [6] chemicals (liquid and solid); [7] pharmaceuticalwaste; [8] anatomic waste;

401 domestic waste quantity produced/day (estimated, in kg) N

402 sharps quantity prod/day (in kg or number of sharps boxes) N

403 infectious (non-sharp) waste quantity produced/day (estimated, in kg) N

404 anatomic waste quantity produced/day (estimated, in kg) N405 pharmaceutical waste quantity produced/day (estimated, in kg) N

406 chemicals (liquid and solid) quantity produced/day (estimated, in litres) N

407 radioactive waste quantity produced/day (estimated, in kg) N

408 number of injections performed how many are done in average per day ? N

409 quantities of HCW produced do you have any figures at the national/local level? B

page 12 questions sum


13/43


5 HCW segregation & handling ask to be allowed to take photos of the system !

500 segregation categories into which categories are HCW separated ? C[0] no segregation, [1] general, [2] recyclables, [3] radioactive[4] infectious, [5] sharps; [6] chemicals (liquid and solid); [7]pharmaceutical waste; [8] anatomic waste;

501 needle stick injuries how many cases reported in the past 12 months ? N if yes, what measure do you take when it happens?

502 type of syringes used what type of syringes do you use? C

syringe

503 protective equipment

sufficient personal protective equipment for thehandling of waste is available B Yes / No

504 segregation proper segregation of waste is: N

[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory[4] good; [5] excellent (high)

505 Handling safe handling of waste is: N


6 HCWhandling equipment ask to be allowed to take photos of the system !

600 infectious waste containers what kind of specific containers do you use ? C[0] no specific container;

[1] plastic; [2] metall ic; [3] cardboard; [4] bag; [5] box; [6] oth

601 sharp containers what kind of specific containers do you use ? C[0] no specific container; [1] puncture-proofed single use; [2]puncture-proofed multiple use, [3] not puncture-proof single

use; [4] not puncture-proof multiple use

602 shortage of sharps containers for what reasons are there shortages, if any ? C [0] no shortages; [1] budget; [2] logistical; [3] other (specify)

603 colour coding do you have a specific colour coding system ? B

604 infectious waste containers infectious waste container are lidded B

605 Equipment

sufficient equipment for proper HCWM is availableand properly used C

[0] not available; [1] partly available; [2] widely available; [3]available and properly used

7 HCW storage area ask to be allowed to take photos of the system !

700 storage area do you have a specific area for HCW ? B

701 storage area access Is the area only accessible for authorised pers. B

702 storage area organisation are different waste kinds stored in separated storage B

8 HCW collection & on-site tran ask to be allowed to take photos of the system !

800 Collection and transport is hazardous and non-hazardous waste collected and B

801 HCW on-site transport what kind of means do you use ? C [0] open device; [1] closed device; [2] other (specify)

802 HCW collection & on-site trans. do you think current practices offer enough security? B

9 HCW off-site transport ask to be allowed to take photos of the system !

900 transport services are there any transport documents used? C [0] none; [1] transport form; [2] other (specify)

901 type of transport who generally transports hazardous healthcare waste C

?)



14/43


10 HCW treatment ask to be allowed to take photos of the system !

1000 type of on-site HCW treatment which kind of system is used ? C [0] none; [1] open fire; [2] incinerator; [3] chem. disinf. ; [4] ot

1001 capacity of HCW treatment syst.what is the current capacity of the system(s) ? N in kg/day

1002 operation HCW treatment syst. any operation problems; if so for what reasons ? C [0] none; [1] money; [2] maintenance; [3] spare-parts; [4] othe

1003 failure of HCW treatment syst. what do you do when it doesn't function ? T

1004 domestic waste is it treated on-site or off-site? C

no rea men ; on-s e; o -s e w c rea men

technology is used)

1005 sharps is it treated on-site or off-site? C

[0] no treatment; [1] on-site; [2] off-site (which treatmenttechnology is used)

1006 infectious (non-sharp) waste is it treated on-site or off-site? C

no rea men ; on-s e; o -s e w c rea men

technology is used)

1007 anatomic waste is it treated on-site or off-site? C


1008 pharmaceutical waste is it treated on-site or off-site? C

[0] no treatment; [1] on-site; [2] off-site (which treatment

technology is used)

1009 chemicals (liquid and solid) is it treated on-site or off-site? C no rea men ; on-s e; o -s e w c rea mentechnology is used)

1010 waste recycling is it treated on-site or off-site? C

no rea men ; on-s e; o -s e w c rea mentechnology is used)

1011 on-site treatment is general waste treated on-site? B if yes, which treatment technologies are used?

1012 on-site treatment is hazardous waste treated on-site? B if yes, which treatment technologies are used?

1013 Treatment quality how is the quality of treatment technology N

[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory

[4] good; [5] excellent (high)

1014 Maintenance

how is the maintenance status of the technology(Technical level/Quality) N


11 HCW final disposal

1100 hazardous HCW final disposal s is it on or off-site ? C [0] on-site; [1] off-site

1101 type of hazardous waste dispos which kind of disposal site is used for the HCW ? C [0] open dump; [1] sanitary landfill; [2] small burial pit; [3] oth

1102 protection of disposal site is the area secured ? B

1103 domestic waste where is it disposed off? Ca e o -s e: open ump; o -s e: san ary

landfill; [3] other

1104 off-site: hazardous waste what kind of hazardous disposal types are available? T



15/43


12 HCWM regulations (code of conduct; management plan, policy)

1200 hazardous waste regulations can we have copies of existing (draft) documents? B

1201 national HCWM regulations can we have copies of existing (draft) documents? B

1202 national HCWM regulations (HC are available and enforced C

no ava a e; no en orce ; par y en orce ;available and enforced

1203 national HCWM regulations do their application cause any problems ? T

1204 HCF HCWM regulations internal guidelines and SOP are available and used C

[0] not available; [1] partly available; [2] widely available; [3]available and used

1205 national monitoring regulations are monitoring regulations available? B if yes, could I obtain the legal document and checklists?

1206 monitoring regulations is a monitoring system stipulated and establ ished? B Please provide detailed information

1207 Incineration / waste treatment r can we have copies of existing (draft) doc. ? T

1208 Hazardous goods / waste Trans can we have copies of existing (draft) doc. ? T

1209 monitoring regulations HCWM is monitored regularly by the relevant authori B

13 policy and budget

1300 health system could you outline how it is organised ? T

responsibilities

1301 budget allocation for HCWM is available and used C

[0] not identified; [1] planned; [2] available but not used; [3]available and used

1302 budget allocation for HCWM budget per bed and year N US $ per bed and year

1303 purchase practises is there a national policy for items used in HCWM ? B

1304 relations with other ministries with which ministry(ies) do you work on HCWM ? T

1305 annual report of activities could I obtain a copy of your annual report(s) regardi T please obtain copies of the last 1-2 years

14 sanitation & wastewater

1401 waste water drains to what is the waste water system connected? C [1] sewer; [2] septic tank; [3] open water source; [4] other

1402 sewer connection where does the sewerage system lead to ? C [1] wastewater treatment plant; [2] open water source; [3] oth

15 personal opinion

1501 personal opinionwhat kind of short-comings, weak points regardingHCWM in your country can you point out? T

1502 personal opinion do you think sufficient funds are allocated to HCWM Q

1503 personal opinion do you think HCWM is safely managed? Q

1504 personal opinion

do you think HCWM is environmental friendly

managed? Q

Explanations

Comments: enter any relevant comments made by the interviewee which can help better understand the problematic.

Type: data is eitherquantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down one or several

numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).

All the information noted down corresponds to what the interviewee tells you.Your personal comments are to be put separately in the box below !



16/43

Healthcare waste management Rapid assessment tool name of country

Tool A (recommended) Interview Duration: 30"

Active in the field of:

Tel. n:

Date of assessment:

question type Answer

General Information1 T

Activities and Project regarding healthcare waste management

2 T

3 T

4 T

Future Strategies / Plans

5 T

6 T

7 T

Personal comments/remarks of the interviewer

Address:

Name of interviewee: Function:

Which activities or projects have been implemented so far by your organisation in

this country?

Did your organisation develop any documents, guidelines etc. on healthcare waste

management? If available, would it be possible to receive these documents?

person in charge of association, NGO

Assessment made by:

Organisation:

Please provide a general Description of your organisation:

If healthcare waste is one of the envisaged areas, which activities are planned?

Would your organisation be interested to be part of the national planning and

implementation process?

Do you know other organisations which are active in the field of healthcare waste

management?

Which areas will your organisation be focused on in future (e.g. Climate change,

health improvement, environment, healthcare waste,)?

page 16 Quest A


17/43


Tool B-1 Interview

Department:

Function:

Date:



104 population could I get detailed demographic data of the country ? N


202 HCFs could I obtain a list of all HCFs in the country ? T

if possible by category & type (Number of beds), by locality/ district

3 staff

300 medical staff training is training of med. staff available regarding HCWM ? B

if yes, what kind of training is given ? What training

structure is available?

301 staff for HCWM a responsible person for HCWM is identified and operati C

[0] not identified; [1] planned; [2] identified but notoperational; [3] operational

305 medical staff numbers could I have a break down of the medical staff ? T please provide numbers, diagrams.

4 HCW generation

409 quantities of HCW produced do you have any figures at the national/local level? T please provide available figures

6 HCW waste handling containers

603 colour coding do you have a specific colour coding system ? B

9 HCW off-site transport

900 transport services are there any control measures ? C [0] none; [1] transport form; [2] other (specify)

10 HCW treatment

1011 on-site treatment is general waste treated on-site? B

1012 on-site treatment is hazardous waste treated on-site? B


1101 type of hazardous waste disposawhich kind of disposal site is used for the HCW ? C

[1] open dump; [2] sanitary landfill; [3] small burial pit; [4]other

12 HCWM regulations (code of conduct; management plan, policy, monitoring)

1201 national HCWM regulations can we have copies of exist ing (draft) documents? T


1206 monitoring regulations is a monitoring system stipulated and established? B Please provide detailed information


1300 health system could you outline how it is organised ? T

try to obtain a flowchart of the health system +responsibilities

1301 budget allocation for HCWM is available and used C

[0] not identified; [1] planned; [2] available but not used; [3]available and used

1302 budget allocation only for HCW budget per bed and year N US $ per bed and year

1303 purchase practises is there a national policy for items used in HCWM ? B


1305 annual report of activities regardi could I obtain a copy of your annual report(s) regarding t B please obtain copies of the last 1-2 years

15 personal opinion


what kind of short-comings, weak points regarding

HCWM in your country can you point out? T

1502 personal opinion do you think sufficient funds are allocated to HCWM ? Q

1503 personal opinion do you think HCWM is safely managed? Q

1504 personal opinion do you think HCWM is environmental friendly managed? Q

Explanations Legend for [Q]

excellent = 5

good = 4

satisfactory = 3

insufficient = 2bad (low) = 1

non-existent = 0


Ministry: Address:

Name of interviewee:


Assessment made by:

Type: data is eitherquantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down one or several numbers

which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).

if yes, which treatment technologies are used?

Person in charge of Ministry of Health


page 17 Quest B-1


18/43


Tool B-2 (optional) Interview

Department:

Function:

Date:

c n topic question type data comments / multiple choice


203 services which services do you have in your HCF C

[1] medicine; [2] gynaecology; [3] surgery; [4] childrenservices[5] emergencies; [6] radiology; [7] laboratory; [8] other(specify)

4 HCW generation

409 quantities of HCW produced do you have any figures at the national/local level ? T if yes, please provide figures.

9 HCW off-site transport

900 transport services are there any control measures ? C [0] none; [1] transport form; [2] other (specify)

901 type of transport who generally transports hazardous healthcare waste C

[0] the HCF; [1] municipal service; [2] private company(name ?)


1004 domestic waste is it treated on-site or off-site? C

[0] no treatment; [1] on-site; [2] off-site (which

treatment technology is used)

1005 sharps is it treated on-site or off-site? C

[0] no treatment; [1] on-site; [2] off-site (whichtreatment technology is used)

1006 infectious (non-sharp) waste is it treated on-site or off-site? C


1007 anatomic waste is it treated on-site or off-site? C


1008 pharmaceutical waste is it treated on-site or off-site? C


1009 chemicals (liquid and solid) is it treated on-site or off-site? C


1010 waste recycling is it treated on-site or off-site? C


11 HCW final disposal ask to be allowed to take photos of the place !

1103 domestic waste where is it disposed of? Ca e o s e: open ump; o s e:

sanitary landfill; [3] other

1104 off-site: hazardous waste what kind of hazardous disposal types are available? T

e.g. none; open dumps; secured hazardous wastelandfills; mines, other (specify)


1200 hazardous waste regulations can we have copies of existing (draft) doc. ? T

1207 Incineration / waste treatment r can we have copies of existing (draft) doc. ? T

1208 Hazardous goods / waste Trans can we have copies of existing (draft) doc. ? T



1305 annual report of activities

could I obtain a copy of your annual report(s) regardingtransport, treatment, disposal of how? T please obtain copies of the last 1-2 years

15 personal opinion

1501 personal opinionwhat kind of short-comings, weak points regardingHCWM in your country can you point out? T

1503 personal opinion do you think HCWM is safely managed in your country? Q

1504 personal opinion do you think HCWM is environmental friendly managed? Q


excellent (high) = 5

All the information noted down corresponds to what the interviewee tells you. good = 4

Your personal comments are to be put separately in the box below ! satisfactory = 3

insufficient = 2

bad (low) = 1

non-existent = 0


Type: data is eitherquantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B]

(yes/no); multiple choice [C] (write down one or several numbers which correspond to the answer) or text [T] (write

essential relevant points told to you by the interviewee).


person in charge of Ministry of Environment

Ministry:

Assessment made by:

Address:

Name of interviewee:

page 18 Quest B-2


19/43

ealthcare waste management Rapid assessment tool name of country

ol C Interview Duration: 15"

Address:

Function: Tel. n:

Date of assessment:



103 population how many people live in your locality ? N

400 quantities of HCW produced do you have any figures at the national/local level B


1007 domestic waste how is it generally treated ? T

1202 national HCWM regulations does their appl icat ion pause any problems ? T

planations Legend for [Q]


good = 4

satisfactory = 3

insufficient = 2

bad (low) = 1

non-existent = 0

sonal comments/remarks of the interviewer

Type: data is eitherquantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write

down one or several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).


nicipality:


Never leave a field empty ! If something doesn't exist or is not applicable, put a "0" (zero); if the interviewee doesn't know, put a " ?".

essment made by:

Person in charge of Municipal Authority

me of interviewee:

c (code): questions only necessary to ask when: HCW is segregated (=); when HCW in taken off-site ().

page 19 Quest C


20/43


Tool D-1 Interview

District:

Function:

Date of assessment:



200 HCF which category is it (are they) ? C [1] small (ambulant service); [2] medium ((sub-)district hos

201 HCF which type is it ? C

204 bed capacity how many beds do you have in total ? N

205 occupancy what is the average bed occupancy ? N206 outpatients how many outpatients come each day on average? N

3 staff

301 staff for HCWM a responsible person for HCWM is identified and oper C [0] not identified; [1] planned; [2] identified but not operation


1202 national HCWM regulations (HC are available and enforced C [0] not available; [1] not enforced; [2] partly enforced; [3] av

1203 national HCWM regulations does their application cause any problems ? T

1204 HCF HCWM regulations Internal guidelines and SOP are available and used C [0] not available; [1] partly available; [2] widely available; [3


1301 budget allocation for HCWM is available and used C [0] not identified; [1] planned; [2] available but not used; [3]

1302 budget allocation for HCWM budget per bed and year N

1305 annual report of activities could I obtain a copy of your annual report(s) regardin T

14 wastewater

1401 waste water drains to what is the waste water system connected? C [0] sewer; [1] septic tank; [2] open water source; [3] other

1402 sewer connection where does the sewerage system lead to ? C [0] wastewater treatment plant; [1] open water source; [2] o

Explanations


[1] public; [2] private

please obtain copies of the last 1-2 years

Type: data is eitherquantitative [N] (enter a number or percentage); Boolean [B] (yes/no); multiple choice [C] (write down one or several numbers which

correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).

US $ per bed and year



Assessment made by:

Management, Finance, Legal Regulations

page 20 Quest D-1


21/43

Healthcare waste management Rapid assessment tool country:

Tool D2 Interview

Function:

Date:

n question type data comments / multiple choice

4

400

Which kind of waste is generated in the healthcare

facility C

[1] general, [2] recyclables, [3] radioactive, [4] infectious, [5]sharps; [6] chemicals (liquid and solid); [7] pharmaceutical

waste; [8] anatomic waste;

401 quantity produced/day (estimated, in kg) N

402 quantity prod/day (in kg or number of sharps boxes) N




406 quantity produced/day (estimated, in litres) N


5

500 into which categories are HCW separated ?

C[0] no segregation, [1] general, [2] recyclables, [3] radioactive,

[4] infectious, [5] sharps; [6] chemicals (liquid and solid); [7]

pharmaceutical waste; [8] anatomic waste;

504 proper segregation of waste is: N

[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4]good; [5] excellent (high)

505 safe handling of waste is: N

[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4]

good; [5] excellent (high)

6

600 what kind of specific containers do you use ?C

[0] no specific container;

[1] plastic; [2] metallic; [3] cardboard; [4] bag; [5] box; [6] other

601 what kind of specific containers do you use ?

C[0] no specific container; [1] puncture-proofed single use; [2]puncture-proofed multiple use, [3] not puncture-proof single use;

[4] not puncture-proof multiple use

602 for what reasons are there shortages, if any ? C [0] no shortages; [1] budget; [2] logistical; [3] other (specify)

603 do you have a specif ic colour coding system ? B

604 infectious waste container are lidded B

605 sufficient equipment for proper HCWM is available C

[0] not available; [1] partly available; [2] widely available; [3]

available and properly used

7

700 do you have a specific area for HCW ? B

701 Is the area only accessible for authorised pers. B

702

are different kind of waste stored in separated

storage areas? B

8

800 Is hazardous and non-hazardous waste collected a B

801 what kind of means do you use ? C [0] open device; [1] closed device; [2] other (specify)

802 do you think current practices offer enough security B

9

900 are there any transport documents used? B [0] none; [1] transport form; [2] other (specify)

901 who generally transports the HCW ? C [0] the HCF; [1] municipal service; [2] private company (name ?)

10

1000 which kind of system is used ? C [0] none; [1] open fire; [2] incinerator; [3] chem. disinf.; [4] other

1001 what is the current capacity of the system(s) ? N in kg/day and how often treatment is done per week

1002 any operation problems; if so for what reasons ? C [0] none; [1] money; [2] maintenance; [3] spare-parts; [4] other

1003 what do you do when it doesn't function ? T

1004 is it treated onsite or offsite? C




technology is used)



technology is used)





technology is used)



1013 how is the quality of treatment technology N

[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4]

good; [5] excellent (high)

1014 how is the maintenance status of the technology N

[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4]good; [5] excellent (high)



technology is used)

11 ask to be allowed to take photos of the place !

1100 is it on or off-site ? C [0] on-site; [1] off-site

1101 which kind of disposal site is used for the HCW ? C

[0] none, [1] open dump; [2] sanitary landfill; [3] small burial pit;[4] other

1102 is the area secured ? B

1103 where is it disposed of? C

a e o s e: open ump; o s e: san ary

landfill; [3] other

Explanations


Type: data is eitherquantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C]

(write down one or several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the

interviewee .

All the information noted down corresponds to what the interviewee tells you.Your personal comments are to be put separately in the box bel


Application of Healthcare Waste Management duration 30"

District:

Assessment made by:

page 21 Quest D-2


22/43


Tool D-3 Interview Duration: 10"

District:

Function:

Date of assessment:


3 staff304 hepatitis B and tetanus do you vaccinate your personnel against them ? C [0] none; [1] only tetanus; [2] only HBV; [3] both

4 HCW generation

408 number of injections perform how many are done in average per day ? N

5 HCW segregation & handling

501 needle st ick injuries how many cases reported in the past 12 months (average)? N

502 type of syringes used what type of syringes do you use ? C

503 protective equipment

sufficient personal protective equipment for the handling of

waste is available B

15 personal opinion


what kind of short-comings, weak points regarding HCWM in

your country can you point out T

1502 personal opinion do you think sufficient funds are allocated to HCWM ? Q

1503 personal opinion do you think HCWM is safely managed? Q1504 personal opinion do you think HCW M is environmental friendly managed? Q



good = 4

satisfactory = 3

insufficient = 2

bad (low) = 1non-existent = 0




Type: data is eitherquantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down one or

several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).

[0] disposable; [1] sterilisable; [2] auto-disable; [3] safety syringe

Occupational Safety

Assessment made by:

page 22 Quest D-3


23/43

althcare waste management Rapid assessment tool name of country

ol D-4 Interview Duration: 10"

district:

Function:

date of assessment:


3 staff

300 medical staff training is training of med. staff available regarding HCWM B if yes, what kind of training is given ? How often is trained?302 training responsible of HCWM what kind of training has this person followed ? T

303 staff for HCW awareness awareness of risks of person(s) handling HCW ? Q

306 medical staff training Is the participation in the trainings documented? B Please provide participation sheets

307 staff training on monitoring staff is trained on monitoring and supervising of HC B

12 HCWM regulations (code of conduct; management plan, monitoring)


1206 monitoring regulat ions is a monitoring system st ipulated and establ ished? B

1209 monitoring regulations

HCWM is monitored regularly by the relevant

authorities B

lanations Legend for [Q]


good = 4

satisfactory = 3

insufficient = 2

bad (low) = 1

non-existent = 0

sonal comments/remarks of the interviewer

All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below !


Training & Monitoring

essment made by:

Type: data is eitherquantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down

one or several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).

page 23 Quest D-4


24/43


Tool D5 Personal observations duration: non defined

healthcare facility: district:

Assessment made by: date of assessment:

n topic question type ata (0-100 % comments / multiple choice

3 staff

304 staff for HCW awareness awareness of risks of person(s) handling HCW ? Nmonitoring quality of HCWM is N

Summary N 0%

5 HCW segregation & handling

how is the quality of waste segregation? N

is risk and non-risk waste segregated appropriately? N

Summary N 0%

6 HCW containers

how is the availability of waste container? N

how is the quality of waste container? N

Summary N

7 HCW storage area

how is the all over quality of the waste storage area? N

is the storage area safe and in accordance to national

and international rules? N

Summary N 0%

8 HCW collection & on-site transport

how is the collection frequency? N

how is the quality of transport equipment? N

how is the safety of collection and on-site transport? N

Summary N 0%

10 HCW treatment

how is the quality of treatment technology? N

how is the maintenance status of the technology? N

is the treatment technology safe for staff and public? N

is the treatment technology environmental friendly? N

Summary N 0%


how is the quality of the used disposal site? N

is the disposal method safe for staff and publ ic? N

is the disposal environmental friendly? N

Summary N 0%


how is the implementation level of national regulations? N

HCWM is monitored appropriately and regularly? N

Summary N 0%

15 personal opinion

do you think sufficient funds are allocated to HCWM ? N

do you think HCWM is safely managed? N

do you think HCWM is environmental friendly managed? N

Summary N 0%

Legend for [N]

0-10% (critical situation)

11-30% (problematic situation)

31-60% (satisfactory situation)

61-80% (good situation

>81% (excellent situation)

Personal comments, remarks

page 24 Quest D_5


25/43

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

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A B C D E F G H I J K L M

Evaluation of questionnaires DDate:Name:Country:

n topic question TEXT INPUT of questions D1-D4

3 staff

302 trainingresponsible ofHCWM

what kind oftraining has thisperson followed ?

305 medical staffnumbers

could I have abreak down of themedical staff ?lease rovide

10 HCW treatment93 failure of HCWtreatment syst.

what do you dowhen it doesn'tfunction ?


1203 national HCWMregulations

does theirapplication causeany problems ?


1305 annual report ofactivities

could I obtain acopy of your

annual report(s)regardingtransport,

15 personal opinion

1501 personal opinion What kind of short-comings, weakpoints regardingHCWM in yourcountry can you


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N O P Q R S T U V W X Y Z AA AB AC AD


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AK AL AM AN AO AP AQ AR AS AT AU AV AW AX AY AZ BA BB BC BD


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BL BM BN BO BP BQ BR BS BT BU BV BW BX BY BZ CA CB CC CD C

Evaluation Questionnaire E - personal observation


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CJ


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INPUT D1 - Management, Finance, Legislation

Question 200 201 204 205 206 301 1202 1204 1301 1302 1401 1402o.

Questionn

aire Kind of HCF Type

Number

of beds

Occ.r

ate%

Outpatient

s per year

Points

0 - 3

Points

0 - 3

Points

0 - 3

Points

0 - 3

US$/bed/

day

code 0 -

3

code

0 - 212345


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N O P Q R S T U V W X Y Z AA AB AC AD AE AF

D2 - Application of Healthcare Waste Management400 Which waste is generated? 401 402 403 404 405 406 407 500 504 505

General

Waste

Recyclin

g Waste

Radioacti

ve Waste

Infectiou

s Waste

Sharp

Waste

Chemica

l Waste

arma

ceutical

s

Pathologic

al Waste

um

generated

waste

omes c

waste (kg /

day)

sharps (kg

/ day)

n ec ous

waste (kg /

day)

anatomic

(kg / day)

p armace

utical (kg /

day)

c em ca

waste (kg /

day)

ra oac ve

waste (kg /

day)

Number 0-

8

Points

0 - 5

Points

0 - 5


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AK AL AM AN AO AP AQ AR AS AT AU AV AW AX AY AZ BA BB BC BD BE BF

603 604 605 700 701 702 800 801 802 900 901 1000 1001 1002 1004 1005 1006 1007 1008 1009 1010 1013

Yes /

No

Yes /

No

Points

0 - 3

Yes /

No

Yes /

No

Yes /

No

Yes /

No

code 0

2

Yes /

No

code 0

- 2

code 0

- 3

code 0

- 4

rea men

capac.

kg/day

code 0

- 4

Points

0 - 2

Points

0 - 2

Points

0 - 2

Points

0 - 2

Points

0 - 2

Points

0 - 2

Points

0 - 2

Points

0 - 5


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BL BM BN BO BP BQ BR BS BT BU BV BW BX BY BZ CA CB CC CD CE CF

D3 - Occupational Safety D4 - Training & Monitoring INP D5 - personal observation304 501 502 503 1502 1503 1504 300 303 306 307 1205 1209 Secti 3 5 6 7 8 10

Yes /

No

um er

needle

sticks/a

code

0- 3 Yes / No

Points

0 - 5

Points

0 - 5

Points

0 - 5

Yes /

No

Points

0 - 5 Yes / No Yes / No

Yes /

No

Yes /

No

HC

F staff %

segregatio

n %

waste

container % storage %

co ec,

onsite-

trans. %

treatm

%1

2345


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CJ


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47


No. of Answers

Sum 0 0 0 0 0 0 0 0 0 0 0 0Large HCF 0 0 0 0 0 0 0 0 0 0 0 0

HCF 0 0 0 0 0 0 0 0 0 0 0 0

Small HCF 0 0 0 0 0 0 0 0 0 0 0 0

RESULTS 2. Healthcare Facility 3. staff 4. Gener

No. 200 201 204 205 206 300 301 303 304 306 307 400 Whi

Question

Number of

participated

HCF

Number of

public HCF

Average

No. Of

beds

Occ.

Rate

%

Outpatient

s / year

Average

Training

on how:

Yes

Resp

Person

Average

Score

Awarene

ss

Average

Score

Vaccina

tion:

Yes

Training

document

ed: Yes

Training

on

Monitorin

g: Yes

General

Waste

Large 0 0 #DIV/0! o inpu #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 100% #DIV/0!Medium 0 0 #DIV/0! o inpu #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 50% #DIV/0!Small 0 0 #DIV/0! o inpu #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 100% #DIV/0!All (Averag 0 0 #DIV/0! #### #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 83% #DIV/0!


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4546

47

N O P Q R S T U V W X Y Z AA AB AC AD AE AF

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

tion 5. Segregation

h waste is generated? 401 402 403 404 405 406 407 408 500 501 502

Recyclin

g Waste

Radioact

ive

Waste

Infectious

Waste

Sharp

Waste

Chemic

al Waste

Pharmac

euticals

Patholo

gical

Waste

Sum

generated

waste

kinds

domestic

Average

per bed

and day

sharps

Average

per bed

and day

infectious

Average

per bed

and day

anatomic

Average

per bed

and day

utics

Average

per bed

and day

chemical

Average

per bed

and day

radioactive

Average

per bed

and day

Injection

Average per

bed and day

Average

% of

segregate

d classes

Average

No. Of

needle

sticks / a

Average

Score

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

502:

type of

syringe

Code

reva en

ce of

scores

0 #DIV/0!1 #DIV/0!2 #DIV/0!3 #DIV/0!4

56


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AK AL AM AN AO AP AQ AR AS AT AU AV AW AX AY AZ BA BB BC BD BE BF

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

dling equipment 7. HCW storage area 8. HCW collection & onsite transport 9. offsite transport 10. HCW treatment

601 602 603 604 605 700 701 702 800 801 802 900 901 1000 1001 1002 1004 1005 1006 1007 1008

Averag

e Score

Averag

e Score

colour

coding

Average

Score

.

Cont

lidded

Averag

e Score

nt

equipm

ent

Averag

specific

storage

How

Yes

authori

sed

access

Yes

separate

storage

Yes

.

coll.

And

trans

Yes

Average

Score

collecti

on &

trans

Yes

Average

Score

Average

Score

Average

Score

treatme

nt

capacit

y

#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!

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