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Dr. Himanshu Bhushan

MOHFW

Health Waste Management

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Outline

Why Environment in Health sectorprograms

The IMEP and its rationaleWay forward

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Environment in Health Sector

Key areas of interface between Health sector programsand the Environment are:

Environmental health (referring to air and water quality andsanitation)Worker health and safety Healthcare Waste management

Over 10% of all preventable ill-health today is due to poor

environmental quality bad housing, overcrowding, indoorair pollution, poor sanitation and unsafe water, climatechange, bad practices in agriculture, industrialdevelopment, transport, etc

Good Infection Control +

sound waste management

Improved health services +

safeguard the environment =

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GOIs Regulatory framework Healthcare Waste Management:

Environmental Protection Act, 1986Bio-medical Waste Management Rules, 1998 (amended 2000)

EIA Notification, July 2004CPCB Manual on Hospital Waste ManagementGuidelines for Universal Immunization ProgramGuidelines on AD syringesGuidelines on Mercury-contaminated wastes

Guidelines on Central Waste Treatment FacilitiesGuidelines for Bio-Medical Waste incineratorsMOHFWs National Health Policy 2002 MOHFWs Hospital Waste Management Guidelines

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Implementation of Env in Health

Comprehensive legalframework Common TreatmentFacilities mandated as thefinal solution for disposalof HCW.Partnerships with privatesector, NGOs etc

Increased awarenessthrough trainingprograms, media, andextensive guidancematerials etc

What has workedMixed implementationSustained behavioral change

not yet evidentInadequate monitoring of CTFs and healthcarefacilitiesLack of integration amongdifferent programs causingduplication and lack of consistency in IEC andtraining

What has not

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The Ground Reality!

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To help manage avoid, reduce and control publichealth and environmental risks associated withHealth sector activities.

IMEP provides a structured and systematic approachto incorporate appropriate technology, good practicesand effective institutional framework to managethese risks effectively.

IMEP is to be used by all those involved withNRHM/RCH-II Program at the various levels, i.e.national, state, district and health care facilities.

Helps RCH- II meets GOIs legal requirements

Rationale of IMEP

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IMEP has a two-pronged approach:

IMEP Policy Framework Manual : Generic guidance toCentre & State. Finalized IMEP Operational Guidelines for CHCs/PHCs/Sub-centres user-friendly, pictorial guidance for health-care workers at PHCs, CHCs and SCs. Finalized

Prepared in collaboration with DFID and World bank

Need not be restricted to RCH can be used asgeneric guidance for all programs and schemes eg.RNTCP, IDSP, NACP, SHS etc .

IMEP

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The IMEP addresses and provides guidance on thefollowing issues:

Preventing nosocomial infectionsSegregation, treatment, storage and disposal of infectious biomedical wasteHandling and disposal of sharps, esp auto-disable(AD) syringes.Management of construction waste.Water and sanitation in healthcare facilitiesIncreased skills, information and behaviouralchangeTimelines, budget and systems for monitoring andevaluation

Focus of IMEP

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MOH&FW

Dissemination of Guidelines to states.Link with IPHSMonitoring RCH II Joint Review Mission/StatePIP Appraisal

State (State Directorate/State Health Society) &District (DHS/CMO)

Adoption and dissemination to all peripheral healthfacilities (CHCs,PHCs,SCs)RCH-II State PIPs Critical component as per MoU.Training and monitoring

Link with IPHS.

Roles and responsibilities

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Increased ownership by states, districts, facilities,healthcare workers and community

Need for increased awareness

Large degree of inter-ministerial coordination (MoEF,PCBs)

Need for intensive enforcement and monitoring

Resource intensive (consumables, CTF agreements)

Need for consistent training to induce sustainedbehavioural change

Innovative solutions to deal with size and volumes of

waste from RCH activities in outreach and SCs

Critical issues of Implementation

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Infection PreventionHand washing protocol Mopping by disinfectants of all areas of centre twice a dayFumigation of OT, LR and Lab at periodic intervalAdequate facilities for autoclave & sterilization of linen &instrumentsUse of disposable gloves/syringesSanitation of toilets and hygiene of staff Autoclaving of all the instruments and linenQuality check of autoclave by using quick strips

http://infection%20management.pdf/http://infection%20management.pdf/http://infection%20management.pdf/http://infection%20management.pdf/http://infection%20management.pdf/http://infection%20management.pdf/

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Waste Disposal System

Colour Coded BinsYellow bag

Human tissue

Placenta and PoCs

Waste swabs / bandage

Other items (surgical waste)

Contaminated with blood

Red bagDisinfected catheters

I.V. bottles and tubes

Disinfected plastic gloves

Other plastic material

Black bag

Kitchen wastePaper bags

Waste paper / thermocol

Disposable glasses & plates

Left over food

Color Coded bins

http://color%20coded%20bins.pdf/http://color%20coded%20bins.pdf/http://color%20coded%20bins.pdf/http://color%20coded%20bins.pdf/http://color%20coded%20bins.pdf/http://color%20coded%20bins.pdf/

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Waste Management Uninterrupted power supply to storage unitAvailability of color coded containers, liners,sodium hypochlorite solution, syringe and needlecutter

Deep burial of placenta and all blood and tissuestainedIncineration facility available within the premisesor outsourced

Trained health personnel for handling Bio medicalwaste

http://waste%20mangement.pdf/http://waste%20mangement.pdf/

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MAIN ISSUES

Absence of segregation of waste at sourceLack of technical expertise and appropriateinstitutional arrangementUnwillingness of institutions to introduce proper

collection, segregation, transportation andtreatment / disposal systemsIndifferent attitude of health staff towards wastemanagement due to lack of awareness

Lack of community participation towards wastemanagement and hygienic conditions

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Thanks