Healthcare Waste Management at
Hammoud University Hospital
06 June, 2012
Waste Management Plan
1-Baseline Assessment• Onsite survey conducted at both
model facilities
3-Mercury Phaseout• Policies and Procedures• Replacement of thermometers
Policies and Procedures Update2-Waste Management Program• Organizational structure and
resources’ allocation• Policies & Procedures• Waste Handling• Capacity Building
√
Baseline Assessment
Organizational structure
Policies & Procedures
Practices
Infrastructure
Equipment
Capacity-building
Occupational Health &
Safety
Environmental
Financial
Legal
Baseline Assessment Findings
96% Improper waste Segregation
Baseline Assessment Findings
Organizational structure
• The organizational structure includes a waste management supervisor and the operations’ manager but this position is not filled.
• There is not waste management committee at the hospital level.
Policies & Procedures
• Policies and procedures related to healthcare waste management exist but are not comprehensive.
• Some waste-related policies and procedures are inapplicable.
• Some waste-related policies and procedures are not applied.
Practices• 96% of improper segregation practices.• No monitoring and corrective actions are taken
in relation to waste management.• Some recycling is taking place (cartons, IV
bags…).• Waste is mixed all together during external
transport and final storage.
Baseline Assessment Findings
Infrastructure
• Waste is transported through service elevator, except for 3 floors where main elevator is used.
• Dirty rooms are available except on the 1st , 3rd and B1.
• Waste storage areas on some floors are not compliant with international requirements.
• Location, size and conditions of the Central waste storage area are not consistent with international recommendations.
Equipment
• Overuse of waste bins (namely for GW), especially in admin. offices → Encourage exaggerated GW generation rates.
• Inappropriate assignment of waste bins based on the waste type to be contained → Negatively affect good segregation practices
• Deficiency of waste bins in some wards (i.e.: Need to place general waste bins in dialysis main treatment area) → Negatively affect good segregation practices
Baseline Assessment
Baseline Assessment Findings
Capacity-building
• No training curriculum specifically for healthcare waste. HCW management is given as part of the infection control orientation.
• The housekeeping department trains its employees on waste collection and internal transportation.
Occupational Health & Safety
• Health workers are only provided with Hepatitis B Vaccines.
• None of the hospital staff is vaccinated against Tetanus.
• Health workers are trained on the use of PPEs as part of the occupational health and safety training .
• Waste workers use mainly latex gloves during duty hours.
• PPEs are available in stock in adequate quantities and quality.
• 45% of needle stick injuries are due to needle recapping.
Baseline Assessment Findings
40%
36%
Distribution of Occupa-tional Injuries
Needle StickSharps Injury
45%
55%
Causes of Needle Stick In-juries
Needle Recapping
Other
Nursing staff Physicians students ancillary staff0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50% 47%
24%
19%
10%
Distribution of Needle Stick Injuries by Af-fected Population
Affected Population
Perc
ent I
njur
ies
Baseline Assessment Findings
Environment
al
• The quantity of waste generated is on the high end of the benchmark.
• The percentage of infectious waste is high constituting around 40% of the total waste.
• No proper segregation of different types of hazardous and special waste which causes public health and environmental hazards.
• Different types of wastes are combined together for final disposal at Saida sea dump without prior treatment which causes environmental pollution and releases of dioxins.
• No policies/procedures related to mercury containing waste management and disposal are available.
• Broken thermometers are disposed of in sharps boxes.
• Wastewater is disposed of without treatment.
Baseline Assessment Findings
Indicator Result
Bench Mark Values
Average daily occupancy rate (%) 58
Average outpatients per day 462
Average total waste generation rate in kg per bed per day
3
Average total waste generation rate in kg per occupied bed per day
5.3 0.8- 61
Average total waste generation rate in kg per total patient per day
1.5
Average infectious waste generation rate in kg per bed per day
1.15 0.3-0.41
Average percentage of infectious waste from total waste (%) 37.3
37 16%2
1 References: WHO, 1999; Chen et al., 2009 (for middle income countries)2 Including pathological, infectious and sharp wastes (WHO, 1999)
Results of the 22 days waste assessment
Baseline Assessment Findings
Financial
• Only monthly operating cost was estimated (including Costs of sharp boxes, waste plastic bags, disposable PPEs, nursing staff training, and Wages of the waste management team)
• The average monthly operating cost amounts to 11 USD/in‐patient.
• 4.5% of the mercury thermometers are broken or overused.
Legal• Inconsistency with national laws &
regulations specifically:• Law 64/1988 (The law of conservation of the
environment against pollution from hazardous waste and hazardous materials).
• Law 444/2002 (Law of protection of the environment).
• Decree 13389/2004 (Determining the types of waste from healthcare facilities and their disposal).
Waste Management Plan
1-Baseline Assessment• Onsite survey conducted at both
model facilities
3-Mercury Phaseout• Policies and Procedures• Replacement of thermometers
Policies and Procedures Update2-Waste Management Program• Organizational structure and
resources’ allocation• Policies & Procedures• Waste Handling• Capacity Building
√
Steps Of Proper Waste Management
Waste minimizati
onSegregati
on Handling Treatment Transportation Disposal
1-Drafting the TORs of the waste management committee
3-Creation of a coordination mechanism between departments (Setting responsibilities of different staff groups)
2-Drafting the TORs of the waste management coordinators in each department
Waste Management Program – Organizational StructureOrganizational Structure
Responsibilities for HCWM
Waste Management Program – Resources’ AllocationSpecification of Waste Containers
Specification of Sharp Containers
Waste Management Program – Resources’ Allocation
Color Coding & Specification of Waste Bags
Waste Management Program – Resources’ Allocation
Placement of Waste Containers & Sharp Boxes
Waste Management Program – Resources’ Allocation
Number of Staff Needed for HCWM
Waste Management Program – Resources’ Allocation
Requirements for Storage Areas
Waste Management Program – Resources’ Allocation
1-Healthcare Waste Management Policy
3-Waste Segregation Procedure
5-Cytotoxic Waste Management Procedure
2-Classification and Definitions
4-Waste Collection, Transport and storage Procedure
Drafted Policies:
Waste Management Program – Policies & Procedures
7-Laboratory Waste Management Procedure6-Pathological Waste Management Procedure
8-Spills Management Procedures
Policies and Procedures
9-Pharmaceutical waste management
11-Waste minimization
13-Environmentally preferable purchasing
10-Management of mercury contaminated waste and mercury containing devices
12-Cleaning and disinfection
14-Training management15-Monitoring, inspection forms16-Audit procedures (Plastic bags, bins, PPEs, segregation, containment, Training coverage, Competencies & Compliance)
Waste Management Program – Policies & Procedures
Development of Performance Indicators, including:•Segregation efficiency•Training effectiveness•Stock control•Compliance to OHS•Compliance to reporting procedures•Compliance to collection, transport and storage procedures•Minimization effectiveness•Respect to green purchasing policy•Control of financial aspects
Waste Management Program – Monitoring & Reporting
Municipal
Sharps
Infectious
Hazardous
HCW Segregation ChartType Category of Waste Labeling & color coding-Paper- Plastic - Metal-Organic material
- Blades- Needles- Ampoules
- Blood or body Fluids -Items contaminated with blood and body fluids
- Chemicals- Pharmaceuticals
Type Category of Waste Labeling & color coding
- Items contaminated with chemotherapy Drugs
- Sharps contaminated with chemotherapy Drugs
- Body parts & organs
- Items Contaminated withRadioactive material
Cytotoxic
Cytotoxic Sharps
Pathological
Radioactive
HCW Segregation Chart
Waste Management Program – Handling:Segregation
Healthcare waste
Non-Hazardous
Recyclable Recycling Bin Recycling facilities
Non-recyclable Black Bag Municipal
wasteSanitary Landfill
Hazardous
Infectious
Non-Sharps Yellow Bag Treatment by sterilization
Sharps Sharp Containers
Non-Infectious Red Bag Temporary
StorageExport under
Basel Convention
Special Waste
Expired Pharmaceutic
alsRed Bag Temporary
StorageExport under
Basel Convention
Cytotoxic waste
SharpsSharp
containers with purple lid
Non-sharps Purple Bag Temporary storage
Export under Basel
Convention
Pathological Silver Bag Burial
Waste Management Program – HandlingCollection
Waste Management Program – HandlingRouting for Waste Transport (Floor to Temporary Storage) Transport
Waste Management Program – Handling:Final Disposal
Healthcare wasteNon-Hazardous
RecyclableRecycling Bin
Recycling facilities
Non-recyclableBlack Bag
Municipal wasteSanitary Landfill
HazardousInfectious
Non-SharpsYellow Bag
Treatment by sterilization
SharpsSharp Containers
Non-InfectiousRed Bag
Temporary StorageExport under Basel Convention
Special WasteExpired Pharmaceuticals
Red BagTemporary Storage
Export under Basel Convention
Cytotoxic wasteSharps
Sharp containers with purple lid
Non-sharpsPurple Bag
Temporary storageExport under Basel
Convention
PathologicalSilver Bag
Burial
Training of Staff
Visual aids
Segreg-ation
Collection &
Transport
Storage & Treatment
Waste Management Program – HandlingRouting for Waste Transport (Floor to Temporary Storage) Auditing HCWM
Waste Management Program – HandlingRouting for Waste Transport (Floor to Temporary Storage) Auditing HCWM
Waste Management Program – HandlingRouting for Waste Transport (Floor to Temporary Storage) Auditing HCWM
1 Training Needs Assessment:-Six target groups- TNA = Desired competencies – Existing Competencies
Training Material Development
ToT & Training workshops
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Waste Management Program – Capacity Building
1- Baseline Assessment• Onsite survey conducted at both
model facilities
3-Mercury Phase-out• Replacement of mercury
thermometers
Policies and Procedures Update2-Waste Management Program• Organizational structure and
resources’ allocation• Policies & Procedures• Waste Handling• Capacity Building
Waste Management Plan
√
Comparative Evaluation of Non-Mercury Thermometers and Healthcare Staff Preferences
Mercury Phase-outComparative Evaluation of Non-Mercury Thermometers and Healthcare Staff Preferences
Infrared Temporal
Thermometer
Mercury thermometer
The Infrared temporal thermometer was chosen to replace mercury thermometers.