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

Pe

rce

nt

Inju

rie

s

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

on

Segregation Handling Treatment Transporta

tion 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 management

15-Monitoring, inspection forms

16-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 waste

Sanitary Landfill

Hazardous

Infectious

Non-Sharps Yellow Bag Treatment by sterilization

Sharps Sharp Containers

Non-Infectious Red Bag Temporary Storage

Export under Basel

Convention

Special Waste

Expired Pharmaceutica

lsRed Bag Temporary

Storage

Export 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

EXAMPLE TEXTGo ahead and replace it with your own text.

2.1.

3.

2 3

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.