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    Individualized Rapid Assessment Tool

    Healthcare Waste Management

    Content

    Section Content

    1. Introduction Basic information and instructions on the use of the I-RAT

    2. I-RAT Individualized Rapid Assessment Tool for a single facility

    3. Answer Guide Guide to YES and NO responses to the I-RAT questions

    4. Glossary Glossary of terms and abbreviations

    > To access any of the above sections, click on the tabs below.

    When finished, send your data with the completed tool to the UNDP GEF Global Project Team.

    Website: www.gefmedwaste.org

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    Individualized Rapid Assessment Tool Healthcare Waste Management

    Background

    Basic Information

    Instructions

    Preparation and Planning (3 days)

    > Save a master copy of the I-RAT in your computer or memory device. Make additional copies for your use.

    Part I - Initial Interview (30 - 45 minutes)

    The I-RAT is a rapid assessment tool to obtain an initial indication of the level of healthcare waste management atan individual healthcare facility. The tool results in an overall score that can be used by Ministries of Health to

    compare and rank healthcare facilities for the purpose of prioritizing interventions. The tool can also be used as aquick tool to identify possible areas for improvement. The I-RAT is not intended to provide a detailed orcomprehensive assessment. The I-RAT was designed for use by technical consultants and/or hospital personnelspecializing in healthcare waste management.

    The Individualized Rapid Assessment Tool (I-RAT) was developed in 2009 as part of the UNDP GEF GlobalProject on Healthcare Waste by Dr. Jorge Emmanuel, Chief Technical Advisor. The I-RAT is based on WHO'sRapid Assessment Tool (RAT), which is part of WHO's overall strategy to reduce the disease burden caused bypoor healthcare waste management (HCWM) through the promotion of best practices and the development ofsafety standards. The RAT can be found at:http://www.who.int/water_sanitation_health/medicalwaste/hcwmtool/en/index.html Unlike the RAT whichevaluates the HCWM situation on a national level, the UNDP GEF Project's I-RAT is intended for use at theindividual healthcare facility level.

    The I-RAT will be used by the model healthcare facilities at the beginning and end of the project to demonstrate

    improvements in the HCWM systems for the UNDP GEF Project.

    The I-RAT is comprised of a series of questions. Most questions can be answered by a YES or NO. Others requirenumerical or text answers. The I-RAT was designed to take about 4 to 8 hours to complete, depending on the sizeof the facility, scheduling, the level of knowledge of the people interviewed, and the availability of data.

    The I-RAT automatically computes a final score. A YES answer signifies good HWCM practices. Each YES/NOquestion is assigned a value (weighting factor) in column D. Some questions have a higher value than othersbecause of their importance in healthcare waste management. The higher the final score, the better is the HCWMsystem of the facility. The highest score is 100 points.

    The I-RAT was designed for use by the technical consultants of the UNDP GEF Project in conjunction with the

    staff of the model healthcare facilities. The process has five main activities: (1) preparation, (2) I-RAT Part I - InitialInterview, (3) inspection tour of the facility, (4) I-RAT Part II - post-inspection tour Interview, and (5) scoring andfinal meeting. The section below gives instructions for each stage and an estimated time needed to accomplisheach activity.

    1

    > Go through the entire I-RAT to make sure that both its structure and contents are clear to you. Review theAnswer Guide well to understand the criteria for YES and NO responses. Before conducting a rapid assessment,experiment with a copy of the I-RAT to understand its use.

    > Contact the healthcare facility ahead of time to schedule the individualized rapid assessment and to explain the

    nature and purpose of the I-RAT. Request a list of personnel who can provide the answers to the list of topics, findout about availability, and request the facility to develop a schedule of interviews, inspection tour, and the finalmeeting with key personnel. If necessary, provide examples of the questions under Part I-Initial Interview. Do notprovide a copy of questions under Part II. Work with the designated project liaison to make logistical arrangements(hotel, transportation, etc.).

    > Familiarize yourself with national and local laws, regulations, and standards related to healthcare waste andwastewater (liquid waste).

    > Familiarize yourself with general infection prevention and control procedures (see NOTE H at the bottom of theAnswer Guide)

    > Download a copy of the I-RAT to your laptop to be used on site. Prepare a checklist, a journal to take notes, anda digital camera to document specific practices.

    2

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    > Ask to be provided with copies of policies and plans as well as copies of training curriculum if available.

    Inspection Tour of the Facility (2 - 4 hours)

    Part II - Post-Inspection Tour Interview (1 to 2 hours)

    Scoring and Final Meeting (15 to 30 minutes)

    > Check for any mistakes in the input data and obtain the final score from the I-RAT.

    After the Completion of the I-RAT

    > Meet with the administration, project liaison, and HCWM coordinator (or the person most responsible forhealthcare waste) to obtain responses to questions under the Part I - Initial Interview topics. If possible, input theYES/NO responses into the I-RAT during the interview. Avoid discussing Part II topics until after the inspectiontour.

    > Make arrangements to obtain responses to the questions that were not answered during the initial interview.

    Request that the responses be given during the post-inspection tour interview.3

    > Conduct an inspection of the facility with the project liaison, HCWM coordinator, and/or other facilityrepresentatives. Be polite, sensitive to staff concerns, and respectful of the privacy of patients. Ask permission totake photographs. Avoid taking photographs of the faces of facility personnel without their permission. Do not takephotographs of patients or their visitors. Follow infection control procedures. Use appropriate personal protectionequipment (PPE)such as gloves, a face mask, gown, and/or shoe coverswhen entering sterile areas. Use PPEwhen touching waste containers and wash hands thoroughly after the inspection tour.

    > Ask to see examples of the following: classification system used, segregation practices, types of containersused especially sharps containers, quality of plastic bags used for infectious waste, color coding, labeling,collection and handling of waste including the use of PPE by waste workers, waste transport carts and theircondition, waste storage areas and their condition, accessibility of storage areas and the length of time that waste

    is kept, waste treatment technology including the condition of the treatment unit, method of disposal of treatedwaste, and method of treatment of wastewater. Take notes of poor or improper practices.

    > If possible, take photographs of the following: the contents of unsealed waste containers especially those thatshow improper segregation, use of inappropriate containers or plastic bags, overfilled containers, incorrect colorcoding or labeling, handling of waste without PPE, dirty transport carts or storage areas, spilled waste that has notbeen cleaned up, poor maintenance of the treatment unit, and improper waste or wastewater disposal.

    > Visit all major departments where healthcare waste is generated. Ask questions of staff members handlingwaste in each department.

    4

    > Go through the list of questions in Part II with the HCWM coordinator and/or facility representatives. Input the

    YES/NO responses into the I-RAT during the interview.

    > Consider their responses in light of your inspection tour. If some responses are inconsistent with what youobserved or documented, politely point out the inconsistencies by citing examples of what you saw, what you weretold by staff members, or what you photographed. As much as possible, responses should be based on facts orprima facie evidence.

    > Obtain the responses to questions that were unanswered during the initial interview. Obtain the copies ofpolicies, plans, and training curriculum, or make arrangements to have them sent to you as soon as possible.

    > Enter the rest of the data in your laptop. Ideally, this should be done in the presence of the HCWM coordinatorand/or facility representatives.

    5

    > Meet with the administrator, project liaison, HCWM coordinator, and other key personnel to present the resultsof the I-RAT and discuss any urgent issues that need to be addressed.

    Write a brief report and present it with a copy of the completed I-RAT and copies of any facility policies/plans andtraining curriculum to the National Coordinator.

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    Prepare an evaluation of the I-RAT including responses to the following questions: (1) Were the instructions onusing the I-RAT clear and complete? If not, what changes would you make? (2) Was the I-RAT easy to use? (3)How long did each activity take? (4) What difficulties did you encounter when doing the rapid assessment? (5) Doyou agree with the values (column D) assigned to each question? If not, which values would you change? (6) Doyou agree with the criteria for YES or NO responses as found in the Answer Guide? If not, which criteria would youchange? (7) Does the final score reflect your overall assessment of the healthcare facility? If not, should the finalscore have been higher or lower? (8) What range of scores would you consider excellent, satisfactory, poor, and

    critical for a healthcare facility? (9) Do you think the I-RAT is a useful tool for assessing and comparing healthcarefacilities? (10) What suggestions do you have to improve the I-RAT?

    Send a copy of your report, a copy of the completed I-RAT, copies of any facility policies/plans and trainingcurriculum, and your evaluation of the tool to the UNDP Global Project Team.

    This document was developed by the UNDP GEF Project on Healthcare Waste and may be used as aresource to improve healthcare waste management. The document is copyrighted but may bereproduced in its original unaltered form without permission for advocacy, campaigning and teachingpurposes. Reproduction and distribution for commercial resale is strictly prohibited. If more than fivecopies are reproduced for distribution, UNDP/GEF must be notified by email at

    http://www.gefmedwaste.org/contactus.php. If quotations of excerpts or short passages are used,users must provide proper citation of the source. UNDP GEF does not warrant that the informationcontained in this document is complete and correct and shall not be liable for any damages incurred asa result of its use.

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    Individualized Rapid Assessment Tool Healthcare Waste Management

    C F

    Name of the person collecting the data

    Date of assessment

    PART I. INITIAL INTERVIEW

    BASIC DATA

    Name of the healthcare facility:

    Address

    Telephone/Fax:

    Description of healthcare facility:

    Number of beds: 100

    Average occupancy rate (in percent):

    Average number of outpatients per day:

    Names of persons interviewed:

    Lengths of service of persons interviewed in healthcare facility:

    # "y" or "n" Score Text or Numerical Input

    ORGANIZATION

    1 Is there a person in charge of healthcare waste management? 5 0

    If yes, write the name of the person in charge:

    2 1.5 0

    3 1.5 0

    POLICY AND PLANNING

    4a 2 0

    4b 2

    5 3.5 0

    6 1.5 0

    7 0.5 0

    8 1.5 0

    TRAINING

    9 5 0

    10 1 0

    11 2 0

    Put yes/no responses in the yellow spaces in column C; use "y" for yes and "n" for no. Put text or numerical responses inthe yellow spaces in column F. Numerical answers should be in the units specified and should not include any text. The

    final score is shown at the bottom.

    WeightValue

    Is there a permanent committee that deals with healthcare wastemanagement and meets on a regular basis?

    Are the roles and responsibilities regarding healthcare wastemanagement made clear to the staff?

    Does the healthcare facility have written policies dealing withhealthcare waste management?

    Does the healthcare facility have written plans, manuals, orAre the policies, plans, manuals, and/or written procedures consistentwith national laws, regulations, and any permits?

    Does the healthcare facility have a plan for recycling or wasteminimization?

    Does the healthcare facility policy explicitly mention a

    commitment to protect the environment?Is the healthcare facility mercury-free? OR Does the healthcarefacility have a policy or plan to phase out mercury?

    Does the facility have a training program on healthcare wastemanagement for managers, health professionals, waste workers,and auxiliary staff?

    Does the training program include relevant national laws andregulations?

    Does the training program include the following: segregation,collection and handling of sharps waste, use of proper containers

    and bags for infectious waste, color coding, 3/4th fill rule, use ofpersonal protection equipment by waste workers, transport,storage, and treatment?

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    12 3 0

    13 Is there refresher training at least once a year? 1 0

    OCCUPATIONAL HEALTH AND SAFETY

    14 3 0

    15 2 0

    16 2 0

    MONITORING, EVALUATION AND CORRECTIVE ACTION

    17 1 0

    18 1 0

    19 0.5 0

    FINANCING

    20 4 0

    21 2 0

    Budget for healthcare waste management (in the local currency):

    22 0.5 0

    PART II: POST-INSPECTION TOUR INTERVIEW

    CLASSIFICATION AND SEGREGATION

    List the types of waste produced in the facility:

    23 5 0

    24 2 0

    WASTE GENERATION DATA

    25 1 0

    100

    100

    Infectious waste generated on average (in kilograms per day): 15

    percentage of infectious waste relative to total waste: 15 0.5 0.5kilograms infectious waste per bed per day: 0.2

    kilograms unrecycled waste per bed per day: 1.0 0.5 0.5

    Are the staff trained, including new staff when they begin theiremployment?

    Do the policies and plans related to healthcare wastemanagement include occupational health and safety (including

    policies for needle-stick injuries or exposure to blood splatter)?OR Does the facility have separate occupational health andsafety policies that include needle-sticks and exposure to blood?

    Are the workers who collect, transport and treat waste providedwith the proper personal protection equipment (gloves, shoes orboots, and aprons)?

    Are the health workers and workers handling waste givenhepatitis and tetanus vaccinations?

    Is there a system of internal monitoring or inspection to determine

    compliance with healthcare waste management requirements?

    Is there a system of taking corrective action when practices ortechnologies related to healthcare waste management do notmeet the requirements?

    Are policies and/or plans reviewed or updated at least once ayear?

    Does the facility have an annual allocation in its budget forhealthcare waste management?

    Is the current budget sufficient for healthcare waste

    management?

    Does the facility have a long-term financing plan or mechanism tocover the costs for sustainable healthcare waste management?

    Are the wastes properly segregated at the source according todifferent categories?

    Are the health workers familiar with the classification andsegregation requirements?

    Have the amounts of total waste and infectious waste producedper day been measured? If yes, put the figures below; if no,provide the best estimate below.

    Total waste (infectious and non-infectious) generated on average(in kilograms per day):

    Total waste minus recycled or reused waste (in kilograms perday):

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    COLLECTION AND HANDLING

    26 Are used syringe needles collected WITHOUT recapping? 2 0

    27 5 0

    28 2 0

    29 2.5 0

    30 Are the sharps containers or needle-destroyers always available? 1 0

    31 1.5 0

    32 1 0

    33 1 0

    34 1 0

    35 0.5 0

    36 Are the infectious wastes removed at least once a day? 1 037 0.5 0

    COLOR CODING AND LABELING

    38 3 0

    39 2 0

    40 1 0

    POSTERS OR SIGNAGE

    41 0.5 0

    TRANSPORTATION INSIDE HEALTH ESTABLISHMENT

    42 0.5 0

    43 1 0

    44 Is the transport cart cleaned at least once a day? 0.5 0

    STORAGE

    45 Does the storage area meet the proper requirements? 1 0

    46 Is the storage area kept clean? 0.5 0

    Describe the types of containers used for each separatedcategory:

    Is sharps waste collected in sharps containers or destroyed usingneedle destroyers?

    Are the sharps containers puncture-resistant and leak-proof? ORAre the needle destroyers approved under existing regulations orstandards?

    Are the sharps containers filled only 3/4th full? OR Are theneedle-destroyers well maintained?

    Are the sharps containers or needle-destroyers properly placedsuch that they are easily accessible to personnel and located asclose as possible to the immediate area where the sharps areused?

    Do the health workers know what to do in the event of a needle-

    stick injury? OR Are the health workers familiar with the policy onneedle-stick injuries?

    Are the plastic bags used for non-sharps infectious waste of goodquality? OR Do you use specialized containers that aredisinfected, cleaned and reused and do not require a plasticbags?

    Are plastic bags always available? OR are the specializedcontainers described in #33 always available?

    Are the bag holders or hard containers holding the plastic bags ofgood quality? OR Do you use specialized containers that aredisinfected, cleaned and reused and do not require a plasticbags?

    Do the waste workers know what to do if sharps or infectiouswaste is accidentally spilled? OR Are the waste workers familiarwith the spill clean-up plans?

    Does the healthcare facility use a system of color coding fordifferent types of wastes?

    Are the colors of the waste containers consistent with the colorcoding?

    Are the infectious waste bags colored or labelled in accordancewith the policies or regulations?

    Are there posters or signs showing proper segregation ofhealthcare waste?

    Is the waste transported away from patient areas and other cleanareas?

    Is the waste transported in a closed (covered), wheeled transportcart?

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    47 1 0

    48 4 0

    49 1 0

    TREATMENT AND DISPOSAL

    50 25 0

    51 2 0

    52 1 0

    53a

    53b

    For facilities with on-site treatment:

    Describe the method of treatment used:

    54 Is the waste transported safely to the treatment area? 0.5 0

    55 0.5 0

    56 3 0

    57 3 0

    58 1 0

    59 6 0

    Are the wastes removed before the maximum allowable storagetime is exceeded?

    HAZARDOUS CHEMICAL, PHARMACEUTICAL ANDRADIOACTIVE WASTE

    Are hazardous chemical, pharmaceutical, and radioactive wastessegregated from infectious and general non-risk wastes? (Put Y

    in column C if the facilities does not generate these categories ofwaste.)

    Does the healthcare facility have a plan for the treatment anddisposal of hazardous chemical, pharmaceutical, and radioactivewastes? (Put Y in column C if the facilities does not generatethese categories of waste.)

    Does the healthcare facility treat its infectious waste (either on-site or at an off-site treatment facility) before final disposal? Ifinfectious waste is not treated before disposal, put N in column Cof QUESTION #53b and skip to QUESTION #69.

    Are laboratory cultures and stocks of infectious agents treatedwithin the healthcare facility before being taken away from thefacility?

    Is there a contingency plan for the treatment of infectious wastein the event that the treatment technology is shut down forrepair?

    >> Does the healthcare facility treat its waste on-site? If yes, putY in column C, make sure column C of QUESTION #53b is leftblank, and go to QUESTIONS #54-61. If the healthcare facilitytreats its waste off-site, put N in column C, make sure column Cof QUESTION #53b is left blank, and go to QUESTIONS #63-68.

    However, if the healthcare facility treats its waste BOTH on-siteand off-site, put Y in column C and Y in column C of QUESTION#53b.

    >> Does the healthcare facility treat its waste both on-site andusing an off-site treatment center? If yes, put Y in column C andanswer QUESTIONS #54-68.If the healthcare facility does nottreat its waste before disposal, put N in column C of QUESTION

    Is the treatment area located in a place that is easily accessibleto the waste worker but not accessible to the general public?

    Does the healthcare facility have a program of regular inspectionand periodic maintenance of the treatment technology?

    Is the treatment system clean, operating properly, and wellmaintained?

    Does the treatment system destroy or mutilate sharps waste inorder to prevent reuse?

    Does the healthcare facility use an approved non-incinerationtreatment technology such as an autoclave-shredder, integratedsteam treatment system, or microwave unit? If yes, put Y incolumn C and skip to QUESTION # 60.

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    60 3 0

    61 0.5 0

    62 1 0

    For facilities that use centralized off-site treatment:

    Name of the company that transports the infectious waste:

    Name and location of the off-site treatment center:

    63 2 0

    64 2 0

    65 2 0

    66 7 0

    67 4.5 0

    68 2 0

    If yes, described the final disposal of the treated waste or ash:

    WASTEWATER69 3 0

    70 1 0

    TOTAL SCORE = 0

    If the facility uses an incinerator: Does the incinerator meetinternational standards?

    If the facility uses an incinerator: Are PVC plastics kept out of the

    Is the waste that is treated in an alternative technology disposedof in a sanitary landfill? OR Is the incinerator ash buried in ahazardous waste landfill?

    >> If the answer to QUESTION #53a is yes, go to QUESTION

    #69. If the answer to QUESTION #53b is yes, answerQUESTIONS #63-68.

    Does the transport vehicle meet the regulations or internationalstandards?

    Does the healthcare facility keep copies of manifests or shipmentrecords?

    Has a representative of the healthcare facility inspected the off-site treatment center?

    Describe the method of treatment used at the off-site treatmentcenter:

    Does the off-site treatment center use an approved non-incineration treatment technology such as an autoclave-shredder,integrated steam treatment system, or microwave unit? If yes, putY in column C and skip to QUESTION #68.

    If the answer to QUESTION #66 is no, does the off-site treatmentcenter use an incinerator that meets international standards?

    Does the healthcare facility know where the treated waste or

    Does the healthcare facility treat its wastewaste (liquid waste)before being released? OR Is the healthcare facility connected toa sanitary sewer that is linked to a wastewater treatment plant?

    Does the treated wastewater from the healthcare facility meetnational or international standards?

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    Individualized Rapid Assessment Tool Healthcare Waste Management

    Answer guide: criteria for YES and NO responses to the I-RAT questions

    YES NO

    PART I. INITIAL INTERVIEW

    ORGANIZATION

    1

    2

    3 NO - The YES criteria cannot be met.

    POLICY AND PLANNING

    4a

    4b

    5

    6

    7

    8

    TRAINING9

    10

    Is there a person in charge ofhealthcare waste management?

    YES - There is a person and the name of theperson has been provided.

    NO - There is no person, OR the nameof the person cannot be provided.

    Is there a permanent committeethat deals with healthcare wastemanagement and meets on aregular basis?

    YES - A permanent healthcare waste committeeofficially exists and meets at least once a year todiscuss healthcare waste.

    NO - There is no healthcare wastecommittee, OR the committee existsonly in name, OR the committee doesnot meet at least once a year.

    Are the roles and responsibilitiesregarding healthcare wastemanagement made clear to the

    staff?

    YES - The facility representative states that atleast 80% of the health professional staff, wasteworkers, and cleaners, and 50% of the

    administrative staff are informed about theirspecific roles and responsibilities related tohealthcare waste mana ement.

    Does the healthcare facility havewritten policies dealing withhealthcare waste management?

    YES - There is a written policy which has beenshown to the consultant and a copy can beprovided.

    NO - A written policy cannot be shownto the consultant.

    Does the healthcare facility have YES - There is a written plan, manual, or written NO - A written plan, manual, or written

    Are the policies, plans, manuals,and/or written proceduresconsistent with national laws,

    YES - There are no inconsistencies with lawsand regulations.

    NO - There are one or moreinconsistencies with the laws andregulations.

    Does the healthcare facility havea plan for recycling or wasteminimization?

    YES - There is a written plan which has beendescribed or shown to the consultant.

    NO - There is no specific plan OR nowritten plan has been shown to theconsultant.

    Does the healthcare facility policyexplicitly mention a commitmentto protect the environment?

    YES- The policy (or plan) explicitly mentions acommitment to environmental protection.

    NO - The policy (or plan) does notmention a commitment toenvironmental protection.

    Is the healthcare facility mercury-free? OR Does the healthcarefacility have a policy or plan tophase out mercury?

    YES - All mercury thermometers andsphygmomanometers are mercury-free, OR thereis a written mercury phase-out policy or planwhich has been shown to the consultant.

    NO - Mercury thermometers andsphygmomanometers are used in thefacility, and there is no mercury phase-out policy or plan shown to theconsultant.

    Does the facility have a trainingprogram on healthcare wastemanagement for managers,health professionals, wasteworkers, and auxiliary staff?

    YES - The facility can show the consultant a copyof curricula specific to managers, healthprofessionals, waste workers, and auxiliary staff.

    NO - There is no training program, ORno curriculum was shown to theconsultant.

    Does the training program includerelevant national laws andregulations?

    YES - The training curriculum shows adiscussion of relevant national laws andregulations..

    NO - The training curriculum does notmention relevant national laws andregulations.

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    11

    12

    13

    14

    15

    16

    17 NO - The YES criteria cannot be met.

    18

    19

    Does the training program includethe following: segregation,collection and handling of sharpswaste, use of proper containersand bags for infectious waste,color coding, 3/4th fill rule, use ofpersonal protection equipment by

    waste workers, transport, storage,and treatment?

    YES - The training curriculum, slides or manualmentions all of the listed topics.

    NO - The training curriculum, slides ormanual lacks one or more of the listedtopics.

    Are the staff trained, includingnew staff when they begin theiremployment?

    YES - at least 95% of the staff working for morethan 1 year at the facility have been trained; and75% of new staff working less than 1 year havebeen trained.

    NO - One or both of the YES criteriahas not been met.

    Is there refresher training at leastonce a year?

    YES - There is a refresher course every year andthe facility can show documentation.

    NO - There is no annual refreshercourse, OR the facility has nodocumentation of the annual refreshertraining.

    OCCUPATIONAL HEALTH ANDSAFETY

    Do the policies and plans relatedto healthcare waste managementinclude occupational health andsafety (including policies forneedle-stick injuries or exposureto blood splatter)? OR Does thefacility have separateoccupational health and safetypolicies that include needle-sticksand exposure to blood?

    YES - The facility can show the consultant a copyof the healthcare waste management plan whichincludes prevention and emergency response toneedle-stick injuries and blood splashes; OR thefacility can show the consultant a copy of theoccupational health and safety plan that includesexposure prevention and safety regardinghandling of sharps and blood/body fluids.

    NO - One or more of the YES criteriacannot be met.

    Are the workers who collect,transport and treat wasteprovided with the proper personalprotection equipment (gloves,shoes or boots, and aprons)?

    YES - During the inspection tour, the consultantsees that all the workers collecting andtransporting waste are using gloves, shoes orboots, and an apron or outer cover to protecttheir clothing.

    NO - The consultant sees one or morewaste worker without personalprotection.

    Are the health workers andworkers handling waste givenhepatitis and tetanusvaccinations?

    YES - At least 75% of health workers and 90% ofwaste workers have both hepatitis and tetanusvaccination. Documentation of all tetanus and allthree doses of hepatitis B can be provided.

    NO - One or both of the YES criteriacannot be met.

    MONITORING, EVALUATIONAND CORRECTIVE ACTION

    Is there a system of internalmonitoring or inspection todetermine compliance withhealthcare waste managementrequirements?

    YES - There is at least one staff person going toall the major departments that generatepotentially infectious waste to inspect healthcarewaste management practices at least once every6 months.

    Is there a system of takingcorrective action when practicesor technologies related tohealthcare waste management donot meet the requirements?

    YES - The hospital can give one or moreexamples in the last five years showing howimproper practices or poor techniques have beencorrected.

    NO - The hospital cannot give anyexamples of corrections orimprovements in the last five years.

    Are policies and/or plansreviewed or updated at least once

    a year?

    YES - The policies and/or plans dealing withhealthcare waste management have been

    reviewed or updated some time within the lastyear.

    NO - The policies and/or plans havenot been reviewed or updated in more

    than one year.

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    FINANCING

    20

    21

    22

    PART II: POST-INSPECTION TOUR INTERVIEW

    23

    24

    WASTE GENERATION DATA

    25

    COLLECTION AND HANDLING

    26

    Does the facility have an annualallocation in its budget forhealthcare waste management?

    YES - The hospital can provide the actualamount of funds budgeted for healthcare wastemanagement in the last year.

    NO - The hospital cannot provide anamount for their annual healthcarewaste management budget.

    Is the current budget sufficient for

    healthcare waste management?

    YES - The facility representative states that their

    budget is sufficient AND the consultant does notsee any evidence of an inadequate budget, suchas insufficient waste containers, missing carts,inadequate maintenance of the treatmenttechnology, lacking personal protectionequipment, etc.

    NO - One or both of the YES criteria

    cannot be met.

    Does the facility have a long-termfinancing plan or mechanism tocover the costs for sustainablehealthcare waste management?

    YES - The facility representative can explain theirlong-term plan to cover the costs of healthcarewaste management now or in the future.

    NO - The facility representative cannotdescribe a long-term financing plan.

    CLASSIFICATION ANDSEGREGATION

    List the types of waste producedin the facility:

    (Write down the general waste categories usedby the facility.)

    Are the wastes properlysegregated at the sourceaccording to different categories?

    YES - The consultant observes that the contentsof waste bags or containers show goodsegregation of sharps, non-sharps infectiouswaste, and general waste.

    NO - The consultant finds one or morebags or containers with items of thewrong category, such as non-infectiouswaste in infectious waste containers orvice versa.

    Are the health workers familiarwith the classification andsegregation requirements?

    YES - Staff members questioned randomlyduring the inspection tour show a clearunderstanding of the classification andsegregation requirements.

    NO - One or more of the staff membersquestioned during the inspection tourdo not understand the classificationand segregation requirements.

    Have the amounts of total wasteand infectious waste producedper day been measured? If yes,put the figures below; if no,provide the best estimate below.

    YES - The hospital can show documentation ofprevious measurements, OR can provide figuresof their generation rates for total waste andinfectious waste.

    NO - One or both of the YES criteriacannot be met.

    percentage of infectious waste

    relative to total waste:

    (The percentage of infectious waste relative to

    total waste should be between 3% (for smallfacilities) to 25%.)

    kilograms infectious waste perbed per day:

    (Ideally, this should be the the order of 0.2 kginfectious waste per bed per day)

    kilograms unrecycled waste perbed per day:

    (Ideally, this should be less than 6 kg perbed per day.)

    Describe the types of containersused for each separated

    category:

    (Photographs can be used in place of adescription.)

    Are used syringe needles

    collected WITHOUT recapping?

    YES - The consultant does not see any recapped

    needles in the sharps containers.

    NO - The consultant sees one or more

    recapped needles in the sharpscontainers.

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    27

    28 NO - The YES criteria cannot be met.

    29

    30

    31

    32

    33

    34

    35

    36

    Is sharps waste collected insharps containers or destroyedusing needle destroyers?

    YES - The consultant sees sharps containers orneedle destroyers in use.

    NO - The consultant sees one or moresharps in plastic bags or other non-sharps containers.

    Are the sharps containerspuncture-resistant and leak-proof? OR Are the needledestroyers approved underexisting regulations or standards?

    YES - The consultant sees that the containersare made of metal, hard plastic, or thickcardboard sufficient to resist puncture andenclosed at the bottom and sides to preventleaks of small amounts of liquid.

    Are the sharps containers filledonly 3/4th full? OR Are theneedle-destroyers wellmaintained?

    YES - The consultant does not see any over-filled containers, OR The consultant sees that theneedle destroyers are clean and functioningproperly.

    NO - The consultant sees one or moresharps containers filled beyond the3/4th mark, OR The consultant seesneedle destroyers that are dirty or notoperating properly.

    Are the sharps containers orneedle-destroyers alwaysavailable?

    YES - The facility representative states that theyalways have enough sharps containers or needledestroyers, and the consultant does not see anylacking containers.

    NO - One or both of the YES criteriacannot be met.

    Are the sharps containers orneedle-destroyers properly placedsuch that they are easilyaccessible to personnel andlocated as close as possible tothe immediate area where thesharps are used?

    YES - The consultant sees that the sharpscontainers or needle-destroyers are placedwithin easy reach of the people using them.

    NO - One or more of the sharpscontainers or needle-destroyers are toofar from the people who need them.

    Do the health workers know whatto do in the event of a needle-stick injury? OR Are the healthworkers familiar with the policy onneedle-stick injuries?

    YES - Staff members randomly questioned bythe consultant know what to do or are able todescribe the policy regarding needle-stickinjuries.

    NO - One or more of the staff membersrandomly questioned do not know whatto do or are unable to describe thepolicy regarding needle-stick injuries.

    Are the plastic bags used for non-sharps infectious waste of goodquality? OR Do you usespecialized containers that aredisinfected, cleaned and reusedand do not require a plastic bags?

    YES - The facility representative states that noneof their plastic bags have broken, and a simpletest by the consultant indicates that the bags areof good quality (see NOTE A); OR the facilityrepresentative states that they use specializedcontainers that are disinfected, cleaned andreused.

    NO- plastic bags are not of goodquality as described in YES Criteria;OR no plastic bags are used OR nospecialized contaners are used

    Are plastic bags alwaysavailable? OR are the specializedcontainers described in #33always available?

    YES - The facility representative states thatwaste bags are always available, and theconsultant does not see any lackingbags;OR the facility representative statesthat specialized containers are alwaysavailable and the consultant does not seeany lacking specialized containers.

    NO - plastic bags are not alwaysavailable as defined in the YESCriteria; OR special containers are notavailable; OR plastic bags are not used

    Are the bag holders or hardcontainers holding the plasticbags of good quality? OR Do youuse specialized containers thatare disinfected, cleaned andreused and do not require aplastic bags?

    YES - The bag holders and/or containers arehard, durable, stable, with no sharp ends thatcould puncture the bags, and properly sized forthe capacity of the plastic bag; OR the facilityuses specialized containers that are disinfected,cleaned and reused.

    NO - the bag holders and/or containersare not of good quality as described inthe YES criteria; AND the facility doesnot use specialized containers

    Are the infectious wastesremoved at least once a day?

    YES - The facility representative states thatinfectious wastes are removed at least once aday, and the consultant does not see anyinfectious waste bags piled up except in the

    storage area.

    NO - One or both of the YES criteriacannot be met.

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    37 NO - The YES criteria cannot be met.

    38 NO - The YES criteria cannot be met.

    39

    40

    POSTERS OR SIGNAGE

    41 NO - The YES criteria cannot be met.

    42

    43 NO - The YES criteria cannot be met.

    44

    STORAGE

    45

    46 Is the storage area kept clean? NO - The YES criteria is not met.

    47

    Do the waste workers know whatto do if sharps or infectious wasteis accidentally spilled? OR Arethe waste workers familiar withthe spill clean-up plans?

    YES - Waste workers questioned by theconsultant are able to describe what to doduring a spill (see NOTE B).

    COLOR CODING AND

    Does the healthcare facility use asystem of color coding differenttypes of wastes?

    YES - The consultant sees that color codingis used in the facility.

    Are the colors of the wastecontainers consistent with thecolor coding?

    YES - The consultant sees that all of the wastecontainers use the correct color code for theintended content.

    NO - One or more containers have thewrong color code.

    Are the infectious waste bagscolored or labelled in accordancewith the policies or regulations?

    YES - The consultant sees that all the bags areof the correct color code and/or label (generallythe international biohazard label) according to thepolicies or regulations.

    NO - One or more plastic bags havethe wrong color code or label.

    Are there posters or signsshowing proper segregation ofhealthcare waste?

    YES - The consultant sees at least oneposter or sign illustrating propersegregation.

    TRANSPORTATION INSIDEHEALTH ESTABLISHMENT

    Is the waste transported awayfrom patient areas and otherclean areas?

    YES - The facility representative states that theinfectious waste is transported properly, theconsultant is shown some of the routes, and theroutes are safe and away from patients and cleanareas.

    NO - One or more of the YES criteriacannot be met.

    Is the waste transported in aclosed (covered), wheeledtransport cart?

    YES - The consultant sees that the transportcarts are covered.

    Is the transport cart cleaned atleast once a day?

    YES - The facility representative states that thecarts are cleaned at least once a day, and theconsultant is shown where and how the carts arecleaned.

    NO - One or both of the YES criteriacannot be met.

    Does the storage area meet theproper requirements?

    YES - The consultant inspects the storage areaand finds that all the regulatory requirements (orWHO standards (see NOTE C) if there are noregulatory requirements) are met.

    NO - One or more of therequirements in the regulation or inthe international standard are not

    met.

    YES - The consultant sees that the storageare is clean.

    Are the wastes removed beforethe maximum allowable storagetime is exceeded?

    YES - The facility representative states that thewastes are stored less than the maximumstorage time (see NOTE D) and if the bags arelabelled, the consultant does not see any labelledwaste bags that have exceeded the time limit.

    NO - One or both of the above criteriacannot be met.

    HAZARDOUS CHEMICAL,PHARMACEUTICAL ANDRADIOACTIVE WASTE

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    48

    49 NO - The YES criteria cannot be met.

    TREATMENT AND DISPOSAL

    50 YES - Infectious waste is treated.

    51 NO - The YES criteria cannot be met.

    52 NO - There is no contingency plan.

    53a

    53b

    54

    55 NO - The YES criteria cannot be met.

    56

    Are hazardous chemical,pharmaceutical, and radioactivewastes segregated frominfectious and general non-riskwastes?

    YES - The consultant is shown at least oneexample of hazardous chemical,pharmaceutical or radioactive wastesegregated in separate containers.

    NO - The consultant sees hazardouschemical, pharmaceutical orradioactive waste mixed with infectiousor general (non-risk) waste.

    Does the healthcare facility have

    a plan for the treatment anddisposal of hazardous chemical,pharmaceutical, and radioactivewastes?

    YES - The consultant is shown a written

    plan or policy regarding the treatment anddisposal of hazardous chemical,pharmaceutical, and radioactive wastes.

    Does the healthcare facility treatits infectious waste (either on-siteor at an off-site treatment facility)before final disposal?

    NO - Infectious waste is discardedwithout treatment.

    Are laboratory cultures and stocksof infectious agents treated withinthe healthcare facility before

    being taken away from thefacility?

    YES - The laboratory manager or staffshows where and how the cultures and

    stocks are treated before leaving the facility.

    Is there a contingency plan for thetreatment of infectious waste inthe event that the treatmenttechnology is shut down forrepair?

    YES - The facility representative shows orexplains the contingency plan.

    >> Does the healthcare facilitytreat its waste on-site?

    If yes, put Y in column C, make sure columnC of QUESTION #53b is left blank, and goto QUESTIONS #54-61. If the healthcarefacility treats its waste BOTH on-site and

    off-site, put Y in column C and Y in columnC of QUESTION #53b.

    If the healthcare facility treats its wasteoff-site, put N in column C, make surecolumn C of QUESTION #53b is leftblank, and go to QUESTIONS #63-68.

    >> Does the healthcare facilitytreat its waste both on-site andusing an off-site treatmentcenter?

    If yes, put Y in column C and answerQUESTIONS #54-68.

    If the healthcare facility does not treatits waste before disposal, put N incolumn C of QUESTION #50 and go toQUESTION #69.

    For facilities with on-sitetreatment:

    Describe the method of treatmentused:

    (Write a brief description and attach one ormore photographs.)

    Is the waste transported safely to

    the treatment area?YES - The facility representative or wasteworker report that there have been no majorspills in the last year due to problems in themethod of transport to the treatment area.

    NO - At least one major spill has been

    reported in the last year due toproblems in transporting to thetreatment area.

    Is the treatment area located in aplace that is easily accessible tothe waste worker but notaccessible to the general public?

    YES - The consultant sees that thetreatment area is accessible to the wasteworker but is not accessible to the public.

    Does the healthcare facility havea program of regular inspectionand periodic maintenance of thetreatment technology?

    YES - The manager shows the consultantthe repair and maintenance records, OR theoperator shows an inspection andmaintenance schedule, OR the operator is

    able to describe daily, weekly, monthly andannual maintenance procedures.

    NO - Not one of the YES criteria canbe met.

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    57 NO - The YES criteria cannot be met.

    58 NO - The YES criteria cannot be met.

    59

    60 YES - see NOTE E.

    61 NO - The YES criteria cannot be met.

    62

    (Write the company name.)

    63 NO - The YES criteria cannot be met.

    64 NO - The YES criteria cannot be met.

    65 NO - The YES criteria cannot be met.

    (Write a short description.)

    66 NO - The YES criteria cannot be met.

    67 NO - The YES criteria cannot be met.

    Is the treatment system clean,operating properly, and wellmaintained?

    YES - The consultant sees that thetreatment system is reasonably clean andseems to be operating properly.

    Does the treatment systemdestroy or mutilate sharps wastein order to prevent reuse?

    YES - The treatment system uses ashredder, grinder, crusher, combustion(incineration), melting, solidifier, or other

    method to prevent sharps from beingreused; or the facility uses auto-disable orretractable syringes.

    Does the healthcare facility usean approved non-incinerationtreatment technology such as anautoclave-shredder, integratedsteam treatment system, ormicrowave unit?

    YES - The consultant sees the treatmenttechnology and confirms that the technology isan approved alternative technology.

    NO - The technology is not anapproved alternative technology.

    If the facility uses an incinerator:Does the incinerator meetinternational standards?

    NO - The incinerator does not meet allof the criteria in NOTE E.

    If the facility uses an incinerator:Are PVC plastics kept out of thewaste that is burned?

    YES - The facility representative explains to theconsultant how PVC plastics are kept out of theincinerator.

    Is the waste that is treated in analternative technology disposed ofin a sanitary landfill? OR Is theincinerator ash buried in ahazardous waste landfill?

    YES - The facility representative states that theincinerator ash is buried in a special pit or landfill,OR that the treated waste from an alternativetechnology is sent to a sanitary landfill.

    NO - Not one of the YES criteria canbe met.

    For facilities that usecentralized off-site treatment:

    Name of the company thattransports the infectious waste:

    Name and location of the off-sitetreatment center:

    (Write the name and address of the off-sitetreatment center.)

    Does the transport vehicle meetthe regulations or internationalstandards?

    YES - The hospital representative's description ofthe transport vehicle is consistent withregulations or WHO standards (see NOTE F).

    Does the healthcare facility keepcopies of manifests or shipmentrecords?

    YES - The facility representative shows theconsultant where they keep the manifests orrecords for the transport of infectious waste.

    Has a representative of thehealthcare facility inspected theoff-site treatment center?

    YES - The facility representative states that theyhave visited the off-site treatment center at leastonce.

    Describe the method of treatment

    used at the off-site treatmentcenter:

    Does the off-site treatment centeruse an approved non-incinerationtreatment technology such as anautoclave-shredder, integratedsteam treatment system, ormicrowave unit?

    YES - The facility representative describesthe treatment technology which theconsultant recognizes as an approvedalternative technology.

    If the answer to QUESTION #66is no, does the off-site treatmentcenter use an incinerator thatmeets international standards?

    YES - The facility representative is able todescribe the incinerator with sufficient detail toallow the consultant to determine that it meetsinternational standards listed in NOTE E.

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    68 NO - The YES criteria cannot be met.

    (Write a short description.)

    WASTEWATER

    69

    70

    NOTE A

    NOTE B

    NOTE C

    The storage area should have an impermeable, hard-standing floor with good drainage; it should be easy to clean and disinfect.

    There should be a water supply for cleaning purposes.

    The storage area should afford easy access for staff in charge of handling the waste.

    It should be possible to lock the store to prevent access by unauthorized persons.

    Easy access for waste-collection vehicles is essential.

    There should be protection from the sun.

    The storage area should be inaccessible for animals, insects, and birds.

    There should be good lighting and at least passive ventilation.

    The storage area should not be situated in the proximity of fresh food stores or food preparation areas.

    Does the healthcare facility knowwhere the treated waste orincinerator ash is dumped?

    YES - The facility representative is able todescribe where the treated waste or ash isdumped.

    If yes, described the final disposalof the treated waste or ash:

    Does the healthcare facility treatits wastewaste (liquid waste)before being released? OR Is thehealthcare facility connected to asanitary sewer that is linked to awastewater treament lant?

    YES - The facility representative explains howthe wastewater is treated, OR the facilityrepresentative states that they are connected toa sanitary sewer that is linked to a wastewatertreatment plant.

    NO - Not one of the YES criteria canbe met.

    Does the treated wastewater fromthe healthcare facility meetnational or internationalstandards?

    YES - The consultant sees copies of the testresults of effluent analysis and sees that theresults meet the national standards, OR thewastewater treatment system meets the basicWHO standard (see NOTE G)..

    NO - Not one of the YES criteria canbe met.

    Some countries have specific requirements for infectious waste bags, as well as standardized tests such as ISO 7765-1, ASTM D 1709Method A, BS2782 Method 352D, or IS 2508. Other countries specify a minimum thickness, typically 38 microns (1.5 mils) or 76 microns (3mils). The consultant should inquire about the thickness of the plastic bags. Thicknesses greater than 30 microns (1.2 mils) are probablysufficient.

    In the absence of thickness data, the consultant can perform a simple test of the durability, strength of the seals, and leakage resistance.Fill the bag with 10 kg (22 pounds) of water. Lift the bag from the top and carry it for 60 seconds. If the bag does not break and there areno signs of leakage, the bag is likely of sufficient quality.

    The consultant can also conduct the following simplified test to obtain some indication of the impact resistance of the plastic bags. Obtaina metal or hard plastic object weighing no less than 165 grams (0.36 pounds) with a rounded end that measures about 3.8 cm (1.5 inches)in diameter. Open the plastic bag and tie two or more ends of it to sturdy immovable structures that can hold the plastic bag open and inplace. Measure a point that is 66 cm (25 inches) above the bottom of the bag. Drop the object with the rounded end pointing downwardsinto the inside of the plastic bag from the point 66 cm (26 inches) above the bottom of the bag. If the bag does not break, it is an indication

    that the quality may be sufficient.

    If the facility has no standard procedure, the consultant can evaluate the waste worker's responses based on the following typical spillprocedure: (1) Determine the nature and extent of the spill; (2) Evacuate and restrict access to the spill area; (3) If an injury or exposure toinfectious agents occurred, provide medical attention; (4) Put on the appropriate personal protective equipment depending on the potentialexposure pathway (e.g., gloves, apron, goggles, face mask or respirator); (5) Remove spilled material using tools (e.g., shovels for solids,absorbent material for liquids), place the waste in the appropriate container (e.g., infectious waste bags, sharps container, etc.), anddispose of properly; (6) Clean and disinfect the area; (7) Remove and disinfect personal protective equipment, and wash hands and allexposed skin thoroughly.

    The following are the WHO recommended standards for infectious waste storage areas:

    A supply of cleaning equipment, protective clothing, and waste bags or containers should be located conveniently close to the storagearea.

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    NOTE D

    NOTE E

    NOTE F

    If there are no national regulations on storage time limits, use the following WHO recommended guidelines: Unless a refrigerated storageroom is available, storage times for healthcare waste (i.e. the delay between production and treatment) should not exceed the following: fortemperate climate: 72 hours in winter, 48 hours in summer; for warm climate: 48 hours during the cool season, 24 hours during the hotseason.

    The Stockholm Convention, ratified by the GEF project countries, requires the use of Best Available Techniques for medical wasteincinerators. The guidelines of Best Available Techniques requires performance levels in air emissions of dioxins and furans that do notexceed 0.1 nanograms I-TEQ/normal cubic meter at 11% O2. Moreover, dioxins and furans in the wastewater of treatment plants treatingeffluents from any gas treatment scrubber effluents should be well below 0.1 nanograms I-TEQ per liter.

    Since it is unlikely that the facility has conducted difficult and expensive dioxin tests, the consultant should inquire first about theincinerator design. The guidelines describe the following design as acceptable. An incineration plant should consist of the following units:(1) Furnace or kiln as the primary combustion chamber, (2) Afterburning chamber as the secondary chamber, (3) Flue gas cleaning devicesystem, and (4) Wastewater treatment plant if a wet flue gas cleaning system is used. Single-chamber, drum and brick incinerators are notacceptable designs. The thermal treatment process used in the furnace or kiln could be one of the following: pyrolysis or gasification, rotarykiln, grate incineration specially adapted for healthcare waste, fluidized bed incineration, or modular excess air or controlled airincineration.

    In addition, in order to meet the performance level, the incinerator needs the following primary measures: 1. Introduction of the waste inthe combustion chamber only at temperatures of 850 C; the plant should have an automatic system to prevent waste feed before theabove-mentioned temperature is reached. 2. Installation of auxiliary burners (for start-up and shut-down operations). 3. Avoidance ofstarts and stops of the incineration process. 4. Avoidance of temperatures below 850C and no cold regions in the flue gas. 5. Control ofoxygen input depending on the heating value and consistency of feed material. 6. Minimum residence time of 2 seconds above 850C inthe secondary chamber after the last injection of air, or at 1100C for wastes containing more than 1% halogenated organic substances (asis generally the case for medical waste), and 6% O2 by volume. 7. High turbulence of exhaust gases and reduction of air excess byinjection of secondary air or re-circulated flue gas, pre-heating of the air-streams, or regulated air inflow. 8. On-line monitoring forcombustion control (temperature, oxygen content, CO, dust), and operation and regulation of the incinerator from a central console.Preheating and initial co-firing with a clean fossil fuel is recommended, and continuous operation (as opposed to batch processes) shouldbe the method of choice. Upsets should be minimized through periodic inspection and preventive maintenance. Operators should not feedwaste during severe combustion upsets or during a filter bypass (dump stack) operation.

    The following secondary measures should also be applied to meet the performance levels: the secondary measures below (an

    appropriate combination of dedusting and other equipment to further reduce dioxins) should be applied as best available techniques.1. Dedustingo Fabric filters used at temperatures below 260 Co Ceramic filters used at temperatures between 800 to 1000 Co Cyclones used for pre-cleaning of flue gaseso Electrostatic precipitators used at temperatures of around 450 Co High-performance adsorption units with activated charcoal (electrodynamic venturi)

    2. Techniques to further reduce emissions and PCDD/Fo Catalytic oxidationo Gas quenchingo Catalyst-coated fabric filterso Different types of wet and dry adsorption systems using mixtures of activated charcoal, coke, lime and limestone solutions in fixed bed

    reactors (adsorption with activated charcoal or open hearth coke), moving bed reactors, or fluidized bed reactors (entrained flow orcirculating fluidized beds with activated coke/lime or limestone followed by the use of fabric filters).

    In the absence of regulations, the following WHO recommended standards should be used: The body of the vehicle should be of asuitable size commensurate with the design of the vehicle, with an internal body height of 2.2 metres. There should be a bulkheadbetween the driver's cabin and the vehicle body, which is designed to retain the load if the vehicle is involved in a collision. There shouldbe a suitable system for securing the load during transport. Empty plastic bags, suitable protective clothing, cleaning equipment, tools,and disinfectant, together with special kits for dealing with liquid spills, should be carried in a separate compartment in the vehicle. Theinternal finnish of the vehicle should allow it to be steam-cleaned, and the internal angles should be rounded. The vehicle should bemarked with the name and address of the waste carrier. The international hazard sign should be displayed on the vehicle or container, aswell as an emergency telephone number.Vehicles or containers used for the transportation of health-care waste should not be used for the transportation of any other material.They should be kept locked at all times, except when loading and unloading. Open-topped skips or containers should never be used fortransporting health-care waste.

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    NOTE G

    NOTE H

    The method of choice for wastewater treatment is a sanitary sewer connected to a centralized sewage treatment plant that provides atleast primary and secondary treatment, and preferrably tertiary treatment as well. In the absence of a centralized modern treatmentsystem, WHO recommends the use of a septic tank connected to a soakaway or infiltration trench, or an oxidation pond or lagoon systemwith mechanical aeration.

    The technical consultant should follow basic infection prevention and control procedures during the site visit. Standard precautions includethe use of personal protective equipment such as the correct types of gloves and masks in situations where the consultant may beexposed to infectious agents that can be transmitted through direct contact or inhalation, respectively. Appropriate personal protectiveequipment should also be used when examining sterile areas such as surgical theaters. The consultant should practice hand hygieneespecially after touching waste bins, removing gloves, before taking breaks, before meals, and at the end of the day; washing the handswith soap and warm water remains the single most important procedure for preventing nosocomial infections. An alcohol-based handsanitizer is highly recommended. Examining infectious waste containers should be done visually without touching the contents. Thecontents of infectious or hazardous waste containers or bags should not be handled, removed, or transferred. Once the infectious orhazardous waste containers or bags have been sealed, they should not be re-opened. The consultant should follow any transmission-based precautions when inspecting isolation wards or rooms of patients known or suspected to be infected with highly transmissiblepathogens.

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    Individualized Rapid Assessment Tool Healthcare Waste Management

    Glossary of Terms

    Term Definition

    Anatomic waste Consists of recognizable body parts.Auto-disable Syringe

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

    Chemical waste

    Color coding Designates the use of different colors for the storage of various categories of HCW.

    Container

    Cytotoxic waste Drugs possessing a specific destructive action on certain cells.

    Disposal

    Handling The functions associated with the movement of waste materials.

    Healthcare waste

    Hepatitis B

    Hepatitis C

    Incineration

    Infectious waste

    Open dump Characterized by the uncontrolled and scattered deposit of wastes.

    Pharmaceutical waste

    Pathogen A microorganism capable of causing disease.

    Radioactive waste

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

    Sanitary landfill

    Sharps container

    Segregation The systematic separation of waste into designated categories.

    Sharps

    Storage

    Treatment

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

    Consists of/or containing chemical substances.

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

    Intentional burial, deposit, discharge, dumping, placing or release of any waste material intany air, land or water.

    Healthcare waste is all waste that is generated from healthcare establishments, research flaboratories, and other sources. It includes infectious waste (including sharps waste andpathological waste), hazardous chemical waste (including pharmaceutical, cytotoxic, andradiological waste), and non-risk general waste.

    Health-care wastes withhigh content of heavymetals

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

    Hepatitis caused by a virus and transmitted by exposure to blood or blood products or durisexual intercourse. It causes acute and chronic hepatitis. Chronic hepatitis B can cause liv

    Hepatitis caused by a virus and transmitted by exposure to blood or blood products. Hepatusually chronic and can cause cirrhosis and primary liver cancer.

    The burning of solid, liquid or gaseous wastes to produce gases and residues containing licombustible material.

    Infection prevention andcontrol

    The activities aiming at the prevention of the spread of pathogens between patients, fromhealthcare workers to patients, and from patients to healthcare workers in the healthcare s

    Discarded materials from health-care activities on humans or animals which have the potetransmitting infectious agents to humans. These include discarded materials or equipmentdiagnosis, treatment and prevention of disease, assessment of health status or identificatipurposes, that have been in contact with blood and its derivatives, tissues, tissue fluids, orfrom infection isolation wards.

    Consisting of/or containing pharmaceuticals.

    Consisting of/or containing radioactive substances.

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

    Characterized by the controlled and organized deposit of wastes which is then covered re

    A puncture proof/liquid proof container designed to hold used sharps safely during disposa

    Sharps are a subcategory of infectious health care waste and include objects that are shar

    The placement of waste in a suitable location where isolation, environmental and health prand human control (e.g. radiation control, limitation of access) are provided. This is doneintention that the waste will be subsequently retrieved for treatment and conditioning and/o

    Any method, technique or process for altering the biological, chemical or physical charactewaste to reduce the hazards it presents and facilitate, or reduce the costs of, disposal. Thetreatment objective include volume reduction, disinfection, neutralization or other change ocomposition to reduce hazards, including removal or radionuclides from radioactive waste.

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    Waste management

    Abbreviation Definition

    HCW Healthcare waste

    HCWM Healthcare waste management

    HCF Healthcare facility

    All the activities - administrative and operational - involved in the handling, treatment, condstorage, transportation and disposal of waste

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    itioning,