who health care waste management protection of the human environment (phe) richard m. carr
TRANSCRIPT
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Richard M. Carr
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Content of Presentation
• Needs Assessment
• National Action Plans
• Relative Risks
• Technology Options
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Needs Assessment
WHY Needed?
• Identifies health risks
• Describes current management practices
• Raises awareness
• Provides information on amounts and types of waste generated
• Supports development of a National Action Plan
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Needs Assessment
How?
• Assess HCWM at representative facilities of all sizes and in typical settings
• Interview facility staff at all levels
• Interview staff from key government agencies, NGOs, and municipalities
• Evaluate curriculums at School of Public Health, MedicineNursing, etc.
• Assess current laws governing HCWM
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Needs Assessment
Tools/Resources
• WHO Rapid Assessment Tool (RAT)
• Aide-Memoire Safe health-care waste management
• Websites: www.healthcarewaste.org www.safeinjection.org
• Technical option database on website
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
National Action Plan
Successful HCWM Strategies Include:
• National policy for safe HCWM
• Comprehensive system of HCWM
• Awareness and training
• Selection of options for HCWM
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
National Action Plan
National policy for safe HCWM
• Designate responsible authority
• Regulatory framework & guidelines
• Assessment of status & problems
• Overall waste management plan
• Monitoring & evaluation
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
National Action Plan
Comprehensive system for HCWM
• Assign waste management responsibilities to staff
• Allocate Resources
• Minimization of waste (procurement)
• Segregation of waste
• Safe collection, handling and storage
• Safe treatment and disposal
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
National Action Plan
Awareness and Training
• Add waste management to the curricula for health-care personnel
• Develop national training package
• Develop train the trainers programmes
• Education on health risks
• Education on safe practices
• Increase community awareness
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
National Action Plan
Management Options for HCW
• Review available options for different size facilities and
different settings
• Evaluate safety and environmental aspects
• Ensure worker’s safety
• Evaluate sustainability
• Assess acceptability
• Monitoring of safety and efficiency
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Relative Health Risks
• Reuse of needles and syringes pose the greatest health risks
to patients, staff and the community
• Risks to health-care workers and the community can still be
significant even without reuse
• Burning HCW at low temperatures produces dioxins:
persistent toxins which effect human health and the environment
• Burning HCW can release mercury and other heavy metals
which effect human health and the environment
• Risks from dioxin and mercury due to burning HCW are unknown
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Risk:
Reuse
Staff &
Community
Dioxin
Mercury
Relative Health RisksStrategies for reducing risk:AD syringes, Over-supply needles and syringes,Good management and disposal, Hepatitis B vaccination of staff and children
Sharps boxes, protective clothing, training, Community awareness programmes, good management and disposal Hepatitis B vaccination of staff and children
Non-incineration disposal options, high temperatureIncineration, procurement
Waste segregation, non-incineration disposal options,procurement
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Managing Waste
• No one-size-fits-all solution
• Solutions do exist for many situations “non-availability” of technologies is often a “wrong problem” - or not a technical one
Allocated resources ?Regulatory compliance ?Social acceptance ?
• Environmental concerns, pressure groups, Kyoto, bans on burning in some countries
• “polluter pays” principle ---
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Technical Options for Managing Waste
Safety boxes - first line of defense
• Bundled with vaccines
• Work well in vaccination campaigns and for some routine programme needs
• Reusable plastic sharps boxes can be used for routine needs
• Disposable boxes require frequent re-supply
• Disposal requires burning or incineration – limits options
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Technical Options for Managing Waste
Needle Cutters and Destroyers
• Reduce risks by removing the sharp before disposal
• Prevent reuse and community exposure
• Reduce most dangerous waste significantly
• Manual needle cutters may still pose health risks from splashing
• Expensive
• Needle destroyers very expensive and require electricity
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Technical Options for Managing Waste
Burning – Low temperature
• Open pit
• Brick enclosures and open brick incinerators
• “Drum” incinerators
• Low costs
• Create maximum pollution
• Incomplete combustion does not destroy all sharps
• Least desirable option
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Technical Options for Managing Waste
Burning – High temperature
• Locally built brick incinerators e.g. “De Montford”
• Small factory built pre-fabricated steel incinerator
• Other industrial incinerators
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Technical Options for Managing Waste
Burning – High temperature
• Appropriate for medium to large facilities – better for less densely populated areas
• Reduce harmful emissions by high temperature incineration
• Complete combustion of all sharps
• Moderately expensive to build US$ 1500 – 5000
• May require fuel to operate
• Requires training to operate and maintain
• Requires waste segregation – heavy metals
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Technical Options for Managing Waste
Burning – High temperature
De MontfordLocally built brick IncineratorUS $1500Installed
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Technical Options for Managing Waste
Burning – High temperature
After-burning
Air inlet
Factory builtPrefabricated IncineratorUS $5000Installed
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Technical Options for Managing Waste
Steam Sterilizers e.g. “Hydroclave”
• Appropriate for medium to large facilities
• Essentially no emissions
• Good for densely populated areas
• Complete destruction of all sharps
• Expensive
• Requires training to operate and maintain
• Requires waste segregation – heavy metals
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Technical Options for Managing Waste
Waste Burial Pit
• Suitable for small clinics
• Easy to build, operate and maintain
• Requires space on-site
• Proper segregation of sharps can increase life
• May not be suitable for areas with high water tables
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Technical Options for Managing Waste
Waste Burial Pit
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Technical Options for Managing Waste
Other Options
• Encapsulation
• Melting ovens
• Professional recovery and recycling
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Technical Options for Managing Waste
Waste Minimization
• Reduce injection overuse
• New delivery systems
• Biodegradable syringes and needles
• Reduce packaging
• Eliminate use of toxic components
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WHO Health Care Waste Management
Protection of the Human Environment (PHE)
Conclusion
• Safe HCWM requires a comprehensive system
• Lack of resources can be overcome with creativity and the will to
manage HCW safely
• Technology is only part of the solution
• Raising staff and community awareness are keys to success