HOSPITAL WASTE MANAGEMENT ISSUES AND STEPS

HOSPITAL WASTE MANAGEMENTISSUES AND STEPS TAKEN BYTHE GOVERNMENT OF PAKISTANOCT 2006Presentation By:JAWED ALI KHANDIRECTORMINISTRY OF ENVIRONMENT

Sequence of Presentation Introduction Situational Analysis Hospital Waste Management Project Main Objectives Project Outcomes Major Recommendations Responsibility for Waste Management Awareness and Advocacy Training Component Action Plan2

IntroductionzHospital waste include all waste arising fromhealthcare establishments.zStudies in Pakistan show that large hospital’sgenerate 2.0 kg of waste, per bed per day. Of this,0.5 kg can be categorized as biomedical risk waste.zThere are many small hospitals and clinics whichalso generate risk waste in significant quantities.3

Introduction (contd.)ozzDaily Medical Waste Generation(from both public & private sector hospitals):Approx 0.8 million tons(Source: UN & HSA, MoH)Improper disposal practices results in reuse of discardedsyringes, IV tubes, blood bags and other equipment whichis not 0designed for either sterilization or reuse.If hospital waste is not properly managed and disposed of,it can result in injury by contaminated sharps and infectionwith Hepatitis B, C, and HIV.4

Situational Analysis1.In Pakistan there are about 92,000 beds in publicsector hospitals2.Pakistan –Population 160 million will rise to 250million by year 2025Amount of Hospital Waste generated willincrease to alarming rates due to growth ofpopulation and healthcare facilitiesNo well established segregation systemFrequent dumping of hospital waste withmunicipal waste3.4.5.5

Situational Analysis (contd.)6. Major sources of water table pollutions7. Lapses in Landfill designs8. Maintenance and monitoring issues of incineratortechnology9. Issues related to behaviors change10. Need proper integrated management, prioritysetting & infrastructure development6

HWM: A Perspective (Contd)Initial Project Outcome:zzzDraft Hospital WasteManagement Rules2002Draft Guidelines onHospital WasteManagementSpecifications andGuidelines onIncinerators7

HWM: A PerspectiveRevised HWMP(Duration: 24 months)MoE re-launchedproject under IESE& NUST Consulting(NUST Subsidiariesunder MoST) &HSA underMoH2004:Tasks Assigned: Organize FOUR NationalTraining HWMWorkshops (Cadre-wise,one in each province)Review HWM &Incinerator guidelinesFinalize curriculum forparamedicsLaunch NationalConsensus Seminarsubsequent to Experts’Consultative Sessions8

HOSPITAL WASTEMANAGEMENT PROJECT(May 2004 – August 2006)

Main Objectives Review the existing conditions of HWMfacilities Identify deficiencies in the major cities Propose a financially viable program forelimination of environmental and healthhazards Consolidate the work already done in the10area

Project Outcomesz HospitalWaste Management Rules 2005z Guidelines on Hospital Waste Managementz Specifications and Guidelines on Incineratorsz Training Manuals for Paramedics11

Major RecommendationsAreas:a. Implementation of HWM Rules 2005 at all levelsb. Improvement through HWM Guidelines at District Levelc. SOPs: formulation by all healthcare facilitiesd. Regular Training Programmes / Refreshers (Cadre-wise)e. HWM component needs improvement in curriculum atMBBS/BDS/DVM & nursing / paramedics levelf. Mass Awarenessg. Stick & carrot policyh. Enforcement of laws needed to nudge hospitals intocomplianceh. Research12

Responsibility for Waste ManagementWaste Management Team of the Hospital/ Clinic/Lab. shall be responsible to ensure propermanagement of the waste generated in theHospital/ Clinic/ Lab.13

Duties & Responsibilities of WMT Preparation and Monitoring of Plan Periodic Review Revision or updating Implementation of WMP Compliance14

Type of WasteHospital waste can be broadly be defined into 2 categoriesRisk WastezInfectious WastezPathological WastezSharpszPharmaceutical WasteNon – Risk WasteNon – risk waste is that whichis comparable to normaldomesticgarbageandpresents no greater risk,therefore, than waste from anormal home i.e.-zChemical Waste-zRadioactive WastePaperPackagingFood Waste15

Waste DisposalTreatment: IncinerationChemical DisinfectionAutoclavingEncapsulationMicrowave irradiation etc.,Final Disposal LandfillBurying inside PremisesDischarge into Sewer etc.,16

Unsafe Acts -- ChecklistzzzzzzzzzzzOperating without authorityFailing to secure objectivesFailing to give adequate warning signalsOperating or working at unsafe speedWarning on moving of dangerous equipmentEngaging in horseplayFailing to use personal protective devicesTampering with safety devicesUsing unsafe equipment and using safe equipment unsafelyHandling, lifting, or carrying unsafe loadsTaking unsafe positions or postures17

Waste MinimizationWaste not to be Incinerated Pressurized gas containersLarge amounts of reactive chemical wasteRadioactive wasteSilver salts or radiographic wasteHalogenated plastics (e.g. PVC)Mercury or cadmiumAmpoules of heavy metals18

-Awareness rsWeb-SitePoster Competitions-Advocacy**MediaLobbying19

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TRAINING COMPONENT Three Kinds of Training ManualsDeveloped; English, Urdu & Pictorial Training Video Free Training Programme Refresher Courses 4500 Health Professionals & AlliedStaff provided free training in Govt. &Private Sector Hospital of Lahore.25

WHY SHOULD THIS PROJECTBE REPLICATED IN OTHERCITIES- TO SHOW SOCIAL RESPONSIBILITY- IT IS A SUCCESSFUL MODEL- TO REDUCE THE BURDEN OFDISEASES- TO PREVENT REUSE AND REPACKINGOF MEDICAL DISPOSABLES26

Steps Involvedz WasteMan. Teamz W -M. Planz Trainingz Waste Segregationz Waste Collectionz Waste Storagez Transportationz Disposal27

zWaste SegregationDifferent color coding has to be assigned to variousiii.waste for effective segregation, as:Black : Non-Risk waste.Red: Risk waste with Sharps.Blue: Risk Waste without sharps.iv.Yellow: Radioactive wastev.Green: Chemicals like Mercury & CadmiumzAll this segregation should be done by theindividual user.i.ii.28

zWaste SegregationDifferent color coding has to be assigned to variousiii.waste for effective segregation, as:Black : Non-Risk waste.Red: Risk waste with Sharps.Blue: Risk Waste without sharps.iv.Yellow: Radioactive wastev.Green: Chemicals like Mercury & CadmiumzAll this segregation should be done by theindividual user.i.ii.29

Waste Collectionz Tobe done by Sanitary staff on daily basis,and transferred to Central Waste storagefacility of the Institute.30

Waste Storage:z Storage facility should be covered one, located withinzzzthe hospital premises outside the main building, witheasy approach for vehicles, and inaccessible tounauthorized persons and animals etc.Should have sufficient capacity to contain largeamount of waste in case of incinerator failure.Separate storage room for radioactive waste ( yellowBags).As quoted in Rules, storage at temp 3 – 8C is notpracticable.31

TransportationOn-Site:z All waste bags except yellow ones, should betransferred to W. Storage room on daily basis by thesanitary workers by Four –wheeled trolleys ( threewheeled are quite uncomfortable).z Different colored bags have to be segregated in thestorage room.Off – site:z Should be arranged by concerned municipal / localauthority. The waste should be transferred to thevehicle by sanitary worker under the supervision ofWMO.32

WasteDisposal¾ Landfill: properly designed and properlymanaged.- Cheapest and easily available.¾ Shredders: All the bulk waste of plasticincluding risk waste is disinfected and cut intosmall pieces and converted into compact form.( Cheaper than incinerator, No Pollution, costeffective).¾ Autoclave: (expensive than Shredders ?)33

Risk of WasteAll persons exposed to hazardous hospital waste arepotentially at risk which includes all those whoeither handle the waste at any stage,or are exposed to it as aconsequence ofcareless management.34

Action PlanActivityWhoOutcome TimelineBenefits/RisksTeam FormationMS/MedicalDirectorFormalized WasteManagement Plan1 monthParticipation ofemployees in HWMWaste ManagementPlanWMTPlanning for WasteSegregation1 monthGuideline for WasteRelated ProceduresWaste SegregationEveryone,specifically thehousekeeping staffColor coded wastebags2 weeks (includestraining of staff)Health Safety ofemployees andgeneral publicWaste CollectionSanitary staffFacilitate storage2 weeksSecure WasteCollectionTransportationSanitary StaffSafe Disposal ofWaste2 weeksDocumentation onWaste Disposal35

Action Plan continuedActivityWhoOutcome TimelineBenefits/RisksAccidents andSpillagesWaste ManagementOfficerSafetyAnytimeBetter HygieneTraining forHospital renessAnytimeBetter Managementof HWM36

Stakeholders AnalysisWho?What?Why?How?Hospital StaffTrainings, Waste managWaste generat, At riskFollow guidelinesPatients/attendentsBCCWaste generator, At mostriskCounseling, poster, clips,charts etc.Municipal StaffEquip, BCC, TrainingInvolved in WMImproving behavior,funding, incentivesScavengersRestriction, Punish,EducationSource of inf.Dissemination, at riskSecured storageCommunity RepsAdvocacy, Involve,CommunicatePolitical influence,responsible of commland, awareness, monitoringEnviron. agencyTech assistance, training,MonitoringExpert and Resources andpolicy makersInspect and monitorLaw Enf. AgencyEnforcementPower to enforceProper enforc of rulesNGOAdvisory, Advocacy,FincancingWill, resources, impartial,expertisePublic-Private PartnershipsMediaAwareness, educat,monitoringInfluence on behaviourAds, messages, pictorals,awareness programsLegislatorsEffective LegislationBasic responsibilityEffective updates,37incentives, accreditation

THANK YOU VERY MUCH38

3 Introduction zHospital waste include all waste arising from healthcare establishments. zStudies in Pakistan show that large hospital’s generate 2.0 kg of waste, per bed per day. Of this, 0.5 kg can be categorized as biomedical risk waste. zThere are many small hospitals and clinics