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 Update 2-Waste Management Program Organizational structure and resources’ allocation Policies & Procedures Waste Handling Capacity Building √

Baseline Assessment Organizational structure Policies & Procedures PracticesInfrastructure Equipment Capacity- building Occupational Health & Safety Environmental FinancialLegal

Baseline Assessment Findings 96% Improper waste Segregation

Baseline Assessment Findings 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. Organizational structure 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. Policies & Procedures 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. Practices

Baseline Assessment Findings 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. Infrastructure 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 Equipment

Baseline Assessment

Baseline Assessment Findings 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. Capacity-building 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. Occupational Health & Safety

Baseline Assessment Findings

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. Environmental

Baseline Assessment Findings IndicatorResultBench Mark Values Average daily occupancy rate (%)58 Average outpatients per day462 Average total waste generation rate in kg per bed per day3 Average total waste generation rate in kg per occupied bed per day Average total waste generation rate in kg per total patient per day1.5 Average infectious waste generation rate in kg per bed per day Average percentage of infectious waste from total waste (%) % 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 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. Financial 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). Legal

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 Update 2-Waste Management Program Organizational structure and resources’ allocation Policies & Procedures Waste Handling Capacity Building √

Steps Of Proper Waste Management Waste minimization SegregationHandlingTreatment Transportatio n 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 Structure Organizational Structure Responsibilities for HCWM

Waste Management Program – Resources’ Allocation Specification 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 Procedure 6-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 Chart Type 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 with Radioactive material Cytotoxic Cytotoxic Sharps Pathological Radioactive HCW Segregation Chart

Waste Management Program – Handling: Segregation Healthcare wasteNon-HazardousRecyclableRecycling Bin Recycling facilities Non-recyclableBlack BagMunicipal wasteSanitary LandfillHazardousInfectiousNon-SharpsYellow Bag Treatment by sterilization SharpsSharp ContainersNon-InfectiousRed Bag Temporary Storage Export under Basel Convention Special Waste Expired Pharmaceuticals Red Bag Temporary Storage Export under Basel Convention Cytotoxic wasteSharps Sharp containers with purple lid Non-sharpsPurple Bag Temporary storage Export under Basel Convention PathologicalSilver BagBurial

Waste Management Program – Handling Collection

Waste Management Program – Handling Routing for Waste Transport (Floor to Temporary Storage)Transport

Waste Management Program – Handling: Final Disposal Healthcare wasteNon-HazardousRecyclableRecycling Bin Recycling facilities Non-recyclableBlack BagMunicipal wasteSanitary LandfillHazardousInfectiousNon-SharpsYellow Bag Treatment by sterilization SharpsSharp ContainersNon-InfectiousRed Bag Temporary Storage Export under Basel Convention Special Waste Expired Pharmaceuticals Red Bag Temporary Storage Export under Basel Convention Cytotoxic wasteSharps Sharp containers with purple lid Non-sharpsPurple Bag Temporary storage Export under Basel Convention PathologicalSilver BagBurial

Training of Staff Visual aids Segreg- ation Collection & Transport Storage & Treatment Waste Management Program – Handling Routing for Waste Transport (Floor to Temporary Storage)Auditing HCWM

Waste Management Program – Handling Routing for Waste Transport (Floor to Temporary Storage)Auditing HCWM

Waste Management Program – Handling Routing 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 TEXT Go ahead and replace it with your own text 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 Update 2-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-out Comparative Evaluation of Non-Mercury Thermometers and Healthcare Staff Preferences Infrared Temporal Thermometer Mercury thermometer The Infrared temporal thermometer was chosen to replace mercury thermometers.