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Health Care Waste Management
Standard Operating Procedures (SOPs)
December 2020
Second Edition
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Health Care Waste Management Standard Operating Procedures (SOPs)
3
Citation
Health Care Waste management SOPs
Ministry of Health
Government of Kenya, October 2020
Government of Kenya
For enquiries and feedback, direct the correspondence to:
The Principal Secretary
Ministry of Health
Afya House
P.O Box 30016-00100
Nairobi, Kenya.
Tel: +254 -020-2717077/45034
Email: [email protected]
C
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Foreword
A standard operating procedure is a method of executing a task to get the best
output at minimal risk. Put together, SOPs represent operational level action plans
for achieving broad policy objectives. The procedures are communicated in a step-
by-step approach stating who will perform a task, the intended purpose of
following the recommended steps; hazards and safety concerns related to the task
to be performed; materials required, and type of documentation required to track
how well the task has been performed. This way, compliance to complex tasks is
simplified by explaining to individuals their roles and responsibilities and ensuring
that there is consistency in quality each time the task is performed.
Health care waste management is unique in that each step in the process requires a
human being. Because waste can have the potential to cause harm, it is imperative
that critical steps are followed. This document covers SOPs for achieving best
outcomes when managing waste. The SOPs cover several aspects of HCWM
including; waste management policy and plans; management and oversight; on-site
handling of health care waste; management of special categories of health care
waste; waste treatment and disposal including operating applicable technology; and
practices necessary for achieving occupational health and safety standards. If
followed properly, the SOPs will improve the working environment of health
workers, improve safety of handlers and protect the environment from avoidable
harm.
The MoH therefore calls upon all those concerned with management of health
services to adopt and increase uptake of recommendations provided in the SOPs
among health workers at all levels of care. It is the expectation of the ministry that
with high levels of compliance, individual health workers will be able to self-guide,
supervise each other and take correct decisions when performing tasks related to
managing different types of waste.
The Ministry appreciates development and implementing partners as well as
government officials that participated in the updating exercise for their technical
and financial input to have these SOPs enhanced to meet recommended global
standards.
Susan Mochache
Principal Secretary
Ministry of Health
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Acknowledgement
The Ministry of Health appreciates the contributions of all individuals and teams
that participated in the review and updating of the “Health Care Waste
Management Standard Operating Procedures (SOPs), 2020” (second edition). The
process involved reviewing existing literature, collecting data on current practices
through health facility surveys, benchmarking global and regional guidance on safe
and appropriate management of health care waste, notably the WHO Blue Book for
safe and appropriate management of health care waste and other global
conventions related to health care waste management. The exercise also required
reviewing recommendations of manufacturers regarding operation of waste
treatment technologies. Consultative meetings were held with subject matter
experts and county and national level managers for their views and perspectives.
Content for updating was agreed on in a validation workshop that took place in
Naivasha town, Nakuru County.
The MoH would like to appreciate colleagues in the Ministry of Environment and
Forestry, MoH staff at national, county and health facility levels and UNDP staff for
the dedication exercised when guiding the process. Special recognition goes to Ms.
Julia Saino (ME&F)/UPOPs Project, Mr. Francis Kihumba (ME&F)/UPOPs Project,
Mr. Gamaliel Omondi (MoH), Mr. Bosco Lolem (MoH), Mr. Michael Mwania
(MoH), Ms. Pauline Ngari (MoH), Mr. Muitungu Mwai (NEMA) and Mr.
Washington Ayiemba (UNDP).
Special acknowledgement goes to Dr. Joseph Okweso who was the Consultant for
the review and updating of the Standard Operating Procedures (SOPs).
Ms Susan Mutua
Chief Public Health Officer, Kenya
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Preface
If not managed well, health care waste distinctively poses risks to patients, health
workers, communities, the public and the environment. Appreciating the
magnitude of the problem, the government of Kenya through the MoH in 2016
developed Health Care Waste Management Standard Operating Procedures to
direct operational level health workers on best steps for accomplishing waste
management tasks without posing avoidable risks. The 2016 version (First Edition)
focused mainly on risks associated with handling infectious waste such as
transmission of diseases like HIV, Hepatitis B, Hepatitis C and related cancers,
sharps and a limited number of chemicals. SOPs for executing tasks associated with
handling several potentially harmful chemicals, heavy metals, electrical and
electronic waste, persistent organic pollutants, and contaminated sites were not
given the same attention. In addition, the SOPs were silent about the need to
eliminate mercury from the health sector.
This second edition builds on earlier achievements and comes in to better protect
human life and the environment by providing SOPs that, in addition to previous
level of protection, provide guidance on management of a broader range of
chemicals and heavy metals, emphasize use of signs and symbols as part of
labelling, detail how waste handlers that deal with chemicals should be protected;
specify how electrical and electronic waste should be managed, elaborate on how
hazardous waste should be transported and provide guidance on how
contaminated sites should be mapped and communities residing within the
mapped zones should be monitored for adverse effects.
The SOPs will be used by health workers at all levels of care in both public and
private settings, as well as those in training and research institutions. It is also
envisioned that all partners in health, including patients, will make provision
within their plans and budgets to ensure full implementation of all SOPs.
Dr. Patrick Amoth
Ag. Director General of Health
Ministry of Health
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Table of Contents Citation .................................................................................................................................................................. 3
List of figures ...................................................................................................................................................... 10
Acronyms ............................................................................................................................................................ 11
CHAPTER 1: INTRODUCTION .................................................................................................................... 13
1.1 What is a standard operating procedure? .......................................................................................... 14
1.2 Purpose ................................................................................................................................................... 14
1.3 How to use the SOPs ............................................................................................................................. 15
CHAPTER 2: DEVELOPMENT OF FACILITY HCWM POLICY AND PLAN .................................... 16
2.1 SOP for Developing Facility Health Care Waste Management Policy ....................................... 16
2.2 SOP for Developing Facility Health Care Waste Management Plan .......................................... 19
A. Steps for developing the plan ................................................................................................................... 21
B. Contents of the plan .................................................................................................................................. 21
CHAPTER 3: MANAGEMENT AND OVERSIGHT FOR HCWM ....................................................................... 23
3.1 SOP for Formation of Facility Waste Management Oversight Committee ............................... 23
3.2 SOP for conducting Health Care Waste Management Audit ....................................................... 26
CHAPTER 4: ON-SITE HANDLING OF HEALTH CARE WASTE ........................................................ 32
4.1 SOP for Health Care Waste Recycling and Reuse .......................................................................... 32
4.2 SOP for Waste Identification and Segregation ............................................................................... 35
4.3 SOP for Collection of Health Care Waste ........................................................................................ 38
4.4 SOP for Health Care Waste Storage .................................................................................................. 40
4.5 SOP for Health Care Waste Transportation ..................................................................................... 42
4.6 SOP for Trans-boundary Movement of Hazardous Waste ........................................................... 44
CHAPTER 5: WASTE TREATMENT AND DISPOSAL ............................................................................... 48
5.1 SOP for Diesel Fired Incinerator Operation .................................................................................... 49
Procedures .................................................................................................................................................... 51
Before starting operation ........................................................................................................................... 51
5.2 SOP for Maintenance of Diesel Fired Incinerator .......................................................................... 53
D. Monthly Maintenance ............................................................................................................................. 55
5.3 SOP for Operating and Testing of Medical Waste Autoclave ...................................................... 56
5.4 SOP for Operating a Medical Waste Shredder ............................................................................... 60
Shredder Operation ................................................................................................................................. 61
5.5 SOP for Operating a Medical Waste Microwave ............................................................................ 63
5.6 SOP for Disposal of HCW in a Health Care Waste Landfill ........................................................ 67
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5.7 SOP for Disposal of Health Care Wastewater ................................................................................. 70
5.8 SOP for Wastewater De-chlorination ............................................................................................... 72
CHAPTER 6: OCCUPATIONAL HEALTH AND SAFETY IN HCWM.................................................. 75
6.1 SOP for Handling Infectious Spills .................................................................................................. 75
6.2 SOP for Post Exposure Prophylaxis (PEP) ....................................................................................... 78
6.4 SOP for Use of Personal Protective Equipment .............................................................................. 82
6.5 SOP for Training of Staff to protect them from Hazards associated with handling Chemicals
........................................................................................................................................................................ 85
6.6 SOP for Harmonized Risk Assessment ............................................................................................ 87
CHAPTER 7: MANAGEMENT OF SPECIAL WASTE................................................................................................. 90
7.1 SOP for Management of Amalgam Waste ............................................................................................. 90
7.2 SOP for Management of Cytotoxic Waste .............................................................................................. 93
7.3 SOP for Management of Radioactive Waste........................................................................................... 98
7.4 SOP for Chemical Waste Management .......................................................................................... 102
7.5 SOP for Mercury Spillage Clean-up ....................................................................................................... 105
7.6 SOP for Replacing Mercury Containing Devices ......................................................................... 109
7.7 SOP for Mapping Sites Contaminated with Chemical Waste ............................................ 111
7.8 SOP for Managing Diapers and Sanitary Towels ........................................................................ 114
7.9 SOP for Management of Special Sharps Waste ........................................................................... 117
References .......................................................................................................................................................... 118
Annex 1: HCWM Facility Plan Template ............................................................................................................. 124
Annex 2: Facility audit checklist .................................................................................................................... 131
Annex 3: Diesel-fueled Incinerator; Incinerator Burn Log ........................................................................ 101
Annex 4: Autoclave Operation Log .................................................................................................................... 103
Annex 5: Autoclave testing and validation log ................................................................................................... 100
Annex 6: Health Effects of Chemicals ................................................................................................................. 109
Annex 7: Stakeholders Consulted During the Document Review/Updating Exercise ........................................ 111
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LIST OF TABLES
Table 1. Content for developing a facility HCWM policy……………………………17
Table 2: Waste management auditing - the six steps………………………………....28
Table 3: Segregation of waste according to color codes and category of risk … ….37
Table 4: Common Radioactive Materials – Definition……………………………….98
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List of figures
Figure 1: Membership of the IPC/Waste Management Committee…………………24
Figure 2: Segregation of health care waste…………………………………………….36
Figure 3: Step by step operation of the microwave…………………………………...66
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Acronyms
AIDS Acquired Immunodeficiency Syndrome
ARV Anti-retro Viral
BCC Behavioural Change Communication
BSL Biosafety Level
CDC US Centres for Disease Control and Prevention
CME Continuous Medical Education
CTC Cancer treatment Centre
FBO Faith-based Organisation
HAO Hospital Administration Officer
HAI Hospital Acquired Infections
HAV Hepatitis A Virus
HBC Home-Based Care
HBV Hepatitis B Virus
HCV Hepatitis C Virus
HCW Health Care Waste
HCWM Health Care Waste Management
HEPA High Efficiency Particulate Air
HIV Human Immuno-deficiency Virus
HMIS Health Management Information System
HOD Head of Department
IEC Information Education Communication
IPC Infection Prevention and Control
KEBS Kenya Bureau of Standards
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KEMRI Kenya Medical Research Institute
KMTC Kenya Medical training college
KNH Kenyatta National Hospital
M & E Monitoring and Evaluation
MEA Multi-lateral Environmental Agreement
MoH Ministry of Health
MSDS Material Safety Data Sheets
NEMA National Environment Management Authority
NGO Non-Governmental Organisation
PATH Program for Appropriate Technology in Health
PCB Polychlorinated Biphenyls
PEP Post Exposure Prophylaxis
PEPFAR Presidents Emergency Plan for AIDS Relief
PHC Primary Health Care
PPE Personal Protective Equipment
SCBIs Self-Contained Biological Indicators
SDP Service Delivery Point
SOP Standard Operating Procedures
TWG Technical Working Group
USAID United States Agency for International Development
WC Water Closet
WHO World Health Organisation
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CHAPTER 1: INTRODUCTION
With increasing population, technology and burden of disease, provision of health
care services is accompanied with massive challenges in management of health care
waste in line with safety and environmental concerns. In Kenya, health services are
being offered by over 4,000 health facilities, which are either public, private for
profit or not for profit, or faith-based organisations. Large volumes of potentially
hazardous waste can pollute the environment and consequently be injurious to
health. Unsafe handling of waste is associated with disease burden. The actual
burden of Hospital Acquired Infections has not been accurately quantified but is
projected to account for about 10% to 20% of hospital admissions in government
health facilities; 2.5% of HIV infections; 32% of cases of Hepatitis B; and 40% of new
cases of Hepatitis C (WHO, 2010).
The Kenya Constitution, 2010, entitles each person to a clean and healthy
environment and a reasonable standard of sanitation. In order to make this
practical for the benefit of citizens, the health sector has been developing legal and
regulatory frameworks to provide guidance to health care providers and managers
on minimum operation requirements.
The MoH, Kenya, has made progress towards addressing the problem of HCWM.
Key milestones in this regard so far include the development of the National
Infection Prevention and Control Guidelines, 2010; National Guidelines for Safe
Management of Health Care Waste, 2011; Injection Safety and Medical Waste
Management Policy, 2007; Kenya Environmental Sanitation and Hygiene Policy
(2016 – 2030); Injection Safety and Safe Disposal of Medical Waste National
Communication Strategy; Guide for Training Health Workers in Health Care Waste
Management and the Kenya HCWM Strategic Plan (2015 – 2020), among others.
These standard Operating Procedures (SOPs) are meant to tackle critical issues of
procedure and will specifically ensure adherence the provisions of safe waste
management policies and practices, from waste generation to final disposal. Steps
recommended will ensure that risks to health workers, patients, waste handlers,
communities and the environment are minimised through application of best
available techniques and best environmental practices.
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1.1 What is a standard operating procedure?
A standard operating procedure is a method for accomplishing a task. The Health
Care Waste Management SOPs provide instructions on how to execute tasks related
to HCWM, hence are instrumental in implementation and/ or operationalization of
related policies and guidelines. SOPs therefore serve as part of action plans for
achieving the contents of related policies and guidelines.
The details in the SOP standardise the processes and provide step-by-step
instructions that will enable anyone within the system to perform the task or
procedure in a consistent manner.
The SOP also serves as an instructional and reference resource. Furthermore, the
step-by-step written procedure contributes to the concept of accountability as staff
expectations and health care facility procedures are documented and quality of care
can be measured against the SOP. Communicating procedures that anyone in the
system can follow and get consistent results from will ensure that health facilities
continually provide desired quality of care.
A SOP usually informs a work instruction downstream and forms part of staff
members’ scope of work and job description. It is an essential component of health
service delivery system which strives to keep and/ or maintain ISO standards. The
SOPs will address key aspects of health care waste management such as waste
handling, storage, transportation, treatment, and disposal.
1.2 Purpose
The purpose of SOPs is to provide clear guidance on task execution in a format that
is easy to comprehend while emphasising roles and responsibilities of individuals
and groups. They outline what is needed as part of proper planning to execute a
procedure; how the procedure is done; and precautions that staff need to be aware
of even in the absence of a supervisor. The SOPs provide direction and steps that
promote best outcomes and safety of staff as well as protect the environment.
Major expected outcomes where there is total adherence to SOPs include reduction
in transmission of infectious diseases, reduced exposures to chemicals and injuries,
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better patient safety and management outcomes, reduced operational costs and
significant reduction in hospital stay among in-patients, among others.
1.3 How to use the SOPs
The document will be used by health managers and practitioners across all levels of
health service delivery, including national referral health facilities, county and sub-
county hospitals, health centres, dispensaries, clinics and home-based care facilities
and/ or settings, both in public and private sectors, and will be cross referenced
with other HCWM guiding documents in the country such as the National
Guidelines for Safe Management of Health Care Waste, Health Care Waste
Management National Communication Strategy, Injection safety and Medical Waste
Management Policy and the National Infection Prevention and Control Guidelines
for Health Care Services in Kenya. Where appropriate, extracts of specific SOPs can
be used as stand-alone job aids at service delivery points.
Stakeholders in the health sector are many and range from government ministries,
private sector institutions, non-governmental organisations, professional
associations and development partners. The SOPs will be rolled out to all these
institutions to achieve high levels of uptake. High levels of compliance will go a
long way in safeguarding health workers, patients, communities and improving
efficiency in resource utilisation as well as protecting the environment from
avoidable harm. All stakeholders are called upon to participate in promoting use of
SOPs for improved quality and efficient service delivery.
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CHAPTER 2: DEVELOPMENT OF FACILITY HCWM POLICY AND
PLAN
2.1 SOP for Developing Facility Health Care Waste Management Policy
MINISTRY OF HEALTH
DEVELOPMENT OF
FACILITY HCWM POLICY
Standard Operating
Procedures for Developing
Facility Health Care Waste
Management Policy
SOP/MOH/HCWM-2/001
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Purpose
This guidance outlines the steps and contents of developing a health care waste
management policy.
Scope
This section details guidance on developing a health facility policy.
Responsibilities
• Hospital Management – Provide guidance for developing the policy.
• Hospital Director – Approve the policy.
• Hospital Staff- implementation of the hospital policy.
Procedure
The table 1 below outlines the content of developing a facility HCWM policy.
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Table 1. Content for developing a facility HCWM policy
Outline Content
a) General Policy
Statement
Outline the hospital commitment in managing the health
care waste in accordance with hospital procedures, subject
to national guidelines, laws or regulations;
- Kenya Constitution
- National Guidelines for Safe Management of
Healthcare Waste 2020
- Waste Management Guidelines, 2003 (NEMA)
- Sustainable Waste Management Bill, 2019
- Hazardous and Toxic waste Regulations, 2020
b) Policy Purpose:
Describe the purpose of the policy in protecting people and
the environment from hazardous exposure from health
care waste.
c) Risk for Non-
compliance of Policy:
Describe the risks of ineffective management of waste to
the hospital and the community.
d) Applicability of
Policy:
Outline the applicability e.g. This Policy is intended for use
and compliance by all hospital employees, students on
attachment and interns.
e) General
Responsibility Policy
Statements:
Outline responsibilities in policy implementation of:
▪ Hospital Management
▪ Staff Responsibilities
▪ Individual Responsibilities:
- Hospital Director
- Infection Prevention and Health Care Waste
Management Committee.
- Heads of Departments
- Hospital Matron
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- Ward Supervisors.
- Waste Management Officer
- Hospital Staff
- Waste Handlers
- Incinerator Operators
f) Health Worker Safety
Policy Statements:
List all the hospital actions to address health workers
Safety i.e. Occupational Vaccinations, provision of PPE,
Workplace Provisions.
g) Public safety policy
statements:
List all hospital actions to address safety of patients and
environmental concerns i.e. segregating and securing
waste, creating awareness on risks associated with unsafe
HCWM and use of environment friendly disposal methods.
h) Monitoring and
Compliance with
Policies
Accountability:
o Designate all supervisors and departments under their
control to have an up‐to‐date copy of this Policy and
Guidelines.
Policy Effectiveness:
o Determine the frequency of audit to be conducted to
promote and improve compliance with the policy.
Review:
o Indicate the frequency in which the hospital
management will review the policy.
i) Authority to Establish
Policy
• Indicate the facilities authority to establish the policy.
“The Hospital Management has the authority to establish this
policy under…..”
• Indicate the references used.
“This Policy was established in keeping with the following
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laws and regulations: (Medical Waste and Injection Safety
Policy, Infection Prevention and Control Policy, Environmental
Sanitation and Hygiene Policy, National Guidelines for Safe
Management of HCW).
• Indicate the Date of Issuance of the Policy.
j) Approval The policy must be signed by the Facility Director.
2.2 SOP for Developing Facility Health Care Waste Management Plan
MINISTRY OF HEALTH
DEVELOPMENT OF FACILITY
HCWM PLAN
Standard Operating
Procedures for Developing
Facility Health Care Waste
Management Plan
SOP/MOH/HCWM-
2/002
Version :00
Review date
DIVISION OF
ENVIRONMENTAL HEALTH
AND SANITATION
Scope
These guidelines define all aspects of managing waste, from minimization, proper
segregation and containment, safe handling, storage and transport, to treatment and
disposal.
Purpose
This SOP outlines the requirements for developing the facility health care waste
management plan.
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Responsibilities
Every member of the facility is responsible for the waste they generate; however,
certain personnel will have specific waste management tasks and responsibilities
assigned to them.
a) Facility manager
• Ensure compliance with legal and other requirements, overall responsibility and
accountability for waste generated and managed on site, as well as for transport
from the facility for treatment and/or disposal off-site.
• Ensure that sufficient resources are allocated for proper management of health
care waste.
b) Facility management and supervisors
• Ensure appropriate standards are set and maintained.
c) Waste generators
• Ensure that waste is properly segregated at source and suitably contained to
reduce risk of exposure to others.
d) Waste handlers
• Ensure that waste in the intermediate storage areas is contained and labeled.
e) Waste management officers
• Responsible for ensuring that waste is managed according to legal and other
requirements, checking that standards are maintained, that everyone is aware of
these requirements, that relevant personnel are appropriately trained to safely
deal with waste in their areas and that all necessary data are recorded and
communicated to the waste management committee and other related agencies.
f) IPC/Waste management committee. This committee should meet monthly to
discuss the key performance indicators (e.g., volume of waste generated, hazardous
versus general waste ratio, incidents, audit findings, etc.) and plan awareness programs
and other initiatives to improve compliance with legal and other requirements.
g) Contractors – ensure their staff are adequately trained to comply with waste
management requirements.
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Procedures
A. Steps for developing the plan
i. Secure approval from senior management to develop the plan.
ii. Convene a committee to steer the development of the plan; it should be lean
and inclusive.
iii. Agree on major policy points.
iv. Identify quick wins - Identify some actions that will make a big impact
quickly. For example: returning expired items to the suppliers; purchasing
items that are reusable, where possible and ensuring waste segregation is
practiced.
v. Consult with stakeholders - Seek guidance from the county authorities and
relevant stakeholders.
vi. Undertake a baseline assessment of current waste management practices.
vii. Disseminate the findings of the baseline to stakeholders, consult and design
waste management options for each waste stream:
viii. Create a detailed implementation plan including time frames, resources
(financial, people, time and equipment), and details of deliverables.
ix. Finalize budget and seek approval from the county government.
x. Communicate - Regularly communicate how the project is progressing and
showcase good practices.
xi. Monitor progress once the plan is rolled out.
xii. Set targets to track trends, so you can try to improve year by year.
B. Contents of the plan
The facility waste management plan should include the following items:
• Glossary
• Duties and responsibilities for each category of personnel generating
and/or involved in managing health care waste.
• Assessment of current state of waste management activities.
• Implementation plan - a detailed plan and timetable outlining the stages
of the implementation.
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• Resources (people, equipment, and budget) required to implement the
plan.
• HCWM Training requirements.
• Documentation - Waste management documentation (procedures,
training and awareness, signage, contractors, authorizations, etc.).
• Information, Education and Communication materials.
• Incident management and reporting.
• Targets and strategies for reaching them - communicating progress and
plans for continuous improvement. Some targets might include:
o Reducing the number of incidents and injuries related to health care
risk waste management.
o Reducing the environmental impact of waste treatment technologies.
o Reducing the amount and toxicity of waste year by year.
o Improving recycling/reuse rates.
C. Reporting and Recordkeeping
HCWM approved plan (see annex 1) for a template that can be used for generating
a health facility plan.
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CHAPTER 3: MANAGEMENT AND OVERSIGHT FOR HCWM
3.1 SOP for Formation of Facility Waste Management Oversight
Committee
MINISTRY OF HEALTH
MANAGEMENT AND
OVERSIGHT FOR HCWM
Standard Operating
Procedures for formation of
Facility Health Care Waste
Management Committee
SOP/MOH/HCWM-
3/001
Version :00
Review date
DIVISION OF
ENVIRONMENTAL HEALTH
AND SANITATION
Purpose
To provide guidance for the health facility when forming a HCWM oversight
committee.
Scope
This document describes the steps required to establish and maintain the Waste
Management Oversight Committee of the health care facility.
Membership of the IPC/Waste Management Committee
The membership of the committee should be multidisciplinary, involving all
departments in the hospital.
24
Waste Oversight
Committee
ProcurementSenior
Management
Medical Personnel
Long-term Contractors
Maintenance
Waste Service Providers
Infection Prevention & Control
Security
Caterers
Safety & Health Reps
Waste Management
personnel
Figure 1: Membership of the IPC/Waste Management Committee
Responsibilities
The Waste Management Oversight Committee is responsible for establishing
standards for acceptable waste management that seek to minimize harm to the
people and environment.
The responsibilities of specific members of the committee are as follows:
Chairperson is responsible for convening and chairing meetings and ensuring that
the associated administration is carried out efficiently and effectively.
Secretary is responsible for maintaining the records of the committee.
Waste Management Coordinator is responsible for:
- Providing expertise on health care waste management to committee
members and other staff as needed.
- Researching and reporting on ways to improve waste management.
- Organizing and reporting on inspection and audits.
- Assisting the Chairperson and Secretary in convening and conducting
meetings.
25
Committee members are responsible for the timely reporting on waste
management in their areas, non-conformity to the requirements, any other
problems, and undertaking improvements to the system as necessary.
Senior Management must ensure they provide the strategic support to the work by:
- Ensuring that appropriate plans are developed to deal with any deteriorating
trends.
- Providing sufficient resources (people, time, funds, equipment, etc.).
Facility In-charge: This person is ultimately responsible and accountable for waste
management and ensuring compliance with legal requirements.
Materials and Equipment
• HCWM facility audit tool.
Hazards and Safety Concerns
When conducting visits to the site, committee members should refer to the
appropriate SOPs and procedures for information on hazards and safety concerns.
Procedures
i. Develop and execute a committee charter.
ii. Provide oversight of HCWM to ensure that waste is managed safely by:
• Reviewing monthly reports from the different sectors of the facility/waste
management and agreeing on appropriate actions needed to solve problems.
• Conducting periodic audits.
• Ensuring that waste management documents are adequate and current.
iii. Provide periodic feedback.
iv. Implement improvement by developing and executing a facility HCWM
strategy and implementation plan.
Reporting and Recordkeeping
• Meeting minutes.
• Routine and audit reports on waste generated, treated and disposed of as per
the SOPs and guidance documents.
26
• Records of contracts with contractors dealing with the facility’s waste, e.g.
waste treatment facilities, waste transportation agencies, recycling
contractors, municipal authorities.
• Financial reports including the investment, training and operating costs for
the waste management system and income from sales of recyclables.
• The waste management committee should hold copies of all policies and
procedures relevant to the facility including approved designs of posters and
signage to be used.
3.2 SOP for conducting Health Care Waste Management Audit
MINISTRY OF HEALTH
MANAGEMENT AND
OVERSIGHT FOR HCWM
Standard Operating
Procedures for conducting
Health Care Waste
Management Audit
SOP/MOH/HCWM-3/002
Version :00
Review date
DIVISION OF
ENVIRONMENTAL HEALTH
AND SANITATION
Scope
Outlines the key areas to be audited in the health facility and procedures for
identifying current gaps in relation to best practices.
Purpose
This SOP is intended to guide health facilities on how to appropriately audit facility
waste management systems.
Responsibilities
• Waste Management Oversight Committee and Coordinator - Establish
systems to monitor compliance with the agreed-upon health care waste
procedures.
27
• Conduct regular and routine audits of the waste management system
and provide feedback to the Management.
• Undertake corrective
Materials and Equipment
The auditor may need to refer to:
1. Facility health care waste management policy.
2. Facility safety procedures.
3. National or county health care waste treatment guidelines.
4. Previous audit/inspection reports.
5. Accident or incident reports.
6. Collection records where final disposal is off-site.
7. Service agreement (if collection and/or treatment is outsourced).
8. Service agreement (if housekeeping is outsourced).
9. Service agreement (if waste handling is outsourced).
10. Staff training logs.
11. Standard operating procedures for housekeeping and waste handling.
12. Standard operating procedures for waste holding and storage.
13. Standard operating procedures for waste treatment and disposal.
• PPE – gloves, overalls/lab coat, sealed shoes/boots, eye protection, face mask
(surgical or equivalent to prevent inhalation of particles and aerosols).
• Tongs and other waste handling tools.
• Bins, buckets, bags, safety boxes and other waste containers.
Hazards and Safety Concerns
• Avail appropriate PPEs for use when conducting audits.
• Secure authorization from respective departmental heads prior to
accessing restricted areas.
• Ensure environmental safety, adequate lighting, proper ventilation and
ease of access.
28
• Adhere to signages on handling of equipment and movement within
buildings.
• Follow recommended SOPs and guidelines for consistency of practice.
Procedures
The table below summarizes the procedure for conducting facility HCWM audits.
Table 2: Waste management auditing - the six steps
A. PLAN i. Define the
study area.
• Agree on schedule of audit with the
management.
• Set audit objectives and method.
• Determine locations to be audited (entire
facility or part of it) (see annex 2 for
samples of health facility and service
delivery data capture tools).
• Determine types and approximate
quantities of waste to be audited.
ii. Collect
background
information.
Visit locations and record:
• Number of employees in each location.
• Number, types, and locations of bins.
(infectious and hazardous waste bins
should not be in public areas).
• Types of waste seen.
• Who empties bins and when are the bins
emptied?
iii. Prepare for
the audit.
• Collect auditing equipment (PPE, scale)
and tools (see annex 2 for samples of
health facility and service delivery data
capture tools).
• Finalize additional questionnaire for the
staff, if any is required.
• Brief/train cleaners and handlers.
29
• Finalize waste collection details.
• Double-check locations of bins.
B.
COLLECTION
i. Waste
Collection
• Waste handlers must wear PPE.
• Collect all waste daily.
• Label bin/bags showing location and day.
• Record relevant collection details.
ii. Transport the
waste to the
area for
segregation.
• Store waste on site if possible, otherwise
transport to secure location using a
licensed transporter.
• Liquid waste should be transported
separately and very carefully. It may not
need to be segregated but will need to be
classified and quantified.
C.
SEGREGATIO
N
i. Prepare the
segregation
area.
• Ensure PPEs are used before handling
waste.
• Cover tables with plastic for solid waste.
• Set up tables and scales.
• Collect buckets, bins, brooms, etc.
• Have water and first aid kit on hand.
ii. Segregate the
solid waste.
• Count and/or weigh individual bags
containing waste materials.
• Record findings on data sheet.
• Dispose of waste.
iii. Carry out clean-up
and decontamination
at the end of each
day.
• Dispose of waste.
• Clean and disinfect tables.
• Clean buckets and disinfect other
equipment.
• Sweep and disinfect floor.
30
• Shower and change clothes.
D.
TREATMENT
AND
DISPOSAL
i. Environmenta
lly sound
disposal using
BAT/BEP
• Auditor should visit treatment facilities
and final disposal area (either on-site or
off-site) to collect information.
• Check if the incinerator, if used, meets the
standards.
• Record how they treat the chemical and
liquid waste.
• If the facility has a sewage treatment
plant (STP) or effluent treatment plant
(ETP), check to see if it meets all the
requirements.
E. ANALYSE
i. Enter and
analyze the data.
• Enter all data sets captured in the facility
audit checklist (See annex 2) into
spreadsheet. The checklist is organized as
follows: Section A: Staff training; Section
B: Procedures and practices; section C:
segregation and transport; Section D:
Floor and other areas; Section E: Waste
disposal; Section F: Spill control.
• Do calculations and generate summaries
generalizable to service delivery areas
and facilities (as appropriate).
• Ensure accuracy and consistency in data
entry
ii.Prepare an audit
report.
• Prepare audit report, including findings
and recommendations.
31
F. DATA USE. i. Disseminate report
to intended users
• The report can be required by regulatory
authorities, labor officers, occupational
safety and health officers, facility waste
management committee, insurance
service providers, global monitors,
municipal officers, licensing authorities,
public health teams etc.
• The generated data can also be used for
purposes of renewal of licenses, selecting
facilities for inclusion in insurance
schemes, assessing value for money, and
to guide re-planning.
Reporting and Recordkeeping
• Auditors should produce an audit report that includes a summary of
findings and recommendations to the HCWM Committee and HCWM
Coordinator.
• Completed inspection checklists should be shared with the HCWM
Oversight Committee and the HCWM Coordinator (see annex 2).
32
CHAPTER 4: ON-SITE HANDLING OF HEALTH CARE WASTE
This chapter describes the SOPs for proper handling of waste from minimization,
segregation, handling and collection, storage, transportation and treatment and
disposal within the facility. Waste minimization SOP focuses on materials within
the ‘General Waste’ category that have potential for resource recovery through
reuse and/ or recycling.
Each SOP outlines the scope, purpose, responsibilities, materials and equipment,
hazards, and safety concerns together with the procedures.
4.1 SOP for Health Care Waste Recycling and Reuse
MINISTRY OF HEALTH
ON-SITE HANDLING OF
HEALTH CARE WASTE
Standard Operating
Procedures for Waste
Minimisation, Recycle and
Re-use
SOP/MOH/HCWM-4/001
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
The SOP incorporates the activities to prevent unnecessary waste generation,
reduce amount of waste generated and promote the reuse and recycling of non-
infectious waste.
Purpose
This SOP is intended to provide hospitals, laboratories and other health facilities
with information about how to reduce or minimize the amount of waste they
produce through recycling and/ or reuse where it is feasible.
33
Responsibilities
Senior Management:
• Approve the facility waste minimization strategy and recycling and reuse
procedures.
• Provide the required resources.
• Obtain the necessary permits and authorization as may be required from
NEMA and the County Government.
Waste Management Oversight Committee:
• Develop a Facility Waste Minimization Strategy.
• Develop detailed waste recycling and reuse plans, including budgets.
• Conduct regular reviews and institute improvements as appropriate.
Procurement Department
• Procure goods of high quality and in quantities needed.
All health care workers
• Practice segregation.
Materials and Equipment
1. Stock sheets.
2. Segregation charts.
3. Appropriate PPE.
4. Colour coded waste bins and liners.
5. Cleaning and decontamination tools and supplies.
6. Waste storage and transfer station.
Hazards and Safety Concerns
• Expired Items – These may pose hazards to the health workers in the facility
and need to be stored and labelled.
• Exposure to dust and aerosols.
• Un-segregated or poorly segregated waste – poses hazards to the waste
handlers, such as needle stick injuries.
34
Procedures
i. Identify channels for moving different streams of health care waste including
recyclables.
ii. Train all staff on principles of waste minimization, re-use and recycling.
iii. Adopt the culture of green procurement.
iv. Generate high quality specifications for medicines and health supplies.
v. Procure goods of good quality and in adequate quantities to address the
hospital needs.
vi. Establish and maintain an efficient inventory management system (i.e.
FIFO/FEFO).
vii. Practice waste segregation at source and according to national guidelines.
viii. Identify materials with potential for resource recovery at the procurement
stage such as – plastic bottles, cardboard, paper packaging, glass bottles etc.
ix. Recycling: place appropriately labelled/ colour-coded bins at designated
collection sites or take recyclables to a processing centre or sell to recyclers.
x. Conduct regular collection and transport recyclables to a central processing
and storage area.
xi. Sort each type of waste separately and package for reuse onsite or collection
and transportation offsite for recycling by contracted vendors.
xii. Ensure that any contaminated materials or those that cannot be reused or
recycled are dispatched to treatment and disposal area.
xiii. Ensure all waste leaving the facility is captured/ recorded in a waste tracking
form to ensure accountability.
xiv. Reuse vials as specimen bottles where applicable, i.e. laboratory specimen
bottles after sterilization.
xv. Promote rational use of injectable medicines and advocate for oral
medication.
xvi. All staff involved in waste recycling should always have adequate PPE, be
immunized and be under regular health screening.
Note: prevent unofficial sale of waste to avoid potential reuse of dangerous items.
35
4.2 SOP for Waste Identification and Segregation
MINISTRY OF HEALTH
ON-SITE HANDLING OF
HEALTH CARE WASTE
Standard Operating
Procedures for Waste
Segregation
SOP/MOH/HCWM-4/002
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
This SOP covers segregation of all waste generate d in healthcare facilities.
Purpose
To provide a standard procedure for healthcare workers to appropriately segregate
waste at point of generation.
Responsibilities
a) All health care workers - Segregate waste at point of generation.
b) Facility In-charge - Ensure availability of HCWM commodities - colour coded
bins, liners and PPE.
c) Waste Management Officer:
• To ensure that segregation is done at point of generation and remedial action
taken accordingly.
• To do quantification of the commodities and ensures continuous supply of
commodities.
• Ensure appropriate bin placement.
Materials and Equipment
1. Color coded bins/liners.
36
2. Waste segregation charts.
3. Appropriate PPE.
Hazards and Safety Concerns
• Spillages of waste.
• Needle-prick injuries.
Procedures
• Segregate all waste at the point of generation in accordance with the
segregation schedules.
• Separate the waste into color-coded plastic bags or containers.
• The recommended color-coding scheme is provided in Table 3 here-
below.
Figure 2: Segregation of health care waste.
37
Table 3: Segregation of waste according to color codes and category of risk
Category Examples of Wastes Color of Bin and
Liner
Marking
General or non-
infectious
Paper, packaging materials,
plastic bottles, food, cartons
Black No recommended marking
Infectious Gloves, dressings, blood, body
fluids, used specimen
containers
Yellow – pedal
action
Highly infectious
or anatomical/
pathological
Laboratory specimens and
containers with biological
agents, anatomical waste,
pathological waste
Red- pedal act
Chemical Formaldehyde, batteries,
photographic chemicals,
solvents, organic chemicals,
inorganic chemicals
Brown Marking will vary with
classification of the chemical
Radioactive Any solid, liquid, or
pathological waste
contaminated with radioactive
isotopes of any kind
Yellow
Radioactive symbol
Genotoxic/
Cytotoxic
All drug administrative
equipment (e.g. needles,
syringes, drip sets), gowns and
bodily fluid/ waste from
patients undergoing cytotoxic
drug therapy
Purple
Sharps Box
( Safety Box)
Needles, Syringes, broken
vials
White/yellow safety
boxes (WHO
Approved)
38
4.3 SOP for Collection of Health Care Waste
MINISTRY OF HEALTH
ON-SITE HANDLING OF
HEALTH CARE WASTE
Standard Operating
Procedures for Collection of
Health Care Waste
SOP/MOH/HCWM-4/003
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
SOP outlines the best practices to be followed when handling and collecting waste
within the health facility.
Purpose
To provide guidance on proper handling and effective collection of waste within
the health facility.
Responsibilities
a) Waste Management Officer
▪ Ensures safe handling and collection of health care waste including
through training of handlers.
▪ Ensures the waste handlers collect the waste as outlined in the schedule.
▪ Develops a waste collection plan.
b) Waste handler
▪ Tie the bin liners and collect the waste from the generation point when
receptacle is ¾ full.
▪ Label the waste bags according to the day, origin and location.
▪ Replace the liners.
c) Health care worker
39
▪ Ensures waste is well segregated.
Ensures safety boxes that are ¾ full are closed and stored appropriately, ready
for collection.
Materials and Equipment
1. Waste trolleys.
2. Colour coded bins and liners.
3. PPE.
Hazards and Safety Concerns
Spillages – while collecting the waste care must be taken to avoid spillage of the
waste; however, if they occur; cordon the area, collect the spilled waste, disinfect
with 5% hypochlorite solution, and clean the area.
Procedures
i. Follow the waste collection schedule
ii. Remove the liners from the bins.
iii. Tie/knot the liners.
iv. Weigh, label the liners with their point of generation (hospital and
ward or department) and contents.
v. Replace the liners immediately with new ones of the same type.
vi. Record amount of waste collected.
vii. Take the waste to the temporary storage area within the
ward/department i.e., sluice room.
viii. Collect the waste from sluice room and place in the trolley for
transportation.
Note: Waste must be collected daily from point of generation; however, in areas
with high waste generation it may be collected twice a day or as it is required as
advised by the departmental in-charge.
40
4.4 SOP for Health Care Waste Storage
MINISTRY OF HEALTH
ON-SITE HANDLING OF
HEALTH CARE WASTE
Standard Operating
Procedures for Health Care
Waste Storage
SOP/MOH/HCWM-4/004
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
The SOP covers the procedures to be followed when storing waste within the health
facility.
Purpose
Provide guidance and standardize storage of waste within the health facility.
Responsibilities
a) Health Facility Management
• Provide adequate temporary storage area in the facility that is secure, easily
cleaned, and leak-proof.
• Ensure provision of adequate tools and supplies required for safe storage of
waste.
b) Waste Management Officer
• Assess the facility waste storage needs and advise the Management
accordingly.
• Oversee/ supervise waste storage within the facility.
• Conduct regular audits to ensure waste is stored according to the
guidelines.
c) Waste handler
41
• Maintain the storage facility in a clean condition free of pest and vermin.
• Ensure storage area is always under lock and key to keep out unauthorized
entry.
• Ensure waste is not stored longer than the maximum stipulated time of
storage for each category of waste. See guidelines on waste storage times.
Materials and Equipment
1. Secure and safe storage facility.
2. Cleaning and decontamination tools and commodities.
3. PPE.
4. Fire Extinguisher.
Hazards and Safety Concerns
• Needle prick injuries.
• Spillages.
• Inhalation of aerosols from waste bags may lead to infection.
• Fire hazard.
• Physical injuries and exhaustion from carrying loads of waste.
Procedures
Waste Storage
i. Restrict access to storage areas.
ii. Wear PPE when handling waste.
iii. Maintain segregation at the designated storage area.
iv. Place the Safety boxes in a dry floor to avoid soaking.
v. Maintain cleanliness in the storage area.
vi. Ensure storage area is free of pests and rodents.
vii. Fill the waste receipt log with waste treatment staff.
viii. Summarize the daily waste quantities in a weekly waste quantification tool.
Note: Waste should not be stored for more than 2 days before treatment.
42
4.5 SOP for Health Care Waste Transportation
MINISTRY OF HEALTH
ON-SITE HANDLING OF
HEALTH CARE WASTE
Standard Operating
Procedures for Health Care
Waste Transportation
SOP/MOH/HCWM-4/004
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
The SOP covers the procedures to be followed when transporting waste within a
health facility.
Purpose
Provide guidance and standardize transportation of waste within the health facility.
Responsibilities
Health Facility Management
• Provide adequate temporary storage area in the facility that is secure, easily
cleaned, and leak-proof together with a waste transfer trolley.
Waste Management Officer
• Oversee waste transportation within the facility.
• Prepare waste transport route within the facility.
• Ensure adherence to transport schedule and safety guidelines by the
waste handlers.
• Ensure waste handlers always use PPE when transporting waste.
• Monitor incidents, accidents and near-misses that may occur during
transport and institute corrective measures.
Waste handler
• Transport waste to the onsite temporary storage area/ sluice room.
43
• Collect waste from the generation points/ sluice rooms and transport to
the treatment site/storage area according to routing and guidelines.
• Report accidents and incidents that may occur during waste
transportation.
Materials and Equipment
• Waste transfer trolley.
• PPE.
• Cleaning and decontamination tools and supplies.
Hazards and Safety Concerns
• Needle prick injuries.
• Spillages of waste.
• Possible contamination along the waste transport route.
Procedures
ix. Wear appropriate PPE.
x. Wheel the trolley to the temporary storage area/ generation sites.
xi. Knot bin liners and place them in the trolley.
xii. Collect the safety boxes and ensure the safety boxes are not more than ¾ full
and are closed.
xiii. Maintain sharps containers in the upright position while being transported.
xiv. Wheel the trolley through designated route to avoid contact with the patients
and other clean areas.
xv. Adhere to the waste collection schedule for both onsite and offsite transport
by the contracted firm.
xvi. Always wear PPE when handling waste.
xvii. Weigh the amount of waste to be collected by the waste transporter and
record in the tracking form.
xviii. Keep copy of the tracking form for accountability.
xix. Clean and decontaminate transport vehicle after the trip or at the end of the
shift.
44
Documentation
i. Fill the waste receipt log with waste treatment staff.
ii. Summarize the daily waste quantities in a weekly waste quantification tool.
4.6 SOP for Trans-boundary Movement of Hazardous Waste
MINISTRY OF HEALTH
WASTE STORAGE AND
TRANSPORTATION
Standard Operating
Procedures for Trans-
boundary Movement of
Hazardous Waste
SOP/MOH/HCWM-4/005
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
The SOP covers the procedures to be followed when transporting hazardous waste
across boundaries.
Purpose
Aims at reducing generation of hazardous waste ; promoting adoption of
environmentally sound management of hazardous waste; ensuring restriction of
trans-boundary movement of hazardous waste in accordance with principles of
sound management of hazardous waste and putting in place a regulatory system
when trans boundary movement are permissible.
Responsibilities
Global community
• Supporting countries to establish channels to collect hazardous waste e.g. e-
waste
• Operationalize extended producer responsibility (EPR).
45
• Oversee implementation of take back schemes including organizing waste
producers into sectoral and sub-sectoral producer responsibility organizations.
• Perform due diligence to ensure that products used in the health sector are
clearly labelled for easy identification and to show constituents of the product.
Note: The global community needs to be involved because of the transboundary
nature of activities involved including a need to fulfil requirements of the Basel
convention. The channels for communication need to be complete to give
confidence to lower-level collectors but also for purposes of enforcing extended
manufacturer responsibility.
Importers
The following are the applicable guidelines when making decisions to import
electrical and electronic products:
• Specify standards for products on the expected remaining lifespan of the
equipment and electrical appliances.
• Secure clearance from NEMA to transport hazardous waste such as e-waste
through Kenya or use licensed transporters.
• For pre-owned products, state the number of years a device with hazardous
waste such as computer has been used before being donated to the country.
• Ensure that used goods that have parts made of potentially hazardous
elements such as pieces used in electrical and electronic products reach
intended beneficiaries including documenting receipt of the goods. This is
for purposes of facilitating collection at the end of the product life cycle.
• Indicate envisaged lifespan of used items when importing used equipment
and bear responsibility for this by ensuring that take back mechanisms are in
place.
National regulatory authorities
• Should ensure that hazardous waste is not imported into the country, for
example, radioactive waste destined for disposal and highly infectious waste
such as waste from isolation centers.
• Where permissible, ensure that transporters of hazardous waste have written
consent from export, transit and import countries.
Health managers
• Ensure segregation and proper temporary storage of hazardous waste.
Waste generators
• Hand over hazardous waste to licensed collectors.
46
Materials and equipment
- Global, regional, and national guidelines for managing trans-boundary
movement of hazardous waste.
- Personal protective equipment, covered transport vehicles with proper
labeling and symbols, transfer documents and consent from origin, transit
and destination, Temporary storage area and waste transfer trolley.
Hazards and concerns
Heavy metals cause neurological complications and birth defects, chemicals
cause skin and lung irritation, radio-active material is genotoxic, polyvinyl
chloride is carcinogenic. Risks of exposure to hazardous chemicals.
Procedures
i. National and County governments should establish a system for managing
hazardous waste.
ii. Prepare a framework with appropriate legislation to support hazardous
waste management.
iii. Monitor the processes of hazardous waste handling regularly.
iv. Create a management plan with responsibilities for different target groups.
v. National and county governments should provide incentives to
entrepreneurs to set up hazardous waste collection and treatment facilities.
vi. Approve innovative hazardous waste management technologies that are
environmentally sound.
vii. Form multi-stakeholder monitoring committees to oversee the
implementation of the hazardous waste management guidelines.
viii. Create awareness among all stakeholders through legislative framework of
hazardous waste management.
ix. Enforce standards to prevent importation and donation of useless or harmful
hazardous waste.
x. Make strategic plans for transitioning from harmful to less harmful
technologies. Decisions made should be guided by environmental impact
assessments.
47
Generation of hazardous waste.
Waste generators should
i. Segregate hazardous waste from other types of health care waste.
ii. Hand over hazardous waste generated to hazardous waste collection centers.
iii. Sell or donate hazardous waste to licensed refurbishers.
iv. Send back the equipment to the manufacturer, importer, or assembler
according to prior arrangements.
v. Dispose of hazardous waste at designated/licensed dumping sites.
vi. Adhere to recommended disposal dates of expiry, end of usage periods,
actual disposal procedures and methods.
Waste transportation
i. Vendors dealing in hazardous waste must be licensed and vehicles
transporting the waste must be licensed and secure.
Disposal authorities
i. Send back the equipment to the manufacturer, importer or assembler
according to prior arrangements.
ii. Dispose of hazardous waste at designated/licensed dumping sites.
iii. Adhere to recommended disposal dates of expiry, end of usage periods,
actual disposal procedures and methods.
Guidelines for people living near dump sites
People living near dumpsites need to be educated on how to detect potential health
hazards, through organized workshops by e-waste management stakeholders and
environmental health practitioners as per the Guidelines for E-waste Management
in Kenya.
General guidance on waste collection
i. Collection mechanism for hazardous waste in terms of packaging, labelling and
transportation shall be as per the existing Waste Management Regulations, 2006.
ii. Collection centers shall be established by NEMA licensed producers/dealers,
manufacturers, importers, and distributors.
iii. Collection centers shall store the hazardous waste after sorting it into various
access by downstream users as well as to facilitate record keeping on the
quantities of various categories of waste.
iv. Producers/dealers, manufacturers, importers, and distributors have to enroll in a
hazardous waste collection scheme by virtue of the fact that they introduce
electrical and electronic equipment into the environment.
48
v. Producers/dealers, manufacturers, importers, and distributors should have the
extended producer manufacturer responsibility to ensure that at the end-of-life
span of the equipment, disposal is managed responsibly.
vi. NEMA and other regulatory authorities will regulate collection, recycling,
refurbishing and disposal of Hazardous waste.
vii. Manufacturers, local authorities, importers, and distributors will create
awareness of waste collection systems.
CHAPTER 5: WASTE TREATMENT AND DISPOSAL
49
It is desirable that counties and sub-counties in Kenya establish centralised systems
for managing health care waste. Public private partnerships in health care waste
management should be explored.
This section describes the SOPs to be followed when treating the waste by
incineration, autoclaving, and shredding.
5.1 SOP for Diesel Fired Incinerator Operation
MINISTRY OF HEALTH
WASTE TREATMENT AND
DISPOSAL
Standard Operating
Procedures for operating
Diesel Fired Incinerators
SOP/MOH/HCWM-5/001
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Important to note:
Open burning is an environmentally unacceptable process that generates chemicals
listed in Annex C of the Stockholm Convention and numerous other pollutant
products of incomplete combustion. In consistence with Annex C, Part V, section A,
sub-paragraph (f) of the Stockholm Convention, the best guidance is to reduce the
amount of material disposed of via this method with the goal of elimination
altogether.
Other techniques which may affect improvement, with respect to the materials
burned, include avoiding inclusion of non-combustible materials, such as glass and
bulk metals, wet waste, and materials of low combustibility; waste loads containing
high chlorine content, whether inorganic chloride such as salt or chlorinated
organics such as PVC; and materials containing catalytic metals such as copper,
iron, chromium, and aluminum, even in small amounts. Materials to be burned
should be dry, homogeneous, or well blended, and of low density, such as non-
compacted waste.
With respect to the burning process, you should aim to: supply sufficient air;
maintain steady burning or rate of mass loss; minimize smouldering, possibly with
50
direct extinguishment; and limit burning to small, actively turned, well-ventilated
fires, rather than large poorly ventilated dumps or containers.
Diesel powered incinerators are for the time being the preferred option among
incinerators because of their cost effectiveness but where financial resources are not
the limitation, other alternatives can be explored.
In using them, consideration should be given to
• Waste input and control
• Combustion
• Over 850o
C in general; over 1100o
C for waste containing over 1% chlorine;
residence time over 2 seconds at 6% oxygen.\
• Avoiding cold starts, upsets and shutdowns.
Scope
To outline standard operating procedures for safely operating a Diesel Fired
Incinerator.
Purpose
To provide guidance for operating a diesel-fired waste incinerator.
Responsibilities
a) Health Facility Management.
• Provide the waste treatment equipment; fuel and operational budget,
maintenance spares and tools; occupational vaccinations for the incinerator
operator(s).
• Use national guidelines for safe management of health care waste to select,
specify and procure an incinerator.
• Eliminate and avoid future procurement of small incinerators that do not
meet environmental and air quality requirements.
a) Waste Management Officer:
• Ensure the waste is treated before final disposal, securing of site, final disposal
of ash.
b) Maintenance Officer
• Regular Servicing and maintenance of the incinerator.
51
c) Waste handlers
• Collect and transport waste to the incinerator (incineration site).
d) Incinerator Operator
• Operate the incinerator and maintain records of waste treated, report
malfunctions of the incinerator to the maintenance officer.
Materials and Equipment
• Personal Protective Equipment (PPE).
• Incinerator.
• Burn log.
Hazards and Safety Concerns
• Burns – The incinerator operator must follow operation guidelines and wear
appropriate PPE (Leather Gloves).
• Spillages – Spillage of HCW may occur when loading the waste in the
incinerator. Spill kit and training on management of spillages must be
provided at water treatment area.
• Explosions – Care must be taken to ensure explosive materials are not
incinerated.
• Smoke and fumes – Incineration produces smoke and fumes; therefore the
incinerator operator must be provided with adequate and recommended PPE
at all time, i.e. N95 masks.
Procedures
Before starting operation
i. Check the maintenance log in case a previous user has experienced a
problem that will prevent the incinerator being used as usual.
ii. Check that the incinerator logs (daily and monthly) are up to date and record
any new data relevant to the upcoming run including the amount and type
of waste to be incinerated.
iii. Don PPE before handling any waste or performing maintenance. Avoid
contamination during doffing of PPE.
iv. Check that enough fuel is available for operating the incinerator.
• Perform any routine maintenance checks and record the results in the
maintenance log.
• Remove any ash from the incinerator combustion chamber.
• Rake ash into a heat-proof, puncture-proof container.
52
• Dispose the ash in the ash pit or package and label appropriately for off-
site disposal.
A. Before burning waste
i. Preheat the incinerator for 20-30 minutes or to manufacturer’s instructions
and load waste when temperature in the secondary chamber is above 850OC.
C. Loading the waste
i. Load waste according to instructions of the manufacturer.
ii. Make sure that items that are not supposed to be incinerated are not loaded in the
incinerator.
Note: The following materials should not be incinerated: chemical residues,
genotoxic and radioactive waste, inorganic compounds, pressurized containers,
halogenated plastics and waste with high content of heavy metals.
D. Monitor the Combustion Process
i. Do not leave the incinerator unattended during operation.
ii. Monitor operator exposure to heat, ensure adequate hydration and
mitigate against operator fatigue.
iii. Monitor the temperature, air inlet and other parameters that are being
measured throughout the combustion process.
iv. Monitor the colour of the smoke emitted at the chimney.
v. Monitor to make sure that prohibited items are not loaded in the
incinerator.
Note: The following materials should not be incinerated: chemical residues,
genotoxic and radioactive waste, inorganic compounds, pressurized containers,
halogenated plastics and waste with high content of heavy metals.
E. Burn down
i. Add the last load batch and burn for 30 minutes.
ii. Turn off the burners and leave the blower fans running for at least one hour.
iii. Shut off the fuel supply and allow the fire to die down.
iv. Do not leave the incinerator until the fire has died down completely.
53
v. Ensure that the area is clean and that all materials, including PPE, are
cleaned and put away at the end of the day.
vi. Complete necessary record-keeping.
vii. Wash before leaving work.
Documentation
Record all incineration activities in an Incinerator Burn log; type of waste treated,
quantities in kilograms, operating temperatures, and incineration time.
A sample of a Diesel-fueled Incinerator Burn Log is available in annex 3.
Key message
Incinerator should have Environmental Impact Assessment (EIA) report that
clarifies most of the issues above.
5.2 SOP for Maintenance of Diesel Fired Incinerator
MINISTRY OF HEALTH
WASTE TREATMENT AND
DISPOSAL
Standard Operating
Procedures for Maintaining
Functionality of Diesel Fired
Incinerators
SOP/MOH/HCWM-5/002
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
To outline standard operating procedures for maintaining a diesel fired incinerator.
Purpose
To provide procedures and schedules for maintaining functionality of a diesel-fired
waste incinerator.
54
Responsibilities
Health Facility Management.
• Provide the equipment maintenance budget, spares and tools, occupational
vaccinations for the incinerator operator.
• Use equipment user manual to generate incinerator maintenance schedules.
• Ensure timely implementation of maintenance activities.
Waste Management Officer
• Ensure that the incinerator is safe for the maintenance teams to work on.
Maintenance Officer
• Regular servicing and maintenance of the incinerator.
Waste handlers
• Clean out the incinerator as guided by the maintenance team.
Incinerator Operator
• Keep a copy of the maintenance schedule, ensure timely maintenance, keep
records of maintenance done and report malfunctions of the incinerator to
the Maintenance Officer.
Materials and Equipment
• Personal Protective Equipment (PPE).
• Incinerator.
• Maintenance manual.
• Maintenance equipment.
Hazards and Safety Concerns
• Burns – The incinerator operator must follow operation guidelines and wear
appropriate PPE (Leather Gloves).
• Spillages – Spillage of HCW may occur when loading the waste in the
incinerator. Spill kit and training on management on spillages must be
provided at water treatment area.
55
• Explosions – Care must be taken to ensure explosive materials are not
incinerated.
• Smoke and fumes – Incineration produces smoke and fumes, therefore the
incinerator operator must be provided with adequate and recommended
PPEs at all time, i.e. N95 masks.
Procedures for Maintenance of Diesel Fired Incinerators
A. Daily Maintenance
i. Check for evidence of cracks in the incinerator metal sheets casing and
chamber refractory bricks.
ii. Check on complete removal of ash.
iii. Keep the area clean and disinfected.
iv. Carefully sweep and mop up the area around the incinerator.
v. Clean tools and equipment.
vi. Maintain fuel stock levels available for incineration.
vii. Check door seals for wear, closeness of fit and air leakage of the burning
chamber.
viii. Blower intake: Inspect for accumulations of lint or debris.
ix. Check on oil filter and fuel line for leakages.
B. Weekly Maintenance
i. Maintain good housekeeping of the ash storage site.
ii. Ensure the fencing is intact.
iii. Control panels: Inspect and clean as required.
C. Fuel intake: Investigate source of fuel leakage as required.
D. Monthly Maintenance
i. External surface of incinerator and stack: Inspect and clean as required. Keep
panel securely closed and free of dirt to prevent electrical malfunction.
ii. Refractory: Inspect external “hot” surfaces. White spots or discoloration may
indicate loss of refractory.
iii. Secondary combustion chamber: Inspect for wear. In case of stainless steel
faces a replacement may be required within 1-5 years.
56
iv. Burner: Lubricate and inspect like indicated in the manual.
v. Take an inventory of condition of tools and equipment.
vi. Lubricate the blowers.
E. Yearly Maintenance
i. Inform Service Company for yearly check: Overhaul the incinerator;
thermocouple, motors- valve and injector, gasket seal, control panel, burners,
oil filter, oil pump corrosion.
ii. External surfaces: Inspect and paint with high-temperature point as required.
iii. Perform annual audit and documentation.
iv. Ensure environmental audits and licenses are obtained and still valid.
v. Ensure equipment history sheet is filled whenever service of equipment is
done - maintenance Schedule.
F. Reporting and Recordkeeping
• Maintenance Schedule.
5.3 SOP for Operating and Testing of Medical Waste Autoclave
MINISTRY OF HEALTH
WASTE TREATMENT AND
DISPOSAL
Standard Operating
Procedures for Operating
and Testing of Medical
Waste Autoclave
SOP/MOH/HCWM-5/003
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
The SOP outlines the key autoclave operation and safety procedures, testing and
validation.
Purpose
57
To provide guidance to safely operate and test medical waste autoclaves to ensure
effective disinfection of waste.
Responsibilities
a) The Waste Management Officer and laboratory manager (or other assigned
officer) are ultimately responsible for the safe use of the autoclave.
b) Autoclave Operator – to safely operate the autoclave as stated in the
procedures, conduct tests to validate the sterilization at every charge.
c) Maintenance Officer – to carry out maintenance activities and attend to any
malfunctions raised by the operator.
Materials and Equipment
• Autoclave containers/bins.
• Autoclave bags.
• Autoclave tape.
• Integrator strips.
• Self-contained biological indicators (SCBIs).
• Personal protective equipment (PPE);
o Latex or rubber gloves for handling cool waste and other potentially
infectious materials.
o Thick, elbow-length, heat-resistant gloves for handling any hot materials.
o Safety glasses.
o Overall.
o Lab coat.
o Safety shoes/boots.
Hazards and Safety Concerns
Risks
o Substantial heat and pressure generated by the autoclave.
o Heat from steam, hot liquids, and other materials, including containers, the
autoclave chamber and door.
o Falling items e.g., heavy containers of waste being put into/removed from
autoclave.
o Infectious waste, including untreated waste and waste from a failed treatment
cycle.
58
o Sharps, when glassware has broken or has been placed in bags rather than
puncture-proof containers.
Safety Concerns
o Never autoclave materials that contain toxic agents (e.g. disinfectants),
corrosives (e.g. acids, bases, bleach, phenol), solvents or volatiles (e.g. ethanol,
methanol, acetone, chloroform), or radioactive materials.
o Training of autoclave operator on equipment safety measures e.g. potential
burn hazard, emergency switch, safety valves, electrical isolators, and the use
of fire extinguishers.
Procedures
Autoclave operation
i. Wear appropriate personal protective equipment (gum boots, overall, gloves,
safety glass).
ii. Perform routine maintenance checks – using check list.
• Prepare waste to be autoclaved.
a. Check state of waste bag: closed, not overfilled or broken, labeled, no
sealed bottles.
b. Bag should be closed by process test strip to confirm sterility after
autoclaving.
iii. Record the weight / number of safety boxes and bags to be treated and log in
in the operation log.
iv. Autoclave preparation:
a) Connect the power: Plug the power, turn on the switch.
b) Add demineralized water into the water container inlet.
c) Set sterilizing temperature and time.
v. Loading:
a) Put the waste bags into the loading bins.
b) Do not overfill.
c) Add chemical indicator in the load.
d) Put the basket/loading bin into the autoclave chamber.
e) Close the autoclave.
NB: do not tighten the lid too much to avoid damages for the rubber seal.
vi. Record the time when sterilization begins.
59
vii. Chart the pressure readings in the operation log.
viii. Record the time when sterilization stops.
ix. Allow aeration/cooling of the autoclave after sterilization is complete.
x. Wait until pressure gauge falls to zero.
xi. Unloading of the waste.
a. Wear heat-insulating gloves, eye protection, lab coat, and closed-toe
shoes.
b. Ensure that the cycle has completed and both temperature and pressure
have returned to a safe range.
c. Stand back from the door as a precaution and carefully open door no
more than 1 inch. This will release residual steam and allow pressure
within liquids and containers to normalize.
d. Allow the autoclaved load to stand for 10 minutes in the chamber to
allow steam to clear and trapped air to escape from hot liquids.
e. Do not agitate containers of super-heated liquids or remove caps before
unloading.
f. Remove items from the autoclave.
xii. Shut autoclave door and turn off from power source.
xiii. Remove PPE and perform personal and hand hygiene.
xiv. Secure the area.
Documentation
• Autoclave Operation- for Log – for recording operation procedures, each
cycle must be recorded. A sample of the Autoclave Operation Log is
provided (see annex 4)
• Autoclave Validation and Challenge Test Log – for recording achieved
parameters during the equipment validation exercise (see annex 5).
60
5.4 SOP for Operating a Medical Waste Shredder
MINISTRY OF HEALTH
WASTE TREATMENT AND
DISPOSAL
Standard Operating
Procedures for Operating a
Shredder
SOP/MOH/HCWM-5/004
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
This SOP outlines the operation procedures and safety concerns to be followed
when operating a shredder.
Purpose
The purpose of this SOP is to provide guidance to the shredder operators and
maintenance officers to safely operate the medical waste shredders.
Responsibilities
a) The Waste Management Officer - Responsible for the safe use of the
shredder.
b) Shredder Operator – Safely operate the shredder as stated in the procedures.
c) Maintenance Officer – Carry out preventive maintenance activities and
attend to any malfunctions raised by the operator.
Materials and Equipment
• Eye and hearing protection
• Footwear
61
• Overall
• Helmet
• Gloves
• Heavy duty Boots
Hazards and Safety Concerns
• Rotating cutting blades
• Noise
• Entanglement
• Eye injuries
• Flying debris
• Pricks
Procedure
Pre-occupational safety checks
• Check all bolts and screws for proper tightness to ensure the machine is in
safe working condition.
• Ensure all guards are fitted, securely attached and functional.
• Never operate without the shredder hopper, chipper chute or discharge
chute properly attached to the machine.
• Be familiar with all controls and their proper operation.
• Faulty equipment must not be used. Report any malfunction to the
supervisor immediately.
Shredder Operation
i. Wear PPE (helmet, google/face shields, respirators, overall, apron, protective
gumboots).
ii. Perform daily clean up procedures in the shredder room.
iii. Perform daily maintenance checks.
a. Check Oil levels at the gear reducer, Shredder
gearbox oil and the tipper oil.
b. End plate bearings fitting.
c. Check for any loose fasteners.
d. Check the discharge chute/screen for any remaining
materials
62
iv. Make sure there are no people in the shredder room.
v. Turn the main power switch “ON”. Turn the control power switch on. The
screen should turn RED. The screen read
vi. The screen will read MCR not Reset. Press the “MCR ON RESET” button in
the control panel. This will turn on the Master control relay. If the relay
button does not turn on, make sure the Emergency STOP button at the
control panel is pulled out.
vii. Press and hold the Shredder Start/RUN button. A warning horn will sound
for 5 seconds; at the end of the 5 seconds the shredder will start.( The knives
will run anticlockwise for 5 seconds to clear any debris in the knives then it
will run normally).
viii. Load the Shredder.
a. To load the Shredder, use the tipper system. Do not load the shredder by
hand.
b. Ensure the power supply to the tipper is on and the Emergency stop button
is pulled out.
c. Turn “ON” the start button at the control panel.
d. Wheel the trolley/Aluminum bin to the loading cart.
e. Use the lever to dump the waste by “PULL UP” and “ PULL DOWN”
to continue loading.
f. Feed the shredder steadily.
TOUCH Screen
Turn Power on
IF there is a jam the “SHREDDER JAM” light will glow; this means the PLC has shut the
shredder down.
Determine the cause of the JAM
o If it’s a non-shredable item in the cutting chamber, shut off and lock out the main
power supply, remove the object and restart the Machine
o If the Machine is overloaded, RESET and start the shredder; DO NOT feed any more
material into the hopper until the current material is cleared
o To reset the Shredder jam, Press and Hold the “SHREDDER JAM” button, press the
“fault reset” button in the touch screen, or turn the control power key switch to
OFF and back to ON and Restart the shredder normally.
63
ix. Stopping the shredder
a. Stop feeding the shredder.
b. Keep running the shredder until the cutting chamber, discharge
chutes and conveyer belts are empty.
c. Press the “STOP” button on the control panel.
DO NOT USE THE EMERGENCY STOP,
It’s only for EMERGENCIES
d. Turn the panel key switch to “OFF” and remove the key.
x. Remove the shredded waste and pack to liners ready for final disposal.
xi. . Remove the PPE, clean and perform personal hygiene.
Documentation
• Shredder operation log.
5.5 SOP for Operating a Medical Waste Microwave
MINISTRY OF HEALTH
WASTE TREATMENT AND
DISPOSAL
Standard Operating
Procedures for Microwave
Treatment of Health Care
Waste
SOP/MOH/HCWM-5/005
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
This covers an outline of operation, safety procedures, testing and validation of a
microwave treatment of health care waste.
64
Purpose
To provide guidance on how to safely operate and test medical waste microwave to
ensure effective disinfection of waste.
Terms and definitions
Medical Waste Microwave – an equipment which disinfects medical waste by
exposing it to microwave radiation in the electromagnetic spectrum.
Responsibilities
a) Facility management team
• Provide microwave equipment, operational budget and vaccinations for
operators.
• Ensure adequately trained manpower.
b) Waste Management Officer
• To ensure use of the waste microwave.
c) Waste Microwave Operator
• To safely operate the waste microwave as per the laid down procedures.
• To conduct tests to validate the sterilisation for every loading.
d) Maintenance Officer
• To carry out PPM activities.
• To attend to any malfunctions as may be raised by the operator.
Hazards and safety concerns
Risks
• Direct microwave exposure.
• Substantial heat generated by the microwave.
• Infectious waste, including untreated waste and waste from failed treatment
cycle.
• Sharps - when glassware has broken or has been replaced in bags rather than
puncture proof containers.
65
Safety concerns
Never microwave materials that contain toxic agents (e.g. disinfectant), corrosives
(e.g. acids, bases, bleach, phenol), solvents or volatiles (e.g. ethanol, methanol,
acetone, chloroform), or radioactive material.
Ensure training of Microwave operator in equipment safety measures e.g. potential
burn hazard, emergency switch, safety valves, electrical isolators, and use of fire
extinguishers.
Material
• Micro-wave equipment.
• Microwave containers/bins.
• Microwave bags.
• Self-contained biological indicators (SCBIs).
• Personal protective equipment (PPE);
- Latex or rubber gloves for handling cool waste and other potentially
infectious materials.
- Thick, elbow length, heat resistant gloves for handing any hot
materials.
- Safety glasses.
- Overall.
- Laboratory coat.
- Safety shoes/boots.
Procedures
66
Figure 3 below summarises step by step operation of the microwave as approved by
the WHO.
Figure 3: step by step operation of the microwave (Source: www.Sterilwave.com)
More details on parts of the microwave and its step-by-step operations are provided
in annexes 8 & 9.
Documentation
The system is monitored by a software program which ensures a full tracking of
each cycle.
• At the end of each cycle, the equipment generates an automatic printout of
key performance parameters such as load, temperature, duration of cycle etc.
A printed sticker is therefore available after each cycle.
• Data on all operations carried out in a day can be electronically captured and
stored on SD memory card.
• The equipment can, through an IP address, be connected to remotely track
the maintenance operations.
67
• Several languages are available (flexible end-user preferences).
5.6 SOP for Disposal of HCW in a Health Care Waste Landfill
MINISTRY OF HEALTH
WASTE TREATMENT AND
DISPOSAL
Standard Operating
Procedures for Disposal of
health care Waste in a
Health Care Waste Landfill
SOP/MOH/HCWM-5/006
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
An outline of operations and safety procedures for safe disposal of medical waste.
Purpose
To provide procedures for safe disposal of medical waste.
Terms and definitions
Encapsulation involves mixing waste with cement and other substances before
disposal in order to minimise the risk of harmful waste injuring people who come
in contact with it.
Responsibilities
a) Waste Management Committee
• Provide the waste disposal equipment, operational budget and vaccination
for the waste handlers that dispose of waste.
b) Waste Management Officer
68
• To ensure health care waste is segregated, stored and transported to the
treatment facility before disposal.
• Securing of the disposal site and final disposal of treated waste.
d) Waste Disposal Officer
• Manage the disposal site.
• Ensure the medical waste is well separated before disposal.
• Ensure proper disposal of health care waste at demarcated disposal sites.
• Report any concerns arising from waste to be disposed or the disposal site to
the waste management officer.
Hazards and safety concerns
• Scavenging in sanitary landfills must be prevented.
• Open dumping of health care waste is highly discouraged.
• In a situation where there is no landfill, you are advised to dump health care
waste in a controlled dumping site and the area must be protected from
scavengers.
• Encourage encapsulation to minimise contamination, injuries and
environmental damage.
Materials and equipment
• Land for disposal.
• Septic or liquid waste treatment systems.
• NEMA Registered transport vehicles to the disposal site (off-site disposal).
• Personal protective equipment.
• Waste disposal records and registers (including manifest).
Procedures
i. Open dumps
Health care waste should not be deposited on or around open dumps. The risk of
either people or animals coming in contact with infectious pathogens is obvious,
with a risk of subsequent disease transmission, either directly through wounds,
inhalation, or ingestion, or indirectly through the food chain or pathogenic host
species.
ii. Sanitary landfills
69
• This is the most preferred method of disposing of less infectious health care
waste.
• Some essential elements for designing and operating a sanitary land fill;
o There should be good access to the site and working areas to make it
easy for waste delivery and site vehicle movement.
o Presence of site personnel capable of effective control of daily
operations.
o Division of the site into manageable phases, appropriately prepared
before landfill starts.
o Adequate sealing off of the base and sides of the site to minimise
movement of wastewater (leachate) off the site.
o Provide adequate mechanisms for leachate collection and treatment
systems if necessary.
o Organised deposit of wastes in small area, allowing them to be spread,
compacted, and covered daily.
o Surface water collection trenches around site boundaries.
• In the absence of sanitary landfills, any site from a controlled dump site
could accept health care waste and avoid measurable increase in infection
risk. The minimal requirements would be the following:
o An established system for rational and organised deposit of wastes
which could be used to dispose of health care waste.
o Some engineering works already completed to prepare the site to
retain its waste more effectively.
o Rapid burial of health care waste so that as much human or animal
contact as possible is avoided.
• It is further recommended that health care waste be disposed of in one of the
two following ways
o In a shallow excavated area within mature municipal waste (landfill
below the layer of the working surface) and immediately covered with
a 2-meter layer of fresh municipal waste. Scavengers should not be
allowed in this part of the landfill.
o In a deeper (1-2 metre) pit excavated in mature municipal waste
(waste covered 3 months earlier). The pit is then backfilled with
mature municipal waste that was removed from this excavation site.
Scavenging should be prevented from this area of the landfill.
70
Note: before health care waste is sent to the disposal site, it is prudent to
inspect the landfill to ensure that there is sensible control of waste
disposition.
5.7 SOP for Disposal of Health Care Wastewater
MINISTRY OF HEALTH
WASTE TREATMENT AND
DISPOSAL
Standard Operating
Procedures for Disposal of
Health Care Wastewater
SOP/MOH/HCWM-5/007
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND SANITATION
Scope
An outline of operations and safety procedures in safe disposal of health care
wastewater.
Purpose
To provide procedures for safe disposal of health care wastewater.
Terms and definitions
Inertization
Involves mixing waste with cement and other substances before disposal in order to
minimize the risk of toxic substances contained in the waste migrating into surface
waste or ground water.
Responsibilities
a) Waste Management Committee
• Provide the waste disposal equipment and operational budget and vaccinations
for the waste handlers.
b) Waste Management Officer
• Monitor the level of hazardous HCW water being generated at the facility before
treatment and disposal.
71
c) Wastewater Treatment and Disposal Officer
• Manage the wastewater treatment and disposal site.
• Ensure the liquid waste is well treated before disposal into main water
bodies.
• Report any concerns arising from the wastewater to be treated and disposed
of or the water treatment and disposal plant site to the waste management
office.
Hazards and safety concerns
• Strict limit on the discharge of hazardous liquids to sewers.
• Only in an outbreak of acute diarrhoeal diseases should excreta from patients
be collected separately and disinfected.
• Where waste use is commonly high, sewage is usually diluted.
• For effluents treated in treatment plants, no significant health risks should be
expected, even without further specific treatment of these effluents.
• Excreta from patients being treated with cytotoxic drugs may be collected
separately and adequately treated (as for other cytotoxic waste).
• During outbreaks of communicable diseases, effluent disinfection by chloride
dioxide (chlorine powder) or by any other efficient process is recommended.
• Encourage inertization to minimize contamination of ground water.
Procedures
i. The health-care establishment should ideally be connected to sewerage
system.
ii. Where there are no sewerage systems, technically sound on-site sanitation
such as the simple, ventilated pit latrine, and pour-flush latrine, and more
advanced septic tank with soak away or the aqua-privy should be provided.
iii. In temporary field hospitals during outbreaks of communicable diseases,
other options such as chemical toilets may also be considered.
iv. If the final effluent is discharged into coastal waters close to shellfish
habitats, disinfection of the effluent will be required throughout the year.
Components of health care wastewater
• Wastewater from health care establishments is of similar quality to urban
wastewater but may also contain various potentially hazardous components.
72
• The principal area of concern is wastewater with a high content of enteric
pathogens including bacteria, viruses, and helminths, which are easily
transmitted through water.
• Contaminated wastewater is produced by wards treating patients with
enteric diseases and is a particular problem during outbreaks of diarrheal
diseases.
• It may also contain various potentially hazardous components such as
microbiological pathogens, hazardous chemicals, pharmaceuticals, and
radioactive materials. Small amounts of chemicals from cleaning and
disinfection operations are regularly discharged in sewers.
• Small amounts of pharmaceuticals are usually discharged to the sewers from
hospital pharmacies and from the various wards.
• Radioactive isotopes should be discharged into holding tanks by oncology
departments.
• The toxic effects of any chemical pollutants contained in wastewater on the
active bacteria of the sewerage purification process may give rise to
additional hazards.
5.8 SOP for Wastewater De-chlorination
MINISTRY OF HEALTH
WASTE TREATMENT AND
DISPOSAL
Standard Operating
Procedures for Wastewater
De-chlorination
SOP/MOH/HCWM-5/008
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
This SOP addresses operations and safety procedures in safe de-chlorination of
wastewater.
Purpose
73
To achieve effective de-chlorination of wastewater without posing risks to health of
health workers and the environment.
Definition
Disinfection using chlorine
Disinfection is the process of destroying pathogenic micro-organisms by physical
means. This SOP is directed towards chlorine, the most widely used chemical for
disinfection and sulfur dioxide for dechlorination.
Proper disinfection ensures removal of pathogens from wastewater before it is
discharged to the environment. The importance of proper disinfection must not be
minimized even with imposed discharge limitations on chlorine residuals as low as
0.02 ppm or no detectable limit.
Dechlorination
Dechlorination is a practice used to reduce or remove the chlorine discharge levels.
Free and combined chlorine residuals are reduced by sulfur dioxide, sulfites and
other dechlorinating agents.
Responsibilities
a) Waste Management Committee
• Provide the wastewater treatment equipment and operational budget.
• Organise for vaccination for the waste treatment staff.
• Train health workers in safe treatment of chlorinated wastewater.
b) Waste Management Officer
• Monitor the level of hazardous HCW water being generated at the facility before
treatment and disposal.
c) Wastewater Treatment and Disposal Officer
• Manage the wastewater treatment and disposal site.
• Ensure that chlorinated liquid waste is well treated before disposal into main
water bodies.
• Report any concerns arising from the wastewater to be treated and disposed
of or the water treatment and disposal plant site to the waste management
officer.
74
Hazards and safety concerns
• Inhalation of chlorine fumes
• Contact with the skin
• Potential for explosions
Note: Chlorine can react with skin, damage lungs and enhance combustion
of organic materials. Exposure can also be endocrine disrupting and chlorine
compounds have oxidising properties that can make blood vessels rupture.
Procedures
• Sulfur dioxide dissolves in water rapidly, forming sulfuric acid as shown in
the following reaction:
SO2 + H2O → H2SO3
• The sulfite radical formed in this solution reacts with free and combined
chlorine as shown in the following equations:
H2SO3 + NH3Cl + H2O → H2SO4
H2SO3 + NH3Cl + H2O → NH4HSO4 + HCl
Each reaction is rapid and complete.
Components of health care wastewater
• Wastewater from health care establishments is of similar quality to urban
wastewater but may also contain various potentially hazardous components.
• The principal area of concern is wastewater with a high content of chlorine.
• Chlorinated wastewater is produced by wards disinfecting items and
surfaces contaminated with infectious agents.
• It may also contain various potentially hazardous components such as
microbiological pathogens, hazardous chemicals, pharmaceuticals, and
radioactive materials. Small amounts of chemicals from cleaning and
disinfection operations are regularly discharged in sewers.
• Small amounts of chlorine are usually discharged to the sewers from hospital
pharmacies and from the various wards.
75
CHAPTER 6: OCCUPATIONAL HEALTH AND SAFETY IN HCWM
6.1 SOP for Handling Infectious Spills
MINISTRY OF HEALTH
OCCUPATIONAL HEALTH
AND SAFETY IN HCWM
Standard Operating
Procedures for Handling of
Infectious Spills
SOP/MOH/HCWM-
6/001
Version :00
Review date
DIVISION OF
ENVIRONMENTAL HEALTH
AND SANITATION
Scope
Covers safe handling of infectious waste spills which include preparation for clean-
up and handling solid spillage.
Purpose
To safeguard and protect other people who may get into contact with infectious
waste spills.
Responsibilities
a) Facility Managers
• Provide spill kits and appropriate PPE with the guidance of the
facility biosafety officer.
b) Biosafety Officer
• Ensure health workers are trained to properly handle spillage.
Hazards and Safety Concerns
76
▪ No cleaning action should be initiated without proper use of appropriate and
approved PPE.
▪ Always cordon off the area with the spill before cleaning.
Materials and Equipment
• Personal protective equipment
1. Impervious safe disposable gloves.
2. Goggles and/or face shield.
3. Safety shoes.
4. Apron
• Spill kit
a. Effective disinfecting agent (i.e., 10% bleach made fresh daily, clidox,
2% amphyl, etc.).
b. Absorbent paper towels; may also include spill pillows for large spills.
o Small disposable broom with dustpan.
o A waterproof copy of spill response and cleanup procedures.
Procedures
i. Preparation for clean up
• A general review of the incident must be conducted immediately after the
incident has taken place or has been discovered.
• Contaminated areas must be cordoned off as soon as possible and not
released before proper cleaning has been carried out.
• All involved persons must be checked for injuries and possible
contamination and then treated accordingly.
ii. Management of different kinds of spills
• Involved persons must not leave the incident area before they have been
checked to prevent spreading of infectious or chemical materials to other
areas of the facility.
• Names of all involved persons must be registered for follow-up and
monitoring.
a. Solid infectious waste spills (e.g., a waste bin or sharps box is spilled)
• Evacuate the area around the spill and cordon off the area.
• Prevent further spill.
77
• Do not touch or step on the waste.
• Wear appropriate PPE using tongs, a dustpan and brush or other suitable
tools, clear up the spilled waste. A magnet can be useful for picking up
spilled needles from a needle or hub cutter.
• Collected in the most appropriate container that is readily available. Wash
and disinfect the floor according to normal procedures.
• Ensure that the waste is packaged and labeled appropriately.
• Wash and disinfect the tools that were used in the clean-up.
• Wash and disinfect hands thoroughly.
b. Spot cleaning of small surface area liquid spills (biological)
• Pour alcohol on a paper towel or cloth and wipe up the spill.
• Allow 10 – 15 minutes contact time and wipe up the spill area.
• Discard all contaminated materials, including the gloves in the waste
container for infectious health care waste.
• Wash and disinfect hands thoroughly.
c. Cleaning after larger surface area liquid spill
• Use an appropriate spill kit.
• Pour alcohol on a paper towel or cloth and wipe up the spill area.
• Allow 10 – 15 minutes contact time and wipe up the spill area.
• Use absorbent material to absorb the blood and/or body substances.
• Use dustpan and scraper to collect the absorbent materials and spill.
• Remember that absorbed materials have the same properties and hazards as
the original spilled materials.
• Dispose of all collected material into the containers for infectious health care
waste.
- Wipe the area with damp paper towel.
- Mop the area with a detergent solution.
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- Wipe the site with disposable towels soaked in a solution of 1% (10,000
ppm) available chlorine.
- Clean and disinfect pan, scraper, mop and bucket.
- Dispose of gloves and paper towels (without chlorine) into the container
for infectious health care waste.
- Dispose of paper towels soaked in chlorine solution into the bin for
normal waste (as chlorine can damage autoclave for treatment of health
care waste).
- Clean and disinfect re-usable personal protective equipment
immediately after use.
- Wash and disinfect hands thoroughly.
- The spill kit is re-stocked and returned immediately after the cleaning.
d. Reporting and Recordkeeping
• When the contaminated area has been cleaned, complete the Incident Reporting
Form.
6.2 SOP for Post Exposure Prophylaxis (PEP)
MINISTRY OF HEALTH
OCCUPATIONAL HEALTH
AND SAFETY
Standard Operating
Procedures for Post Exposure
Prophylaxis
SOP/MOH/HCWM-6/002
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
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All health care waste handlers within the facility and will include waste handlers
and plant/equipment operators
Purpose
To ensure that all the people exposed to needle-stick injuries and body fluid flashes
or accidental cuts are taken through post-exposure prophylaxis procedure.
Responsibilities
Hospital Management:
• Ensure that PEP infrastructure is in place; drugs available 24 hours, staff to
administer the drugs and provide adequate counselling.
• All waste handlers and health workers exposed to needle-stick injuries shall
immediately report to their supervisors.
Materials and Equipment
1. HIV/AIDS tests kits.
2. ARVs.
Hazards and Safety Concerns
• Exposure to infectious waste can lead to infection with HIV/AIDS, Hepatitis
B & C, tuberculosis, tetanus, Ebola, viral hemorrhagic fevers.
• Physical injuries from sharps.
Procedures
Exposure to Needle-stick Injury
i. Encourage bleeding from the site but do not scrub or cut the site, wash it
with soap and water.
ii. Report the injury to your supervisor.
iii. Determine risk associated with exposure.
• Evaluate the source and exposed person.
• Assess the potential risk of infection.
• Both the source and exposed person need to be counselled for HIV-testing. A
known source should be tested for HIV; if the source person is not willing to
be tested, he/she should not be coerced into having the test.
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• Discarded sharps/needles should not be tested.
iv. The exposed person should not receive ARV drugs without being tested.
However, where immediate testing is not feasible, treatment should not be
delayed since HIV testing can be carried out the following day or soon
thereafter. Counselling and support should be provided to the exposed and
for those who decline to be tested, they should be offered further
appropriate support.
v. HIV test should be done at baseline, at 3 months and at 6 months for persons
exposed.
vi. Offer PEP as appropriate.
vii. Treatment should not be continued if status of exposed individual remains
undetermined.
viii. Hepatitis B vaccination should be offered to non-immune where available.
ix. Review staff health and safety: evaluate exposure and determine whether
local preventive procedures could be improved.
x. Provide follow up testing and counselling for the exposed person.
xi. Proper documentation and reporting of event and patient management.
xii. Post exposure prophylaxis is not indicated
• If the exposed person is HIV-positive.
• If the exposure occurred more than 72 hours previously.
• Exposure to intact skin with potentially infectious material, any exposure
to noninfectious material (e.g., feces, urine, saliva and sweat).
•
•
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6.3 SOP for Immunization against Hepatitis B and Tetanus
MINISTRY OF HEALTH
OCCUPATIOAL HEALTH
AND SAFETY
Standard Operating
Procedures for
Immunisation against
Hepatitis B and Tetanus
SOP/MOH/HCWM-6/003
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
All health care waste handlers within the facility and will include waste handlers
and plant/equipment operators.
Purpose
To ensure that all the people involved in health care waste are protected against
hepatitis B, hepatitis C and Tetanus.
Responsibilities
Hospital Management
▪ Ensure that appropriate and adequate vaccines are available.
▪ Ensure all staff working at the hospital are fully vaccinated.
All Hospital Staff
• Ensure that they are fully vaccinated as required.
Materials and Equipment
• Hepatitis B vaccines.
• Tetanus Vaccines.
• Syringes & needles.
• Refrigerators,
• Sharps containers
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Hazards and Safety Concerns
Any contact with body fluids, tissues and sharps is a potential cause of transmission
of hepatitis B & C.
Procedures
Hepatitis B Vaccine (HBV)
• All New & old staff not immunized to undergo HBV vaccination.
• Staff to present themselves for vaccination.
• Use 0-, 1- and 6-months schedule of 3 injections.
• Assess the risk of HBV exposure and determine the immune status of the
patient.
• Once the 3 doses have been completed, booster doses are not necessary.
Tetanus
• Injured staff to irrigate injured area/part with water.
• Injured staff to present themselves to vaccination center.
• Treat exposure site appropriately.
• Give tetanus immunization or booster if more than ten years have passed
since immunization.
6.4 SOP for Use of Personal Protective Equipment
MINISTRY OF HEALTH
OCCUPTATIONAL
HEALTH AND SAFETY
Standard Operating
Procedures for use of
Personal Protective
Equipment for Waste
Handlers
SOP/MOH/HCWM-6/004
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
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Scope
All health care waste handlers within the facility and will include waste collectors
and plant/equipment operators
Purpose
To ensure that all the people involved in health care waste are protected against
occupational diseases and accidents.
Responsibilities
a) The Hospital Management shall ensure that the appropriate PPE are
provided for all workers in health care waste stream.
b) All waste handlers shall wear appropriate PPE while on duty.
Materials and Equipment
Surgical gloves, heavy duty gloves, protective boots, apron, overalls, goggles,
helmet, mouth mask and nose mask
Hazards and Safety Concerns
• Exposure to infectious waste can lead to HIV/AIDS, Hepatitis B & C,
tuberculosis, tetanus, Ebola, viral hemorrhagic fevers, etc.
• Physical injuries from sharps
Procedures
i. Putting on of PPE (Gown/Apron).
• Fully cover torso from neck to knees, arms to end of wrists, and wrap around
the back.
• Fasten behind neck and waist.
ii. Mask or Respirator
• Secure ties or elastic bands at middle of head and neck.
• Fit flexible band to Nose Bridge.
• Fit snug to face and below chin.
• Fit-check respirator.
iii. Goggles or Face Shield
▪ Place over face and eyes and adjust to fit.
iv. Gloves
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▪ Extend to cover wrist of isolation gown.
v. Removal of PPE
Gloves
▪ Outside of gloves is contaminated!
• Grasp outside of glove with opposite gloved hand; peel off.
• Hold removed glove in gloved hand.
• Slide fingers of ungloved hand under remaining glove at wrist.
• Peel glove off over first glove.
• Discard gloves in waste container.
Goggles or Face Shield
• Outside of goggles or face shield is contaminated!
• To remove, handle by head band or earpieces.
• Place in designated receptacle for reprocessing or in waste container.
Gown/Apron
• Gown front and sleeves are contaminated!
• Unfasten ties.
• Pull away from neck and shoulders, touching inside of gown only.
• Turn gown inside out.
• Fold or roll into a bundle and discard.
Mask
• Front of mask/respirator is contaminated — DO NOT TOUCH!
• Grasp bottom, then top ties or elastics and remove.
• Discard in waste container.
Hand Hygiene
Putting on PPE
• Wash hands.
• Dry hands adequately.
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• Put on PPE in this order - Gloves, Mask, Goggles/Face mask, Headgear/Helmet,
Overall, Boots and Apron.
Removal of PPE
• Remove as follows - Apron, Headgear/helmet, Goggles/face mask, Boots, Overall,
Mask (Mouth, nose) and Gloves.
• Wash hands.
6.5 SOP for Training of Staff to protect them from Hazards associated with
handling Chemicals
MINISTRY OF HEALTH
OCCUPTATIONAL
HEALTH AND SAFETY
Standard Operating
Procedures for Training
Staff in Managing
Chemicals
SOP/MOH/HCWM-6/005
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope. This SOP provides guidance on minimal training requirements for health
workers at risk of exposure to chemicals.
Purpose. To put in place a framework that ensures adequate capacity building
among health workers at risk of being exposed to chemicals with the objective of
protecting their health.
Roles and responsibilities
Supervisors and Principal Investigators
• Must provide employees with information and training regarding the
physical and health hazards of the chemicals in the work area before
assigning employees to work with hazardous chemicals.
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• Employees must be provided with hazard notification and precautionary
measures to avoid or minimize the potential for risk of exposure.
Health workers and other employees
• Employees must undertake training or refresher training prior to engaging in
a non-routine task.
Risks and hazards
Heavy metals cause neurological complications and birth defects; chemicals cause
skin and lung irritation; radio-active material is genotoxic while polyvinyl chloride
is carcinogenic.
Materials and equipment
Training program covering the following areas.
• Signs and symptoms related to the exposures to hazardous chemicals used in
the work area.
• Methods that may be used to detect the presence or release of a hazardous
chemical. This could include industrial hygiene monitoring, the use of
continuous monitoring devices, visual appearance, or odours of chemicals.
• Specific procedures to protect employees such as safe work practices,
standard operating procedures (SOPs), emergency response procedures, and
use of personal protective equipment.
• Details of manufacturer labels, SDSs and workplace labelling system, and
how that information can be used to assure safe handling and storage; and
• Procedure for addressing non-routine tasks involving hazardous chemicals.
Items for use during practical sessions
• Small samples of chemicals for use in learning about visual appearance and
odours of chemicals.
• SOPs on use of PPE.
• Samples of manufacturer’s labels, SDSs.
• Samples of workplace labelling system.
• Samples of devices used for continuous monitoring.
Procedures
General and Department-specific; Employees must complete.
i. Iinitial hazard communication training as part of staff induction.
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ii. Refresher training is required every two (2) years within the department or
by retaking an e-learning course.
iii. In addition, employees must be trained on the specific hazards of the
chemicals used in their department on an annual basis.
iv. Refresher training is required whenever a new chemical hazard is introduced
into the workplace or a new or updated SDS is received.
Documentation and Record Retention
Training must be documented, and records must be retained for at least three years.
The Illness & Injury Prevention Program or its equivalent should keep Training
Attendance Record for future reference.
6.6 SOP for Harmonized Risk Assessment
MINISTRY OF HEALTH
OCCUPTATIONAL
HEALTH AND SAFETY
Standard Operating
Procedures for Harmonized
Assessment of Chemicals for
Potential Risks
SOP/MOH/HCWM-6/006
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope: This SOP covers the purpose, roles and responsibilities of stakeholders,
required materials and equipment, hazard and safety concerns and procedures for
harmonized risk assessment.
Purpose: to provide guidance on programs and projects intending to use chemicals
and can evaluate the potential the threat poses.
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Roles and responsibilities
Managers: should make sure that no hazardous product is used, handled or stored
in a workplace unless the product carries a label, a safety data sheet and the worker
has received the training and information to carry out the work entrusted to him
safely.
Employees: should not handle or store any hazardous product unless the product
carries a label, a safety data sheet, and the worker has received the training and
information to carry out the work entrusted to him safely.
Materials and equipment
• Personal protective equipment.
• Threshold Limit Values (TLVs) for chemicals.
• Ceiling of Ceiling (C) is a maximum concentration of each chemical never to
be exceeded.
• Concise International Chemical Assessment Documents (CICADs) that
provide internationally accepted reviews on the effects on human health and
the environment of chemicals or combinations of chemicals (check
htpps://who.int/ipcs/publications/cicad/cicads-alphabetical order)
• Safety Data Sheet (SDS) (formerly MSDSs or Material Safety Data Sheets).
Hazards and safety concerns
There is concern that exposure to chemicals through skin, inhalation, injection and
ingestion will lead to the following.
• Chemical burns or skin/eye irritation.
• Causing chronic organ damage over time.
• Causing an allergic reaction; and
• Causing genetic or reproductive harm.
In addition, the chemicals can cause
• Fire and/or smoke.
• Explosion or violent reaction.
• Corrosion to equipment or facilities.
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Procedures
i. Identification of health and physical hazards associated with the material or
procedures and the ramifications of that exposure.
ii. Estimating the probable exposure by
iii. Considering the quantity and form of material.
iv. Determining the distribution and degree of exposure, personnel exposed.
v. Determining stability, compatibility, and storage issues.
vi. Assessing the availability and use of various controls, including PPE,
engineering controls and administrative controls.
vii. Reviewing regulatory issues such as waste or shipping issues, cleaning up
spills, contamination control.
viii. A systematic plan or work instruction should be generated for projects and
programs intending to use chemicals taking into consideration outcomes of
the above assessment.
ix. Evaluate any other alternatives that can be explored to mitigate risks.
Documentation
• SDS library containing an SDS sheet for every chemical in their inventory.
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CHAPTER 7: MANAGEMENT OF SPECIAL WASTE
This chapter gives guidance on the management of other wastes generated in the
health facility – Amalgam Waste, Radioactive Waste, Cytotoxic Waste, and other
sharps.
7.1 SOP for Management of Amalgam Waste
MINISTRY OF HEALTH
MANAGEMENT OF
SPECIAL WASTE
Standard Operating
Procedures for Management
of Dental Amalgam
SOP/MOH/HCWM-7/001
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
This procedure is applicable to all dental health-care workers and describes the process for
handling and disposing of amalgam waste.
Purpose
To effectively handle and dispose of amalgam waste safely
Terms & Definitions
• Amalgam—amalgam is an alloy of mercury with various metals used for dental fillings. It
commonly consists of mercury (50%), silver (~22-32%), tin (~14%), copper (~8%), and
other trace metals.
• Contact amalgam– amalgam that has been in contact with the patient e.g. extracted teeth
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with amalgam, amalgam captured during procedures in side traps, filters or screens.
Non-contact amalgam: (scrap): excess mix left over at the end of a dental procedure
Responsibilities
• The In-charge of Dental unit has the overall responsibility to ensure that the
requirements for appropriate handling, segregation and disposal of amalgam waste are
available.
• Develop appropriate procedures for cleanup/spills of amalgam.
• Dentists and Nurses: Segregate amalgam waste during amalgam placement or removal
procedures to designated container.
• Support staff: transport waste containers to designated area that is secure and lockable.
• Licensed Recycler: collects amalgam waste from designated storage area for recovery.
Materials and Equipment
• Airtight container.
• Segregation chart.
Labels: Amalgam for recycling.
Hazards and Safety Concerns
▪ All staff involved in the handling of amalgam waste must have training in spill
management and decontamination.
▪ Wear personal protection during clean-up: lab coat or gown to protect your clothes
from contamination and use nitril disposable gloves.
▪ If it's a large spill - also wear enclosed footwear and a mercury vapor respirator.
Always consult with the Hospital Biosafety Officer when handling any spillages
Procedures
a) Stock amalgam capsules in a variety of sizes to minimize the amount of amalgam
waste generated.
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b) Use high velocity evacuation, if appropriate with air/water spray, when carving,
finishing, polishing, or removing amalgam restorations.
c) Use personal protective equipment such as gloves, masks and protective eyewear
when handling it since amalgam waste may be mixed with body fluids, such as saliva
or other potentially infectious material.
d) Store amalgam waste in a covered plastic container labeled “Amalgam for Recycling”.
Consider keeping different types (e.g., contact, and non-contact) of amalgam wastes in
separate containers.
e) Transport containers to designated area that is secure and lockable.
f) Arrange for your registered recycler to collect your amalgam waste on a regular basis.
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7.2 SOP for Management of Cytotoxic Waste
MINISTRY OF HEALTH
MANAGEMENT OF
SPECIAL WASTE
Standard Operating
Procedures for
Managing Cytotoxic
Waste
SOP/MOH/HCWM-7/002
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
This procedure describes the process of handling and disposing of cytotoxic waste.
Purpose
To guide health care workers on safe handling, treatment, and disposal of cytotoxic
waste.
Terms & Definitions
CTC – Cancer Treatment Center.
Cytotoxic reconstitution team – a team of healthcare workers involved in the processing
of cytotoxic drugs from their original formulation into a product that is ready to
administer.
Cytotoxic spill kit - a specially assembled receptacle containing all the necessary
equipment and material required to handle a cytotoxic drug spillage
Responsibilities
• The In-charge of Oncology unit has the overall responsibility to ensure that the
requirements for handling cytotoxic drugs and waste are available for complete and
safe execution of the process.
• The HOD Pharmacy, HOD CTC, HOD Nursing and HOD Public Health have the
responsibilities to familiarize themselves with, implement oversight and review the
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SOP.
• The cytotoxic reconstitution team shall ensure safe handling, administration and
proper disposal of cytotoxic waste.
• The waste handlers have the responsibility for appropriate handling, collection and
disposal of the waste.
Materials and Equipment
1. PPE.
2. Cytotoxic spill kit.
3. Pedal-operated cytotoxic waste bin.
4. Purple liner bags.
5. Appropriate waste trolley.
6. Plastic purpose-made sharps containers
7. Emergency drugs and equipment.
Hazards and Safety Concerns
Exposure to potentially gene damaging chemicals and immune suppressing agents.
First Aid Measures
1. If the eyes are contaminated, immediately irrigate with water or saline eyewash for at
least 15-20 minutes. Seek medical advice immediately.
NOTE: If gloves are worn, these should be removed before irrigating the eyes as they
may be contaminated.
2. Remove contaminated clothing and place in cytotoxic waste disposal bag if to be
discarded. For clothing not to be discarded, wash separately in hot wash and repeat
wash.
3. If the drug has come into contact with the skin, shower with copious amounts of
water for 10-20 minutes, then with soap and rinse off with running water. The shower
must be cleaned thoroughly immediately after use.
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Large Spills
• Contain the chemotherapy involved in the spill by covering with an impermeable
plastic packed pad.
• Cordon off the area. If possible, close off the area by closing windows and doors.
• Turn off any fans which may spread the spill/aerosols.
• Obtain the Cytotoxic drug spillage kit.
• Move patients away from the area of the spill.
• Open the Cytotoxic spill kit.
• Identify Spill. Any spill should be identified with a warning sign so that other
people in the area will not be contaminated.
• Ensure the spill is covered with an impermeable packed pad before placing on any
protective clothing.
• Put on protective clothing in the following order
- Shoe covers (water-repellent).
- Disposable water-repellent long-sleeved gown.
- Mask.
- Non-sterile gloves (nitrile gloves).
Liquid Spills
• Cover the area immediately with thick absorbent pads, paper towels or paper
mats.
Powder Spills
• If there is a powder spill, cover with a wet wad of paper towels and manage as
liquid spill. Cover gently to avoid spread of powder.
Carpet Spills
• If there is a spill onto a carpeted area, wash area with soap and water and disinfect
with bleach. If bleach is required, use precept granules. If bleach is not required,
follow normal spill management process.
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Linen Spills
• Contaminated linen is to be double bagged in a specially marked linen bag
labelled “Cytotoxic” and kept separate from all other linen.
• Wash the soiled items twice using hot water and detergent and rinse well. It can
now be washed with other linen
Procedures
i. The staff involved in the chemotherapy preparation, administration and waste
handling shall don on the appropriate PPE which shall include:
• Overalls.
• Lint free disposable gowns.
• Head covering.
• Closed footwear.
• Nitrile powder free gloves.
• Safety glasses.
• Masks.
ii. Handling of patient waste
Patient body fluids, secretions, and excretions such as urine, feces, vomitus and the
contents of colostomy and urostomy bags may be disposed of in the normal sewerage
system.
Segregation and Storage
i. All cytotoxic waste shall be segregated at the point of generation in purple colour
coded liner bags.
ii. The chemotherapy reconstitution team shall ensure that waste is not more than ¾
full, sealed, labelled, and securely stored in a temporary storage area.
iii. All sharps shall also be segregated at the point of generation in appropriate sharps
containers.
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Treatment and Disposal
A. Onsite Treatment and Disposal
i. The cytotoxic waste shall be incinerated at 11000C.
ii. The bottom ash shall be disposed of in ash pit.
B. Offsite Treatment and Disposal
The facility shall use NEMA licensed waste transportation, treatment, and disposal
facilities for the management of cytotoxic waste
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7.3 SOP for Management of Radioactive Waste
MINISTRY OF HEALTH
MANAGEMENT OF
SPECIAL WASTE
Standard Operating
Procedures for Managing
Radioactive Waste
SOP/MOH/HCWM-7/003
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
This procedure shall apply to segregation, handling, treatment, and disposal of radioactive
waste.
Purpose
To guide health facilities to effectively manage radioactive waste.
Table 4: Common Radioactive Materials - Definition
Name of radioactive element
(synonym)
Common sources and uses
Cesium-137 (Cs-137, 137Cs) Commonly used in various medical
interventions such as medical radiation therapy
for treating cancer.
Cobalt-60 (Co-60, 60Co) Used in medical interventions such as cancer
radiotherapy
Nickel-63 (Ni-63, 63Ni) Used in electron capture devices for gas
chromatographs.
Hydrogen-3 (H-3, 3H, tritium) Medical diagnostics and sign illumination,
especially EXIT signs
Thorium (Th-232, 232Th)
Natural radionuclide used in some sources and
old gas mantles.
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Uranium (U-238, 238U, U-Nat,
EU(%), DU, yellowcake)
Uranyl nitrate (common in school
labs)
Natural radionuclide unless processed, used in
various applications, including old ceramic
glazing, sources, and counterweights.
Americium-241 (Am-241, 241Am) Used in smoke detectors and other sources,
including moisture density gauges.
Phosphorous-32 (P-32, 32P) Used in laboratory research.
Iodine-123 (I-123, 123I) Used in medical treatments.
Responsibilities
Head of Department (HOD) - Radiation Department
Develop a training program outlining how radioactive material should be
recognized.
Generate SOPs for managing radioactive material relevant to assigned job duties.
Develop an emergency plan for responding to radiation exposures.
Health facility Management
Procure radioactive materials that are recommended in the national guidelines
Put in place waste management and disposal procedures.
Provide appropriate PPE for the radiation department staff.
Radiation Department Staff
Follow guidelines and SOPs on handling radioactive material.
Segregate the waste in the recommended bins.
Materials and Equipment
A geiger counter for measuring ionizing radiation including absorbed dose
delivered by ionizing radiation and detect levels of radioactivity being emitted
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Hazards and Safety Concerns
Radioactive rays – Care must be taken by ensuring appropriate PPE is worn when
handling radioactive material.
Precautions
Avoid handling the material and do not disturb the container until preliminary
evaluation for level of radioactivity is completed. If not sure, treat suspect material
as if it is radioactive and limit the number of staff near immediate area of suspected
material.
If radioactive materials are inadvertently received, immediately contact the officer
in-charge.
If a potentially radioactive material is discovered, evacuate all persons from the
immediate area until further help or investigation has been completed
Procedures
Waste identification
▪ Visually inspect all incoming containers to determine if the contents are
potentially radioactive.
▪ Staff shall identify the party responsible for generating the waste.
▪ Look for markings, key words, or labels indicating “Radioactive.” Laboratory
mixtures or solutions containing uranium or thorium.
a. Determine the radioactive level
▪ Use the radiation detecting equipment such as Alpha Survey radiation meter
by following the directions contained in the manufacturer’s operation manual
to determine the radioactivity level.
b. Segregation
▪ Radioactive waste should be segregated in a yellow container labelled
radioactive waste, marked with a radioactive symbol.
c. Securing/packaging radioactive material
• Gently remove and place radioactive waste in secondary containment or in a
specifically staged area away from staff and traffic.
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• Package the radioactive waste in a sealed container, clearly marked
radioactive level, its half-life.
d. Storage
• Store the waste in a dark room, as recommended by the manufacturers.
• Sort the radioactive waste in accordance with its half-life.
• Restrict entry to the storage area.
• Maintain records of each waste in the storage room.
e. Transportation
• Radioactive waste must be transported after its half- life has been achieved.
• Licensed radioactive contractors should be used to transport the waste.
f. Disposal
• Radioactive materials require pre-approval for disposal from the Kenya
Nuclear Regulatory Authority.
• Facilities should have disposal contracts with the suppliers of the radioactive
materials.
• Keep records of all disposed waste for accountability.
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7.4 SOP for Chemical Waste Management
MINISTRY OF HEALTH
MANAGEMENT OF
SPECIAL WASTE
Standard Operating
Procedures for Managing
Chemical Waste
SOP/MOH/HCWM-7/004
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
This SOP provides information on classification of chemical waste, proper containerization
and labeling, storage, disposal, and special handling procedures for various chemical wastes
generated in health care facilities.
Purpose
To ensure safe management of chemical waste to protect health and the environment.
Responsibilities
Health care workers
▪ Ensure that chemical waste is segregated into a brown container and liner marked
with appropriate biohazard symbol for the class of the chemical. The waste should
also be labelled “chemical waste”.
Lab manager
▪ Ensure that appropriate and adequate chemical waste management practices are in
place and that all staff are trained and adhere to the procedures and policies provided.
▪ Should report any breaches in safe chemical waste handling practices that might harm
human health or the environment.
Laboratory workers
▪ Should determine and identify hazards in chemical waste by following accumulation
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guidelines for the various types of chemical waste.
Biosafety Program Officer
▪ Should provide guidance and training for laboratory workers on proper hazardous
chemical waste management.
▪ The team should establish systems to monitor compliance with the agreed-upon
chemical waste management procedures.
The department should conduct regular and routine audits of waste handling system.
Target Chemicals:
Chemicals that are commonly found in health care settings include:
Laboratory chemicals, cleaning products, ethidium bromide gels, ethidium bromide
contaminated waste (gloves, paper towels etc.), phenol/chloroform contaminated waste,
chemically contaminated sharps, mercury, mercury containing bulbs and thermometers, x-
ray film, oil, paint cans, aerosols, batteries, silica gel, pesticides and herbicides, flammable
and combustible liquids, 10 or 20 litre solvent cans, lead, asbestos, etc. but does not include
explosives, or materials containing or contaminated with polychlorinated bi-phenyls (PCBs).
Hazards and Safety Concerns
• Broken Glass Equipment (broken beakers, pipets, etc. that are waste) should be
promptly swept up and disposed of in rigid containers. When the container is full tape
it shut.
• Broken Thermometers (Mercury);
- Immediately clean up broken glass and spilled mercury from broken thermometers.
- Do not handle mercury by hand.
Enclose thermometer pieces in a sealed jar with a small amount of water over the mercury
and follow chemical waste packaging instructions for disposal.
Procedures
a) Chemical Waste Identification
• Label each container you package with its identity – Material Safety Data Sheet
(MSDS).
• Attach a properly completed Chemical Discard Tag on each waste container.
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a) Segregation
• Segregate the chemicals considering chemical compatibility when packaging.
b) Storage
• Store chemicals in closed containers that will not leak.
• Store liquids separately from solids.
• If you have multiple containers of the same chemical, pack your chemicals in a strong
chemical waste receptacle.
c) Collection
• Chemical waste must be collected by specialized chemical waste collectors.
• Collectors must be licensed, and they should know how to request for the collection of
chemical /hazardous waste.
d) Disposal
• Always refer to MSDS when disposing chemicals for guidance on the best method of
disposal.
• Small amounts of pharmaceutical waste may be incinerated with the other wastes.
Disposal of chemical waste and contaminated items into receptacles for trash and/or
discharge of contaminated wastewater into municipal sewer must at all times be done after
pre-treatment of chemical waste
105
7.5 SOP for Mercury Spillage Clean-up
MINISTRY OF HEALTH
MANAGEMENT OF
SPECIAL WASTE
Standard Operating
Procedures for Cleaning
up Mercury Spillages
SOP/MOH/HCWM-7/005
Version :00
Review date
DIVISION OF
ENVIRONMENTAL HEALTH
AND SANITATION
Scope: This SOP provides information for managing small mercury spills.
Purpose
To ensure safe management of mercury spillages to protect health and environment.
Responsibilities
Health care workers
▪ Ensure that all Mercury waste in general is segregated into a brown container and
liner marked with biohazard symbol labelled “Chemical Waste”.
Ward manager
▪ Ensure that appropriate and adequate mercury waste management practices are in place
and that all staff are trained and adhere to the procedures and policies provided.
▪ To report any breaches in safe chemical waste handling practices that might harm
human health or the environment.
Facility workers
▪ To determine and identify hazards in mercury waste by following accumulation
guideline of Mercury waste.
Occupational Safety and Health Officers
▪ They should provide guidance and training for health workers on proper hazardous
106
chemical waste management including specific training in handling mercury spillages.
▪ The team should establish systems to monitor compliance with the agreed-upon
chemical waste management procedures.
The department should conduct regular and routine audits of waste handling system
Target Chemicals:
Significant releases of mercury to the environment result from the breakage of thermometers
and blood pressure monitors used in the health sector, and from the incineration of medical
waste contaminated with mercury. Health-care facilities may be responsible for as much as
5% of all mercury released in wastewater.
Dental amalgam is a potentially significant source of exposure since it can contain up to 50%
elemental mercury. It is released as vapour ions or fine particles and may be inhaled or
ingested.
Hazards and Safety Concerns
Elemental and methyl mercury are toxic to the central and peripheral nervous system. The
inhalation of mercury vapor can produce harmful effects on the nervous, digestive and
immune systems, lungs and kidneys, and may be fatal. The inorganic salts of mercury are
corrosive to the skin, eyes, and gastrointestinal tract, and may induce kidney toxicity if
ingested.
Acute inhalation of mercury vapour: chills, nausea, general malaise, tightness in the chest,
chest pains, dyspnoea, cough, stomatitis, gingivitis, salivation, and diarrhoea.
• Short exposure to high levels of mercury: severe respiratory irritation, digestive
disturbances, and marked renal damage.
• Chronic exposure to mercury: weakness, fatigue, anorexia, weight loss and
disturbance of gastrointestinal function.
Procedures
• Quickly determine the extent of the spill.
• Immediately block off foot traffic for a radius of about 2 metres around the spill.
• Contain the spill – use rags or impervious materials to prevent mercury balls from
spreading or falling into cracks or drains.
107
• Evacuate the immediate area – give priority to pregnant women and children.
• Minimize the spread of vapours to interior areas – close doors to interior areas, turn
off ventilation or air conditioning that circulates air to other areas.
• Reduce vapour concentration in the spill area if possible – open doors or windows
that lead to outside areas that are free of people.
• Prepare for clean-up by getting the mercury spill kit and removing your jewelry,
watch, mobile phone and other metallic items that could amalgamate with mercury;
cover eyeglass metal frames.
• Put on PPE – put on old clothes, apron or coveralls, shoe covers, rubber or nitrile
gloves, eye protection and respiratory protection.
• Use tweezers to remove broken glass.
• Place the wide mouth jar on the plastic tray.
Cleaning procedure:
Hard surfaces:
• First remove visible mercury balls and broken glass beginning from the outer
edge of the spill and moving towards the center of the spill.
• Use playing cards or pieces of plastic to slide mercury balls into the scoop then
into the jar over the tray to catch spillage.
• Use the eye dropper or syringe to capture small mercury beads.
• Search and remove tiny mercury droplets.
• Shine the flashlight at low angles to see reflections of tiny droplets; use sticky tape
to pick up tiny droplets and place the tape with the mercury in a sealable plastic
bag.
• Sprinkle sulfur powder, zinc or copper flakes on cracks, floor crevices and hard
surfaces that have come in contact with mercury.
• Use a brush to collect the powder or flakes and put them in a re-sealable bag.
• Wipe with vinegar-soaked and peroxide-soaked swab.
Clean up of carpets, rugs, etc:
• Remove contaminated soft material – use a knife to cut out contaminated carpets,
rugs, etc. and put in a re-sealable bag.
108
• Clean up of drains: carefully transfer any mercury in the J or S trap and transfer to
an air-tight container;
• replace the trap
• Dispose of decontaminated material in leak-proof, sealable plastic bags and
dispose as mercury waste.
• Label and seal all contaminated material.
• Wash hands and all exposed skin with soap and water.
• Ventilate the spill area.
• Place heaters and fans to volatilize residual mercury and to blow contaminated air
to the outside (if possible 48 hours).
• For facilities with central ventilation, increase air exchange rates for several days
• Conduct medical monitoring for staff or patients that were exposed to high levels
of mercury.
• Write a report on the spill incident and recommend improvements to prevent
future spills (in healthcare facilities).
What not to do during a mercury spillage
• Do NOT use a regular vacuum cleaner – it will spread more mercury vapours and will
contaminate the vacuum cleaner.
• Do NOT wash contaminated clothing or fabrics in a washing machine – it will
contaminate the machine and wastewater.
• Do NOT use a large broom to sweep mercury – it could break up mercury balls into
smaller droplets.
• Do NOT pour mercury down the drain – it will contaminate the plumbing system and
septic or sewage treatment system for years to come.
• Do NOT spread mercury with your shoes – use disposal shoe covers or decontaminate
shoes.
109
7.6 SOP for Replacing Mercury Containing Devices
MINISTRY OF HEALTH
MANAGEMENT OF
SPECIAL WASTE
Standard Operating
Procedures for Replacing
Mercury Containing Devices
SOP/MOH/HCWM-7/006
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope: This SOP provides information on procedures for replacing mercury
containing devices
Purpose: To provide guidance on procedures for eliminating mercury containing
devices from the health sector.
Responsibilities
National level managers at policy level
▪ Ensure that there is a road map for eliminating mercury from the health
sector.
▪ Identify facilities that can be used for temporary storage of mercury
containing devices.
▪ Ensure proper hand-over of mercury containing devices to the Ministry of
Environment and Forestry.
National level managers at program level
• Ensure that activity plans are developed, and budgets allocated to replace all
mercury containing devices.
110
• Conduct facility assessment to identify and quantify mercury containing items.
• Generate an inventory of what needs to be replaced.
• Order for mercury free devices to replace what is in use at the health facilities.
• Organize user training programs and ensure that all devices replacement
exercise is accompanied with training.
Facility workers
• Hand over mercury containing devices to assigned collectors once the devices
have been replaced with appropriate alternatives.
Facility supervisors
• They should provide guidance and training for health workers on how to use
new mercury free devices.
• The team should establish systems to monitor knowledge and skills on using
the new devices among county health staff.
• The department should conduct regular and routine compliance audits to
ensure elimination of mercury.
Target Chemicals:
• Significant releases of mercury to the environment result from the breakage of
thermometers and blood pressure monitors used in the health sector and from
the incineration of medical waste contaminated with mercury. The
thermometers tend to break releasing mercury into the environment. Health-
care facilities may be responsible for as much as 5% of all mercury released in
wastewater.
Elemental and methyl mercury are toxic to the central and peripheral nervous
system. The inhalation of mercury vapor can produce harmful effects on the
nervous, digestive, and immune systems, lungs and kidneys, and may be fatal.
The inorganic salts of mercury are corrosive to the skin, eyes and
gastrointestinal tract, and may induce kidney toxicity if ingested.
• Acute inhalation of mercury vapour: chills, nausea, general malaise,
tightness in the chest, chest pains, dyspnoea, cough, stomatitis, gingivitis,
salivation, and diarrhoea.
• Short exposure to high levels of mercury: severe respiratory irritation,
digestive disturbances and marked renal damage.
111
• Chronic exposure to mercury: weakness, fatigue, anorexia, weight loss and
disturbance of gastrointestinal function.
Procedures
i. Generate a roadmap for eliminating mercury containing devices from the
health sector.
ii. Conduct visits to health facilities and assess availability of mercury
containing devices.
iii. Quantify types of mercury containing devices by service delivery area and
generate a list of all items that need to be replaced.
iv. Procure mercury free devices that will replace what is being used at the
health facilities.
v. Retrieve and replace mercury containing devices and train health workers on
how to use the new mercury free devices.
vi. Monitor knowledge and skills of health workers in using the new mercury
free devices.
vii. Sub-county teams should monitor levels of compliance to ensure a mercury
free health sector.
7.7 SOP for Mapping Sites Contaminated with Chemical Waste
MINISTRY OF HEALTH
MANAGEMENT OF
SPECIAL WASTE
Standard Operating
Procedures for Mapping
Sites Contaminated with
Chemical Waste
SOP/MOH/HCWM-7/007
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
112
Scope: This SOP provides guidance on how sites contaminated with chemicals can
be identified and mapped.
Purpose: To provide criteria to be used in identifying sites contaminated with
chemicals and relate these to possible health effects.
Roles and responsibilities
MoH (Department of Environmental Health and Sanitation)
• Should, in collaboration with the Ministry of Environment and Forestry, map
sites contaminated with chemical waste.
• The MoH should monitor for potential health effects of chemicals among
populations working at or residing around the contaminated sites.
• Should collaborate with the Ministry of Environment and Forestry to
establish a system for capturing sites involved in some form of chemical
manufacturing or use.
• Should partner with NEMA to keep an inventory of sites licensed and/or
known to engage in the manufacturing, use and storage of chemicals.
Equipment/ materials
• Lists of sites known or suspected to be contaminated with chemicals.
• GPRS devices.
• PPE.
• Drilling equipment.
• Specimen bottles.
Hazards and concerns
Heavy metals cause neurological complications and birth defects; chemicals cause
skin and lung irritation; radio-active material are genotoxic; while polyvinyl
chloride is carcinogenic. The sites pose risks of exposure to hazardous chemicals. If
contaminated sites are not mapped, significant numbers of health effects may go
unnoticed.
Procedures
A. Use the following criteria to identify sites contaminated with chemical waste:
Identify site(s) where:
113
1. Pesticides and herbicides were manufactured or stored.
2. Fertilizers were stored.
3. Timber was treated.
4. Animals were dipped.
5. Petroleum, gas or coal products were produced, used, stored or sold.
6. Metals or minerals were mined.
7. Hazardous waste was dumped or landfilled (legally or illegally).
8. Asbestos is or was present.
9. Land is affected by discharges from other contaminated sites.
10. There is a scrap yard or site where recycling activities were carried out.
B. Site visits
• Make pre-visits to the sites to book staff that will participate in the mapping
exercise as key informants.
• Conduct field visits to map latitude and longitude using GPRS, interview
staff and communities around the locations about types of chemicals at the
site.
• Collect samples from the sites and analyze for chemical content.
• Generate a geographical map showing sites contaminated with chemicals by
type of chemical.
• Take history from communities and workers at the sites and examine them
for possible health effects of the chemicals.
• Keep an inventory of the sites.
• Keep monitoring for possible health effects of chemicals and provide advise
if toxic levels are detected.
C. Document findings and periodically update the records
• Generate a geographical map showing sites contaminated with chemicals by
type of contaminating chemical.
114
• Keep records of history taken from communities residing around
contaminated sites and information collected from workers engaged at the
premises. All examination findings should be documented.
• Keep an inventory of names of the affected sites.
• Keep track records of findings from monitoring activities paying attention to
possible health effects of chemicals.
• Document guidance given whenever toxic levels are detected.
7.8 SOP for Managing Diapers and Sanitary Towels
MINISTRY OF HEALTH
MANAGEMENT OF
SPECIAL WASTE
Standard Operating
Procedures for Managing
Diapers and Sanitary Towels
SOP/MOH/HCWM-7/008
Version :00
Review date
DIVISION OF
ENVIRONMENTAL
HEALTH AND
SANITATION
Scope
This SOP covers handling and disposal of diapers used for pediatrics, adults and
geriatric care.
Purpose
To provide guidance on management and disposal of used diapers and sanitary
towels.
Terms & Definitions
115
• Diapers – a type of underwear that allows one to defecate or urinate in a
discrete manner without the use of a toilet.
NO i/c– Nursing Officer in-charge
Responsibilities
a) Nurse in charge: Oversees the overall availability and appropriate use of
diapers.
b) Guardian: Ensures the appropriate use and disposal of diapers.
c) Nurse: Issues and ensures appropriate use and disposal of diapers.
d) Support staff: ties, labels, transports to the transfer station and replaces the
yellow liner bag.
e) Equipment operator (Incinerator /Macerator): Undertakes appropriate and
safe treatment and disposal of diapers
Materials and Equipment
• Diapers.
• PPE.
• Hand hygiene commodities.
• Transfer trolleys.
• Liner bags.
• Waste Bin
• Labels
• Segregation chart
• Incinerator
Hazards and Safety Concerns
▪ Clogged drainage systems, plumbing problems and high maintenance costs.
• Environmental degradation.
Procedures
1. Procurement department shall ensure the purchase of good quality diapers (as
per the specifications).
2. Donning a diaper
• Perform hand hygiene
• Wear disposable gloves
116
• Ensure sanitizer 70% alcohol , protective barrier cream and waste receptacle
are within arm’s reach
• Prepare the client
➢ Child lies on the back
➢ Adult lies on side.
• Unstrap the diaper
• Adult: Lift the upper leg place the diaper in-between the legs; spread the
diaper at the back. Turn the patient to lie on the back and strap the diaper.
• Child: lift the legs, place the diaper under and strap.
• Remove gloves and dispose in a yellow liner labelled Infectious Waste.
• Perform hand hygiene
3. Removal of diaper
• Perform hand hygiene
• Wear disposable gloves
• Unstrap the straps
• Remove the diaper from front to back to prevent infection.
• Wipe the patient front to back
• Roll up the diaper
• Dispose of in a yellow bin labelled “diapers”
• Remove gloves and dispose in yellow liner
• Perform hand hygiene
4. Segregation: Segregate the diapers in a yellow bin labelled infectious waste
5. Collection and transportation: Infectious waste must be collected daily form the
point of generation and taken to the waste treatment site.
6. Treatment and Disposal : Diaper and pads must be incinerated in high
temperatures of 11000C
Because most diapers are not recyclable and are difficult to biodegrade or compost,
awareness should be raised among hospital Diaper users to procure only bio-
degradable diapers.
117
7.9 SOP for Management of Special Sharps Waste
MINISTRY OF HEALTH
MANAGEMENT OF
SPECIAL WASTE
Standard Operating
Procedures for managing
Special Sharps Waste
SOP/MOH/HCWM-7/009
Version :00
Review date
DIVISION OF
ENVIRONMENTAL HEALTH
AND SANITATION
Scope
This procedure shall apply to the disposal of special sharps waste in health care
facilities to ensure safety of all health care workers and the community.
Purpose
To effectively handle and dispose of special waste safely in order to prevent
hazards associated with poor sharps waste management.
Terms & Definitions
Special sharps waste –These are sharps which cannot fit in to the standard sharps
safety box; for the purpose of this SOP special sharps will include trucut biopsy
needle, chest tube cannula, central line introducer and cord clumps
Responsibilities
o HOD Public Health: Has the overall responsibility to ensure that the
requirements for safe handling and disposal of special sharps waste are
available.
o Nurse in charge: Oversees the overall appropriate use and containment of
special sharps.
118
o All health care workers ensure segregation of special waste at the point of
generation.
o Waste Handlers: Seal and transport the safety box to the transfer station and
replace appropriate safety box
• Incinerator operator: Appropriate and safe treatment and disposal
Materials and Equipment
o Special Safety box
o PPE
o Hand hygiene commodities
• Waste transfer trolleys
Hazards and Safety Concerns
• Sharps injury
• Transmission of blood-borne infections
Procedures
• Purchase good quality safety box (as per the specifications).
• Dispose all the sharps at the point of generation in rigid, leak proof sharps
container labelled as biohazard waste with biohazard symbol and phrase.
• Wear appropriate PPE will always be worn when performing procedures
using these sharps.
• Ensure that the safety box is in the designated area with the correct label and
are three quarter full or once week whether even if not ¾ full shall be
disposed.
• Assemble a new safety box to replace the disposed one
• Transport sealed safety boxes to the temporary storage area awaiting
removal
• Incinerate the sharps at 11000Cand dispose the ash into the ash pit.
References 1. Gaia (Global Alliance for Incinerator Alternatives) website http://www.no-
burn.org/section.php?id=67
119
2. Global Healthcare Waste Project. Guidance on the microbiological challenge
testing of healthcare waste treatment autoclaves. New York (NY):
UNDP‒GEF; 2010. 9 p. Basel Action network website:
http://ban.org/library/medical_waste.html
3. Republic of Kenya, 2015. Guide for Training Health Workers in Health Care
waste Management. Ministry of Health.
4. Health Care Without Harm Asia. Best practices in health care waste
management-examples from four Philippine hospitals. Manila: Health Care
without Harm; 2007. 69 pp.
http://noharm.org/lib/downloads/waste/Best_Practices_Waste_Mgmt_Philip
pines.pdf
5. Injection Safety Policy and Guidelines, 2007.
6. Laboratory Safety, Waste Disposal and Chemical Analyses Methods, Storm
water Effects Handbook.
http://unix.eng.ua.edu/~rpitt/Publications/BooksandReports/Stormwater%20
Effects%20Handbook%20by%20%20Burton%20and%20Pitt%20book/appe.pd
7. Lallas, Peter L. “The Stockholm Convention on Persistent Organic
Pollutants.” The American Journal of International Law, vol. 95, no. 3, 2001, pp.
692–708. JSTOR, www.jstor.org/stable/2668517. Accessed 8 Nov. 2020.
8. Republic of Kenya, 2011. National Guidelines for Safe Management of Health
care Waste. Ministry of Health; Government Printers, Nairobi, Kenya.
9. Republic of Kenya, 2007. Occupational Health and Safety Guidelines.
Ministry of Labour and Social Services; Government Printers, Nairobi,
Kenya.
10. PATH, 2005. Guiding principles for managing medical waste. Seattle (WA):
P1. http://www.path.org/publications/files/TS_gps_mng_med_wst.pdf
120
11. PATH, 2010. Personal protective equipment and segregation supply
specifications for health care waste management. Seattle (WA): P 14.
http://www.path.org/publications/files/TS_ppe_specs.pdf
12. PATH, 2005. Training health workers in the management of sharps waste.
Seattle (WA): 108 p.
http://www.path.org/publications/files/TS_sharps_waste_training.pdf
13. WHO/ILO, 2007. Post-exposure prophylaxis to prevent HIV infection : joint
WHO/ILO guidelines on post-exposure prophylaxis (PEP).
14. Republic of Kenya, 2006. Legal notice No. 121, Environmental Management
and Coordination (Waste Management) Regulations, 2006. Kenya Gazette
supplement No 69. Government Printers, Nairobi, Kenya.
15. Republic of Kenya, 2012. National Guidelines on Safe Management and
Disposal of Asbestos. National Environment Management Authority
(NEMA).
16. SAICM, 2002. Strategy for strengthening the engagement of the health sector
in the implementation of the Strategic Approach to International Chemicals
Management. Minutes of the third session of International Conference for
Chemicals Management (ICCM 3) held in Nairobi, Kenya; 17–21 September
2012.
17. The International Regulation of Trans-boundary Traffic in Hazardous
Wastes: The 1989 Basel Convention. The International and Comparative Law
Quarterly Vol. 41, No. 3 (Jul., 1992), pp. 530-562 (33 pages) Published By:
Cambridge University Press.
18. Republic of Kenya, 2010. Guidelines for E-Waste Management in Kenya.
National Environment Management Authority. Ministry of Environment and
Mineral resources.
19. Republic of Kenya, 2016. Health Care Waste Management Standard
Operating Procedures (SOPs); 1st Edition. Ministry of Health.
121
20. The Republic of Kenya, 2016. National Guidelines for Safe Management of
Health Care Waste. Ministry of Health.
21. Republic of Kenya, 2017. Report on the Review of the Kenya National
Guidelines for Safe Management of Health Care Waste, Injection Safety and
Safe Disposal of Medical Waste National Communication Strategy and
Health Care Waste Management Standard Operating Procedures (SOPs).
Ministry of Environment and Natural Resources and Ministry of Health.
22. The World Bank, 2016. The Cost of Air Pollution; Strengthening the
Economic Case for Action. International Bank for Reconstruction and
Development.
23. World Health Organization, United Nations Environment Program and
United Nations Development Program. Guidance documents on establishing
a waste management program. United Nations Development
Programme‒Global Environment Facility (UNDP‒GEF), Global Healthcare
Waste Project. Core competencies related to health care waste management.
New York (NY): UNDP‒GEF; 21 p.
http://gefmedwaste.org/downloads/Core%20Competencies%20Related%20to
%20HCWM%20September%202009%20UNDP%20GEF%20Project.pdfU.S.
25. United Nations Development Programme‒Global Environment Facility
(UNDP‒GEF), Global Healthcare Waste Project. Guidance on the
microbiological challenge testing of healthcare waste treatment autoclaves.
New York (NY): UNDP‒GEF; 2010. 9 p.
http://gefmedwaste.org/downloads/Guidance%20on%20Microbiological%20
Challenge%20Testing%20for%20Medical%20Waste%20Autoclaves-
%20November%202010.pdf
26. United Nations Development Programme‒Global Environment Facility
(UNDP‒GEF),
122
27. United Nations Environment Programme (UNEP). Compendium of
technologies for treatment/destruction of healthcare waste. Osaka: UNEP;
2012. 226
.http://www.unep.org/ietc/Portals/136/News/Publication%20of%20Healthcar
e%20Waste%20compendium%20of%20technologies/Compendium_Technolo
gies_for_Treatment_Destruction_of_Healthcare_Waste_2012.pdf
28. United Nations, 2017. Guidance on Calculation of action Plan Costs for
Persistent Organic Pollutants under the Stockholm Convention.
29. Waddell, Dave. Laboratory Waste Management Guide, Final Report.Seattle,
WA: Local Hazardous Waste Management Program in King County,
2005.http://www.labwasteguide.org
30. Waste Disposal Guide. Environmental Health & Safety (EHS)/Office of
Radiation, Chemical & Biological Safety(ORCBS). Michigan State University.
2009.
http://www.ehs.msu.edu/waste/programs_guidelines/WasteGuide/wg_02toc
.htm
31. Republic of Kenya, 2003. Waste Management Guidelines, 2003. NEMA.
32. World Health Organization [Internet]. Injection safety, fact sheet Available
from: http://www.who.int/mediacentre/factsheets/fs231/en/
33. World Health Organization, 2007. WHO core principles for achieving safe
and sustainable management of health-care waste.These core principles were
developed during the International Health Care Waste meeting hosted by
WHO in Geneva on June 20 - 22, 2007
34. World Health Organization, 1999. Guidelines for safe disposal of unwanted
pharmaceuticals in and after emergencies. Geneva: 31 pp.
http://www.who.int/water_sanitation_health/medicalwaste/unwantpharm.pdf
123
35. World Health Organization, 2007. Core principles for achieving safe and sustainable
management of health-care waste. Geneva: 2 p.
http://www.who.int/water_sanitation_health/medicalwaste/hcwprinciples.pdf
-
124
Annex 1: HCWM Facility Plan Template
Name of The Hospital ________________________________________
County _______________________________________________________
Period of the HCWM Plan______________________________________
Staffing Plan
A– 1 Roles and Responsibilities
Cadre Roles and Responsibilities
Medical Superintendent:
Nursing Officer In-Charge:
Health Care Workers (Doctors and Clinicians and
Nurses)
Public health officer:
Maintenance Officer:
Hospital Administrator:
IPC Committee
Incinerator operator:
Waste Handlers
A-2 Staff List
Designation Number
Consultants doctors/MOH
Nurses
Laboratory staff
Patient attendants
Waste handlers
Incinerator Operators
Clinicians
HAO
Store keepers
Telephone operators
Drivers
Records officers
Personnel officers
125
Pharmacist
Plaster technicians
Physiotherapist
OT
Nutritionist
Bio-medical engineers
Social workers
Public health officers
Total
B. Quantifying Healthcare Waste
Type
Quantity per week(in kg/no of
SB/bin liners)
Non-infectious waste/General Waste
Infectious waste
Highly infectious waste
Sharps waste
HCWM handling practices
Concept Practice
Segregation/separation into
different colored waste bins
Infectious:
Anatomical/Highly infectious:
Sharps:
General:
Food:
Storage of waste awaiting
disposal
Safety boxes:
Infectious waste:
Highly infectious/Anatomical:
General waste:
126
C-1 Guidelines for Bin Placement
Ward/Department Black Yellow Red
TOTAL
D. Treatment and Disposal Procedures
Category of Waste Treatment Method Disposal Method
Sharps
Highly Infectious/
Anatomical Waste
Infectious Waste
General Waste
Food Waste
127
E. Schedule for Treatment and Disposal of Waste
Day Incineration
Burn Burying
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Note: Anatomical waste is disposed of immediately after generation into protected pits, Safety
boxes are collected when ¾ full, Food waste is collected after every meal time.
G. List the proposed improvements the hospital needs to work on HCWM/ Occupational PEP
Systems in order of priority.
1.
2.
3.
4.
G. HCWM supplies and Operational Costs:
Supplies Annual Quantity Cost per Unit Total Cost (Kshs.)
Safety boxes
Color coded bins
Color coded bin liner bags
Heavy duty rubber gloves
Heavy duty leather gloves
Goggles
Helmet
128
Apron
Heavy duty boots
Respirators
Hand broom
Waste Transfer Trolleys
Shovel
Ash rake
Equipments maintenance
costs
Fuel for incinerator
(Quarterly)
TOTALS
H. Training and capacity building on HCWM through CME’s.
Cadre of Staff Frequency Mode ( departmental/hospital
CME’s)
Waste handlers
Incinerator operators
Health Care Providers
PEP Providers
I. Monitoring Schedule
Cadre of Staff Supervisor Frequency
Waste handlers
Incinerator operators
Healthcare providers
129
J. Budget Allocation
Hospital budgetary allocation for HCWM per Quarter (3months?) List other potential
sources of funds?
1.
2.
K. Outline the key steps to be taken to operationalize the Facility HCWM Plan
L. Organization structure and reporting authority for HCWM in the facility
Annual Work Plan
NO
OBJECTIVE
ACTIVITY
DATE
RESPONSIBLE
RESOURCES
NEEDED
BUDGET
SOURCE OF
FUNDING
1
2
3
4
5
6
7
8
130
Annex 2: Facility audit checklist
FACILITY AUDIT CHECKLIST
Activities Response
Check Yes or No Remarks
Section A: Staff training and safety
Have all housekeepers/waste handlers of the facility attended training on
health care waste management? Yes No
Is the training housekeepers/waste handlers received on health care waste
management documented? Yes No
Is refresher training available for all housekeepers/waste handlers at least
once a year? Yes No
Are personnel training files available and up to date? Yes No
Do housekeepers and waste handlers understand how to correctly use
disinfectants to clean the facility? Yes No
Do housekeepers/waste handlers correctly understand the color-coded bins
for waste collection? Yes No
Do housekeepers/waste handlers know what to do if there is an accidental
spill? Yes No
Are there SOPs for handling spills? Yes No
Can housekeepers/waste handlers correctly explain how to handle
infectious waste? Yes No
Can housekeepers/waste handlers correctly explain how to handle sharps
waste? Yes No
Do housekeeping/waste handlers use proper PPE (gloves, waterproof
gown, and boots)? Yes No
Are PPEs in good condition and ready to use? Yes No
Are all housekeepers/waste handlers properly vaccinated? Yes No
Is there an injury and emergency response procedure available? Yes No
Do all housekeepers/waste handlers understand the injury and emergency
response procedure? Yes No
Do housekeepers or waste handlers know how to report accidents and
incidents when they occur? Yes No
Section B: Procedures and practices
Are responsibilities of housekeepers/waste handlers related to collecting
and handling waste clearly defined for each ward or department? Yes No
Are SOPs for collection and handling of wastes from the specified ward or
department clearly written? Yes No
Are copies of these SOPs available to housekeeping/waste handlers? Yes No
Is a waste collection schedule outlined, including a timetable for each
trolley route, the type of waste to be collected and number of wards to be
visited on one round clearly defined?
Yes No
Is this waste collection schedule posted and/or easily accessible to
housekeeping/waste handlers? Yes No
Section C: Segregation and transport
Are bins clean? Yes No
Are bins color-coded? Yes No
Are bins labeled and posters in place? Yes No
Do bins have correct color tags? Yes No
Is wasted segregated correctly? Yes No
Are there separate trolleys for infectious/hazardous waste and for
general/recyclable waste? Yes No
Do the waste collection trolleys allow segregation to be maintained? Yes No
Are compartments properly colored and/or labeled? Yes No
Do the trolley compartments have lids? Yes No
Are the trolleys clean? Yes No
Section D: Floor and other areas
Are floors clean and clear of waste? Yes No
Is there adequate number of waste containers? Yes No
Are signs posted to warn of wet floors? Yes No
Are the mats placed at building entryway cleaned regularly (if available)? Yes No
Are waste containers located where the waste is produced? Yes No
Are appropriate bins available for various waste types (infectious waste,
noninfectious, and sharps waste)? Yes No
Are waste containers emptied regularly? Yes No
Section E: Toilet and bathroom
Are toilets and bidets visibly clean without blood or body substances, scum,
dust, deposit and smears? Yes No
Are sinks visibly clean with no debris, stains and spillages? Yes No
Is waste removed/ emptied regularly? Yes No
Section E: Waste disposal
Are waste containers emptied daily? Yes No
Are there separated collection containers for sharps waste? Yes No
Are there separated collection containers for mercury waste? Yes No
Section F: Spill control
Are there SOPs for spill clean-up? Yes No
Is there a mercury spill clean-up kit? Yes No
Is a spill area surrounded by a barrier to prevent a spill from spreading? Yes No
Are all spills wiped up quickly? Yes No
Are procedures followed as indicated on the material safety data sheet? Yes No
Are used rags and absorbents disposed of promptly and according to
relevant SOPs? Yes No
Attachment 11.2: Service Delivery Point Waste Container Audit Form
Enter name of service delivery point (SDP): SDP: SDP: SDP:
Enter name/location of waste container (WC):
For each waste container, mark whether the answer is
Y=Yes, N=No, NA=Not applicable WC
:
WC
:
WC
:
WC
:
WC
:
WC
:
WC
:
WC
:
WC
:
WC
:
WC
:
WC
:
WC
:
WC
:
WC
:
1. Are there color-coded bins in black/yellow/red?
2. Are the bins labeled?
3. Are there matching color-coded bin liners?
4. Are waste segregation containers positioned near
the waste generation points?
5. Are waste segregation containers located away from
patients?
6. Is waste segregated adequately?
7. Do patient carts have designated containers for
collecting waste?
8. Are patient collection waste containers labeled and
devoted to each waste stream (sharps, infection,
noninfectious)?
9. Are sharps containers available in areas where
sharps are generated?
10. Is positioning of sharps containers within arm’s
reach?
11. Are there any HCWM posters or other BCC
materials posted in the facility/ward?
Annex 3: Diesel-fueled Incinerator; Incinerator Burn Log
Facility name
Incinerator’s name
Month / Year Model
Serial number
Day Amount of
diesel used
(liters)
Daily totals - Type and amount of waste (kg/box) Comments
Sharps
(kg or # of boxes)
Noninfectious waste
(kg or # of bags)
Infectious waste
(kg or # of bags)
Monthly total
Annex 4: Autoclave Operation Log
Autoclave Operation Log Document No:
Department
Autoclave make
Autoclave Model Number
Serial Number
Date
Waste
Type
Weight
( Kgs)
Heating
Phase
( mins)
Sterilization Phase Test strip from PCD Operators
Name Cycle
start
time
( h:min)
Cycle
end
time
( h: min)
Phase
duration
Temperat
ure ( 0 C)
Pressure (
PSI)
• There may be different cycles for liquid and solid wastes, or warm up or testing cycles that run at start of each day.
100
Annex 5: Autoclave testing and validation log
Test Report Template
Autoclave Tests after Installation
(Photo of the autoclave)
Manufacturer:
Type:
Content
1. General information on the autoclave
- Description of the process
2. In-house conditions
- Electricity supply
- Water quality tests ( Hardness, PH and conductivity)
- Structural and technical prerequisites of the building
3. Delivery check
4. Operation Qualification/Performance Checks
- Visual inspection
- Vacuum tests ( Bowie- Dick tests)
- Hollow Load tests
- Chemical tests
- Thermoelectric tests
5. Summary of results/ deviations and recommendations
6. Annexes.
101
1.1 General Information
Autoclave (manufacturer)
Location
Person responsible for overall
qualification
Other inspectors / technician:
Test date:
Type of machine:
Manufacturer: Serial Number:
Type: Year of manufacture:
1.2 Description of process cycles tested
Number Name Temperature
(°C)
Number of
evacuations
Holding time
(min)
In-house conditions
1.1 Water Quality Test
For process optimization, the use of fully de-mineralized or at least of softened water is
recommended. The following values are recommended as a guide if there is no information from the
manufacturer available:
Tap water:
1.1.1 Structural and Technical Prerequisites at the Operator’s Premises
Requirement Available/
ok
Not available/
not ok
Measures/Remarks
Door is labeled: authorized persons only
Test Requirement Water available Result
Conductivity <= 5 μS/cm
pH value 5 – 7
Total hardness <= 0,02 mmol CaO/l
102
Lightening available
Ventilation in servicing room
Condensate drain with trap
Electric connection available and correct
Water connection available
De-mineralized water available
Structural separation between clean side and
decontamination area
Enough space in decontamination area for
storage of waste
Facilities for hand washing and hand
disinfection (washbasin and wall dispenser)
2. Installation of the autoclave
Requirement OK Not OK Measures/Remarks
Position of the autoclave on level
Autoclave is installed more than 20 cm away from
the walls
3. Delivery check
3.1 Correct delivery
Installation qualification Documentation of scope of order and delivery
Scope of order Scope of delivery Damaged (2)
Article description
(1)
Article no. Quantity Quantity supplied Yes / No
Comment
Autoclave
Steam generator
Sterilization trays
Sterilization
basket
(1) Whether the articles ordered were supplied is documented
103
(2) Whether the articles show external damage is documented
3.2 Information provided from the manufacturer to the operator (Documents)
Requirement Available Not
available
Measures/Remarks
Type of products that can be disinfected
with the programs
Values defined for process parameters, e.g.,
time, temperature, water quantity, water,
pressure
Installation plan
Wiring diagrams
Description of specified standard programs
and of deviations permitted from the process
parameters
Maintenance and servicing intervals
Loading specifications for loading trolleys,
trays and inserts
Description of control and display
equipment
Description of settings for safety devices
Procedure in the event of malfunctioning
(trouble shooting)
Safety operation procedure
4. Operation qualification / Performance checklists
4.1 Visual Inspection
Requirement Set point Actual
State
Not applicable Measures/Remarks
Cold water inlet function, filling
capacity
Hot water inlet function, filling
capacity
Vacuum Pump function
104
Requirement Set point Actual
State
Not applicable Measures/Remarks
De-mineralized water inlet
function, filling capacity
Display screen function
Temperature reached and
process time in accordance to
manual
Temperature reached and
process time in accordance to
manual
Requirement
Emergency stop switch function
Door functional check / safety
Piping system tight
Door tight
Water level at steam generator /
waste heater functional
Filter check before circulation
pump suction (clean, airtight)
Connections’ functional check >
loading trolley connected to
supply
Air filter check (HEPA filter)
Unlock/open doors only at
process end
105
4.2 Temperature testing in the empty chamber – Program check
T1 T2 T3 T4
Testing diagram
FIGURE 1 TEMPERATURE PROGRESSION – EMPTY CHAMBER
Result
4.3 Waste to be treated – reference load
Check point Criterion Tick
(x)
Criterion Tick
(x)
Criterion Tick
(x)
Criterion Tick
(x)
Waste to be
processed
solid Liquid Solid and
liquid
Others
BSL I BSL II BSL III -
Waste that is
difficult to
clean
Hollow
devices:
e.g.
tubes,
spirals
Drilling
shafts /
compressed
air tubes
Optics
Hollow
devices/lumens
tubes
<1mm >= 3mm >=5mm >=10mm
Waste
containerization
Container Waste bag bulky Others
T1
T3
T2
T4 Feeding door
Temp
Logger
Autoclave chamber
106
4.4 Reference load:
Small load Full load
Packaging
Content
Picture
4.5 Specification of programs to be tested
Test Load (liquid / solid etc.) Name of Program Time (min) Temperature (oC)
1
2
3
4.5.1 Hollow-Load-Test (PCD)
Date
Result
Test passed Remarks
Yes No
Hollow-Load-Test Colour change
FIGURE 2 PHOTO DOCUMENTATION HOLLOW LOAD (PCD)
4.5.2 Thermometric – small load
Date
Thermoelectric Test 1: Small load solid ………………..for ……. min
Result
Test passed Remarks
Yes No
Temperature during
holding time (Sensor
4)
Biological Test
107
Result
FIGURE 3 PHOTO DOCUMENTATION SMALL LOAD (PCD)
4.5.3 Thermoelectric Test 4: liquid ………………. for …………… min
T1 T2 T3 T4
Result
Test passed Remarks
Yes No
Temperature during
holding time
Sensor 1
Sensor 2
Sensor 3
Sensor 4
Biological Test
FIGURE 4 TEMPERATURE PROGRESSION – 200, 300, 400 ML LIQUID TEST
Result
T1
T2
T3
T4
Feeding door
Temp
Logger
Autoclave chamber
108
4.6 Summary of results / deviation
No.
(1)
deviation Area of
deviation
Remarks / deviation Performance
outcome (2)
Infrastructure /
Delivery Check
Comment
1
2
3
4
5
6
7
8
9
10
(1) Enter the number of remark or deviation
(2) Specify: slight / moderate or severe
For following process cycles the compliance with requirements were checked:
Cycle
number
Description Test
temperature
Number
of
evacuatio
ns
Holding
time (min)
1
2
3
4
5
6
109
Annex 6: Health Effects of Chemicals
Hazards associated with ten most important chemicals
Chemical Health effects
1 Air
pollution
respiratory infections, cardiovascular diseases and lung cancer
2 Arsenic Arsenicosis - skin lesions, peripheral neuropathy,
gastrointestinal symptoms, diabetes, renal system effects,
cardiovascular diseases, and cancer
3 Absestos Lung cancer, mesothelioma
4 Benzene Cancer and aplastic anaemia
5 Cadmium Affects the kidney, the skeletal and the respiratory systems,
and is classified as a human carcinogen
6 Dioxins &
dioxin-like
substances
Immunotoxicity, developmental and neurodevelopmental
effects, and changes in thyroid and steroid hormones and
reproductive function. Developmental effects are the most
sensitive toxic endpoint making children, particularly breast-
fed infants, the population most at risk.
7 Inadequate
or excess
fluoride
Enamel and skeletal fluorosis following prolonged high
exposure
8 Lead Neurologic, hematologic, gastrointestinal, cardiovascular, and
renal systems. Children are particularly vulnerable to the
110
neurotoxic effects of lead, and even relatively low levels of
exposure can cause serious and, in some cases, irreversible
neurological damage
9 Mercury Poses a particular threat to the development of the child in
utero and early in life. Affects the nervous, digestive and
immune systems, and on lungs, kidneys, skin and eyes
10 Highly
hazardous
pesticides
Pose acute and chronic risk to children. self-poisoning (suicides
111
Annex 7: Stakeholders Consulted During the Document Review/Updating Exercise
NAMES DESIGNATION ORGANISATION
1 Dr. John Murima Medical Superintendent Rift Valley Provincial General
Hospital, Nakuru
2 Dr, Salma Swaleh County Director of Public
Health
Mombasa County
3 Ms. Rose Abuya Public Health Officer in-
charge of health care waste
management
Jaramogi Oginga Odinga Teaching
and Referral Hospital, Kisumu
4 Mr. Alphaxard kemboi Nursing Officer in-charge Rift Valley Provincial General
Hospital, Nakuru
5 Ms. Margaret Kuibita Public Health Officer in-
charge of Waste
Management
Nakuru County
6 Penninah Kamau Public Health Officer Mathare Hospital, Nairobi
7 Elly Nyambok County Public Health
Officer
Kisumu County
8 Mr. Joseph Kuria Infection Prevention and
Control Coordinator
Rift valley Provincial General
Hospital, Nakuru
9 Ms. Florence Basweti Public Health Officer in-
charge of Waste
Management
Rift Valley Provincial General
Hospital, Nakuru
10 Mr. Paul Masanga Sub-county Public Health
Officer
Nyando, Kisumu County
11 Anne Ndirangu Public Health Officer Rift Valley Provincial General
Hospital, Nakuru
112
12 Ezekiel Bowen Public Health Officer Naivasha County Hospital, Nakuru
County
13 Ms. Julia Saino Project Manager (UPOPs
Project)
Ministry of Environment and
Forestry
14 Mr. Francis kihumba Technical Adviser (UPOPs
Project)
Ministry of Environment and
Forestry
15 Gamaliel omondi Public Health Officer Ministry of Health, Nairobi
16 Mr. Bosco Lolem Public Health Officer Ministry of Health, Nairobi
17 Mr. Michael Mwania Public Health Officer Ministry of Health, Nairobi
18 Ms. Pauline Ngari Public Health Officer Ministry of Health, Nairobi
19 Mr. Muitungu Mwai Environment Officer National Environment
Management Authority, Nairobi,
Kenya
20 Mr. Washington Ayiemba Program Officer UNDP, Nairobi
21 Dr. Shem Pata County Director of Medical
Services
Mombasa County
22 Ms Jane Raburu County Nursing Officer Kisumu County
23 Mr. Baba Pojjoh Public Health Officer Changamwe Sub-county, Mombasa
24 Dr. Suhel Ibrahim Medical Superintendant Portreiz Hospital, Mombasa
25 Dr. Margaret Ochola Deputy Hospital
Administrator
Coast general hospital, Mombasa
26 Ms. Mwanasiti Abdalla Public Health Officer in-
charge of health care waste
management
Coast General Hospital, Mombasa
27 Mr. Saumu Ibrahim Public Health Officer in-
charge of health care waste
management
Likoni Sub-county Hospital,
Mombasa
113
28 Ms. Medina Wesonga Public Health Officer Coast General Hospital, Mombasa.
HEALTH CARE WASTE MANAGEMENT STANDARD OPERATING
PROCEDURES (SOPs), 2020
SECOND EDITION
THE MINISTRY OF HEALTH ACKNOWLEDGES THE FUNDING AND SUPPORT OF
UNDP/UPOPs PROJECT IN THE REVIEW AND UPDATING OF THE DOCUMENT.
114
MINISTRY OF HEALTH
AFYA HOUSE
P.O.BOX 30016-00100
NAIROBI, KENYA
