WHO Health Care Waste Management

WHO Health Care Waste Management

Protection of the Human Environment (PHE)

Richard M. Carr



Content of Presentation

• Needs Assessment

• National Action Plans

• Relative Risks

• Technology Options



Needs Assessment

WHY Needed?

• Identifies health risks

• Describes current management practices

• Raises awareness

• Provides information on amounts and types of waste generated

• Supports development of a National Action Plan



Needs Assessment

How?

• Assess HCWM at representative facilities of all sizes and in typical settings

• Interview facility staff at all levels

• Interview staff from key government agencies, NGOs, and municipalities

• Evaluate curriculums at School of Public Health, MedicineNursing, etc.

• Assess current laws governing HCWM



Needs Assessment

Tools/Resources

• WHO Rapid Assessment Tool (RAT)

• Aide-Memoire Safe health-care waste management

• Websites: www.healthcarewaste.org www.safeinjection.org

• Technical option database on website



National Action Plan

Successful HCWM Strategies Include:

• National policy for safe HCWM

• Comprehensive system of HCWM

• Awareness and training

• Selection of options for HCWM




National policy for safe HCWM

• Designate responsible authority

• Regulatory framework & guidelines

• Assessment of status & problems

• Overall waste management plan

• Monitoring & evaluation




Comprehensive system for HCWM

• Assign waste management responsibilities to staff

• Allocate Resources

• Minimization of waste (procurement)

• Segregation of waste

• Safe collection, handling and storage

• Safe treatment and disposal




Awareness and Training

• Add waste management to the curricula for health-care personnel

• Develop national training package

• Develop train the trainers programmes

• Education on health risks

• Education on safe practices

• Increase community awareness




Management Options for HCW

• Review available options for different size facilities and

different settings

• Evaluate safety and environmental aspects

• Ensure worker’s safety

• Evaluate sustainability

• Assess acceptability

• Monitoring of safety and efficiency



Relative Health Risks

• Reuse of needles and syringes pose the greatest health risks

to patients, staff and the community

• Risks to health-care workers and the community can still be

significant even without reuse

• Burning HCW at low temperatures produces dioxins:

persistent toxins which effect human health and the environment

• Burning HCW can release mercury and other heavy metals

which effect human health and the environment

• Risks from dioxin and mercury due to burning HCW are unknown



Risk:

Reuse

Staff &

Community

Dioxin

Mercury

Relative Health RisksStrategies for reducing risk:AD syringes, Over-supply needles and syringes,Good management and disposal, Hepatitis B vaccination of staff and children

Sharps boxes, protective clothing, training, Community awareness programmes, good management and disposal Hepatitis B vaccination of staff and children

Non-incineration disposal options, high temperatureIncineration, procurement

Waste segregation, non-incineration disposal options,procurement



Managing Waste

• No one-size-fits-all solution

• Solutions do exist for many situations “non-availability” of technologies is often a “wrong problem” - or not a technical one

Allocated resources ?Regulatory compliance ?Social acceptance ?

• Environmental concerns, pressure groups, Kyoto, bans on burning in some countries

• “polluter pays” principle ---



Technical Options for Managing Waste

Safety boxes - first line of defense

• Bundled with vaccines

• Work well in vaccination campaigns and for some routine programme needs

• Reusable plastic sharps boxes can be used for routine needs

• Disposable boxes require frequent re-supply

• Disposal requires burning or incineration – limits options




Needle Cutters and Destroyers

• Reduce risks by removing the sharp before disposal

• Prevent reuse and community exposure

• Reduce most dangerous waste significantly

• Manual needle cutters may still pose health risks from splashing

• Expensive

• Needle destroyers very expensive and require electricity




Burning – Low temperature

• Open pit

• Brick enclosures and open brick incinerators

• “Drum” incinerators

• Low costs

• Create maximum pollution

• Incomplete combustion does not destroy all sharps

• Least desirable option




Burning – High temperature

• Locally built brick incinerators e.g. “De Montford”

• Small factory built pre-fabricated steel incinerator

• Other industrial incinerators





• Appropriate for medium to large facilities – better for less densely populated areas

• Reduce harmful emissions by high temperature incineration

• Complete combustion of all sharps

• Moderately expensive to build US$ 1500 – 5000

• May require fuel to operate

• Requires training to operate and maintain

• Requires waste segregation – heavy metals





De MontfordLocally built brick IncineratorUS $1500Installed





After-burning

Air inlet

Factory builtPrefabricated IncineratorUS $5000Installed




Steam Sterilizers e.g. “Hydroclave”

• Appropriate for medium to large facilities

• Essentially no emissions

• Good for densely populated areas

• Complete destruction of all sharps

• Expensive

• Requires training to operate and maintain

• Requires waste segregation – heavy metals




Waste Burial Pit

• Suitable for small clinics

• Easy to build, operate and maintain

• Requires space on-site

• Proper segregation of sharps can increase life

• May not be suitable for areas with high water tables




Waste Burial Pit




Other Options

• Encapsulation

• Melting ovens

• Professional recovery and recycling




Waste Minimization

• Reduce injection overuse

• New delivery systems

• Biodegradable syringes and needles

• Reduce packaging

• Eliminate use of toxic components



Conclusion

• Safe HCWM requires a comprehensive system

• Lack of resources can be overcome with creativity and the will to

manage HCW safely

• Technology is only part of the solution

• Raising staff and community awareness are keys to success

Documents

WHO Health Care Waste Management