1、WHO Health Care Waste ManagementProtection of the Human Environment (PHE)Richard M. CarrWHO Health Care Waste ManagementProtection of the Human Environment (PHE)Content of Presentation Needs Assessment National Action Plans Relative Risks Technology OptionsWHO Health Care Waste ManagementProtection
2、of the Human Environment (PHE)Needs AssessmentWHY 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 PlanWHO Health Care Waste ManagementProtection of the Human
3、 Environment (PHE)Needs AssessmentHow? 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. As
4、sess current laws governing HCWMWHO Health Care Waste ManagementProtection of the Human Environment (PHE)Needs AssessmentTools/Resources WHO Rapid Assessment Tool (RAT) Aide-Memoire Safe health-care waste management Websites: www.healthcarewaste.org www.safeinjection.org Technical option database on
5、 websiteWHO Health Care Waste ManagementProtection of the Human Environment (PHE)National Action PlanSuccessful HCWM Strategies Include: National policy for safe HCWM Comprehensive system of HCWM Awareness and training Selection of options for HCWM WHO Health Care Waste ManagementProtection of the H
6、uman Environment (PHE)National Action PlanNational policy for safe HCWM Designate responsible authority Regulatory framework & guidelines Assessment of status & problems Overall waste management plan Monitoring & evaluation WHO Health Care Waste ManagementProtection of the Human Environment (PHE)Nat
7、ional Action PlanComprehensive 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 WHO Health Care Waste ManagementProtection of the Human Envir
8、onment (PHE)National Action PlanAwareness 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 WHO Health Care Waste Mana
9、gementProtection of the Human Environment (PHE)National Action PlanManagement Options for HCW Review available options for different size facilities and different settings Evaluate safety and environmental aspects Ensure workers safety Evaluate sustainability Assess acceptability Monitoring of safet
10、y and efficiency WHO Health Care Waste ManagementProtection of the Human Environment (PHE)Relative Health Risks Reuse of needles and syringes pose the greatest health risks to patients, staff and the community Risks to health-care workers and the community can still be significant even without reuse
11、 Burning HCW at low temperatures produces dioxins: persistent toxins which effect human health and the environment Burning HCW can release mercury and other heavy metalswhich effect human health and the environment Risks from dioxin and mercury due to burning HCW are unknownWHO Health Care Waste Man
12、agementProtection of the Human Environment (PHE)Risk:ReuseStaff &CommunityDioxinMercuryRelative Health RisksStrategies for reducing risk:AD syringes, Over-supply needles and syringes,Good management and disposal, Hepatitis B vaccination of staff and childrenSharps boxes, protective clothing, trainin
13、g, Community awareness programmes, good management and disposal Hepatitis B vaccination of staff and childrenNon-incineration disposal options, high temperatureIncineration, procurementWaste segregation, non-incineration disposal options,procurementWHO Health Care Waste ManagementProtection of the H
14、uman Environment (PHE)Managing Waste No one-size-fits-all solution Solutions do exist for many situations “non-availability” of technologies is often a “wrong problem” - or not a technical one Allocated resources ?Regulatory compliance ?Social acceptance ? Environmental concerns, pressure groups, Ky
15、oto, bans on burning in some countries “polluter pays” principle -WHO Health Care Waste ManagementProtection of the Human Environment (PHE)Technical Options for Managing WasteSafety boxes - first line of defense Bundled with vaccines Work well in vaccination campaigns and for some routine programme
16、needs Reusable plastic sharps boxes can be used for routine needs Disposable boxes require frequent re-supply Disposal requires burning or incineration limits optionsWHO Health Care Waste ManagementProtection of the Human Environment (PHE)Technical Options for Managing WasteNeedle Cutters and Destro
17、yers 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 electricityWHO Health Care Waste ManagementPr
18、otection of the Human Environment (PHE)Technical Options for Managing WasteBurning 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 optionWHO Health Care Wast
19、e ManagementProtection of the Human Environment (PHE)Technical Options for Managing WasteBurning High temperature Locally built brick incinerators e.g. “De Montford” Small factory built pre-fabricated steel incinerator Other industrial incineratorsWHO Health Care Waste ManagementProtection of the Hu
20、man Environment (PHE)Technical Options for Managing WasteBurning High temperature Appropriate for medium to large facilities better for less densely populated areas Reduce harmful emissions by high temperature incineration Complete combustion of all sharps Moderately expensive to build US$ 1500 5000
21、 May require fuel to operate Requires training to operate and maintain Requires waste segregation heavy metalsWHO Health Care Waste ManagementProtection of the Human Environment (PHE)Technical Options for Managing WasteBurning High temperature De MontfordLocally built brick IncineratorUS $1500Instal
22、ledWHO Health Care Waste ManagementProtection of the Human Environment (PHE)Technical Options for Managing WasteBurning High temperature After-burningAir inletFactory builtPrefabricated IncineratorUS $5000InstalledWHO Health Care Waste ManagementProtection of the Human Environment (PHE)Technical Opt
23、ions for Managing WasteSteam 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 metalsWHO Health Car
24、e Waste ManagementProtection of the Human Environment (PHE)Technical Options for Managing WasteWaste 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 tablesWHO
25、 Health Care Waste ManagementProtection of the Human Environment (PHE)Technical Options for Managing WasteWaste Burial PitWHO Health Care Waste ManagementProtection of the Human Environment (PHE)Technical Options for Managing WasteOther Options Encapsulation Melting ovens Professional recovery and r
26、ecyclingWHO Health Care Waste ManagementProtection of the Human Environment (PHE)Technical Options for Managing WasteWaste Minimization Reduce injection overuse New delivery systems Biodegradable syringes and needles Reduce packaging Eliminate use of toxic componentsWHO Health Care Waste ManagementProtection of the Human Environment (PHE)Conclusion Safe HCWM requires a comprehensive system Lack of resources can be overcome with creativity and the will tomanage HCW safely Technology is only part of the solution Raising staff and community awareness are keys to success
