Lavs Issues Lav 12. Tube 26-28. Planning future activities. Conclusions.
Health Care Waste Management in Ghana - World...
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E1 204 >I I I S'f1\ ' JS )1 I IK 1' . ''I'l I Health Care Waste Management in Ghana MOH Policy and Guidelines for Health Institutions Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized Public Disclosure Authorized
Transcript of Health Care Waste Management in Ghana - World...
E1 204
>I I I S'f1\ ' JS )1 I IK 1' . ''I'l I
Health Care Waste Management in Ghana
MOH Policy and Guidelines for Health Institutions
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PO Box I -1 -* Ac r;i (Gh.minPlbonic 233 21 660 693 r-;, 2;3 21 6(j,$(5;
Abbreviations 4 4.2.3 Colour Coding: 14
Glossary vi Table 2:Colour Coding for Storage and
Chapter 1: Introduction 1 4.2.4 Storage 16
1.1 The Nature of 4.2.5 Internal Storage 16
Problems (Impacts) of 4.2.6 External Storage 18
Health Care Waste. 1 4.2.7 General
1.2 Objectives of the Requirements for Waste
Policy and Guidelines 2 Collection Containers 19
1.3 The Policy and Legal 4.2.8 Standards for
Context 2 Disinfection of Reusable
1.3.1 Legal 3 Health Care Waste
Chapter 2: Scope Containers: 19
of Policy 5 4.2.9 Collection and
Chapter 3:Policy Transportation of Health
Statement 6 Care Wastes 20
Chapter 4 :Tecnical 4.2.10General Requirements for the Tr
Guidelines 9 4.2.1lRequirements for the Transporta
4.1 Classification of 4.3 Contracting with
Health Care Waste 9 Health Care Waste
4.2 Overview of Contractor 22
Implementation of Safe 4.4. Treatment Options
Health Care Waste for Various Waste Streams23
Handling and Disposal 4.5 Recommended
System 11 Equipment 24
4.2.1 Sfeps in Health Care 4.6 Waste Minimization25
Waste Management 11 4.7 Waste Water
4.2.2 Segregation and Treatment and Disposal 25
Containment of Waste 13 4.8 Spillage Procedures2 6
4.8.1 Procedure for 7.2 Dissemination
Handling Spillage of Strategy 40
Clinical Waste 27 7.3 Implementation
4.8.2 Spillage of Road Map 41
Chemicals 28 7.4 Responsibility for
4.10 Health and Safety29 Implementation 43
4.11 Record Keeping Chapter 8:
and Documentation 30 Monit
Chapter 5: oring and Review 45
Traini 8.1 Monitoring and
ng, Capacity Building and Control 45
Research 32 8.2 Audits 46
Chapter 6: Information, 8.2.1 Periodic
Education and Management Audit 46
Communication (IEC) and 8.Z2 Extemal Random Audit46
Advocacy 34 8.2.3. Audit Tool 47
6.1 Information, 8.3 Reviews 47
Education and Bibliography 48
Communication 34 APPENDIX 1: SAMPLE
6.2 Advocacy 34 FORM FOR ASSESSMENT
Chapter 7: OF WASTE GENERATION49
Imple Appendix 2: Clinical Waste
mentation 36 Audit Tools 50
7.1 General Principles of Appendix 3: Equipment
Implementation 36 Options and Initial Cost
7.1.1 At the Institutional Outlay 52
Level 37 Appendix 4: Relevant
7.1.2 Local Control of Infection
Arrangements 39 Policies and Other
7.1.3 At the National Guidance 53
Level 39
H e ALT H CAR E WA STE 'MAN AGE MEN T PO LI CY
Clients - Paticnms and their caregivers, visirors to the hcalth facititics
Etiologzc Agents: (.)rganismns or otlher- ageInts that causc .a rculai diseasc
Hazardous Waste: W`aste that can have a significant advcrsc fttcr on ub)lic
health and/or thc environment dILIc tO irs ( nfcctiouL1CS;, roxicity,
corrosiveness, carcinogenicity or otlhe properti:s.
Health Care XVaste: All untreated solid and licitiid vwaste (both lh;azardous and
n1on-hazardous) gciierated duting the administration of nmeclical carc,
vcterinmavy care or the perforenarncc of medical research involving humans
an(d animals. l lese include infectious, pa thotogical, radioactivc,
jl1aUnIacCItrica,l and otrier hazardous wVAStCeS.
Inzfectiouis Waste: \Vaste containinig pathogellic ovrjanismlls likc l)Wrcrla, VitusCe,
piara.sites and fungi in suUficient qLuMitULies to caRuse dliseasc ini susccptiblc
h1osts.
Pathogens: Disease causing agents
Pathological Waste: rissues, organs, bodly parts. f(mlescs, etc. rhat have the
potnt.ial to be infectious and are rhteretote soMenmLes classifieCd as a s1UbC'atCg0o-\
()f iniecCotLs LCS.
Sharps Container: P'uncture resistant waste conraiuner used for disposal of needlcs
and associatcd sr'n'ges.
Sharps: .\lI itemls ilhat pose a risk of injuiry and infecnion duc to thilitr, puncture and
cuting prolperties e.g. needles, scalpels, knives, glass s,ringes. piprtes and
similar items having a point or shar) e(lge or that arc i.kclv to break dullng
tranls,porranon and result in a pnintcd or sharp cdge.
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H EALT H CA RE WA ST E MA N AGE MIE NT FO LI C Y
HE ALT H CARE WASTE MA NAGEMENT PO LI CY
vhicih are incffectve. There is also no valid monitoring mechanism to verify
complpanicc tO ag-rced norms and practices. A survcy carned otu in 2001 to assesshealth care waste management in health facilities in Ghana showed that wastcmanagcment practices were below acceptalle standards and1 poscd nisks to staff andcounniLlities. Kycy findings of that survey ilclude:
o .\bscncc of a national po1icy ind guidelines and standard opcating
prloccdurct-so Different systerms in place for xvastc segregationo No colouir coding in place and wvasrc \v\erc not la,ibelled;o (;ontaincrs for wvastc were unaccepta)blc and not standardized.O \'chic]Ls for transporting waste wer-e inadcquate;o Storage sitcs for waste wVithiln tlc facilities wcre open, accessible to
unatrhorised persons and an.imals, brecdjng grounds for flies, rodents andother insecrs;
o l;inal dlisposal of waste was unacccptable; burying and open burning were tht
notll andc in somc cases infectious zwaste was dumped on peIn groundls.
lII orderl. to addr(eiss these shortfalls, rinc i\ltstr of I-lcaltli set ulp a wvorking grolup
madec ul of sakcholders in the sector, borih public and( private to devclop a policVand guidelincs for managing health care waste.
1.2 Objectives of the Policy and Guidelines
T he pohcLi seeks to enstire that lcalth care \waste is managcd effectvely in
compliance With existing laws and regulations and others to bl passed ini
future in order to protect hecaltlh care workers, thIc cLents (patients,
caleriv ers and visitOrs) and the environimecnt fromll potentially' diseasec-causing xvastc
m.-aetnals. "hc Gciidehi-ics provide standards, procedures and processes for liandling
he;ltth care waste in the sector istiLtutiOtils andc mechanuisms for perfoirnance and
per. fot)snriancc monitoning.
1.3 The Policy and Legal Context
WVI aste management in Ghana is a mul -secromal effort Vith the iaynistrg tfI .ocal Government and the l½ironmencal -IProtection Ayencr playing keyroles. l'his responsibili is discharged rhI thIro the District. Municipal and
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HE ALT H CARE WASTE MA NAG E M E N T PO LI CY
MeLropolipan \ssemb es which are directly un(ici' the Nltinistrv of 1,ocal Gx( CEImlmlt
antd the officeCS of thc Environmenital Pote otion .\ge T. [ het Ullll)at.' IrSpi Ibilit
for ctisuing that wvaste is disp ised of, howvever, lies with ilihe prson ol institunonhIIat gelner-atCs the waste iII 1rne With theC p)inlciple Otf 'tllc pollulter trays. Health care
i1stitutions arc therefore responsible for the wasle that is gel:neratetcd by thlirl activitics
and ;re req cCl d to take practical stelis to ensure tleir separaton. storagc, treatiir
and sia,frc disposal.
1.3. 1 Legal
T hlere is no specific law that addresscs rhe management of hlealth care waste InGhara at the mnomenit. fhc b)est provision sigghtCd is foLnld in thle National
Iiiildiing Regulations, 1996 1L1 1630 which stat-s in Section 145 (8) thal
hazardous refuise shall le handled sepaLately fioml donicstic rcfuse. l-Howcec,
V'arious laxws assign responsibillimes that imIinge pm n o waste maI-nage:ment to the-
District Assemblies and thie Envir-oinienital Protection Agency. l l-his situLation leaves
room for the performanice of the funCt.on tO fall rthroug0h the cracks There is thle
need for a speci6c law that addresses how lihalt1i c-arc wastC should be handlel in
ordel ro avoid any arnbitpiries, especiallv since tre laick of proper managcmernt ot
heilt:h care waste has grave conseq1uences to societV.
Some ol khle laws that have relevance to Health (Care \Waste Management include:
• 'lie Cmistitution o)f the Rcepub)lic of Ghana, 1992
lieC ItviMol-enrital ProLiction Agency Act, 1994 (\ct 490)
*• 1nviLonmrental AsscssmCIlt Rcgulalions. 1 999 (.I 1 652)
* Ti. Locil Governmnent Act, 1993 (Act 462)
National Building Regulations, 1')96 (J,I 1630)
* T-own ancl CounItty Planning Ordinanices, 1944 (Cap 84)
V Vaccination Ordinance Cap 76
* Quarantine Orcdnance Cap 77
N losquito Ordinance C:ap 75
* Infectious Disease Ordinance
F Food Rnd Drugs L-aw 3051) (1992)
Ioicuavies and Fiuncral Facilitics .\ct, l90)8 (Act. 563)
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HEALT H CARE w ASTE. MAN AGE ME NT P D LI C-Y
- h" .l(j C.rIrnil ( lode )i96(' (.c-t N!;
I'hc Constinirion of Ghana enshrines the human rights of the individual and
requires thc President to report to 1Parhlament at least oncc a year all thle steps taken
to ensure the realization of policy objectives contained in Chapter 6 and in particular,
the realization of basic human rights, a healthy economy, the Ligh)t to work, the light
to good h1ea]tlt care and tde right to education (Section 34(2)). Section 41 of the
Constituion lists certaini duties and responsibiites associarcd xvith the cxcrcise and
en'oyrmnen of rights and freedomns, am(ong wlich is the dut\ to protect and SafCguaid
t51e: envuilo`nm1erit.
Thc Criminal Code, 1960 (Act 29) 296(1) provides that whoever placcs or pcrmirs
to be placed, any car-non, filth, dirt, rcfise, or rubbish, or any offensive Or o(hlcrwisC
ur\Vholesomc iatter. on ,inv stieet. yard, cnclosure, or open spIce, CXCCept at suLtCh
places as may rhe set apart bv the local autlhority, or health officer for t1nai purposc
commits a pullishable ofEcnce. The colde went furtlher in section 297 (1), to statc
that vlhell an offence h.-s b)ecn conmiltted under section 296 (1) lbut tihe offeidcr hias
not becn identified or discovered, the fact of any carrion Or Other substancC
mentioned in that subcctCion beintg fotlund in front of any prcnises shall be pr1nmi
facic evidence of its having been placed thlere by rht occupier of the PICn1imses. By-
going to thinS cxtricm, the lawv sceks to enasure tha; tesidents take responsibitiry for
the strects in front of tlhemn as well as their prcliscs. Th'lere arc similar provis ionS In
the other lavs cited above. The National Building Regulations, 1996 (LI 1630)
stipulates in Section 145 (1) that a builiding for residential, commercial, industrial,
civic or cultural use shall have a facilin! for refuse disposal. It wlent furtlhcr to state
in Section 145 '2) a requirement that each dwelling unit shall lhave a standardiscd
dustb;ibn or other recepttacle approvedl by the District .\ssclmlbly in which all efus.,S
generated shall be stored tcmporanily. It provides for transfer stttions, lO bc located
witthin reacch and preferably protected from rain and the prevention of sprecading,
pest infcstation and scavenging acuvirics.
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H E ALT H CARE WAS T E MA N A GEM ENT PO LI C Y
T he t olllc\ and (Gtiinlciiles apphl pLirnaiilv to all hecalth insuori oms \wwlUrl.'d
public, private. quasi-t1(\ovcrnmental, non-governmineltll or- Larh-l ;i, I batolperarc in ItheC COunItr at aU levels: Tevvi/i'eacing/Speeialist I lstLI>.
Regiona] [-lospiltls, District H-lospitals and Sulbdistvnct Hcaltl InsUtLtiUiIs .1c I Centres /Clinics and ComnLtyilv CClinics. Health Researc-h Institti0n1s. I .alva (()iis
Akltcvnmaic Hlealth Care lProviclers, Niortuarics, Funeral -loines and Und(cerAlwrs.Phatinacics and Chemiist-S are also included. 'X"hilst refeencc n-iav le madc rt1gcneral domicstic \vastc genierated by dtese instiLuo01s, thCe fCLIS of hliC lPolt\ a1ldGuiCIClin1es is health care wasre that is consicdered hazardous. Intsutuntons andcomnlpanies with rcsponsiNility for trearm-tent, transport and disposal of w asrc an alsocxpccteCd ro farniljarizc ticlvlelVC5 withl the provisions of the Policy a,iul ( uikiulullSand nmi '; comply with thie,ml.
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H E A L T H C A RE WNASTE MANAGE MENT POLICY
A 11 vaste that meets the definitions of hazardous wvaste shall be considered assuclh and be treated in lnc wvith this polic) and otiher legal requircmenTs inforce at the tinc.
3.1 F:vcrn hcalth institutJon shiall have thi responsibility to serparate, store, labcl,trcat, transport and dispose of all waste in the manner prescilbed in this policy andother laws and regulations regard-ding Health Care \Vaste Management so as U)safeiŽuard the safety of its workers, clients and the environment.
3.2 All health institnions and their officers have a duLc' of care to:
* Storc wvaste correctly and prevent its spillagc or loss of anv kind;
* Segregate \vastes that reqtire different merhods of(disposal;
' I,al)cl waste to idcrufe ' its source an(d contents;
Pvass wvaste on only to pci-sons authorized to reccive IL,
Reccive W"aste only wvhen pproerly authorlsed to dlo so and only from anauthorised person;
• Describe the xvaste (on rhe appropriate fomis) in sufficient detail thaTsubsequent carriers and disosers can deal with it safely and are liable for an!ncgligenice on the part of rtie instiution or its officers.
3.3 Health institutions shall ensure thai ever) xvaste thcy generate and pass n ioa transporter or waste maniagemenit company to be transported to a disposal SitC orto lhe disposed of, is accompanied b) a signed statement ccrrifying that the waste hasbeen properly segregated, stored and treated in accordance With this policy andguidelines and no longer constiattes a hazard. ]n cases where thie institliflon lacksthe facilitv to trcat and thierefore hands in untreated waste, the certifcatc shallcisclosc this fact. fhere shall be affixed to every wvastc a label whlich indicates thieclassification, The processes it has gonic through ancl theJ initials of the officer(s) whoprocessed It.
H E A LT H CARE WAS T E MAN AGE MEN T PO LI CY
3.4 1 hc ap)propriate coloir coding anid maten-ial s,hall be ad(opted fCm ww;s:c
C 1tR1it1CIS )v! all h1calth ilStiiUtiOlS ill oLXdc2r to tacilitate idceoibficatioll of ilw( l (pwVas*e wsingl tile .)-CO)t.lt system. I ICatIl ( ate \\'AStC shall therefore b) scgl ciu;:d awfollo>\x's:
Classification of Waste Container Type /Colour
Nion-hazardous waste Black container
Othier infectious waste
]l1 liliinieeuuca8t.l &; ( tli:- (lk-T1roI ........... .........! \\.1>1ye h4i} .l
3.5 A llhealtl institutions shall recrLitr and tran hlealtlh care wvaste minana',;,cmer
officcrs anlld COSUC that thcCe are WCtell c(.lizpc(. to h1aIleC heaklh carc WvastI. I callth
care \Vastc maliagctimcnt tramlitig should b( incorlpoarted in both prc- andl in- st:txi:c<
training of hcaltl pcrtSormcl T1'his training nortwirlstacliing, whecre it is tL)rfC1tV )o
dCo so for reasons O cost. cfficicy, or othier reason the wvaste managenact ItMIcIIoM
mav be outsouirced to a 1U1V ceLtified wastc maaiagement. 1 cop11anv.
3.6 Accurate records on \vastc mniagetncint activitics shall be kept b\ :ll hicalrh
institutions an(ld waste m11a ,nagemCent cotnpaies. 'h1cse records shall bc miadc
available for inspection by the dcsignated a1uthJorities. Such recolds shlall be1
mainltained foc a minimnuma of fivc years after the disposal of the vastce.
3.7 Places of final disposal of treatcd wastc shall be identified and acquitied, wellici
Such acqutisitiOn iS necessaryS , In accordanc witlh cxisting legal regulations and shall
Le protected fromii unautioriscd cntLy, lesrs and scavengin g actiritics. 'lhe dtsposal
method used shall bc in linc with the approved methocl for each type of waste..
Every region/instituricon is responsible for drctmnininig tlhe disposal mlerhlod for I
particular waste, based oni thlc recotunmendations in Section 4.4 of the lcclnicalGuidelilnes (Cliapter 4) in thiis documnenit, whiichi spells ourt the apprc ved ald
pareferred disposal melthods.
HE ALT H .CARE WASTE MANAGE ME NT POL ICY
3.8 V herever pracricabkc, the disposal Site approved by tihe District, Municipal or
1\ leropolirln Assembly in consultation wVidt an officer of rite FEnvilronmelitial
Protection Agency for the disposal of waste shall havc a scCtion designated for hllcdisposal of treated healtlh care waste.
3.9 1'rovidedl the principle of treating and disposing of waste as close as possiblc
to the point of generation is observed, health insthittions in the satne vicinitV maV
share facilities in order to mirnimize costs.
8
HEALTH CARE WA STE' MANAGEMENT P O L I C Y
I npursuit of thle poLicies set oUt in the preceditng sections, tiie technuical
guidelints provided below shall apply.
4.1 Classification of Health Care Waste
IHcalrh care waste includes all untreated solid and liquid waStC (botih hazardous
and non-hazardous) generated during the administration of medical carc, or thc
performance of miedlical research involving humans and animals. flhse include
infectious, pathological, radioactive, pharmaccutical and othel 1IazltdoULs wastes.
Gcneralk-, bcttween 7 5-9 0% of the waste produced by healti-cire providers is
non-risk or "general" health-carc wvasic, comparable to dloilCstic wvaste. The
reIllaininllg( 10-25"9,) of health care wastc is regarceCI as haza'dIus. Thes
gLuidelinIes there-fore identify r%vo broad catcgorics of licalhti carie w<aste. Ihest:arc:
1. (lneral or non-hazardous waste not contaminaitlerd with ulooid, body
fluids, or otiher harmful agents or materials (also referrcd to as domlecstic
or muinicipal wastes) such as paper, falbrics, glass, food treSidUtS and
contaimcrs:
2. Wastes considered hazardous dut to tileir risk of creating a variety of
lhcalth risks as a result of theit actual or presumed biological, chiemical
and!/or radioactive contaruniauon. Due to their potentially hazardous
nature, these wastes require care from the poinit of generation utiul Final
dis posal.
'thc classification systern adopted is based on the point of generation, mtnthod of
Storage and thie treatmcnt options available, as showvn in 'fablc 1. rhese
categories are a geneval guide and are not meant to be all-inclusive and sp ecific
to all situations that may be encountered inl a health care facilit. Iherefore, as
questionable situations arise, each health care facility must decide if a partcular
device, material or substance slhould be regarded as hazardous \vaste, based on
9
HE A LTH CARE WA STE MA N-AGE M ENT PO LI CY
avai1ablc information and guidanacc from the District Assembly. Nlinisrtr of
-lcaltlh or Environmental Protecoion Agency.
Table 1: Classification of Health Care Waste in Ghana
TY- P1 - CLASSIFICATl iON ANDI) DES(RIPTION i CONTINi/EXAJNIMPLFS..(.,LNF.I'tAI !/NUiRMi"\l *\\:(I r, * -
blils rype of hIospnial xvkste is slrlll;r to dotileClic Vaste. It is inatevCith ncluding thiose
1001 hlrmnful except fo: ilhr Fact ihit it i> produrcvd within tie j from ) nts oigenertio.ll,
hositmal enrironflienr tnd rhciefore reqmives special h:lcdlivig. ki[chen waste, aids. a swi .st.
It Includes S\svectp1os frcnm Imtvns ot colidol'. offices I picces of wood crc
workshop. slovs, w;iste I rom, kitchts, eftcINFEGOUOW'S XAS1TE . . ...... ' Lthoraton waste een,r.cd
I Th1is refers to waste gCrie-jaccd I>v bohii lp-lirs/ol- e liv ntir<>logialplucitvi iaini a,n,as s luch I,t knowni or Ii kel s to Coiliain it, rictg,oll.
ptilogciu1c jijtcro-org-atisnis It incltidts matieral that caii lIe Po..*ItenjtIl\e Infctcdj Isljo<rI .111
dancrouis or iifectittiis it paticutis, he:ilth ca-c workeis and l..tns.n sod aiiold ti.-mc ;v.!
the pl.lbic. 11 the1rOQefTe icmiieS spccil iniaigcmcn borh H lVi
tosice aiinl outSiC tih lIospitl hpdiil II rs tO.llk disposed of.
This im,s tiftrihet I clans5fied oindc r tie iolluiwviig stu
: , 'S-i l.-\-RI'S \Cuc-i-~ - - - -, ; Ij - ; ;,-o - .
Tliese ai-e sha i-p-edgcd s\usics i -twin, pt ti.tic atid orr cutrting blades, ScAlpcis. ICs tibe.properiies that pose itsk on inuv and iisciInfection Tle- ar he 11POUIeS, glMss 111 1IC11i1on. ;
statned or contaminaited with blood or b)od\ fluids fiorn pipeties etc
tilciioiiiiYlil. -2~z1l sli: ,, ' -- - --.i ..¢5 - - -
P P I-EN1 W-ASrul S-.oe 0: ctI VlAlMI 1.
; These ltIC I v-ilC S , tiC lClAT [i)il t11 01 ori.it -pitiCril ;aC 0vtties ' s nitrnAI (C.g. S<i i ll(Cd LOt0
aid Inasv lhC co%itt a td tt <.1 ot i tied wtiThi I It sod or lindl.e flids ch-ol, ii i.edIron,i sutigiul 1 operatisfil' min l 10(tilnts otoiei tiai sha-.rps) i ages/Idretis, gloei.
IIetsni, blood transItsiot lm:pgs.urtine, faeces)
CULTURE/SPECIIMEN -- Cultre spcilllen tc .gClinlicatl spcIcImienl, Ilaborlory Ltlttitre avid littiati tjs>'le. cNpcl-ime.wni slicrimco
,l (animnals), tissuc eitilit-ic.I u nine, stnol)
'j nc. tfacces (stooli) trem| lallori'torl
E:etinsxetital specilnme
PATHOLOGICAL/ORGANIC HU!AN/ANIMAL I* nternal bod r ovgais
TISSUE rmptiir,ted 'itmbs, plactos
hiis rtpc of -stlst tnicloles -nsputatit-lns anid other bods- foertis
tiastics resluti(mg fiom norgita<l operitioslls as'icopsy (post- I-lhuman liutdx tstcC te- t.
ito it-emn), ii iir hir ib td rqtirIrcs special ttea(tmierit for etibical unlnle, Isoni. op iodrLf t
, ,i I AZ R IDIO I _
FtA-7A\RL)Ol S \\ -\Sll i IZtl<t - '''--lu-',lk.T:
t !-s1;I C I > i;i,i~ ,- -Il.Lt iili.il- i,n:-h ;-!..-!C 1 11'i)'.1(.11 .1110 !Sil , ,. , - 5 0
t I l.z., *ll * ITl: I< *10;!!1I]!r;! .:! : k.9t 1)..l(t.I I ,
H EA LT H CARE WAS YE MAN AGE MEN T PO LI CY
iTYp *CLAZ,SIFICA*TIONAN[ D) DES[-CTIrfoN (XONTFI'Nl /I A\AM1p ;:>
i L .'il}ll ei\lX t-- ,\r- -. '\ Ais l l-.-' -- '---
| . , I . , .R A ,,,I Ic(I '.i ' ,' I. , I\ \ I-!I * P 511.
1 I RADIOACTIVE WASTIE
U .AW)R I-' OR \%-
L d .1 '' I I
F) ALKAIA'-~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~I'tr~I
) I _ _ . I I: ... I .-- . i '
* ioI kI' Il4 I.A VY){ IF ()Y'A \.SI Mectic
*I:~ ro-c(in((llEl(l\X.i --- -i .IXrtQ1'! , ~Ih IAl.i....... :CI~~ll~ ' . r
V4 I.r\. 0 1 \INI?RII ORASHANTS -I)F;
)1(tth10"1Trl) t:eSlot , -i dtalto)c u
4.2 OvrviewK[ of IVImpe enaio(f;aeHelh aeSat
H andlosing WAnd Disosa System-
4.21 Overv iewonmlmntto fSf Health Care Waste Mngmn
Ihe -tages ini H.e'lth I are aste NI.anage'ent. (I (AVNI) 'rcproductoni/genraition of warc, segregation of che 1va.st fC a I'''.
; 9,,,,,,0 Iwo. .I jr y)lt
uecep)ta,c1cs (conta;inciisation), inrerna,l storagc (in the wardJs a,nd other
! 1til1,~~~~~~~~i
H EA LT H CARE WASTE MANAGE ME NT PO L ICY
departi,llents). pachaging/lahelling and iinternzal transportation to an cxNernalstorage site iL tiansit storage Sit e.g. an on-site central srorage point. \ll thbcseStai1es take placc %vihilifl the Facility and are follomvcl by transportationl ro atreaCOtineC 1 plant. (on ov off-sitc) and Final dlisposal.
T' Ie sla;ge>s in I l(.WVl arc sLimmarized in figurei 1. In cach instirurion, thc headof the flaciliy 11ust cnstic that ilhc steps arc folowvecl to cnsure adc(luateco'llccrl )I( an(d disposal of the health carc \vastes. 1;u:therinorc, inicroplannings1`10111d b)C C;liei'd olJt starting fromn The fcilit\ and suibdisirict lcvel to enstitrc therno( I cosi -ctd-Ccice e Incalls o)f coilecing,. tranispo)rtling, trcartiln. ;1nd(i final diS1posalOf tlie \vlSte.
Fig 1: Steps in Health Care Waste Management
- L~~ ___;.)
----- -- -1 -
1)e-ar rqn 't) in mind thie following considlecailolls:
1he nauruc of waste, level of to)xicit\ and risk to heal1Th-.* Legal - the prevailing rcgulatr 1s (on health and environincnt)
• J-;iiiancial - jinVestmeTt and runni)'ng costs, as again st The ftacilitv"'/distr ct's/rqugion's budget.Te lchical0 -technologies aalbeon flbe market and( eNisting options Intile sub-r-egion1.Paj1nT ) ,Ad /(]Uanti fltlv 0f \as\ e enerliares:d dalk
12
HE ALT H CARE WAS T E MAN AGE MEN T PO LI CY
*Susraiiabilitry - vicved alonysidC tlte ava lebil ly ne ctlugy sources al1d
OthCr utilities to run e 1 uipmLIlIcnlt.
IL.ocal comm unity' prcecrcnccS - whiljsi sorne C1mmuniIIItIeS 111mnV have anM
avrsinll for some treatmielit ONtiof-s available for sonw Lvl)cs of xvastc t-o
cultural, religious andl othier reasons; (e.g. usc 0i steaM aRutOCIaXrCS 0
incinerLtion, of body parts), others mav wclcorrc treartment options sol[:i
on the lbasis of tmchnological feasibility- and cnvirunrimnental friendicliniess.
l;or whiatcver reasons approved, trca tiuncnli itpii(ns alrc chiosci he ;a
loccality, health care institutions and waste inanatelieni companics siall
ensure ilthat safety and efficiency are not conlPrtomi1iscd.
4.2.2 Segregation and Containment of Waste
fhlec fco luliniig guidelines shall apply to waste scgregation and containment:
* acIh type of Waste reCCuieCs a (lifferent ietilhod of disposal. ThcrcfoeC. 1t
is iimiportant that health care waste is segregated ilro tile various sub-
cat,egories for safety reasons, to facitrarc ininulizaton and application of
the. dlifferent disposal niethiods, wvhich arc reqluillre for cdifferent tplics otr
waste lbased on the classificationrs in Tablc 1 - Appropriate halnd'iiwr
treatmncit and disposal of waste by SLl-CArC(1Dr\ wil l help to reduce cosis
as tihc typc of waste influences thc disp1osal mlllhod usCd, hlience disposal
costs. Non-segregarion of hic wvasre rendcrs all licalth care waste
ge:ncfared infectious or hazardous andc results ill I1ghWe1Cr m.anagemncrt cosrs.
Senegation shlould be at source; that is it slhould take placc as closc as
possible to thie point of guenration of tlh v waste and should always be thle
rcsponsibilitY of the waste produceI.
l1,ach waste stream segregated mnust be placed in ani appropriately coloulr-
coded container as shown in Table 2.
* l:or effcctive planning, each level ot the lhcalth systeCm shiould makc
cStimates of their o\Vti wastc p)roduction: this imIpliCs that chIC fciCl1imx
should estimate the waste it getierates. This includes all wastcs ,v,clcuated
cduring clnical care (itncludinlg surgery). routine IlIld Mass iMmuniz.ation.
'Ic cstirmates shlou` l be collared by thiC D1T-NTl in each cistrict to obtain
thic district wastc gencarctd and furtlier-, by thc RHN'IT to cstiimat
13
HE ALT H CARE W AST E M AN AGE ME N T PO LI CY
regional waste generation. Each region shoul(l then submit returns ontihcsc levcls quarterly to GHIS headquarters.
TFlhe teaching hospitals and GHS shoukl submit their returns to the 'N101H
or an appropliate bodv or department designated b\ the fMOH, which
should furthler collate the statistics into a composite estimate of the
national health care wa,ste.
A sample foriml foi assessmenit of waste generation is shown in Appendlid. 1 for
use bv health facilities and other Icvels of the health care svstcm.
4.2.3 Colour Coding:
Colour coding of waste containers and plasuLc bags should he used to facilitatc
efFicient segregationi of wvastcs.
'I'hc rcco (mmenlded colour-coding schemne for Ghana (adapted from \W1HO) is as
follows:
BLACK Gcnrcal \wastc (e.. kitchen waste remnants of food, p,apecr.
cardboard, sweepings etc)
YELLO\XW hnfectious waste (c.g. sharps, paticnt xvaste (e.g. s\\al)s. drcssin,gs
cic). humnan/animal tissue and cultures/specimens).
BROWN 1-lazAlr_dous \vasre (c.g. expired drugs, vaccines, chenmicals etc)
Table 2 shows the colour coding for the storage medium an d transportatioln ot
health care wvaste. (Colour coding for the plastic bags should always correspoind
or matclh with the waste contailers both at the internal and exterrnal storage sites.
14
:)ST1I.I. -P3,J 1PUL't Vtillq 3iE-\jo ZX1A1 11alO 1UdiG. q.]fU ~n~Z~ZUEU.lS,tl r -^l,ttsl 2t1tDfl lS' \30 (1,1 Dil glOj DIt'!l1OI1C[Ci1 aq; 3SntU- p31Stl S.1,i UIU 0)
,:)A0(IV ; IIcIt j ii p)PLAOidl SLIO1WtpL)U.1tUOD3I )Ij) 0)3 Vti;IP.IODDU -LIIU"JUOD
[)DTh)-.tl)l0, OUIn, p;)llDjxt'l A;)-lmTldo.;(idiU III p-D)99INDIA D(I p1noti,s.DSA J.i1'.D iDJ.LI nN.
-l'"I- Kr '; t\ cu tiI:) k *
------------------*t' ;' ...:. -!1..._.1:"'1-'-,.- .t. -I u - _-j.ii
.:W' '-" , ' j!' 1!I';' 1 - " i- _ I .'. . .. _ _. . . _ _ .
_ . - . . __._._ . _,___,,,,__ ..
!,~~~~~~~.o in:o :Z a l- - __ --
' :t,r- '~.r.~rr ) tI01 d N t 3 ' ' " 1' N, -I " M1 ','f V l: HI1
;~~~~~~~~~~~~~~~~~~~~I K , ,I:;S. i;1*1''I 1 Cl
_ _1. lI 11111l\ hil'l )tI' 1EJt >1)UI$Jlc ' *,r) jl'l' AtsiVKl;| " ' '-.)
W~~~~~~O '(> ti \RA JO117 UOr? 1USq )S'\uo ejosuj l7iltt E1 l3 *u a .ieso Lb -:upo Jnoj t
-~ ~ ~ ~~ AIo lNWDNA -. LSV ~~V3 H-- -- r----1VX ; i��- - -
H EA L TH CARE W AS tE MANAG EM ENT PO LI CY
Contaiiers musr be robust and resistant to corrosion. After use, they must be \Xell
scaled to preveni- spillage (lu ing handling and transportabon.
4.2.4 Storage
,Storaic is thc process entailing hovW the Waste is contained during the time lapse
bcr\\vcen its gcneration and collecoion for final disposal. 1his is classified intoIntcrnal Srorage and Extcrnal Storage. Consideraiion for sroragc inust be bastd
on the classiFication or hvie of waste being dealt wvithl and ihe potential risk )to
infcction to health-care workers and waste disposal staff. Labels otl containers
slhoukl6 be permanent and lcgiblc for the enutre storage period.
4.2.5 Internal Storage
Intet-ial storage is the temporar 'y placcniT of wastc at the pOint of generatio0n
(c.g. ward, OPD) beforc transfer to external storage points and should not
exceed 24 hours. Internal storagc considerations shiould be based oni flhe
cla;ssIfication or type of wvasre being dealt witih and the pornltial risk of infectimn
to health-care workers and \vasrc disposal staff. -he following measures shokuld
be talken to ensute safe management of \vaste at the points of gencration:
i. Storagc time sh,ll be reluced as munch as practicable. Mutiple daily
remcoval of the waste is recommendiecl:ii. I verv site xvithin the Health Care Facility e.g ward, thieatre, laboratory,
pliannacy, kitchen, laundry etc.) shiouid be provided with su ffIcien1t
number of suitable waste containers;iii. Polvthene bags must be placed in rigid containers with thie openin,g
foldig outwvard over the rim to mirli-mize contamination of thie
surrounding. hl-c top of the container should havc a wider diameter than
the blase,iv. Disposaable polytilcne hags sh,lIl be of appropriatc size wmth a minimum of
60 iTucrojns and maximum of 100 microns in thickness;
16
H r L Tr H c A R F w A S I E ANAGME t r P o I C
Vx Filled bags slhall b)e sealed o4l using a plastiy sturp whilich \xvhen f,lslencld
Can'otI be ti.-opened; tilhc l)gs shouldc be sealed whcni `i'4 full. To srvc ;is,t rcindCdc, tIC bags sloulUd have a mark showing thec mark.
vi Sharps shall bc stored ill pulcture-1esisSarI containers maJc of hllckcardboard, s5or ig plastic, pwvoocd or mnctal;
Vii Sharps shall not bc manpulatccd (c.g. by brheakling or bendihn) hbc(nqc
disposal and needilcs shall nor hc rI:ecappcd before discarding sinlCc rlths i ,1
Commron Causc Of punCture inllulr; rhe use oF devices likCl nfl( (citrerswvhich frecs rllt syrinte of tihe nedle by cdestroying and rm:nvo-viig [1wL
latter is a sate alternlative (still undeler consideraion for- usc: in develtopin)g.
Countries) may be considered an exceprionl to this rule.
viii. Puncturc Cesistant containrcs shall be placed as Close as posslble to rtharea where shaip itCms are usedl;
ix. Infectious andl haz;ardous wavastc shall he segrecgated at the poinl ot oni gil
rather than at rile Lanllsfel: O' Cx\teral StOra,ge Sitet ro facilirate apCrop i;ncpackaging, colour codirng and transportationl;
x. Storage bins shall be placed in roofed bulil[-in areas protected frf)mfl \watcr,rain, wind, aniRmals a Td pests such as rodents, cockroaches et atidscaenwe.nrig s; ; b
xi. Bino-hazar karks anld orther varning signs shall he
conspicuouslyV posted oni doors leadiing tO storae sui Ito ptc\ener people fr(oTm untnecessaarilv galninlg aCCess to the ac:
sii. Access (etllranlee) to sloraeg arca shall l)e securelv l(Ic(l xvilw
unattendecd;xiii. Storage areas slhall have sutieict spIace to afford eas accss nc inoa
of \vaste:xiv. 1-Icaltit care wvaste slhall be (ollected one waxy to external sv raige site
witlhoult returning to tile po;llt of generation: thus the neecl t(i sizahl
receptacles for effecting the transfer
xv . ITransfer of Waste lags funl' intcrnal to exicrilal storage sh,all l.)e Lb )ne wit
car( to prevClnt rupturinl, or opening of b)ags whicl caln cal ntam-l aim thenvirontnent;
xvi. \Vehicles carwlts etc) used for transporting waste from intcrnal t() et ernal
storage Sites shall be madie of a smooth surfacc material (e.g. plastic) forCeasy cleansi5ng and disinfcction
17
HE ALT H CARE WASTE MANAGE M E NT P OL ICY
xVii. ihc ConairnCrs u*sed for internal Sto-rage as wvell as thle storage sites shouldbe cleanied, disinfected and furnigated frequendy
4.2.6 External Storagelxternal storage refers to storage at the transit point xvherc waste is stored aftcrremoval from internal storage until it is collected and transportecd foir treatinenitand final disposal. The external storage is usually situated within the.J health) carc
facility, vhile treatment and/or disposal sites could be on-site or ouLtside thefaciliry. 1 'lic freluency of removal of waste stored dependcs on the volum-ne andnature of waste generated. The following measures should be taken to CnsurC
the safe cdisposal of tlle Waste;
lacilities for external storage slho<uld be remnoved from kcitclhen laundrv.\Vard etc bui be lxvitiin the priecilcts of the fFacility and shall b)e easilaccessible to collcction vehicles;
''liacilirv shlall be enclosed andl surrounded by an im\vlous uall ofappropriate heiglht and provided witlh a gate and lock;Th ihe walls and floors shall be smooth, wvithout cracks, im1periomls, easy tocleani and disinfct;. cleaning and dlisinfectioii rnmusi be carrled out a
frquelitlV as possible.~I lhe site shall be spacious and well ventilated and may'. for COst
c(tectivenessin managing wastes in small facilities, accept waste fromother HIealth Care Facilities if it has the capacitv to process the increased
olunme and the ty pe of waste.V. AII loading and unloading of waste shall take place, within thle designated
cozllection area around the storage poinit;vi. I .arger volume waste bins - 240 Litres and above - should be a\ailable at
tlhe external storage facility to receive wvaste containers from the intcrnal
storage points. Ihlese bins slhall be marked for ease of identification ofCoitelir and the markings must correspond xvitl the colour codce used forpolythene bags in internal storage;
I : llc'atIIT care \vaste shall not be compressed during collection;w\'astc bins shall be washed and disinfected after each collection and morefrequently if reC(uired.. aste water from the point of generation and srorage area mtust bedLrain2eCd ilnto sctic tanks and soakavays and must not be allowed to drain
1 into storm uVater drainage or streams; liquid \vastes mut be
18
H E A L T H CARE WA STE MAN A GrE MEN T PO LI CY
approp) ui;:tely trieated (e.g. disinfeetion, neutrralizai in.) prior lo Finaldisposal.
N I xierial s torage facilities nmLISt m1eeCt Ce:tLain kasic stand aidS fh clie typCof wasae stored e.g. refitgerarors for storng oirganic tissues o0lId bc
considerdcl and provcidcd in facilitics. This w%ill cnsiure ihar thetemert Irur: of body parrs wvill be sLIlh as to prevntcii furthier'
decomnjp()SL100 orn multiplication1 of pathogens; \v11re r trigeraiu )n is n()
availalec, these materials should bc disposed of W1ith0out dhY
xi. Bio-haxard marks and other warning signs shiall lbe Consp)ieLIOusly post(Cdon doors to prevent peopic fromtinecessarily gaining a(cees to tlhe area.
xii. Only autliorized persons shall have access to external storage areasiii Staff slhould be trained to undcrstand (ihe prilCiples of segrendtion ancl to
folloM pro)cedLiVes for colour coding, storage and dOCUnMwnMatioln.
xiv. Records on xvaste generated and processed includinpg the t\pe of wastc,
Voluncs and/or wveight, and the perso(ns xw'ho processcd thllCll at thc
v arious stagcs should be kept.
4.2.7 General Requirements for Waste Collection Containers
(Containetrs For waste collection shiould mcet tlle following reltiUCiCu-enIs
* 1i1,c\ '1 .i.itl l1,. n,,, mI';tnSpannrul.
I \ ll> lIl(l IheC iitIpIetviol)s to) llW8$tl .
* Tlhc 1 sh1ouldc be of sufficieilt strenigthl to prevenit d-m;a1Y1,ge dLuri: ng;: handlingo r LI, U
* iThev should be leak proof;Thev shiould have close fitting licis,
* ThleV shou,ld be fitted witli hantidles for easy mnanipulation;
* Thcy slhould be ligiit weight and convenicnt for lifting;
* lliey slhould be dcsigned to minimlize plysical contact.
4.2.8 Standards for Disinfection of Reusable Health Care Waste
Containers:
Adec1uate disinfection will be based on swab rests or similaT sampling
proceclriCs for relevant biological indicators eclducec by ani envcIio1menta-
heaih1h officer (or oLther comilpeLCnt pets(,l,) and processed by an accreditel
laboratory for bacterial and fungal cultUrcs.
19
HEALTH CARE WASTE M ANAGEM ENT PO LI CY
-Thlec frequency of teSting should be as follows:
Initial testing prior to commcincement of operations - this is to bc carricdout daily for S daysTcsting during usual operation - veekly sample swab tests of clisinfectedrcusable hicalth care risk waste containers beforc reuse.
Q(uarteily reports are to be compiledl by the responsiblc person (Waste
(Control Managei) regarding the level of disinfectiorn and copics sciet to theDIIFTl and from DFHNFT to RFHMT and then to GHS and MOI\D0-1
heal-uarters as a1ppropriatc, as well as to thle relevant district asscnielicss andl
I. P. \.
4.2.9 Collection and Transportation of Health Care Wastes
(Collection and transportation of health care waste from Health Carc Facilities
should dovetail into the general wvastc management plan of the Distnict.\sscmlllv.
.\t the institurional level, all health care wvastc shouldI be sorted on sitC before
collection and transportation. The rccommenided colour coding m11uNt he usedC.This will allow easy identification of content of containers thus p)reventilngcatcless handling aild thc risk of secondary infection. Wastes from hicalthfacilities shall bef packaged and transl)ortd separately based on tihc ado)ptedclassification as sho\vn in 'lalvlc 2Transporters of wvaste shoul,d b(e trained in identification and handling ofdifferelnt waste streams.
4.2.10 General Requirements for the Transportation of Health CareWaste
Collection, transporration andi disposal of hicalth care waste shall onlIx be dlonc b!accredited Waste Management Contractors and certified bv tie District
\SSemlbly. Relevant departments of the District Assemblies should \vwrk. it
collaboration with tlhc l-Icalti, (Care Facilities in the district;All neccssarv care musl be takJen to prevent odour nuisance 11 thie
neiighbourhoods during transportation;
20
H EA LT H CARE WAS T E MAN AGE ME NT PO LI CY
\VllCl in lfecrious wastes and(I other wastes have beenl mixeld togtelei, fhee- nllmst
be Consli(cLed infectious ,ind marnancd as SLIch.I ealth care wva,ste rlLust lbe trainsp)orted c)ictev to hlic disposal or trea;tT1ilwn1t SIrc
\vithinl rhc shllocrtcst possilblc Tilie )Vechicles Lised for tralnspoItALion of health care waste imist be so cowistrti(ed ;t>to prcvernt the scartterng of packaged wastes, odour nuisance, and tstk hs Ic lix
p rc)(.o C;\astc must nor bc cotmspacted or sulhjectcd to any other treatmcnci. rhat i u-tidcausc bags or containels to` rIuptUre;
All veh7iclCs usCel for thle tranlsportation nf health care WasWt shall CrI1eV IIIQ
biohazardi niark on all sdles:Labels sh(oulld be firmlr attached to containers So that thicv clo not 1h(eCIll mdetachcd diurinig transporration and hiandlinig;
4.2.11 Requirements for the Transportation of RadioactiveWaste Containers
RadioactiVe WasLe containers must be brightly coloured (nort;illk l l kiwo). shrulid
be marked "Radioactive \Wasie( and should bear the internationmal radi(i alIIe
symbol to distinguish it from conrainers meant to receive other vpeS of \va-ite
1ll radioactive waste packa1ges or ConMtainers should have labels 1 amnl he
radiation symlbol on themi. 'lhc label should be completed and signeld l\ tecofflcC in chlarge of vaste mnanagenctit in the organization. 1hI lablcis shoul heCfirmlv attached to the containcrs or packages so that th1-c\ do nl)t hecolincdetached during u ransporttation and hantdling. The printing on the labelAs sly ttldbe permanenti and legiblc for the entire storag;e and transport atlin period.
Radioactive waste should be adequately ECpackaged and contained for transpmi ri`o
ensure safery, not only of those involved in the transport opratlto, b)ut also t-OI'those who Could be affected as a result of transport operations in accordan11ce
with the International ALtomi. c Energy :\gency (ITALA) Rcgulations for the SfecTlarasport of Radioactive tMaterial Requirenients. (1996, Safetv Standardts SiesST-1, IAEA, Vicnnra). Drivers transporting radioactive Mnateria1l have to) he
suitably traillned and carry conringenllc plans on the velicle detailing ation to betaken in the event of an accident
21
H EA LT" CARE WAS T E M A-N AGE ME NT PO LI C Y:
Thhe Radiation Protection Institute of the Ghana Atomic Encrgy Commission is
preparing a 1egulation on the Safe Transport of Radioactive Mlaterials, whiiclshluld l)e complied v itl
4.3 Contracting with Health Care Waste Contractor
Whcre the facllit) is not equipp)ed to carry out on-site trcatnicilr and disposal ofhealth care \V,wIste, the institution should engag,e a \V';astc MI\aInagement (;olrtIactor
based om E.l\ duidelilCs i.e. thie conttactor must be licensed by the District.\sseblvl to collcct and transporr ims wastes to a designared site for treatitnewiaInd disposal.
AS 'i mlw}limlilTn Iequiretie1iit, a contract entcred into between .t asteal.lmcment Contractor anld the hCalth care insututijol should contain thc
* ITvpe and jiuantity of \v,wste to be transpor1tcde
* Finlal dcstination of waste to be transported (municipa,l disp)osal sitc oi- thc
vastc treatment facility Of another health care facilitv);* \W; hat cold lbe recycled, if anmtling;
* Tcnrms of sub1contracting, if pernutted.Icporti-ng format and information flowv and feed-b;ick mcchAiIiSmS,
(ondmions for termination of contract;Fivancial standing of t.hc contractor.
lieofOrc cormlmliSSiOmiilg a Healrtl Care W-aste: Contractor, ihe head of theinstirutIon/facility should verify the par-ticulars of thc (:onitI:Ictor \vItlt respect to
the follon\vgi:'s
\Nhether licensed by the Distlict Asseblyl;l),1 v pe of liccnse e.g. \vhceter for collection, transportauton and / mt
dlispos):ak* (ly of waste that call be handled by the contractor (scopc of contract);* T-imes for renewal of the Lcense, whiclc should be cloIne annually;
C ontractor's capacity, e g fleet size, wvork-force, creditwo-rthiness ctc;K knowledgc / experience in handling health care wastc;A\nv other points of inrv1icsi
22
HE ALT H CARE WA ST E MAN AG e MtE NT PO LI CY
4.4. Treatment Options for Various Waste Streams
Ihlie ricom nclednLc trcacniCntr otions for varitous wvaste streamns to Li,tldel ae}ac
lcvcl of he..th insUtttLto'ls ire lplovidled in Table 3. 'Feiy arc: based on
technology available and cost considerations. Howevv(r, wvithin limitis rIo\vidcd(l
by this policy, saFery considerations antdl cxisung laws, each regiJl should
determine ilhc con&guration of treatment options that is fcasiblc confsRlenri'g td'h
resoul(:t cCs a\ailablc to it an1d OthlCle tegioinatl !)CCLlrietll'CS. 1 01r instance, CCJL1ilpmen1
WithI te1C clpaCity' to handle tnore Wa,sLe than indidvidUal InsUtUtrionls generaITc c-an
be s(ratgicallv located to scrve tnorc than one 1institUtion0} fot COSt effecCt ncss
if spatial location periits accessibility. W\here, considering the volutne of wastc
gencraicd, thic cost of segregationi andi transportation to that centre is fnuch
cheaper than buying incinerators for cacih facility only to process Very small
Molunis of waste that are gctieratcdl infreqJuently, iI will be bettcr to shavc
reSOLIurCS. Such consicderatiolns a1re1 im11poirtant for facilitating the rationial u1sC nf
re:sourcet:s. This neccssitatcs a process of micro planning using a bottomI-uLp
ap roach.
Table 3: Treatment and Disposal Options.
\VASTE TYPE - TREATMENT / (LEVEL OF FINALHEALTH SYSTEM DISPOSAL
* EQUIPMENT)(;cle.ll . food. pap'ctU, iiIsiitrsg 111eI i wi r ;r.
paickIlig 11titi;llI k tC (cOistLOltCd corn!
Hc.ilih CC1111'V/( )Ut- PhrIcnII (I111c -
* COIpIIstrllg, "A U O'i I ,L ItrOr
DistrictC potrir,t3iodigesrion.
, IllczncrI-c,icanoni , ~~~~~~~~~~~~R cplOI:il l ssSpil A,l' - I ttcoltct;~ tOls,
|Biodgestuon.
liii, 1- '-. *.1 AII leveli L.aIdfill
_________ -- Clhern1tc:t C ical di lesfCitoi, iItinIcr.toartonM ll t 11 tls
: PartCnrT \\.I; All ICeelS -- ILICrUr.IT010or
C o (utz' Cl<ii .~C _c _ LDlwu it iti mu nn 1 t, utolt(.u-mtg/tInc 11w 01ton8 - l.avCti --IIAll lesek-------
| nIttt~i c l ii'org;lnic Ihlil An I ncinerst no - All cvels .:.* ii
tissue tBLInal at approrvcd Bunsi C;rounds. - I-!c:ItItk
I ~~l N; tstt 0~ ;.iin.t 'I I!c> .e I i . u / | I;ie - -- __ ;_ , _ _c ' _ _'__ _- -- --- - -,
I% ups Ind tales (I toslitog o C ijecrabIcs; sy;p. slhouild be _.
. _dlued :1nd waShcd down tdle dcaons - All
23
l~~~~~~~~~~~~~~~~~~
I t I I I I V I L t~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
J)I st,i,,,, P-110. 11)(1JtW Vklllg)A 2Ilpe)Ol -ddl.I1IS1.7$S.IMI tI .),1\t) -siomlgII;t{S S.1d .sIl0 1| v(IttIJ RII!(I/I#4|) )16(I,II X i
5>:tXl~ ~ ~ ~ L llll,,LI rA<l,ll)'.Dit]1gsJ1tis d l ,.,; 1: kia, { 1.. _ _ _ _ _ _ _ _ .; . ~~~ ~ ~~~ ~~~-) L - JO .
;uoLua6euuWd '4o iljauin3 :Paqj
.~~~~~~~~~~~~~~~~~~~~~: )jj_.j l j Z.. 1 UL n
-)AV .\1[11:)Uj JO W313JJ
HE ALT H CARE WASTE MA NAG E MEN T P OL ICY
J .1 , I it I J(-
4.6 Waste Minimization
I ICealth EaCIhus Must ai 'l. reduLcing the impact of licaltlh carc risk wa>ic In the iropcrations b5 nrinimnizing the getneration of healtlh carc risk wastc ar soLuice aid,
to a lesser extent, recyclhng
TIhis max' be achicved throughi thic fo[lowving mCasuLes:
IKecping individual wastc streams segregated, thereby kC9eeping.L 11hazard:couIs
WRsIC segvcgated from the non-hazardous.
Improving inventory control by using L1) ol(ld stocks OF drugI,s a:"cdclhcmicals heforc orderincg or using new siockls ordering lz.mid usclhemicals onlyv whlcn neecded and in minimilal quantitics to akold (ooate[dilcC
inv en111 to\
(onsideration shouldi be givcn to recycling as muclh waste as p ss<ihle in1instances where this does not increase hcalth risks or costs e.g. rccvcli,g, ofunconraminactd cardboard I)oxes and wvaste paper.
4.7 Waste Water Treatment and Disposal
\Wastc xarcr froom I Icaltlh ("are facilities is of similar qualty cto urban wastc wvair,but mav also contain various potentiallv hazardous cotmnpOnXeii s It thIerecomme-icndations in Table 5 (Treatmcnt and disposal options) arc not Colkmvecd.
H-1aZardouLs CO11)Ml)CIntS of waste watcr from Hlealth1 Care facililies iI(cludeL tlhc
fe llowving:i) SBacteria, viLusCs and helminths discharged from wvaI:ds trcating patlielts
with infcCtious diseascs.i) 1Hazardouts checmica1s from cleaning and clisinlfectieon opcrationsii) Pharmaceuticals fromll p harmnacies and vanrus wards.iv) Raclioacuve isotopcs.
\WC aste in categories II, iii and iv must be segregatcd and treaterd appro)priatel
25
HE AL I H CARE WAS T E MAN AGE MEN T PO LI CY
Waste water in category i and other general liquid efflucnts should be connectedto tie sewerage system if available, or othetrwise to a technically sound on-sicesysTtem. Floxvever, during epidemics or where Ihighly) infectious patienrs arCwivolvcd, high-risk type xvastes sthould be pre-treared by chemical disinfectionbeforc disposal.
Table 5: Recommended Treatment and Disposal Equipment
Reconmmiended E uiipment Facility / Leveli 1lghly cttricicnt (higli rcinpermLwlrc, filhc,ed Te n g Iiospiral (laerg capacxriv ncrneLatol.,incilneworos) Equpmentr / Conitrollcd combusriAn Regional and D)istrict hospirxls (mcdlrm c:,paoCit
I rt:ltrllcll l£cCillfies. incilerators). Sol,d isrI:ct facilirieN (sinall c:pacm r-
! W~~~~~~~~~~~~~~~~~~ tl1C-lerter1stO
r ;.ajtres At all Icvris_ . .. . . . ~~~~~~~~~I. _ . .
,~~~~~~~~~~~~~~~~~~~~ ,.q,1.1 .n Il-,11 rcii~ il r',1 1-*z-, (,IrI,r
p >irO Rjed pmtms (final disposal of slkidpe) )um it huspitmdm . ia L m lid m f c 'le, mm: i (.d 'm ,
The initial cost outlay of equipment recommended to be used at various lcvels is
pli(- ncw(l in Appendix 3:
4.8 Spillage Procedures
Whilst all effotts should be made to avoid loss or spillage of any kind, in theevent of the latter occurring, a clear procedure must be followed. A ready supplhof all necessary equipmenlt nust be in place for usc whenever sucli an eventoccurs. It is important that information and training for staff is provid(ed pri(rto an\ 'Such eventualiy.
'fhle aim of a spillage procediure is to:* contain the spillai e* limit the escape
26
H EALT H CARE WAS T E MA NAG E MEN T PO LI CY
p protect slaff, pat:ients and v1isiorSpr()tCcr tihe CmWiIOflU0leCt
resiore the area CO no01nalcY aS q_ui Ck1ly as possiblC.
minimize the (c t-cct of thc spillagc on normial -crvice provisi(0n
4.8.1 Procedure for Handling Spillage of Clinical Waste
'[hc main risk is tha of cOSS infcctuon, and the procedtuic consists o luinineprotective clothinlg co0nsistcnr with tlhe r isk, in Inost cases disposable gloves, andapron if appropria1e, an1d placincg the wvastc items into the appropriate vellr\v ha.or into a sharps box, In the case of ncedles, blades or othcr sharl) iclies, taking
special carc not to reccive a shalps InljulrL). Sharps must not be retrieved by hand
lhe follo\ving guidelins shall thereforc apply
• Staff cleaning spills shlall wear p roecuivu clothinig s,uitablc for rhe spillagcat hand.S Standard cleaninig equiplmlleL inicluding a mop and clcaning tbuckt plkus
cleaning agents shall bc teadily availaleb for spills management and slhallbc stored and sign-posted in an area known to all staff.
The procedure for spill ranagcmenLt will dClpnd on the followillg:o Nature of thic spill, c.g. l)lood, UtrinC and facccs.o Possible p-a1l1ogenIs tlaat may!! be involvcd.o Size of the spill i.e. spot, splaslh, puddle, large spill.o VI vpc of surfaCe IIv(ul\'Col i.C. lInolCum. carpeztt, tvood, lalliatead. c(c.o Area involved i.e. preparatoty laboratory, ward, comnatllr)l acccss
areas, ctc.o Likelihood of bare skin contact \vith the soilecd area.
For a small spill, disinfect Usin,g a disinfectant cleaning solution prelerabl)clhlorine based suclh as Blkeach and clcan.For a large spill, flood withi disinfectant, mTop andl clean the area WItL
disinfectant cleaning sokluuon Llusing a mop and allowv to air dr- or clean
wvith absorbent paper (wvhere availablc) wvhich is tlhctn placcd In a yvllow
bag.Large spills of cultures or concentrated infectious agcnts shall als(- be
flooded wvithl high-lcvel clisinfectant (like bleach) before cleaning and tlhcn
decontaminated \vith fresh disinfectant.
27
H EA LT H c ARE WASTE MA NAG EM eNT P OL ICY
xvu.i Ihlc containcrs used for internal storage as xvell as the storage siLCs should
b3c cleaned, disinfccted and furmigated frcqcuntly
4.2.6 External StorageExternal storage refers to storage at the transit point vhCere waste is stored aftetrremoval from internal storage until it is collected and transported foir treatienrand3 fina] disp)osal ,The external storage is usually situated xvithin thc hc;alth carc
facility, whlilc treatment and/or disposal sites could bc on-sitc or ouItSidC the
facilirt-. '[lhe frceucncv of removal of waste stored depends on the. volurmc andnaturc of waste gencratcd. The following measures should be taken to cnsurethc safe disposal of thc waste;
F;;6iliticS for exterlnal storage slhotuld be removed from kitchen. laundr%,W1a1d etc but be within the precincts of the facility and shall bc easilyaiccessible to collection vehicles;
li 1ilc [acility shall 11be cnclosed and( surrounded hv an impctvious wvall ofapp)ropriate heiglht and provided wvith a gate anci lock,
ui. 'J'le xvalls and floors shall be smooth, \vithout cracks, impcnious, easy toclcanl and disinfect; cleaning and disinfection must be carried out asfrequCentl\- as possible.I11c site shall be spacious and xvell ventilated and may, for costcffectiveness *in managing wastes in small facilities, accept Wxaste frotn(thTer Health Cire Facilities if it has the capacity to process the increasedvolumc and the tvpe of waste.
A..\ loading and unloading of waste shall take lplace within tihe diesignatedcollcticon area around the storage point;
Vi. 1 arger volume waste bins - 240 litres and above - should bc available atilhc external storage facilit, to receive \vasrt contaificers froin tlhc internalstorage points. These bins slhall be marked for easc of identif6cation ofconltnlt and the markings must correspond with thec colour code used forp)olythene bags in internal storage;lcalTh care wvaste shall not be comprcssed during collection;\NaSte bins shall be wvashed and disinfected after each collcction and morefFe 1CUCnrl) if rcCluircd.
;aste x,water fi-omi the point of generation and storagc area c, mu.st be*dralincd into sclptic tanks and soakaxvays and must not be alloVed ro drain
(,I I into storm wVater drainage or streams; hjuid \vastes 1Iust be:
18
H E A L T H CARE WA STE MAN AGE MEN T PO LI CY
app1uropiatclk treared (e.g. disinfcc iiot, neurCali7.AiiOan) pior lo finaldisposal.
x I .xternal so ragC facilities mIust 111eCt Certalin blsic Stan(lars( t()r thle ypc
of wvaste stored e.g. refrigerators for stronn,f organiC Iiss(lWs SInould he
considereod and provicded in facilities. This will ci;ure liar the
eilmperairurc of body parts will be sucl) as to lex\vm further
decomp)ositon or muftiplicaton ( of pathogens; where re ge r atu Cis no.r
availablc, thecse materials should be disposecd of Witlhout l ela1 Y
xi. lBio-hazard marks anct other warning signs shiall be Conslpiu)uslly postecd
on doors to prevent peopic from unnecessarily gainling access In thIe areal
xii. OnlV aut.I.riz ed persons shall have acccss to extcrnal sroragc area
Xiii. Staff slhould be trained to understand cle. principles of sCgrea.ltion and to
followv pvocedures for colour coding, storage and CIocumLenr01aiuon.
xiv. Recorcds on waste generated and processed inCludilng th)e t\P(' of wvaste,
volumcs and/otr weighit, and the personis wvl1. processcd tlhcim at the
v'arious stages should be kelt.
4.2.7 General Requirements for Waste Collection Containers
Contaiiers for waaste collection shiould meet tihe follow;ing re(JuiCeucnItsr
I hw\ shi ,ull hc non-transparkc:r.
* i1he1 >hi)ul(l be iili,t)CL%i()LlS to nv,i&itir<.
* Tlhev shiould be: of suffiCient strengthl to prevent daIage duing handling
iTh e 1 sh.ould be leak p)roof;Illch sh1oulId have closc fitting lidls;
* TlheV shIould be fitted withi hancdles for easm manipulation.
T- lich shiouldk be light weiglit and conivenicni for liftinlg;
* l'hev shiouldl be designed ro minturnize physical contact.
4.2.8 Standards for Disinfection of Reusable Health Care Waste
Containers:
Adcequate disinfection will be based on swab rests or similar sampling
poeecldures t(or relevant biological incticators conduced hy ani c-m-irlInmcn tal
1healili offieer (or other competent person) and proessecd by an accreodited
lal)oratory for 1bacterial and fungal Cultures.
19
HE ALT H CA R E WAS T E MA N AGE ME! N T PO LI CY
Thlie frequency Of testing should be as follows:
Initial testing prior to commencement of operations - this is to bc carried
out daily for 5 days.
Tcsting during usUtal operation - weekly sample swab tests of disinfected
reusable health care risk waste containcrs before reuse.
Quarterly reports are to be comapiledl by the responsibIc pcrsoni (Wastt
C( tol Maagei-) regarding thlevel of disinfection and copies senit to the
DIEMNVE and from DKMT to RFHMIT and thcn to GHS and NIGH
h1ld(juartcrs as aappropriate, as wvell as ro the relevant district assemblies and
4.2.9 Collection and Transportation of Health Care Wastes
Collection and transportation of health care waste from Health Care Facilities
slhouldl dovetail into thie general waste management plan of tlle District
Asscilmblv.
At the institutional level, all health care wastc shoulcl be sorted on sitc beforc
collection and rransportation. The rccommeinded colour cocling -must be used.
This will allow easy idlentiFcation of conitent of containers thus prcvcntilnl
caclcess handling and the risk of secondary infection. Wastes fromn lhcalth
facilities shall b piackaged and iransprtecd separately based on flhe adopted
classification as shown in Talble .
Transporters of \xaste should be trainied in idcenrtification and handling of
diffcrent xvaste streams.
4.2.10 GeneralRequirements forthe Transportation of Health CareWaste
Collection, transpmoration and disposal of lhcalth care waste shall only he clonie by
accredited Waste M\Ianagement Contractors and certified by the District
Assembly. Relevant departments of the District .%ssemblies should wVork inl
Collaboration with hCe Hlealth (Care Facilities in the district;
All nccessarv care must be tak-en to prevent odour nuisa:nce t0o th]e
lei,pghbourhoods dukiring transportation;
20
H EA LT H CARE WAS T E MA N AGE ME N T PO LI CY
\Whcre in feifuCtiUs WastCS an(l dther waqcI have l)cti. nmixcd togelici. thee ntthc
be conisidrcd infectious and maniaged as such.
I ICallth care wastc nmUSI bC transpouted ditrectlv co the disposal Or treatiahu nr !rcwithil rhc shortest possible rimc;,
VehicICs used for transpottation of lihalth care Waste Must be so Coii)iRCictcd'(.1 Il
to prevcnit the scattering of packaged wastes, odour nuisance, aind utist bc leals
proo[;\Vasrc rmust nor le comiipacted or subjectcd to any other treatmeni rthai cimtd
cause bags or cofntainers to rulptuec;
All vehicles use:d for the tralisportationi of health care waste shall c:aire ilc
bioliazard miark on all sides;
Labels shOuld be firmlr atrached to containers so that thiev co iot 1)(ec une
detached dutring transporration and handling;
4.2.11 Requirements for the Transportation of RadioactiveWaste Containers
Radioactive waste containers must e brightly coloured (norially yellov). sli'muld
be marked "ladioactive \V.aste'' and shooik] bear the inteinaitloial act ( \ e
sym)bol to distingu.1ish it froml containers meant to receive otlhe tyres () wTs;
All radioactive waste p S aCkckages Or contain1ers sIhouIld have: lal)CIs l) earin hlle
radiation syrnbol on theim. hlle label shiould be completcd and signd be rt(h
officer in charge of waste manatageniciit in the organiizationl. Ihe lablc s shou0ld be
firtily attachcd to tIlC colntaincrs or packages so that tlc\ di)o niit becomilc
detached diuingll Itransportation and handling. Ihe printing onl the libels shmiold
be permanenit and legible for lthe nttiett storage and transportation period.
Radioactive wa,tste should be aidequately )aCekaged and contatned for transpwl tt)
ensure safert, rIot only of thiosc involved in the tranisport operation. bwu also tif a
those who CQuld be affected as a result of transport operatlonis il accord(lie
with tile International Atomic Frnergv Agency (IILA.) Regulations for tie Safc
Tr arnsport of Radioactivc Material Rtccuirerncntq, (1996, Safety Standards Sci o.s
5T'-I, IALA, Vicinna). Drivers transporting radcioaCtive material have to1 1 t
suitably trained and carry contingcy plans on the vehlicle detailing action to be
taken in the event of an acicident.
21
HE ATr" CARE W AST E MA-N AGE ME NT PO LI CY:
Thc Radialioln Protection Inst6tute of the Ghana Atomic Encrgy (,ommission ispreparing a regulation on tile Safe Transport of Radioactive Matcrials, wliclshould )1e complied with
4.3 Contracting with Health Care Waste Contractor
V-he-:c the faciliht is not equipped to carry out on-sitc trCattlmlenT and displosal oflhealth care \vast, thec insuilution slhoulcd enaage a \Vaslc Management (.ContractorbasedC on EPl \ guidleCics i.e. the contractor imust bc licelnsed liv lhe lDisrici
A\sserTnblv to collect and transport its Wastes to a designated site for treatment
ancld disposal.
As a1 1inimum T equireiflelit, a contract entcred into between a W,'astcianair,cment (Contractor and thc hcalth care instrtutiton should contain thc
foil(m 11i4,
* vpre and (juantity of wasTe to be transportcd* Final c3Stination of waste to be transported (mTLnicipall diSpoS site or the
xvastc trcatmlent facility of allotlcr health care faciliv)yW \Vh haT couldi be recycled, if anytdilng;
* Terms of sub:,contracting, if permitted,Reporting format and information flow and feed-ba;ck iiechai iisms,
(Conditions for tennination of contract;Financial standing of the contractor.
JBeforc commisioning a Healthl Care WYastu Contractoro the hecad of theinstitution! facilit- should verify the lalrticulars of tlc (Coi )-aQtor with respect to
thle follouwlg:
\NVhether licensed by the Distict Assemlibly;
'IN-pe of liccnse e.g. \vwietier for collection, transportauion and / oj
disposal;
* l vpe of waste that can be handIled li the contractor (scopc of contract);.
* Times for renewal of the license. whiclh should be dlone annually;
* C(ontractor'S capacity, e g. fleet size, \vork-force, credirwvorthiness ctc;
Klo\%.noledlgc / experiencc in handling hcalth care wvastc;
A\mv other points of inr'l-cst-
22
HE ALT H CARE WASTE MAN AC EM ENT PO LI CY
4.4. Treatment Options for Various Waste Streams
Il recc(rnme n nded treatmncti options for varlous waste strcallmls to guidl each
lcvcl f he.Ith inlstItUtions are p:ovidcld in Lable 3. itvc are: bas d on
technology available and cost consider ations. Howcvcr, within litnits provid-ed
lVy this p)olicv, safetx considerations andl existing laws, each regoti shiould
ictcrminlrLe (lic configuration of treatmcint options thlat is feasiblc consid(1ring uhe
resturlce s aVailable to it and dthCe rClegional pclliaC cS. lCor instanc, CC, LlprtoT
withi tlh capacity to handle more Wa,sSL tian inldividual InStltUtions ge:neral-c can
be statCgically locatcd tO sctve morc thlan onc institution for cost cffectiveness,if spatial lncation perinits accessiblihu. Wflhere, considuring tile volusne f \vastc
gCncradte, thc cost of segregation andl transportation to that centre is inuch
cheapcr thain buying incinerators for cach facility only to process very snmll
Volunes of waste thalt are gencerated infrequently, it will he better to sic
resourCes. Such consicrlations are imiortant for facilitating the ration,al 15sc (nf
resources. This necessitates a process of micro plann1fing using a 1bottomll-Lup
appro)achl
Table 3: Treatment and Disposal Options.
WvASTE TYPE TREATMENT / (L EVEL OF FINALHEALTH SYSTE M DISPOSAL
____L_EQUIPMEN-)IGetict l w.k-cc (food pr 1 3 iodiges ikin. ng. It., , l it.,1 I'm ....... .i-
,p;c Jl<l ng 1i.'tcnialsl ctc i (Coi0lI`OeiCd cni, iiusL: 01n)HcAlilt CckIlL'! )tvi J-piricill (:Imc -
.Coniost Ingw. I ; Cost Inlll-nvtOlr
Disrict - Compou:inh;, l3iodigesrion.
11Ill eCA 111311
j i ~~~~~~~~~Rciion:ii Hctsp:tai. - 1Inclacrilini
.'II levckt -Idc tllhum ': ~~~~~~~~ cI ItcIug I lsndal- Ii1la
':..''Clinici Isnfcc n. I' cInCritton i It I vc
;)irlCn K ' \\iST .A11 Ic \'eIs -- I ic IIiC.'.ltO1 =o . A1 '; _-
('tli in e Spc'ctiiiCnl L)iDlnii iiiitwlinrlB 1.s awt icullstg/ inclt r;n t in - IandUldAll levek
t'dcbnIc,gc 1 t'orglnitc I Ittim4On 11cinersittol - Icvcls , ,e s
inssne 3Bunal at Ap1rrnlMcd Bu3nil Grounds. I-Ie:dil j
,I 1:t lut1.k.:.t: .,11 IC: ZJI-I
Icup;sule _______
! \ ruIps nAlin clIC;l1JI1s (:rkuslijig of ieiccribIcs; sy ruLp shlotild lie -
diiltred incd \vwsicd dwwn tlcr drains - AlI
23
J~~~~~~~~~~~~~~~~~~~~~
I~pol pals 55.L1ilu t Li m') SMOl\ 3 ([lI.L \\ p.'I1'-'kL I I I)S u ~Uo; I i dzit
'SXvII LIIstlL( papo .Suj0o) bS.1301iLIOD SdjL.LIS 1,l,I, ii I
pu siq pop .1111~ V ' I5) I lippoi doi-
IMV ~ ~ ~~~~~1 ,JrZ-tt ,i00 's,ol 'sua .id
4uawao6euiliiW ajseM io; 1uuwdinb3 :t, alL.
.)A AlPf''j Jo lu~' zaDjJqt) II SLM3I -)SlA sI10t*jU'A JJ suoild( JLl-)tudchnbC-)jl`~()Lf';I [ ) fp3 JULWLLI()D~)J ZtJ1 PLIV zY:Isum\ jo sa)d.\ )4j.i -ss o.id IV'S C)dSLp) JIstl,A3L[l JO }L' LIDU) TO.J p.jinbzu St s' it'-dinba, nI|)s ' tDLI1J DJJ) PLI A!'___[_. .IO,
IuaLwdinb3 papuatuwooaM -Hd
I~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~L .1 i.4
Vd=1 1 1D)I
[1I Pn"I 'q 0 1 . IJ PiLlI.O 'l"'' I CI It 3 -1-1 I
lllrXs.)[xit,x [ll! ss;sruI .II0U1 'S[Ot[ Ill:uTI1 s) U1' II i [
~~[;)Aj; I(VI,J 11 lz-tttn
1IVSOdSIQ I W3LSAS H-LITVgH.TVN11 .J0 jA31) / IN IV3t~lJUI 1 S IdAI 9ISViX\
A 3 O d p a3w >V NVY 31SbM 3 H1Itf
HE ALT H CARE WASTE M AN A G E MEN T P O LI CY
I - I - I J 1 .
4.6 Waste Minimization
I leaitth facilities imust aifl at reducing the impact of lhcalrhi care risk wv;i in trV-jir
opcratiolns b) miniinizilig the generation of hiealthi care risk wastc am souvCe avdl,
to a Icsser cXtc(lt, iecycling.
This rnav be achiev,ed through thc followving mCasuIcs:
Kecping individual waste streamns segregated, rhercby kceping Im/ardoltis
wastc segregated from the non-hazardous.
tmproving invCntort control by using uLp old stocks ol (lILIs Illd
clhcmicals hreforc ordering or using new siock: ordering hXazarioIIS
clcmilcals onL whien needed and in rminirmial (qiuntiLies t(o axv (m1 (Ut(MCed
invCnt(r\'.
(onsidcration shoulo bt gbic n to reccling as nIucIh Waste as pssile in
inscanccs wxhere this does not increase health risks or costs e.g. re-vcIiIL of
u171C0nraMTlInatecl cardboard boxes and wvaste lpaper.
4.7 Waste Water Treatment and Disposal
Waste %vartCer Fron-i I Icalth ("are faciLities is of sitnilar (jualitY to urbani wastc \ Ir.ur
but ma!v also contain various potentiallv hazardous cormpontlist it- the
recomeinc-dauions in Table 5 (Treatmcnt and disposal op()tis) artc not) ollowed.
Hlazardtous copntIeJ)nts of waste wvatcr ftom I Health Care tacilitits ii1cluc] chc
following:i) lBacteria, viruses and heliinths discharged from wards treating paticnts
with infectious diseases.
ii) I lazardous chemicals from cicaninig and disinfc;tion peXpo:1;rions
iii) Pharmaceutiicals fromt pharmacies and various \wards
iv) Radioactive isotopes.
\W aste in categories ii, iii and iv must be segregatcd and treated appropriatcl
25
I
H E A L I Vi C A R E W A S T E M A N A G E M E N T P O L I C Y
\Vaste water in category i and other general liquid effluents should be connectedto the sewerage system if available, or othetrwise to a technically sound on-sicesvstemn. HIowvever, during epidemics or where hiighly) infectious pautentrs arcinvolved, high-risk type xvastes sliould bc pre-treared by chemical disinfecuionbefore disposal.
Table 5: Recommended Treatment and Disposal Equipment
Reconilended Eqtiiment Facili!y / Lcve1iI I ilghl ctticient (higl rcinperaturv, filterecd Tachiag -ospirail Oige capaicirv ,ncineiaror.s'
!flcifleifl tArS) EqUtpiienr / Coiirolled COmbulL)StiOfn RepoIni anvd Districr Itospir;ls (nicdiuim c:ip-icIim
(Irritinele l FAcilitIes. | iinciIeralors). SuI,djsism( fiscilitieN (sinanil clpticir-I m1IcmentarsO
r:ici1jties ia a1ii iccIs
Prwcoed pIrS (Fin:1I di5pos-i1 of ,hid,.) c,, h u id, h iI: d viiitc-, t' kw -.
The initial cost outlay of equipment recommended to be. used at various lcvels isl) it1. ) I I in Appendix 3:
4.8 Spillage Procedures
WVhdst all efforts should be made to avoid loss or spillage of any kind, in thleevent of the latter occurring, a cle-ar procedure must be followed. A ready supplyof all necessary equipment rus't be in place for uis whenevec suchi an evnt
occur-,. It is important that information anid training for staff is provided p)ri)rto anv; such eventuality.
Th e aim of a spillage procedlure il 'o:• conitairi the spillage* l'.nimit thlie escape
26
HE ALT H CARE WAS T E MAN AGE ME N T PO LI CY
* protcct staff, paitlcnts aandl visi"IoS
protccr the: c1lVn(m1lCr1nt
rest:lOCC thc area to 1o1nilacy aS CluicklkV as possi'le.
rUruiltnit thae (-ffeCt of the spillage oni normal service provision
4.8.1 Procedure for Handling Spillage of Clinical Waste
I[he main risk is Ihat of cross infcction, andl thc p)cCedutC consist;St oi(I' dcmiilmn
protective clotling cOnsiCeStC \\ltth tlhe risk, in1 most Cases disposable gloves, and
apron if appropriate, alid placing thle vaste items into the appropriate I(ilOW la')
or into a sharps box, in the case of needles, blades or other sharp iicems, taking
special care not to receive a sharps injtiuy. Sharps must not be retrieved by haild.
Fie followving gUlidelines shall therefore apply
* Staff cleaning spills shiall wvear protectvc clothing su-itablic for rhc spillagc
at hand.
* Standard cleaning ecluipinent including a mop and cieaning bucket plus
cieaning agents shall bc readily available for spills mantagemcnt and shah
be store-d and sign-postedL in an area known to all staff.
The procedure for spill managemient wvill depernd on the followiing:
o Nature of thc spill. e.g. blood, uriic and faeces.
O Possibe pathiogcns that my;t be involved.
O Size of thlC spill i.e. spot, splash, puddle, large spill.
o T Vpe of surfa:Ce 1inVlved i.e. lrinolecu. CUl .arpet, wood, lamtilale .d e1c.
O A rca inv0 lved i.c. preparatory laboratory, ward, conillloii access
areas, etc.
O I.ikehhood of bare skitn contact wVith thle soiledl area.
For a small spill, disinfect USilng a disinfeianI cleaning soluti(.)n preLferablv
chlorinec based such as Bleach and cieani.
For' a large spill, nood with disinfectant, inop and clean thle a Wea vLt
disitfectaIit cleaning SOlut-on using a rnmol and allow to air div or clean
with absorbent paper (\viere available) wvhich is thien placed in a velo\v
bag.Lacge spills of cultures or concentrated infectious agents shall also be
flooded witli high-lcvc]el cisinifectant (like bleach) before cleaninig and thlein
decontlllllinateCd with frelsh disinfectant.
27
HE ALT H CA I RE WASTE MANAGE M ENT PO LI CY
4.8.2 Spillage of Chemicals
'ile essentlal steps are:Contain the spillage to prevent furthet sprcad
Plrevent exposure of:o Othicr persons in the vicinityo Staff dcaling with the spill
*.-\bsorb andI dispose as quickl); as possible
lDeco ntainin-atc the area and returt) it to normal i.se
Simuilalr principles apply to any othier chemical spilla,gc. For clhemicalls like
,//tarake/dyde., wvhich readily evaporate to prodLucc very nirrita t fumes, a respirator
dlesigne(d for LIse With organic vapours should be worn. TIhe licjuidl should be
moJ(pp)(ed L 1 as 1ulicklV as possibIc 'With absorbent, disposa;ble. nmaterials. wVhilch
muist hlen 1)( douhlc baggcd and reinoved to The open-air wvasie sloras2ge
Cofllr)(wi-iud as xoon as possible.
Ilix ;m ca of the spill should be well ventilated, and \,ill re(iLltire sufficiC1nt timc for
thieC \-,'poLr to dlisprsc lbefore being reoccLlpiedl.
,A leam)n i anorthr clhcmical whose hanidling siould be mentioned. The mailn risk is
that of skin absorption on contact Vitl merculy, and by inhlalatioll ot Imercun'apour, whllch 11 axV slowly vapolisc inltO the air from exposed surfaces Of 1111cML1V.
TJhe risik is increased in hot, confined areas.
i\l ecIClr readily combinies with other metals to formn 'amalgams; which in turn
iT erC-u1-V vRapour, and from vwhiclh mercury may ibe abc sorbecd v skin contact.
PreeC\nllT \Vith rings, (by removal of jewellk-n-. or \vearin'p, of dlsposalcgovQ,;), and \vitl) any metal equipmenit, as they ma.y be dilficult or inmipossible To
deC ont II u m1)11a te.
The aimn of the spillage procedure is to collect an)' significant quanrity of free
mel-cur-y (thiat coukli possibly be recycled) and to chemlclicall com-ibinc any smallrem:mmi g rcsidu-eis as quicklv as possible \vith1 a hot suLsp)en1sion1 of sulphur and
slakd linic (calciumin hydroxide) that may be nbtained from tilhe facility's
laborITo(r\y. After drI-Ong out, the powder mixturt is collected into a tlghtlv
cap1ped platSTic bottlc.
28
HE ALT H CARE WASTE MAN AG EM ENT P OL ICY
4.9 Contingency Plan
L.ac h facilrv slhall deivelop a contingency planc tO p)1o\'icdc guidanice tro \Vlastcrnanalgcmcnt and otlier staff as wcll as visitors to faEiliCi o(:n 0()Il sLl:CS to be
implmlullunied iII thc cvcrtt of unexpected inciclents. This plan is t() incltucd amongothiers I)C,1SULI(CS to manage spillages, fire, floodinig and otheCrI hazatrds peCu.iar to
rlte localtr.
4.10 Health and Safety
''lhc N [iniistry of Local Government and Rural Devclopmnent thirough thc DIstrlctAssemblties 1oinll. vwith the Ministty of Hicalth and its implemtnentirig agrclcis aswvell as otler corporate and individual employers wlitilin thic hcalth sector are;rcszonsil)lc for providing the necessary rCsoLIces for correct atid htfcuvc haltihcare wasrt nmanagenent. Mlanagcrs in the abovc lMDA-s and otlher (organizatiOn1sarc cxcctcd io provide safc systcls of workl for staff gcrlaul11 , handlCInIg.St'0i0g,, tranSporting trcating and carrying our final disposal of wasic.
Thecy, are t) instirtutc a systcm of regular mcdical scrcecning and imn-munizationsfor all sa,,ff tnvok\ed il Wvaste mranagcmrcnt.
Tfhc, arc to proxide appcopriate information and training f;or all rclevat stLaff.Thley arc ro coricluct regular monitoring and periodic rcviewvs of thic s\s-tcm sothat deficiencies arc correctedl within a reasonable timescalc and the sVstemcontinuolusly imprl oved in the Ltght of expericnce gainiecd.
Indivicdual emplloces of the health sector are expected t(o eCNCiSCC rceasnablccarc to prIotect thelmselves and others whion may be affcctcd by tliei ;tCtli onSo(inactionls.
In order to avoid any injurics or infection of people, hecalth care Waste handlersti'lUs t
a) Go-operate in matters of hcalthl and safetyI)) (Correctly use personal protective eq1uipillcmlt and any otheirc work
ecquipmcit designated for the task.c) (Correctkl apply the informatiotn and training received aL induction and
subssecuently in lhandling issues such as:
29
H EA L T H C A R E W A S T E M A N A G E M E N Y P O L I C Y
Taking all necessary measures to ensure that re-usable containers areeffectively disinfcctcl before re-use.
ii) Providing adeq1uate scrvicc storage areas for health care waste.iii) Making provision for mitnimal manual handilillg of hcalth care risk
Nvaste.
d) lReport any perceived hazards in thcir \vorking environmnent OiJdeficienicies in the safe system of \vork io their- manager.
In the eveint of an inluvj arising o(t of \asrct handling, it mist iinmdiaclc be:reportcd to rhc re]eeant manager or suierv,isor and action taken b;ised on theinfection prcvention and MIV / AIDS pol-icies of the lO1H / (;HS.
4.11 Record Keeping and Documentation
I ,ach health institution, is requircd to maintain recor-ds of its wastcmanagemenT. In additon to srores and logistics management rccrdR-s at theinsttuitional level discussed untdler Section 7.1.1, issues reg,arcding the type ofWvastc, wvlere il is gencratcd, when separated, by wvhorn aixi c\ en vtllhcrsub9seqiuent actionl ulntil final disprosal or handing over to a \vasicc dislosal
comlpany, when\\:I such is thlic c,ase, shall be dOCumllCT1ted. The Follokving arcimipo)rtant sleific in for tion, w1ich should bc docmerntre(d bV eaLChillstitutionl:
I) Inforination oni Waste types ancl Handbing Processes* IDate* TIhe t\ ple and vo lu-mCe/\eigliT of \vaste generated,* '111 I.pc, origin an(l wcighlt of waste received fromn othicr- health
care facilities (in cascs vhecre facilities are shared);* The Tmeans of transportation, tyvpe and volume transportedl
T Xhe plar 'culars of the c(mmiTussioned wvaste contractor (namne: ofcompany, type of licClnse, site of treatment and / or final disposal):
* Disposal Iethorldo ani(l c]qLatities per method: cg. v.olumeincince-ated, volullme aT cvery point o)f interm(cdiate treannentvo(lulme final:ly dispsedrs cl t~.
ii)' In ]addititP1i, rcsults of rests for srandards for dlisinfec'in shoultl hecircilalel tl)c t Dl- I'I's / RI INUIs, ( ITS, INMOH, DAs all(n P \ ()c ,I
30
HEALTH CARE WASTE V MAN AGE MEN T PO LI CY
cluarterly basis as spccifiec under the scctioIl on MonitOring andConitrol.
i.ii) Rccords of environmental performance for Incinerators slioLdlci also bc
sent to thic above aut1horitics every 0 months.
iv ) The I HJI'Ls and Rl-MIls shall ensure Yccord compilatlion and analysislwv t]le health facilities unicl- rthcir Jurisdliction.
31
H EA LT H CARE WASTE MANAGE ME NT PO t. ICY
it is essential that training in tlle safe and correct maiiagemient of calllh care
waste is provicled to all staff includLiLn healrI manag,es.
i. Pre- Service and Post-J3asic training of health \vorkers should inclucdc
health care \vaste management. Therc is the neecd therefome to rce\vIChealth-tuaining institutio,0s' curricula to incorporate wvastc management.
ii. Htealth care wvaste mnanagcmert should also be incorporated into in-service
trailning curricula. TIhis trainilng should be tailored ro the needls of staff
iil. Ilcalth marnagcrs shall ensure that all tleir staff under,go in-serAice training,in health care waste managemtnt.
iV ['raining (urricula, Guidelinew, and Training N\Lann)als on hebaltll Carc \wast.e
managemgent shall be developed to facilitate l'rc-Service, In-Secrvice and
Po\st Basic training.
-. MrStandard Operating Procedures (based on the national guidelines) shall hldeveloped and communlicared ro all p ersons involved in t[le handlini,
transporting and disposal of health care wastes as wvell as their skipervisors.
vi. llThese standards shoulcl forlm thC basis For the in-service training to b1e
rovided for managers ancd staff involved in the c day-to-day disposal ofhealth care wvaste. Thicr- training should also cover cOntingencymanagement of incidents involving health care managemn-ent.
vii. Ihe MOH shall co-ordinate the drawing up of training curri-cula Lwhich
should be adaptable for regional and district training in healthi care wastcmanagemcnt and should be budgCted for in the annual budgct at all Icvels
oF the l ealth care svstem and the necessary fuLnds allocated to it as amatrcr of priority.
32
H EA LT H CARE WASTE MANAGE ME NT -P- OL ICY
viz. (Colla)oration between the health sector and universities as well as otherrescarch institutions should be strengthened to facilitate the developmentof and adaptation of tecllnologies available for health care wastemanagement.
33
HE ALT H CARE WAS T E MAN A.G E MEN T PO LI CY
6.1 Information, Education and Communication
i here is no gainsaying the Importance of educanon of a p-, pl moire-
Conscious the soci.ety is of dte isks from. health care \vAse and how to
minirniusc themii, the nmore effectivelhealthI care waste managenictitw,ill bc. 16
ou1In cmtizcns understand the classification of wastc, the need &)r \ast n t
arndl s'paratioln usinIg the CCOiLinended colouI- co(lcs F[Otl thleir s`ud.(iS in sCol:10'l
anidl adcult. educdLtion pr0ogVrUamImIcs, thev xvi-1 liandlc properhl thc wasti hey geticriate
as paticnts and visitors o our ospitals, therel cilitang h lth cat. waste
managcinent In the hcalth facilities. This is even more critical consicinng the
prevt'aiing situatio in wlhiclh, in the face of thie inadequacy of hiealrh pcrs,.onnd,
relatlivcs of patielnts have to play inore roles in caring for theit relarives onS admissiSon0.
Ihlc II";.( planI viU invol\e the use of mass mnedia to eclucatc tllch plhlic on the
Importance of lcalth care wasrte management, tihC codiinig systel alld whlat 1e ot
wastC is to be placed inI a particular type of vessel ancl tlic othfer cssertial velee:it.s (ot
su,chl education. Releva"nt aspects of the education should al.s() hb incorlpm )atcdl into
tlhe curricula of l,asic schools and adult education prograrnnws. T he public lhealtlh
units slhould Incorporate igonfnationi on health care wasic anage(t;l 11ment ito
outreach cCIaLnx1 progiranlnes. linallv, at thie instirutrimlal level, sI,n s,, Ind Str cS
shiould be strategically posted to educate and guide the public.
6.2 AdvocacyAdvocacy slhould be undertaken vigorouslv to solicit support for the policy font all
stakeholders. The fincdings of the evaluation of hacalth care waste marnaemncit
practices undertaken by thle health sector shIould be dissemninated to all the mliniStni
in-volved at the highest possible level. The attention of tlle deCvelopmenclt. lpartincrs
IIJ alJ civil societv organiLzations should be drawn to the ceiSting sitmatiol nl order
34
HE ALT H CARE WAS T E MAN AG E M ENT PO LI CY
to obtain the widest possiblc support including financial commnitment and thedevelopment of a legal framework. Feature articles in the print media drawing kcymessages from the findings of the study should be published. This is necessary, forwvhlpping up the multi-scctor collaboration and financial support that is required fortihc success of the programme. There slhould also be media encountIrs, all in aneffort to move health care waste management to the top of our priorities. We oughtto bc saying that if we cannot handle the waste that wegenerate izn the process of crinfg oulrpeoplean1d this can become a serious sozirce of health problems, then our people are betle,' off withoutl ahealth .ystem. Our health i'stition; shorlold be safeplatces to (cquire uwe-not infections.
To secure the cornuitment of pnivate health institutions, the MOH slhould involvethemn tlhrough their respective trade associations, in programs meant to implemcnTthe policy. The implementation of the policy has financial implications for healthinsutunons, which may tend to be a disincentive in the face of scarce resourccs. Thepilvate healtlh institutions in particular should bc encouraged to participatc in tiletrainillg pr an-ims that the i\IH- wvill orgaillse for thle 11ealth insitutic)ns tnder costsharing arrangements. The assistance of development partners, NGOs and othercivil society organizations should be sought in orclcr to reduce the financial burdenon the institutions at least at the bcginruing. In thc long tern, more durable solutionlsto the funding problem that are consistent xviti the existing cost recoveny policshould be explored.
''lie advocacy program should also encourage health care training institurions toinclude health care waste management into their curticula. All efforts should1 be
made to inform and educate key stakeholders in order to achiieve unity of purposcand action. These efforts should include insti tions that arc responsible for
approving newv health institutions, e.g. Private Hospitals and Maternity lomesBoard, to ensure that tley insist otn dte health care waste management readincss of
newv institutions in terms of facilities, humnan resources, plans and othler aspects ofcapacity to deliver. The same rigorous standards should be maintained in themonitoting of existing institutions and sanctions should include the withdra al ofcertihcates until the relevant shortfalls are corrected.
35
HEALT H CARE W AST E MAN AGE ME NT PO LI C Y.
Hc ealth care waste milnagri-cnt involves morc than onle sctor. I m-.dcuswl
collaboration is tliercforc nccessarv for tde cffcctivcless (d liwunpIcn(>ic:11tat1t)ll 4t tli-j1k ll w mltll:11(- ;lt11C(: dick lkc. flxl.l-]l () : ll:
dlliffucillx 111i1lstille. -1, w ith lth( m1 % I-hil.11 o,)lll.;. sruIlIlII-c
7.1 General Principles of Implementation
O ne of the key ptinciples thlat inform the implementation plan outhincl II tlice
ensuing secions include 'the polluter pays' plinciple which rcquircs rhegenerator ofxvaste to he legtylI and filnanctiAlty tsponsible for its disposal. Ih ihc vprinciples ale:
The Basel Con7vention - concerned w"ith trans-bounrdar movncmicts of iiaxardomltwaste inclucling healthi care waste
The Precautionary P'rinciple, w-litch advocates rhe adoption of I-(-;tSelIC> k1
protrct health and safety whren I li magnitudc of thle particular tisk is uncerltCIn.
The Proximity Principle, which rtCtuitres h1aardous WastC inclucling hIcalhrh carcwxaste to be disposedl of ar thic closest possible location to, its source II uIr to
minilise the Lisks involved in its transport.
The Environmettal Policy seceks to guide developmnct in accordanceu wvilit uaIiT\
requiremcnts to prevent, rcLuce and, as far as possible, clininatc poLlunota andnuisances.
The National Environmental Sanitation Policy, 1999 also rCquilc' all e11a
care institutions to estal)ish his titunot.al o vIJwaser nmanagemcnt svstems for tit- O iltpimar
managuement of wastes. It recItLites Healthi Care L`acihties to pre-trcat 11(health CaIre
WastC (e.g. bVl autoclaving) prior to storage. Ilhc polic)' further states tiat DistrictAssemblics shall provide separate collection of hazardous and hcalth care \VaStc.Ttalns1 ioct of such waste shall be in closed no-compaction vehicles, wVhichl sh1ul.d I)c
cleandcl and/or disinfected at thc end of vcvvr collection dav
36
H EA LT H CARE WAS T E MAN AGE MEN T P O L i C Y
7.1.1 At the Institutional LevelA tt de institutional level, the Public Health Unuits of the larger public healthinstitutions shall have the overall responsibility for thc management of health
care waste This is in line with the MIOH's policy to set up public healtlh uni'ts to berecsponsible for all public health activities in hospitals. Each health care facility sh allestablish a Health Care \Waste Mianagement CoTmlittee (HC iMC) appointed by theheead of tde insutution, or make an alternative arrangement to supcirvise, advise andmoriTor waste management within the facilities. In smaller institutions or ptivatescctor institutions, tde appointment of a properly trained HCW Manager \vith thcr-equisitc autholity, to effectively implement HCW policics and guidelilnes shallsufficc.
1The membership of HCWMC shall include:
o The Head of the Institution or His/Hcr Appointee (who 'ill serve as theChl.,trman)
o All Departmental Fleadso Infection Coni-ol Officero The Radiation Control Officer (likely to be a trained radiographer)o The IMatron or Sister in Chargeo Tfhe Financial Controllero Thle Public Health Unit Head/Environmental Health officcr (who wi.l1 be the
H-] CW\Y Manager)o Union Representativeso The Local Authority lRepresentativeso Representatives of the Local Conmmunity.
TIhe Healtlh Care Waste Managemeent Comrmittee shall meet regularly (at least(luartcrly) to discuss issues related to health care waste management in the hospital.
lThe Coommittee shall begin its work with an iritial asscssment of the l-JCVNIpractices and procedures currently in place. This should providc baselincinfor-mation for the monitoting and review activities.
'Ihlc Conmnittee shall review any HCWNM plans already in place and develop ncw
(loes in line \vith tllis policy and guidelincs. WVhere thlere is no plan in existcnce, the
37
HE ALT H CARE WA s.T E MAN AGE MEN T PO LI CY
COiYIlittMcC shallI dCvelop onC LIsinIg a participatory approaclh tii ord(rt to ehst thec
SLIp[)( dit Of all Co)nCCIernCed lighlt 1COm thc O(utsCt.
-rhe conmimittee shall implement tllc plan so develh pcd bv ap)o.ntinig and
supeciAising substantive officers. Therc shall be p)elodtc sitc visits to ob)scevc the
HC.\Vl staff at wvork in addition to the re:;gular reports that thc substantive staff are
required to submit to the Committee.
Training rot thc f-IC\VN staff shal be a pniority; both pre- and iii- service training
shall b)e offered to all staff to ensure that thev ar-e very much abreast wVith
developnients in the HCWNI.
ithe {(Aw Mfanager slhall do supervision of the labourcrs and othIe auxiLIarY staff.
l-lo\eve r, this Function shall not be th-e prcsecve of the Line managers. Consideting
the fact that waste is generated in all sections of the ins,rutio)ns, it would beexpedient for the managers of the respective departmentlts lo 1havC authoritY OVCt thlC
auxiliary staff. 'there should thereforc be effctive coordinaion bcrbetween the 1-1(X
Mia,nagcrs and the heads of department in iwhich the auxiliaii staff work so that
supervision will bc effective. HCW\ Managers themselves should pay StUrLlsc visits
to all departmcnits to observe their staff at work and to ensure thar the wvork is bcinIg
done as plannied. These visits will also provide opporru,nintes fou coachliing whilst
cngcidering disciplinc.
Participatory planning and evaluative mietlhods should be adoptcd wvithl the
insitutio(ns taking the stance of a learning organization. HowM /Mne,, can le done befter
should beI the focus.
*I'he activities of the health care waste management staff shall be doculmnntcd.
Pcoper srore keeping measures in cespec[ of logistics should be adopted. 'thcsc
reccrds are usefil in validating evaluative findings. For instancc thie numler and
ty-pc (in tenrs of colour coding) of polythene bags and plastic waste containers in
store, numbers issued out and the quantities rcceivecl, when issucs and(1 rcceipts took
place and whlo received or issued them and to whomn they wcrc issuCed vill all b)e
valuable information that could be used to validate records of wvaste processed.
This documenitauon shall cover all thte aspects of Waste manlagemtllent: Thc type,
volume and/or weight of waste, where it was gcnerated and the person proccssing ir
38
HE ALT H CARE WASTE MAN AGE ME NT POL ICY
slhouki all bC documented. r\ lalicl attached to the blin or plastic bag shiould alsopr'vlde this informarion.
7.1.2 Local Arrangements
L ocal afrangcmnents Include thlOS aCtivitics that thl institutioll and thif
rcsplectivc coin-niuntiLes and district assermlieS Cainl COltie togethcr to involvC
rhe!r people in for effective implemenranion of thle Polkcv. Thc inclusion of a
represcntative of the district assemrblies and thc community on the HJ\XVCM((:s is tO)
facilitltc the involvement of the coMmun1ity and also to safeguard their intcrCst.
MtteCUS rclateCd to acquisition of land for final disposal sites, protection of disposal
sitcs amkinst unrttuho'zed visits and scavenging are issues that tcquirecoILmmunit)
coopcrat6un.
Ilvh local authorities should also be involved in the nrgotiatioll for facilirv sharinga liecmeilts with neighbouting institutiols. 13v involving tI e local authoriis in the
H-l(:\V\l(:, such dlecisions can be taciit-iracd in a anliannrn Ilhat pronmotes thlC activc
support of all. Political and administramtve boundan'es neced not influcnce sticlhcoolrati.uoll, what is key is the proximity and cost cffectVCivelneSS.
IThe cilisrlict/!i unlmcmpal/rnetrololitran Uiaulioncs are to en force compl>liance To
strandards and should take responsibility for external Tra risportation and final dispios;ilof waste.
is,tncr he 1alth autlorities vho \\ill also be supervised by the rcgional health
dlire cior-are xill do direct supervision of the indwidual itStitutions. Infornmation flomegardillg staustical information on lHC\N\J will be con-trunicatcd along tlhesc Lics
\\ithd inusilorions reporting to the Distlict Director of I Icaith Services wvho \ill
collate the reports from all institutions under his care and fornvardl it to the Rceona-l
Diiector- of HIcaltl Services who, in turn, will forward die collated regional
informainon to the Head of Occupational and Environmental l{ealth Unit at the
Natilonal level.
7.1.3 At the National Level
A r rthe national leVel, thltC (ccpl;ational ind Invironinental Health Unit of thc
l Jil-[ealth DDivision wvill collaborate with all the divisionslls to enisure
39
H E A L T H C A R E W A S T E M A N A G E M e N T P O L I C f
Ihie vaniouLs LecC0lo1giCs for p1roXcessing wvasre slhouldl be assessed and :ati(,n,tlIscd.
l1ihe standards of emission, etc shoukl be developed and a sWrUIcru rc l pi InlpKA2 P)
monitor tlhem. hle C Ghana Standards Board and the TAl' shlould approue ile
technolo,gies.
Ile ,N[COH and Mlinistrv of Finance should make some bLud,et alk)10caion0s r(t (I SlSl
theC ht.,alth in(SIMnoS with the iniril investMcnt inI heal1th caLrC wa.,re l(',WIMllInI
eqiiuincnt. hlic dcevelopment pariners, NGOs and civil society sho uld )ie liCvtedWAAiJ reSOLrce mo0ihzati0n.
7.2 Dissemination Strategy
I n developing this policy and guideLines, a parteipatory approach wxas adoplud.Consequcntlv, reprsenratives of stakeholder organizauoons came togctherl in
wvorkshops and discussed the lissues of conccrnt regarding I IV\C N. Ti_sapspproach
promoted tlhe spint of teamwork and ownerslhip of the policies and gukiCde lines. I ke
disseininarion strategy ci nvisioned will follow the same parricipaturx app (;leCh isl
in p) rep-pi thn I 5 'I9k
The follo\ving acilviocs are enmisaged:a) [hfe Policy and Guidelines xviiU be presented to a tia onal workshop of
stakeholders wlho will reViewv and validate the p)olicy as Vcll as theNational Action Plan (N A]').
b) lhe documtcni will be presented to regional clircctors and orthcrsenior healthI managers, district directors and managements ofteaching and regional hospitals and professional health associations
for their inlput. Any relcvant amendments arising, from thosesoulrces wvill be madc.
c) 1-he final document will be presented to the H-lonourablle MliniSiC
for IHIealtlhcl) It will also be presented to hlealth workers, relevant NG()S, oinion
laders ancl the public; anid in those districts in vhich the lb'rdcr
40
HE ALT H CAR e V AST E PA A N AGE ME N-T PO LI CY
toWNns involvcd in the \lc,st African Corridor Projcct are locatecd aswvell as othl selccted pilot districts.
c) NManagers at the rcgional levcl xvill then be expected to organizedi;sseinlatio)n eSsilonS tO explain the contents of thl policy to smaflin tlheir regions, districts, sul) districts and healtlh facilitics.
f) ^Funds will thelreforc have to be mobilized to ensure ihat theregional and district disseminations progrcss on schedule.
7.3 Implementation Road Map
I he prPoposed btmetable for the dissenlmination of the policy and itSimpllmentltlionl are sumnanrized it Table 7.
Table 7: Work Plan
Strategy Activitics Tirning Rcsponsibile Persuni
I Sner ilincil * R ovirs of di.,ft HCN\I policN Fclh. NIiilrch, (,o fIcdL dt:lkii" I aild tleg.1l sid gmI(lintcs bwvovking groiip 2(0i 4
ir.,incw, lk bXtr lit:]ih * \cio11,nenl of Nanioiatl I)11 Pi'Mi-1. Ci(V I
I t ,\.I Itr (m I t \\Ni :ichlem PIan (N.-\P) Ail . 2-11)4
* '. 1;.:.1l (,kslIm}o 1t ............ \IcL\ .! 2t'' I 'Hl PI'\Il .21 11I~~~~~~~~I 1 1k4l 11 11'.stqslnl
Legislation - Draft a 1;mw oni I ''~ In Niini-tel of I ic;1iilihealih care waste m!InIag!n!
2 Diss~c nil arltil * D),qem ! i! ! 100 II i-onlit, i -_ '; I, 5ovrng Cnrmnn;rev.d!!.i.ric level- Prsentation Of 2! IIdor ;n sciior marimgers. RH'I'T& Du-1 N IT Irr eciinig
1 lin rlose lic:jiih * P:i)(le ndcqlaetc pie -
Cill'C.(';i91c cutolkc10o1 inal lials. I uI' N. 1 I
miilyiLc pi , * 1' ,o -,idc adequiat.e heafl ci 2e ic 2 ' 4
xv;ilTiv pnciak iigg and sTor;ge 711 ;tI! g ' ' Ii
Provite mcnicilCr:tors and oilier I ! ' .im0c1itticdl rclev-i111A cqtiiflCiil i foi- 'pIll
l reli ilt-ji of wvastes (I)! lcvcls)
41
JO I I OV3 I ~I0I t. JO LaI;)wdIlZAULW)Cj.1 111~It
Jo J3I.1I'~fl 1.ya LLaLId0jA3 tt :jaujta :
aaaatuau~~ 3t10(1U3A131111 tAt a p111t11.L CaSaid -
IVaItIt I 31aaaa-JIUeIAI. qa C)a
taP at - - ta(~~ ~ I - pa -)I IL 33)1 11W
- I -3LSt''a\ tLt3 [iVIj l (.IjO La opLLlno~J- tt-
3ifla3o UIODIZsaa -u
LI.~v 3 LIit -_ii1 J31DILILIII .4
-' - LL NUJ'~IIK \:)- d vutitlvi Q Ix,t )1531 a
- a. ap a1.Dil Jo mo&I
ill a -~~~~~~~ MJ- L pll- 1 1aL jkllALLtii\t j 1113)
A I 0 WUtL3O.d I NaaWLatJIN W S V~
HE ALT H CARE W AS Tr MA N.AG E MEN T PO LI CY
' :' 'S11 z l 51l 1:"! :'!1\1II 1wi di:91:T! I& rt r1 i'' 1 e . 1(j R10 IS,) DD 1).) : ' (
N[sd-tcsn SuicveN oni progress of - it:.I
z ., i :: !, ,,~~~ I 1'SN I1.1 l!
:2 I )I IT J
.~~~ ~ .I.i .- (..
* "(E Isis.' s :11; 1.
S -s 5 t fi r P * i . t 1,! .11 11 ,o11 -1 111, I! (( S - 11 111 (
7.4 Responsibility for Implementation
Thi-S poiACy is mcant to provide guidance for the heaIlth sector ats ', whlcuk.
EahSUb SCC101 namely1CI, thec Ghana FHealtb Scr-vice, II-IC I caching11
I-Iospitals, Qua-si-(Governmen1Cft Hospitals, N1i,~Sion Hospitals; and IIIe 1l3 rtvatc
sctor health 1IflTtLltiOflS 7ic to t .1pIlcm!;t .,s, polc1es and guidelines
.'4i NfOl thereforns Ibs the y tsporiibilit for its oiplementation
T1hise arc huoweve o(thoer nill stries that play complemtentary r;les: Ihc
(l II llct /'III(pI)ImlI IIiI lTh. t)W Ii>C1l)l' t I e: Nr'II St ,~ r\ o Ct II I C \ II;ThlII t .HJI (
Scoi-ie. Ninistry of I c:l- Govctlunnew and rural Development, -and Ictcriniar
lserv ics Deparrcsinr. The pcolic-3\ is thereforc meaiont to clovetall the plans and
responsibilities of the NID\s. ThrsiLS Whiklt the M1OH through thce Individual
'instituto is respolsicl for- segreigatng, storing and trealtin [oksAN' 3th
(istiOcI/munuicipral rnlecronlial ascrnmblies have to ensurc that liv %v,Stc is
ii:iii'),s 1 tit iiiJ c1i'l>su.-s.I i.n the .pj1(tptatc m lannr. IC p1:er->< ihe.t1 t4.
43
,. ~~~~~~~~~~~~~~~~~~~~rHEAL T H CARE WAS T E MA N A GE E MEN T PO LI CY
treatillent whe rc possible and transport to the transit pointl. he
distcict/munnicip,al/-nctrol)olitan assembLies have to ensure that thcrC arc wvcl-
traincd and effective companics in the svstern to do the trainslportation and
disposal and in somnc cases, treatment. They are the ones tn screcn, 11cense and
supervise the private waste management companiis.
44
wI~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
KEALTH C A R E WASTE MA N A G EM E N T P O LI CY
onitOlinlg and review are very critical functions for the effectiveness -fi anyprogrmimnnic. No matter ho\V wcU a programmr is planned andimpiclieented, there are chances that solime details may be overlooked.
(;ood supcmislion and monuitoinng, as processes are underway, are citincal in additiontO Post audlJitS, to assure the discov'erv of errorS and their correctoll in good time.Ihe also proVide the opportunity to rCeiC\V the plans as well as training
prog-an-unes in order to make theml moMr effectivc. Periodic reviews arc alsoimportant in accessing program impact Thus the effec iveness of ilhc programmes
\xill l)e a+ssessedl from Sboth the pzoint of vie\v osl~ managemisent fo bocc5tCi andtsrne imp)acts. l'he guidelines for 1\No11ito i-ig and Rjv are presented in thec
.S,etions X. 1 to 8 2.3.
8.1 Monitoring and Control
Ile obsjecCTVe of monitorinig and control is to ensure thar problems and rislksin1VolVCd aRe identifie6d whille preventinig tIle deCVelopm11elnt of fItLIre lprol)lemI.s andenhXslanlcin> sa;fetv.(omipliance wVithi laid dlowni regula7tions and gUidelinTes will be the norin while
district assemblies are expected to enforce compliaice.Ihough the, FI-\VINl committees are to advise on thic handling and dis'posal ofWaste, daily supervision is to be carried Out by the \vasre control manager (line
:inaeral of lab2oiUrers and auxiliarv staff involved inl \vaste mana1tcgmenlt) whio inrnI liS aINS\\''Crable to the head of the inIsitution1. 11 institutional headslhere fore have overall responsibility for ensuring that procedures are in place. arc
being, implemented and sanctions enfor-ced where appropriate. Ihey arc(expectcd to wvork closely with the H(7\\W1\I comiiittee wvhich they (or tlleirrcepresentative) chair and conlduct rcgular spot chccks.
In addition to dailv and weekl- inspections of procedures, Lhe followvingparaineters are to be monitored:
ill Standard ()pxirating Procedures (S(o)ls) which shiould be developed by theV1'ar0LIS stilbsctir.s in health for tihcir staff inlvedL at each stagc of handling
45
H EALT H CARE WA STE MA NAG EM ENT PO LI CY
VzstC should be monitored frcqucnd\ by supcrvisors in the lhcalth facility, 1) 1h
DHINf[TS andl cltc RJNI TS.
The SOi's shLould co'el- areas like waste mninimuation, segregation otf wasie,
transportation, storage, trcatinent andl final disposal. In addition, it Shlou(ld Cove l
the disinfection of rcusable health care rislk waste containers based on srandardsfor disinfection as requil-cd b)y this guidelline.
b) M\inimum environnmental performancc requirements for contlollcdcombustion treatment facilities like incinerators should be carried out a1 telc
onset of use of the facility and at least once yearly based on guidclines to beprovided by the EPA.
Whcre it may be considered maore effcctive to conduct these detcrinlationscent.rally, arrangements should be made to organize testing from national lcvcl
8.2 Audits
8.2.1 Periodic Management Audit
Fach regional directovate should arrange to carry out their own internal audit on
waste management pracuces in their facilities at lcast once annually. ancl followx
up anv serious incident, which is relevant to waste management proccdLrics.This is in an effort to amend procedures whlere appropriate in order to Improve
the management of the waste. The results of the audit should be forwardcd to
GI-IS / M1OH headquarters and communicated to hcalth institutions involved.
8.2.2 Extemal Random Audit
Random audits on waste management will be carried out each year by theMinistry of Health, whiclh may delegate the Occupational and l'nvironmentalHealth Unit, Institutional Care Division or other appropriate depr.utenclnt tocarrv out this funrction oln its behalf.
Additionally, audits offered by audit bodies external to the MOdI-I will b)cencouraged to facilitate obiCctivc evaluations, which favour comparisons \vithinternational norms on vwaste manag,crnent.
46
H EA LT H CARE WAS T E MANAGE ME NT PC) °L CGY
8.2 3. Audit Tool
A\udit tools designed for mcasuring compliance with cl-inical waste proceduresslhould be uscd for audits. An cxarnplc of such an auldit tool is to be foundl at
Appendix 2
8.3 Reviews
Therc shiould( bc a review of tile pcrtforlmance to the ipvo,ArI ( mfmcliffC IRVO vcars
after tlic liunch of thle policY and( aT tile clnd of thle fifthl year to asscss tlhc compBlinceanid thec }lt-el:ammeCS ImpZactS. Thel<'se reviewvs xill ksc the find(ings of studies
COnclICeTd on- hiealtlh care wvaste pracuices in the hlospitals ais bxasclinc andl will asscssthe progiess of the progranvuie agatinst the kev indicators esTablished. Thc tpe.s ()
\v,istc disposal nmethods in use. Cmssionis frolm ilix'rlllatotS and wheicthier the
cotn)osiin miieets thic standardlS S't l'b the relevant authonities and other I \SUcS Will
be trackdl dO\Vll.
47
H E A LTH CARE WASTE MAN AGE ME NT PO LI CY
48
H E AL TH C A RE W AST E MA N AG E ME NT P OL IC Y
*} '.1 .' .*, 2 .... 1,
1\r \i. s - f Ql,,lil \.fIX,v I.1rlll r 1.~ )2x (V. 1 ;gh. : V1 . i r. r) = - ~- --- ~ - ~ = -= =~ ~
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,e a q s& U1 JO SIIII.)ll > 1}S(ur ~~~~~--- -- -.- - --- ----- - -. . . .. .:liI ........ _>II'j .__i .
- ~ ~ ~ p~~;u Iim ol 3 1 11.ZInvlc;
} ---- -- --- - -- - -- , Hv'o :dIIj J--' 1''-LsLis-tU0) wt1ltj!1
i __ "- ' ' li)llulll P* lu ' cil hl I103 'c-' ; I!"
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I . ........ . .- -…*. ... .. . '' '_ l'lIII' I ,,,,,'"' 1s-.a 1xlo ,lls n
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! ~ ~ NolI c- - --'~- ----- -j--- ---- -- -- t-- --- - -_______ )i
-i~~~~~~~~~~~~ viu utlCIi UCI:4Jr~- IV i 1'N1 ,. ,t 12]I.
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JeSodSi,U puc Eu!IpueH sdju4S qrVZ
< -_ D\I 'I
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Ae'infO Iso: le?illul pue suolido juiawdinb3 :j xipueddvy
Appendix 4: Relevant C6sntrol of Infection Policies and.OtherGuidance
1 GHS, Policy and Procedures for Infection Prevention Control on Health F:cilities,2002
2. GiIS / \WI-IO GAVI infectiorn Saftry P5oUcy and Strategic Plan, 2000
53
A2.2 Waste Disoosal
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