Medical Waste Managing and Controlling Removal in ...Supply chain strategy: the logistics of supply...

Medical WasteManaging and Controlling Removal in Emerging MarketsCraig UsswaldSpecialist LeaderDeloitte Consulting LLPFebruary 2016

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USAID | Deliver ProjectSupply Chain Management Services (SCMS): Providing quality medicines for people living with and affected by HIV & AIDS

Key Steps of Health Care Waste Management

Minimize

Segregate

Storage &Transport

Treatment & Disposal

Consider and plan for waste reduction‏before purchasing health care materials and supplies

Separate waste by type and identify type‏of waste – segregate waste at the source where the waste is generated

Never allow waste to accumulate at the‏point of generation – collect it daily, or as often as possible

Methods depend on local conditions and‏regulations but in most cases, send the waste back to the facility that provided the supplies


USAID | Deliver ProjectSupply Chain Management Services (SCMS): Providing quality medicines for people living with and affected by HIV & AIDS

Key Resources for Health Care Waste Management

• Logistics of Health Care Waste Management• Guide to Health Care Waste management for the Community Health Worker in English and French.• Transporting, Storing, and Handling Malaria Rapid Diagnostic Tests in Health Clinics• Transporting, Storing, and Handling Malaria Rapid Diagnostic tests at Central and Peripheral Storage Facilities

Disposing of Unusable Health Commodities

http://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/LogiHealtWastMgmt.pdf

http://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/GuidHealCareWastMgmt.pdf

http://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/GuidHealCareWastMgmt_FR.pdf

http://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/TranStorRDT_Clinic.pdf

http://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/TranStorRDT_Central.pdf

https://player.vimeo.com/video/89648849


• Strategy to distribute 12 million LLIN (Long lastingInsecticide-treated bed nets) succeeds

• Residual packaging poses a challenge to childrenpotentially suffocating

• Packaging at this scale can also harm the environment ifrandomly disposed of.

• Personal use can result in poisoning and or allergies

• Designated collection areas are created in districts• Disposal methods defined in accordance with Ghana

EPA (Environmental Protection Agency) and globalstandards like WHO.

• Recycling decisions are reached and 12.5 40-footcontainers are filled to transport LLIN to a recycling plant

• Pavement blocks for public and private spaces turn arisk into a benefit

Success and Resulting Challenges

Solutions

USAID | Deliver Project Case StudyGhana: Recycling Turns Environmental Risk into Community Benefit

Finished pavement blocks made from recycled bed net plastic bags

Plastic bags from more than 12 million long-lasting insecticide-related bed nets waiting to be recycled


Voluntary Medical Male Circumcision (VMMC) Guidance DocumentProper Management of Disposable Non-Sharp Metal Instruments

VMMC Guidance Document: Table of Contents


Voluntary Medical Male Circumcision (VMMC) Guidance DocumentVarious Waste Systems


Voluntary Medical Male Circumcision (VMMC) Guidance DocumentContainerization Recommendations


Voluntary Medical Male Circumcision (VMMC) Guidance DocumentStorage and Decontamination

• All decontaminated non-sharp instruments must be returned to a central or regional location for temporary, access-controlled storage until the product can be properly transported to an appropriate recycling/smelting facility or to a facility where it will be buried in a sharps pit/concrete vault

• Decontaminated disposable non-sharp metal instruments should be stored in a heavy-duty rigid plastic container with the appropriate caution symbol on the container

• Place in a secure storage area away from other health care risk waste to reduce the potential of cross-contamination

• Place properly decontaminated single use instruments in sealable storage containers with appropriate caution signage for temporary storage

• Traffic to this storage area should be limited to individuals who know how to handle the instruments properly

Temporary On-Site Storage

Post-Decontamination

Post-decontamination storage container with appropriate caution symbol on container

The temporary storage receptacles should not be filled past three-quarters full, or the designated fill line on the container


Voluntary Medical Male Circumcision (VMMC) Guidance DocumentCompliance to National Regulatory Requirements

Swaziland VMMC Campaign

SCMS managed the handling, transport and disposal of approximately 33.36 metric tons of hazardous waste (infectious, sharps and decontaminated non-sharp metal instruments) generated during its one-year lifespan of the Swaziland VMMC campaign without incident

• Once the disposable metal instruments have been decontaminated, they are rendered non-hazardous, and can therefore be transported in a vehicle that carries usable products, provided they are safely containerized and labeled correctly for identification purposes

• They should be handled, packed and stacked with care so that they cannot topple and/or break during transit, with all packaging/containers remaining wholly intact en route to their destination

• The following symbol must be displayed on the container during transport

• Of course, the transport vehicle and driver’s competency must be suitably certified to transport goods according to the laws of the country

Off-site Transport


Voluntary Medical Male Circumcision (VMMC) Guidance Document

References to Guide Implementation

• ANSI/AAMI ST79: 2010 & A1:2010 & A2:2011, Comprehensive guide to steam sterilization and sterility assurance in health care facilities

• South African National Standard (SANS) 10248-1:2008, Management of Healthcare Waste. Part 1: Management of Healthcare Waste from a Healthcare Facility: https://www.sabs.co.za/webstore/standards/product.php?id=14016220

• Safe Management of Wastes from Health-care Activities. Annette Pruess, E. Giroult, P. Rushbrook, eds. WHO, 1999. Download in pdf from http://www.healthcarewaste.org/resources/documents/

• Management of Solid Health-care Waste at Primary Health-care Centers: A Decision-making Guide. WHO, 2005.• http://www.scms.pfscm.org/portal/page/portal/SCMS_Content/community/Tools/hcwm_casestudies/F34353D8AC6

73A93E0433C2B10AC32F3

https://www.sabs.co.za/webstore/standards/product.php?id=14016220

http://www.healthcarewaste.org/resources/documents/


Logistics of Health Care Waste Management: Broad Based Guidelines (BBGs)Information and Approaches for Developing Country Settings

Table of Contents


Logistics of Health Care Waste Management: Broad Based Guidelines (BBGs)Sharps Disposal

• In facilities where burning devices cannot reach high temperatures, or where transport of the safety boxes to a treatment facility is not an option, needle removers and sharps pits may be an option to safely dispose of used needles.

• Protected sharps pits are constructed on-site, set in the ground, and designated for disposal of sharps only (i.e., no injection devices such as used syringes).

• They should be located away from ground water sources and the bottom of the pit should be above the water table, and usually lined with concrete or brick.

• An approximately 1 meter long chute should extend from the top of the pit and include a lid that will prevent water from entering. The entire structure should be fenced to prevent unauthorized entry.

• PATH has developed instructions for constructing a sharps pit (PATH 2005); see figures to the right for two designs currently in use.

Sharps Pit Sharps Barrel and Metal Funnel

In facilities where sharps pits may not be an option because of scarcity of land or high water table, sharps barrels can be used to safely dispose of used needles.


Logistics of Health Care Waste Management: Broad Based Guidelines (BBGs)Incineration

Medical Waste Disposal UnitDe Montfort Incinerator in Myanmar

The De Montfort incinerator is a classic example of a double-chamber small-scale incinerator. The double-chamber design helps ensure that toxic emissions are minimized and that incinerator operators and nearby communities have minimal impact from incinerator emissions.

Lower-level health facilities may consider constructing a waste disposal unit (WDU) to facilitate safe and efficient HCWM using a combination of on-site incineration and burial of HCW.


Logistics of Health Care Waste Management: Broad Based Guidelines (BBGs)

Additional References

• CREATE. 2008. Website: http://www.create.org.in/wdu_component.htm (accessed October 2008). • Frazelle, Edward. 2002. Supply chain strategy: the logistics of supply chain management. New York: McGraw-Hill Companies, Inc. • John Snow, Inc./DELIVER, in collaboration with the World Health Organization. Guidelines for the Storage of Essential Medicines and Other

Health Commodities. 2003. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International Development. • MMIS/JSI/PATH. 2008. Personal Protective Equipment and Segregation Supply Specifications for Health Care Waste Management.

www.path.org• Nersesian, Paula V., Vanessa Cesarz, Allison Cochran, Jennifer Mboyane, and Katie Schmidt. 2004. Safe Injection and Waste Management: A

Reference for Logistics Advisors. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International Development. • PATH. 2005. Training Health Workers in the Management of Sharps Waste. Washington, DC: PATH. • Pruess A, Giroult E, Rushbrook P. 1999. Safe Management of Wastes from Health-care Activities. World Health Organization. Geneva. • Rushbrook, P., and R. Zghondi. 2005. Better Health Care Waste Management: An Integral Component of Health Investment. Amman, Jordan:

World Health Organization. • Smith, Lesly-Ann. 2007. Standard Operating Procedure 16, Freight and Logistics, Destruction of Rejected Goods. Submitted to the U.S. Agency

for International Development by the Supply Chain Management System (SCMS). • USAID | DELIVER PROJECT, Task Order 1. 2007. Logistics Handbook: A Practical Guide for Supply Chain Managers in Family Planning and

Health Programs. Arlington, Va.: USAID | DELIVER PROJECT. • World Health Organization (WHO). 2003. Guiding Principles to Ensure Injection Device Security. Geneva: WHO. • World Health Organization (WHO). 2005a. “Health Care Waste Management: The Eight Steps Along the Waste Stream.” Available at

www.healthcarewaste.org/en/127_hcw_steps.html (accessed July 2008). • World Health Organization (WHO); USAID | DELIVER PROJECT, Task Order 3; Foundation for Innovated Diagnostics (FIND); Roll Back Malaria

Partnership; President’s Malaria Initiative (PMI); and UNICEF. 2009. Transporting, Storing, and Handling Malaria Rapid Diagnostic Tests at the Peripheral Storage Facilities. Arlington, Va.: USAID | DELIVER PROJECT, Task Order 3; and Geneva: World Health Organization.

• World Health Organization (WHO); USAID | DELIVER PROJECT, Task Order 3; Foundation for Innovated Diagnostics (FIND); Roll Back Malaria Partnership; President’s Malaria Initiative (PMI); and UNICEF. 2009. Transporting, Storing, and Handling Malaria Rapid Diagnostic Tests in Health Clinics. Arlington, Va.: USAID | DELIVER PROJECT, Task Order 3; and Geneva: World Health Organization.

• World Health Organization (WHO). 2005b. Management of Solid Health Care Waste at Primary Health-Care Centers: A Decision-making Guide. Geneva: WHO.

• World Health Organization (WHO). 2005c. The Ten Categories of Health Care Waste. Website: www.healthcarewaste.org/en/128_hcw_categ.html (accessed July 2008).

• World Health Organization (WHO). 2006. Management of Waste from injection activities at the district level. Geneva: WHO. • WHO/AFRO/JSI/MMIS. 2005a. Do No Harm: Injection Safety in the Context of Infection Prevention and Control, Facilitator’s Guide. (unavailable)

http://www.create.org.in/wdu_component.htm

http://www.path.org/

http://www.healthcarewaste.org/en/127_hcw_steps.html

http://www.healthcarewaste.org/en/128_hcw_categ.html


Logistics of Health Care Waste Management: Broad Based Guidelines (BBGs)

References to Guide Implementation

To obtain additional information on HCWM, many documents are readily available. Following is a sample of the literature on HCWM. See appendix B for a list of agencies to contact for additional information. An excellent overall reference is WHO’s Safe Management of Wastes from Health Care Activities (Pruess, Girouit, and Rushbrook 1999).

A complement to the text above is Better Health Care Waste Management (Rushbrook and Zghondi 2005). This publication, written for managers and health care providers in developing countries, starts with an easy-to-read introduction and includes a reference guide to HCWM.

For advice on selecting the most appropriate options for managing waste generated by health care facilities, see Management of Solid Health Care Waste at Primary Health-Care Centers: A Decision-making Guide (WHO 2005b). For training materials on HCWM, the Making Medical Injections Safer (MMIS) Project1 developed a complete set—Do No Harm: Injection Safety in the Context of Infection Prevention and Control, Facilitator’s Guide (WHO/AFRO/JSI/MMIS 2005a). Guidelines for the Storage of Essential Medicines and Other Health Commodities, a joint USAID; John Snow, Inc./DELIVER; WHO; and UNICEF publication, includes a chapter on waste management in health care facilities. (John Snow, Inc./DELIVER 2003).

The Transporting, Storing, and Handling Malaria Rapid Diagnostic Tests in Health Clinics (World Health Organization et al. 2009) and Transporting, Storing, and Handling Malaria Rapid Diagnostic Tests at the Central and Peripheral Storage Facilities (World Health Organization et al. 2009), both forthcoming, describe the processes for disposing of rapid diagnostic tests (RDTs).

The Supply Chain Management System (SCMS) project has produced a detailed standard operating procedure fordestroying unusable goods, including pharmaceuticals (Smith 2007).Additional resources are available on the JSI/MMIS website (mmis.jsi.com), WHO’s health care waste management website(healthcarewaste.org), and PATH’s website (path.org).

Medical Waste Managing and Controlling Removal in ...Supply chain strategy: the logistics of supply...

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