Manual on Hospital Waste Management Guidelines

Manual for Hospital Waste Management

Preface

Hospital waste can not be seen as a new problem in the South Asia. One of the major areas of today’s concern is the west management more specifically “Hospital waste management” which has always been overlooked and thereby has produced many of the health hazards for the people in terms of morbidity and mortality. Through out the world at present times, the proper way to handle the wastes and its disposal has become one of the major problems, especially hospital waste. A significant proportion of biomedical waste is actually regular garbage and has been continuously posing a threat to the human health, starting right from its generation up to the final disposal.

Hazardous portion of hospital waste includes all infection and pathological waste. Despite the possible danger by this type of waste, rational management has yet to be introduced. Moreover proper care is not being taken in collecting, handling, separating, carrying, storing and disposing of hospital waste by the workers, who are thus exposed to a wide range of hazards.

It relevant current aspect of waste management practice from its point of generation to final disposal and found a strategy for effective hospital waste management. Wastes generated at Hospital are indeed varied both in composition and in quality. Hospitals offer a wide range of serious and encompass a variety of activities, each of which generates different characteristic waste.

Waste management in most Asian countries is running in an old traditional way for decades. It is not possible to bring massive changes within a short time. At present our aim is to ensure that waste should be handled and disposed off efficiently and economically as per as possible. A reduction in the indiscriminate disposal of hospital waste will give immediate benefits to the service providers and community, safety at the hospital waste will give immediate benefits to the service providers and community, safety at the hospital improvement of local quality of the environment and results in lowering the level of pollution to the eco-system.

This manual-under the activity of “Short term immediate action” is aimed for the Hospital managers, Health providers, Policy makers and all the Administration, with an interest to ensure hospital waste that are generated and disposed off efficiently and economically, as far as possible to make an environmental friendly hospital.
A.


1. Introduction
Environmental pollution is now one of the major human concerns and medical wastes constitute an important component of this emerging catastrophe. Apart from indirect risks through environment, medical waste also poses a direct threat to human health and welfare, and it also creates a socio-Psychological devastation as medical facilities are conceived, as institutions, which save life, not endanger life. Realizing its importance, WHO arranged a consultative Meeting in 1992 on this issue and, in 1995, it conducted a survey in 9 countries of South East Asian Region. A regional consultative meeting was also organized in Thailand in 1996.

Health-care waste management, as well as poisoning technical problems, is strongly influenced by cultural, social and economic circumstances. A well designed waste policy, a legislative framework and plans for achieving local implementation are essential. Change will be gradual and should be technically and financially sustainable in the long term.

2. Vision of Hospital Waste Management
To ensure safe, efficient, cost-effective, acceptable and sustainable management of hospital waste and to minimize the occupational health hazard towards an Environmental friendly hospital.

3. Scope and Opportunity regarding Waste Management

• Is to provide information within the National Health Service (Waste management) policy and to give guidance on their implementation.
• Compliments the strategic guide for “Chief executive or managers” of the health care establishment.
• Provides a regime with an aim of ensuring the safe and effective disposal of hospital waste.
• Indicates some of the areas by which hospital executives may need to familiarize themselves and they may need to take steps to ensure operational requirements in waste management.
• Indicates the need of “Health and Safety Policy” for health care employees. Considers in the development of “Management policy” and “Legislation” on Hospital waste management.

4. Definition of Hospital Waste
Practice of generating, handling separating collecting carrying storage and finally disposing the waste as per the policy of the hospital. Level of knowledge attitude of the waste generator and their practice are the key issues for successful waste management. Waste management varies with different circumstance for each hospital but should take into account of there major issues. In the other hand Hospital waste refers to the waste resulting directly from patient’s diagnosis, prevention, research, alleviation of disablement and treatment purpose, as well as waste generated from all other departments of the health-care establishment.
B.


5. Classification of Medical Waste
There is no study on type of medical waste in Bangladesh however it seems that the usual classification is also applicable here.

HOSPITAL WASTE

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5.1 Suggested classification of waste as per type
Type-1      General Waste
Type-2      Infectious/Pathological/Anatomical Waste
Type-3      Cytotoxic/Pharmaceutical Waste
Type-4      Radioactive Waste
Type-5      Sharp Waste
Type-6      Liquid Waste

5.2 Definition of the hospital waste category
5.2.1 General waste
General waste comes mostly from the administrative and housekeeping functions of healthcare establishments and may also include waste generated during maintenance of health-care premises. General wastes should be dealt with by the municipal waste disposal mechanism.

5.2.2 Infectious waste
Infectious waste is suspected to contain pathogens (bacteria, viruses, parasites, or fungi) in sufficient concentration or quantity to cause disease in susceptible hosts. This category includes :

• Cultures and stocks of infectious agents from laboratory work;
• Waste from surgery and autopsies on patients with infectious diseases (e.g. tissues, and materials or equipment that have been in contact with blood or other body fluids);
• Waste from infected patients in isolation wards (e.g. excreta, dressings from infected or surgical wounds, clothes heavily soiled with human blood or other body fluids);
• Waste that has been in contact with infected patients undergoing haemodialysis (e.g. dialysis equipment such as tubing and filters, disposable towels, gowns, aprons, gloves, and laboratory coats);
• Infected animals from laboratories;
• Any other instruments or materials that have beer in contact with infected persons or animals.

5.2.3 Pathological waste
Pathological waste consists of tissues, organs, body parts, human fetuses and animal carcasses, blood, and body fluids. Within this category, recognizable human or animal body parts are also called anatomical waste. This category should be considered as a subcategory of infectious waste, even though it may also include healthy body parts.

5.2.4 Sharps waste
Sharps are items that cause cuts or puncture wounds, including needles, hypodermic needles, scalpel and other blades knives, infusion sets, saws, broken glass, and nails. Whether or not they are infected, such items are usually considered as highly hazardous health-care waste.

5.2.5 Pharmaceutical waste
Pharmaceutical waste includes expired, unused, split and contaminated Pharmaceutical products, drugs, vaccines, and sera that are no longer required and need to be disposed of appropriately. The category also includes discarded items used in the handling of Pharmaceuticals, such as bottles or boxes with residues, gloves, masks, connecting tubing, and drugs vials.

5.2.6 Genotoxic waste
Genotoxic waste highly hazardous and may have mutagenic, teratogenic, or carcinogenic properties. It raises serious safety problems, both inside hospitals and after disposal, and should be given special attention. Genotoxic waste may include certain cytostatic drugs (see below), vomit, urine or faces from patients treated with cytostatic drugs, chemicals, and radioactive material.

5.2.7 Chemical waste
Chemical waste consists of discarded solid, liquid and gaseous Chemicals for example from diagnostic and experimental work and form cleaning, housekeeping and disinfecting procedures. Chemical waste form health care may be hazardous or nonhazardous, in the context of protecting health, it is considered to be hazardous if it has at least one of the following properties :

• Toxic
• Corrosive (e.g. acids of pH < 2 and bases of pH >12);
• Flammable
• Reactive (explosive, water-reactive, shock-sensitive)
• Genotoxic (e.g. cytostatic drugs)

1. Formaldehyde
2. Photographic Chemicals
3. Solvents
4. Organic Chemicals
5. Inorganic Chemicals

5.2.8 Waste with high content of heavy metals
Waste with a high heavy-metals content represent subcategory of hazardous chemicals waste, and are usually highly toxic. Mercury wastes are typically generated by spillage from broken clinical equipment but their volume is decreasing with the substitution of solid-state electronic sensing instruments (thermometers, blood pressure gauges etc.). Whenever possible, spilled drops are mercury should be recovered. Residues from dentistry have a high mercury content. Cadmium waste comes mainly from discarded batteries. Certain “reinforced would panels” containing lead are still used in radiation proofing of X-ray and diagnostic departments. A number of drugs contain arsenic, but these are treated here as pharmaceuticals waste.

5.2.9 Pressurized containers
Many types of gas are used in health care and are often stored in pressurized cylinders, cartridges, and aerosol cans. Many of these, once empty or of no further use (although they may still contain residues), are reusable, but certain types — notably aerosol cans — must be disposed of. Whether inert or potentially harmful, gases in pressurized containers should always be handled with care, containers may explode if incinerated or accidentally punctured.

5.2.10 Radioactive waste
Ionizing radiation can not be detected by any of the sense and other than bums, which may occur in exposed areas — usually cause no immediate effects unless an individual receives a very high dose. The ionizing radiation of interest in medicine include the X-rays, a- and B- particles, and -y- rays emitted by radioactive substances.
C.


6. Sources of Medical Waste
Wastes generated in the health care establishment are in solid, liquid and gaseous forms. Health care waste comprises not only the by-product of health care activities but also the waste from administrative activities, housekeeping, patient themselves, support services etc that’s from every corner of the health care establishment. The composition of the Medical Waste varies from country to country, among hospitals within the same country, even within departments within the same hospital.

7. Sources of Medical Wastes
The Type, Composition and site of Medical Waste are as follows :
View Source


8. Risk associated with Hospital waste management
A part of the hospital waste is hazardous and may cause a threat to health and life not only to patients and staff but also to the community at large.

• Injuries from sharps to all categories of hospital personnel and waste handlers.
• Nosocomial infections in-patients from poor infection control and poor management.
• Risk of infections outside the hospital for waste handles, scavengers and general change of microbial ecology and antibiotic resistance.
• Risk associated with hazardous chemicals, drugs, being handled by persons hazardous wastes al all levels.

8.1 Identified constraints in Hospital waste management

• Lack of awareness
• Negligence
• Lack of accountability and responsibility
• Operational insufficiency
• Inadequate final disposal facilities
• Lack of formal/informal sectors in waste recycling
• Inadequate manpower
• Inadequate financing
• Job security
• Trade union
• Lack of National policy/plan

D.


9. Definition of Medical waste Management
Health-care waste includes all the waste generated by health-care establishments, research facilities and laboratories. In addition, it includes the waste originating from minor or scattered source — such as that produced from the administrative and housekeeping functions of health-care establishments and may also include waste generated during maintenance of health-care premises. In the other hand Hospital waste refers to the waste resulting directly from patient’s diagnosis, prevention, research, alleviation of disablement and treatment purpose, as well as waste generated from all other departments of the health-care establishment.

Practice of generating, handling separating collecting carrying storage and finally disposing the waste as per the policy of the hospital. Level of knowledge attitude of the waste generator and their practice are the key issues for successful waste management. Waste management varies with different circumstance for each hospital but should take into account of there major issues.

• The risks involved (Financial, Technical and legal)
• The cost of each option
• The managerial skill and time required
• Careful management of hospital waste required to achieve the goal minimize occupational health hazard and for environmental friendly hospital.

9.1 Organizational structure of Hospital Waste Management methodology

Management

↓

Director (Health-care)

↙ ↘

Matron/Ward master

↓

Nurse

↓

Aayaa

Administrative Officer

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Supervisor (Waste management)

↓

Cleaner

Hospital waste management - Present practice and recommended option for Bangladesh

10. Management of Medical Waste
Strategies for Hospital waste management — Steps and organizational structure : Steps for Hospital waste management :

The United Nation Conference on the Environment and Development recommends a set of measure for effective waste management, which are —

• Prevent and minimize waste production
• Reuse and recycle the waste to the extent possible
• Treat wastes by safe and environmentally sound methods
• Dispose off the final residues by landfill in confined and carefully designated areas

As per WHO, for effective waste management the life cycle of hospital waste must follow the pathway of some elements are —

• Waste minimization
• Waste identification
• Waste segregation
• Waste handling
• Waste treatment and hospital
• Security
• Record keeping
• Training
• Supervise & Monitoring

Different time of wastes is generated in different quantities at different section of the hospital. The life cycle of the wastes must follow the pathway of some elements, which should be addressed in terms of personnel, material cost and health risk and safety.

10.1 Waste Minimization
Administration and staff should play positive role in minimization the amount and type of waste. Minimization waste may eventually reduce handling and operational cost. Waste minimization should be done by :

• Source reduction by purchasing and supplying materials, which generate less hazardous waste
• Recyclable products should be used more.
• Use oldest stock and short term period expiry dated goods first.
• Checking the expired dated at the time of receiving and supply of goods.
• Monitoring the follow of chemical and pharmaceuticals form receipt to supply.
• Monitoring the dated of different drugs and equipment every 3 (three) months.
• Plastic disposable goods should be limited as far as possible, because of non-biodegradability, subject to illegal recycling and reuse, generates hazardous materials if burned or incinerated.
• Select non-PVC plastic materials.

10.2 Waste management plan for a health-care establishment Assignment of responsibilities
The proper management of health care waste depends largely on good administration and organization but also requires adequate legislation and financing, as well as active participation by trained and informed staff.

The head of the hospital should form a waste management team to develop a waste management plan. The team should have the following members :

• Head of Hospital (as chairperson)
• Head of hospital departments
• Infection control officer
• Chief pharmacist
• Radiation Officer

10.3 Safe management of wastes from health-care activities

• Matron (or senior nursing officer)
• Hospital Manager
• Hospital Engineer
• Financial Controller
• Waste Management Officer (if already designated).

In certain establishment, the structure may include a hospital Hygienist, in addition to or instead of the infection Control Officer, to address specific problems relating to hospital hygiene. In such cases, some or all of the duties of the infection control officer specified below will be carried out by the hospital hygienist.

The head of Hospital should formally appoint the members of the waste management team in writing, informing case of them of their duties and responsibilities as outlined in the following section. (In an institution that is not directly involved in patient care, Such as a medical research institution the head of the establishment should use his discretion to appoint members of the waste management officer with overall responsibilities for the development of the hospital waste management plan and for the subsequent day-to-day operation and monitoring of the waste disposal system. Depending on Availability of relevant staff, this post may be assigned to the hospital Engineer, to the hospital manager, or to any other appropriate staff member at the discretion of the head of Hospital.

10.4 Organizing Hospital Waste Management
For effective Waste Management there should be one “Hospital Waste Management committee” chaired by Hospital Director and he will delegate responsibilities to the sub group. Member of the committee should include :

• Director of the Hospital/Hospital superintendent
• Head of the Department/Consultants
• Nursing superintendent/Matron or in charge (senior staff nurse).
• Ward Master
• DD/Designated Waste Management officer (WMO)
• Engineer in charge of the Hospital/PWD
• Other members may be
• Medical technologists
• Accountant

10.5 Operation and Auditing of hospital Waste Management

• Each hospital will assign one senior officer as the “Waste Management officer” for ensuring that Waste Management system is appropriate and functioning well”
• The WMO should ensure that the Hospital Waste Management policy and guidelines are procedures by simple graphic instruction on waste handling.
• Giving guidelines constantly reinforces cleaners understanding on Waste Management procedures by simple graphic instruction on Waste handling.
• Staff will segregate Waste at the point of generation and dispose it to the appropriate containers.
• Cleaners will use protective devices for the handling and transpiration of waste.
• Every unit head/department head/institutional head will be responsible for Waste

10.6 Management activity of his/her unit/department/institution

• Waste receptacles, trolleys, containers, storage facility/area will be kept clean and will maintain good condition.
• Collection and transportation of waste will follow specific guidance marked by hospital authority.
• Hospital spill clean-up procedures will be followed if there is any spillage of waste
• Officer responsible will ensure record and reporting regularly on quantity and quality of waste and will take action to improve practice.
• Facility (Poster, all writing, neon sign and video show) will be available within hospital for the awareness of the patients and attendance.
• Ensure availability of waste containers at all points of necessity.
• Training/retraining/workshop orientation will be arranged for ensuring awareness on waste management for all level of staff.
• Liaison will be maintained between WMO and managers responsible for supplies and all departments in the hospital.

10.7 Existing system of Hospital waste management in Bangladesh
There are no well-defined rules and regulation of Hospital waste management in our court means no specific definition of Hospital waste and no specific and separate regulation for disposal Hospital waste. There is less priority for proper disposal of waste by the authorities and accountability of the concern authorities. More over people are not aware of harmful hazardous waste on community and environment.

11. “DO”s” and “Don’t”s for Hospital waste management
11.1 “DO”s” for waste management :

• Do segregation of waste at the point of generation
• General from hazardous
• Sharps from all other waste
• Radioactive, chemicals and pharmaceuticals
• Infectious and pathological
• Do collect in color coded bags
• Yellow for infectious and pathological wastes.
• Black for general wastes.
• Red for Radioactive, chemicals and pharmaceutical
• Yellow box for sharps.
• Do shred plastic waste from its original form.
• Do use needle and syringe destroy?
• Do label before collection by waste handlers.
• Do quantification of waste.
• Do use recyclable and reusable items as possible.
• Do cover the waste collection containers.
• Do secure store areas.
• Do provide protective equipments to the waste handlers.
• Do wear protective equipments during handling of waste.
• Do immunize all waste handlers.
• Do transport through covered trolleys and through designated route.
• Do chemical disinfection for inactivate pathogenic organism.
• Do train and educate all categories of staff on waste management.
• Do take measures for waste recycling.
• Do documentation on waste management.
• Do send the report to the designated person.

11.2 “Don’ts” for Hospital waste management

• Don’t mix the hazardous waste with general waste.
• Don’t handle the waste with bare hands and without protecting equipments.
• Don’t throw sharp waste out of specified puncture proof container.
• Don’t recap the needle after use.
• Don’t fill the waste bag more than 3/4 th of its size.
• Don’t handle the broken, tear and punctured waste containers.
• Don’t drag the waste containers over the floor.
• Don’t handle the waste containers without tying the neck of the bag.
• Don’t use open bucket for infectious and sharp wastes.
• Don’t try to change any waste from infectious waste containers to general waste containers.
• Don’t incinerate PVC containing plastic goods.
• Don’t dispose clinical waste in loose manner over ground in and or around hospital.
• Don’t fires, to be lit to burn clinical waste.

12. Existing system for disposal in Bangladesh
Waste management system in our country has been running in an old traditional way for decades. Hazardous portion of hospital waste includes all infectious and pathological waste. Despite the possible danger by this type of waste, rational management has yet to be introduced. Moreover, proper care is not being taken in collecting, handling, separating, carrying, storing and disposing of hospital waste by the workers, who are thus exposed to a wide range of hazards.

13. Economic aspects of Medical waste management
There is no available data to know the economic status of Medical Waste Management System. There is limited study on Economic status. Recently a study done by BRAC. Findings of this study are as follows :

Item

Price (tk./kg)

1. Syringe
2. Saline bag
3. Water Bottle
4. Paper
5. Plastics
6. Broken Glass
7. Metal container

• 10-20
• 10-24
• 7-10
• 2-5
• 10-20
• 1.5-5
• 4-10

There is no exact economic value in Re-cycling process,Composting for fertilizer, Safe land filling. This also required for survey which can be done by Expert group/Private Sector/NGO sector under control of MOHF&W.

14. Steps taken by the Government in Bangladesh
Country’s participation in WHO-SEAR survey (1995) provides its scenario on regional basis; but need for having its scenario on wider national context as envisaged is being increasingly felt. Accordingly, Line Director, Hospital services, DGHS proposed a survey named “Situation assessment and analysis of hospital waste management” with an aim to identify/revise and recommend on present hospital waste management practice all over the country. Hospital managers, service providers, waste generators and waste handlers of the country’s five hospitals (Secondary and Tertiary) were interacted for observation. It reviewed the current aspect of waste management practice from its point of generation to final disposal and found a strategy for effective hospital waste management.

15. Non Govt. initiatives involved in Waste Management Area
Some NGO’s are working on Waste Management study and build up of awareness about the Medical Waste hazards. Among them BRAC, Waste Concern CATALYST, PRISM are prominent. But reflection of there efforts in national level is relatively small in comparison to the volume and multifarious nature of health hazards.

16. Existing Situation
Even of most of the Govt. Hospitals which provide 57% (more or less) of health care services in the country, have no special arrangement for disposal of the medical waste produced by them and it is learnt that the same way of disposal i.e. throwing to the nearby dustbins producing the cause for hazards and suffering for the people.

Private Sector Hospitals, Clinics, Medical Colleges and Diagnostic Centers provide 43% of the Healthcare Services in the country. These Private Sector Health Care units generate a substantial volume of Medical Waste and most of them do not have any proper Medical Waste Management systems. This hazardous waste is thrown to the dustbin and the impact is most alarming un-think able damage to the public health and environment too.

Moreover, there is no organization who are solely managing or organizing Medical Waste Management. Considering the magnitude of the Medical Waste and the depth and range of the bad effects it generates, wide participation of Govt. and Private sector organizations is the need of the time.

The disposal of Wastes are the Generators responsibility and Collection/transportation and disposal may be contracted out to private organization as already done in some European Countries, Australia and very recently in India also.

17. What Should We Do Now?
The hospital waste is critically linked to the quality and quantity of patients care. There is a wide variation in the hospitals within the country and thus all methods and strategies may not be applicable in all hospitals. Although it is not possible to achieve the optimum standard at one time, a partial approach is the best strategy towards a sustainable system. At present our aim is to ensure that waste should be handled and disposed off efficiently and economically as far as possible.

In our opinion these are the following issues which should be addressed immediately

17.1 Need for a coordinating body

• Options
• Formation of Specific Ministerial Body e.g. Ministry of Health & Family Welfare
• Inter-ministerial body.
• Formation of Apex body.

17.2 Need for Regulations and Regulatory Authority

• Formulate policy and
• Ensuring accountability
• Public Sector,
• Private Sector &
• NGO Sector

17.3 Situation Analysis studies

• Volume of Waste
• Nature of Waste
• Close monitoring &
• Supportive Supervision
• Safe Disposal
• Economic aspects of Medical waste

17.4 Pilot studies

• Generation of Medical Waste
• Waste minimization
• Collection identification
• Disposal system in different level

E.


18. Waste Identification and Segregation
The key of effective management of Hospital waste is segregation and has a major influence on the options for the treatment and disposal of waste, budget and also on manpower.

• First decide, which category of particular waste is being disposed and where?
• Never do guess and do not dispose any waste without knowing thoroughly.
• Ensure that waste materials are properly and completely thrown into the waste containers and lids are firmly closed.
• Staff should never attempt to correct segregation by placing items from one container to another container
• Wastes should be segregated at source point as per (segregated for Bangladesh) color code for easy identification of category of the waste.
• If generation and hazardous waste are mixed together, the mixed waste should be considered as hazardous waste
• If any staff is confused about the type of waste. Treat the waste as infections waste during segregation
• Red color containers should contain Cytotoxic, and pharmaceuticals that should be returned to suppliers or manufactures.
• Radioactive waste materials will be contained in “Silver” colored lead proof container that must not be incinerated rather should be collection, treatment and disposal as per instruction of the “Atomic Energy Commission” of Bangladesh.
• Plastic and rubber materials should be segregated in Black or Yellow color container, identifying its natures, whether it is infected or not.
• All drainage bags, used in infusion or transfusion, all types of tubes should be shredded before putting into respective c colored container.
• Waste should be dropped/collect in the respective colored containers, some common examples are.
• It is better into not to segregated/collect Bangladesh and Biodegradable general waste altogether with in the same container, color of container will be different.
• Refers to the waste resulting directly from patient’s diagnosis, prevention, research alleviation disablement and treatment purpose, as well as waste generation from all other departments of the health care establishment.

18.1 Magnitude of Impacts and risks

• Contamination of whole mass of soil waste by infectious hospital waste.
• Spread of diseases in professional and hospital staff.
• Recycling of contaminated sharps.
• The risk of silent epidemics of infectious diseases, like Viral hepatitis, Typhoid Pneumonia, AIDS etc.
• Due to unhealthy dumping of hazardous waste, there is risk of surface water and air pollution.
• It cerates public nuisance. It clogs sewers and drains, encroach road, diminished landscape aesthetics, volatile organic.
• Winds also carry the pathogenic and hazardous materials, thus open the route of infection.
• Health hazard of Tokai/Rag pickers for scavenging the valuables from wastes.
• Laboratory and radioactive waste materials have potentially serious effects on soil microbial pollution, reduce the rate of decomposition and lowers the soil fertility.

18.2 Waste containers should be impervious, washable rigid with average size with covering lid’s and color should be chosen depending upon the type of waste :

Waste containers and its placement

• General Waste (Type—1)
• Infectious/Pathological/Anatomical Waste (Type—2)
• Cytotoxic / Pharmaceutical Waste (Type—3)
• Radioactive Waste (Type—4)
• Sharp Waste (Type—5)
• Liquid Waste (Type—6)

• Plastic bins
• Plastic bins/Polythene bags
• Polythene bags
• Special Lead proof container approved by Atomic Energy Commission, Bangladesh
• Paper/Wooden rigid box
• Plastic bowl/Containers

• Black
• Yellow
• Red
• Silver
• Yellow
• Blue

F.


19. Organizational responsibility
Hospital management must document amount If waste generated and encourage waste management practice. There must be comprehensive audit on current personnel duties, responsibilities and reporting practice. Each departmental head or nominated efficient officer should conduct audit in his department. The audit should record waste separation, storage, collection, transportation and amount of waste produced, related materials and supplies used.

20. Head of the hospital has the following responsibilities

• Formation of hospital waste management team and develop management plan.
• Designate the waste management office, who will do addition job with his own job.
• The efficiency and effectiveness of waste disposal should be monitored
• Immediate appoints a successor in absence of personnel from key position, if the procedure is delaying one responsible person should assign temporarily.
• Ensure training to the officer and staff related with waste management
• Call periodical meeting, exercise of views, suggestion and cooperation to improve or modify the plan.
• The hospital director remains overall responsible for ensuring effective waste management
• Proper documentation

21. Waste management officer (WMO)
21.1 WMO should be responsible for operation and monitoring of waste management. He will maintain good communication with other members of the committee and will be responsible to the director for all activities. The WMO will be the key person in waste management. The WMO should :

• Ensure for availability and placing of colour-coded containers.
• Ensures the patient, attendant and auxiliary workers for correctly changing the used bag with a new one.
• Ensures cleanliness around the coloured containers.
• Ensures printed posters labelled at different places of the hospital
• Make linkage with the supply department, about the availability of the materials and equipment
• Correct use of central storage facility
• Maintains system for inaccessibility of unauthorized person
• Monitors waste disposal operation properly.
• Monitors transport of waste both in-site and off-site
• Ensures that the waste is not stored for long time.
• Ensures about the labeling of all-waste containers
• Should clean the outflow of waste and note the source, type and quality produced
• Communications with departmental heads for waste segregation at the generation
• Make liaison and ensures that people are performing their responsibilities.
• Ensures that the quality of the waste in its life cycle is properly measured and recorded.
• Ensures quantifying waste and reporting system
• WHO will monitor operational cost, supply cost, training cost and cost of contracted service?

21.2 Departmental Head

• Continuously communicates with WHO
• Ensures that doctors and nurses are awarding/teaching the patients properly about segregation.
• Training of the key members related with hospital waste management.
• Ensures medical and nursing staff to be vigilant.
• Responsible for waste management for his/her department.
• Ensuring hat all the doctors, nurse and other staff working in the department are aware about segregation standard and storage procedures.
• Ensure quantifying waste and reporting system

21.3 Nursing Superintendent/Matron/Senior Staff Nurse

• Liaison with WMO and other members of the committee especially with the departmental heads.
• Ensure that he nurses are working well on segregation and separation of waste.
• Ensures training for nursing staff, medical assistants and auxiliary staff

21.4 Ward Master

• Implements effective waste disposal procedure
• Ensures that adequate waste containers are kept and well maintained at all strategic areas
• Timely supply and monitor the necessary equipment of workers
• Ensures labelling and quantifying of the wastes
• Ensures the audit and the records related to hospital waste management.
• Should arrange periodic health check up and immunization for the workers
• Ensure quantifying waste and reporting system.

21.5 Waste handlers (Cleaners)

• Will collect the waste from bins and carry it to the containers in the trolley.
• Will collect the waste-containing bags if used in the trolley.
• Will push trolley containing waste to the disposal or storage area, following the designated road marked by the Hospital executive.
• Before fine disposal, will segregate the recyclable waste from general waste bins.
• Will transfer the liquid waste from containers to latrine or sewerage system after neutralization or dilution with water
• Will transfer the biodegradable waste from the pits to the municipal lorry or public dustbins.
• Will clean and wash each bin, trolley and containers with 5% Chlorine solution and or water.
• Will replace the bins or containers with a new one if damaged.
• Will strictly follow the waste management standards.

21.6 Waste generators (Nurse/Technologists)

• Will ensure the placement of bins or bags in or around the designated piece.
• Will supervise the work of cleaners, ward-boys and ayas.
• Will motivate patients, attendant and visitors to follow waste management standard
• Will ensure minimization and segregation of waste as per standard.
• Will ensure and record the quantity and quality of generated waste.
• Will ensure about cutting the needle and nozzles and segregation of sharps.
• Will restrict, especially sharps recycling.
• Will strictly follow the waste management standard.

21.7 Doctors

• Will ensure and follow the waste management standards.
• Will monitor the activities of staff and of working places by using checklist
• Will conduct on job training on waste management for the staff.
• Will ensure minimization and segregation if waste as per standard.
• Will support (consultative) the activities of staff on waste management.
• Will be responsible for sending report (monthly or annual) on waste to the WMO and or Director! superintendent
• Will supervise the work of staff.

21.8 All staff of the hospital

• Will strictly follow waste management standards.
• Will motivate patients, attendant, follow and visitors to follow waste management standard.
• Will help and cooperate each other’s to follow waste management standard.

G.


22. Public education on hazards linked to health-care waste
Promotion of the appropriate handling and disposal of medical waste is important for community health, and every member of the community should have the right to be informed about potential health hazards. The objectives of public education on health-care waste are the following :

• To prevent exposure to health-care waste and related health hazards: this exposure may be voluntary, in the case of scavengers, or accidental, as a consequence of unsafe disposal methods.
• To create awareness and foster responsibility among hospital patients and visitors to health-care establishment regarding hygiene and health-care waste management.
• To inform the public about the risks linked to health-care waste focusing on people living or working in close proximity to, or visiting health-care establishments, families of patients treated at home and scavengers on waste dumps.

The following methods can be considered for public education on risks waste segregation, or waste disposal practices :

• Poster exhibitions on health-care waste issues, including the risks involved scavenging discarded syringes and hypodermic needles.
• Explanation by the staff of health care establishment to incoming patients and visitors on waste management policy. This may be difficult to achieve, in which case the distribution of leaflets should be considered.