Health-Care Waste Management - Rapid Assessment Tool: For Country Level Content

Health-care waste management Rapid assessment tool
for country level

Content
Section
Scope
Content
1. Introduction
2. Preparation
3. Planning
Provides basic information on this Rapid assessment tool

Checklist for chronological preparation of the assessment
Plan for a two week field assessment with a few hints of what to do when
4. Contacts
5. Terminology
Contact list to help you keep track with all your main interlocutors
Listing of all specific terms used
Questionnaire to collect data from associations, NGOs and universities or other research institutes which have had relevant
activities in HCWM in different settings of the country.
6. Tool A
National
7. Tool B
8. Tool C
National
Local
Questionnaire to collect data at Ministerial level

Questionnaire to collect data at Municipal Authority level
9. Tools D
10. Tool E
Local
Local
Questionnaires to collect data from personnel of health care facilities (HCF)

Personal observations made during visits of health care facilities
11. Tool F
12. Questions
National
Rating system for the HCWM situation assessed by main headings

Complete listing of all questions existing within the different tools.
> To access any of the above "chapters", click on the tabs below.
We are interested in your data

Thanks to send to WHO a computerised copy of the spreadsheets containing the data you will have collected with this tool
Contacts
Contact: World Health Organization: http://www.healthcarewaste.org / E-mail: [email protected]
page 1 cover
1 Introduction
In many (mainly low income) countries, improper management of wastes generated in health care facilities causes direct health impacts on the community, the personnel working in health care
facilities, and on the environment. In addition, pollution due to inadequate treatment of waste can cause indirect health effects to the community.
Health-care wastes (HCW) include sharps (syringes, disposable scalpels, blades, etc.), non-sharps (swabs, bandages, disposable medical devices, etc.), blood and anatomic waste (blood bags,
diagnostic samples, body parts, etc.), chemicals (solvents, disinfectants, etc.), pharmaceuticals, and others, and may be infectious, toxic, create injuries or be radioactive.
This rapid assessment tool is a part of an overall strategy developed by WHO which aims at reducing the disease burden caused by poor health care waste management (HCWM) through the
promotion of best practices and the development of safety standards.
2 Basic assumptions and objectives
The basic assumption is that it is possible - in a short period of time (10-15 days), by questioning main stakeholders and by selecting a number of health care facilities representative of the
country - to gather the essential data necessary to have a sufficient understanding of the situation regarding HCWM at a national level.
By analysing the role of each stakeholder along the HCWM stream it should be possible to identify where problems remain and what simple, practical actions should be undertaken to solve
them.
The aim of this tool is to gather sufficient relevant information so as to provide decision makers/experts, etc. with the necessary data to help them elaborate a national action plan. An example of
such a plan can be found at the following address: www.healthcarewaste.org
3 Who can/should use this rapid assessment questionnaire ?
Senior management personnel (or other trained personnel) responsible for the design, implementation, evaluation and update of national policy and plans for health care waste management
constitute the primary audience of this rapid assessment toolbox. Assistance from appropriate national or international persons or group should be sought before conducting the proposed
assessment if senior management staff do not have the required expertise and experience.
International experts will find this simple toolbox useful when being asked for assistance to conduct assessments or evaluations of waste management systems in countries where poor healthcare waste management is suspected.
National policy makers may find this rapid assessment tool useful to better understand data for decision-making requirements in safe and appropriate waste management.
4 How to use this rapid assessment questionnaire ?
Assessment of health care waste management practices should follow 4 steps to ensure that the procedure will be useful, feasible, ethical and accurate.
1) Engaging all relevant stakeholders by using tools A, B 1-2, C, D 1-4.
2) Describing the situation by using tool E.
3) Gathering credible evidence of defined quality and quantity by filling in as precisely and completely as possible all questions in each tool.
4) Justifying conclusions in your final report by giving access to readers of field data collected with each tool.
To ensure that information collection is a process conducted and analysed appropriately, this toolbox has been organised in several parts which follow a logical and chronological frame which
you are invited to follow. This frame goes from national (organisations, ministries) to local (the health facilities) and from the start of the HCWM stream (waste generation) to the end (final
disposal).
It is recommended that you start by going through each tool to make sure you understand the questions. Data collected should be as complete, short and precise as possible. It can be of several
types: [C] multiple choice; [N] numerical (quantitative); [Q] qualitative (ranking from 1-5); Boolean [B] (yes/no) or [T] text.
page 2 intro
5 Description of the tools
The tools are all structured in the same way and the numbering of topics and questions are made in such a way that data can be easily retrieved and analysed.
Each tool is described shortly below with its' main stakeholder and the kind of information which it is hoped they can provide you.
A Associations, NGOs, Universities: these actors can provide interesting elements which can help you complete your understanding of how the system works linked to their practice of how HCWM
is practised in places they have visited/worked in.
B Ministries (Health, Environment, Education): these key interlocutors should assist you and provide you with a complete picture of how the system (should) function on both a practical, technical,
financial and legislative level.
C Municipal/local political authorities: confronted on a daily basis with general waste management issues, they can provide good information about waste collection, transport and final disposal as
well as eventual recycling habits, etc.
D1 Hospital managers: often caught between several "conflicting" requests (national legislation / limited financial means at their disposal), they are in a good position to give you an overall view of
how the HCF functions and how HCWM is dealt with.
D2 Head nurse: she will be in the best position to give information regarding waste generation and segregation.
D3 Person responsible for HCWM: this person will be the best source of information regarding HCW collection, transport, treatment and final disposal.
D4 Person handling HCW: these people will provide interesting information on actual practices regarding HCW collection, transport; treatment and final disposal (if done on-site)
E Personal observations: so as to be able to cross-check information given by all health care facility personnel, your own observations and comments are necessary.
F Rating system: this last tool is made to help you rate the HCWM situation by topic.
6 Identifying & engaging relevant stakeholders
Most problems stem from and solutions are found at a human level. It is therefore essential to identify all relevant stakeholders, consult them and engage them by convincing them of the
importance/interest of having a simple and efficient HCWM system.
The existing tools deal with the major stakeholders. Nevertheless it may be possible that, for example other important injection providers outside health care establishments should be included in
the analysis, etc. In such cases, we recommend you use the listing of all questions and choose those you believe are the most relevant.
In certain (especially small) facilities, you may find out that the same person will have to be interviewed for several tools !
7 Selection of health care facilities
So as to be able to extrapolate collected data, a sufficient number of health care facilities representative of the country must be visited.
To keep things simple, choose between one and two health care facilities per size and category of structure (private, public, religious), type of area (urban, peri-urban, rural) and by distinct
ethnical and/or geographical area (topographic or climatic zone). This should normally lead you to visit between 6 and 12 health establishments.
Specialised health care facilities such as psychiatric, geriatric institutes, etc. are not considered as important HCW producers and are therefore left out of this study.
8 Information & Contacts
To comment on this tool, please contact WHO: [email protected]]
Potential partners with international or regional outreach who are interested in advancing the agenda of safe HCWM and wish to cooperate in the further development and implementation of
activities can contact WHO [E-mail: [email protected]]. Visit our web site www.healthcarewaste.org or www.who.int/peh for additional information
r
page 3 intro
Health care waste management Rapid assessment tool

weeks
time needed
count about 15-20

Before hours in total
8
action
done remarks
The success of your field assessment will depend greatly on how well it has been prepared beforehand. Having all logistical aspects settled; meetings with key
interlocutors agreed upon and authorisations from the ministry of Health provided or promised in a written form will save you lots of time and energy. The following
points are not exhaustive, but give most of the main points.
3 hours
Go through the entire Rapid assessment tool (RAT) to make sure both its structure and content are clear for you.
8-7
6 x 30 min.
Get in touch with the Ministry of Health (if not already done), so check when is the most appropriate period to perform the
field assessment. Ask for their support in the preparation of this assessment: can they suggest a list of HCF (health care
facilities) that you could visit
2 - 5 hours
Try and find a local counterpart both for the organisation of the logistics (driver, hotel, etc), assistance during the mission
and follow up once it is finished (there are always some bits of information one would need and can only get if someone is
on the spot.
2 hours
Once you have a fair amount of information about where you will be going, try to make up a realistic plan according to
distances to be driven, road status, size of HCF to be visited, etc.
2 hours
Make a list of all the key interlocutors you should/must meet. Enter their coordinates in the contact sheet so as to have it
at all times with you.
2 hours
Request from the Ministry of Health that they provide you with a document giving you full access to all documentation you
may need.
1 hour
According to the number of HCFs you intend to visit, make the corresponding number of paper copies of the tools you will
need (D1-D4), unless you are sure to be able to make photocopies on site.
1-2 hours per day to

During sum up and prepare
the next day
If you have any questions don't

hesitate to contact us !
The success of your field assessment will depend greatly on how well it has been prepared. Having all logistical aspects settled, meetings with key interlocutors agreed
upon and authorisations from the ministry of Health will save you lots of time and energy.
At the end of each day, make a summary of the day and check your field notes. Prepare the plan of the next day
according to data collected, planned meetings
Confirm the meetings for the next day
Enter data collected on your computer on a daily basis. Sending this information on regularly by e-mail ensures data to be
stored in an other place than your computer only (for security reasons).
2 days before the end of your field mission, go through the entire documentation you have managed to collect. Think
about any information you believe would be important to have and try and get hold of it while you are in the country.
After
1
1-2
count about 2-3

weeks of full time
work
The quality of your report and proposals depends on both the quality and amount of representative data you managed to collect during your field visits as well as the
possibility to get, via a local counter part, any further data needed.
Go through the entire documentation.
Write the report. An example of such a report can be found at: www.healthcarewaste.org or www.who.int/peh under
healthcare waste
Envisage organising a workshop 3-6 months after your field assessment so as to implement it. People convened to this
reunion are both local (Ministry of Health + Environment; resp. of medical staff training; representatives of the medical
staff) and foreign (potential donors, cooperation agencies already working in the country)
page 4 preparation
Field assessment planning

Days
n
Date
(name of mission) (year)
Participants
xx
xx
xx
xx
xx
Locality
Objectives
Interlocutors
Final preparations & contacts

Announce the beginning of the mission and receive
Ministry of Health
all necessary authorisations & documentation

Collect general information about who deals with what
2
Ministry of Environment
i.e. try and find out who are the most relevant/important actors
who can help you advance your agenda on HCWM.
Other official meetings
Gather "independent" information about the country's practices.
meeting with assoc. or NGO representatives
The aim is to start collecting HCF data with a good background of how the system works.
Visit of first health care facility
Visit of health care facility
page 5 planning
Remarks
Field assessment planning

Days
n
Date
Participants
xx
xx
xx
xx
xx
Locality
Objectives
Interlocutors
10
11
12

13
Collection of eventual missing information
Feedback on how the mission went to Ministry of Health

14
+ eventual request for assistance in gathering some more information
Participants: xx (first letter of first and last name of participant);
page 6 planning
Ministry of Health
Remarks
Contacts
send report
Institution
wshop
person
field
When
Ministry of Health
Ministry of Environment
Title
Last name
First name
Name
Street
Zip
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
page 7 contacts
Locality
tel
fax
e-mail
Glossary and abbreviations

n Term
Definition & [includes]
1 Anatomic waste
Consists of recognizable body parts.
2 Auto-disable Syringe
A specially modified disposable syringe with a fixed needle which is automatically disabled by plunger blocking after a single use.
3 Bloodborne pathogens
Infectious agents transmitted through exposure to blood or blood products.
4 Burden of disease
The health and socio-economic cost of a given medical condition on a society.
5 Chemical waste
Consists of/or containing chemical substances.

[Includes: laboratory chemicals; film developer; disinfectants expired or no longer needed; solvents, cleaning agents and other].
6 Colour coding
Designates the use of different colours for the storage of various categories of HCW.
7 Container
Vessel in which waste is placed for handling, transportation, storage and/or eventual disposal. The waste container is a component of the waste package.
8 Cytotoxic waste
Drugs possessing a specific destructive action on certain cells.
9 Disinfectant
Chemical agent that is able to reduce the viability of microorganisms.
10 Disposable syringe
An all-plastic syringe designed for a single use, with a separate, steel needle. Because there is no mechanism to prevent re-use, this type of syringe may be
used more than once.
11 Disposal
Intentional burial, deposit, discharge, dumping, placing or release of any waste material into or on any air, land or water.
12 Handling
The functions associated with the movement of waste materials.
13 Health-care wastes with high Consists of materials and equipment which include heavy metals and derivatives in their structure.
content of heavy metals
[Includes: batteries; broken thermometers; manometers].
14 Hepatitis B
Hepatitis caused by a virus and transmitted by exposure to blood or blood products or during sexual intercourse. It causes acute and chronic hepatitis. Chronic
hepatitis B can cause liver disease, cirrhosis, and liver cancer.
15 Hepatitis C
Hepatitis caused by a virus and transmitted by exposure to blood or blood products. Hepatitis C is usually chronic and can cause cirrhosis and primary liver
cancer.
16 HIV / AIDS
Human Immunodeficiency Virus, a virus transmitted through exposure to blood or blood products or during sexual intercourse. HIV causes the Acquired
Immunodeficiency Syndrome (AIDS).
17 Incineration
The controlled burning of solid, liquid or gaseous wastes to produce gases and residues containing little or no combustible material.
18 Infection control
The activities aiming at the prevention of the spread of pathogens between patients, from healthcare workers to patients, and from patients to healthcare
workers in the healthcare setting.
19 Infectious health-care waste Discarded materials from health-care activities on humans or animals which have the potential of transmitting infectious agents to humans. These include
discarded materials or equipment from the diagnosis, treatment and prevention of disease, assessment of health status or identification purposes, that have
been in contact with blood and its derivatives, tissues, tissue fluids, or wastes from infection isolation wards.
[Includes: cultures and stocks; tissues; dressings, swabs or other items soaked with blood; blood bags. Sharps, whether contaminated or not, should be
considered as a subgroup of infectious health-care waste].
20 Open dump
Characterized by the uncontrolled and scattered deposit of wastes.
page 8 glossary + abbrev.
n Term
Definition & [includes]
21 Pharmaceutical waste
Consisting of/or containing pharmaceuticals.

[Includes: pharmaceuticals expired, no longer needed; their containers, items contaminated by or containing pharmaceuticals (bottles, boxes)].
22 Pathogen
A microorganism capable of causing disease.
23 Pressurized containers
Consists of containers (full or empty) with pressurized liquid, gas or powdered materials.
[Includes: gas cylinders and cartridges; aerosol cans].
24 Radioactive health-care
waste
Consisting of/or containing radioactive substances.

[Includes: unused liquids from radiotherapy or laboratory research; contaminated glassware, packages or absorbent paper; urine and excreta from patients
treated or tested with unsealed radionuclides; sealed sources].
25 Recycling
A term embracing the recovery and reuse of scrap or waste material for manufacturing or other purposes.
26 Risk
Probability that a hazard will cause harm and the severity of that harm.
27 Safe injection
An injection that does not harm recipients neither exposes health workers to risks or results in waste that puts communities at risk.
28 Safety (sharps) box
A puncture proof/liquid proof container designed to hold used sharps safely during disposal and destruction.
29 Safety syringe
Modified, disposable plastic syringe designed for the HC worker to disable it in a way that the needle is protected & cannot be re-used.
30 Sanitary landfill
Characterized by the controlled and organized deposit of wastes which is then covered regularly (daily) by the staff present on site. Appropriate engineering
preparations of the site and a favorable geological setting (providing an isolation of wastes from the environment) are required.
31 Segregation
The systematic separation of waste into designated categories.
32 Sharps
Sharps are a subcategory of infectious health care waste and include objects that are sharp and can cause injuries.
[Includes: syringe needles, scalpels, infusion sets, knives, blades, broken glass].
33 Sterilisable syringe
Either all plastic or all glass syringe with steel needle. This type of syringe is designed for re-use after proper cleaning and sterilisation in a steam sterilizer or
autoclave.
34 Storage
The placement of waste in a suitable location where isolation, environmental and health protection and human control (e.g. radiation control, limitation of
access) are provided. This is done with the intention that the waste will be subsequently retrieved for treatment and conditioning and/or disposal (or clearance
of radioactive waste).
35 Treatment
Any method, technique or process for altering the biological, chemical or physical characteristics or waste to reduce the hazards it presents and facilitate, or
reduce the costs of, disposal. The basic treatment objective include volume reduction, disinfection, neutralization or other change of composition to reduce
hazards, including removal or radionuclides from radioactive waste.
36 Waste management
All the activities - administrative and operational - involved in the handling, treatment, conditioning, storage, transportation and disposal of waste
Abbreviations
n abbreviation
definition
1 HCW
Health-care waste
2 HCWM
Health-care waste management
3 HCF
Health care facility
4 =
only necessary to ask question when HCW is segregated
5 <>
only necessary to ask question when HCW in taken off-site
page 9 glossary + abbrev.

Tool
A (recommended)
Organisation:
(country)
Interview
person in charge of association, NGO
Active in the field of:
Address:
Name of interviewee:
Function:
Tel. n:
Assessment made by:

c
<>
<>
topic
Duration: 30"
Date of assessment:
question
type
data
comments / multiple choice
9 HCW off-site transport

900 transport services
10 HCW treatment
1013 waste recycling
11 HCW final disposal
1103 domestic waste
are there any control measures ?
[0] none; [1] transport form; [2] other (specify)
ask to be allowed to take photos of the system !

can you list any HCW recycled (by whom & how) ?
ask to be allowed to take photos of the place !

where is it disposed of ?
Explanations
Legend for [Q]
Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down one or several
numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).
All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below !
Comments: enter any relevant comments made by the interviewee which can help better understand the problematic.
Never leave a field empty ! If something doesn't exist or is not applicable, put a "0" (zero); if the interviewee doesn't know, put a "?".
c (code): questions only necessary to ask when: HCW is segregated (=); when HCW in taken off-site (<>).
Personal comments/remarks of the interviewer
page 10 Tool A
excellent (high) = 5
good = 4
satisfactory = 3
insufficient = 2
bad (low) = 1
non-existent = 0

Tool
B-1
Ministry:
(country)
Interview
person in charge of Ministry of Health
Department:
Address:
Function:
Tel. n:
Assessment made by:

c
topic
duration: 1h00
Date of assessment:
question
type
data
1 geographical situation & population

104 population
could I get detailed demographic data of the country ?
could I obtain a list of all HCFs in the country ?
300 medical staff training
is training of med. staff available regarding HCWM ?
306 medical staff numbers
could I have a break down of the medical staff ?
do you have any figures at the national/local level ?
do you have a specific colour coding system ?
2 health care facility (HCF)

202 HCFs
if possible by category & type (Nbr. of beds), by locality / district
3 staff
4 HCW generation
400 quantities of HCW produced
6 HCW storage containers
=
<>
603 colour coding

<>
<>
901 type of transport
who generally transports the HCW ?
[1] the HCF; [2] municipal service; [3] private company (name ?)
[1] open dump; [2] sanitary landfill; [3] small burial pit; [4] other

1101 type of disposal site

which kind of disposal site is used for the HCW ?
12 HCWM regulations (code of conduct; management plan, policy)

1201 national HCWM regulations
can we have copies of existing (draft) documents ?
does their application cause any problems ?
13 policy and budget

1300 health system
could you outline how it is organised ?
1301 budget allocation for HCWM
do you think sufficient funds are allocated to HCWM ?
which % of the national health budget do you allocate ?
1304 purchase practises
is there a national policy for items used in HCWM ?
1305 relations with other ministries
with which ministry(ies) do you work on HCWM ?
1306 cooperation with agencies
with which bi(multi)lateral agencies do you cooperate ?
1308 annual report of activities
could I obtain a copy of your annual report(s) ?
page 11 Tool B-1
try to obtain a flowchart of the health system + responsibilities

if there is no specific budget allocation, put 0.
try to obtain copies of the last 2-3 years
Explanations
Legend for [Q]
Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down one or several numbers
which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).
page 12 Tool B-1
good = 4
satisfactory = 3
insufficient = 2
bad (low) = 1
non-existent = 0

Tool
B-2 (optional)
Ministry:
(country)
Interview
person in charge of Ministry of Environment
Department:
Address:
Function:
Tel. n:
Assessment made by:

c
topic
Duration: 30"
Date of assessment:
question
type
data
4 HCW generation
10 HCW treatment
1007 domestic waste
1103 domestic waste

how is it generally treated ?

where is it disposed of ?

1200 hazardous waste regulations
can we have copies of existing (draft) doc. ?
with which bi(multi)lateral agencies do you cooperate ?
Explanations
Legend for [Q]
page 13 Tool B-2
good = 4
satisfactory = 3
insufficient = 2
bad (low) = 1
non-existent = 0

Tool
(country)
Interview
Person in charge of Municipal Authority
Municipality:
Address:
Function:
Tel. n:
Assessment made by:

c
topic
Duration: 15"
Date of assessment:
question
type
data

103 population
how many people live in your locality ?
10 HCW treatment
1007 domestic waste
does their application pause any problems ?
Explanations
Legend for [Q]
page 14 Tool C
good = 4
satisfactory = 3
insufficient = 2
bad (low) = 1
non-existent = 0

Tool
D-1
(country)
Interview
Manager or deputy of health care facility
Duration: 30"
Health care facility:
Address:
District:
Function:
Tel. n:
Assessment made by:

c
topic
Date of assessment:
question
type
data

200 HCF
which category is it ?
[1] ambulant service; [2] (sub-)district hospital; [3] large hospital
201 HCF
which type is it ?
[1] public; [2] private
203 services
which services do you have in your HCF
[1] medicine; [2] gynaecology; [3] surgery; [4] children services

[5] emergencies; [6] radiology; [7] laboratory; [8] other (specify)
204 bed capacity
how many beds do you have in total ?
if yes, what kind of training is given ?
302 staff for HCWM
who is in charge of HCWM in your facility ?
303 training of responsible of HCWM
what kind of training has this person followed ?
3 staff
<>
<>
<>
who does generally transport the HCW ?
[1] on-site; [2] off-site
10 HCW treatment
1000 HCW treatment
is it treated on-site or off-site ?
<>
1001 off-site HCW treatment
who's in charge with the off-site treatment ?
<>
does this organisation offer satisfactory options ?

1203 HCF HCWM regulations
can we have copies of existing (in preparation) doc. ?
which % of the HCF budget do you allocate ?
page 15 Tool D-1
Explanations
Legend for [Q]
Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down one or several numbers
which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).
page 16 Tool D-1
good = 4
satisfactory = 3
insufficient = 2
bad (low) = 1
non-existent = 0

Tool
D-2
(country)
Interview
Head nurse
Duration: 20"
Address:
District:
Function:
Tel. n:
Assessment made by:

c
topic
Date of assessment:
question
type
data

205 occupancy
how many beds are currently occupied ?
206 occupancy
what is the average bed occupancy ?
207 outpatients
how many outpatients come each day on average ?
do you vaccinate your personnel against them ?
how many are done in average per day ?
500 segregation categories
into which categories are HCW separated ?
501 needle stick injuries
how many cases reported in the past 12 months ?
if yes, what measures do you take when it happens ?
503 needle handling
if needles are taken off syringes, where do they go ?
504 type of syringes used
what type of syringes do you use ?
[1] disposable; [2] sterilisable; [3] auto-disable; [4] safety syringe
600 infectious waste containers
what kind of containers do you use ?
[0] no specific container;

[1] plastic; [2] metallic; [3] cardboard; [4] bag; [5] box; [6] other
601 sharp containers

[1] puncture-proof; [2] not puncture-proof
[3] single use; [4] multiple use
602 shortage of sharps containers
for what reasons are there shortages, if any ?
[0] no shortages; [1] budget; [2] logistical; [3] other (specify)
603 colour coding
3 staff
305 hepatitis B and tetanus
4 HCW generation
408 number of injections performed
5 HCW segregation & handling
[0] no segregation;
[1] sharps; [2] infectious (non-sharp) waste; [3] anatomic waste;
[4] pharmaceutical waste; [5] chemicals (liquid and solid);
[7] radioactive waste; [8] other (specify)

are there displayed written instructions ?
page 17 Tool D-2
Explanations
Legend for [Q]
page 18 Tool D-2
good = 4
satisfactory = 3
insufficient = 2
bad (low) = 1
non-existent = 0
F17:
[0] no segregation
[1] sharps
[2] infectious (non-sharp) waste
[3] anatomic waste
[4] pharmaceutical waste
[5] chemicals (liquid and solid)
[7] radioactive waste
[8] other (specify)
F21:
[1] disposable
[2] sterilisable
[3] auto-disable
[4] safety syringes
F23:
[0] no specific container

[1] plastic
[2] metallic
[3] cardboard
[4] bag
[5] box
[6] other (specify)
F24:
[0] no specific container

[1] puncture-proof
[2] not puncture-proof
[3] single use
[4] multiple use
F25:
[0] no shortages
[1] budget
[2] logistical
[3] other (specify)
F26:
if yes, note which colours are used for each waste category.
page 19 Comments

Tool
D-3
(country)
Interview
Person responsible for HCWM
Address:
Function:
District:
Assessment made by:

c
topic
duration: 1h00
Date of assessment:
question
type
data
3 staff
304 staff for HCW awareness
awareness of risks of person(s) handling HCW ?
4 HCW generation
401 domestic waste
quantity produced/day (estimated, in kg or litres)
402 sharps
quantity prod/day (in kg or number of sharps boxes)
403 infectious (non-sharp) waste
404 anatomic waste
405 pharmaceutical waste
406 chemicals (liquid and solid)
quantity produced/day (estimated, in litres)
407 radioactive waste
which equipment the staff handling waste has ?

505 protective equipment
7 HCW storage area
[0] none; [1] gloves; [2] boots; [3] apron; [4] trousers; [5] mask
700 storage area
do you have a specific area for HCW ?
701 storage area access
is the area secured ?
702 storage area organisation
are waste stored according to specific rules ?
800 HCW on-site transport
what kind of means do you use ?
802 injuries/accidents
any reported cases in the past 12 months ?
8 HCW collection & on-site transport
10 HCW treatment
[1] open device; [2] closed device; [3] other (specify)
1003 type of HCW treatment system
which kind of system is used ?
[0] none; [1] open fire; [2] incinerator; [3] chem. disinf.; [4] other
1004 capacity of HCW treatment syst.
what is the current capacity of the system(s) ?
in kg/day and how often treatment is done per week
1005 operation of HCW treatment syst.
any operation problems; if so for what reasons ?
[0] none; [1] money; [2] maintenance; [3] spare-parts; [4] other
1006 failure of HCW treatment system
what do you do when it doesn't function ?
1007 domestic waste
1008 sharps
how are they treated ?
page 20 Tool D-3
topic
how is it treated ?
1010 anatomic waste
how is it treated ?
how is it treated ?
can you list any HCW recycled (by whom and how)?
question
type
data
1100 HCW final disposal site
is it on or off-site ?
1102 protection of disposal site
1103 domestic waste
where is it disposed off?
1104 segregated HCW disposal
where are the different types of HCW disposed of ?
1400 use of toilets
do all patients have access/use toilets in the HCF?
[0] no facility available; [1] yes; [2] no
1401 WC connection
if it's a WC, to what is it connected ?
[1] sewer; [2] septic tank; [3] open water source; [4] other
1402 sewer connection
where does the sewerage system lead to ?
[1] wastewater treatment plant; [2] open water source; [3] other
14 sanitation & wastewater
Explanations
Legend for [Q]
page 21 Tool D-3
good = 4
satisfactory = 3
insufficient = 2
bad (low) = 1
non-existent = 0

Tool
D-4
(country)
Interview
Person handling HCW
Address:
Function:
district:
Assessment made by:

c
topic
duration: 15"
date of assessment:
question
type
data

if yes, what measures do you take when it happens ?
which equipment does the staff handling waste has?
Explanations
Legend for [Q]
page 22 Tool D-4
good = 4
satisfactory = 3
insufficient = 2
bad (low) = 1
non-existent = 0

Tool
(country)
Personal observations
duration: non defined
Address:
district:
Assessment made by:

c
topic
date of assessment:
question
type
data

100 area type
in which area is the facility located ?
[1] urban, [2] peri-urban, [3] rural
101 area geography
climatic, topographical specifications if relevant
102 cultural practices
are there any that must be taken into consideration ?

7 HCW storage area

10 HCW treatment
<>


1105 syringes present on site
is there evidence of partially treated syringes ?
1106 infectious waste present on site
is there evidence of partially treated inf. HCW ?
Explanations
Legend for [Q]
page 23 Tool E
good = 4
satisfactory = 3
insufficient = 2
bad (low) = 1
non-existent = 0

Tool
(country)
Rating at national level
Rating made by:
date of rating:
Explanations
This rating system is here to give you a set of indicators of how good/bad is the situation regarding HCWM per topic (staff, HCW generation, segregation, etc.) for health care facilities according to their
size (big, medium and small) as well as at national level (to be read in the last column "total").
The column "national level" is there to take into account what exists or doesn't exist in terms of technical support, monitoring capacities and regulatory framework at national level. For example, if there is
no staff working specifically on HCWM issues at national level within the Ministry of Health or Environment, put a "1".
Health care facilities are divided into three size categories (see question n 200): large hospitals (big); (sub-)district hospitals (medium); ambulant services (small).
For each question, add up per HCF category size the number of points you have "assessed" during your field visits and enter the figure in the appropriate column.
The figures you will enter are then automatically summed (total points) and calculated according to the percentage of HCFs visited to give an equivalent number of points at national level (national
equivalent points).
The national equivalent percentage is calculated as follows: "national equivalent points" / (total number of HCFs for each size category * number of questions in the topic). This produces a result in
percentage that can be read as follows: 0-10% (excellent situation); 11-30% (good situation); 31-60% (satisfactory situation); 61-80% (problematic situation); >81% (critical situation).
At the bottom of the page a summary per topic can be found.
This evaluation is based on key issues that need to be fulfilled to ensure a safe management of HCW.
Data entry table

n
topic
HCFs visited
national
question
answer
point
level
big
medium
small
total
0 HCFs general information

HCFs by category
number visited
HCFs by category
total number in country
0
total
percentage visited
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
percentage of total HCFs
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
3 awareness and training of staff

302 staff for HCWM
if nobody
303 training of responsible of HCWM
if none
if the value of Q 2
no
total points
national equivalent points

national equivalent %
0
0
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

into which categories is HCW separated ?
no segregation
which equipment does the staff handling waste have ?
if none
total points
page 24 Tool F
Data entry table

n
topic
HCFs visited
national
question
answer
point
level
big
medium
small
total
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

if no specific container
if no rigid container
if any shortages
total points
0
0
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
7 HCW storage area

is area secured (only accessible for authorised pers.)
no
total points

do you think current practices offer sufficient security ?
no
total points

page 25 Tool F
Data entry table

n
topic
HCFs visited
national
question
answer
point
no
total points
level
big
medium
small
total

0
0
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
10 HCW treatment
no
1008 sharps
if no treatment
how is it treated ?
if no treatment
how is it treated ?
if no treatment
total points
0
0
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

if [1]
yes
yes
total points
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!

can we have copies of existing (draft) documents ?
no documents existing
can we have copies of existing (in preparation) doc. ?
no documents existing
no
total points

page 26 Tool F
0
0
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Data entry table

n
topic
HCFs visited
national
question
answer
point
no
total points
level
big
medium
small
total

0
0
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
1401 use of toilets
do all patients use the toilets in the HCF ?
no
if [2] or [3]
total points
0
0
0
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
overall situation at national level

total points
page 27 Tool F
24
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
0%
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
Data entry table

n
topic
HCFs visited
national
question
answer
point
level
big
Summary table
n
topic
staff (and training)
HCW segregation & handling
HCW storage containers
HCW storage area
HCW collect. & on-site transp.
HCW off-site transport
level / category
situation
at national level
#DIV/0!
big = large hospitals
#DIV/0!
medium = (sub-)district hospitals
#DIV/0!
small = ambulant services
#DIV/0!
at national level
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
at national level
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
at national level
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
at national level
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
at national level
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
page 28 Tool F
comments / suggestions
medium
small
total
Data entry table

n
10
11
12
13
14
topic
HCW treatment
HCW final disposal
HCWM regulations (code of

conduct; management plan,
policy)
policy and budget
sanitation & wastewater
overall situation at national level
HCFs visited
national
question
answer
point
at national level
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
at national level
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
at national level
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
at national level
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
at national level
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
at national level
#DIV/0!
#DIV/0!
#DIV/0!
#DIV/0!
page 29 Tool F
level
big
medium
small
total
Data entry table

n
topic
HCFs visited
national
question
answer
page 30 Tool F
point
level
big
medium
small
total
Health care waste management data collection
(country)
Inventory of all questions

c
topic
question
type
data

100 area type
[1] urban, [2] peri-urban, [3] rural
101 area geography
climatic, topographical specifications if relevant
102 cultural practices
are there any that must be taken in consideration?
103 population
how many people live in your locality ?
104 population
could I get detailed demographic data / country?
200 HCF
which category is it (are they) ?
[1] ambulant service; [2] (sub-)district hospital; [3] large hospital
201 HCF
which type is it (are they) ?
[1] public; [2] private
202 HCFs
could I obtain a list of all HCFs in the country ?
if possible by category & type (Nbr. bed), by locality / district
203 services
which services do you have in your HCC
[1] medicine; [2] gynaecology; [3] surgery; [4] children services

[5] emergencies; [6] radiology; [7] laboratory; [8] other (specify)
204 bed capacity
how many beds do you have in total ?
205 occupancy
how many beds are currently occupied ?
206 occupancy
what is the average bed occupancy ?
207 outpatients
how many outpatients come each day on average?
if yes, what kind of training is given ?
302 staff for HCWM
303 training responsible of HCWM
do you have any figures at the national/local level?
3 staff
4 HCW generation
401 domestic waste
402 sharps
quantity prod/day (in kg or nbr. of sharps boxes)
404 anatomic waste
quantity produced/day (estimated, in kg)
quantity produced/day (estimated, in litres)
407 radioactive waste
quantity produced/day (estimated, in kg)
N
page 31 questions
topic
408 number of injections performed
question
type
data
how many are done in average per day ?
into which categories are HCW separated ?
if yes, what measure do you take when it happens?
503 needle handling
if needles are taken off syringes, where do they go?
504 type of syringes used
what type of syringes do you use?
[1] disposable; [2] sterilisable; [3] auto-disable; [4] safety syringe
which equipment does the staff handling waste has?
what kind of specific containers do you use ?

[1] plastic; [2] metallic; [3] cardboard; [4] bag; [5] box; [6] other
what kind of specific containers do you use ?

[1] puncture-proof; [2] not puncture-proof
[3] single use; [4] multiple use
[0] no shortages; [1] budget; [2] logistical; [3] other (specify)
603 colour coding

[0] no segregation;
[1] sharps; [2] infectious (non-sharp) waste; [3] anatomic waste;
[4] pharmaceutical waste; [5] chemicals (liquid and solid);
[7] radioactive waste; [8] other (specify)
7 HCW storage area
700 storage area
do you have a specific area for HCW ?
is the area only accessible for authorised pers.
702 storage area organisation
are waste stored according to specific rules ?
<>
800 HCW on-site transport
what kind of means do you use ?
801 HCW collection & on-site trans.
do you think current practices offer enough security?
802 injuries/accidents
any reported cases in the past 12 months ?
[1] open device; [2] closed device; [3] other (specify)
<>
<>
who generally transports the HCW ?
10 HCW treatment
1000 HCW treatment
is it treated on-site or off-site ?
<>
who's in charge with the off-site treatment ?
<>
1003 type of HCW treatment syst.
which kind of system is used ?
[0] none; [1] open fire; [2] incinerator; [3] chem. disinf.; [4] other
1004 capacity of HCW treatment syst.
what is the current capacity of the system(s) ?
in kg/day
1005 operation HCW treatment syst.
any operation problems; if so for what reasons ?
[0] none; [1] money; [2] maintenance; [3] spare-parts; [4] other
1006 failure of HCW treatment syst.
what do you do when it doesn't function ?
T
page 32 questions
topic
question
type
1007 domestic waste
1008 sharps
how is it treated ?
1010 anatomic waste
how is it treated ?
how is it treated ?
can you list any HCW recycled (by whom & how)?
data
1100 HCW final disposal site
is it on or off-site ?
1103 domestic waste
where is it disposed off?
1104 segregated HCW disposal
where are the different types of HCW disposed of ?

1200 hazardous waste regulations
can we have copies of existing (draft) documents?
can we have copies of existing (draft) documents?
does their application cause any problems ?
can we have copies of existing, in preparation doc.?
1300 health system
could you outline how it is organised ?
do you think sufficient funds are allocated to HCWM?
which % of national health budget do you allocate?
which % of the HCF budget do you allocate ?
1304 purchase practises
is there a national policy for items used in HCWM ?
with which bi(multi)lateral agency do you cooperate?
1307 hazardous waste management
which national agencies work on this topic ?
1400 use of toilets
do all patients have access/use toilets in the HCF?
[0] no facility available; [1] yes; [2] no
1401 WC connection
if it's a WC, to what is it connected ?
[1] sewer; [2] septic tank; [3] open water source; [4] other
[1] wastewater treatment plant; [2] open water source; [3] other

try to obtain a flowchart of the health system + responsibilities
if there is no specific budget allocation, put 0.
page 33 questions

Health-Care Waste Management - Rapid Assessment Tool: For Country Level Content

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Health-care waste management Rapid assessment tool

for country level

Provides basic information on this Rapid assessment tool

Questionnaire to collect data at Ministerial level

Questionnaires to collect data from personnel of health care facilities (HCF)

Rating system for the HCWM situation assessed by main headings

We are interested in your data

Health-care waste management Rapid assessment tool

2 Basic assumptions and objectives

3 Who can/should use this rapid assessment questionnaire ?

4 How to use this rapid assessment questionnaire ?

5 Description of the tools

6 Identifying & engaging relevant stakeholders

7 Selection of health care facilities

8 Information & Contacts

To comment on this tool, please contact WHO: [email protected]]

Health care waste management Rapid assessment tool

count about 15-20

1-2 hours per day to

If you have any questions don't

count about 2-3

Field assessment planning

(name of mission) (year)

Final preparations & contacts

all necessary authorisations & documentation

Other official meetings

Gather "independent" information about the country's practices.

meeting with assoc. or NGO representatives

Visit of health care facility

Visit of health care facility

Visit of health care facility

Field assessment planning

(name of mission) (year)

Visit of health care facility

Visit of health care facility

Visit of health care facility

Visit of health care facility

Visit of health care facility

Collection of eventual missing information

Feedback on how the mission went to Ministry of Health

+ eventual request for assistance in gathering some more information

Participants: xx (first letter of first and last name of participant);

(name of mission) (year)

Health-care waste management Rapid assessment tool

Glossary and abbreviations

Definition & [includes]

Consists of recognizable body parts.

Infectious agents transmitted through exposure to blood or blood products.

The health and socio-economic cost of a given medical condition on a society.

Consists of/or containing chemical substances.

Drugs possessing a specific destructive action on certain cells.

Chemical agent that is able to reduce the viability of microorganisms.

The functions associated with the movement of waste materials.

Characterized by the uncontrolled and scattered deposit of wastes.

page 8 glossary + abbrev.

Definition & [includes]

Consisting of/or containing pharmaceuticals.

A microorganism capable of causing disease.