Health-care waste management • Rapid assessment tool

for country level

Content
Section Scope Content
1. Introduction Provides basic information on this Rapid assessment tool
2. Preparation Checklist for chronological preparation of the assessment
3. Planning Plan for a two week field assessment with a few hints of what to do when
4. Contacts Contact list to help you keep track with all your main interlocutors
5. Terminology Listing of all specific terms used
6. Tool A National Questionnaire to collect data from associations, NGOs and universities or other research in
have had relevant activities in HCWM in different settings of the country.
7. Tool B National Questionnaire to collect data at Ministerial level
8. Tool C Local Questionnaire to collect data at Municipal Authority level
9. Tools D Local Questionnaires to collect data from personnel of health care facilities (HCF)
10. Tool E Local Personal observations made during visits of health care facilities
11. Tool F National Rating system for the HCWM situation assessed by main headings
12. Questions 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

Contacts

Contact: World Health Organization: http://www.healthcarewaste.org / E-mail: [email protected]

page 1 • cover
Health-care waste management • Rapid assessment tool
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,
• 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 health-care 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
t
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-
it )
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
• 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

page 3 • intro
Health care waste management • Rapid assessment tool
weeks time needed action done rema
count about 15-20 The success of your field assessment will depend greatly on how well it has been prepared beforehand. Having all
Before hours in total meetings with key interlocutors agreed upon and authorisations from the ministry of Health provided or promised in a writ
of time… and energy. The following points are not exhaustive, but give most of the main points.
8 3 hours Go through the entire Rapid assessment tool (RAT) to make sure both its structure and content are clear If you
for you. hesita
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…
7 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.
7 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.
6 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.
6 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 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 The success of your field assessment will depend greatly on how well it has been prepared. Having all logistical aspects
During to sum up and interlocutors agreed upon and authorisations from the ministry of Health will save you lots of time… and energy.
prepare the next
d 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.
count about 2-3 The quality of your report and proposals depends on both the quality and amount of representative data you managed
After weeks of full time visits as well as the possibility to get, via a local counter part, any further data needed.
work
1 Go through the entire documentation.
1-2 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 (name of mission) • (year)
Days Participants
n° Date xx xx xx xx xx Locality Objectives h Interlocutors Remarks

Final preparations & contacts

1
Announce the beginning of the mission and receive Ministry of Health
all necessary authorisations & documentation
Collect general information about who deals with what Ministry of Environment
i.e. try and find out who are the most relevant/important actors
2
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.
3
Visit of first health care facility

4
Visit of health care facility

5
Visit of health care facility

6
Visit of health care facility

page 5 • planning
Field assessment planning (name of mission) • (year)
Days Participants
n° Date xx xx xx xx xx Locality Objectives h Interlocutors Remarks

9
Visit of health care facility

10
Visit of health care facility

11
Visit of health care facility

12
Visit of health care facility

Visit of health care facility

13
Collection of eventual missing information

Feedback on how the mission went to Ministry of Health Ministry of Health

+ eventual request for assistance in gathering some more information
14

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

page 6 • planning
Contacts (name

send report
When person Institution

wshop
n° Title Last name First name Name Street Zip Locality tel fax

1 field
x x x Ministry of Health

2 x x x Ministry of Environment

10

11

12

13

14

15

16

17

18

19

20

21

22

page 7 • contacts
Health-care waste management • Rapid assessment tool
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
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 a
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
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 prev
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 wat
12 Handling The functions associated with the movement of waste materials.
13 Health-care wastes with Consists of materials and equipment which include heavy metals and derivatives in their structure.
high content of heavy [Includes: batteries; broken thermometers; manometers].
metals
14 Hepatitis B Hepatitis caused by a virus and transmitted by exposure to blood or blood products or during sexual intercourse. It ca
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
and primary liver cancer.
16 HIV / AIDS Human Immunodeficiency Virus, a virus transmitted through exposure to blood or blood products or during sexual inte
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 combus
18 Infection control The activities aiming at the prevention of the spread of pathogens between patients, from healthcare workers to patien
to healthcare workers in the healthcare setting.
19 Infectious health-care Discarded materials from health-care activities on humans or animals which have the potential of transmitting infectiou
waste These include discarded materials or equipment from the diagnosis, treatment and prevention of disease, assessmen
identification purposes, that have been in contact with blood and its derivatives, tissues, tissue fluids, or wastes from i
wards.
[Includes: cultures and stocks; tissues; dressings, swabs or other items soaked with blood; blood bags. Sharps, wheth
20 Open dump Characterized by the uncontrolled and scattered deposit of wastes.
21 Pharmaceutical waste Consisting of/or containing pharmaceuticals.
[Includes: pharmaceuticals expired, no longer needed; their containers, items contaminated by or containing pharmac
22 Pathogen A microorganism capable of causing disease.

page 8 • glossary + abbrev.

n° Term Definition & [includes]
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 Consisting of/or containing radioactive substances.
waste [Includes: unused liquids from radiotherapy or laboratory research; contaminated glassware, packages or absorbent p
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 commu
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 & ca
30 Sanitary landfill Characterized by the controlled and organized deposit of wastes which is then covered regularly (daily) by the staff pr
Appropriate engineering preparations of the site and a favorable geological setting (providing an isolation of wastes fr
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
steam sterilizer or autoclave.
34 Storage The placement of waste in a suitable location where isolation, environmental and health protection and human contro
control, limitation of access) are provided. This is done with the intention that the waste will be subsequently retrieved
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 th
and facilitate, or reduce the costs of, disposal. The basic treatment objective include volume reduction, disinfection, ne
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, transporta

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.

Health-care waste management • Rapid assessment tool
Tool A (recommended) Interview person in charge of association, NGO…

Organisation: Active in the field of: Address:

Name of interviewee: Function: Tel
Assessment made by: Date of assessm

c n° topic question type data comments / multiple choice

<> 9 HCW off-site transport

<> 900 transport services are there any control measures ? B [0] none; [1] transport form; [2] other
10 HCW treatment ask to be allowed to take photos of the system !
1013 waste recycling can you list any HCW recycled (by whom & how) ? T
11 HCW final disposal ask to be allowed to take photos of the place !
1103 domestic waste where is it disposed of ? T

Explanations
• 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
Health-care waste management • Rapid assessment tool (country)
Tool B-1 Interview person in charge of Ministry of Health duration: 1h00

Ministry: Department: Address:

Name of interviewee: Function: Tel. n°:
Assessment made by: Date of assessment:

c n° topic question type data comments / multiple choice

1 geographical situation & population

104 population could I get detailed demographic data of the country ? B
2 health care facility (HCF)
202 HCFs could I obtain a list of all HCFs in the country ? B if possible by category & type (Nbr. of beds), by locality / district
3 staff
300 medical staff training is training of med. staff available regarding HCWM ? B
306 medical staff numbers could I have a break down of the medical staff ? B
4 HCW generation
400 quantities of HCW produced do you have any figures at the national/local level ? B
6 HCW storage containers
= 603 colour coding do you have a specific colour coding system ? B
<> 9 HCW off-site transport
<> 900 transport services are there any control measures ? B [0] none; [1] transport form; [2] other (specify)
<> 901 type of transport who generally transports the HCW ? C [1] the HCF; [2] municipal service; [3] private company (name ?)
11 HCW final disposal ask to be allowed to take photos of the place !
1101 type of disposal site which kind of disposal site is used for the HCW ? C [1] open dump; [2] sanitary landfill; [3] small burial pit; [4] other
12 HCWM regulations (code of conduct; management plan, policy…)
1201 national HCWM regulations can we have copies of existing (draft) documents ? B
1202 national HCWM regulations does their application cause any problems ? T
13 policy and budget
1300 health system could you outline how it is organised ? T try to obtain a flowchart of the health system + responsibilities…
1301 budget allocation for HCWM do you think sufficient funds are allocated to HCWM ? B
1302 budget allocation for HCWM which % of the national health budget do you allocate ? N if there is no specific budget allocation, put 0.
1304 purchase practises is there a national policy for items used in HCWM ? B
1305 relations with other ministries with which ministry(ies) do you work on HCWM ? T
1306 cooperation with agencies with which bi(multi)lateral agencies do you cooperate ? T
1308 annual report of activities could I obtain a copy of your annual report(s) ? B try to obtain copies of the last 2-3 years

page 11 • Tool B-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 excellent (high) = 5
one or several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee). good = 4
• All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below ! satisfactory = 3
• Comments: enter any relevant comments made by the interviewee which can help better understand the problematic. insufficient = 2
• 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 "?". bad (low) = 1
• c (code): questions only necessary to ask when: HCW is segregated (=); when HCW in taken off-site (<>). non-existent = 0

Personal comments/remarks of the interviewer

page 12 • Tool B-1

Health-care waste management • Rapid assessment tool
Tool B-2 (optional) Interview person in charge of Ministry of Environment

Ministry: Department: Address:

Name of interviewee: Function: Te
Assessment made by: Date of assessm

c n° topic question type data comments / multiple choice

4 HCW generation
400 quantities of HCW produced do you have any figures at the national/local level ? B
10 HCW treatment ask to be allowed to take photos of the system !
1007 domestic waste how is it generally treated ? T
11 HCW final disposal ask to be allowed to take photos of the place !
1103 domestic waste where is it disposed of ? T
12 HCWM regulations (code of conduct; management plan, policy…)
1200 hazardous waste regulations can we have copies of existing (draft) doc. ? B
13 policy and budget
1305 relations with other ministries with which ministry(ies) do you work on HCWM ? T
1306 cooperation with agencies with which bi(multi)lateral agencies do you cooperate T
1308 annual report of activities could I obtain a copy of your annual report(s) ? B try to obtain copies of the last 2-3 ye

Explanations
• Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write d
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 13 • Tool B-2

Health-care waste management • Rapid assessment tool
Tool C Interview Person in charge of Municipal Authority

Municipality: Address:
Name of interviewee: Function: Te
Assessment made by: Date of assessm

c n° topic question type data comments / multiple choice

1 geographical situation & population

103 population how many people live in your locality ? N
400 quantities of HCW produced do you have any figures at the national/local level ? B
10 HCW treatment ask to be allowed to take photos of the system !
1007 domestic waste how is it generally treated ? T
1202 national HCWM regulations does their application pause any problems ? T

Explanations
• 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 14 • Tool C
Health-care waste management • Rapid assessment tool (country)
Tool D-1 Interview Manager or deputy of health care facility Duration: 30"

Health care facility: Address: District:

Name of interviewee: Function: Tel. n°:
Assessment made by: Date of assessment:

c n° topic question type data comments / multiple choice

2 health care facility (HCF)

200 HCF which category is it ? C [1] ambulant service; [2] (sub-)district hospital; [3] large hospital
201 HCF which type is it ? C [1] public; [2] private
[1] medicine; [2] gynaecology; [3] surgery; [4] children services
203 services which services do you have in your HCF C
[5] emergencies; [6] radiology; [7] laboratory; [8] other (specify)
204 bed capacity how many beds do you have in total ? N
3 staff
300 medical staff training is training of med. staff available regarding HCWM ? B
301 medical staff training if yes, what kind of training is given ? T
302 staff for HCWM who is in charge of HCWM in your facility ? T
303 training of responsible of HCWMwhat kind of training has this person followed ? T
306 medical staff numbers could I have a break down of the medical staff ? B
<> 9 HCW off-site transport
<> 900 transport services are there any control measures ? B [0] none; [1] transport form; [2] other (specify)
<> 901 type of transport who does generally transport the HCW ? C [1] the HCF; [2] municipal service; [3] private company (name ?)
10 HCW treatment ask to be allowed to take photos of the system !
1000 HCW treatment is it treated on-site or off-site ? C [1] on-site; [2] off-site
<> 1001 off-site HCW treatment who's in charge with the off-site treatment ? T
<> 1002 off-site HCW treatment does this organisation offer satisfactory options ? B
12 HCWM regulations (code of conduct; management plan, policy…)
1203 HCF HCWM regulations can we have copies of existing (in preparation) doc. ? B
13 policy and budget
1301 budget allocation for HCWM do you think sufficient funds are allocated to HCWM ? B
1303 budget allocation for HCWM which % of the HCF budget do you allocate ? N
1308 annual report of activities could I obtain a copy of your annual report(s) ? B try to obtain copies of the last 2-3 years

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 excellent (high) = 5
one or several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee). good = 4
• All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below ! satisfactory = 3
• Comments: enter any relevant comments made by the interviewee which can help better understand the problematic. insufficient = 2
• 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 "?". bad (low) = 1
• c (code): questions only necessary to ask when: HCW is segregated (=); when HCW in taken off-site (<>). non-existent = 0

Personal comments/remarks of the interviewer

page 16 • Tool D-1

Health-care waste management • Rapid assessment tool (country)
Tool D-2 Interview Head nurse Duration: 20"

Health care facility: Address: District:

Name of interviewee: Function: Tel. n°:
Assessment made by: Date of assessment:

c n° topic question type data comments / multiple choice

2 health care facility (HCF)

205 occupancy how many beds are currently occupied ? N
206 occupancy what is the average bed occupancy ? N
207 outpatients how many outpatients come each day on average ? N
3 staff
305 hepatitis B and tetanus do you vaccinate your personnel against them ? B
4 HCW generation
408 number of injections performed how many are done in average per day ? N
5 HCW segregation & handling
[0] no segregation;
[1] sharps; [2] infectious (non-sharp) waste; [3] anatomic waste;
500 segregation categories into which categories are HCW separated ? C
[4] pharmaceutical waste; [5] chemicals (liquid and solid);
[7] radioactive waste; [8] other (specify)
501 needle stick injuries how many cases reported in the past 12 months ? N
502 needle stick injuries if yes, what measures do you take when it happens T
503 needle handling if needles are taken off syringes, where do they go T
504 type of syringes used what type of syringes do you use ? C [1] disposable; [2] sterilisable; [3] auto-disable; [4] safety syringe
6 HCW storage containers
[0] no specific container;
600 infectious waste containers what kind of containers do you use ? C
[1] plastic; [2] metallic; [3] cardboard; [4] bag; [5] box; [6] other
[0] no specific container;
= 601 sharp containers what kind of containers do you use ? C [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 ? C [0] no shortages; [1] budget; [2] logistical; [3] other (specify)
= 603 colour coding do you have a specific colour coding system ? B
12 HCWM regulations (code of conduct; management plan, policy…)
1204 HCF HCWM regulations are there displayed written instructions ? B

page 17 • Tool D-2

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 excellent (high) = 5
down one or several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee). good = 4
• All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below ! satisfactory = 3
• Comments: enter any relevant comments made by the interviewee which can help better understand the problematic. insufficient = 2
• 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 "?". bad (low) = 1
• c (code): questions only necessary to ask when: HCW is segregated (=); when HCW in taken off-site (<>). non-existent = 0

Personal comments/remarks of the interviewer

page 18 • Tool D-2

 Cell: F17
Comment: [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)

Cell: F21
Comment: [1] disposable
[2] sterilisable
[3] auto-disable
[4] safety syringes

Cell: F23
Comment: [0] no specific container
[1] plastic
[2] metallic
[3] cardboard
[4] bag
[5] box
[6] other (specify)

Cell: F24
Comment: [0] no specific container
[1] puncture-proof
[2] not puncture-proof
[3] single use
[4] multiple use

Cell: F25
Comment: [0] no shortages
[1] budget
[2] logistical
[3] other (specify)

Cell: F26
Comment: if yes, note which colours are used for each waste category.

page 19 • Tool D-2

Health-care waste management • Rapid assessment tool
Tool D-3 Interview Person responsible for HCWM

Health care facility: Address: Dis

Name of interviewee: Function:
Assessment made by: Date of assessm

c n° topic question type data comments / multiple choice

3 staff
304 staff for HCW awareness awareness of risks of person(s) handling HCW ? Q
4 HCW generation
401 domestic waste quantity produced/day (estimated, in kg or litres) N
= 402 sharps quantity prod/day (in kg or number of sharps boxes N
= 403 infectious (non-sharp) waste quantity produced/day (estimated, in kg or litres) N
404 anatomic waste quantity produced/day (estimated, in kg or litres) N
= 405 pharmaceutical waste quantity produced/day (estimated, in kg or litres) N
= 406 chemicals (liquid and solid) quantity produced/day (estimated, in litres) N
407 radioactive waste quantity produced/day (estimated, in kg or litres) N
5 HCW segregation & handling
505 protective equipment which equipment the staff handling waste has ? C [0] none; [1] gloves; [2] boots; [3] ap
7 HCW storage area ask to be allowed to take photos of the place !
700 storage area do you have a specific area for HCW ? B
701 storage area access is the area secured ? B
702 storage area organisation are waste stored according to specific rules ? B
8 HCW collection & on-site transport
800 HCW on-site transport what kind of means do you use ? C [1] open device; [2] closed device; [3
802 injuries/accidents any reported cases in the past 12 months ? B
10 HCW treatment ask to be allowed to take photos of the system !
1003 type of HCW treatment system which kind of system is used ? C [0] none; [1] open fire; [2] incinerator
1004 capacity of HCW treatment syst. what is the current capacity of the system(s) ? N in kg/day and how often treatment is
1005 operation of HCW treatment syst. any operation problems; if so for what reasons ? C [0] none; [1] money; [2] maintenance
1006 failure of HCW treatment system what do you do when it doesn't function ? T
1007 domestic waste how is it generally treated ? T
= 1008 sharps how are they treated ? T
= 1009 infectious (non-sharp) waste how is it treated ? T

page 20 • Tool D-3

c n° topic question type data comments / multiple choice

= 1010 anatomic waste how is it treated ? T

= 1011 pharmaceutical waste how is it treated ? T
= 1012 chemicals (liquid and solid) how are they treated ? T
1013 waste recycling can you list any HCW recycled (by whom and how) T
11 HCW final disposal ask to be allowed to take photos of the place !
1100 HCW final disposal site is it on or off-site ? C [1] on-site; [2] off-site
1101 type of disposal site which kind of disposal site is used for the HCW ? C [1] open dump; [2] sanitary landfill; [3
1102 protection of disposal site is the area secured ? B
1103 domestic waste where is it disposed off? T
= 1104 segregated HCW disposal where are the different types of HCW disposed of ? T
14 sanitation & wastewater
1400 use of toilets do all patients have access/use toilets in the HCF? C [0] no facility available; [1] yes; [2] no
1401 WC connection if it's a WC, to what is it connected ? C [1] sewer; [2] septic tank; [3] open w
1402 sewer connection where does the sewerage system lead to ? C [1] wastewater treatment plant; [2] o

Explanations

• Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write d
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 21 • Tool D-3

Health-care waste management • Rapid assessment tool
Tool D-4 Interview Person handling HCW

Health care facility: Address: dis

Name of interviewee: Function:
Assessment made by: date of assessm

c n° topic question type data comments / multiple choice

5 HCW segregation & handling

501 needle stick injuries how many cases reported in the past 12 months ? N
502 needle stick injuries if yes, what measures do you take when it happens ? T
505 protective equipment which equipment does the staff handling waste has? C [0] none; [1] gloves; [2] boots; [3] ap

Explanations

• Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write d
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 22 • Tool D-4

Health-care waste management • Rapid assessment tool
Tool E Personal observations

Health care facility: Address: distr

Assessment made by: date of assessme

c n° topic question type data comments / multiple choice

1 geographical situation & population

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

7 HCW storage area ask to be allowed to take photos of the place !

8 HCW collection & on-site transport

10 HCW treatment ask to be allowed to take photos of the system !

<> 1002 off-site HCW treatment does this organisation offer satisfactory options ? B
11 HCW final disposal ask to be allowed to take photos of the place !
1102 protection of disposal site is the area secured ? B
1105 syringes present on site is there evidence of partially treated syringes ? B
1106 infectious waste present on site is there evidence of partially treated inf. HCW ? B

Explanations

• 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 23 • Tool E
Health-care waste management • Rapid assessment tool (country)
Tool F 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);
• 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 national HCFs visited

n° topic question answer point level big medium small total

0 HCFs general information

HCFs by category number visited 0
HCFs by category total number in country total 0
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 who is in charge of HCWM in your facility ? if nobody 1 0
303 training of responsible of HCWM what kind of training has this person followed ? if none 1 0
304 staff for HCW awareness awareness of risks of person(s) handling HCW ? if the value of Q ≤ 2 1 0
305 hepatitis B and tetanus do you vaccinate your personnel against them ? no 1 0
total points 4 0 0 0 0 0
national equivalent points 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
national equivalent % #DIV/0! #DIV/0! #DIV/0! #DIV/0!
5 HCW segregation & handling
500 segregation categories into which categories is HCW separated ? no segregation 1 0
505 protective equipment which equipment does the staff handling waste have if none 1 0
total points 2 0 0 0 0
national equivalent points #DIV/0! #DIV/0! #DIV/0! #DIV/0!
national equivalent % #DIV/0! #DIV/0! #DIV/0! #DIV/0!

page 24 • Tool F
Data entry table national HCFs visited

n° topic question answer point level big medium small total

6 HCW storage containers

600 infectious waste containers what kind of containers do you use ? if no specific container 1 0
601 sharp containers what kind of containers do you use ? if no rigid container 1 0
602 shortage of sharps containers for what reasons are there shortages, if any ? if any shortages 1 0
total points 3 0 0 0 0
national equivalent points #DIV/0! #DIV/0! #DIV/0! #DIV/0!
national equivalent % #DIV/0! #DIV/0! #DIV/0! #DIV/0!
7 HCW storage area
701 storage area access is area secured (only accessible for authorised pers.) no 1 0
total points 1 0 0 0 0
national equivalent points #DIV/0! #DIV/0! #DIV/0! #DIV/0!
national equivalent % #DIV/0! #DIV/0! #DIV/0! #DIV/0!
8 HCW collection & on-site transport
801 HCW collection & on-site transpo do you think current practices offer sufficient security no 1 0
total points 1 0 0 0 0 0
national equivalent points 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
national equivalent % #DIV/0! #DIV/0! #DIV/0! #DIV/0!

page 25 • Tool F
Data entry table national HCFs visited

n° topic question answer point level big medium small total

9 HCW off-site transport

900 transport services are there any control measures ? no 1 0
total points 1 0 0 0 0 0
national equivalent points 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
national equivalent % #DIV/0! #DIV/0! #DIV/0! #DIV/0!
10 HCW treatment
1002 off-site HCW treatment does this organisation offer satisfactory options ? no 1 0
1008 sharps how are they treated ? if no treatment 1 0
1009 infectious (non-sharp) waste how is it treated ? if no treatment 1 0
1011 pharmaceutical waste how is it treated ? if no treatment 1 0
total points 4 0 0 0 0
national equivalent points #DIV/0! #DIV/0! #DIV/0! #DIV/0!
national equivalent % #DIV/0! #DIV/0! #DIV/0! #DIV/0!
11 HCW final disposal
1101 type of disposal site which kind of disposal site is used for the HCW ? if [1] 1 0
1105 syringes present on site is there evidence of partially treated syringes ? yes 1 0
1106 infectious waste present on site is there evidence of partially treated inf. HCW ? yes 1 0
total points 3 0 0 0 0
national equivalent points #DIV/0! #DIV/0! #DIV/0! #DIV/0!
national equivalent % #DIV/0! #DIV/0! #DIV/0! #DIV/0!
12 HCWM regulations (code of conduct; management plan, policy…)
1201 national HCWM regulations can we have copies of existing (draft) documents ? no documents existing 1 0
1203 HCF HCWM regulations can we have copies of existing (in preparation) doc. ?no documents existing 1 0
1204 HCF HCWM regulations are there displayed written instructions ? no 1 0
total points 2 0 0 0 0 0
national equivalent points 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
national equivalent % #DIV/0! #DIV/0! #DIV/0! #DIV/0!

page 26 • Tool F
Data entry table national HCFs visited

n° topic question answer point level big medium small total

13 policy and budget

1301 budget allocation for HCWM do you think sufficient funds are allocated to HCWM ?no 1 0
total points 1 0 0 0 0 0
national equivalent points 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
national equivalent % #DIV/0! #DIV/0! #DIV/0! #DIV/0!
14 sanitation & wastewater
1401 use of toilets do all patients use the toilets in the HCF ? no 1 0
1402 sewer connection where does the sewerage system lead to ? if [2] or [3] 1 0
total points 2 0 0 0 0
national equivalent points #DIV/0! #DIV/0! #DIV/0! #DIV/0!
national equivalent % #DIV/0! #DIV/0! #DIV/0! #DIV/0!

overall situation at national level

total points 24 0 0 0 0 0
national equivalent points 5 #DIV/0! #DIV/0! #DIV/0! #DIV/0!
national equivalent % 0% #DIV/0! #DIV/0! #DIV/0! #DIV/0!

page 27 • Tool F
Data entry table national HCFs visited

n° topic question answer point level big medium small total

Summary table
n° topic level / category situation comments / suggestions
at national level #DIV/0!
big = large hospitals #DIV/0!
3 staff (and training)
medium = (sub-)district hospitals #DIV/0!
small = ambulant services #DIV/0!
at national level #DIV/0!
big = large hospitals #DIV/0!
5 HCW segregation & handling
medium = (sub-)district hospitals #DIV/0!
small = ambulant services #DIV/0!
at national level #DIV/0!
big = large hospitals #DIV/0!
6 HCW storage containers
medium = (sub-)district hospitals #DIV/0!
small = ambulant services #DIV/0!
at national level #DIV/0!
big = large hospitals #DIV/0!
7 HCW storage area
medium = (sub-)district hospitals #DIV/0!
small = ambulant services #DIV/0!
at national level #DIV/0!
big = large hospitals #DIV/0!
8 HCW collect. & on-site transp.
medium = (sub-)district hospitals #DIV/0!
small = ambulant services #DIV/0!
at national level #DIV/0!
big = large hospitals #DIV/0!
9 HCW off-site transport
medium = (sub-)district hospitals #DIV/0!
small = ambulant services #DIV/0!

page 28 • Tool F
Data entry table national HCFs visited

n° topic question answer point level big medium small total

at national level #DIV/0!

big = large hospitals #DIV/0!
10 HCW treatment
medium = (sub-)district hospitals #DIV/0!
small = ambulant services #DIV/0!
at national level #DIV/0!
big = large hospitals #DIV/0!
11 HCW final disposal
medium = (sub-)district hospitals #DIV/0!
small = ambulant services #DIV/0!
at national level #DIV/0!
HCWM regulations (code of
big = large hospitals #DIV/0!
12 conduct; management plan,
policy…) medium = (sub-)district hospitals #DIV/0!
small = ambulant services #DIV/0!
at national level #DIV/0!
big = large hospitals #DIV/0!
13 policy and budget
medium = (sub-)district hospitals #DIV/0!
small = ambulant services #DIV/0!
at national level #DIV/0!
big = large hospitals #DIV/0!
14 sanitation & wastewater
medium = (sub-)district hospitals #DIV/0!
small = ambulant services #DIV/0!

at national level #DIV/0!

overall situation at national big = large hospitals #DIV/0!
level medium = (sub-)district hospitals #DIV/0!
small = ambulant services #DIV/0!

Personal comments/remarks of the interviewer

page 29 • Tool F
Data entry table national HCFs visited

n° topic question answer point level big medium small total

page 30 • Tool F
Health care waste management • data collection
Inventory of all questions

c n° topic question type data comments / multiple choice

1 geographical situation & population

100 area type in which area is the facility located ? C [1] urban, [2] peri-urban, [3] rural
101 area geography in which area is the facility located ? T climatic, topographical specifications if relevan
102 cultural practices are there any that must be taken in consideration? T
103 population how many people live in your locality ? N
104 population could I get detailed demographic data / country? B
2 health care facility (HCF)
200 HCF which category is it (are they) ? C [1] ambulant service; [2] (sub-)district hospital;
201 HCF which type is it (are they) ? C [1] public; [2] private
202 HCFs could I obtain a list of all HCFs in the country ? B if possible by category & type (Nbr. bed), by lo
[1] medicine; [2] gynaecology; [3] surgery; [4] c
203 services which services do you have in your HCC C
[5] emergencies; [6] radiology; [7] laboratory; [8
204 bed capacity how many beds do you have in total ? N
205 occupancy how many beds are currently occupied ? N
206 occupancy what is the average bed occupancy ? N
207 outpatients how many outpatients come each day on average? N
3 staff
300 medical staff training is training of med. staff available regarding HCWM ? B
301 medical staff training if yes, what kind of training is given ? T
302 staff for HCWM who is in charge of HCWM in your facility ? T
303 training responsible of HCWM what kind of training has this person followed ? T
304 staff for HCW awareness awareness of risks of person(s) handling HCW ? Q
305 hepatitis B and tetanus do you vaccinate your personnel against them ? B
306 medical staff numbers could I have a break down of the medical staff ? B
4 HCW generation
400 quantities of HCW produced do you have any figures at the national/local level? B
401 domestic waste quantity produced/day (estimated, in kg or litres) N
= 402 sharps quantity prod/day (in kg or nbr. of sharps boxes) N
= 403 infectious (non-sharp) waste quantity produced/day (estimated, in kg or litres) N
404 anatomic waste quantity produced/day (estimated, in kg or litres) N
= 405 pharmaceutical waste quantity produced/day (estimated, in kg) N
= 406 chemicals (liquid and solid) quantity produced/day (estimated, in litres) N
407 radioactive waste quantity produced/day (estimated, in kg) N

page 31 • questions
c n° topic question type data comments / multiple choice

408 number of injections performed how many are done in average per day ? N
5 HCW segregation & handling
[0] no segregation;
[1] sharps; [2] infectious (non-sharp) waste; [3]
500 segregation categories into which categories are HCW separated ? C
[4] pharmaceutical waste; [5] chemicals (liquid
[7] radioactive waste; [8] other (specify)
501 needle stick injuries how many cases reported in the past 12 months ? N
502 needle stick injuries if yes, what measure do you take when it happens? T
503 needle handling if needles are taken off syringes, where do they go? T
504 type of syringes used what type of syringes do you use? C [1] disposable; [2] sterilisable; [3] auto-disable;
505 protective equipment which equipment does the staff handling waste has? C [0] none; [1] gloves; [2] boots; [3] apron; [4] tro
6 HCW storage containers
[0] no specific container;
600 infectious waste containers what kind of specific containers do you use ? C
[1] plastic; [2] metallic; [3] cardboard; [4] bag; [
[0] no specific container;
= 601 sharp containers what kind of specific containers do you use ? C [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 ? C [0] no shortages; [1] budget; [2] logistical; [3] ot
= 603 colour coding do you have a specific colour coding system ? B
7 HCW storage area ask to be allowed to take photos of the place !
700 storage area do you have a specific area for HCW ? B
701 storage area access is the area only accessible for authorised pers. B
702 storage area organisation are waste stored according to specific rules ? B
8 HCW collection & on-site transport
800 HCW on-site transport what kind of means do you use ? C [1] open device; [2] closed device; [3] other (sp
801 HCW collection & on-site trans. do you think current practices offer enough security? B
802 injuries/accidents any reported cases in the past 12 months ? B
<> 9 HCW off-site transport
<> 900 transport services are there any control measures ? B [0] none; [1] transport form; [2] other (specify)
<> 901 type of transport who generally transports the HCW ? C [1] the HCF; [2] municipal service; [3] private c
10 HCW treatment ask to be allowed to take photos of the system !
1000 HCW treatment is it treated on-site or off-site ? C [1] on-site; [2] off-site
<> 1001 off-site HCW treatment who's in charge with the off-site treatment ? T
<> 1002 off-site HCW treatment does this organisation offer satisfactory options ? B
1003 type of HCW treatment syst. which kind of system is used ? C [0] none; [1] open fire; [2] incinerator; [3] chem
1004 capacity of HCW treatment syst. what is the current capacity of the system(s) ? N in kg/day
1005 operation HCW treatment syst. any operation problems; if so for what reasons ? C [0] none; [1] money; [2] maintenance; [3] spare
1006 failure of HCW treatment syst. what do you do when it doesn't function ? T

page 32 • questions
c n° topic question type data comments / multiple choice

1007 domestic waste how is it generally treated ? T

= 1008 sharps how are they treated ? T
= 1009 infectious (non-sharp) waste how is it treated ? T
= 1010 anatomic waste how is it treated ? T
= 1011 pharmaceutical waste how is it treated ? T
= 1012 chemicals (liquid and solid) how are they treated ? T
1013 waste recycling can you list any HCW recycled (by whom & how)? T
11 HCW final disposal ask to be allowed to take photos of the place !
1100 HCW final disposal site is it on or off-site ? C [1] on-site; [2] off-site
1101 type of disposal site which kind of disposal site is used for the HCW ? C [1] open dump; [2] sanitary landfill; [3] small bu
1102 protection of disposal site is the area secured ? B
1103 domestic waste where is it disposed off? T
= 1104 segregated HCW disposal where are the different types of HCW disposed of ? T
1105 syringes present on site is there evidence of partially treated syringes ? B
1106 infectious waste present on site is there evidence of partially treated inf. HCW ? B
12 HCWM regulations (code of conduct; management plan, policy…)
1200 hazardous waste regulations can we have copies of existing (draft) documents? B
1201 national HCWM regulations can we have copies of existing (draft) documents? B
1202 national HCWM regulations does their application cause any problems ? T
1203 HCF HCWM regulations can we have copies of existing, in preparation doc.? B
1204 HCF HCWM regulations are there displayed written instructions ? B
13 policy and budget
1300 health system could you outline how it is organised ? T try to obtain a flowchart of the health system +
1301 budget allocation for HCWM do you think sufficient funds are allocated to HCWM? B
1302 budget allocation for HCWM which % of national health budget do you allocate? N if there is no specific budget allocation, put 0.
1303 budget allocation for HCWM which % of the HCF budget do you allocate ? N
1304 purchase practises is there a national policy for items used in HCWM ? B
1305 relations with other ministries with which ministry(ies) do you work on HCWM ? T
1306 cooperation with agencies with which bi(multi)lateral agency do you cooperate? T
1307 hazardous waste management which national agencies work on this topic ? T
1308 annual report of activities could I obtain a copy of your annual report(s) ? B try to obtain copies of the last 2-3 years
14 sanitation & wastewater
1400 use of toilets do all patients have access/use toilets in the HCF? C [0] no facility available; [1] yes; [2] no
1401 WC connection if it's a WC, to what is it connected ? C [1] sewer; [2] septic tank; [3] open water source
1402 sewer connection where does the sewerage system lead to ? C [1] wastewater treatment plant; [2] open water

page 33 • questions