01 Bio Med Wast
01 Bio Med Wast
01 Bio Med Wast
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.
Contacts
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.
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.
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
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
13
Collection of eventual missing information
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
Abbreviations
n° abbreviation definition
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 (<>).
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
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 (<>).
Municipality: Address:
Name of interviewee: Function: Te
Assessment made by: Date of assessm
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 (<>).
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"
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.
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
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 (<>).
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 (<>).
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 (<>).
page 23 • Tool E
Health-care waste management • Rapid assessment tool (country)
Tool F Rating at national level
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.
page 24 • Tool F
Data entry table national HCFs visited
page 25 • Tool F
Data entry table national HCFs visited
page 26 • Tool F
Data entry table national HCFs visited
page 27 • Tool F
Data entry table national HCFs visited
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
page 29 • Tool F
Data entry table national HCFs visited
page 30 • Tool F
Health care waste management • data collection
Inventory of all questions
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
page 33 • questions