Presentation for safhe april 2014

1. Planning for HCWM
SAFHE April 2014
By: Janet Magner
Magner Risk Services
Acknowledgement: Infrastructure Unit Support Systems
(IUSS) Project dated 04/10/2013; Development Draft 1.0

2. Set the Scene
— What is HCW?
— Basic principles:
— Waste Management Hierarchy
— Integrated waste management
— 7 Steps of Cradle-to-Grave Process

3. Category
Class No. as
per SANS
10228 and
Annex D of
SANS
10248*
Hazard Type
as per SANS
10228*
Hazard Rating
as per DWAF
Minimum
Requirements
** and Annex
D of SANS
10248
Sub-category as per
SANS 10248***
/Examples
Colour Coding
for packaging
as per S.7
Table 1 of
SANS 10248***
Hazard Label as per
Annex D of SANS
10248***
Human body parts Red Infectious hazard label
Animal body parts Orange Infectious hazard label
Non-infectious animal
anatomical
Blue
Infectious non-
anatomical
6,2 infectious 1
Includes all material
contaminated with material
suspected to contain
pathogens
Red Infectious hazard label
Sharps 6,2 Infectious 1
Needles, Blades, needles
with or without tubing,
broken clinical glass, blood
vials, ampoules
Yellow
"Danger" "Contaminated
Sharps" and the Infectious
hazard label
6,1 Gas 1 Danger hazard label
3 Flammable 1-4 Flammable hazard label
5 Oxidising 1-4 Oxidising hazard label
6,1 Toxic 1 Cytoxic Hazard label
8 Corrosive Corrosive hazard label
Radioactive 7
Ionising
radiation
1 Nuclear medicine, oncology None Radioactive hazard label
* South African National Standards (SANS) 10228:2006 Fourth Edition ; The identification of dangerious goods for transport
** Department of Water Affairs (DWAF) Minimum requirements for the handling, classification and disposal of hazardous waste; Waste management series; Second Edition 1998
*** South African National Standards (SANS) 10248-1:2008 First Edition; Management of Healthcare waste: Part 1 Management of health care waste for healthcare facilities
Categories of Health Care Risk Waste
Dark Green
6,2 1Infectious
Pharmaceutical, cytotoxic
pharmaceutical and various
chemicals
Chemical and
Pharmaceutical
Infectious
Anatomical

4. ©
Icando
&
Magallan
Risk
Services
Avoid waste first
Minimise through reuse and
recycling
Treat
Landfill
Energy Recovery
Treat
Disposal
Hierarchy of waste managementOrderofincreasingimportance

5. The 7 Steps
Step 7: Treatment
and Disposal
Cradle to Grave
Process
Integrated Health Care Waste Management
Storage of
consumable items
Green Procurement and procurement of equipment and consumables for HCWM
Steps 1-3:
Generation,
segregation,
containerisation
and Interim
Storage
Step 4: Internal
transport
Step 5: Central
Storage
Step 6: External
Transport
Internal transport for the of HCGW
categories
Internal transport
for the categories of
HCRW
Health Care Waste
Reuse Recycle Remaining
HCGW
Categories of
HCRW (Solid)
Categories of
HCRW (Liquid)
Health Care Risk
Waste Non-Hazardous Health Care General
Waste
Other Hazardous
Waste
External collection
and Transport by
contracted Service
Provider
External
collection and
transport
Municipality
- Infectious/highly infectious
(solid & liquid)
- Anatomical
- Sharps
- Pathological (Lab)
- Pharmaceutical
- Radiocative
- Cytotoxic/Genotoxic
Some items
require a
system for
cleaning e.g.
reusable
containers.
Non-clinical
glass
Paper
Cardboard
Containers
Reuse
Bottles,
Paper
Cardboard
Tins
Plastic
bottles etc
Recycle
remaining
items of
HCGW
(including
food for
disposal
Remaining
HCGW
- Mercury
- Silver
- Asbestos
- flurorescent tubes
- Chemicals
- Grease
- Oil
- Paints
- Solvents
- Batteries
- Electronic waste
External
collection and
transport by
contracted SP
External collection
and transport by
contracted SP
Disposal of residue of
treatment to a
hazardous (H:H or
H:h) landfill site.
Disposal of
HCGW to a non-
hazardous
Landfill site.
To sewer Disposal of residues
of treatment and/or
disposal to a H:H or
H:h landfill site.
Treatment through
burn or non-burn
technologies
Reprocessing
of recycled
materials.
Only that with a
pH values >6 to
<10
Some reprocessing for
recycling
Some for disposal

6. Where is the HCWM Industry
at present?
— Focus on Illegal dumping
— Focus on Treatment Facilities
— Focus on good segregation
— Focus on training

7. Historical focus on
Segregation
— Continual focus on good segregation
— The results research conducted in two projects:
— National Solid Waste Management Strategy for
Swaziland - Mbabane Hospital (2000 – 2001)
— Sustainable health care waste management in
Gauteng - Leratong and Itireleng (2000 – 2003)

8. Result of the research on
segregation
1. Insufficient containers and / or liners at point of generation
2. Inconsistent colour coding
3. No disposable containers
4. Incorrect type, sizes of containers used
5. Incorrect placing of equipment
6. Poor inter-relations between departments
7. Poor job performance
8. Non-adherence to colour coding
9. lack of people management and accountability
10. lack of regular monitoring and supervision

9. Historical focus on Training
— Training frequently considered as the panacea for
all the ails the industry
— Training cannot be effective in isolation

11. So, what are the critical shifts?
1. Impact that procurement has on all the 7 steps
2. Impact that poor storage facilities at dispatch has on
ability to plan and provide containers at source
3. Impact that poor segregation has on internal and
external collection, transport and treatment
4. Impact that lack of adequate interim storage has on
internal transport and within the hospital environment
5. Impact of inadequate internal transportation systems
6. Impact that the Central Storage has on the hospital
environment and external collection and transportation

12. 1. Impact of Procurement on
7 steps of cradle-to-grave
— Correct containers for the type of waste
— Supplied at the right time
— Types of containers purchased impacts on placement
— Interim storage requirements are determined by the type of size
of containers (or vice versa)
— Internal transport needs are determined by the type of
containers used
— The types and sizes of containers used to store the waste will
impact on the size of the Central Storage area
— External transport needs to cater for the type of container
— The containers (whether single use or reusable) impact on how
treatment is carried out

13. Procurement needs
— Knowledge of the types, sizes and colours of
containers required
— Budget to purchase the necessary items
— Good stock control system in place to maintain a
consistent supply and order before stock runs out
— Sufficient stock for emergency situations
— Ordering routines set up in accordance with usage,
size of the facility and delivery delays

14. 2. Impact of poor storage
facilities at dispatch store
— Inadequate storage for new items resulting in the
need to keep small quantities of consumable items
— Ordering required to be done on more frequent
intervals
— Poor security at storage areas

15. • Uncontrolled stock levels in
units
• Stores not aware of the impact
Before: After:
• Sufficient
stock
for
levels
in
the
central
warehouse
Regular
supply
and
good
stock
control

16. Storage needs at dispatch
store
— Storage needs for consumable items planned.
— Size determined by quantities generated
— Access for delivery vehicle with sufficient space for
turning circles
— Storage space sufficient in size to accommodate 2 – 3
months supply
— Storage requirements for new reusable containers
awaiting distribution.
— Secure store, sufficient venitlation, good lighting,
protection from the elements, (closed brick building)

17. 1
10
100
1,000
0 1,000 2,000 3,000 4,000 5,000 6,000 7,000
Storagearearequired-m2(logarithmicscale)
Daily HCRW mass generation - kgs
180
120
90
60
30
Stock-
holding
(days):
Storage area required for consumableHCRW containers at
hospitals and MOUs
120
180
90
60
30

18. 3. Impact of poor segregation
— Injury to collection and transport staff
— Additional expense incurred due to larger quantities
required to be incinerated
— Larger items such as gas cylinders thrown into the
waste
— Dumping of HCRW on landfill as HCGW
— Access of children to infectious waste and sharps

19. Support needs for good
segregation
— Supply of sufficient containers for all categories of HCW
generated
— Correct placing for easy access on walls and floor
— Brackets on walls, baskets or containers on floors, dressing
trolleys and/or other means for getting the waste containers
to source
— Sufficient height where containers are safe and not accessible
to children
— Small autoclaves in laboratories provided to reduce highly
infectious waste
— Space for wheelie bins or trolleys to maneuver during internal
transport
— Regular removal of full containers with frequency determined
by the quantities of HCW generated

20. 4. Impact of lack of
adequate interim storage
— Build-up of HCRW within the wards
— Exposure to patients and visitors
— Infection control compromised

21. Interim storage needs
— Temporary storage of the size to accommodate the
generation of 2 – 3 days of HCRW (over weekends or
when the internal collection does not happen)
— Sufficient in size to accommodate both HCRW and
HCGW.
— Able to accommodate the containers for each category
of waste generated in the HC Facility. (Plastic boxes in
smaller units, wheelie bins in larger units)
— Space for refrigeration of anatomical waste if the need
to store for longer than 24 hours.
— Space required for the storage of pathological in
laboratories and pharmaceutical waste in pharmacies
— Well ventilated, adequate light, smooth surfaces, good
ventilation

23. 5. Impact of poor internal
collection and transport
— Exposure of HCRW to patients and visitors
— Exposure to staff transporting
— Infection Control principles compromised

24. Needs for Internal Transport
— HCRW and HCGW transported separately
— Larger HC Facilities can have a separate service
route/lifts
— Routes and lifts large enough to allow for size of
containers and turning circles
— Trolleys provided sufficient support
— Ramps/slopes provided instead of steps
— Provision made for motorised transport in larger
hospitals

27. 6. Impact of poor central
storage facilities
— Accumulation of HCW in all different areas of the
HC Facility
— More frequent collections required
— Access to HCRW by patients and visitors
— Infection control principles compromised
— Injury to staff and transporters
— Cleaning of reusable containers not carried out
regularly

28. Central Storage Area needs
— Size of the storage area determined by the
quantities of waste generated over a given period
and the specified frequency of collection
— Space requirements are also determined by the
size of the reusable bins (wheelie bins in larger
facilities or plastic boxes in smaller facilities)
— Freezer or cold room (2 degrees C or less) required
for the storage of anatomic al waste if stored for
longer than 24 hours
— .

29. -
500
1,000
1,500
2,000
2,500
3,000
0 1,000 2,000 3,000 4,000 5,000 6,000 7,000
Usablebeds
Daily HCRW mass generation (kg)
Central Hospital
60%
80%
100%
Bed
occupancy:
0
200
400
600
800
1,000
1,200
1,400
0 1,000 2,000 3,000 4,000 5,000 6,000 7,000
Storagearearequiredm2
30
16
9
7
5
4
3
Collection
interval
(days):
Storage area
required for
full 100 L
re-usable box
containers
3
7
5
4
16
9
30
0
200
400
600
800
1,000
1,200
1,400
1,600
0 1,000 2,000 3,000 4,000 5,000 6,000 7,000
Storagearearequiredm2
30
16
9
7
5
4
3
Collection
interval
(days):
Storage area
required for
full 770 L
wheelie-bins
7
5
3
9
4
1630

30. Central Storage Area needs
— Both HCGW and HCRW is required to be stored for periods of
time
— Ideal to have an area that can accommodate the full spectrum
of HCW (including recycling)
— Reduction of HCGW can be achieved by having waste
compactors on site in the larger hospitals
— Provision for clean and dirty areas
— Provision for scales
— Provision made for the storage of oil, grease, thinners, paint
etc.
— Provision made for the storing and collection of recycled
items

31. Central Storage Area needs
— Provision made for good ventilation and lighting,
easy cleaning and drainage, emergency lighting,
access control, signage.
— Easy access to the area for wheelie bins, and
vehicles of different sizes
— Provision made for cleaning of reusable containers

33. Summary
The nursing staff are the proverbial ham in the
sandwich where HCWM is concerned.
They cannot effectively operate without:
— Proper procurement and dispatching facilities and
procedures for the regular supply of containers
— The full support of hospital services for the
provision of adequate facilities and systems