Post00264 HEALTHCARE WASTE MANAGEMENT 4 July 2000
CONTENTS
1. NEW: WORLD BANK HEALTHCARE WASTE MANAGEMENT GUIDANCE NOTE
Marcia Rock, WB/PHTG/HDN/HNP, has kindly posted the Banks' recent health
care waste management guidelines. The text of the executive summary follows
Marcia's introduction.
This document compliments the WHO waste management strategy and guidelines
posted in Technet Forum Post00259, 20 June 2000.
___________________________________________________________________________
The file is available for download in Adobe acrobat PDF format.
The free viewer is available from www.adobe.com
To get the file go to the website
ftp://ftp.acithn.uq.edu.au/Technet/1-ClickHereForTECHNETfiles/Waste
then click on the file name: HealthCareWasteGuidelinesWB-6March2000.PDF
or by email:
Send an email to: [[email protected]][email protected][/email]
With the message:
get technet HealthCareWasteGuidelinesWB-6March2000.PDF
___________________________________________________________________________
From: [[email protected]][email protected][/email]
Subject: HealthCare Waste Management Guidance Note
To: Allan Bass
Date: Wed, 28 Jun 2000
Allan,
Here is the World Bank draft Health Care Waste Management Guidance Note for
posting on the Technet Forum. It is authored by Lars Mikkel Johannessen,
Marleen Dijkman and Candace S. Chandra with input from David Hanrahan, Carl
Bartone and many others.
It intends to complement WHO's waste management note, and is primarily for
Bank task managers, but contains information that is useful to a nonBank
audience as well. As the author's note states:
"This guidance note should be viewed as an internal World Bank working
document that attempts to synthesize the currently available knowledge and
information in the field of healthcare waste management. There is much
interest, but a lack of practical information, in this rapidly developing
field. WHO has just released technical guidelines for healthcare
facilities and waste management projects. These relatively comprehensive
and explicit guidelines (Safe Management of Wastes From Health-care
Activities, WHO, 1999) are the technical basis for this guidance note. In
the meantime, we hope that this guidance note will help to fill the current
information gap on specific issues relative to the World Bank."
The Bank's work in this area is in progress. Further material is being
developed and will be released in the weeks ahead.
Best regards,
Marcia Rock
Marcia N. Rock
Operations Analyst, Public Health Thematic Group
Human Development Network, Health Nutrition and Population
Room #G3-079
phone 202.473-5425
email [[email protected]][email protected][/email]
The World Bank 1818 H St. N.W. Wash., D.C. 20433
___________________________________________________________________________
Extracts of Healthcare Waste Management Guidance Note
___________________________________________________________________________
HEALTHCARE WASTE MANAGEMENT GUIDANCE NOTE
January 12, 2000
Lars Mikkel Johannessen
Marleen Dijkman
Candace S. Chandra
http://www.worldbank.org/?
The World Bank
Revised March 2000
TWU/ENV/HNP Anchor Teams
The World Bank
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Table of Contents
Abbreviations Used in This Report
Authors' Note and Acknowledgment
1. Scope of the Problem
1.1 Healthcare Waste and its Management
1.2 Definition of Healthcare Waste Types
1.3 How to Use These Guidance Notes
1.4 Policy Options and a Decision Tree for Health Care Waste Management
2. Guidance for Small Healthcare Facilities with Minimal Resources
2.1 Small Facility Assessment Checklist
2.2 Basic Steps in HCW Management at Small Facilities
3. Guidance for Large Healthcare Facilities
3.1 Large Facility Assessment Checklist
3.2 Basic Steps in HCW Management at Large Facilities
4. Guidance for Municipal, Metropolitan and Regional Healthcare
Waste Projects
4.1 Regional Healthcare Waste Sector Assessment
4.2 Planning New Regional Waste Management Projects
5.Guidance for National Healthcare Waste Projects
5.1 National Sector Assessment
5.2 A National Strategy and Action Plan for HCW Management
6. Information Sources and Bibliography
Annexes
Annex A.Healthcare Waste Terms Used in this Report
A.1 Types of Healthcare Waste
A.2 Types of Healthcare Facilities
Annex B. Management Issues
B.1 Authorities Involved in Healthcare Waste Management
B.2 Role of the Private Sector
Annex C. National and International Healthcare Waste Regulations
Annex D. Technology Considerations for Special HCW Treatment and Disposal
D.1 Technology Options
D.2 Dioxins and Related Compounds
Annex E. Cost Considerations for Waste Treatment and Disposal
Annex F. Conducting Environmental Assessments
Annex G. Packaging Options
Annex H. Sample Terms of Reference: Feasibility Study for Regional HCW
Management
M.1 Emergency Situations
M.2 Long Term Care
Annex Tables
A1:Types of Healthcare Waste
D1:Technical Requirements for Treatment and Disposal of Special HCW
D2:Treatment and Final Disposal Technologies for Special HCW
D3:Comparisons with Technical Requirements
E1:Estimates of Capital Costs per Ton of Treatment Capacity/Various
Treatment Options
E2:Treatment and Disposal Costs per Ton of Special HCW/Selected Countries
E3:Average Treatment and Disposal costs for Special HCW/ Selected Cities
G1:Packaging Requirements for HCW and for Different Types of Treatment
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1. SCOPE OF THE PROBLEM
Healthcare Waste and its Management
Healthcare waste typically derives from two sources in developing
countries: emergency relief donations (leftover from international
donor response to either a humanitarian crisis or a natural
disaster) and long term healthcare services. Healthcare services
aim to reduce health problems and to prevent potential health
risks. In doing so, however, waste is often generated that is
potentially harmful to public health and the environment. Leftover
emergency relief donations normally create a one-time healthcare
waste issue, and can be dealt with in much the same way as long
term healthcare services waste.
In several countries, where many health concerns often compete for
very limited resources, the management of healthcare waste may not
get the priority it deserves. The goal of this guidance note is to
raise awareness of the importance of proper healthcare waste (HCW)
management, help define the various types of healthcare waste, and
offer practical guidance on ways to assess and improve HCW
management in a variety of settings. This note intends to serve an
internal World Bank audience.
Definition of Healthcare Waste Types
Most waste generated in healthcare establishments can be treated as
regular solid municipal waste. But a varying proportion of HCW
requires special attention, including sharps (e.g. needles, razors,
scalpels), pathological waste, other potentially infectious waste,
pharmaceutical waste, biological waste, and hazardous chemical
waste. Collectively, these wastes are known as "special healthcare
waste". In addition, all waste generated under certain
circumstances, such as in isolation wards and microbiological
laboratories, requires special attention. (See Annex A for the WHO
definition of special healthcare waste and its components.) Other
waste streams generated by HCW could include packaging, reusable
medical equipment, and secondary waste created through disposal
technologies.
The mismanagement of healthcare waste poses risks to people and the
environment. Healthcare workers, patients, waste handlers, waste
pickers, and the general public are exposed to health risks from
infectious waste (particularly sharps), chemicals, and other
special HCW. Improper disposal of special HCW, including open
dumping and uncontrolled burning, increases the risk of spreading
infections and of exposure to toxic emissions from incomplete
combustion. For these reasons, occupational health and safety
should be a component of HCW management plans.
Transmission of disease generally occurs through injuries from
contaminated sharps. Infections of particular concern are Hepatitis
B (HBV), Hepatitis C (HCV), and the human immunodeficiency virus
(HIV). HBV, for example, can remain infectious for a week, even
dried at room temperature, and the probability that a single needle
stick will result in sero-conversion is approximately 30 percent.
For HIV and HCV, the probability that a single needle stick will
result in sero-conversion is 0.3-0.5 percent and 2-5 percent,
respectively (WHO, 1997). In the healthcare sector alone, the
World Health Organization estimates that unsafe injections cause
approximately 30,000 new HIV infections, 8 million HBV infections,
and 1.2 million HCV infections worldwide every year. Toxic risks
arise among others from reagents (particularly laboratory
reagents), drugs, and mercury thermometers (CEC, 1993).
Furthermore, sensitivity is needed in the management of special HCW
when dealing with biological waste. Many cultures have definite
views on the disposal and burial of body parts. It is important to
consider cultural factors in the disposition plans of special HCW.
Additionally, appropriate consideration of local community
perception in the proposed waste management plan for all HCW is
integral to a sustainable disposition plan. This includes proper
consideration of a reliable waste management plan for the community
(Essential Waste Management Plan). Quite often, rural health care
facilities will utilize different methods of waste management from
urban health facilities.
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Proper management of HCW can minimize the risks both within and
outside healthcare facilities. The first priority is to segregate
wastes, preferably at the point of generation, into reusable and
non-reusable, hazardous and non-hazardous components. Other
important steps are the institution of a sharps management system,
waste reduction, avoidance of hazardous substances whenever
possible (e.g. PVC-containing products, mercury thermometers),
ensuring worker safety, providing secure methods of waste
collection and transportation, and installing safe treatment and
disposal mechanisms.
Generally, there are four key steps to HCW management: 1)
segregation into various components, including reusable and safe
storage in appropriate containers; 2) transportation to waste
treatment and disposal sites (see Annex B2); 3) treatment (see
Annex D2); and 4) final disposition.
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