HCWM in small HCFs

Small HCFs, typically primary healthcare centres (PHCs) are particular cases in that they produce both limited quantities and types of hazardous HCW (mainly sharps, infectious waste and some pharmaceuticals, etc.).

Human and financial resources being often very limited the management of waste at this level is usually dealt with by the doctor/ nurse in charge of the facility. Responsibility is hence clearly defined.

Developing and Implementing an extensive waste management plan doesn't make much sense: what is required at this level is a set of well defined management practices to ensure HCW is properly and safely dealt with.

Basic principles

Effective confinement of waste and safe handling measures provide significant health protection. Actions such as:

• burying hazardous HCW in a waste pit is better than uncontrolled dumping;
• reducing the amount of hazardous waste by segregation is better than having to cope with large volumes of mixed waste;
• good stock management of chemicals and pharmaceuticals not only reduces waste quantities but also saves purchase costs;
• proper identification of waste packages warns healthcare personnel and waste handlers about their contents.

All these measures to reduce risk are relatively simple and cheap and should be applied systematically.

The principle of «doing something is better than doing nothing» is important and underlies any effort to initiate a system for the management of healthcare waste.

This said, managing HCW requires a rigorous approach that doesn't only apply for building/ managing sophisticated treatment systems in large HCFs but also applies to the construction and management of a simple burial pit in a PHC !

Four basic actions for a minimal HCWM programme

1. Training of the HCF staff is the basis for a systematic and coherent waste management programme.

2. Segregating waste using a simple three bin waste disposal system will help minimize the amount of waste that needs to be buried in the waste pit and reduce the risks of injuries from sharps:

• sharps should be disposed of in safety boxes or alternative containers such as plastic bottles, etc. Use of needle cutters are an effective way of making sure syringes aren't reused.
• infectious waste should be discarded into a plastic bin that will then be emptied each day into the pit and cleaned on a regular basis.
• non hazardous waste can be disposed of in the municipal waste stream.

3. Managing the waste treatment/ disposal system properly. Even a simple pit requires some attention such as making sure that a small layer of earth is put on top of each load of HCW.

4. Informing the local population: officials from the local authority should be informed about the measures taken by the HCF to reduce the overall public health and environmental risks. Providing some basic information to both teachers and pupils in the local school(s) to raise awareness about the risks in relation with HCW should help avoid kids playing around the waste pit.


Resources

The WHO manual "Safe management of wastes from healthcare activities" provides in chapter 16 a minimal programme for HCWM that can be used for such HCFs.

The WHO decision-making guide "Management of solid healthcare waste at primary healthcare centres" provides useful information for the selection of the most appropriate treatment and disposal options.