http://www.healthcarewaste.org/ Last added documents en contact@ecodev.ch 600 http://www.healthcarewaste.org/en/documents.html?id=219 The safe and sustainable management of health-care waste is a public health imperative and a responsibility of all. Improper management of health-care waste poses a significant risk to patients, health-care workers, the community and the environment. This problem can be solved. The right investment of resources and commitment will result in a substantive reduction of disease burden and corresponding savings in health expenditures. http://www.healthcarewaste.org/en/documents.html?id=220 An international meeting on health-care waste was held in Geneva on June 20-22, 2007. The meeting was attended by 53 participants from about two dozen countries representing 33 organizations concerned with health-care waste management (HCWM). The specific objectives of the meeting were: to explore areas of collaboration between the International Solid Waste Association (ISWA) and key international partners on HCWM; to agree on a plan to update the WHO reference document on health-care wastes; to review the latest developments in projects related to HCWM; and to obtain agreement on core principles regarding funding of HCWM. http://www.healthcarewaste.org/en/documents.html?id=218 Allocating insufficient financial resources to manage HCW properly has an even greater financial cost in the medium and long term in terms of morbidity and mortality as well as environmental damage, that will, in the end, impact negatively on peoples’ health. The expanded costing analysis tool (ECAT) is a modified version of the cost analysis tool (CAT) and provides more options and approaches than the CAT. It was created to help the user estimate costs related to health care waste management (HCWM) at the health care facility (HCF), central treatment facility or cluster, and national levels. [URL=http://healthcarewaste.org/documents/HCWM_ECAT_H_2007.xls]- High-income countries[/URL] [URL=http://healthcarewaste.org/documents/HCWM_ECAT_M_2007.xls]- Medium-income countries[/URL] [URL=http://healthcarewaste.org/documents/HCWM_ECAT_L_2007.xls]- Low-income countries[/URL] http://www.healthcarewaste.org/en/documents.html?id=217 This costing tool has been created to help estimate and calculate costs relating to HCWM at National and health-care facility (HCF) levels. Prepared by Mark Haltmeier on behalf of the Protection of the Human Environment departments / Water, Sanitation and Health unit at WHO http://www.healthcarewaste.org/en/documents.html?id=215 Due to financial and institutional constraints, limited efforts have been made to provide District Management Teams with simple and adequate guidelines to set-up health-care waste management plans for primary and secondary health-care facilities. In particular, management of waste from mass and routine injection activities remains problematic as significant quantities of disposable or auto-disable syringes and needles are generated, for which there must be safe disposal options. This guide is designed as a simple and practical tool to help District Health Managers elaborate a realistic District level plan to reduce improper disposal of waste from injection activities. http://www.healthcarewaste.org/en/documents.html?id=216 http://www.healthcarewaste.org/en/documents.html?id=214 http://www.healthcarewaste.org/en/documents.html?id=213 http://www.healthcarewaste.org/en/documents.html?id=210 The WHO policy paper “Safe health-care waste management” (August 2004) calls on countries to develop and implement national plans, policies, and legislation on health-care waste. This paper describes an organizational model and strategy for developing health-care waste management policies and plans through National Steering Committees and National Working Groups. http://www.healthcarewaste.org/en/documents.html?id=211 Due to financial and institutional constraints, limited efforts have been made to provide District Management Teams with simple and adequate guidelines to set-up health-care waste management plans for primary and secondary health-care facilities. In particular, management of waste from mass and routine injection activities remains problematic as significant quantities of disposable or auto-disable syringes and needles are generated, for which there must be safe disposal options. This guide is designed as a simple and practical tool to help District Health Managers elaborate a realistic District level plan to reduce improper disposal of waste from injection activities. http://www.healthcarewaste.org/en/documents.html?id=212 http://www.healthcarewaste.org/en/documents.html?id=208 http://www.healthcarewaste.org/en/documents.html?id=209 Cet outil est conçu comme une aide lors de l'évaluation de la gestion des déchets biomédicaux au niveau d'un pays. Il permet de synthétiser les pratiques actuelles, de se faire une idée du degré de conscience des risques associés avec une gestion inapropriée des DAS, d'aborder les questions légales, etc. Le document d'origine (en anglais) a été élaboré par Mark Haltmeier et Frank Bouvet à la demande de l'OMS et de l'UNEP/SBC. http://www.healthcarewaste.org/en/documents.html?id=206 Mercury is highly toxic, especially when metabolized into methyl mercury. Health-care facilities are one of the main sources of mercury release into the atmosphere because of emissions from the incineration of medical waste. To understand better the problem of mercury in health-care sector, it is recommended that countries conduct assessments of current mercury usage and health-care waste management programmes. WHO proposes to work in collaboration with countries through short-, medium- and long-term strategic steps presented in this document. http://www.healthcarewaste.org/en/documents.html?id=207 http://www.healthcarewaste.org/en/documents.html?id=205 http://www.healthcarewaste.org/en/documents.html?id=204 http://www.healthcarewaste.org/en/documents.html?id=202 http://www.healthcarewaste.org/en/documents.html?id=203 http://www.healthcarewaste.org/en/documents.html?id=201 See summary in English http://www.healthcarewaste.org/en/documents.html?id=199 The Moldovan Health Authorities have recently made a real effort to standardize the Health Care Waste Management (HCWM) procedures and reinforce legislation with the edition in 2002 of a new regulation for medical waste management. An assessment carried out in 2004 shows that HCWM practices are still unsafe and should be more in accordance with the international procedures recommended by the World Health Organization. http://www.healthcarewaste.org/en/documents.html?id=200 Sharps are one of the most hazardous categories of waste generated in health care facilities. Injections are responsible for the generation of the largest quantity of infectious sharps generated during both immunization and curative practices. Due to the risks associated with sharps it is very important to manage them properly and to ensure they remain safe to the health care workers and the community at large. The present study documents successful sharps management systems in urban areas and evaluates non-burn treatment and disposal technologies. The study evaluated the coherence of these technologies with the current regulatory health care waste management (HCWM) framework in India. Due to the nation-wide introduction of Auto Disable (AD) syringes for immunization programmes, the study also analyses the implications linked to their use and the possibilities of material recovery of these syringes. The findings of the study indicate that it is of paramount importance to contain the infectious sharps in puncture resistant containers, disinfect and mutilate them at point of generation to ensure the safety of the health care workers and the community at large. The use of alternative treatment and disposal technologies covered in the 13 success stories include needle cutters, chemical disinfection, autoclaving, microwaving, advanced autoclave like Hydroclave™, cement encapsulation and sharps pit. The health care institutions were satisfied with the technologies and felt that mutilation after disinfection was the most effective technique to ensure that infectious sharps are not re-used. Currently, the methods used for final disposal of sharps were not found to be sustainable. The health care workers felt that it was important to look into the option of material recovery from the injection units. The concept of AD syringes was new to many health care workers they felt that AD syringes would be very useful during immunization programmes, as it would make sure that the sharps are not re-used. However, the health care workers felt that more research needs to be carried out in identifying the treatment and sustainable final disposal options of AD syringes before these are introduced throughout the country. Recommendations for the future in the field of sharps management are also presented. http://www.healthcarewaste.org/en/documents.html?id=196 The guidelines provide information for the proper treatment of wastes from health-care establishments (public and private). The information provided takes due consideration of the waste management requirements of disposal and recovery measures as well as hygiene requirements. In addition to ecological aspects, the information and recommendations should be economically feasible and easy to undertake. It and also makes allowances for technical progress. http://www.healthcarewaste.org/en/documents.html?id=197 Ces guides se focalisent sur les spécifications, l'installation, l'opération et la maintenance de l'Unité de Gestion des Déchets. Ces guides peuvent être supplémentés par un manuel pour opérateur [URL=../documents/WDU_operManual2_fr.pdf]Manuel de l'opérateur[/URL]. Ces guides sontdivisés en quatre sections. Section 1 offre une large vision de l'unité de gestion des déchets. Section 2 couvre l'installation incluant des spécifications techniques, procédure de construction, les appels d'offres et des aspects de contrôle de qualité dirigés vers des techniciens... Section 4 adresse les aspects de maintenance, planification et d'autres procédures et est à l'intention d'un ministère de la santé, contracteur en chage de la maintenance... http://www.healthcarewaste.org/en/documents.html?id=193 10 steps to implementing a regulated medical waste reduction plan. http://www.healthcarewaste.org/en/documents.html?id=194 This guideline describes the environmentally sound management of medical waste, in particular those that are classified as hazardous medical waste. Therefore the guideline defines which wastes are considered medical wastes and which of them are classified as hazardous medical wastes. The individual medical waste streams are assigned to different groups. The state of the art technology for the treatment, collection, intermediate storage and the disposal is also described in this guideline, as well as responsibilities. Fact sheets contain detailed information on the individual groups of hazardous medical wastes. http://www.healthcarewaste.org/en/documents.html?id=195 This Report draws together the findings of researchers in Bogota, Colombia; Hanoi, Vietnam; Karachi, Pakistan; and Manila, Philippines. They studied the techniques and systems applied for the segregation, storage, collection, disposal and recycling of wastes generated in hospitals and other health care institutions in these four cities and focussed particularly on the role of micro and small enterprises (MSEs). http://www.healthcarewaste.org/en/documents.html?id=192 The objective of this brief is to provide guidance on short- and medium-term measures to mitigate both risks to health and long-term environmental damage. This guidance supplements and does not replace longstanding recommendations for hazardous waste management. That said, to the extent that waste management was inadequate before the tsunami, these recommendations may suggest procedures that improve long-term strategies. http://www.healthcarewaste.org/en/documents.html?id=191 The manual is the result of experience gathered over several years (2000-2004) in conducting technical assistance projects in a number of countries in the Sub-Saharan region. It aims at identifying appropriate practices for health care waste management by providing assessment and planning tools applicable in most sub-Saharan countries of Africa. The document is divided into four sections. Prepared by Frank Bouvet & Mark Haltmeier on behalf of the Protection of the Human Environment department / Water, Sanitation and Health unit at the World Health Organization and the Secretariat of the Basel Convention http://www.healthcarewaste.org/en/documents.html?id=190 Overview of health-care waste management: - advantages of good HCWM - HCW handling and disposal - HCW worker safety and procurement issues - Who is responsible for HCWM - Do's and Don'ts http://www.healthcarewaste.org/en/documents.html?id=187 The objective of this study was to estimate the costs of recycling the plastic of AD syringes as carried out in a pilot project launched in April 2003 in Khmelnytsky oblast and in Kiev city in Ukraine with the support of the WHO European Regional Office. The cost information is essential in order to assess the feasibility and sustainability of expanding the new waste management system to a wider scale. http://www.healthcarewaste.org/en/documents.html?id=188 The guidelines focus on the product specification, installation, operation and maintenance of a Waste Disposal Unit. These can be supplemented by an [URL=../documents/WDU_operManual2_en.pdf]operator's manual[/URL]. The guidelines are divided into four sections. Section 1 provides an overview of the waste disposal unit. Section 2 covers installation, including technical specification, construction process, tendering and quality control issues for engineers... Section 3 is a training manual intended for trainers. Section 4 addresses maintenance and planning and other procedures and is intended fr ministry of health, maintenance contractors... http://www.healthcarewaste.org/en/documents.html?id=189 This report deals with the riks associated with treatment and disposal of health-care wastes by means of technologies that have been demonstrated in the field. Information regarding the risks associated with each one of the treatment or disposal methods was obtained from the results of research and in some cases from research conducted on the teatment or disposal of medical wastes. http://www.healthcarewaste.org/en/documents.html?id=184 This 4-step document expresses public health risks, management, simple disposal options and a long term approach for emergency situations. http://www.healthcarewaste.org/en/documents.html?id=185 Fact sheet on the management of waste during emergencies. http://www.healthcarewaste.org/en/documents.html?id=186 Health-care facilities require access to safe water, basic sanitation, hygiene and safe disposal of wastes. Goal 4, target 5 of the Millenium Development Goal aims at reducing by two-thirds the death rate for children under five while goal 5, target 6 aims at reducing maternal mortality by three quarters. http://www.healthcarewaste.org/en/documents.html?id=182 The lack of policies, strategies and enforcement of legislation for the handling and disposing of health care waste (HCW) in many Eastern Mediterranean Countries has resulted in poor management of such waste. As a result many health care establishments in the Region are increasingly exposing patients and medical and support staff in health care establishments to avoidable health risks. Field experience demonstrates that the inclusion of HCWM planning within health care institutions is a first step towards encouraging the development of better hygiene practices and optimizing the operation of existing HCWM systems. It can also become the catalyst for encouraging the development of national HCWM plans in due course. This document provides practical steps for the development of HCWM plans for small, medium and large health care establishments in the Region. http://www.healthcarewaste.org/en/documents.html?id=183 The overall objective of this publication is to demystify the topic of health care waste management and demonstrate that positive improvements are possible in almost every situation with relatively modest levels of effort and investment. http://www.healthcarewaste.org/en/documents.html?id=181 Unhygienic disposal of hospital waste in Dhaka City poses a serious health hazard to the city dwellers in general and the scavengers in particular. The hospitals require hygienic system approach in handling, storage, transport, treatment, and disposal of their wastes by the methods that at all stages minimize the risk to public health and to the environment. Public awareness through mass media, proper hygiene education to the scavengers, mandatory staff education in waste segregation, and legislation to regulate hospital waste management systems will change the traditional habits of different group of people involved in this sector. http://www.healthcarewaste.org/en/documents.html?id=167 In the last few years there has been growing controversy over the incineration of health-care waste. Under some circumstances, including when wastes are incinerated at low temperatures or when plastics that contain polyvinyl chloride (PVC) are incinerated, dioxins and furans and other toxic air pollutants may be produced as emissions and/or in bottom or fly ash (ash that is carried by air and exhaust gases up the incinerator stack). Exposure to dioxins, furans and co-planar PCBs may lead to adverse health effects. This document also exists in French. Prepared by Immunization, Vaccines and Biologicals department and the Protection of the Human Environment department / Water, Sanitation and Health unit at WHO http://www.healthcarewaste.org/en/documents.html?id=168 This short analysis states the main problems before analysing the causes and listing basic requirements for improving the situation. Prepared by the Protection of Human Environment department / Water, Sanitation and Health unit at WHO http://www.healthcarewaste.org/en/documents.html?id=169 The objective of this document is to provide guidance for selecting the most appropriate waste management methods for safely managing solid waste generated at Primary Health-Care centres (PHCs) in developing countries. The main tool of this guide consists of six decision-trees aimed at assisting the user in identifying appropriate waste management methods. The guide takes into consideration the most relevant local conditions, the safety of workers and of the general public as well as of environmental criteria. http://www.healthcarewaste.org/en/documents.html?id=170 The manual is the result of experience gathered over several years (2000-2004) in conducting technical assistance projects in a number of countries in the Sub-Saharan region. It aims at identifying appropriate practices for health care waste management by providing assessment and planning tools applicable in most sub-Saharan countries of Africa. The document is divided into four sections. Prepared by Frank Bouvet & Mark Haltmeier on behalf of the Protection of the Human Environment department / Water, Sanitation and Health unit at the World Health Organization and the Secretariat of the Basel Convention http://www.healthcarewaste.org/en/documents.html?id=171 This document aims at reviewing the scientific literature for findings on health impacts from microbiological hazards of health-care wastes. It also reviews health impacts of similar exposures in similar circumstances, to evaluate health risks by analogy. Although the available literature is relatively scarce, this document may constitute an initial review, to be updated as additional evidence becomes available. It is targeted at scientists and public health professionals, and those involved in policy setting around health-care waste management. Prepared by the Department of Blood Safety and Clinical Technology and the Department of the Protection of the Human Environment / Water, Sanitation and Health unit at WHO http://www.healthcarewaste.org/en/documents.html?id=172 This document reviews the risks before providing guiding policy principles and a strategy to implement it. This policy paper also exists in French, Spanish and Russian. Prepared by Immunization, Vaccines and Biologicals depratment and the Protection of the Human Environment department / Water, Sanitation and Health unit at WHO http://www.healthcarewaste.org/en/documents.html?id=173 As a follow up of the 2002 injection safety assessment and the 2003 introduction of AD syringes in Ukraine, a pilot project was initiated with the objective to design a safe and viable process for disposing AD syringes through a non-burn option. The project was to test a system using a) needle removing with needle cutter, b) neutralisation by autoclaving, c) containment with safety container and autoclaving bag, d) different methods of transport, e) disposal through shredding and recycling. The costs analysis was also an objective of the pilot project. <br> http://www.healthcarewaste.org/en/documents.html?id=166 This report provides an analysis of low cost small-scale incinerators used to dispose of health-care waste in developing countries, specifically sharps waste (used and possibly infected syringes and needles). The report includes a situation analysis, a “best practices” guide to small-scale incineration, a screening level health risk assessment for ingestion and inhalation exposure to dioxin-like compounds, and other information related to the operation and evaluation of the incineration option for health-care waste. by S. Batterman on behalf of the Protection of the Human Environment Department / Water, Sanitation and Health unit at WHO http://www.healthcarewaste.org/en/documents.html?id=165 This document provides a good overview of non-incineration technologies (thermal, chemical, irradiative, biological, mechanical), describing each of them as well as discussing factors to consider in selecting a technology. http://www.healthcarewaste.org/en/documents.html?id=113 To assist health-care planners at national level, an aide-mémoire has been produced which provides an overview of the main aspects that have to be dealt with: a checklist for actions at national and local level is also included. <a href="http://healthcarewaste.org/documents/aidememoire_fr.pdf">French</a>, <a href="http://healthcarewaste.org/documents/aidememoire_ru.pdf">Russian</a> and <a href="http://healthcarewaste.org/documents/aidememoire_arabic.pdf">Arabic</a> versions are also available. Prepared by the Protection of the Human Environment department / Water, Sanitation and Health unit at WHO http://www.healthcarewaste.org/en/documents.html?id=114 This document – developed by WHO and UNICEF – provides practical guidelines for planners, managers of health-care facilities or mobile vaccine team leaders to improve planning and coordination at the central level as well as waste management practices at the local level where immunisation activities are conducted. We encourage immunisation campaign coordinators to field test this and send there comments / feedback to hcwaste@who.int. Prepared by the Immunization, Vaccines and Biologicals department and Protection of the Human Environment department / Water, Sanitation and Health unit at WHO