Strategies in Waste Management in low income countries


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Lecture on waste management in low income countries by Prof. Shaheen Mehtar during the 6th International Infection Control Conference 2006

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Strategies in Waste Management in low income countries

  1. 1. Strategies in Waste Management in low income countries Prof Shaheen Mehtar Academic Unit for IPC Tygerberg Hospital & SUN
  2. 2. Principles of Waste Management <ul><li>Segregation at source– ward or unit level </li></ul><ul><li>Colour coding to support source segregation </li></ul><ul><li>Identify destination of each type of waste </li></ul><ul><li>Transport safely to pick up site </li></ul><ul><li>Ensure safe disposal </li></ul><ul><li>Keep tract of usage. </li></ul>
  3. 3. Segregation of waste (WHO) Own choice Office/ paper waste Non medical waste, kitchen Clinical waste infectious Sharps infectious Blood and body fluids colour Item landfill landfill Incinerate/ decontaminate incinerate incinerate destination
  4. 4. Situation in Industrial Countries <ul><li>Legislation exists, and in is implemented, on waste management </li></ul><ul><li>Hospital waste generated- 100,000 tonnes per annum in NHS hospitals (UK) </li></ul><ul><li>Equal to 0.5 kg per bed per day (average) </li></ul><ul><li>Legislation to protect waste handlers </li></ul>
  5. 5. Cost of waste management in industrialized countries <ul><li>Segregation and disposal high cost- allocated budget </li></ul><ul><li>Only 20% of hospital waste should go for incineration or similar </li></ul><ul><li>Cost of </li></ul><ul><ul><li>Colour coding </li></ul></ul><ul><ul><li>Transport </li></ul></ul><ul><ul><li>Incineration </li></ul></ul><ul><ul><li>Staff </li></ul></ul><ul><li>Little or no recycling of single use products </li></ul>
  6. 6. Recycling of waste to generate heat
  7. 7. Waste disposal in Developing Countries <ul><li>Don’t know how much waste is generated in hospitals because there is little or no source segregation. </li></ul><ul><li>At TBH (1250 bedded) 7 kg per bed per day </li></ul><ul><li>Legislation exists but not enforced </li></ul><ul><li>Segregation of waste not taken seriously at ward level </li></ul><ul><li>Waste disposal inadequate and often dumped in open land fill areas </li></ul><ul><li>Protection of healthcare workers inadequate </li></ul>
  8. 8. Waste disposal in Developing Countries <ul><li>Incineration of clinical waste inadequate </li></ul><ul><li>Clinical waste dumped with non infectious waste </li></ul><ul><li>High risk activity for workers and public </li></ul>
  9. 9. Cost of waste management in developing countries <ul><li>Little or no segregation of waste– low budget allocation– cost not known </li></ul><ul><li>Non compliance to colour coding therefore unnecessary expense on infectious waste </li></ul><ul><li>A 1250 bedded hospital spent R 4 million up until 2005. </li></ul><ul><li>IPC Team now responsible for waste management and appointed a waste manager </li></ul><ul><li>Cost in 2006 reduced to R 2.4 million when source segregation was introduced. </li></ul>
  10. 10. George Hospital (200 bedded) monthly cost of private contractor 8 n/s injuries reported 22351.07 August 22671.64 July 47319.85 June 43326.26 May 38344.05 April 17822.59 March Cost in Rands
  11. 11. Waste Disposal– whose responsibility is it? <ul><li>Ultimately the Manager or CEO of the healthcare facility but responsibility devolved to IPC Team </li></ul><ul><li>Private companies: responsibility starts at collection point in hospital up to disposal </li></ul><ul><li>Each health care worker– segregation of waste and appropriate disposal </li></ul><ul><li>Management of land fill and management of waste is the responsibility of the municipality. </li></ul><ul><li>Incineration facilities responsibility of municipality or local government. </li></ul>
  12. 12. Dumping of clinical waste
  13. 13. Ward Waste
  14. 14. Waste on the ward
  15. 15. Syringe found in laundry basket <ul><li>Risk of BBV </li></ul><ul><li>Hepatitis B pos. blood delivery product found in laundry. </li></ul><ul><li>Recovered from washing machine by engineers </li></ul>
  16. 16. Source segregation <ul><li>Strongly recommended by the WHO. </li></ul><ul><li>Separation of waste by colour coding </li></ul><ul><li>Containers should be robust and leak proof </li></ul><ul><li>Cannot be opened when once closed and sealed </li></ul>
  17. 17. Non segregation of waste
  18. 18. Poorly organised waste sites
  19. 19. Sharps containers <ul><li>Should be made of robust material which will withstand penetration from needles </li></ul><ul><li>Should be leak proof </li></ul><ul><li>Should not be over filled </li></ul><ul><li>Must be able to stand upright </li></ul><ul><li>The opening should be large enough to take a needle and syringe as one unit YET small enough not to allow hands to enter </li></ul><ul><li>Once sealed cannot be opened </li></ul>
  20. 20. Unsafe sharps containers
  21. 21. Private Contractors <ul><li>Submit tender- contract with Govt dept. NOT health care facility </li></ul><ul><li>Inadequate and unsatisfactory containers </li></ul><ul><li>Responsibility of safe disposal not clearly defined </li></ul><ul><li>Inadequate checks of implementation of waste management and cost </li></ul>
  22. 22. Pharmacy Waste <ul><li>Mixed waste from pharmacy </li></ul><ul><li>Medicines and equipment </li></ul><ul><li>should be segregated </li></ul><ul><li>Treated as chemical waste </li></ul><ul><li>Special disposal system- usually incineration </li></ul>
  23. 23. Public Safety <ul><li>Dumping of medical waste at landfill site </li></ul><ul><li>Recycling of needles and syringes from either hospital waste containers or from landfill site </li></ul><ul><li>Must dispose medical waste safely </li></ul>
  24. 24. Community involvement in clean up
  25. 25. Summary <ul><li>Start with source segregation </li></ul><ul><li>It is difficult and needs education and vigilance by the IPC Team and Management </li></ul><ul><li>Become involved in purchasing and setting up of waste management systems which are safe, robust and where some of the expenses can be recovered by the hospital such as electricity and steam </li></ul><ul><li>Protection of healthcare workers essential </li></ul><ul><li>Monitor progress of waste management and adjust within safe principles </li></ul><ul><li>Legislation which exists needs to be strengthened. </li></ul>