The document summarizes healthcare waste management issues at hospitals and clinics in the RM Sub-district. Key issues include: - Waste segregation is not carried out correctly and there is poor or no recording of waste. - In rainy seasons, cardboard waste boxes collapse when wet, making the waste unsafe. Reusable plastic containers would be safer. - Manual transport of waste boxes lacks safety and ergonomics. A better transport system is needed. - Mortuaries are used to store anatomical waste but dedicated refrigeration facilities would be required. - Plastic liners vary in quality and size, sometimes being too large or small for safe waste containment. Colour coding is also inconsistent.

1. Trigreen (Pty) Ltd
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Phill Love
Hospitals
• Segregation not carried out correctly
• Poor or no recording of waste
• In the rainy season, HCRW cardboard boxes in the unsheltered central storage areas collapse
when wet, becoming unsafe, and the
• The cardboard boxes containing HCRW are moved manually
available. This is not recommended from both a safety as well as an ergonom
better system must be found for internal transport of the HCRW in hospitals.
• The mortuaries are used for the refrigerated storage of anatomical HCRW.
station should be used; dedicated refrigeration facilities of a
accommodate the anatomical HCRW
• The plastic liners presently provided by the service provider for use inside the cardboard
boxes are of good quality and thickness for the safe management of HCRW. The smaller plastic
liners are thin and tear easily and are therefore ill
the liners are too large for the containers.
• Colour coding is not consistent, with yellow and red used interchangeably and due to
procurement difficulties, other colours are also used.
• The smaller plastic liners are presently not adequately supported by any kind of container or
basket at the point of HCRW generation making
use. There is no system for closi
Protecting The Future
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Segregation not carried out correctly
Poor or no recording of waste
In the rainy season, HCRW cardboard boxes in the unsheltered central storage areas collapse
unsafe, and the use of reusable plastic containers would be a safer option.
The cardboard boxes containing HCRW are moved manually at Hospital as no trolley is
available. This is not recommended from both a safety as well as an ergonomic point of view. A
better system must be found for internal transport of the HCRW in hospitals.
The mortuaries are used for the refrigerated storage of anatomical HCRW.
dedicated refrigeration facilities of adequate size will be required to
accommodate the anatomical HCRW
The plastic liners presently provided by the service provider for use inside the cardboard
boxes are of good quality and thickness for the safe management of HCRW. The smaller plastic
rs are thin and tear easily and are therefore ill-suited for the containment of HCRW. Sometimes
the liners are too large for the containers.
Colour coding is not consistent, with yellow and red used interchangeably and due to
ther colours are also used.
The smaller plastic liners are presently not adequately supported by any kind of container or
basket at the point of HCRW generation making too difficult to dispose of the HCRW and unsafe to
use. There is no system for closing the liners.
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In the rainy season, HCRW cardboard boxes in the unsheltered central storage areas collapse
use of reusable plastic containers would be a safer option.
as no trolley is
ic point of view. A
The mortuaries are used for the refrigerated storage of anatomical HCRW. A central transfer
dequate size will be required to
The plastic liners presently provided by the service provider for use inside the cardboard
boxes are of good quality and thickness for the safe management of HCRW. The smaller plastic
suited for the containment of HCRW. Sometimes
Colour coding is not consistent, with yellow and red used interchangeably and due to
The smaller plastic liners are presently not adequately supported by any kind of container or
difficult to dispose of the HCRW and unsafe to

2. Trigreen (Pty) Ltd
Protecting The Future
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Phill Love
• The separation of the needles from the syringes is practised in some areas. This does have
some costs saving with regard to the consumption of fewer sharps containers.
• Difficulties are experienced with shortages of liners and some protective equipment due
mainly to inadequate procurement procedures.
• There is no system in place for minimizing the HCW through green procurement, reuse or
recycling where such activities do not increase the risk of infection. There will need to be a capacity
building initiative undertaken to train the management on the benefits of managing the quantities of
HCW in a proactive manner
• The top loading sharps containers are not ideal and fall over easily.
• Waste is classified into ‘wet’ and ‘dry’ waste. This can cause confusion as these terms are
not used in the hospitals, nor do they relate to a recognised HCW classification system.
• The 25 litre specicans filled with the “wet waste” can become very heavy (> 20 kg). The
loading and unloading of these heavy specicans to the Light Delivery Vehicle (LDV) is done manually.
A trolley for this is recommended and can be kept in the LDV.
• Central storage not suitable for storing the specicans with the “wet waste” that contain
mainly placentae. The area should be dedicated for HCRW and refrigeration is essential to prevent
decay of the placentae over the long periods before collection (up to 4 weeks)
• The plastic liners are of poor quality and with a thickness of < 30 micron. Although not a
legal requirement, this is well below the recommended thickness in the Gauteng Regulations and
SANS Code 10248. The disposable containers supplied by the Service Provider are rigid, they are
yellow (clinic colour coding is red which is also the standard recommended in SANS Code 10248) ,
and the lids do not secure properly.
• The plastic liners are ill-suited for the containers and on many occasions not sufficiently
supported, especially on the nursing trolleys, making it unsafe and difficult for disposal. Shortages of
liners lead to poor segregation. Sometimes the liners are too large for the containers.
• The assortment of containers presently used for the “dry” infectious waste and the general
waste are not ideal. The rubber bins are not ideal to use inside as they are difficult to keep clean
and many of the pedal bins have damaged lids due to abuse.
• Protective equipment such as latex gloves, masks, plastic aprons are used
• Improvements in the procurement procedures, stock control will obviate many of the
difficulties presently experienced with shortages of liners and specicans
• There is no system in place for minimizing the HCW through green procurement or reuse,
nor is there any recycling carried out. There will need to be a capacity building initiative undertaken
to train the management on the benefits of managing the HCW in a proactive manner.

3. Trigreen (Pty) Ltd
Protecting The Future
__________________________________________________________________________________
__________________
Phill Love
• Storage for HCW is difficult in the clinics as space is always at a premium. No dedicated HCW
Storage areas at clinics
• No waste recording system in place
• Communication with the clinics is sometimes difficult
• The top loading sharps containers are not ideal 9.4 Skills and Awareness
• Training in HCW management is largely informal and has not been extensive. It is conducted
through the OHS structures as in-service training. All cadres of staff indicated the need for more
comprehensive training in HCW management.
o Recording of waste
o Colour coding not adhered to
o Using correct size of the liners
o Segregation not carried out correctly
• There is very little planning, coordination and monitoring of the overall HCW management
system. The lack of information on waste quantities generated results in no forward planning for
the provision of the correct quantity and type of containers supplied.
• Colour coding not always followed. The difficulties with supply make it impossible to
enforce the colour coding standards
• Segregation is not carried out correctly in both hospitals and clinics. There is confusion as to
what constitutes ‘wet’ and ‘dry’ waste at the clinics, what goes into the specicans as opposed to the
red liners, which end up together with the black liners in the burning pit.
• There is no knowledge of waste quantities and types or the usefulness of recording this. A
simple method for recording types and quantities of waste can be introduced to assist in planning,
budgeting, monitoring and improving HCW management at the hospitals

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Phill Love
Estimated annual kg of waste generated by RM Sub
Estimated HCRW generation rate for clinics (medium
Estimated annual mass of HCRW from hospitals
Estimated % pathological waste (hospitals)
Estimated pathological waste (hospitals)
Estimated HCRW generation (excl pathological) by clinics
Estimated pathological by clinics
Estimated overall HCRW generation by clinics
Estimated total HCRW generat
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Estimated annual kg of waste generated by RM Sub-district14
Estimated HCRW generation rate for clinics (medium rate)
Estimated annual mass of HCRW from hospitals
Estimated % pathological waste (hospitals)
Estimated pathological waste (hospitals)
Estimated HCRW generation (excl pathological) by clinics
pathological by clinics
Estimated overall HCRW generation by clinics
Estimated total HCRW generation by clinics and hospitals
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0,015
25,800 kg
6%
1,548 kg/yr
7,050 kg/yr
1,200 kg/yr
8,250 kg/yr
34 050 kg/yr

5. Trigreen (Pty) Ltd
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Phill Love
The transportation of HCRW is regulated by the National Road Traffic Act No. 93 (RTA) of
1996 and the regulations passed in 20001
. The NRT Act makes reference to the SANS
10228, SABS 0232-1, SANS 10231 AND Annex E of SABS 0232 and they therefore have
legal status.
SANS 10228 classifies infectious substances in division 6.2 and assigned the UN Number
3291. Annexure E of SABS 0232 has no exempt quantities listed. This implies that the
requirements of RTA are therefore applicable for even 1 kg of infectious waste.
Organisation Roles and Responsibility
National DEAT Determines policy, promotes implementation of; Project
partner providing knowledge, some resources, capacity
building and support.
National DoH: Guidance for formation of policy, broad guidance:
HCWM falls within its function of Hazardous Waste
Management however its role is largely administrative
rather than functional.
Provincial DoH: Technical and financial support, policy formation,
consultation with the working task team. Liaison with
other provincial departments

6. Trigreen (Pty) Ltd
Protecting The Future
__________________________________________________________________________________
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Phill Love