Management of solid health-care waste at primary health-care centres : a decision-making guide.

1. INTRODUCTION ..........................................................................................................................................1 Audience ..............................................................................................................................................................1 Scope....................................................................................................................................................................1 Definition of Health-Care Waste .........................................................................................................................2 Scenarii used in this guide ...................................................................................................................................2 2. BASIC RISKS ASSOCIATED WITH THE POOR MANAGEMENT OF HEALTH-CARE WASTE.........2 Infectious sharps and occupational Risk...............................................................................................................3 Risk to the general public ....................................................................................................................................3 Risks for the environment....................................................................................................................................3 3. RELATIVE RISK APPROACH.....................................................................................................................4 4. IMPORTANT ISSUES FOR THE SAFE MANAGEMENT OF HEALTH-CARE WASTES ......................4 5. KEY PARAMETERS TO ASSESS BEFORE SELECTING OPTIONS........................................................6 6. SCENARII CONSIDERED............................................................................................................................7 Urban area with access to legally approved modern waste treatment facility ......................................................9 Urban area without access to legally approved modern waste treatment facility ...............................................10 Peri-urban area...................................................................................................................................................10 Rural area with access to legally approved modern waste treatment or within reasonable distance ..................10 Remote area without access to legally approved modern waste treatment or disposal facility...........................10 Immunization activities at PHC .........................................................................................................................11 Outreach immunization activities ..................................................................................................................... .11 7. REMARKS...................................................................................................................................................11 8. EXPLANATION OF CRITERIA AND PRACTICES USED IN THE DECISION TREES ........................11 Safe transportation available..............................................................................................................................11 Disinfection with bleach ....................................................................................................................................11 Encapsulation of needles ..................................................................................................................................12 Municipal waste stream .....................................................................................................................................12 Space available on premises ...............................................................................................................................12 Densely populated area......................................................................................................................................12 Acceptable operating conditions for incineration of non plastic wastes.............................................................12 9. COSTING METHODOLOGY....................................................................................................................13 10. HEALTH CARE WASTE MANAGEMENT TRAINING ...........................................................................16 11. INTRODUCTION TO TREATMENT OPTION ..........................................................................................17 iv TABLE 1. Approximate percentage of waste type per total waste in PHC centres ..........................................2 TABLE 2. Basic elements of the safe management of HCW for PHC centres...................................................5 ANNEX A. Further sources of information on the management of health-care wastes .................................35 ANNEX B. Waste prevention, reduction and strorage.......................................................................................38 ANNEX C. Waste treatment technologies ..........................................................................................................40 ANNEX D. Local solutions for managing health-care waste.............................................................................43 ANNEX E. Land disposal ...................................................................................................................................44 ANNEX F. Management of specific wastes ........................................................................................................47 ANNEX G. Case study: Estimating the costs of recycling the plastic of AD syringes…….……………...….51