Table 1 Pre-interventional evaluation of Healthcare waste management practices

Part I. Initial interview

Organization

1

In-charge of HCWM

5

N

0

Y

5

2

Permanent committee that deals with HCWM and meets on a regular basis

1.5

N

0

Y

1.5

3

Roles and responsibilities regarding HCWM made clear to the staff

1.5

N

0

Y

1.5

Policy and Planning

4a

HCF has written policies dealing with HCWM.

2

N

0

Y

2

4b

HCF has written plans, manuals, or written procedures dealing HCWM.

2

N

0

Y

2

5

Policies, plans, manuals, and/or written procedures consistent with national laws, regulations, and any permits.

3.5

N

0

Y

3.5

6

HCF has a plan for recycling or waste minimization.

1.5

N

0

Y

1.5

7

HCF policy explicitly mentions a commitment to protect the environment.

0.5

N

0

Y

0.5

8

HCF is mercury-free. OR HCF has a policy or plan to phase out mercury.

1.5

N

0

Y

1.5

Training

9

HCF has a training program on HCWM for managers, health professionals, waste workers, and auxiliary staff.

5

N

0

Y

5

10

Training program includes relevant national laws and regulations.

1

N

0

Y

1

11

Training program includes segregation, collection and handling of sharps waste, use of proper containers and bags for infectious waste, color coding, 3/4th fill rule, use of personal protection equipment by waste workers, transport, storage, and treatment

2

N

0

Y

2

12

Staffs are trained, including new staff when they begin their employment.

3

N

0

Y

3

13

Refresher training at least once a year

1

N

0

Y

1

Occupational Health and Safety

14

Policies and plans related to HCWM include occupational health and safety (including policies for NSI or exposure to blood splatter). OR HCF has separate occupational health and safety policies that include needle-sticks and exposure to blood.

3

N

0

Y

3

15

Workers who collect, transport and treat waste are provided with proper PPE (gloves, shoes or boots, and aprons)

2

N

0

Y

2

16

Health workers and workers handling waste are given hepatitis and tetanus vaccinations.

2

N

0

Y

2

Monitoring, Evaluation and Corrective Action

17

System of internal monitoring or inspection to determine compliance with HCWM requirements.

1

N

0

Y

1

18

System of taking corrective action when practices or technologies related to HCWM do not meet the requirements.

1

N

0

Y

1

19

Policies and/or plans are reviewed or updated at least once a year.

0.5

N

0

Y

0.5

Financing

20

HCF has an annual allocation in its budget for HCWM.

4

Y

4

Y

4

21

Current budget is sufficient for HCWM.

2

N

0

Y

2

22

HCF has a long-term financing plan or mechanism to cover the costs for sustainable HCWM.

0.5

N

0

Y

0.5

Part II. Post-Inspection Tour Interview

Classification and Segregation

23

Wastes are properly segregated at the source according to different categories.

5

N

0

Y

5

24

Health workers are familiar with the classification and segregation requirements.

2

N

0

Y

2

Waste Generation Data

25

Amounts of total waste and infectious waste produced per day has been measured.

1

N

0

N

0

Percentage of infectious waste relative to total waste

0.5

N

0

N

0

Kilograms unrecycled waste per bed per day

0.5

N

0

N

0

Collection and Handling

26

Used syringe needles are collected without recapping.

2

N

0

Y

2

27

Sharps waste are collected in sharps containers or destroyed using needle destroyers.

5

N

0

Y

5

28

Sharps containers are puncture-resistant and leak-proof. OR Needle destroyers are approved under existing regulations or standards.

2

N

0

Y

2

29

Sharps containers are filled only 3/4th full. OR Needle destroyers are well maintained.

2.5

N

0

Y

2.5

30

Sharps containers or needle-destroyers are always available.

1

N

0

Y

1

31

Sharps containers or needle-destroyers are properly placed such that they are easily accessible to personnel and located as close as possible to the immediate area where the sharps are used.

1.5

N

0

Y

1.5

32

Health workers know what to do in the event of a needle-stick injury. OR Health workers are familiar with the policy on NSI.

1

N

0

Y

1

33

Plastic bags are used for non-sharps infectious waste of good quality. OR Specialized containers that are disinfected, cleaned and reused and do not require plastic bags are used.

1

Y

1

Y

1

34

Plastic bags are always available. OR Specialized containers described in #33 are always available.

1

Y

1

Y

1

35

Bag holders or hard containers holding the plastic bags are of good quality. Specialized containers that are disinfected, cleaned and reused and do not require plastic bags are used.

0.5

Y

0.5

Y

0.5

36

Infectious wastes are removed at least once a day.

1

Y

1

Y

1

37

Waste workers know what to do if sharps or infectious waste is accidentally spilled. OR Waste workers are familiar with the spill clean-up plans.

0.5

N

0

Y

0.5

Color Coding and Labeling

38

HCF uses a system of color coding for different types of wastes.

3

N

0

Y

3

39

Colors of the waste containers are consistent with the color coding.

2

N

0

Y

2

40

Infectious waste bags are colored or labeled in accordance with the policies or regulations

1

N

0

N

0

Posters or Signage

41

posters or signs showing proper segregation of healthcare waste

0.5

N

0

Y

0.5

Transportation Inside Health Establishment

42

Waste is transported away from patient areas and other clean areas.

0.5

Y

0.5

Y

0.5

43

Waste is transported in a closed (covered), wheeled transport cart.

1

N

0

Y

1

44

Transport cart is cleaned at least once a day.

0.5

N

0

Y

0.5

Storage

45

Storage area meets the proper requirements.

1

N

0

Y

1

46

Storage area is kept clean.

0.5

N

0

Y

0.5

47

Wastes are removed before the maximum allowable storage time is exceeded.

1

N

0

Y

1

Hazardous Chemical, Pharmaceutical and Radioactive Waste

48

Hazardous chemical, pharmaceutical, and radioactive wastes are segregated from infectious and general non-risk wastes.

4

N

0

Y

4

49

HCF has a plan for treatment and disposal of hazardous chemical, pharmaceutical, and radioactive wastes.

1

N

0

Y

1

Treatment and Disposal

50

HCF treats its infectious waste (either on-site or at an off-site treatment facility) before final disposal.

25

Y

25

Y

25

51

Laboratory cultures and stocks of infectious agents are treated within HCF before being taken away from the facility.

2

Y

2

Y

2

52

Contingency plan for treatment of infectious waste in the event that the treatment technology is shut down for repair.

1

N

0

Y

1

53

Waste is transported safely to the treatment area.

0.5

Y

0.5

Y

0.5

54

Treatment area is located in a place that is easily accessible to the waste worker but not accessible to the general public.

0.5

Y

0.5

Y

0.5

55

HCF has a program of regular inspection and periodic maintenance of the treatment technology.

3

N

0

Y

3

56

Treatment system is clean, operating properly, and well maintained.

3

N

0

Y

3

57

Treatment system destroys or mutilates sharps waste in order to prevent reuse.

1

N

0

N

0

58

HCF uses an approved non-incineration treatment technology such as an autoclave-shredder, integrated steam treatment system, or microwave unit.

6

N

0

N

0

59

Incinerator meets international standards.

3

N

0

N

0

60

PVC plastics are kept out of the waste that is burned.

1

N

0

N

0

61

Waste that is treated in an alternative technology is disposed of in a sanitary landfill. OR Incinerator ash is buried in a hazardous waste landfill.

1

N

0

N

0

Wastewater

62

HCF treats its wastewater (liquid waste) before being released. OR HCF is connected to a sanitary sewer that is linked to a wastewater treatment plant.

3

N

0

N

0

63

Treated wastewater from HCF meets national or international standards.

1

N

0

N

0

Total Score

142

36

123