Health Waste Management

Dr. Himanshu Bhushan MOHFW

Outline
Why Environment in Health sector

programs The IMEP and its rationale Way forward

Environment in Health Sector

Key areas of interface between Health sector programs and the Environment are: Environmental health (referring to air and water quality and sanitation) Worker health and safety Healthcare Waste management
Over 10% of all preventable ill-health today is due to poor environmental quality bad housing, overcrowding, indoor air pollution, poor sanitation and unsafe water, climate change, bad practices in agriculture, industrial development, transport, etc Good Infection Control + Improved health services + sound waste management = safeguard the environment

GOIs Regulatory framework

Healthcare Waste Management:
Environmental Protection Act, 1986 Bio-medical Waste Management Rules, 1998 (amended 2000) EIA Notification, July 2004 CPCB Manual on Hospital Waste Management Guidelines for Universal Immunization Program Guidelines on AD syringes Guidelines on Mercury-contaminated wastes Guidelines on Central Waste Treatment Facilities Guidelines for Bio-Medical Waste incinerators MOHFWs National Health Policy 2002 MOHFWs Hospital Waste Management Guidelines

Implementation of Env in Health

What has worked
Comprehensive

What has not

Mixed implementation Sustained behavioral change not yet evident Inadequate monitoring of CTFs and healthcare facilities Lack of integration among different programs causing duplication and lack of consistency in IEC and training

legal

framework Common Treatment Facilities mandated as the final solution for disposal of HCW. Partnerships with private sector, NGOs etc Increased awareness through training programs, media, and extensive guidance materials etc

The Ground Reality!

Rationale of IMEP
To help manage avoid, reduce and control public

health and environmental risks associated with Health sector activities.

IMEP provides a structured and systematic approach

to incorporate appropriate technology, good practices and effective institutional framework to manage these risks effectively. NRHM/RCH-II Program at the various levels, i.e. national, state, district and health care facilities.

IMEP is to be used by all those involved with

Helps RCH-II meets GOIs legal requirements

IMEP
IMEP has a two-pronged approach:

IMEP Policy Framework Manual: Generic guidance to Centre & State. Finalized IMEP Operational Guidelines for CHCs/PHCs/Subcentres user-friendly, pictorial guidance for healthcare workers at PHCs, CHCs and SCs. Finalized

Prepared in collaboration with DFID and World bank Need not be restricted to RCH can be used as

generic guidance for all programs and schemes eg. RNTCP, IDSP, NACP, SHS etc.

Focus of IMEP
The IMEP addresses and provides guidance on the

following issues: Preventing nosocomial infections Segregation, treatment, storage and disposal of infectious biomedical waste Handling and disposal of sharps, esp auto-disable (AD) syringes. Management of construction waste. Water and sanitation in healthcare facilities Increased skills, information and behavioural change Timelines, budget and systems for monitoring and evaluation

Roles and responsibilities

MOH&FW

Dissemination of Guidelines to states. Link with IPHS Monitoring RCHII Joint Review Mission/State PIP Appraisal

State (State Directorate/State Health Society) &

District (DHS/CMO) Adoption and dissemination to all peripheral health facilities (CHCs,PHCs,SCs) RCH-II State PIPs Critical component as per MoU. Training and monitoring Link with IPHS.

Critical issues of Implementation

Increased ownership by states, districts, facilities,

healthcare workers and community

Need for increased awareness Large degree of inter-ministerial coordination (MoEF,

PCBs)

Need for intensive enforcement and monitoring Resource intensive (consumables, CTF agreements) Need for consistent training to induce sustained

behavioural change

Innovative solutions to deal with size and volumes of

waste from RCH activities in outreach and SCs

Infection Prevention

Hand washing protocol Mopping by disinfectants of all areas of centre twice a day Fumigation of OT, LR and Lab at periodic interval Adequate facilities for autoclave & sterilization of linen & instruments Use of disposable gloves/syringes Sanitation of toilets and hygiene of staff Autoclaving of all the instruments and linen Quality check of autoclave by using quick strips

Waste Disposal System

Colour Coded Bins

Yellow bag

Human tissue

Placenta and PoCs

Waste swabs / bandage Other items (surgical waste) Contaminated with blood

Red bag

Disinfected catheters I.V. bottles and tubes Disinfected plastic gloves Other plastic material

Color Coded bins

Black bag

Kitchen waste Paper bags Waste paper / thermocol Disposable glasses & plates Left over food

Waste Management
Uninterrupted power supply to storage unit Availability of color coded containers, liners,

sodium hypochlorite solution, syringe and needle cutter Deep burial of placenta and all blood and tissue stained Incineration facility available within the premises or outsourced Trained health personnel for handling Bio medical waste

MAIN

ISSUES

Absence of segregation of waste at source Lack of technical expertise and appropriate institutional arrangement Unwillingness of institutions to introduce proper collection, segregation, transportation and treatment / disposal systems Indifferent attitude of health staff towards waste management due to lack of awareness Lack of community participation towards waste management and hygienic conditions

Thanks