Post on 29-Jul-2020
PresentationPresentation
National Workshop on Health Care Waste National Workshop on Health Care Waste Management Management
& & Mercury Free Health CareMercury Free Health Care
Management DivisionDepartment of Health services
Teku, KathmanduNepal
Presentation PlanPresentation Plan
• Assessment of Health Care Waste Management in Different Health Facilities of Nepal.
• The Study on Sanitary Condition and its Management Status at Hospital and other Health Facilities of Nepal
• Current status • Activities Planned for FY 2011• Issues & Challenges • Future directives
Assessment of Assessment of Health Care Waste Health Care Waste
Management in Management in Different Health Facilities of Different Health Facilities of
NepalNepal2007 (Dec)2007 (Dec)
Government Owned Health Facilities Government Owned Health Facilities in Nepal in Nepal
Particulars
Hospital PHCC/HC Health Post Sub Health Post
TotalTotal No. of Hospital
Total No. of PHC
Total No. of HP
Total No. of SHP
Mountain 16 19 149 383 567
Hill 48 104 364 1,600 2,116
Terai 25 86 164 1,143 1,418
National Total 89 209 677 3,126 4,101
Eastern Total 18 51 142 721 932
Central Total 24 67 173 999 1263
Western Total 21 42 145 691 899
Mid-Western Total 15 30 129 426 600
Far-Western Total 11 19 88 289 407
Tanahu
Surkhet
Arg
PyutDang
Banke
Kapilv
Bardiya RolpaSalyan
Palpa
NawalpRupa Chitwan
Myagdi
Gulm
Bagl
Syan
ParKaski
Humla
Dadel
KailaliKancha
AchhamDoti
Darchula
Baitadi BajuraBajhang
Dolpa
Rukum
JajarkotDailekh
Manang
Mustang
KalikJumla
Mugu
Parsa
UdayMah
Dhan Siraha
Raut BaraSarl
Sindhuli
Saptari MoraSunsJhapa
Dhan
Khot Bhoj
Ilam
TehrPanc
Sinpal
B
Makw L Kavre
K Dhad
GorkhaLamj
Nuwa
Rasuwa
RameOkhal
SankhuwaSolukhum
Dolk
Taplejung
Nepal
Central Region
Eastern Region
Mid-Western RegionFar-Western
Region
Western Region
N
Survey Site
Objectives of the AssessmentObjectives of the Assessment
• General Objective: To assess the Health Care Waste Management in different Health facilities of the country in order to establish Health Care Waste Management as a part of Health Service Delivery System by developing practical Guideline for the whole country.
Contd..
Specific Objectives Specific Objectives
• To assess the present situation of Health Care Waste Management in Health Facilities of different part of the country
• To assess the knowledge of Health Care Workers in Health Care Waste Management for the development of Health Care Waste Management Guideline
• To find out the present practice of Health Care Waste Management in different Health Institutions. (Private and Government)
• To assess the skill of Health Care Workers on the Health Care Waste Management.
Selected Districts with selected Number of Health InstitutionsSelected Districts with selected Number of Health Institutions
S.N. Name of District Govt. Hospital
Institutional Clinic PHC HP/SHP Pvt. Hospital,
Nursing HomePolyclinics,
LABMedical shop Total
FW Region
1 Dadeldhuda 1 - 1 7 1 - 2 12
2 Kailali 2 1 1 3 4 - 3 14
MW Region
3 Banke 1 1 2 6 5 - - 15
4 Bardiya 1 - 1 7 - - 3 12
Western Region
5 Rupandehi 2 - 3 8 4 - - 17
6 Palpa 1 - 1 2 1 - 3 8
Central Region 7
7 Sindhupalchowk 1 - 3 12 - - 2 18
8 Lalitpur 1 - 3 9 5 - - 18
9 Bhaktpur 1 1 2 6 3 3 - 16
Eastern Region
10 Jhapa 1 1 1 2 1 3 1 10
11 Ilam 1 - 2 6 1 - 2 12
12 Solukhumbu 1 - - 8 1 - - 10
Total 14 4 20 76 26 6 16 162162
Different Level of Health Facilities Visited Different Level of Health Facilities Visited During HCWM AssessmentDuring HCWM Assessment
5. Pvt. Hosptial/ Nursing Home, 26,
16%
6. Poly Clinic/Pathology, 6,
4%
2. PHC, 20, 12%
3. Health Post, 35, 22%
4. Sub Health Post, 41,
25%
7. Medical Shop, 16, 10%
1. Hospital, 18, 11%
Health FacilityYes No Total
No. % No. % No. %
1. Hospital 17 94.4 1 5.6 18 100
2. PHC 16 80.0 4 20 20 100
3. Health Post 28 80.0 7 20 35 100
4. Sub Health Post 35 85.4 6 14.6 41 100
5. Pvt. Hospital/ Nursing Home 24 92.3 2 7.7 26 100
6. Poly Clinic/Pathology 6 100.0 0 0 6 100
7. Medical Shop 15 93.8 1 6.3 16 100
Grand Total 141 87.0 21 13 162 100
Knowledge of segregation of Health Care Waste at source (by QA)
Health FacilityAdequate knowledge Satisfactory Inadequate
Grand Total
No. % No. % No. % No. %
1. Hospital 7 38.9 9 50.0 2 11.1 18 100
2. PHC 6 30.0 6 30.0 8 40.0 20 100
3. Health Post 6 17.1 17 48.6 12 34.3 35 100
4. Sub Health Post 5 12.2 11 26.8 25 61.0 41 100
5. Pvt. Hospital/ Nursing Home 6 23.1 11 42.3 9 34.6 26 100
6. Poly Clinic/Pathology 2 33.3 1 16.7 3 50.0 6 100
7. Medical Shop 0.0 7 43.8 9 56.3 16 100
Grand Total 32 19.8 62 38.3 68 42.0 162 100
Knowledge level of Respondents (HW) about total process of Health Care Waste management
<=2, Inadequate, 3-4 Satisfactory, >4 Adequate Knowledge
Health Facilities
Use of land pit Incineration
Burning in Open space
Make Disinfection
& throwNo Any
No. % No. % No. % No. % No. %
1. Hospital 10 55.6 13 72.2 2 11.1 1 5.6 0 0.0
2. PHC 17 85.0 6 30.0 1 5.0 2 10.0 0 0.0
3. Health Post 31 88.6 10 28.6 2 5.7 2 5.7 0 0.0
4. Sub Health Post 35 85.4 6 14.6 4 9.8 1 2.4 1 2.4
5. Pvt. Hospital/ Nursing Home 17 65.4 14 53.8 0 0.0 2 7.7 1 3.8
6. Poly Clinic/Pathology 3 50.0 0 0.0 1 16.7 1 16.7 0 0.0
7. Medical Shop 9 56.3 1 6.3 3 18.8 2 12.5 0 0.0
Grand Total 122 75.3 50 30.9 13 8.0 11 6.8 2 1.2
Methods (in use) for Health Care Waste Methods (in use) for Health Care Waste Disposal in Health Facilities (QA) Disposal in Health Facilities (QA)
Knowledge of Health Workers about Health Knowledge of Health Workers about Health Care Waste disposalCare Waste disposal
Type of HFs
Proper Knowledge
Partial Knowledge
Inadequate Knowledge Grand Total
No. % No. % No. % No. %
Hospital 7 41% 2 12% 8 47% 17 100%
HP 6 19% 11 35% 14 45% 31 100%
Poly Clinic 2 40% 2 40% 1 20% 5 100%
PHC 6 32% 8 42% 5 26% 19 100%
Private Hospital/Nursing Home 5
20%9
36%11
44%25
100%
SHP 5 14% 22 61% 9 25% 36 100%
Medical Shop 1 6% 10 63% 5 31% 16 100%
Grand Total 32 21% 64 43% 53 36% 149 100%
Health Facilities with Incinerator and Placenta PitHealth Facilities with Incinerator and Placenta Pit
HFs
Available Incinerator
Available Placenta Pit Both Available Total
HfsNo. % No. % No. %
Hospital 10 59% 12 71% 8 47.1% 17
HP 6 19% 8 26% 1 3.2% 31
Poly Clinic 1 20% 1 20% 0.0% 5
PHC 5 26% 6 32% 3 15.8% 19Private Hospital/Nursing Home 7 28% 14 56% 5 20.0% 25
SHP 2 6% 7 19% 1 2.8% 36
Grand Total 31 23% 48 36% 1813.5
% 133
ConclusionConclusion::• Most of the Health Workers are not aware
of the importance of Health Care Waste Management
• Waste Management is not the priority area for most of the Health Institutions
• No specific person allocated for Health Care waste management
• Waste Handlers do not posses proper skill for Health Care Waste Management
Contd..
ConclusionConclusion::
• Waste Handlers do not use proper protective measures during Health Care Waste Management
• Attempt to segregate Health Care Waste at source is found in large Health Institutions but there was not proper waste segregation in place
Contd..
ConclusionConclusion::
• Lack of specific rules and regulations for Waste Management cause further problem
• large Health institutions are found interested in coordinated waste disposal system e.g. common incinerator or autoclaving but need central coordinating mechanism in place
A REPORT OF "THE STUDY ON A REPORT OF "THE STUDY ON SANITARY CONDITION AND ITS SANITARY CONDITION AND ITS
MANAGEMENT STATUS AT MANAGEMENT STATUS AT HOSPITAL AND OTHER HEALTH HOSPITAL AND OTHER HEALTH
FACILITIES OF NEPAL."FACILITIES OF NEPAL."
Objectives of the studyObjectives of the study
General objective • The overall objective of the study is to assess
the sanitary condition and waste management practices at Public and Private Health Facilities of Nepal.
Specific objectives:Specific objectives:
• To identify the Sanitary condition of Health Facilities and Health Care Waste Management (HCWM) within Health Facilities premises.
Availability of safe and adequate water at Health Facilities.Availability and utilization of sanitary latrines at Health Facilities.Proper hand washing practices by health care provider at Health Facilities.
• To assess the practice of liquid and solid waste management including Health Care Waste at Health Facilities.
• To assess the perceptions of users and staff on the availability of waste water management and waste management practice at Health Facilities.
DistrictType of Health Facility
Hospital Percent PHC Percent HPPercen
t SHPPercen
tNursing Home/Pvt.
Hospital Percent Total Percent
Sindhupalchowk 1 7.7 3 23.1 3 23.1 2 15.4 4 30.8 13 100.0
Jhapa 2 14.3 4 28.6 4 28.6 - - 4 28.6 14 100.0
Kailali 1 6.3 6 37.5 3 18.8 - - 6 37.5 16 100.0
Dadeldhura 1 7.7 1 7.7 5 38.5 5 38.5 1 7.7 13 100.0
Total 5 8.9 14 25.0 15 26.8 7 12.5 15 26.8 56 100.0
Health Facilities visited
Existence of running Water in Health Facilities on a regular basis (observation)
Type of Health FacilityExistence of running water on a regular basis.
Yes Percent No Percent Total Percent
Hospital 4 80.0 1 20.0 5 100.0
PHCC 11 78.6 3 21.4 14 100.0
Health Post 9 60.0 6 40.0 15 100.0
Sub Health Post 2 28.6 5 71.4 7 100.0
Nursing Home/Pvt. Hospital 15 100.0 - - 15 100.0
Type
Public 26 63.4 15 36.6 41 100.0
Private 15 100.0 - - 15 100.0
Total 41 73.2 15 26.8 56 100.0
Type of Health Facility
Presence of reliable drinking water points for staffs, patientsand carers.
Yes Percent No Percent Total Percent
Hospital 1 20.0 4 80.0 5 100
PHCC 9 64.3 5 35.7 14 100
Health Post 8 53.3 7 46.7 15 100
Sub Health Post 4 57.1 3 42.9 7 100
Nursing Home/Pvt. Hospital 13 86.7 2 13.3 15 100
Total 35 62.5 21 37.5 56 100
Presence of reliable drinking water points for staffs, patients and carers. (QA)
Type of Health FacilityPresence of reliable drinking water points for staffs, patients and
carers.
Yes Percent No Percent Total Percent
Hospital - - 5 100.0 5 100.0PHCC 9 64.3 5 35.7 14 100.0Health Post 7 46.7 8 53.3 15 100.0Sub Health Post 2 28.6 5 71.4 7 100.0Nursing Home/Pvt. Hospital 13 86.7 2 13.3 15 100.0
Type
Public 19 46.3 22 53.7 41 100.0Private 13 86.7 2 13.3 15 100.0Total 34 60.7 22 39.3 56 100.0
Presence of reliable drinking water points for staffs, patients and carers (observation).
Type of Health FacilityPresence of reliable Hand washing point with soap or alternatives
Yes Percent No Percent Total Percent
Hospital 3 60.0 2 40.0 5 100.0
PHCC 12 85.7 2 14.3 14 100.0
Health Post 14 93.3 1 6.7 15 100.0
Sub Health Post 3 42.9 4 57.1 7 100.0
Nursing Home/Pvt. Hospital 13 86.7 2 13.3 15 100.0
Total 45 80.4 11 19.6 56 100.0
Presence of reliable Hand washing points with soap or alternatives (QA)
Type of Health FacilityExistence of Hand washing basins at more than 50% critical
points (as per guideline)
Yes Percent No Percent Total Percent
Hospital 3 60.0 2 40.0 5 100.0PHCC 8 57.1 6 42.9 14 100.0Health Post 8 53.3 7 46.7 15 100.0Sub Health Post 1 14.3 6 85.7 7 100.0Nursing Home/Pvt. Hospital 10 66.7 5 33.3 15 100.0
Type
Public 20 48.8 21 51.2 41 100.0Private 10 66.7 5 33.3 15 100.0Total 30 53.6 26 46.4 56 100.0
Existence of Hand washing basins by observation
Type of Health FacilityToilets in use within Health Facility premises
Yes Percent No Percent Total Percent
Hospital 5 100.0 - - 5 100.0
PHCC 13 92.9 1 7.1 14 100.0
Health Post 11 73.3 4 26.7 15 100.0
Sub Health Post 4 57.1 3 42.9 7 100.0
Nursing Home/Pvt. Hospital 14 93.3 1 6.7 15 100.0
Total 47 83.9 9 16.1 56 100.0
Toilets in use within Health Facility premises (observation)
Type of Health Facility
Clean without smell Percent
Clean but smelling Percent Dirty Percent Total Percent
Hospital 0 0.0 3 60.0 2 40.0 5 100
PHCC 1 7.7 8 61.5 4 30.8 13 100
Health Post 2 18.2 8 72.7 1 9.1 11 100
Sub Health Post 0 0.0 3 75.0 1 25.0 4 100
Nursing Home/Pvt. Hospital 8 57.1 5 35.7 1 7.1 14 100
Total 11 23.4 27 57.4 9 19.1 47 100
Cleanliness of toilets (Observation)
Type of Health Facility
Water drainage system in place within the Health facility
No Water drainage system Total Percent
Covered Percent Not Covered Percent No. Percent
Hospital 2 40.0 3 60.0 0 0.0 5 100
PHCC 2 14.3 7 50.0 5 35.7 14 100
Health Post 3 20 2 13.3 10 66.7 15 100
Sub Health Post 0 0.0 0 0.0 7 100.0 7 100
Nursing Home/Pvt. Hospital
6 40.0 4 26.7 5 33.3 15 100
Total 13 23.2 16 28.6 27 48.2 56 100
Water drainage system in place within the Health facility (observation)
Type of Health Facility
Segregation of Health Care waste at source
Yes Percent No Percent Total Percent
Hospital 5 100 - - 5 100
PHCC 10 71.4 4 28.6 14 100
Health Post 13 86.7 2 13.3 15 100
Sub Health Post 4 57.1 3 42.9 7 100Nursing Home/Pvt. Hospital 13 86.7 2 13.3 15 100
Total 45 80.4 11 19.6 56 100
Segregation of Health Care Waste at source (QA)
Type of HF
Yes No Total
No % No % No. %
Hospital 3 60.0 2 40.0 5 100
PHCC 3 30.0 7 70.0 10 100
Health Post 7 53.8 6 46.2 13 100
Sub Health Post 2 50.0 2 50.0 4 100
Nursing Home/Pvt. Hospitals 5 38.5 8 61.5 13 100
Total 20 44.4 25 55.6 45 100
Segregation of Health Care Waste as per color coding (at least 3 colors: Red, Green, Blue) (QA)
Type of Health FacilitySegregation of Health Care Waste at source. (At least use
of 3 colour code bucket: Green, Blue, Red)
Yes Percent No Percent Total Percent
Hospital 3 60.0 2 40.0 5 100.0
PHCC 3 21.4 11 78.6 14 100.0
Health Post 6 40.0 9 60.0 15 100.0
Sub Health Post 2 28.6 5 71.4 7 100.0Nursing Home/Pvt.
Hospital 5 33.3 10 66.7 15 100.0
Total 19 33.9 37 66.1 56 100.0
Segregation of Health Care Waste at source. (At least use of 3 colour coding bucket Green , Blue, Red) (Observation)
Type of Health Facility
Existence of Health Care Waste Disposal System
ExistsDo not
%Total PercentAppropriate %
Non
%
ExistAppropriat
e
Hospital 1 20 4 80 0 0 5 100PHCC 2 14.3 9 64.3 3 21.4 14 100Health Post 1 6.7 10 66.7 4 26.7 15 100Sub Health Post 0 0 4 57.1 3 42.9 7 100Nursing Home/Pvt. Hospital 4 26.7 8 53.3 3 20 15 100Total 8 14.3 35 62.5 13 23.2 56 100
Existence of appropriate Health Care Waste Disposal System (observation)
Type of Health Facility
Placenta pit in use
Yes Percent No Percent
No Placenta
Pit Percent Total Percent
Hospital 5 100.0 - - - - 5 100.0PHCC 9 64.3 5 35.7 - - 14 100.0Health Post 4 26.7 5 33.3 6 40.0 15 100.0Sub Health Post 1 14.3 5 71.4 1 14.3 7 100.0
Nursing Home/Pvt. Hospital 9 60.0 6 40.0 - - 15 100.0
Total 28 50.0 21 37.5 7 12.5 56 100.0
Placenta pit in use (observation)
Type of Health Facility
Safety box or puncture proof container used for sharp waste
Yes Percent No Percent Total Percent
Hospital 4 80.0 1 20.0 5 100
PHCC 13 92.9 1 7.1 14 100
Health Post 11 73.3 4 26.7 15 100
Sub Health Post 7 100.0 0 0.0 7 100
Nursing Home/Pvt. Hospital 9 60.0 6 40.0 15 100
Total 44 78.6 12 21.4 56 100
Safety box or puncture proof container used for sharp wastes (observation)
Type of Health Facility
Methods of Disposal of Safety Box
Buried Percent Burn Percent Total Percent
Hospital 0 0.0 2 100.0 2 100
PHCC 2 16.7 10 83.3 12 100
Health Post 1 7.1 13 92.9 14 100
Sub Health Post 1 14.3 6 85.7 7 100
Nursing Home/Pvt. Hospital 1 16.7 5 83.3 6 100
Total 5 12.2 36 87.8 41 100
Methods of disposal of Safety Box (observation)
ConclusionConclusion
• Most of the Health facilities do not have adequate supply of water on a regular basis
• Most of the Health facilities have less reliable Hand Washing points with soap or alternatives
• Most of the Health Facilities have toilets within their premises but accessibility to the toilets is less.
• Less separate Male and Female toilets• Cleanliness of toilets is not satisfactory
• Most of the Health Facilities do not have proper water drainage system (covered) within Health Facility premises
• Management of the final disposal of waste water is not sufficiently proper
• Less Health Facilities segregate Health Care Waste at source as per color coding
• Final disposal of HCW is still not scientific• Disposal of sharp waste is found satisfactory
but its disposal is not satisfactory
RecommendationRecommendation• Sensitization about management of sanitary
condition should be given to the policy makers and managers
• Orientation about the management of sanitary condition should be given to the mid level managers, Health Workers and technician involve in construction of HF
• Coordination should be strengthened among stake holders to support sanitary activities in the Health Facilities
• Awareness programmes should be conducted to the clients & visitors and community people promoting their active participation
• Common final disposal should be promoted• Infrastructure should be developed for proper
sanitation• Proper recording & reporting and Monitoring
mechanism should be established
Recommendation cont.....Recommendation cont.....
Current StatusCurrent Status
A. Documents at working LevelA. Documents at working Level• National Policy and strategy for solid waste
management in general - published in 1996 A.D. (2053 B.S.).
• NHCWM Guideline prepared by NHRC with the support of WHO - May 2002
• HCWM Training manual for medical professionals, prepared by NHTC with the support of WHO - May 2002
• HCWM Orientation manual for health personnel, prepared by Management Division – 2007, Revised 2009
• HCWM Guideline 2009• Mercury Management Orientation Manual 2009
B. Activities Carried up to 2010 B. Activities Carried up to 2010 ContdContd……..
• Sharps management Orientation at Health Facilities (Seti Zonal Hospital & Dhading District Hospital)
• Stakeholders meetings for coordinated Health Care Waste Management (4 times at central Level)
• Orientation on environmentally sound management of Health Care Waste (Dhading District)
• Training to health workers for good practices in HCWM (ToT at central Level 3 times)
• Development of IEC materials (Posters, Brochures & HCWM Orientation Manual, Guideline, Mercury Manual Developed)
Contd….
• Construction of placenta pits-80(40 Dists) • Development and distribution of HCWM
Guideline (In co-ordination with other Stakeholders)
• National Workshop on Mercury Management conducted 2009 Dec
Districts Covered for HCWM (FY-2064/2065) Contd…
1 Kailali2 Kanchanpur3 Bardiya4 Banka5 Dang6 Kaski7 Kapilbastu8 Rupandehi9 Bhaktapur10 Parsa11 Dhanusha12 Chitwan13 Morang14 Ilam15 Doti
Districts Covered for HCWM (FY-2065/2066) Contd..S.N. Districts 16 Sarlahi17 Sunsari18 Mahottari 19 Rautahat20 Lalitpur 21 Arghakhachi22 Makawanpur23 Udayapur24 Palpa25 Jhapa26 Siraha27 Sanja28 Tanahu29 Dhading30 Kavra
Districts Covered for FY 2066/67S.N. Districts
1 Nuwakot 2 Dolakha 3 Sindhupalchok 4 Bara 5 Parbat 6 Lamjung 7 Gorkha 8 Surkhet 9 Dailekh 10 Dadeldhura
DistrictsDistricts Covered for HCWM (FYCovered for HCWM (FY--2067/20682067/2068
1. Pachathar2. Dhankuta3. Okhaldhunga4. Ramechap5. Nawalparashi6. Gulmi7. Baglung8. Salyan9. Achham10.Baitadi
Activities planned for HCWM 2011Activities planned for HCWM 2011
• Stakeholders meetings for coordinated Health Care Waste Management
• Promoting appropriate legislation for HCWM• Orientation on environmentally sound
management of Health Care Waste• Training and Orientation to health workers
for good practices in HCWM
• Contd..
• Construction of placenta pits (50 Dist-100 pits)
• Follow up of programs implemented in last fiscal year.
• Promotion of Sanitation Management at Hospitals & other Health Facilities.
Challenges/Issues Challenges/Issues
• Increasing Health Care Facilities without proper planning for HCWM
• Lack of specific policy regulation for HCWM • There are no standards set for the operation
of disposal/treatment facilities (Incinerators, Burners)
• There is lack of guideline for proper disposal of different type of healthcare wastes
• No Punishment and Reward system for the effective Health Care Waste Management
Contd...Contd...
• Policy makers/Managers yet to be sensitized for HCWM
• Co-ordination among public/Private & Municipality yet to be strengthened
• Use of burn technique promoting Environmental hazards
• Less initiation for the common final disposal of HCWM
Way ForwardWay Forward– Installment of cost effective, simple and safe
treatment/disposal of HCW– Central treatment facility is necessary in big
municipalities (Kathmandu, Pokhara, Biratnagar)– Formation of Committee and practice Waste Management
in a team– Regular planning and monitoring of HCWM in the HFs– Vaccination, training and supply of Personal Protective
Measures to Health Workers and Waste Handlers – Proper recording and reporting of waste related
accidents/incidents for evaluating effectiveness of HCWM
Way ForwardWay Forwardcontd..contd..
• At policy level–There needs to be a national policy on
Health Care Waste Management–There needs to be legal provision for
punishment and reward for effective management of Health Care Waste
Way Forward Way Forward contd....contd....• Implementation of HCWM Rules and Regulation • Develop Health Care Waste Management policy• Orientation on policy to all stakeholders • Preparation of Monitoring Plan for Policy
Implementation • Monitoring of policy implementation • Suggestions for the Improvement • Promote common HCWM disposal site • HCWM plan should be in place before approval or
renewal of private Hospital/Nursing home
THANK YOU