National Workshop on Health Care Waste Management Mercury Free Health … · 2013-12-05 ·...

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.


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.


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


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)


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


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)


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)


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)


Segregation of Health Care waste at source


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)


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)


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)


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)


Safety box or puncture proof container used for sharp waste


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


Total 44 78.6 12 21.4 56 100

Safety box or puncture proof container used for sharp wastes (observation)


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


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

National Workshop on Health Care Waste Management Mercury Free Health … · 2013-12-05 ·...

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