GEF/UNDP project for best practices in HCWM, a sound way to involve African health systems in fighting environment pollution: Example from Senegal

Transcription

1 GEF/UNDP project for best practices in HCWM, a sound way to involve African health systems in fighting environment pollution: Example from Senegal Prof Babacar NDOYE (ICAN) Dr Jorge EMMANUEL (UNDP)

2 OUTLINE I. Introduction II. Methodology III. Results IV. Discussion V. Conclusion

3 I. INTRODUCTION Inadequate practices in HCWM in Africa are causing many health and environmental risks Shortcomings in waste segregation and unsuitable treatment (burning or incineration under poor technical conditions) generate significant environmental pollution Burning and poor incineration are a main source of dioxins in health care and a major mode of transport for mercury

4 Illustrations of environmental pollution by incineration and open burning of healthcare waste Other Organic Compounds Trace Metals including Lead, Cadmium, Mercury Dioxins & Furans Acid Gases Carbon Monoxide Particulate Matter Toxic Incinerator Ash

5 GEF/UNDP Global project, in collaboration with WHO and Health Care Without Harm, demonstrated: Best management practices Phasing out of mercury in health facilities, and Promotion of non-incineration treatment technologies.

6 Objectives of the presentation To describe the GEF/UNDP global project To describe the activities implemented, and the outcome in Senegal To give, after discussion, relevant recommendations for all African countries: the aim is to replicate and to sustain best practices and technologies implemented, in order to reduce environmental releases of dioxins and mercury

7 II. METHODOLOGY Methodology at global level is firstly described Methodology in Senegal is then described

8 GEF/UNDP Global Project The project set up a healthcare waste management model facility in each part of the world (with best practices and non-incineration technologies) under the aegis of a global steering committee Countries involved: Argentina, India, Latvia, Lebanon, Philippines, Vietnam and Senegal was chosen as the pilot for the African region A special component in Tanzania and South Africa was the development of low cost, non-burn technologies, appropriate and adapted to the sub-saharan Africa working conditions.

9 Acivities implemented in Senegal National level - National Steering Committee, involving all national stakeholders to elaborate, implement and monitor action plan named Mercury and Dioxins Project Management (PROGEDIME), and taking into account recommendations from the global committee - Main actors: Ministry of Environment which appointed a national coordinator for the project and the Ministry of Health represented by the PRONALIN s Coordinator - PRONALIN is a national program in hygiene to fight healthcare associated infections: applying SP in facilities is its priority activity, so for the two projects, the best practices in HCWM became a common goal.

10 Operational level - A health facility as model at all three levels of the health system: a hospital, a health center and a health post. - Activities implemented in model facilities Administrative and organizational measures Information and sensitization Training of all staff

11 - Activities implemented in model facilities (continued) Supplied equipment and products to manage properly healthcare waste, from segregation to treatment Supplied mercury-free devices, and gradually phased out mercury Supplied non-burn technology (autoclave) for the treatment of infectious waste Monitoring of all activities by the steering committee, but also by PRONALIN in the framework of its national action plan

12 III. RESULTS There are model facilities in each part of the world, demonstrating best management practices and nonincineration technologies for HCWM Examples: SENEGAL: 287-bed urban hospital LEBANON: 325-bed private hospital PHILIPPINES: 75-bed provincial hospital ARGENTINA: 475-bed pediatric hospital LATVIA: 355-bed municipal hospital INDIA: 3000-bed teaching hospital Many hospitals are now mercury-free facilities : guidances and procedures to manage mercury are available (cleanup, containment, transport, interim storage)

13 Examples of Non-Incineration Technologies Demonstrated by the GEF/UNDP Project in Different Countries Autoclave technologies Autoclave and shredder Senegal, Vietnam, Philippines Very large autoclave (5 tonnes/day) and compactor - Vietnam Vietnam: large autoclave Advanced hybrid autoclave systems Hybrid autoclave with internal shredding - Lebanon Rotating autoclave - Latvia Microwave technologies - Latvia Alkaline hydrolysis technology for anatomical waste - Latvia Lebanon: hybrid autoclave Latvia: rotating autoclave Latvia: microwave

14 Illustrations of South Africa outcome New affordable non-incineration technology is now available for Africa Multiple vacuum autoclave with sterilization at 134 deg C Manufactured by Medi-Clave Pty Ltd (Pretoria, RSA) Developed in collaboration with the GEF/UNDP Project 175 liters per cycle, 1 to 1.5 hours per cycle Dimensions: 1.1m x 1.5m x 2m high Certified to meet or exceed international autoclave standards (ASME, STAATT) Includes boiler, all stainless steel construction Easy sliding door Special trolley with barrel to collect waste; the whole barrel slides into the autoclave to be sterilized After treatment, the barrel can rotate to dump out treated waste

15 1 2 Illustrations of South Africa outcome 3 4 Place waste inside stainless steel barrel and close the lid 8 When barrel is full, take to autoclave 7 Slide barrel into autoclave 6 Close sliding door 5 Barrel and trolley are ready to pick up more waste Start heating, multi-vacuum and sterilization cycles Unlock & rotate barrel to dump treated waste at the bottom When finished, open door and remove sterilized barrel

16 Illustrations of Tanzania outcome Autoclave (200 liters) Horizontal designed Compact, it fits on a pick-up truck Uses electricity but can be changed to use bottled gas Autoclavable metal waste containers Leak-proof, color-coded, metal containers Containers fit inside the autoclave Holes in lid are opened to allow steam penetration 35 & 20 liters container sizes Container fit on stands with foot pedals to open the container lids Autoclavable mechanical needle cutter & autoclavable sharps container Compactor + mechanical baler Autoclave not yet certified to international standards

17 Results from Senegal At each of the model establishments, the project has led to standard practices, and a new waste treatment technology was installed based on the principle of autoclaving : it is ecological and adapted to the climatic and economic working conditions in Africa Illustrations of the management of waste before and after PROGEDIME implementation : pictures from the model hospital

18 BEFORE

19 Area of waste: open burning after poor segregation

20 Illustration of the poor segregation and storage

21 AFTER

22 Inauguration of a new treatment center for medical waste in a model facility (by the Minister of Health)

23 New technology installed Autoclave (left) and Shredder (right) Photo of waste after autoclave treatment and then shredding

24 Availability of PPE for well trained workers

25 Changes in practices (segregation and packaging)

26 Changes in practices (storage)

27 IV. DISCUSSIONS It appears possible in Africa to comply with standards of HCWM, despite multiplicity of gaps, especially lack of human and material resources One of the biggest challenges remains the sustainability of achievements Favoring factors met in Senegal was a national program (PRONALIN), responsible for the implementation and monitoring of national hospital hygiene policy

28 This success story deserves to be popularised to African health and environmental authorities for several reasons: - The HCWM process in Africa is far behind and sanitary and environmental damage is immense - In the context of improving Patient Safety, a number of technical recommendations in the field of hygiene, with tools for implementation, are now available

29 - UNDP/GEF project adds to this the availability of technology within the reach of African countries thereby enabling them to participate in the global fight against environmental pollution - The only thing missing now is the willingness and political will to implement national programs like the one in Senegal

30 V. CONCLUSION Opportunity for Africa to reduce pollution generated by health system while solving health problems Proper implementation of this program and its maintenance over time will have to be part of an overall hospital hygiene policy All these considerations must be taken into account in national programs for Patient Safety, which should in principle soon emerge in many African countries.

31 ACKNOWLEDGEMENT We acknowledge the United Nations Development Progamme (UNDP) and Global Environment Facility (GEF) We are grateful for the collaboration with the World Health Organisation and Health Care Without Harm More information about the GEF/UNDP Global Healthcare Waste Project can be found in the website (with documents in English, French, Spanish, Arabic and Russian by December 2014)