Health Care Waste Management Training. Resource Guide

Transcription

1 Training Resource Guide 5 August 2011

2

3 Training Resource Guide 5 August 2011 Scott Ackerson SCMS sackerson@pfscm.org Acknowledgements The authors of this report would like to acknowledge the assistance, support, and guidance of all those involved with the design, organization and implementation of the ASI- MC Program.

4 Capacity Building in Supply Chain Management of ARV Drugs and HIV Tests About SCMS The Supply Chain Management System (SCMS) was established to enable the unprecedented scale-up of HIV/AIDS prevention, care and treatment programs in the developing world. SCMS procures and distributes essential medicines and health supplies, works to strengthen existing supply chains in the field, and facilitates collaboration and the exchange of information among key donors and other service providers. SCMS is an international team of 13 organizations funded by the US President s Emergency Plan for AIDS Relief (PEPFAR). The project is managed by the US Agency for International Development. This document was made possible through support provided by the US Agency for International Development, under the terms of contract number GPO-I The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the US Agency for International Development or the US government. Recommended Citation Ackerson Training Resource Guide. Submitted to the US Agency for International Development by the Supply Chain Management System (SCMS). This document may be reproduced if credit is given to SCMS. Supply Chain Management System 1616 Ft. Myer Drive, 12 th Floor Arlington, VA USA Telephone: Fax: scmsinfo@pfscm.org Website: 4

5 5

6 HCWM 1 Management of Medical Waste 1 1. Purpose Name: Title: Date: Lead Author: Scott Ackerson Program Officer 9/2/2011 Section Approval: Sameer Sakallah Sr. Principal Advisor 9/2/2011 Effective Date: Review Period: Annually Medical waste generated from the MC sites are presumed to be infectious and can pose risks to patients, health care workers and visitors when not handled, contained and or disposed of appropriately. In order to control and minimize these risks the MC sites are required to comply with the standards set forth in this document. 2. Scope Waste materials shall be handled, contained, and disposed of according to the Swaziland Environmental Unit s policies. The following guidelines provide specific definitions of and disposal methods for NONINFECTIOUS, INFECTIOUS, and SHARPS wastes. 3. Responsibilities MC Services, Deputy Director Obtain and be familiar with national waste management policies. Enforce facility waste management plan (goal, budget, personnel, roles, supervision, training, reporting). Conduct quality audits and check for compliance to SOP of HCWM. Ensure supply of safety boxes, colored liners, posters on proper segregation, and other quality assurance equipment is on site. Create climate of support for needle-stick injury reporting. Page 1 of 11

7 HCWM 1 Management of Medical Waste 1 Advocate for health worker safety. Clinical Staff Follow waste management policies. Follow color-coded waste segregation system. Place sharps containers properly at designated locations. Immediately dispose of sharps in closed containers. Record keeping record number of filled sharps containers, identify supply needs, report stock outs. Store infectious and sharps waste in secure location. Hygienist and Theater Runner Know color-coding system. Collect filled sharps containers and waste. Ensure waste is securely stored until disposal. Use protective equipment when handling medical waste and sharps. Provide waste to waste collection vehicle or service. Ensure a clean and orderly environment at the facility. Waste Carriers Maintain segregation. Remove waste from facility in accordance with contract. Safely transport waste to final disposal site. Transport waste in safe and acceptable manner in accordance with contractual protocols. Page 2 of 11

8 HCWM 1 Management of Medical Waste 1 Incinerator or autoclave operators: All operators and personnel must be certified through training and assessments to have the required knowledge and skills needed to competently perform their assigned tasks. 4. Definitions Follow incinerator/autoclave operations procedures. Use the required protective equipment when handling waste. Ensure supply of fuel is maintained above the minimum requirement. Record weight and type of waste received. Follow and document that the regular maintenance schedule for the incinerator has been performed in accordance with requirements. Ensure regular transport of ash to protected ash pit. Hazardous healthcare waste is of primary concern in Swaziland, due to its potential to cause disease or injury. A precise definition of types of health care waste (HCW) takes into account the associated hazards and is incorporated into Swaziland health care waste management (HCWM) legal, regulatory, technical, and information documents. The hazardous nature of HCW may be due to the following properties: It contains infectious agents It contains contaminated sharps It is cytotoxic or genotoxic It contains toxic or hazardous chemicals, or pharmaceutical products Page 3 of 11

9 HCWM 1 Management of Medical Waste 1 Healthcare Wastes (HCW) is all waste generated by healthcare establishments (human or veterinary)including research facilities and laboratories. It can include waste generated in the course of health care in homes. HCW includes: Noninfectious waste. This is general waste that presents no risk to persons who handle it. Examples: paper, packaging materials, office supplies, drink containers, hand towels, boxes, glass, plastic bottles, and food. Infectious waste. This is waste that may have been in contact with human blood or bodily fluid and may have the ability to spread disease. Examples: gauze, cotton, dressings, laboratory cultures, IV fluid lines, blood bags, gloves, anatomical waste, surgical instruments and pharmaceutical waste. Sharps waste. This is waste that may puncture the skin and cause disease. Examples: needles, infusion sets, scalpels, knives, blades, lancets, and broken glass. 5. Procedures Segregation of waste Waste which must be disposed of in a particular manner should be segregated at point of generation using the following color coded bags system. Red bags RED BAGS For all potentially infectious waste Black bags BLACK BAGS For all noninfectious or general waste Page 4 of 11

10 HCWM 1 Management of Medical Waste 1 Safety Boxes (card board or plastic) For used and contaminated sharps Under no circumstances are bags to be used for any other purposes than those listed above A vigorous, effective and properly monitored segregation procedure is necessary to ensure that no waste which should be transported for incineration enters any other waste stream. It will be the responsibilities of the Waste Handlers to notify the MC Service, Deputy Director of any cross contamination. Color coded charts showing the actual color of the bag and type of container appropriate to each type of waste must be located in every area where waste is put into bags. Both infectious and noninfectious waste bags must be filled to no more than ¾ full and tied in the approved manner using the swan necking method secured with a numbered tag tie. Immediately take the bags to the temporary holding area and place the waste in its designated large bin. Infectious waste must be place in the designated biohazard bin in a secure area. Waste bags and containers Adequate supplies of appropriate waste bags and containers must be provided where waste materials are generated. Containers must be made of durable plastic which can be properly cleaned and sterilized. All waste containers must be capable of containing the waste without spillage or puncture. Containers intended for incineration must not be made of polyvinyl chloride (PVC). Page 5 of 11

11 HCWM 1 Management of Medical Waste 1 All clinical waste bags must be securely fastened when no more than 3/4 full and tie tagged in the approved manner using the swan necking method secured with a numbered tag tie which includes the identification of source. Sharps Waste sharps (discarded syringe needles, scalpels, cartridges, broken glass and any other disposable sharp instruments) must be placed in containers complying with national standards and guidelines. Needles and syringes should be discarded as a single unit where possible. It is the responsibility of the person using the sharp to dispose of it correctly. Up to date sharps policy must be posted in every clinical area and all personnel should be trained to conform to the requirements. Containers must be sealed when no more than 3/4 full and labelled for identification of source before being securely stored in designated large plastic bin for transport. Handling of waste PERSONAL PROTECTIVE EQUIPMENT Correct standard infection control precautions are recommended for health care workers when handling highly infectious health care waste. Items should include: Face shields Eye protectors N95 respiratory masks Gowns Page 6 of 11

12 HCWM 1 Management of Medical Waste 1 Plastic aprons Knee-length boots Disposable gloves (surgical, fluid repellent) Thick gloves for waste handlers The Theater Runner and/or Hygienist is responsible for the pick up and transport of all waste from the surgical theatre to the temporary storage location. Waste will be collected when the bag becomes ¾ full and will be replaced by another bag of the same color. Storage of waste For ease of use all small waste bins must be placed in convenient strategic locations within the facility. All waste bags must be sealed when no more than 3/4 full and held in the temporary storage area in the waste s designated plastic large bins prior to transport and final disposal. Infectious waste must be placed in the lockable plastic bins or a secured location before transport. Waste must not be allowed to accumulate in unsuitable places. There must be enough storage capacity to allow for the proposed frequency of collection. Holidays should be taken into account and a margin provided for any interruption in the disposal system. Large storage bins must be easily accessible. Only authorized persons should be able to gain entry into the large bins. They should be kept secure from entry by animals and free of infestation by rodents or insects. Large waste bins (noninfectious and infectious) must be away from food preparation, general storage areas and from routes used by the public. Buildings used must be well lit, well ventilated and clearly labelled. If possible the waste material egress route should not be the same as the incoming supplies ingress route. Page 7 of 11

13 HCWM 1 Management of Medical Waste 1 Spillage of medical waste: In the event of waste being spilled, or a bag being torn or the seal broken, the MC Service, Deputy Director must be informed. The origin of the waste must be determined before being dealt with. Responsibility for clearance of the spillage must not be delegated and only carried out by persons trained in the correct procedures, e.g. cleaning of bloody, bodily fluids and sharps. The Theater Runners and/or Hygienist is responsible for dealing with the waste spillage and completing the Incident Form. Spillage of dry clinical waste: Using a fresh RED bag/sack the spillage should be re-bagged and labelled. Heavy duty gloves should be worn and properly disposed of after the cleanup. Dust pan/shovel and brush should be used to minimise contact. Dust pan/shovel and brush should be washed in warm detergent solution after use. Spillage of sharps Never pick up sharps by hand. A fresh container must be used and heavy duty gloves and apron worn. A dust pan/shovel and brush may be used. Small quantities of sharps may be picked up using disposable forceps. If equipment comes into contact with body fluid, then it must be treated as contaminated and in most cases the item needs to be destroyed. All items which have come into contact with potentially infectious materials should be cleaned and sterilized before being placed back in service. Spillage of blood: Cover with paper towels and freshly prepared hypochlorite solution (10,000 ppm available chlorine) prepared in accordance with labelled procedures from hypochlorite capsules or hypochlorite granules, properly diluted hypochlorite solution. Page 8 of 11

14 HCWM 1 Management of Medical Waste 1 After 10 minutes collect the towels up and put carefully into a RED clinical waste bag. Ensure that you wear disposable gloves, an apron and eye/face protection during this operation. After clearing the area wash the exposed surfaces with warm detergent solution and dry. Spillage of other bodily fluids: Spillage of bodily fluids other than blood can be dealt with by using hot water and detergent. Ensure that you wear disposable gloves and apron during this operation. Eye and face protection will be necessary where large volumes are concerned or splash/spray into the face is possible. Normal low risk/low volume body fluids that are not contaminated by blood can be disposed of by putting into a RED bag. Special/hazardous waste Pharmaceutical All pharmaceutical waste (excluding Controlled Drugs) will be classed as special waste and handled as such. Used test kits and materials stained by lab reagents should be collected in a RED bag and stored with other infectious wastes for treatment by high temperature incineration. Expired pharmaceuticals in large quantity should be collected in a box, sealed and labelled for treatment and disposal. The label should contain among other things, name of drug, and date of expiry and name of IP/HF and stored away in a locked up storage room. The same procedure should be followed with expired lab reagents or test kits as well as drugs that failed quality testing. The expired pharmaceuticals, test kits and lab reagents will be transported to the CMS for treatment using high temperature rotary kiln incinerators, and the resultant ash buried in a landfill or protected lined pit. Transport of waste Page 9 of 11

15 HCWM 1 Management of Medical Waste 1 Noninfectious and Sharps Waste Noninfectious waste will be collected by the municipality or burned in a secure and protected burn pit. Infectious and Sharps Waste Infectious and sharps waste will be incinerated at the site or collected by a certified waste handler and transported to an incineration facility. The Hygienist will load the large plastic bin onto a transport truck and complete the required chain of custody forms before transfer of waste to the incineration facility. Disinfected Surgical Instruments Place clean and dry instruments into a cardboard container and seal the container using tape. Place in a dry area way from other medical supplies and commodities. Have the clinic doctor on site sign a certification of disinfection and tape the certification to the top of the box. The Interfreight distribution company will pick up the instruments monthly and take them to the central warehouse for storage. Have the chain of custody form completed by a representative of the Interfright transportation company before instruments leave the site. 7. Distribution 1. To all Male Circumcision Sites 10. Amendment History Page 10 of 11

16 HCWM 1 Management of Medical Waste 1 Revision: Effective Date: Changed By: Reason: 11. Additional Reviewers Revision: Name: Title: Date: Comments: Page 11 of 11

17 HCWM 1 Disinfection of Surgical Instruments 1 1. Purpose Name: Title: Date: Lead Author: Scott Ackerson Program Officer 9/2/2011 Section Approval: Sameer Sakallah Sr. Principal Advisor 9/2/2011 Effective Date: Review Period: Annually Medical waste generated from the MC sites are presumed to be infectious and can pose risks to patients, health care workers and visitors when not handled, contained and or disposed of appropriately. In order to control and minimize these risks the MC sites are required to comply with the standards set forth in this document. 2. Scope Hypochlorite solutions are widely used as a means of sterilization in healthcare facilities in a variety of settings including disinfecting surgical instruments, laboratory equipment and for spot-disinfection of countertops and floors. This document will outline the correct procedures for disinfecting surgical instruments for safe transport. 3. Responsibilities MC Services, Deputy Director Obtain and be familiar with national waste management policies. Enforce facility waste management plan (goal, budget, personnel, roles, supervision, training, reporting). Ensure an adequate supply of safety boxes, colored liners, poster on proper segregation, and other quality assurance equipment is on site. Conduct quality audits and check for compliance to SOP of HCWM. Create climate of support for needlestick injury and cuts reporting. Page 1 of 8

18 HCWM 1 Disinfection of Surgical Instruments 1 Advocate for health worker safety. Clinical Staff Follow waste management policies. Follow color-coded waste segregation system. Place sharps containers properly at designated locations. Immediately dispose of sharps in closed container. Record keeping record number of filled sharps containers, identify supply needs, report stock outs. Store sharps waste in secure location. Waste Handler (Hygienist and MC Theater Runner) Know color-coding system. Collect filled medical and sharps containers and waste. Disinfect surgical instruments for safe transport. Ensure waste is securely stored until disposal. Use protective equipment when handling medical waste and sharps. Provide waste to waste collection vehicle or service. Ensure a clean and orderly environment at the facility. Waste Carriers Maintain segregation. Remove waste from facility in accordance with contract. Safely transport waste to final disposal site. Page 2 of 8

19 HCWM 1 Disinfection of Surgical Instruments 1 Dispose of waste in safe and acceptable manner in accordance with contractual protocols. Incinerator or autoclave operators: All operators and personnel must be certified through training and assessments to have the required knowledge and skills needed to competently perform their assigned tasks. Follow incinerator/autoclave operations procedure. Use the required protective equipment when handling waste. Ensure supply of fuel is maintained above the minimum requirement. Record weight and type of waste received. Ensure payments received, as appropriate. Follow and document that the regular maintenance schedule for incinerator has been performed in accordance with requirements. Ensure regular transport of ash to protected ash pit. 4. Definitions Hazardous healthcare waste is of primary concern in Swaziland, due to its potential to cause disease or injury. A precise definition of types of health care waste (HCW) takes into account the associated hazards and is incorporated into Swaziland health care waste management (HCWM) legal, regulatory, technical, and information documents. The hazardous nature of HCW may be due to the following properties: It contains infectious agents It contains contaminated sharps It is cytotoxic or genotoxic It contains toxic or hazardous chemicals or pharmaceutical products Page 3 of 8

20 HCWM 1 Disinfection of Surgical Instruments 1 Healthcare Wastes (HCW) is all waste generated by healthcare establishments (human or veterinary) and including research facilities and laboratories. It can include waste generated in the course of health care in homes. HCW includes: Noninfectious waste. This is general waste that presents no risk to persons who handle it. Examples: paper, packaging materials, office supplies, drink containers, hand towels, boxes, glass, plastic bottles, and food. Infectious waste. This is waste that may have been in contact with human blood or bodily fluid and may have the ability to spread disease. Examples: gauze, cotton, dressings, laboratory cultures, IV fluid lines, blood bags, gloves, anatomical waste, surgical instruments and pharmaceutical waste. Sharps waste. This is waste that may potential to puncture the skin and cause disease. Examples: needles, infusion sets, scalpels, knives, blades, lancets, and broken glass. 5. Procedures Equipment All waste handlers must wear or have the following equipment when disinfecting surgical instruments: Gloves: protects any cuts on hands and helps protect against chemical reagents. Boots: protects feet from sharps and accidental spills. Aprons (rubber or plastic): keeps contaminants off of clothes. Goggles (plastic): protect the eyes from accidental splashes. Commercial household hypochlorite solution: 3% - 5% Page 4 of 8

21 HCWM 1 Disinfection of Surgical Instruments 1 2 Large Plastic buckets Instruction on diluting Hypochlorite for use: Obtain a solution of sodium hypochlorite and determine from the list of active ingredients the concentration of sodium hypochlorite in the solution. It should range from approximately 1% to 10%. Use the table below to correctly mix the water and appropriate amount of sodium hypochlorite to create the cleaning solution. Mix well with a clean utensil. Total Volume of Solution IN LITRES Amount of Water in Bucket / Container Used Sodium Hypochlorite Concentration (3-5%) Amount of Water in Bucket / Container Amount of Sodium Hypochlorite Solution to add Amount of Sodium Hypochlorite Solution to add IN LITRES (L) IN MILLILITRES (ML) IN LITRES (L) IN MILLILITRES (ML) (L) Page 5 of 8

22 HCWM 1 Disinfection of Surgical Instruments The Hypochlorite solution should not be reused and a new solution must be made for every cleaning. If the solution becomes visibly contaminated the solution is not suitable for reuse. WARNING: Avoid skin and eye contact. Solution may sensitize and may cause skin irritation. This solution is extremely corrosive and harmful to swallow. Disinfection Process Immerse the surgical instruments completely in the active solution for 20 minutes. The bucket should not be filled more than ¾ full of solution and instruments. Remove the surgical instruments from the solution and scrub the surgical instrument until all signs of contaminates is removed. Place the surgical instruments into the other bucket that contains a clean water bath for 10 minutes. Remove the instruments from the water bath, rinse carefully then dry; wear protective gloves when handling instruments. Place the dried instruments into a cardboard box seal with tape Page 6 of 8

23 HCWM 1 Disinfection of Surgical Instruments 1 Place the box in a secure area. Before storing have the clinic doctor on site sign a certification of disinfection and tape the certification to the top of the box. Place the certified instruments into a secure area. Transport and Storage Place the instruments in a secure container and in a secure area. Place the box in a dry area away from other medical supplies and commodities. The distribution company will pick up only certified instruments during routine delivery of supplies and commodities, however special arrangements can be made upon request. The instruments will then be taken to the central warehouse for storage. Have the waste sign off sheet completed by Waste Handler and a copy given to a representative of the Inter freight company. Contact with skin and eyes If the skin comes into contact with the solution flush thoroughly with water for 3 minutes. If the solution comes into contact with the eyes flush with water immediately and get medical attention. Disposal of Waste Dilute the Hypochlorite solution by running water to the top of the bucket Pour the contents of the bucket down a drain or at a waste disposal site. 10. Amendment History Revision: Effective Date: Changed By: Reason: Page 7 of 8

24 HCWM 1 Disinfection of Surgical Instruments Additional Reviewers Revision: Name: Title: Date: Comments: Page 8 of 8

25

26

27

28 Monthly Waste Log Date/Month: Indicate the total number of bags of waste the facility produces in one day below Waste Category Sunday Monday Tuesday Wednesday Thursday Friday Saturday Weekly Total Noninfectious Waste Infectious Waste Sharp Waste Daily Total Week 1 Week 1 Week 5 Week 4 Week 3 Week 2 Waste Category Sunday Monday Tuesday Wednesday Thursday Friday Saturday Weekly Total Noninfectious Waste Infectious Waste Sharp Waste Daily Total Waste Category Sunday Monday Tuesday Wednesday Thursday Friday Saturday Weekly Total Noninfectious Waste Infectious Waste Sharp Waste Daily Total Waste Category Sunday Monday Tuesday Wednesday Thursday Friday Saturday Weekly Total Noninfectious Waste Infectious Waste Sharp Waste Daily Total Waste Category Sunday Monday Tuesday Wednesday Thursday Friday Saturday Weekly Total Noninfectious Waste Infectious Waste Sharp Waste Daily Total Example Chart Waste Category Sunday Monday Tuesday Wednesday Thursday Friday Saturday Weekly Total Noninfectious Waste Infectious Waste Sharp Waste Daily Total

29 Sodium Hypochlorite Concentration Tables Used Sodium Hypochlorite Concentration Amount of Water in Bucket (in litres) Amount of Sodium Hypochlorite Solution to add (in litres) Total Volume of Solution (in litres) 0.5% - 1.0% % - 3.0% % - 5.0% % % Total Volume of Solution Sodium Hypochlorite Concentration (0.5-1%) Amount of Water in Bucket / Container Amount of Water in Bucket / Container Amount of Sodium Hypochlorite Solution to add Amount of Sodium Hypochlorite Solution to add IN LITRES (L) IN LITRES (L) IN MILLILITRES (ML) IN LITRES (L) IN MILLILITRES (ML)

30 Total Volume of Solution Used Sodium Hypochlorite Concentration (1-3%) Amount of Water in Bucket / Container Amount of Water in Bucket / Container Amount of Sodium Amount of Sodium Hypochlorite Solution to Hypochlorite Solution to add add IN LITRES (L) IN LITRES (L) IN MILLILITRES (ML) IN LITRES (L) IN MILLILITRES (ML) Total Volume of Solution Used Sodium Hypochlorite Concentration (3-5%) Amount of Water in Bucket / Container Amount of Water in Bucket / Container Amount of Sodium Hypochlorite Solution to add Amount of Sodium Hypochlorite Solution to add IN LITRES (L) IN LITRES (L) IN MILLILITRES (ML) IN LITRES (L) IN MILLILITRES (ML)

31 Total Volume of Solution Used Sodium Hypochlorite Concentration (5-10%) Amount of Water in Bucket / Container Amount of Water in Bucket / Container Amount of Sodium Hypochlorite Solution to add Amount of Sodium Hypochlorite Solution to add IN LITRES (L) IN LITRES (L) IN MILLILITRES (ML) IN LITRES (L) IN MILLILITRES (ML)

32 Certification of Instrument Disinfection Date: I certify that the surgical instrument contained in this container have been disinfected following standard operating procedures that meet the Kingdom of Swaziland standards, and recommended World Health Organization procedures for the disinfection of surgical instruments. Signature Witness

33 Chain of Custody Record for Medical Waste Serial #: Final Destination (Name & Address) Transport Company (Name & Address) Serial # on Transporter / Container Product Description (Indicate Medical Waste. Sharps Waste, Instruments, etc?) Serial # on Bag in Transporter / Container (weight in kg) Source / Location e.g. A001 e.g. Medical Waste e.g. A002 (9kg) e.g. Matacula JCI Source / Location Representative's Signature e.g. MC Site Manager signs here Witness of Destruction Signature e.g. Incinerator Operator signs here once waste is incinerated Date of Destruction e.g. Date of Destruction recorded here Signature of Point of Delivery (Incinerator Operator signs here when receiving the waste) Signature of Transport Company Representative Print Name and Date Print Name and Date White - MOH / Hospital Yellow - Transport Company Green - Garvey Investments Pink- MC Site

34 Category Solid Waste Red Bags Sharps Instruments Other Reception X Counseling (2-3 per site) X X X Theater X X X X Recovery Room X X X Post OP/Review X X X Category Small Red Bag Large Red Bag Reception 0 0 Counseling Room (2-3 per site) 3 0 Theater 35 9 Recovery Room 1 0 Post OP/Review 3 0 Total Bags Weight (Kg) (.5kg per small bag) 21 Number of Large Bags per container Number of Containers used per day Number of Containers per site 12 Number of Containers required for program 254 Category (7 gallon Sharps Box: Fisher) 3 Months Reception 0 Counseling Room (2-3 per site) 3 Theater 4 Recovery Room 1 Post OP/Review 1 Total Number of Sharps Boxes per month 9 Total Number of Sharps Boxes for the project July September July December July September