SAFE DISPOSAL OF SYRINGES AND NEEDLES

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SAFE DISPOSAL OF SYRINGES AND NEEDLES

• In The Context Of Health Care Waste Management
  Systems
• WHO Taskforce on Immunization (TFI)
• Luanda, 3-5 December, 2003

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Waste Workshops GAVI-ITF Workplan 2002-3

• to review the problem of infectious waste
  management,
• paying particular attention to primary health
  facilities (PHFs) where immunizations are
  conducted,
• to review potential technical solutions and
• to recommend priority actions for national
  planning

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Issues RaisedTechnical optionsGeneral
recommendations
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Issues raised

• Absence of HCWM legislation
• Poor results of HCWM surveys
• Problems of small-scale incinerators
• Lack of waste segregation and sharps boxes in
  PHFs

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Issues raised (1)

• Absence of HCWM legislation

of countries
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Issues raised (2)

• Absence of HCWM legislation
• Poor results of HCWM surveys

• No HCWM rules at PHFs
• Little segregation of waste
• Few sharps boxes
• On-site is by burial or by open burning danger to
  community
• Small-scale incinerators poorly installed,
  misused and not staffed
• Many hospital-based incineration systems have
  fallen out of use
• Little hospital HCWM support for primary health
  facilities

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Issues raised (3)

• that the small-scale incinerator has an important
  part to play until research has produced more
  environmentally acceptable and affordable
  alternatives
• A guideline on the construction methods and
  materials, the correct use and the maintenance of
  these incinerators January 2004

• Absence of HCWM legislation
• Poor results of HCWM surveys
• Problems of small-scale incinerators

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Issues raised (4)

• Absence of HCWM legislation
• Poor results of HCWM surveys
• Problems of small-scale incinerators
• Lack of waste segregation and sharps boxes in PHFs

• Safety boxes used for campaigns
• Some use in routine
• None in curative
• Cost high
• Local production rare

Senegal 2001
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Critical indicators of progress

• National HCWM committee or coordination mechanism
  established
• HCWM legislation enacted and policies published
• National injection safety plan prepared
• HCWM rapid assessment conducted
• District micro-plans for syringe disposal made
  and implemented
• Safety boxes provided for all injections

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Technical options presented
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Technical options

• Infectious sharps waste handling
• Technologies and procedures
• Final destruction/recycling
• Incineration, both centralized and on-site at
  PHFs
• Non-incineration processing of waste

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Technical options(1)

• Infectious sharps waste handling technologies and
  procedures

• Segregation for PHFs
• Sharps yellow
• Non-hazardous waste black
• Hazardous HCW yellow
• Needle removal reviewed
• Trials in India, Eritrea, Senegal, and soon Kenya
• Benefits shown
• Evaluation continues to 2004

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Technical options(2a)

• Infectious sharps waste handling technologies and
  procedures
• Incineration, both centralized and on-site at
  PHFs

• Centralized
• Dispositek system for Dar es Salaam
• Capacity for all health waste commercial
• So, low cost
• Out of town, meets e-standards
• Interest shown by Uganda, Kenya, DRC.,
  Ghana,Mozambique

0.24-0.42US/kg Compared to 3.50US/kg in
Hospitals
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Technical options(2b)

• Infectious sharps waste handling technologies and
  procedures
• Incineration, both centralized and on-site at
  PHFs

• District collection small-scale
• Serves 10 to 30 PHFs by collection system
• DeMontfort lowest cost, built on site model
• Emissions OK if
• WHO Guidelines to be followed
• UNICEF to supply kits for local assembly

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Technical options(3a)

• Infectious sharps waste handling technologies and
  procedures
• Incineration, both centralized and on-site at
  PHFs
• Non-incineration processing of waste

• Centralised collection systems require
• Autoclaving
• Shredding/grinding
• Industries that use recycled plastics

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Technical options(3b)

• Infectious sharps waste handling technologies and
  procedures
• Incineration, both centralized and on-site at
  PHFs
• Non-incineration processing of waste

• Decentralised processing at each PHF
• Research on Solar Melters in Senegal
• Sterilizes, compacts to cakes for recycling

Cost approx. 200-250US
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Summary of options

• Segregation of waste (3part) and use of safety
  boxes for ALL sharps
• Needle removal at point of use (subject to
  validation policy revision)
• Centralized, outsourced waste processing for
  large cities (eg. Dispositek)
• Hospital incineration to serve surrounding PHFs
• District infectious waste collection and
  small-scale incineration (eg. DeMontfort)

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General recommendations
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General Recommendations (1)

• Every country should have a collaborative
  mechanism for developing a regulatory framework
  for HCWM

• National HCWM Committee to develop policies for
  handling, processing and final destruction of
  infectious waste

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General Recommendations (2)

• Every country should have a collaborative
  mechanism for developing a regulatory framework
  for HCWM
• Every country should have and pursue a national
  plan for HCWM based on a national assessment

• Segregation of infectious and sharps waste
• Centralized systems of waste collection and
  destruction/processing to serve urban areas
• Small-scale incineration to serve PHFs
  installed, used maintained properly

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General Recommendations (3)

• Every country should have a collaborative
  mechanism for developing a regulatory framework
  for HCWM
• Every country should have and pursue a national
  plan for HCWM based on a national assessment
• External partners are exhorted to assist
  countries to establish and implement their HCWM
  plans

• GAVI asked to emphasize importance of HCWM in
  policies
• Vaccine Fund is asked to include a larger portion
  of disposal costs in the current safety grant
• Governments are requested to make adequate
  provision for the recurrent costs of the new HCWM
  systems

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Thank you!
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Recommendations

• Every country should have a collaborative
  mechanism for developing a regulatory framework
  for HCWM
• Every country should have and pursue a national
  plan for HCWM based on a national assessment
• External partners are exhorted to assist
  countries to establish and implement their HCWM
  plans

• INDICATORS
• National HCWM committee or coordination mechanism
  established
• HCWM legislation enacted and policies published
• National injection safety plan prepared
• HCWM rapid assessment conducted
• District micro-plans for syringe disposal made
  and implemented
• Safety boxes provided for all injections

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Waste Workshops GAVI-ITF Workplan 2002-3

• General recommendations
• Main issues raised in workshops
• Technical options available and in evaluation
• Current status of planning and implementation

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Current status of planning and implementation

• Legislation and policy
• Planning and implementation

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Legislation and policy (1)
East Africa
Southern Africa
WHO/ICP East African Block analysis
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Legislation and policy (2)
West Africa
Central Africa
WHO/ICP West African Block analysis
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Planning and implementation (1)
East Africa
Southern Africa
WHO/ICP East African Block analysis
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Planning and implementation (2)
West Africa
Central Africa
WHO/ICP West African Block analysis