Health Care Waste Management (HCWM) Regional Approach

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Health Care Waste Management (HCWM)Regional
Approach

• Ohrid,
• Ana Petrovska

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Minimum Requirements for single generators

• Small generators
• Segregation following the requirements of the
  Regulation (OGRM no 146/07).
• Obligatory use of a yellow (as receptacle), plus
  special boxes for pharmaceuticals, amalgam boxes,
  etc.
• Storage room should as a minimum be equipped with
  shelves for storage of the boxes

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Minimum Requirements for single generators (II)

• Large generators
• Segregation following the requirements of the
  Regulation (OGRM no 146/07), via the use of
  colour coding and identification labels. Also the
  use of special receptacles is recommended.
• When full the receptacles shall be collected and
  transported to a central storage facility. For
  the infectious and biological (pathological)
  waste collection should take place minimum once a
  day. Collection and transportation is done using
  a hand-pushed trolley or similar
• The central storage facility shall in the
  basement or at ground level of the HI, with easy
  access to the outside of the building.
  Ventilation and easy cleaning of surfaces should
  be enabled. Unauthorised access must be avoided.

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Collection Frequency

• Large generators
• 1-2 times each week in order to maintain proper
  sanitary conditions in the storage room.
• Small generators
• 1-2 times per month or on request. At collection
  the boxes used at smaller HIs will be transferred
  to containers used as the secondary packaging
  required for transport.

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Standard Wheeled Plastic Containers

• By introducing standard plastic containers on
  wheels as the main transport packaging two
  important objectives are achieved
• Skilled staff will perform loading of the
  containers and no reloading takes place before
  the container is emptied at the treatment
  facility
• Compliance with the ADR rules specifying the use
  of a combination (inner and outer) packaging for
  transport of dangerous goods by road.

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Collection Vehicles

• Large generators
• Collection of HCRW from hospitals and health
  centres is performed by larger trucks equipped
  with a closed cargo compartment large enough to
  hold approx. 40 containers (size 240 litres). The
  truck is equipped with a back-lift for easy
  loading of the containers. Both containers and
  the truck must be marked with a label according
  to the ADR Convention (Class 6.2, UN 2814 and UN
  3291).
• Small generators
• Collection of HCW from the smaller HIs, i.e.
  ambulatories, private GPs, dentists, etc. is done
  by a small truck or van operated by the local
  general hospital or health centre transporting
  the collected HCW to the central storage facility
  at the general hospital or health centre.

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Regional HCWM System

• Collection and transportation of HCW in the
  Skopje area could be provided by PE Komunalna
  Higiena Skopje, using larger trucks for the
  transport of the standard plastic containers on
  wheels from the central storage facilities at
  hospitals and health centres.
• Small trucks or vans can be delivered to the
  health centres for the provision of the
  collection service towards the smaller His.

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Regional HCWM System (II)

• Outside the Skopje area the 15 general hospitals
  and the 32 health centres may function as
  collection points for HCW generated in the
  smaller HIs in their respective areas.
• Received waste at the general hospitals and the
  health centres may be stored in the respective
  central storage facilities until the transport to
  the treatment facility is carried out. The
  central storage facilities at hospitals will be
  cooled with maximum temperature of 8 Co, while
  this is not necessary for immediate storage
  facilities.
• Transport from regional storage centres to the
  treatment facility will take place minimum once a
  week by a company having the proper permit and
  license to carry out transport of hazardous
  waste.

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Organizational (Institutional) Issues

• Regional Centres (Health Care Institutes or
  General Hospitals) provide collection to smaller
  generators
• Similarly, these Centres provide also the
  transport to the treatment facility.
• Hospitals are organized at regional level and can
  decide on the contracting out of the collection
  and transport.
• A special arrangement for the primary collection
  service could be considered for Skopje, due to
  the fact that PE Komunalna Higiena Skopje
  already is performing this collection service.
  Existing contracts between PE Komunalna Higiena
  Skopje HIs must be revised in accordance with
  the change in services in addition, the company
  must obtain a proper permit and license for
  collection and transport of hazardous waste

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New Duties of Regional Systems / Organizations

• Collection and transport of HCW from central
  storage facilities (general hospitals and health
  centres)
• Registration and reporting of all waste types and
  amounts collected (preparation of Waste
  Transportation Lists to be used as consignment
  documents)
• Division of waste collected, for in-house
  treatment and/or for treatment and disposal at
  regional treatment/disposal facilities
• Operation of the medical waste treatment facility
  (incinerator or autoclave(s)) including all
  necessary maintenance, monitoring and reporting
  activities
• Transport of medical waste treatment residues for
  final disposal including registration of types,
  amounts and final destination.

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Ownership of Regional Systems / Organizations

• Joint Ownership
• Shareholding
• Association of hospitals
• Individual Ownership
• Ownership over the collection and transportation
  equipment by the regional centers
• Ownership over the regional treatment facilities
• Public Private Partnerships
• Tendering out of the collection transportation
• Tendering out of the treatment