Transcript Health Care Waste Management (HCWM) Baseline

Health Care Waste
Management (HCWM) Baseline
Ohrid,
Ana Petrovska
18.12.2007
STRATEGY ON THE MANAGEMENT
OF THE BIOMEDICAL WASTE
Legal Base – EU Directives
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Biological Agents Directive 90/679/EEC
Hazardous Waste Directive 91/689/EEC
Health and Safety Framework Directive 89/391/EEC
Waste Directive 75/442/EEC
Waste Oils Directive 75/439/EEC
Packaging Waste Directive 94/62/EC
Carcinogens Directive 90/394/EEC
Dangerous Substances Directive 76/769/EEC
Natural Habitats Directive 92/43/EEC
Protective Equipment Directive 89/656/EEC
PPE Directive 89/656/EEC
18.12.2007
STRATEGY ON THE MANAGEMENT
OF THE BIOMEDICAL WASTE
Legal Base – National Framework
 Law on Waste (OGRM no. 68/04; 71/04)
 Law on Environment (OGRM no 53/05)
 Law on Public Health Protection (OGRM no no 17/97,
11/02, 10/04, 84/05, 111/05, 65/06, 05/07).
 Law on Veterinary Health (OGRM no 28/98)
 Law on Sanitary and Health Inspection (OGRM no
71/06)
 Basel Convention on the Control of Transboundary
Movements of Hazardous Wastes and their Disposal
(OGRM no 49/97)
 Ordinance on Integrated Pollution Prevention and
Control, IPPC (OGRM no 89/05)
 Regulation on the Procedure for Issuing of A
Integrated Environmental Permit (OGRM no 04/06)
18.12.2007
STRATEGY ON THE MANAGEMENT
OF THE BIOMEDICAL WASTE
Legal Base – National Framework (II)
 List of types of waste (OGRM no 100/04)
 Regulation on Conditions for Handling Hazardous Waste and
the Manner of Packaging and Labelling the Hazardous Waste
(Draft)
 Regulation on the Methods and Conditions for Storage of
Waste (OGRM no 29/07)
 Regulation on the form and content of the Request and Permit
for processing, treatment and/or storage of waste, form and
content of the permit and the technical conditions for
performing the activity (OGRM no 23/07)
 Regulation on the form and content of the journal for waste
handling, the forms and content of the forms for identification
and transport of waste and content of forms for annual reports
for handling waste (OGRM no 7/06)
 Regulation on the Manner of Handling HCW, Labelling and
Forms for Handling HCW and on Types of HCW for which
Processing is prohibited (OGRM no 146/07)
18.12.2007
STRATEGY ON THE MANAGEMENT
OF THE BIOMEDICAL WASTE
Stakeholders
Parliament
Government
MoEPP
Waste
collection &
transport
companies
MoAFWE
MoH
Veterinary
Establishments
HC
Institutions
internal
HCWM
SVI
SEI
Waste storage
facilities
SSHI
Waste disposal
facilities
18.12.2007
STRATEGY ON THE MANAGEMENT
OF THE BIOMEDICAL WASTE
MoTC / LSG
Dog Pounds
SCI
Current Gaps
 Regulation on Conditions for Handling Hazardous
Waste and the Manner of Packaging and Labelling
the Hazardous Waste will be put into effect in the
beginning of 2008
 Regulation on the Manner of Handling HCW,
Labelling and Forms for Handling HCW and on Types
of HCW for which Processing is prohibited has been
put into effect in he end of 2007, thus closing the
major legal gap; waste originating from veterinary
establishments has also been regulated with this
piece of legislation
 Secondary legislation regulating the emission
thresholds for the incineration is still missing
18.12.2007
STRATEGY ON THE MANAGEMENT
OF THE BIOMEDICAL WASTE
Main Generators of HCW
Type of Healthcare Institution
Tertiary healthcare level institutions comprises:
University clinics and institutes, Skopje
Clinical Centre
Dental Clinical Centre
Clinic for Maxillofacial Surgery
Institutes of the Medical Faculty
Institute for radiotherapy and oncology
Republic Institute for Health Protection, Skopje
Secondary level healthcare institutions comprises:
Regional Institutes for Health Protection
Specialised Hospitals and Institutes
Public General Hospitals
Private Hospitals (incl. Military Hospital, Skopje)
Primary level healthcare institutions comprises:
Health Centres
Health Stations
Other HIs comprises:
Private healthcare for elderly people
Private healthcare laboratories
Healthcare Institutions (HIs) in total
18.12.2007
STRATEGY ON THE MANAGEMENT
OF THE BIOMEDICAL WASTE
Number
5
1
10
18
15
4
34
2
5
7
101
Annual HCW generation
Healthcare facility
HCW amounts
Tons/year
%
of total
Hospitals and Specialised Institutions
730
78.7%
Institutes for Health Protection
22
2.4%
Health Centres
102
11.0%
Dentist Ambulatories outside health centres
20
2.2%
Veterinary Healthcare Facilities
43
4.6%
Pharmacies and Laboratories
10
1.1%
In total
927
100%
18.12.2007
STRATEGY ON THE MANAGEMENT
OF THE BIOMEDICAL WASTE
Present Practice
• Segregation in hospitals is carried out for three
waste streams: non-hazardous, hazardous HCW and
sharps. No other (either hazardous or nonhazardous) are anticipated so far.
• Coverage of the collection service for HCW is
estimated to be close to 100% in the Skopje urban
area, covering all types of HIs (hospitals, health
centres, ambulatories, private GPs, etc.).
• Approximately 70% of HCW is collected in
Kumanovo; remaining quantities are collected as an
ordinary municipal waste.
• In other towns collection of HCW is provided by
Public Enterprises servicing generators of municipal
waste. Consequently, the HCW is collected together
with the MSW and dumped at the municipal landfills.
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STRATEGY ON THE MANAGEMENT
OF THE BIOMEDICAL WASTE
Present Practice
(within hospitals)
• 82.9% of the HIs have appointed a responsible
person for infection control
• The generated amount of medical waste is not
reported (100%) at a regular basis to the State
Environmental Inspectorate, Ministry of Environment
and Physical Planning.
• Minimum once per day at a scheduled time they
transport HCW in e.g. yellow plastic containers on
wheels (70 kg) or other types of trolleys in 58.5% of
hospitals; in 41,5% waste is handled within the
premises manually
• 73.2% of hospitals use colour code marking for segregated
wastes
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STRATEGY ON THE MANAGEMENT
OF THE BIOMEDICAL WASTE
Present Practice within hospitals (II)
• 100% of waste collection equipment has fixed places
at ward and facility level.
• 56.1% of the HIs use instructive posters (developed
by WHO and RIHP) describing the way of separation
of medical waste.
• 87.8% of the special storage containers are used for
HCW
• 63.4% of the HIs have special storage room/facilities
for HCW.
• 100% of sweepers and orderlies use protective
clothing handling medical HCW
• Since 2005 health staff professionally exposed to
HCW (during diagnostic, therapeutic and research
work) is protected by vaccination against Hepatitis
B.
STRATEGY ON THE MANAGEMENT
18.12.2007
OF THE BIOMEDICAL WASTE