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National Guidelines: Managing Healthcare Waste Generated from Safe Male Circumcision Procedures | I AUGUST 2013 This publication was made possible through the support of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development under contract number GHH-I-00-07-00059-00, AIDS Support and Technical Assistance Resources (AIDSTAR-One) Project, Sector I, Task Order 1. Uganda National Guidelines: Managing Healthcare Waste Generated from Safe Male Circumcision Procedures | i Acronyms ACP AIDS Control Programme HCW health care waste HCWM health care waste management IP implementing partner MoH Ministry of Health NDA National Drug Authority NEMA National Environmental Management Authority PEPFAR U.S. President’s Emergency Plan for AIDS Relief PHC primary health center PMTCT prevention of mother-to-child transmission POP persistent organic pollutants SMC safe male circumcision STI sexually transmitted infections UAC Uganda AIDS Commission UNBOS Uganda National Bureau of Standards USG U.S. Government WHO World Health Organization ii | Uganda National Guidelines: Managing Healthcare Waste Generated from Safe Male Circumcision Procedures Table of Contents Acronyms ......................................................................................................................................................... ii Preface ............................................................................................................................................................. v 1.0 BACKGROUND .......................................................................................................................................... 1 1.1 HIV Situation in Uganda ........................................................................................................................... 1 1.2 National Response to the Epidemic .......................................................................................................... 1 1.3 Male Circumcision .................................................................................................................................... 1 1.4 Supply Chain Considerations ................................................................................................................... 2 1.5 Health Care Waste Management as a Challenge to Achieving Desired Targets ....................................... 3 2.0 GENERAL OVERVIEW OF HEALTH CARE WASTE MANAGEMENT ..................................................... 4 2.1 Introduction .............................................................................................................................................. 4 2.2 Risks Caused by Poor Management of Health Care Wastes .................................................................... 4 2.3 Basic Elements for Safe Management of Health Care Waste for PHC Centers ........................................ 5 2.3.1 Waste Minimization and Segregation ................................................................................................. 6 2.3.2 Recommended Techniques for Treatment of Infectious Waste .......................................................... 8 2.3.3 Storage and Transportation of Waste ................................................................................................ 8 2.3.4 Final Disposal .................................................................................................................................... 9 2.4 Roles and Responsibilities of Stakeholders ............................................................................................ 10 3.0 GENERAL OVERVIEW OF HEALTH CARE WASTE MANAGEMENT ................................................... 12 3.1 Identifying SMC Waste Generation Points .............................................................................................. 12 3.2 Mapping the Flow of HCW within the Health Facility or Outreach Site .................................................... 13 3.3 Considerations for All Streams of SMC Waste ....................................................................................... 14 3.3.1 How to Select a Waste Handling Service Provider ........................................................................... 14 3.3.2 Segregating SMC Waste ................................................................................................................. 15 3.3.3 Treatment of SMC Waste Streams .................................................................................................. 17 3.3.4 Decontamination and Disposal of Used Instruments ........................................................................ 18 3.3.5 Summary of Treatment and Disposal Methods for SMC Kit Components ........................................ 20 4.0 REFERENCES .......................................................................................................................................... 23 5.0 ANNEXES ................................................................................................................................................. 24 5.1 List of Health Facilities Participating in SMC Supported by IPs .............................................................. 24 5.2 Laws and Regulations - Health Care Waste Management ..................................................................... 30 5.3 Estimated Volumes of Waste ................................................................................................................. 31 5.4 Managing HCW Using a Centralized System ......................................................................................... 32 Uganda National Guidelines: Managing Healthcare Waste Generated from Safe Male Circumcision Procedures | iii 5.5 List of General Hospitals with Installed Incinerators (March 2013).......................................................... 32 5.6 Licensed Waste Handling Service Providers (March 2013) .................................................................... 33 5.7 Decontamination Process ...................................................................................................................... 35 List of Figures Figure 1: Distribution of Health Facilities Providing SMC Services ................................................................. 2 Figure 2: Critical Steps in Health Care Waste Management ........................................................................... 6 Figure 3: Colour-Coding for Waste Segregation ............................................................................................. 6 Figure 4: Waste Segregation Chart ................................................................................................................ 7 Figure 5: Roles of Stakeholders ................................................................................................................... 10 Figure 6: SMC Health Facility Client Flow and Waste Generation ................................................................ 12 Figure 7: Flow Chart for SMC Waste Generated at an Outreach Site ........................................................... 13 Figure 8: Safe Male Circumcision Waste Segregation Chart ........................................................................ 16 Figure 9: Handling and Treatment of SMC Waste ........................................................................................ 17 Figure 10: How to Decontaminate Instruments ............................................................................................. 19 Figure 11: SMC Sites and HCWM Availability .............................................................................................. 22 List of Tables Table 1: Elements for Safe Management of HCW for Primary Health Care Centers ....................................... 5 Table 2: Recommended Techniques for Treatment of Infectious Waste ......................................................... 8 Table 3: Waste Treatment and Disposal Methods .......................................................................................... 9 Table 4: Male Circumcision Kit Component Disposal Methods: Health Care Facility Level ........................... 20 List of Boxes Box 1: A Minimum Package of Service for SMC ............................................................................................. 3 Box 2 : Definitions .......................................................................................................................................... 4 Box 3: Key Messages .................................................................................................................................. 11 Box 4: Criteria for Selecting a Waste Handling Service Provider .................................................................. 14 Box 5: Waste Collection Supplies for SMC procedure .................................................................................. 15 iv | Uganda National Guidelines: Managing Healthcare Waste Generated from Safe Male Circumcision Procedures Preface These guidelines have been put together to guide health service providers when managing waste generated from safe male circumcision (SMC). The guidelines will go a long way in mitigating risks of exposure and subsequent transmission of infections to health service providers, patients, and the community. In addition, the guidelines will protect the environment against undesirable effects that can result from using less than optimal methods of waste disposal. The document provides guidance on management of SMC waste at both static and outreach service delivery
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