Regional Workshop on Health-care Waste Management Kathmandu, Nepal, 7-9 December 2011 Regional Office for South-East Asia SEA-EH-579 Distribution: General Regional Workshop on Health-care Waste Management Kathmandu, Nepal, 7-9 December 2011 Regional Office for South-East Asia © World Health Organization 2012 All rights reserved. Requests for publications, or for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – can be obtained from Publishing and Sales, World Health Organization, Regional Office for South- East Asia, Indraprastha Estate, Mahatma Gandhi Marg, New Delhi 110 002, India (fax: +91 11 23370197; e-mail: [email protected]). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. This publication does not necessarily represent the decisions or policies of the World Health Organization. Printed in India Contents Page Abbreviations .........................................................................................................v 1. Background ...................................................................................................1 2. Objectives of the workshop ...........................................................................2 3. Inaugural session............................................................................................2 4. Global and regional overview of management of HCW.................................4 4.1 Essential environmental health standards in health care – Yves Chartier, Public Health Engineer, WHO-HQ, Geneva....................4 4.2 HCWM in the SEA Region – Ms Payden ................................................7 4.3 HCWM: Issues and challenges – Ruth Stringer, Health Care Without Harm...................................................................................................10 4.4 Indian legislation on HCWM: Issues and challenges – Dr Geeta Mehta, MD, MPH ...............................................................................13 5. Panel discussions .........................................................................................16 5.1 Country-level initiatives in HCWM: Case studies from Nepal, India and Indonesia – Moderated by Terrence Thompson............................16 5.2 Best practices and approaches on management of HCW and phasing out mercury equipment in health-care services – Moderated by Yves Chartier ................................................................22 6. Field visit to model waste management systems ...........................................30 6.1 HCW water treatment at Dhulikhel .....................................................30 6.2 HCWM System at Bir Hospital, Kathmandu.........................................30 7. Group work: development of country-level action plans ..............................31 7.1 Bangladesh..........................................................................................32 7.2 Bhutan ................................................................................................33 iii 7.3 Democratic People’s Republic of Korea...............................................35 7.4 India....................................................................................................36 7.5 Indonesia ............................................................................................39 7.6 Maldives..............................................................................................41 7.7 Myanmar.............................................................................................43 7.8 Nepal ..................................................................................................44 7.9 Sri Lanka .............................................................................................45 7.10 Thailand..............................................................................................48 7.11 Timor-Leste .........................................................................................49 8. Recommendations.......................................................................................50 8.1 Recommendations for Member States .................................................51 8.2 Recommendations for WHO...............................................................52 9. Closing.........................................................................................................53 Annexes 1. Message from Dr Samlee Plianbangchang, Regional Director, World Health Organization, South-East Asia Region.....................................54 2. Agenda ........................................................................................................57 3. List of participants........................................................................................59 4. Field visit sites – detailed information...........................................................64 iv Abbreviations AIDS acquired immune deficiency syndrome BMW biomedical waste CBWTF centralized [or common] biomedical waste treatment facility CEPHED Centre for Public Health and Environmental Development CFL compact fluorescent lamp CHC community health centre CPCB Central Pollution Control Board GEF Global Environment Facility HBV hepatitis B virus HCAI health-care associated infections HCF health-care facilities HCV hepatitis C virus HCW health-care waste HCWH health care without harm HCWM health-care waste management HECAF Healthcare Foundation, Nepal HIV human immunodeficiency virus IEC information, education and communication v IGNOU Indira Gandhi Open University INGO international nongovernmental organization MoEF Ministry of Environment and Forests MoH Ministry of Health MoHFW Ministry of Health and Family Welfare MoPH Ministry of Public Health MT megatonnes NGO nongovernmental organization PCC Pollution Control Committee PPE personal protective equipment SEA South-East Asia SPCB State Pollution Control Board UN United Nations UNDP United Nations Development Programme UNEP United Nations Environment Programme WHO World Health Organization vi 1. Background Health-care waste (HCW) is generated in the process of providing medical services. HCW is a by-product of health care that includes sharps, non- sharps, blood, body parts, chemicals, pharmaceuticals, medical devices and radioactive materials. These waste products are hazardous by nature and are basically classified as infectious and non-infectious wastes. They can be solid or liquid, but gas emissions from medical waste incineration are also considered as HCW. Outdated pharmaceuticals also contribute to stocks of hazardous waste generated by the health sector. The daily amount of HCW generated in health facilities of countries belonging to the World Health Organization (WHO) South-East Asia (SEA) Region is estimated to be over 1000 metric tonnes. The improper management of wastes generated in health-care facilities (HCF) can severely affect the health of caregivers, patients and individual members of the community. Additional health hazards occur from scavenging on waste disposal sites and from manual sorting of waste at health-care facilities. These practices are common in many regions of the world. The waste handlers are at immediate risk of needle-stick injuries and other exposures to toxic or infectious materials. The safe disposal of used needles and syringes and other infectious sharps should, therefore, be seen as a critical component of any HCW management programme, if infection is to be prevented. In the past several years, WHO has been supporting Member countries to develop policies, guidelines and laws on health-care waste management (HCWM) and capacity-building in this area. In 1997, the WHO SEA Regional Office initiated a regional consultation which drew attention to the need for sound management of HCW in Member countries and led to the framing of an action plan for the same. In 2001, the Government of India and WHO launched a pilot project on HCWM in 11 states in that country. National guidelines supporting the new legislation were developed with WHO assistance. WHO, jointly with Indira Gandhi National Open University (IGNOU) in New Delhi, developed a distance learning course on HCWM in 2005. Since then hundreds of health workers from Member countries have enrolled in the course. The WHO SEA 1 Regional Workshop on Health-care Waste Management Regional Office in collaboration with