Definitions

Waste: any unwanted material that can pose danger to the environment

Management: taking care of the waste to avoid diseases.

Waste management committee: comprised of representatives from senior management, those

who generate waste, waste handlers, infection control, procurement and stores, catering, long-
term or resident contractors and waste management service providers.

Pathological waste Pathological waste include human organs, tissues, body parts, foetuses, and
unused blood products.

Pharmaceutical waste Pharmaceuticals include expired drugs, and items contaminated by or

containing pharmaceuticals.

Cytotoxic waste include waste containing cytostatic drugs and genotoxic chemicals Chemical
waste Chemical waste includes laboratory reagents, disinfectants, and film developer that are
expired or no longer needed; waste with high content of heavy metals, e.g. batteries; blood-
pressure gauges and broken thermometers.

Radioactive waste include waste containing radioactive substances or urine and excreta from
patients treated or tested with unsealed radionuclides.

Waste hierarchy — waste generation is avoided

where possible; minimized by recycling, reusing,
recovering, refurbishing, etc.; treated to reduce the
risk; and only the smallest residue incinerated or
disposed of to landfill.

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INTRODUCTION

This plan recommends safe, efficient, sustainable, affordable and culturally acceptable methods
for the treatment and disposal of health care waste (HCW), both within and outside health-care
facilities. Poor management of health care waste potentially exposes health care workers, waste
handlers, patients and the community at large to infection, toxic effects and injuries, and risks
polluting the environment. It is essential that all medical waste materials are segregated at the
point of generation, appropriately treated and disposed of safely.

Waste generated by health care activities includes a broad range of materials, from used needles
and syringes to soiled dressings, body parts, diagnostic samples, blood, chemicals,
pharmaceuticals, medical devices and radioactive materials.

For effective healthcare waste management in a hospital, it is important to have a guiding

document as a reference document to improve healthcare waste management measures of
hospital.

Scope of the plan

The risk originates from waste that may be hazardous due to infectious agents, heavy metals
(such as mercury), radioactivity (from oncology treatments), as well as redundant and expired
pharmaceuticals. General waste, which includes the waste produced from activities in the
kitchen, in offices and from other nonhazardous sources, may be safely minimized by recycling
and reuse and the residual amount disposed of by landfilling.

There is an opportunity to reduce risk and costs by managing waste effectively. For waste to be
managed, it must be measured. General waste should comprise 70-80% of the facility’s waste
stream. If the figure is less, this usually means that nonhazardous waste is being discarded with
hazardous waste. It is much more expensive to treat waste before disposal than to manage it as
general waste. Squandering financial resources on inappropriate waste management will result in
less to spend on helping people to live healthy lives.

The health care facility’s waste management plan integrate all aspects of managing waste, from
avoidance and minimization, proper segregation and containment, safe handling, storage and
transport, to treatment and disposal.

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Purpose of the plan
The purpose of the Waste Management Plan is to describe the principles, procedures and
management of the waste generated by the health care facility and to ensure that Plan to ensure
wastes are reduced, reused and recycled wherever possible.

Objectives

The main objective is to

 Improve the occupational health conditions for the employees in the system such as health
workers, waste collectors and landfill staff.
 Enable the environmentally sound treatment and final disposal of health care waste to be
established and operated.
 Reduce the risk of other people getting in contact with infectious waste such as patients,
vistors, the public, scavenging at landfills.

Mission
To promote high standards of Health Care Waste Management in order to reduce the risk of
exposure to Hazardous waste and improve the safety of patients, clients, Health Care Waste, and
the general public.
Health Care Waste at the health facility

Health facility were assessed to verify the health care waste generation capacity per month. It
was estimated that, health facilities have the potential of generating up to 0.12 tones within the
period of five months of infectious health care waste. Currently the estimated waste generation
is at 1131 Kg in a period of five months.

Formulation of committee at the Facility

Head of facility will formulate the Health Care Waste Management committee which should
include; hospital administrator (chairperson), waste management officer, waste management
officer, head of hospital departments, infection control officer, senior nursing officer, hospital
engineer, financial controller. However, the Medical Officer in Charge at the health facility will
appoint the Principal/Senior Environmental Health Officer (PEHO/SEHO) as a focal point
person for Health Care Waste Management Officer in the hospital. The Principal Environmental
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Health Officer/Senior Environmental Health Officer will in turn recommend Health Care Waste
Management officers for the hospital. There shall be a Hospital Health Care Waste Management
committee administered by the focal point unit.

Health Care Waste Committee

The Waste Management committee shall be responsible for the better administration,
preparation, careful planning, monitoring, periodic review, coordinate and control disposal
operations, revision or updating if necessary, and implementation of the Waste Management
Plan.

Hospital Administrator
The Hospital Administrator should ensure that all members of staff are aware of their own
responsibilities for Health Care Waste Management.
Pharmacist in-Charge
The Pharmacist in-Charge is responsible for the sound management of stores and pharmaceutical
waste minimization. The duties are to:
 Liaise with Departmental Heads, the Focal Point Person, the Matron, and the Hospital
Administrator, giving advice, in accordance with the national policy and guidelines, on the
appropriate procedures for pharmaceutical waste disposal;
 Coordinate continuous monitoring of procedures for the disposal of pharmaceutical waste.
The focal point unit

The focal point unit shall drive the health care waste management issues in the facility and shall
be constituted from from heads of departments and duties is as follows:

 To liaise with all the departments that generate Health Care Waste
 To disseminate Health Care Waste Management guidelines (including written emergency
procedures) to the facility
 To support implementation of Health Care Waste Management through unit heads.

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Infection Control Officer
The Infection Control Officer should liaise with the Waste Management Officer on a continuous
basis and provide advice concerning the control of infection and the standards of the waste
disposal system. His or her duties are to:
 Identify training requirements according to staff grade and occupation;
 Organize and supervise staff training courses on safe waste management;

. Laboratory department
 Ensure necessary steps for educating of staffs on the safe handling and disposal of various
waste which include hazardous ,sharps, infectious
 It’s also encompasses all necessary tracking of waste after is is removed from the department
and from the facility.

Waste Management Officer (WMO)

In the area of waste collection the Waste Management Officer will:
 Liaise with the Supplies Department to ensure that an appropriate range of bags and
containers for health-care waste, protective clothing, and collection trolleys are available at
all times;
 Ensure that hospital attendants and ancillary staff immediately replace used bags and
containers with the correct new bags or containers;
Quantities of waste generated

A one day waste generation survey was conducted at the Health facility on 10 th of December,
2021 with the objective of identifying current situation of hospital on healthcare waste
management. With the average patient occupancy of 63%, it is revealed that the waste generated
within five(5) months periods from the health facility 1131Kg out of which 409 Kg (36.2%) is
general healthcare waste (Non-hazardous) while, Chemical, radiological, cytotoxic and
pharmaceutical( Harzadous health care waste) 397Kg (35.1%) and the Infectious, sharps and
pathological( Harzadous health care waste) 325Kg (28.7%) is healthcare risk waste. As per
WHO standard, Waste in Health Care Facilities should be around 20% hazardous and 80% non-
harzadous waste.

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Estimate of waste generation in Health Care Facility

Pie chart below shows the percentages of typical

waste compositions at Health care facility
Infectious,sharps and patho-
logical( Hazardous health care
waste) 28.7% General ( Non- Hazardous
29% health care waste) 36.2%
36%

Chemical, radiological,cytotoxic
and pharmaceutical( Hazardous
health care waste) 35.1%
35%

Based on the information demonstrated on the pier chart, the following precaution should
be taken;
 If on-site treatment is impossible or uneconomical, cooled storage facilities should be
provided and there should be a regular collection by a contractor who has suitable
incineration facilities.
 Animal carcasses that cannot be destroyed immediately after experimentation should be
stored at a temperature below -20°C.

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Waste Minimization And Reuse.
Waste minimization will be summarized in an order of preference called the ‘waste hierarchy
with the most desirable method at the top to the least desirable at the base.

Most preferable

Prevent
Reduce
Reuse
Recycle
Recover
Treat
Least preferable
To minimize health facility waste , the health facility shall:

 waste recycling programmes, involving return of un-used or waste chemicals in quantity to

the supplier for reprocessing, return of pressurized gas cylinders to suppliers for refilling and
reuse, sale of materials such as mercury, cadmium, nickel and lead-acid to specialized
recyclers, and transportation of high level radioactive waste to the original supplier, and
waste reduction practices in all hospital departments.
 To encourage reuse, each hospital shall separately collect, wash and sterilize, either thermally
or chemically in accordance with approved procedures, surgical equipment and other items
which are designed for reuse and are resistant to the sterilization process.

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HEALTH CARE WASTE HANDLING PRACTICES
The Practice of Waste Segregation
For effective Health Care Waste Management the following shall be the Health Care Waste
segregation practices:
 Segregation system shall be uniformly applied throughout the whole country and shall be
maintained throughout the entire waste stream up to disposal.

 Health Care Waste receptacles shall be readily available at the point of generation, located
away from patient areas to avoid cross infections;

 Health care providers and any other personnel shall not sort through waste by correcting
errors of segregation. If general and hazardous waste are accidentally mixed, the mixture
should be treated as hazardous Health Care Waste.

Packaging
In general, the waste shall be packaged in sealed bags or receptacles to prevent spilling during
handling and transportation. The bags or containers shall be resistant to their content (puncture-
proof for sharps, resistance to chemicals reaction) and to normal conditions of handling and
transportation such as vibration and changes in temperature, humidity or pressure (resulting from
altitude).
Storage, Collection and Transportation of Health Care Waste
Storage
Storage is classified into internal and external. Consideration for storage must be based on the
classification or type of waste being dealt with and the potential risk of infection to health-care
workers and waste disposal staff.
Collection and on-site transportation
In order to avoid accumulation of the waste, it must be collected on a regular basis and
transported to a central storage area within the Health Care Facility before being treated or
removed. The collection will follow specific routes through the HCF to reduce the passage of
loaded carts through wards and other clean areas. The carts should be easy to load and unload
and have no sharp edges that could damage waste bags or containers and it should also easy to
clean.

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Waste handling
Great care will be taken when handling Health Care Waste. The most important risks are linked
with the injuries that sharps can produce. When handling Health Care Waste, sanitary staff and
cleaners should always wear protective clothing including, as minimum, overalls or industrial
aprons, boots and heavy duty gloves.
On-site storage
Health Care Waste are temporarily stored before being treated / disposed of on-site or
transported off-site. A maximum storage time will not exceed 24 hours. Non-risk HCW will
always be stored in a separate location from the infectious / hazardous HCW in order to avoid
cross-contamination. A storage facility, sized according to the volume of waste generated as well
as the frequency of collection, must be found inside all Health Care Facilities.
Waste transportation.

 The sealed plastic bags shall be carefully loaded by hand onto the trolley, to minimize the
risks of punctures or tears.
 Yellow-bagged risk waste and black-bagged non-risk waste shall be collected on
separate trolleys which shall be painted or marked in the corresponding colours.
 The collection route shall be the most direct one from the final collection point to the
central storage facility designated in the Waste Management Plan. The collected waste
shall not be left even temporarily anywhere other than at the designated central storage
facility.
 Transportation off-site shall, unless otherwise agreed, be the responsibility of the local
council, which shall ensure that all yellow-bagged waste is collected at least once daily

Waste disposal

Depending upon the type and nature of the waste material and the organisms in the waste, risk
waste should be inactivated or rendered safe before final disposal by a suitable thermal,
chemical, irradiation incineration, filtration or other treatment method, or by a combination of
such methods, involving proper validation and monitoring procedures.

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 Sharps containers which have not been placed in yellow bags for incinerator shall be
disposed of by encapsulation or other method of disposal approved by the Federal Agency or
provincial Agency concerned.
 The method of disposal, whether by burning in an incinerator or by burial in a landfill or
otherwise, shall be operated by a hospital only after approval of its EIA in accordance with
the provisions of section
 All risk waste delivered to an incinerator shall be burned within 24 hours.
 Ash and residues from incineration and other methods shall be placed in robust,
noncombustible containers and sent to the local council's designated risk waste landfill site.
 Landfills shall be located at sites with minimal risk of pollution of groundwater and rivers.
Access to the site shall be restricted to authorized personnel only. Risk waste shall be buried
in a separate area of the landfill under a layer of earth or non-risk waste of at least 1 meter
depth which shall then be compacted. The landfill shall be regularly monitored by the local
council to check groundwater contamination and air pollution. The local council shall also
ensure that the landfill operators are properly trained, especially in safe disposal procedures,
use of protective equipment and hygiene and emergency response procedures.

MONITORING AND EVALUATION

Regular reporting and field visits as well as a good information system to store and analyse the
data are the basis of an efficient monitoring plan. The monitoring plan aim at providing relevant
information for two different but complementary objectives:

 Progress in the implementation of the Health Care Waste Management plans within the
Health Care Facility and evaluation of the impact of the Health Care Waste Management
Plan.
 Measure the Operation and Maintenance performance of the health services to maintain a
good standard of Health Care Waste Management within the Health Care Facility.

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CONTIGENCY PLANS

Contingency Plan shall be used by the Primary or Secondary Emergency Coordinator for
emergencies involving chemical spills, releases to the environment, and fires or explosions
involving chemical substances.

Control Procedures
The primary chemical spill emergency control measure will be the adequate provisioning of
containment areas.
Access to and housekeeping of each department shall be the responsibility of the organization
that is the end user. The end user shall monitor the building to ensure chemical waste storage
capacity is not exceeded and that all materials are stored with compatible materials.

EMERGENCY PROCEDURES IN CASE OF SPILLAGES OR ACCIDENTS

In case of accidents or spillages, the following action shall be taken:

 The emergency procedures mentioned in the Waste Management Plan shall be implemented
immediately;
 The contaminated area shall be immediately evacuated, if required;

RECORDING KEEPING
The Waste Management Officer shall immediately investigate, record and review all such
incidents to establish causes and where necessary shall amend the Waste Management Plan to
prevent recurrence. The transportation of waste is properly documented, and all vehicles carry a
consignment note from the point of collection to the incinerator or landfill or other final disposal
facility, and all vehicles are cleaned and disinfected after use.

TRAINING OF STAFFS
All healthcare staff should be aware of the technical aspect of hospital’s basic healthcare waste
management and their role in the plan. They shall be properly trained and prepared for
emergency response, including procedures for treatment of injuries, cleanup of the contaminated
area and prompt reporting of all incidents of accidents, spillages and near-misses and are also
properly trained in the handling, loading and unloading, transportation and disposal of yellow

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bagged waste, and are fully aware of emergency procedures for dealing with accidents and
spillages.

Estimation Of Cost Relating To Waste Management:

Item/Activity Unit Cost Multiplying Cost (ZMW) Source of
(ZMW) Factor funding
Incinerator 25,000.00 1 25,000.00 GRZ
Biohazard 550.00 7 3,850.00 GRZ
boxes
PPEs 450.00 9 4,050.00 GRZ
HCWM 38,000.00 1 38,000.00 GRZ
workshops
Storage waste 345.00 11 3,795.00 GRZ
receptacles
Total 74,695.00
Total Contingency @ 10% 7,469.50

STRATEGY FOR THE IMPLEMENTATION OF THE PLAN

Implementation of waste management plan is the responsibility of the head of a health care
facility and the following shall be the steps of implementation of the waste management plan:
 Interim measures to be introduced as a precursor to complete implementation of the new
waste management system, shall be developed by the Waste Management Officer, in
collaboration with the Waste Management Team, and be appended to the plan.
 Provision for future expansion of the hospital or of waste storage facilities shall be made.
In this strategic plan, healthcare facility generate will set up customized waste management
systems based on the most appropriate means of achieving the environmentally safe management
of health care waste at a reasonable cost dependent on the level of operation. The starting point
of a successful program is building capacity for advocacy among the operators and their partners
by encouraging them to carry out a situation analysis and coming up with a plan of action.

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SECURITY MEASURES
A range of measures will be developed in relation with the handling and the treatment or disposal
of Health Care Waste to promote personal hygiene and protective measures. These measures will
also concern municipal staff operating in solid waste management at the city level.
Personal protection
As already mentioned, staff which are in contact with Health Care Waste should wear the
following personal
Protective clothing:
 Suitable heavy-duty gloves when handling HCW containers;
 Safety shoes or industrial boots to protect the feet against the risk of containers being
Accidentally dropped;
 Industrial apron or leg protectors when container handling could cause wounds.
Immunization
Staff handling Health Care Waste should be offered appropriate immunization, including
hepatitis B and tetanus. As Health Care Waste are often found in municipal solid waste
municipal staff should also be offered this immunization.

3.4 BUDGET AND EXPENDITURES

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 S/N BUDGET ITEMS UNIT COST MULTIPLYI TOTAL
NG COST
FACTORS
Logistics
1 Phone Credit Recharge 20.00 5 x 20.00 100.00
2 Allowances during 400 10x 400 4000
meetings
2 Transport 18.00/Litre 18 x 15.00 270.00
3 Bins 100.00/day 5 x 100.00 500
Subtotal 780.00
Stationary
4 Gloves 20 per box 100x20.00 2000
5 Pens 2.00 20 x 2.00 40.00
Subtotal 2040.00
Secretarial work
6 Printing 2.500/page 500 x 2.50 1250.00
7 Printing of charts with 10 10 x 100 100
lebellings
Grant Total 15 194
PROCUREMENT PROGRAMMES
The Procurement Officer or department should liaise with the Focal point Person to ensure a
continuous supply of the items required for waste management (plastic bin liners in approved
colours and containers of the right quality, spare parts for on-site health-care waste treatment
equipment, purchase of waste transport tricycles, bin trolleys, hand-held thermometers and it
should be based on the budget constituted.

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CONCLUSION
Health-care facility inevitably generates wastes that may be hazardous to health or have harmful
environmental effects. Some of them, such as sharps, pharmaceuticals from medical laboratories
or infected blood, carry a higher potential for infection and injury than any other type of wastes.
The absence of or improper management measures to prevent exposure to hazardous health-care
waste (HCW) results in important health risks to the general public, in and outpatients as well as
the medical. However, the lack of resources in the health sector tends to affect negatively the
way Health Care Waste is managed. Therefore, implementations of health care waste
management plan will in the managing of health care waste generated in the health care facility.

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APPENDICES

Chemical waste

Period 1 2 3 4 5
Chemical volume 34 42 43 46 48
weight
waste
Accumulative 34 76 119 165 213
wastes

Sharp waste

Period 1 2 3 4 5
Sharp volume 29 25 33 32 29
waste weight
Accumalative 29 54 87 119 148
waste

Infectious waste

Period 1 2 3 4 5

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Infectious volume 19 22 25 33 21
weight
waste
Accumulative 19 41 66 99 120
waste

Accumulative curve
Waste

Chemical waste Sharp waste Infectious waste

250

200

150

100

50

0
Month 1 Month 2 Month 3 Month 4 Month 5 Period

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