Best Environmental Practices

Color-coded containers and bags with segregation posters at a model facility in the Philippines

Color-coded containers and bags with segregation posters at a model facility in the Philippines

The proper management of healthcare waste entails a set of best environmental practices and environmentally friendly technologies dealing with:

  • Waste minimization, such as environmentally preferable purchasing, inventory control, materials recovery and recycling, safe reuse, and composting
  • Use of appropriate containers that are color-coded and labelled
  • Waste segregation
  • Proper waste collection, transport, and storage
  • Environmentally sound treatment and disposal.

These healthcare waste management practices are intrinsically linked to practices relating to hospital hygiene, infection control, and occupational safety. Importantly, healthcare waste management should be viewed as a system that includes:

  • Policies that express the facility’s commitment to environmental protection
  • Plans that describe everyone’s roles and responsibilities
  • Awareness-raising and training
  • An active healthcare waste management organization
  • Environmental champions or advocates among the staff
  • Periodic monitoring, evaluation, and continuous improvement
  • Incentives and corrective actions to ensure compliance with policies and plans
  • Sufficient budget to sustain the healthcare waste management system.

In order to institutionalize a healthcare waste management system, the following process is useful:

  • Obtain the commitment of the facility management
  • Conduct a baseline assessment and identify problems and gaps
  • Create a committee to help develop a plan
  • Solicit the input and active participation of staff in developing the plan
  • Estimate the required budget
  • Finalize a plan that defines the goals, activities, persons responsible for each activity, expected outputs, timeline, and budget
  • Implement the plan, monitor its implementation, and document the progress
  • Regularly evaluate the management system, review the plan and revise it as needed using a process of continuous improvement.
  • Each of these topics is discussed in various modules of the training materials based on the World Health Organization’s reference guidelines Safe management of wastes from health-care activities (2nd Edition). The UNDP GEF Global Healthcare Waste Project developed guidances, tools, training materials, and other resources to help developing countries manage healthcare waste.

    Resources:

    • Elements of a Model Facility Policy: Sample facility policy that defines general, staff and individual responsibilities; responsibilities towards health and safety; training responsibilities; monitoring and compliance; and definitions.
    • Guidance on Estimating Baseline Dioxin Releases from Health Facilities:  Discusses estimation method using emission factors and stack sampling and analysis; provides dioxin/furan emission factors for 22 different types of medical waste incinerators.
    • Guidance on Conducting a Baseline Assessment of the Model Healthcare Facility: Tool for obtaining baseline information including a rapid assessment, current waste management and training practices, and data on waste generation, occupational safety, cost, dioxin, and mercury.
    • Individualized Rapid Assessment Tool (I-RAT): An Excel-based tool to obtain an initial indication of the level of healthcare waste management at an individual healthcare facility. The tool results in an overall score that can be to prioritize interventions or identify areas for improvement.
    • Module 5: HCWM Planning in a Healthcare Facility: Describes the steps for developing a healthcare waste management plan, the key members of a waste management team and their tasks, how to conduct an assessment, and potential obstacles to implementing the plan.
    • Module 11: Healthcare Waste Minimization: Describes the waste management hierarchy, practices to encourage waste minimization, green purchasing, reuse, recycling, materials recovery, and environmental management systems.
    • Module 10: Segregation of Healthcare Waste: Reviews waste classification and the importance of waste segregation; describes color coding, waste containers, their proper placement, and use of segregation posters; includes exercises to improve segregation.
    • Sample Waste Segregation Posters
    • Segregation Training Game (Arabic only, from Lebanon)
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    • Module 12: Labeling, Handling and Collection of Healthcare Waste: Describes labeling, handling and collection of healthcare waste, with special consideration of sharps waste, ergonomics, PPE, bag closure, steps to develop a collection system, and common problems.
    • Module 13: On-site Transport and Storage of Healthcare Waste:  Describes basic principles, equipment specifications, routing, specifications for storage, clean-up and disinfection of transport equipment.
    • Treatment Technologies
    • Module 17: Management of Specific Infectious Wastes: Describes specific issues related to the management of sharps waste, blood and body fluids, microbiological cultures and stocks, and pathological waste, as well as their treatment and disposal.
    • Module 18: Management of Chemical, Cytotoxic, Pharmaceutical and Radioactive Wastes: Describes sources and risks associated with chemical, cytotoxic, pharmaceutical and radioactive wastes, and specific aspects related to their management, treatment and disposal.
    • Mercury Waste Management and Mercury Free Health Care
    • Module 22: Contingency Planning and Emergency Response to Healthcare Waste Spills: Gives examples of contingencies related to healthcare waste; describes procedures for cleaning up spills, steps in developing a contingency plan, and dealing with major emergencies.
    • Suggested Parameters for Wastewater Analysis Related to Healthcare Facilities: Gives a list of parameters and methods for testing wastewater from healthcare facilities, discusses sampling and frequency of testing, and presents examples of discharge limits from different countries.
    • Module 23: Management of Healthcare Wastewater: Describes sources of wastewater in a healthcare facility, characteristics and hazards associated with wastewater, and treatment and disposal options.
    • Module 24: Institutionalization of Healthcare Waste Management: Describes the steps for institutionalizing a healthcare waste management program, the role of training, costing tools, and continuous quality improvement.
    • WHO Cost Analysis Tool (CAT): Excel-based tool created by WHO to help estimate and calculate costs relating to HCWM at national and healthcare facility levels.
    • Expanded Cost Analysis Tools (E-CAT) for low-, medium- and high-income countries: Expanded version of the WHO Cost Analysis Tool developed with support of the UNDP GEF Project to provide users with more options and approaches. The Excel-based tool estimates costs at the healthcare facility, central treatment facility, cluster, and national levels.
    • Training
    • Videos: India, Lebanon
    • Guidance on Measurements and Documentation: Tool for documenting policies, plans, organization, training, best practices, waste reduction and segregation, treatment, dioxins and mercury reductions, greenhouse gas emissions, and costs of healthcare waste management.