SIGN Cambodia Oct. 2002 1 From Urban to Rural Health Care Waste Management in India Srishti Health Care Without Harm India
Mar 28, 2015
SIGN Cambodia Oct. 2002 1
From Urban to Rural Health Care Waste
Management in India
Srishti Health Care Without Harm
India
SIGN Cambodia Oct. 2002 2
Srishti
Not for profit, non-governmental environmental organisation
•working of issues of waste, recylcing and toxics since 1992
•areas of policy, research, projects, advocacy
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Brought attention to the issue in India in 1994.
Involved in national legislation and standards setting.
Coordiante a national multistakeholder network.
Implemented 5 model hospitals, training programs, awareness campaigns.
Documentation of best practices, field guides.
Advocacy for cleaner appropriate technologies.
Participated in WHO database, 1999, UNEP Basel Guidelines for bio-medical wastes,2000,SIGN –India partner
Work on Medical Waste
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Rapid Changes in Urban settings since 1995
Perspective shift from technology to management solns.
New national legislation in 1998 with tech. standards.
Focus on In hospital program implementation.Training and capacity building.Segregation and sharps management.Offsite treatment and disposal with transport.
Understanding of occupational safety issuesInstallation of off-site centralised facilities in 6 cities.
Adoption and local manufacture of non-burn technologies
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Lessons learnt in Urban Settings
Waste mgmt as part of housekeeping/ infection
control.
Hosptial staff has a rapid learning curve.
Raising awareness about occupational safety issues
is key.
Simple devices work better such as for sharps mgmt.
Rapid incorporation of non-burn technologies where
availability is assured.
Preference of technologies with lower cost of
operation.
Training and awareness play a citical role.
Industry eager to fill in new markets with products.
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Non-Burn Technologies Being Used for Sharps
•On – site needle cutters and destroyers.
•On site Designed waste pits.
•Off site Waste encapsulation.
•On site and off site Autoclaving.
•On site and off site Micro waving.
•Off site Needle smelting.(Srishti study carried out for SEARO – WHO for evaluating above- Yr2002)
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Legislation applicable to Rural/peri urban settings in India
Mandatory waste management system by 31st
Dec’2002.
Segregation of waste at source.
Secured collection and transportation.
Deep burial allowed (in populations < 500,000)
Burning plastics/ especially chlorinated plastics
not recommended.
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Broad Rural Health Structure
Community Health Center (CHC)A 30 bedded Hospital/Referral Unit for 4PHCs with
specialized services
Primary Health Center (PHC)A referral unit for 6 sub centres
4-6 bedded
Sub Center (SC)Most peripheral contact point between Primary
health care system and community
District Hospital
Sub-District Hospital
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Coverage
Rural Population: 72.2% of total population (2001 census)
Community Health Centre: Caters to a population of 1.2 lakh. Approx 2600 nos.
Primary Health Centre: Caters to a population of around 30,000. Approx 23000 nos.
Sub Centre: Caters to a population of 5,000. Approx 36,258 nos.
Other Health Care Facilities: Missionary health care facilities and Day care clinics
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Types of Health Services
Routine Services provided in rural areas:
Day care/ observatory beds Laboratory investigationsTuberculosis centersMother and Child Care
Campaigns:
-Immunization drives
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Waste Types (based on survey of 5 centers)
Infectious Waste: Body tissues, Blood soaked cotton and gauze pieces and body fluids
Infectious Plastic: Disposable syringes, tubings, IV bottles and gloves
Sharps: Broken glasses and metal sharps like scalpels and needles
Average quantity of bio-medical waste/bed/day: 0.075- 0.1Kg
II. General Waste: Packaging material & food waste
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Exisiting Practices Waste Segregation:
•Waste is generally mixed in a single bin/bag.
•In some districts waste is being segregated into different categories.
Waste collection and storage:
•Open bins and drums.
•Bins are not bagged.
•Spills on floor at the time of generation.
•No regular pattern of waste collection and the waste is collected as and when required.
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Segregation at Source
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Existing Practices
Waste Transportation:•Waste is transported manually from point of generation to final treatment/disposal site.
•No protective gears are provided to the health care workers.
•No immunization/accident reporting.
Waste Treatment:
No specific waste treatment pattern is followed except in 2 cases.
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Existing PracticesWaste Disposal: Open dumping of waste around the health
care facilities
Open burning of waste
Scavenging of waste by waste sorters and animals
Furnaces for burning of waste in some PHCs
In facilities near urban areas waste is being carried by centralized facility
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Needle Destroyer
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Final Storage of Waste in a
Health CareInstitution
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Treatment and disposal methods observed:
• Encapsulation.
• Pit Disposal.
• Needle Devices – Destroyers/ cutters. • Small autoclaves.
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Deep Burial Pit
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Autoclaves
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Training and Awareness
Staff are not aware of the concept of waste management.
No specific training sessions on waste management.
No posters/awareness material provided at the health care settings.
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Interventions possible•Incorporating waste mgmt. into housekeeping and infection control.
•Raising occupational safety awareness.
•Training and capacity building for better
segregation.
•Resolving transport issues (onsite/offsite
decisions)•Incorporating safe-easy to use, low operating cost technologies
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Lessons, understandings and perspectives from the urban experience can be applied
to rural and peri-urban areas.