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Healthcare waste management • Rapid assessment tool
Version - 2011 for country level
Content
Section Scope Content
1. Introduction Provides basic information on this Rapid assessment tool
2. Preparation Checklist for chronological preparation of the assessment.
3. Guide Guidance on how to get prepared - how to train the interviewer and on what results can be expected.
4. Glossary + abbrev Terminology Listing of all specific terms used
5. Questions sum Questionnaire to collect data from the tool.
Summary of all questions used in associations, NGOs and universities or other research institutes which
6. Tool A National have had relevant activities in HCWM in different settings of the country.
7. Tool B National Questionnaire to collect data at Ministerial level
B-1 Questionnaire for the Ministry of Health
B-2 Questionnaire for the Ministry of Environment
8. Tool C Local Questionnaire to collect data at Municipal Authority level
9. Tools D Local Questionnaire to collect data regarding different areas in healthcare facilities
D-1 Area: Management, Finance, Legal Regulations
D-2 Area: Application of Healthcare Waste Management
D-3 Area: Occupational Safety
D-4 Area: Training & Monitoring
D-5 Personal private observations made during visits of healthcare facilities (filled by the interviewer)
10. Input Quest D HCF Local The results of the questionnaires D1 to D5 are gathered by the interviewer in one table
Results Quest D The results of the table "Input Quest D HCF" are summarised and evaluated (Text to be inserted manually.
11. HCF Local Other results are generated automatically)
12. Tool E (D1 - D5) Local Rating system for the HCWM situation assessed at the HCF
We are interested in your data
Thanks to send to WHO a software copy of the spreadsheets containing the data you will have collected with this tool
Contacts
Contact: World Health Organization: http://www.healthcarewaste.org / E-mail: hcwaste@who.int
page 1 • cover
Healthcare waste management • Rapid assessment tool
1 Introduction
• In many (mainly low income) countries, improper management of wastes generated in healthcare facilities causes direct health impacts on the community, the personnel
working in healthcare facilities, and on the environment. In addition, pollution due to inadequate treatment of waste can cause indirect health effects to the community.
• healthcare wastes (HCW) include sharps (syringes, disposable scalpels, blades, etc.), non-sharps (swabs, bandages, disposable medical devices, etc.), blood and anatomic
waste (blood bags, diagnostic samples, body parts, etc.), chemicals (solvents, disinfectants, etc.), pharmaceuticals, and others, and may be infectious, toxic, create injuries or
• be radioactive.
This rapid assessment tool is a part of an overall strategy developed by WHO which aims at reducing the disease burden caused by poor healthcare waste management
(HCWM) through the promotion of best practices and the development of safety standards.
2 Basic assumptions and objectives
• The basic assumption is that it is possible - in a short period of time (7-15 days), by questioning main stakeholders and by selecting a number of healthcare facilities
representative of the country - to gather the essential data necessary to have a sufficient understanding of the situation regarding HCWM at a national level.
• By analysing the role of each stakeholder along the HCWM stream it should be possible to identify where problems remain and what simple, practical actions should be
undertaken to solve them.
• The aim of this tool is to gather sufficient relevant information so as to provide decision makers/experts, etc. with the necessary data to help them elaborate a national action
plan. An example of such a plan can be found at the following address: www.healthcarewaste.org
3 Who can/should use this rapid assessment questionnaire ?
• Senior management personnel (or other trained personnel) r esponsible for the design, implementation, evaluation and update of national policy and plans for healthcare waste
management constitute the primary audience of this rapid assessment toolbox. Assistance from appropriate national or international persons or group should be sought before
conducting the proposed assessment if senior management staff do not have the required expertise and experience.
• International experts will find this toolbox useful when being asked for assistance to conduct assessments or evaluations of waste management systems in countries where poor
healthcare waste management is suspected.
• National policy makers may find this rapid assessment tool useful to better understand data for decision-making requirements in safe and appropriate waste management.
4 How to use this rapid assessment questionnaire ?
• Assessment of healthcare waste management practices should follow 4 steps to ensure that the procedure will be useful, feasible, ethical and accurate.
1) Engaging all relevant stakeholders by using tools A, B 1-2, C, D 1-5
2) Describing the situation by the interviewer using Results Quest D.
3) Gathering credible evidence of defined quality and quantity by filling in as precisely and completely as possible all questions in each tool.
4) Justifying conclusions in your final report by giving access to readers of field data collected with each tool.
• To ensure that information collection is a process conducted and analysed appropriately, this toolbox has been organised in several parts which follow a logical and
chronological frame which you are invited to follow. This frame goes from national (organisations, ministries…) to local (the health facilities) and from the start of the HCWM
stream (waste generation) to the end (final disposal).
• It is recommended that you start by going through each tool to make sure you understand the questions. Data collected should be as complete, short and precise as possible. It
can be of several types: [C] multiple choice; [N] numerical (quantitative); [Q] qualitative (ranking from 1-5); Boolean [B] (yes/no) or [T] text.
page 2 • intro
5 Description of the tools
• The tools are all structured in the same way and the numbering of topics and questions are made in such a way that data can be easily retrieved and analysed.
• Each tool is described shortly below with its main stakeholder and the kind of information which it is hoped they can provide you.
A Associations, NGOs, Universities: these actors can provide interesting elements which can help you to complete your understanding of how the system works linked to their
practice of how HCWM is practised in places they have visited/worked in. This tool is text based, aiming to insert them into the national assessment report in order to provide an
overview of the activities others than on authority or facility level.
B Ministries (Health, Environment): these key interlocutors should assist you and provide you with a complete picture of how the system (should) function on both a practical,
technical, financial and legislative level. This tool is text based, aiming to merge the answers and insert them into the national assessment report.
C Municipal/local political authorities: confronted on a daily basis with general waste management issues, they can provide good information about waste collection, transport and
final disposal as well as eventual recycling habits, etc.
D1 Area: Management, Financing, Legal Regulations : Those questions can be answered e.g. by the Hospital managers like the director, accountancy, administration. T hey are in
a good position to give you an overall view of the healthcare facility structure and data.
D2 Area: Application of Healthcare Waste Management. Those questions can be answered by the person(s) responsible for waste management, the waste handlers , medical staff
or logistic staff. Persons answering these questions should have deep and detailed knowledge about waste management processes in the facility.
D3 Area: Occupational safety. The occupation safety of ficer, infection control committee, head nurses or the responsible person for healthcare waste management can answer
these questions.
D4 Area: Training & Monitoring. The responsible person for training, the responsible person for healthcare waste management, infection safety committee can answer these
question.
D5 The questioner: the questioner can rate by himself what he has seen during the onsite visit in each facility. The questioner can rate areas like the status of awareness,
segregation, equipment, transport & storage, treatment, disposal etc. This to influence the final result in order to reflect a situation analysis as close as possible to reality.
Input All questions of the Tools D (D1-D5) answered by the participating healthcare facilities / interviewer can be filled into this form, in order to receive all results automatically.
Quest D
Results Summarised Results of the Tools D: This tool is displaying all results of the Tools D.
Quest D
E Rating system: this last tool is displaying summarised and rated results by topic automatically, if the "Input Quest D" form is filled.
page 3 • intro
6 Identifying & engaging relevant stakeholders
• Most problems and solutions are found at a human level. It is therefore essential to identify all relevant stakeholders, consult them and engage them by convincing them of the
importance/interest of having a simple and efficient HCWM system.
• The existing tools deal with the major stakeholders. Nevertheless it may be possible that, for example other important injection providers outside healthcare establishments
should be included in the analysis, etc. In such cases, we recommend you use the listing of all questions and choose those you believe are the most relevant.
• In certain (especially small) facilities, you may find out that the same person will have to be interviewed for several tools !
7 Selection of healthcare facilities
• So as to be able to extrapolate collected data, a sufficient number of healthcare facilities representative of the country must be visited.
• To keep things simple, choose between one and two healthcare facilities per size and category of structure (private, public, religious), type of area (urban, peri-urban, rural) and
by distinct ethnical and/or geographical area (topographic or climatic zone). This should normally lead you to visit between 6 and 12 health establishments.
• Specialised healthcare facilities such as psychiatric, geriatric institutes, etc. are not considered as important HCW producers and are therefore left out of this study.
8 Information & Contacts
• To comment on this tool, please contact WHO: hcwaste@who.int
• Potential partners with international or regional outreach who are interested in advancing the agenda of safe HCWM and wish to cooperate in the further development and
implementation of activities can contact WHO [E-mail: hcwaste@who.int]. Visit our web site www.healthcarewaste.org or www.who.int/peh for additional information
page 4 • intro
Healthcare waste management • Rapid assessment tool
weeks time needed action done remarks
count about 15-20 The success of your field assessment will depend greatly on how well it has been prepared beforehand. Having all logistical aspects settled;
Before hours in total meetings with key interlocutors agreed upon and authorisations from the ministry of Health provided or promised in a written form will save you lots
of time… and energy. The following points are not exhaustive, but give most of the main points.
8 3 hours Go through the entire Rapid Assessment Tool (RAT) to make sure both its structure and content are clear If you have any questions don't
for you. hesitate to contact us !
8-7 6 x 30 min. Get in touch with the Ministry of Health (if not already done), so check when is the most appropriate period
to perform the field assessment. Ask for their support in the preparation of this assessment: can they
suggest a list of HCF (Healthcare facilities) that you could visit…
7 2 - 5 hours Try and find a local counterpart both for the organisation of the logistics (driver, hotel, etc), assistance
during the mission and follow up once it is finished (there are always some bits of information one would
need and can only get if someone is on the spot.
7 2 hours Once you have a fair amount of information about where you will be going, try to make up a realistic plan
according to distances to be driven, road status, size of HCF to be visited, etc.
6 2 hours Make a list of all the key interlocutors you should/must meet. Enter their coordinates in the contact sheet so
as to have it at all times with you.
6 2 hours Request from the Ministry of Health that they provide you with a document giving you full access to all
documentation you may need.
1 1 hour According to the number of HCFs you intend to visit, make the corresponding number of paper copies of
the tools you will need (D1-D4), unless you are sure to be able to make photocopies on site.
1-2 hours per day The success of your field assessment will depend greatly on how well it has been prepared. Having all logistical aspects settled, meetings with key
During to sum up and interlocutors agreed upon and authorisations from the ministry of Health will save you lots of time… and energy.
prepare the next
day At the end of each day, make a summary of the day and check your field notes. Prepare the plan of the
next day according to data collected, planned meetings…
Confirm the meetings for the next day
Enter data collected on your computer on a daily basis. Sending this information on regularly by e-mail
ensures data to be stored in an other place than your computer only (for security reasons).
2 days before the end of your field mission, go through the entire documentation you have managed to
collect. Think about any information you believe would be important to have and try and get hold of it while
you are in the country.
count about 2-3 The quality of your report and proposals depends on both the quality and amount of representative data you managed to collect during your field
After weeks of full time visits as well as the possibility to get, via a local counter part, any further data needed.
work
1 Go through the entire documentation.
1-2 Write the report. An example of such a report can be found at: www.healthcarewaste.org or
http://www.who.int/water_sanitation_health/en/ under healthcare waste
Envisage organising a workshop 3-6 months after your field assessment so as to implement it. People
convened to this reunion are both local (Ministry of Health + Environment; resp. of medical staff training;
representatives of the medical staff…) and foreign (potential donors, cooperation agencies already working
in the country…)
page 5 • preparation
Rapid Assessment Tool RAT
Healthcare waste management • Rapid assessment tool
In this "guide" table you find some examples how to get started, the tasks and duties of the team leader and interviewers, how the interviewers can be prepared on the job and which results can
be received from the gathered data. Furthermore it highlights also gaps and difficulties which may be faced.
1. Getting started
The identification of the participating authorities and healthcare facilities is an important factor for the quality of the results of this assessment tool. Key persons from relevant authorities who
have the position and knowledge to answer your questions have to be identified.
It is recommended that the assessment team meet at least the day before the assessment starts, in order to go through the interview schedule together. A master copy of the assessment tool
is printed out for detailed discussion. For every day in the week, a precise schedule should be available. The questionnaire is explained in detail by the team leader and each interviewer receive
a complete set of the tool.
Furthermore the team should received a short training on the topic "healthcare waste management" in order to receive relevant background information for the visits during the assessment
tour. It is recommended to conduct an introducing training on background and the use of the tool. The following topics should be targeted:
Duration Topic Content / Description
This module should educate the participants about the potential risks inside an outside of their sphere of action and about the principle of disease
30 min Risks of healthcare waste
transmission cycle.
45 min Legal Background This module should outline international regulation as well as relevant national laws, regulations and guidelines.
To ensure the trainees understand the need for effective waste segregation and are able to implement this key component of waste management,
45 min Segregation this module includes the principles for segregation and the associated measures such as colour coding, labelling, packaging and collection supported
by practical samples.
45 min Logistics This module should include information about basic principles and practical instructions for safe waste collection, storage and transport.
This module should build awareness and capacity in safe and environmental friendly on-site treatment methods including definition of relevant terms
45 min Treatment of Waste
(incineration, autoclaving, microwaving etc.).
This module should outline the importance of Personal Protective Equipment (PPE), which safety measures are needed during waste handling
30 min Occupational Safety
procedures and how to use it.
In this module it is recommended to go through all tables of the tools and to outline the meaning and usage of all tables. At this point of introduction
30 min Introduction RAT Tool the schedule of conducting the assessment and the procedure should be discussed in detail. Highlight the table "preparation" and "glossary + abbrev"
in order to ensure that all interviewers are aware about the terminology of the tool and preparation needed also during the assessment.
A workshop will help the interviewers to understand the procedure completely and to identify problems and questions. In this workshop the use of the
questionnaires is played through. The following set up could be used during the workshop: For each area of concern of the questionnaires D1 to D4
one participant sits at a desk for answering the questions of the questionnaires (they present the healthcare facility). Other participants take one of
120 min Workshop RAT the questionnaires D1, D2, D3 or D4 and are interviewing the participants at the desks. The interviewers are filling out the questionnaire. After
finalising the first questionnaire, the position of each participant is shifting one position to the right in order to ensure that all participants have
experienced each position. At the end all participants are filing "Quest D5". Afterward the gained experiences are discussed and questions answered.
After clarification the team leader supports the participants how to fill the "INPUT Quest D" table.
Some presentations on the topics above are available at WHO (3 day basic training on healthcare waste management).
guide Site 6
Rapid Assessment Tool RAT
After the interviewers are briefed the following RAT tables are to be copied for the interviewer (Quest A to D5)
Questionnaire A : Number of printed table "Quest A" in accordance with the number of visiting relevant NGO, associations etc. . The results are gathered by the team leader and summarised
in the final report.
Questionnaire B1: Number of printed table "Quest B1" in accordance with the planned interviewed persons in the Ministry of Health. The results are gathered by the team leader and
summarised in the final report.
Questionnaire B2: Number of printed table "Quest B2" in accordance with the planned interviewed persons in the Ministry of Environment or other relevant ministries. The results are gathered
by the team leader and summarised in the final report.
Questionnaire D1-D5: Number of printed tables "Quest D1 to Quest D 5" in accordance with the planned interviewed healthcare facilities. D1- D4 will be answered by the staff of the
healthcare facility and D5 will be filled by the interviewer in order to enable the interviewer to have an effect on the results of the assessment, the received training will help to fill out this table.
The results of these questionnaires are filled by the interviewer into the table "Input Quest D".
The "Input Quest D" table will be filled by each interviewer directly into the excel sheet:
Input Quest D: All results of D1-D5 of all healthcare facilities are summarised. First the questions which is answered in text form are summarised - the other questions can be summarised in a
numeric way. The interviewer is filling this form every day - or after each visit in a healthcare facility by taking the answers of the questionnaires D1-D5 and transfer the results into the template
of the table "Input Quest D". This filled table is handed over to the team leader regularly - or at the latest at the end of the interview tour. It is possible to enter the results of 100 healthcare
facilities. The rows 110 to 122 are analysing the results automatically and should not be manipulated.
Gathering of data by the team leader
Input Quest D : The team leader is gathering all results from the Quest A, Quest B1, Quest, B2, Quest C and "Input Quest D" from all interviewers every day or at the end of the interviews. The
results of the table "Input Quest D" from all interviewers are assembled in a summarised Input Quest D table. Furthermore the questions which are answered in text form are gathered and
assembled. In case of malfunction of the calculations please contact: www.healthcarewaste.org
Automatically generated results
Results Quest D and Tool E: From the data summarised by the team leader in a table "Input Quest D" from all interviewers, the table "Result Quest D" will be generated automatically. The
results apply in text form or quantitative (by numbers or percentages). Also Tool E is generated automatically by the input of the table "Input Quest D". This summarising rating system is to give
you a set of indicators of how good/bad is the situation regarding HCWM per topic. It can be decided how to the influence of the results from the staff of the hospital and the personal evaluation
of the interviewers by changing the weighted percentages of E15 and F15 of Tool E . Out of this results also graphical accounts can be generated like outlined below (3.).
2. Results receiving from the Questionnaire A, B and C
In questionnaires A, B and C the data which are collected are either quantitative [N] (number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (one or
several numbers which correspond to the answer) or text [T]. As there are only one or two questionnaires filled of each questionnaire type (A, B or C) the evaluation can be done manually. The
results can directly be summarised in the report by the team leader.
guide Site 7
Rapid Assessment Tool RAT
3. Exemplary Results received from the Questionnaires D (trial test Uzbekistan)
Example of result for question 400: Which waste kinds are generated in the healthcare facility (%)
General Pharmaceuti
Waste Recyclables Radioactive Infectious Sharps Chemicals cal Anatomical
large 100% 67% 0% 100% 100% 33% 67% 100%
medium 100% 0% 0% 100% 100% 100% 100% 100%
small 100% 0% 0% 33% 100% 0% 33% 0%
average 100% 22% 0% 78% 100% 44% 67% 67%
Quest 400: Generated waste kinds
100%
80%
large
60%
40% medium
20% small
0%
Example of result for question 501: How many needle stick cases reported in the past 12 months (average per person)?
number of large medium small average big = large hospitals
needle
sticks 0.33 0.00 3.00 1.43 medium = (sub-)district hospitals
small = ambulant services
The results on this example clearly indicates urgent mitigation measurements regarding injection safety, especially in small scale healthcare facilities. Injection safety should be targeted by MoH.
Example of result for questions 1301 and 1302: Dedicated budget available for healthcare waste management
No. Question Explanation large medium small
Budget for [0] not identified;
healthcare [1] planned;
1301 waste 3 3 2
[2] available but not used;
management [3] available and used
is available
Budget per
1302 US $ per bed and year $0.77 $0.00 $0.00
bed and year
In this example a contradictory result is shown. At question 1301 it was answered that budget for healthcare waste management is available and partly used. On the other hand at question
1302 only the large healthcare facilities indicated to have in average 0,77 US$ available. The medium and small facilities do not have a budget available. It is important to cross check the
questions on reliability and to decide if these questions should be excluded - or the contradictions should be explained.
guide Site 8
Rapid Assessment Tool RAT
4. Result Tool E (trial test in Uzbekistan)
In Tool E 12 different areas of healthcare waste are summarised: staff (and training), HCW segregation & handling, HCW waste handling equipment, HCW storage area,
HCW collection & on-site transport, HCW treatment, HCW final disposal, HCWM regulations (code of conduct; management plan, policy…), personal opinion. The
summarised results are outlining the results of questionnaires D1- D4 gathered from the staff of the healthcare facilities and the personal observation of the interviewer.
Below the weighted results are applied with a weight of 50 % to 50 % - the weight can be adapted by the team leader to the situation in the country. In the table below all
results of all answers are applied. The all over average of this example is "satisfactory". The results are differentiated in big, medium and small facilities, as there can be
found very different healthcare waste management situations.
Result
Example: Healthcare waste final Results Personal
disposal Questionnair Observation Weighted
es D1-D4 D5 Result Verbal result Possible verbal results:
Weight 50% 50% 0-10% equivalent "critical situation"
All over average 44% 18% 31% satisfactory 11-30% equivalent "problematic situation
big = large hospitals 67% 45% 56% satisfactory 31-60% equivalent "satisfactory situation"
medium = (sub-)district hospitals 0% 10% 5% critical 61-80% equivalent "good situation"
small = ambulant services 67% 0% 33% satisfactory >81% equivalent "excellent situation"
Result
Example: All over result on national Results Personal
level Questionnair Observation Weighted
es D1-D4 D5 Result Verbal result
Weight 50% 50%
All over average 56% 50% 53% satisfactory
big = large hospitals 63% 62% 63% good
medium = (sub-)district hospitals 43% 37% 40% satisfactory
small = ambulant services 63% 50% 57% satisfactory
For a better understanding please try to change the percentages of E78 to E80 and F78 to F80. Also change the weights 50%:50% to e.g. 100 % to 0% (if you do not want influence by the
interviewers).
guide Site 9
Rapid Assessment Tool RAT
5. Drawbacks and gaps that render its use difficult
A crucial point of the RAT tool is its complexity. As the objectives of healthcare waste management are intersectoral and touching topics like occupational safety, hygiene, public health,
environment and economics, an assessment of the current situation in a country is multilayered. Furthermore a critical number of information has to be gathered in order to receive a reliable
Therefore the collection of data should be well prepared. A team of interviewers should be well chosen and should have a fundamental knowledge about healthcare waste management or be
trained on the relevant topics. Information which are gathered by interviewers who know exactly what's the meaning of the questions in order to explain the questions accordingly aiming to
receive the correct and realistic answer of the interviewee.
Furthermore the interviewer should provide sufficient self confident to persuade higher positions in the hierarchy in order to be taken serious and to receive high quality answers.
While visiting healthcare facilities the interviewers should be able to weight the situation correctly, in order to evaluate if the interviewed persons are hiding information or do not have the
awareness to provide high quality answers and to be able to fill out "Quest D5".
The assessed results generated by this tool are comprehensive and need rating and explanation to the relevant stakeholder like authorities. It is important to find incoherent data and to identify
and highlight the most important data.
This tool needs a knowledgeable team leader / team and furthermore a dedicated budget for implementation (daily rates, transport, accommodation, per diems…).
After the assessment phase, the next step is the planning and implementation of a national strategy on healthcare waste management or specific measures aiming to improve the situation. The
RAT can be repeated after some years or if a national strategy on healthcare waste management was implemented the "Monitoring Tool (MT)" on healthcare waste management developed by
WHO can be used in order to evaluate the improvements.
guide Site 10
Healthcare waste management • Rapid assessment tool
Glossary and abbreviations
n° Term Definition & [includes]
1 Anatomic waste Consists of recognizable body parts.
2 Auto-disable Syringe A specially modified disposable syringe with a fixed needle which is automatically disabled by plunger blocking after a single use.
3 Bloodborne pathogens Infectious agents transmitted through exposure to blood or blood products.
4 Burden of disease The health and socio-economic cost of a given medical condition on a society.
5 Chemical waste Consists of/or containing chemical substances.
[Includes: laboratory chemicals; film developer; disinfectants expired or no longer needed; solvents, cleaning agents and other].
6 Colour coding Designates the use of different colours for the storage of various categories of HCW.
7 Container Vessel in which waste is placed for handling, transportation, storage and/or eventual disposal. The waste container is a component of the
waste package.
8 Cytotoxic waste Drugs possessing a specific destructive action on certain cells.
9 Disinfectant Chemical agent that is able to reduce the viability of microorganisms.
10 Disposable syringe An all-plastic syringe designed for a single use, with a separate, steel needle. Because there is no mechanism to prevent re-use, this type of
syringe may be used more than once.
11 Disposal Intentional burial, deposit, discharge, dumping, placing or release of any waste material into or on any air, land or water.
12 Handling The functions associated with the movement of waste materials.
13 healthcare wastes with Consists of materials and equipment which include heavy metals and derivatives in their structure.
high content of heavy [Includes: batteries; broken thermometers; manometers].
metals
14 Hepatitis B Hepatitis caused by a virus and transmitted by exposure to blood or blood products or during sexual intercourse. It causes acute and chronic
hepatitis. Chronic hepatitis B can cause liver disease, cirrhosis, and liver cancer.
15 Hepatitis C Hepatitis caused by a virus and transmitted by exposure to blood or blood products. Hepatitis C is usually chronic and can cause cirrhosis
and primary liver cancer.
16 HIV / AIDS Human Immunodeficiency Virus, a virus transmitted through exposure to blood or blood products or during sexual intercourse. HIV causes
the Acquired Immunodeficiency Syndrome (AIDS).
17 Incineration The controlled burning of solid, liquid or gaseous wastes to produce gases and residues containing little or no combustible material.
18 Infection control The activities aiming at the prevention of the spread of pathogens between patients, from healthcare workers to patients, and from patients to
healthcare workers in the healthcare setting.
19 Infectious healthcare Discarded materials from healthcare activities on humans or animals which have the potential of transmitting infectious agents to humans.
waste These include discarded materials or equipment from the diagnosis, treatment and prevention of disease, assessment of health status or
identification purposes, that have been in contact with blood and its derivatives, tissues, tissue fluids, or wastes from infection isolation
wards.
[Includes: cultures and stocks; tissues; dressings, swabs or other items soaked with blood; blood bags. Sharps, whether contaminated or not,
20 Open dump Characterized by the uncontrolled and scattered deposit of wastes.
21 Pharmaceutical waste Consisting of/or containing pharmaceuticals.
[Includes: pharmaceuticals expired, no longer needed; their containers, items contaminated by or containing pharmaceuticals (bottles,
22 Pathogen A microorganism capable of causing disease.
23 Pressurized containers Consists of containers (full or empty) with pressurized liquid, gas or powdered materials.
[Includes: gas cylinders and cartridges; aerosol cans].
24 Radioactive healthcare Consisting of/or containing radioactive substances.
waste [Includes: unused liquids from radiotherapy or laboratory research; contaminated glassware, packages or absorbent paper; urine and excreta
from patients treated or tested with unsealed radionuclides; sealed sources].
25 Recycling A term embracing the recovery and reuse of scrap or waste material for manufacturing or other purposes.
26 Risk Probability that a hazard will cause harm and the severity of that harm.
27 Safe injection An injection that does not harm recipients neither exposes health workers to risks or results in waste that puts communities at risk.
28 Safety (sharps) box A puncture proof/liquid proof container designed to hold used sharps safely during disposal and destruction.
29 Safety syringe Modified, disposable plastic syringe designed for the HC worker to disable it in a way that the needle is protected & cannot be re-used.
30 Sanitary landfill Characterized by the controlled and organized deposit of wastes which is then covered regularly (daily) by the staff present on site.
Appropriate engineering preparations of the site and a favourable geological setting (providing an isolation of wastes from the environment)
31 Segregation The systematic separation of waste into designated categories.
32 Sharps Sharps are a subcategory of infectious healthcare waste and include objects that are sharp and can cause injuries.
[Includes: syringe needles, scalpels, infusion sets, knives, blades, broken glass].
33 Sterilisable syringe Either all plastic or all glass syringe with steel needle. This type of syringe is designed for re-use after proper cleaning and sterilisation in a
steam sterilizer or autoclave.
34 Storage The placement of waste in a suitable location where isolation, environmental and health protection and human control (e.g. radiation control,
limitation of access) are provided. This is done with the intention that the waste will be subsequently retrieved for treatment and conditioning
and/or disposal (or clearance of radioactive waste).
35 Treatment Any method, technique or process for altering the biological, chemical or physical characteristics or waste to reduce the hazards it presents
and facilitate, or reduce the costs of, disposal. The basic treatment objective include volume reduction, disinfection, neutralization or other
change of composition to reduce hazards, including removal or radionuclides from radioactive waste.
36 Waste management All the activities - administrative and operational - involved in the handling, treatment, conditioning, storage, transportation and disposal of
waste
Abbreviations
n° abbreviation definition
1 HCW healthcare waste
2 HCWM healthcare waste management
3 HCF healthcare facility
page 11 • glossary + abbrev.
Training /Monitoring
Application HCWM
Occupation Safety
Healthcare waste management • data collection
local authority
Management
Inventory of all B, C and D questions
MoH
MoE
n° topic question type data comments / multiple choice B1 B2 C D1 D2 D3 D4
1 geographical situation & population
100 area type in which area is the facility located ? C [1] urban, [2] peri-urban, [3] rural x
101 area geography in which area is the facility located ? T climatic, topographical specifications if relevant… x
102 cultural practices are there any that must be taken in consideration? T x
103 population how many people live in your locality ? N x
104 population could I get detailed demographic data / country? N x
2 healthcare facility (HCF)
[1] small (ambulant service); [2] medium ((sub-)district
200 HCF which category is it (are they) ? C hospital); [3] large hospital x
201 HCF which type is it (are they) ? C [1] public; [2] private x
202 HCFs could I obtain a list of all HCFs in the country ? T if possible by category & type (Nbr. bed), by locality / district x
[1] medicine; [2] gynaecology; [3] surgery; [4] children services
203 services which services do you have in your HCF C
[5] emergencies; [6] radiology; [7] laboratory; [8] other (specify) x
204 bed capacity how many beds do you have in total ? N x
205 occupancy what is the average bed occupancy ? N x
206 outpatients how many outpatients come each day on average? N x
3 staff
300 medical staff training is training of med. staff available regarding HCWM ? B if yes, what kind of training is given? x x
[0] not identified; [1] planned; [2] identified but not operational;
301 staff for HCWM a responsible person for HCWM is identified and operational
C [3] operational x x
302 training responsible of HCWM what kind of training has this person followed ? T x x
303 staff for HCW awareness awareness of risks of person(s) handling HCW ? Q x
304 hepatitis B and tetanus do you vaccinate your personnel against them ? B x
305 medical staff numbers could I have a break down of the medical staff ? T please provide numbers, diagrams…. x
306 medical staff training Is the participation in the trainings documented? B Please provide participation sheets x
307 staff training on monitoring staff is trained on monitoring and supervising of HCWM B x
4 HCW generation
[1] general, [2] recyclables, [3] radioactive, [4] infectious, [5]
sharps; [6] chemicals (liquid and solid); [7] pharmaceutical
400 HCW kinds which kind of waste is generated in the HCF C waste; [8] anatomic waste; x
401 domestic waste quantity produced/day (estimated, in kg) N x
402 sharps quantity prod/day (in kg or number of sharps boxes) N x
403 infectious (non-sharp) waste quantity produced/day (estimated, in kg) N x
404 anatomic waste quantity produced/day (estimated, in kg) N x
405 pharmaceutical waste quantity produced/day (estimated, in kg) N x
406 chemicals (liquid and solid) quantity produced/day (estimated, in litres) N x
407 radioactive waste quantity produced/day (estimated, in kg) N x
408 number of injections performed how many are done in average per day ? N x
409 quantities of HCW produced do you have any figures at the national/local level? B x x x
page 12 • questions sum
n° topic question type data comments / multiple choice B1 B2 C D1 D2 D3 D4
5 HCW segregation & handling ask to be allowed to take photos of the system !
[0] no segregation, [1] general, [2] recyclables, [3] radioactive,
500 segregation categories into which categories are HCW separated ? C [4] infectious, [5] sharps; [6] chemicals (liquid and solid); [7] x
pharmaceutical waste; [8] anatomic waste;
501 needle stick injuries how many cases reported in the past 12 months ? N if yes, what measure do you take auto-disable; [3] safety
[0] disposable; [1] sterilisable; [2] when it happens? x
502 type of syringes used what type of syringes do you use? C syringe x
sufficient personal protective equipment for the
503 protective equipment handling of waste is available B Yes / No x
[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory;
504 segregation proper segregation of waste is: N [4] good; [5] excellent (high) x
[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory;
505 Handling safe handling of waste is: N [4] good; [5] excellent (high) x
6 HCW handling equipment ask to be allowed to take photos of the system !
[0] no specific container;
600 infectious waste containers what kind of specific containers do you use ? C x
[1] plastic; [2] metallic; [3] cardboard; [4] bag; [5] box; [6] other
[0] no specific container; [1] puncture-proofed single use; [2]
601 sharp containers what kind of specific containers do you use ? C puncture-proofed multiple use, [3] not puncture-proof single x
use; [4] not puncture-proof multiple use
602 shortage of sharps containers for what reasons are there shortages, if any ? C [0] no shortages; [1] budget; [2] logistical; [3] other (specify) x
603 colour coding do you have a specific colour coding system ? B x x
604 infectious waste containers infectious waste container are lidded B x
sufficient equipment for proper HCWM is available [0] not available; [1] partly available; [2] widely available; [3]
605 Equipment and properly used C available and properly used . x
7 HCW storage area ask to be allowed to take photos of the system !
700 storage area do you have a specific area for HCW ? B x
701 storage area access Is the area only accessible for authorised pers. B x
702 storage area organisation B
are different waste kinds stored in separated storage areas? x
ask to
8 HCW collection & on-site transport be allowed to take photos of the system !
800 Collection and transport B
is hazardous and non-hazardous waste collected and transported separately? x
801 HCW on-site transport what kind of means do you use ? C [0] open device; [1] closed device; [2] other (specify) x
802 HCW collection & on-site trans. do you think current practices offer enough security? B x
9 HCW off-site transport ask to be allowed to take photos of the system !
900 transport services are there any transport documents used? C [0] none; [1] transport form; [2] other (specify)company (name
[0] the HCF; [1] municipal service; [2] private x x x
901 type of transport who generally transports hazardous healthcare waste C ?) x x
page 13 • questions sum
n° topic question type data comments / multiple choice B1 B2 C D1 D2 D3 D4
10 HCW treatment ask to be allowed to take photos of the system !
1000 type of on-site HCW treatment syst. kind of system is used ?
which C [0] none; [1] open fire; [2] incinerator; [3] chem. disinf.; [4] other x
1001 capacity of HCW treatment syst. what is the current capacity of the system(s) ? N in kg/day x
1002 operation HCW treatment syst. any operation problems; if so for what reasons ? C [0] none; [1] money; [2] maintenance; [3] spare-parts; [4] other x
1003 failure of HCW treatment syst. what do you do when it doesn't function ? T x
[0] no treatment; [1] on-site; [2] off-site (which treatment
1004 domestic waste is it treated on-site or off-site? C technology is used) x x x
[0] no treatment; [1] on-site; [2] off-site (which treatment
1005 sharps is it treated on-site or off-site? C technology is used) x x
[0] no treatment; [1] on-site; [2] off-site (which treatment
1006 infectious (non-sharp) waste is it treated on-site or off-site? C technology is used) x x
[0] no treatment; [1] on-site; [2] off-site (which treatment
1007 anatomic waste is it treated on-site or off-site? C technology is used) x x
[0] no treatment; [1] on-site; [2] off-site (which treatment
1008 pharmaceutical waste is it treated on-site or off-site? C technology is used) x x
[0] no treatment; [1] on-site; [2] off-site (which treatment
1009 chemicals (liquid and solid) is it treated on-site or off-site? C technology is used) x x
[0] no treatment; [1] on-site; [2] off-site (which treatment
1010 waste recycling is it treated on-site or off-site? C technology is used) x x
1011 on-site treatment is general waste treated on-site? B if yes, which treatment technologies are used? x
1012 on-site treatment is hazardous waste treated on-site? B if yes, which treatment technologies are used? x
[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory;
1013 Treatment quality how is the quality of treatment technology N [4] good; [5] excellent (high) x
how is the maintenance status of the technology [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory;
1014 Maintenance (Technical level/Quality) N [4] good; [5] excellent (high) x
11 HCW final disposal
1100 hazardous HCW final disposal site it on or off-site ?
is C [0] on-site; [1] off-site x
1101 type of hazardous waste disposalwhich kind of disposal site is used for the HCW ?
site C [0] open dump; [1] sanitary landfill; [2] small burial pit; [3] other x x
1102 protection of disposal site is the area secured ? B x
[0] at the HCF [1] off-site: open dump; [2] off-site: sanitary
1103 domestic waste where is it disposed off? C landfill; [3] other x x
1104 off-site: hazardous waste what kind of hazardous disposal types are available? T x
page 14 • questions sum
n° topic question type data comments / multiple choice B1 B2 C D1 D2 D3 D4
12 HCWM regulations (code of conduct; management plan, policy…)
1200 hazardous waste regulations can we have copies of existing (draft) documents? B x
1201 national HCWM regulations can we have copies of existing (draft) documents? B x
[0] not available; [1] not enforced; [2] partly enforced; [3]
1202 national HCWM regulations (HCF) available and enforced
are C available and enforced x
1203 national HCWM regulations do their application cause any problems ? T x x
[0] not available; [1] partly available; [2] widely available; [3]
1204 HCF HCWM regulations internal guidelines and SOP are available and used C available and used x
1205 national monitoring regulations are monitoring regulations available? B if yes, could I obtain the legal document and checklists? x x
1206 monitoring regulations is a monitoring system stipulated and established? B Please provide detailed information x x
can we
1207 Incineration / waste treatment regulationhave copies of existing (draft) doc. ? T x
can we have
1208 Hazardous goods / waste Transport regulation copies of existing (draft) doc. ? T x
1209 monitoring regulations HCWM is monitored regularly by the relevant authoritiesB x
13 policy and budget try to obtain a flowchart of the health system +
1300 health system could you outline how it is organised ? T responsibilities… x
[0] not identified; [1] planned; [2] available but not used; [3]
1301 budget allocation for HCWM is available and used C available and used x x
1302 budget allocation for HCWM budget per bed and year N US $ per bed and year x x
1303 purchase practises is there a national policy for items used in HCWM ? B x
1304 relations with other ministries with which ministry(ies) do you work on HCWM ? T x x
1305 annual report of activities please obtain hcw?
could I obtain a copy of your annual report(s) regarding transport, treatment, disposal ofcopies of the last 1-2 years
T x x x
14 sanitation & wastewater
1401 waste water drains to what is the waste water system connected? C [1] sewer; [2] septic tank; [3] open water source; [4] other x
1402 sewer connection where does the sewerage system lead to ? C [1] wastewater treatment plant; [2] open water source; [3] other x
15 personal opinion
what kind of short-comings, weak points regarding
1501 personal opinion HCWM in your country can you point out? T x x x
1502 personal opinion do you think sufficient funds are allocated to HCWM ? Q x x
1503 personal opinion do you think HCWM is safely managed? Q x x x
do you think HCWM is environmental friendly
1504 personal opinion managed? Q x x x
Explanations Legend for [Q]
Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down one or several excellent (high) = 5
numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee). good = 4
All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below ! satisfactory = 3
Comments: enter any relevant comments made by the interviewee which can help better understand the problematic. insufficient = 2
bad (low) = 1
page 15 • questions sum
Healthcare waste management • Rapid assessment tool name of country
Tool A (recommended) Interview person in charge of association, NGO… Duration: 30"
Organisation: Active in the field of: Address:
Name of interviewee: Function: Tel. n°:
Assessment made by: Date of assessment:
question type Answer
General Information
1 Please provide a general Description of your organisation: T
Activities and Project regarding healthcare waste management
2 Which activities or projects have been implemented so far by your organisation in T
this country?
3 Did your organisation develop any documents, guidelines etc. on healthcare waste T
management? If available, would it be possible to receive these documents?
4 Do you know other organisations which are active in the field of healthcare waste T
management?
Future Strategies / Plans
5 Which areas will your organisation be focused on in future (e.g. Climate change, T
health improvement, environment, healthcare waste,…)?
6 If healthcare waste is one of the envisaged areas, which activities are planned? T
7 Would your organisation be interested to be part of the national planning and T
implementation process?
Personal comments/remarks of the interviewer
page 16 • Quest A
Healthcare waste management • Rapid assessment tool name of country
Tool B-1 Interview Person in charge of Ministry of Health
Ministry: Department: Address:
Name of interviewee: Function:
Assessment made by: Date:
n° topic question type data comments / multiple choice
1 geographical situation & population
104 population could I get detailed demographic data of the country ? N
2 healthcare facility (HCF)
if possible by category & type (Number of beds), by locality
202 HCFs could I obtain a list of all HCFs in the country ? T / district
3 staff
if yes, what kind of training is given ? What training
300 medical staff training is training of med. staff available regarding HCWM ? B structure is available?
[0] not identified; [1] planned; [2] identified but not
301 staff for HCWM a responsible person for HCWM is identified and operational
C operational; [3] operational
305 medical staff numbers could I have a break down of the medical staff ? T please provide numbers, diagrams….
4 HCW generation
409 quantities of HCW produced do you have any figures at the national/local level? T please provide available figures
6 HCW waste handling containers
603 colour coding do you have a specific colour coding system ? B
9 HCW off-site transport
900 transport services are there any control measures ? C [0] none; [1] transport form; [2] other (specify)
10 HCW treatment
1011 on-site treatment is general waste treated on-site? B
1012 on-site treatment is hazardous waste treated on-site? B if yes, which treatment technologies are used?
11 HCW final disposal
[1] open dump; [2] sanitary landfill; [3] small burial pit; [4]
1101 type of hazardous waste disposal site kind of disposal site is used for the HCW ?
which C other
12 HCWM regulations (code of conduct; management plan, policy, monitoring…)
1201 national HCWM regulations can we have copies of existing (draft) documents? T
1205 national monitoring regulations are monitoring regulations available? B if yes, could I obtain the legal document and checklists?
1206 monitoring regulations is a monitoring system stipulated and established? B Please provide detailed information
13 policy and budget
try to obtain a flowchart of the health system +
1300 health system could you outline how it is organised ? T responsibilities…
[0] not identified; [1] planned; [2] available but not used; [3]
1301 budget allocation for HCWM is available and used C available and used
budget per bed and year
1302 budget allocation only for HCWM N US $ per bed and year
1303 purchase practises is there a national policy for items used in HCWM ? B
1304 relations with other ministries with which ministry(ies) do you work on HCWM ? T
could I obtain a copy of your annual report(s) regarding transport, treatment, disposal of how?
1305 annual report of activities regarding HCWM B please obtain copies of the last 1-2 years
15 personal opinion
what kind of short-comings, weak points regarding
1501 personal opinion HCWM in your country can you point out? T
1502 personal opinion do you think sufficient funds are allocated to HCWM ? Q
1503 personal opinion do you think HCWM is safely managed? Q
1504 personal opinion do you think HCWM is environmental friendly managed? Q
Explanations Legend for [Q]
• Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down one or several excellent = 5
numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee). good = 4
• All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below ! satisfactory = 3
• Comments: enter any relevant comments made by the interviewee which can help better understand the problematic. insufficient = 2
bad (low) = 1
non-existent = 0
Personal comments/remarks of the interviewer
page 17 • Quest B-1
Healthcare w aste management • Rapid assessment tool name of country
person in charge of Ministry of Environment
Tool B-2 (optional) Interview
Ministry: Department: Address:
Name of interviewee: Function:
Assessment made by: Date:
c n° topic question type data comments / multiple choice
2 healthcare facility (HCF)
[1] medicine; [2] gynaecology; [3] surgery; [4] children
203 services which services do you have in your HCF C services
[5] emergencies; [6] radiology; [7] laboratory; [8] other
(specify)
4 HCW generation
409 quantities of HCW produced do you have any figures at the national/local level ? T if yes, please provide figures.
9 HCW off-site transport
900 transport services are there any control measures ? C [0] none; [1] transport form; [2] other (specify)
[0] the HCF; [1] municipal service; [2] private
901 type of transport who generally transports hazardous healthcare waste C company (name ?)
10 HCW treatment ask to be allowed to take photos of the system !
[0] no treatment; [1] on-site; [2] off-site (which
1004 domestic waste is it treated on-site or off-site? C treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
1005 sharps is it treated on-site or off-site? C treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
1006 infectious (non-sharp) waste is it treated on-site or off-site? C treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
1007 anatomic waste is it treated on-site or off-site? C treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
1008 pharmaceutical waste is it treated on-site or off-site? C treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
1009 chemicals (liquid and solid) is it treated on-site or off-site? C treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
1010 waste recycling is it treated on-site or off-site? C treatment technology is used)
11 HCW final disposal ask to be allowed to take photos of the place !
[0] at the HCF [1] off site: open dump; [2] off site:
1103 domestic waste where is it disposed of? C sanitary landfill; [3] other
e.g. none; open dumps; secured hazardous waste
1104 off-site: hazardous waste what kind of hazardous disposal types are available? T landfills; mines, other (specify)
12 HCW M regulations (code of conduct; management plan, policy…)
1200 hazardous waste regulations can we have copies of existing (draft) doc. ? T
1207 can we
Incineration / waste treatment regulationhave copies of existing (draft) doc. ? T
1208 can we have copies of existing (draft) doc. ?
Hazardous goods / waste Transport regulation T
13 policy and budget
1304 relations with other ministries with which ministry(ies) do you work on HCWM ? T
could I obtain a copy of your annual report(s) regarding
1305 annual report of activities transport, treatment, disposal of how? T please obtain copies of the last 1-2 years
15 personal opinion
what kind of short-comings, weak points regarding
1501 personal opinion HCWM in your country can you point out? T
1503 personal opinion do you think HCWM is safely managed in your country? Q
1504 personal opinion do you think HCWM is environmental friendly managed? Q
Explanations Legend for [Q]
Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B]
(yes/no); multiple choice [C] (write down one or several numbers which correspond to the answer) or text [T] (write
• excellent (high) = 5
• All the information noted down corresponds to what the interviewee tells you. good = 4
Your personal comments are to be put separately in the box below ! satisfactory = 3
• Comments: enter any relevant comments made by the interviewee which can help better understand the problematic. insufficient = 2
bad (low) = 1
non-existent = 0
Personal comments/remarks of the interviewer
page 18 • Quest B-2
page 19 • Quest B-2
page 20 • Quest B-2
Healthcare waste management • Rapid assessment tool name of country
Tool C Interview Person in charge of Municipal Authority Duration: 15"
Municipality: Address:
Name of interviewee: Function: Tel. n°:
Assessment made by: Date of assessment:
c n° topic question type data comments / multiple choice
1 geographical situation & population
103 population how many people live in your locality ? N
400 quantities of HCW produced do you have any figures at the national/local level ? B
10 HCW treatment ask to be allowed to take photos of the system !
1007 domestic waste how is it generally treated ? T
1202 national HCWM regulations does their application pause any problems ? T
Explanations Legend for [Q]
• Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write excellent (high) = 5
down one or several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee). good = 4
• All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below ! satisfactory = 3
• Comments: enter any relevant comments made by the interviewee which can help better understand the problematic. insufficient = 2
• Never leave a field empty ! If something doesn't exist or is not applicable, put a "0" (zero); if the interviewee doesn't know, put a "?". bad (low) = 1
• c (code): questions only necessary to ask when: HCW is segregated (=); when HCW in taken off-site (<>). non-existent = 0
Personal comments/remarks of the interviewer
page 21 • Quest C
Healthcare waste management • Rapid assessment tool country
Tool D-1 Interview Management, Finance, Legal Regulations Duration: 30"
District:
Function:
Assessment made by: Date of assessment:
c n° topic question type data comments / multiple choice
2 healthcare facility (HCF)
200 HCF which category is it (are they) ? C [1] small (ambulant service); [2] medium ((sub-)district hospital); [3] large hospital
201 HCF which type is it ? C [1] public; [2] private
204 bed capacity how many beds do you have in total ? N
205 occupancy what is the average bed occupancy ? N
206 outpatients how many outpatients come each day on average? N
3 staff
301 staff for HCWM C
a responsible person for HCWM is identified and operational [0] not identified; [1] planned; [2] identified but not operational; [3] operational
12 HCWM regulations (code of conduct; management plan, policy…)
are
1202 national HCWM regulations (HCF) available and enforced C [0] not available; [1] not enforced; [2] partly enforced; [3] available and enforced
1203 national HCWM regulations does their application cause any problems ? T
1204 HCF HCWM regulations Internal guidelines and SOP are available and used C [0] not available; [1] partly available; [2] widely available; [3] available and used
13 policy and budget
1301 budget allocation for HCWM is available and used C [0] not identified; [1] planned; [2] available but not used; [3] available and used
1302 budget allocation for HCWM budget per bed and year N US $ per bed and year
1305 annual report of activities T
could I obtain a copy of your annual report(s) regarding HCWM? please obtain copies of the last 1-2 years
14 wastewater
1401 waste water drains to what is the waste water system connected? C [0] sewer; [1] septic tank; [2] open water source; [3] other
1402 sewer connection where does the sewerage system lead to ? C [0] wastewater treatment plant; [1] open water source; [2] other
Explanations
• Type: data is either quantitative [N] (enter a number or percentage); Boolean [B] (yes/no); multiple choice [C] (write down one or several numbers which
correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).
• All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below !
• Comments: enter any relevant comments made by the interviewee which can help better understand the problematic.
Personal comments/remarks of the interviewer
page 22 • Quest D-1
page 23 • Quest D-1
Healthcare waste management • Rapid assessment tool country:
Tool D2 Interview Application of Healthcare Waste Management duration 30"
District:
Function:
Assessment made by: Date:
n° question type data comments / multiple choice
4
[1] general, [2] recyclables, [3] radioactive, [4] infectious, [5]
Which kind of waste is generated in the sharps; [6] chemicals (liquid and solid); [7] pharmaceutical
400 healthcare facility C waste; [8] anatomic waste;
401 quantity produced/day (estimated, in kg) N
402 quantity prod/day (in kg or number of sharps boxes) N
403 quantity produced/day (estimated, in kg) N
404 quantity produced/day (estimated, in kg) N
405 quantity produced/day (estimated, in kg) N
406 quantity produced/day (estimated, in litres) N
407 quantity produced/day (estimated, in kg) N
5
[0] no segregation, [1] general, [2] recyclables, [3] radioactive,
C [4] infectious, [5] sharps; [6] chemicals (liquid and solid); [7]
500 into which categories are HCW separated ? pharmaceutical waste; [8] anatomic waste;
[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory;
504 proper segregation of waste is: N [4] good; [5] excellent (high)
[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory;
505 safe handling of waste is: N [4] good; [5] excellent (high)
6
[0] no specific container;
C
600 what kind of specific containers do you use ? [1] plastic; [2] metallic; [3] cardboard; [4] bag; [5] box; [6] other
[0] no specific container; [1] puncture-proofed single use; [2]
C puncture-proofed multiple use, [3] not puncture-proof single
601 what kind of specific containers do you use ? use; [4] not puncture-proof multiple use
602 for what reasons are there shortages, if any ? C [0] no shortages; [1] budget; [2] logistical; [3] other (specify)
603 do you have a specific colour coding system ? B
604 infectious waste container are lidded B
[0] not available; [1] partly available; [2] widely available; [3]
605 sufficient equipment for proper HCWM is available and properly used available and properly used
C
7
700 do you have a specific area for HCW ? B
701 Is the area only accessible for authorised pers. B
are different kind of waste stored in separated
702 storage areas? B
8
transported separately?
800 Is hazardous and non-hazardous waste collected andB
801 what kind of means do you use ? C [0] open device; [1] closed device; [2] other (specify)
802 do you think current practices offer enough security? B
9
900 are there any transport documents used? B [0] none; [1] transport form; [2] other (specify)company (name
[0] the HCF; [1] municipal service; [2] private
901 who generally transports the HCW ? C ?)
10 [0] none; [1] open fire; [2] incinerator; [3] chem. disinf.; [4]
1000 which kind of system is used ? C other
1001 what is the current capacity of the system(s) ? N in kg/day and how often treatment is done per week
1002 any operation problems; if so for what reasons ? C [0] none; [1] money; [2] maintenance; [3] spare-parts; [4] other
1003 what do you do when it doesn't function ? T
[0] no treatment; [1] on-site; [2] off-site (which treatment
1004 is it treated onsite or offsite? C technology is used)
[0] no treatment; [1] on-site; [2] off-site (which treatment
1005 is it treated onsite or offsite? C technology is used)
[0] no treatment; [1] on-site; [2] off-site (which treatment
1006 is it treated onsite or offsite? C technology is used)
[0] no treatment; [1] on-site; [2] off-site (which treatment
1007 is it treated onsite or offsite? C technology is used)
[0] no treatment; [1] on-site; [2] off-site (which treatment
1008 is it treated onsite or offsite? C technology is used)
[0] no treatment; [1] on-site; [2] off-site (which treatment
1009 is it treated onsite or offsite? C technology is used)
[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory;
1013 how is the quality of treatment technology N [4] good; [5] excellent (high)
[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory;
1014 how is the maintenance status of the technology N [4] good; [5] excellent (high)
[0] no treatment; [1] on-site; [2] off-site (which treatment
1010 is it treated onsite or offsite? C technology is used)
11 ask to be allowed to take photos of the place !
1100 is it on or off-site ? C [0] on-site; [1] off-site
[0] none, [1] open dump; [2] sanitary landfill; [3] small burial pit;
1101 which kind of disposal site is used for the HCW ? C [4] other
1102 is the area secured ? B
[0] at the HCF [1] off site: open dump; [2] off site: sanitary
1103 where is it disposed of? C landfill; [3] other
Explanations
• Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice
[C] (write down one or several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the
interviewee).
• All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below !
• Comments: enter any relevant comments made by the interviewee which can help better understand the problematic.
Personal comments/remarks of the interviewer
page 24 • Quest D-2
Healthcare waste management • Rapid assessment tool name of country
Tool D-3 Interview Occupational Safety Duration: 10"
District:
Function:
Assessment made by: Date of assessment:
c n° topic question type data comments / multiple choice
3 staff
304 hepatitis B and tetanus do you vaccinate your personnel against them ? C [0] none; [1] only tetanus; [2] only HBV; [3] both
4 HCW generation
how
408 number of injections performed many are done in average per day ? N
5 HCW segregation & handling
501 needle stick injuries how many cases reported in the past 12 months (average)? N
502 type of syringes used what type of syringes do you use ? C [0] disposable; [1] sterilisable; [2] auto-disable; [3] safety syringe
sufficient personal protective equipment for the handling of
503 protective equipment waste is available B
15 personal opinion
what kind of short-comings, weak points regarding HCWM in
1501 personal opinion your country can you point out T
1502 personal opinion do you think sufficient funds are allocated to HCWM ? Q
1503 personal opinion do you think HCWM is safely managed? Q
1504 personal opinion do you think HCWM is environmental friendly managed? Q
Explanations Legend for [Q]
• Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down one or excellent (high) = 5
several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee). good = 4
• All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below ! satisfactory = 3
• Comments: enter any relevant comments made by the interviewee which can help better understand the problematic. insufficient = 2
bad (low) = 1
non-existent = 0
Personal comments/remarks of the interviewer
page 25 • Quest D-3
Healthcare waste management • Rapid assessment tool name of country
Tool D-4 Interview Training & Monitoring Duration: 10"
district:
Function:
Assessment made by: date of assessment:
c n° topic question type data comments / multiple choice
3 staff
300 medical staff training is training of med. staff available regarding HCWM ? B if yes, what kind of training is given ? How often is trained?
302 training responsible of HCWM what kind of training has this person followed ? T
303 staff for HCW awareness awareness of risks of person(s) handling HCW ? Q
306 medical staff training Is the participation in the trainings documented? B Please provide participation sheets
307 staff training on monitoring B
staff is trained on monitoring and supervising of HCWM
12 HCWM regulations (code of conduct; management plan, monitoring…)
1205 national monitoring regulations are monitoring regulations available? B if yes, could I obtain the legal document and checklists?
1206 monitoring regulations is a monitoring system stipulated and established? B
HCWM is monitored regularly by the relevant
1209 monitoring regulations authorities B
Explanations Legend for [Q]
• Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down excellent (high) = 5
one or several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee). good = 4
• All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below ! satisfactory = 3
• Comments: enter any relevant comments made by the interviewee which can help better understand the problematic. insufficient = 2
bad (low) = 1
non-existent = 0
Personal comments/remarks of the interviewer
page 26 • Quest D-4
Healthcare waste management • Rapid assessment tool name of country
Tool D5 Personal observations duration: non defined
healthcare facility: district:
Assessment made by: date of assessment:
n° topic question type data (0-100 %)comments / multiple choice
3 staff
304 staff for HCW awareness awareness of risks of person(s) handling HCW ? N
monitoring quality of HCWM is N
Summary N 0%
5 HCW segregation & handling
how is the quality of waste segregation? N
is risk and non-risk waste segregated appropriately? N
Summary N 0%
6 HCW containers
how is the availability of waste container? N
how is the quality of waste container? N
Summary N
7 HCW storage area
how is the all over quality of the waste storage area? N
is the storage area safe and in accordance to national
and international rules? N
Summary N 0%
8 HCW collection & on-site transport
how is the collection frequency? N
how is the quality of transport equipment? N
how is the safety of collection and on-site transport? N
Summary N 0%
10 HCW treatment
how is the quality of treatment technology? N
how is the maintenance status of the technology? N
is the treatment technology safe for staff and public? N
is the treatment technology environmental friendly? N
Summary N 0%
11 HCW final disposal
how is the quality of the used disposal site? N
is the disposal method safe for staff and public? N
is the disposal environmental friendly? N
Summary N 0%
12 HCWM regulations (code of conduct; management plan, policy…)
how is the implementation level of national regulations? N
HCWM is monitored appropriately and regularly? N
Summary N 0%
15 personal opinion
do you think sufficient funds are allocated to HCWM ? N
do you think HCWM is safely managed? N
do you think HCWM is environmental friendly managed? N
Summary N 0%
Personal comments, remarks… Legend for [N]
0-10% (critical situation)
11-30% (problematic situation)
31-60% (satisfactory situation)
61-80% (good situation
>81% (excellent situation)
page 27 • Quest D_5
A B C D E F G H I J K L M
1 Evaluation of questionnaires D
2 Date:
3 Name:
4 Country:
5
6 n° topic question TEXT INPUT of questions D1-D4
7
8 3 staff
302 training what kind of
responsible of training has this
HCWM person followed ?
9
305 medical staff could I have a
numbers break down of the
medical staff ?
10 please provide
11 10 HCW treatment
93 failure of HCW what do you do
treatment syst. when it doesn't
function ?
12
13 12 HCWM regulations (code of conduct; management plan, policy…)
1203 national HCWM does their
regulations application cause
any problems ?
14
15 13 policy and budget
1305 annual report of could I obtain a
activities copy of your
annual report(s)
regarding
16 transport,
treatment,
17 15 personal opinion
1501 personal opinion What kind of short-
comings, weak
points regarding
HCWM in your
18 country can you
point out?
19
N O P Q R S T U V W X Y Z AA AB AC AD AE AF AG AH AI AJ
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
AK AL AM AN AO AP AQ AR AS AT AU AV AW AX AY AZ BA BB BC BD BE BF BG BH BI BJ BK
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
BL BM BN BO BP BQ BR BS BT BU BV BW BX BY BZ CA CB CC CD CE CF CG CH CI
1 Evaluation Questionnaire E - personal observation
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
CJ
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
A B C D E F G H I J K L M
20
21 INPUT D1 - Management, Finance, Legislation
22 Question 200 201 204 205 206 301 1202 1204 1301 1302 1401 1402
No.
Questionn Number Occ.r Outpatient Points Points Points Points US$/bed/ code 0 - code
23 aire Kind of HCF Type of beds ate% s per year 0-3 0-3 0-3 0-3 day 3 0-2
24 1
25 2
26 3
27 4
28 5
N O P Q R S T U V W X Y Z AA AB AC AD AE AF AG AH AI AJ
20
21 D2 - Application of Healthcare Waste Management
22 400 Which waste is generated? 401 402 403 404 405 406 407 500 504 505 408 600 601 602
Pharma Sum domestic infectious pharmace chemical radioactive No.
General Recyclin Radioacti Infectiou Sharp Chemica ceutical Pathologic generated waste (kg / sharps (kg waste (kg / anatomic utical (kg / waste (kg / waste (kg / Number 0- Points Points Injections/ code 0 code code
23 Waste g Waste ve Waste s Waste Waste l Waste s al Waste waste day) / day) day) (kg / day) day) day) day) 8 0-5 0-5 day -6 0-4 0-3
24
25
26
27
28
AK AL AM AN AO AP AQ AR AS AT AU AV AW AX AY AZ BA BB BC BD BE BF BG BH BI BJ BK
20
21
22 603 604 605 700 701 702 800 801 802 900 901 1000 1001 1002 1004 1005 1006 1007 1008 1009 1010 1013 1014 1100 1101 1102 1103
treatment
Yes / Yes / Points Yes / Yes / Yes / Yes / code 0 - Yes / code 0 code 0 code 0 capac. code 0 Points Points Points Points Points Points Points Points Points Points code 0 - Yes / code 0 -
23 No No 0-3 No No No No 2 No -2 -3 -4 kg/day -4 0-2 0-2 0-2 0-2 0-2 0-2 0-2 0-5 0-5 0 or 1 4 No 3
24
25
26
27
28
BL BM BN BO BP BQ BR BS BT BU BV BW BX BY BZ CA CB CC CD CE CF CG CH CI
20
21 D3 - Occupational Safety D4 - Training & Monitoring D5
INPUT - personal observation
22 304 501 502 503 1502 1503 1504 300 303 306 307 1205 1209 Section 3 5 6 7 8 10 11 12 15
Number collec, Legal
Yes / needle code Points Points Points Yes / Points Yes / Yes / HC segregatio waste onsite- treatment Regulation Personal
23 No sticks/a 0- 3 Yes / No 0-5 0-5 0-5 No 0 - 5 Yes / No Yes / No No No F staff % n% container % storage % trans. % % Disposal % s% Opinion %
24 1
25 2
26 3
27 4
28 5
CJ
20
21
22
23
24
25
26
27
28
A B C D E F G H I J K L M
124
125 No. of Answers
126 Sum 0 0 0 0 0 0 0 0 0 0 0 0
127 Large HCF
Medium 0 0 0 0 0 0 0 0 0 0 0 0
128 HCF 0 0 0 0 0 0 0 0 0 0 0 0
129 Small HCF 0 0 0 0 0 0 0 0 0 0 0 0
130
131 RESULTS 2. Healthcare Facility 3. staff 4. Generation
132 No. 200 201 204 205 206 300 303
301 304 306 307 400 Which waste is generated?
Risk
Resp Awarene Training
Number of Average Occ. Outpatient Training Person ss Vaccina Training on
participated Number of No. Of Rate s / year on how: Average Average tion: document Monitorin General
133 Question HCF public HCF beds % Average Yes Score Score Yes ed: Yes g: Yes Waste
134 Large 0 0 #DIV/0! No input #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 100% #DIV/0!
135 Medium 0 0 #DIV/0! No input #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 50% #DIV/0!
136 Small 0 0 #DIV/0! No input #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 100% #DIV/0!
137 All (Average) 0 0 #DIV/0! #### #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 83% #DIV/0!
138
139
140
141
142
143
144
145
146
147
N O P Q R S T U V W X Y Z AA AB AC AD AE AF AG AH AI AJ
124
125
126 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
127 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
128 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
129 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
130
4. Generation
131 5. Segregation 6. HCW handling equipment
400 Which waste is generated?
132 401 402 403 404 405 406 407 408 500 501 502 503 504 505 600
pharmace
Sum domestic sharps infectious anatomic utics chemical radioactive Average Average
Radioact Patholo generated Average Average Average Average Average Average Average Injection % of No. Of Average
Recyclin ive Infectious Sharp Chemic Pharmac gical waste per bed per bed per bed per bed per bed per bed per bed Average per segregate needle Average Average Score (0- Average Average
133 g Waste Waste Waste Waste al Waste euticals Waste kinds and day and day and day and day and day and day and day bed and day d classes sticks / a Score Score 5) Score (0-5) Score
134 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
135 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
136 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
137 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
502:
type of 600: waste
138 syringe 503: PPE container
Prevalen Prevalenc
ce of Prevalenc e of
139 Code scores e of scores Code scores
140 0 #DIV/0! #DIV/0! 0 #DIV/0!
141 1 #DIV/0! #DIV/0! 1 #DIV/0!
142 2 #DIV/0! #DIV/0! 2 #DIV/0!
143 3 #DIV/0! #DIV/0! 3 #DIV/0!
144 4 #DIV/0! 4 #DIV/0!
145 5 #DIV/0! 5 #DIV/0!
146 6 6 #DIV/0!
147
AK AL AM AN AO AP AQ AR AS AT AU AV AW AX AY AZ BA BB BC BD BE BF BG BH BI BJ BK
124
125
126 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
127 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
128 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
129 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
130
handling equipment
6. HCW131 7. HCW storage area 8. HCW collection & onsite transport 9. offsite transport 10. HCW treatment 11. HCW final disposal
132 601 602 604
603 605 700 701 702 800 801 802 900 901 1000 1001 1002 1004 1005 1006 1007 1008 1009 1010 1013 1014 1100
inf. sufficie Sep. Safe HCW Treatment
colour Cont nt specific authori coll. collecti treatme System Monitor
coding lidded equipm storage sed separate And on & nt Quality ing
Averag Averag Average Averag ent How access storage trans Average trans Average Average Average capacit Average Averag disposal
133 e Score e Score Score e Score Averag Yes Yes Yes Yes Score Yes Score Score Score y Score e Score on-site
134 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
135 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
136 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
137 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
1002:
602: 801: 1000: HCW
601: availabi transpo 901: off kinds of treatme
sharp lity rt 900: site how nt
contain sharp equipm transport transpo treatme problem
138 er cont. ent control rt nt s 1004 1005 1006 1007 1008 1009 1010
Prevale Prevale Prevale Prevale Prevale Prevale treat treat treat treat treat treat treat
nce of nce of nce of Prevalenc nce of nce of nce of general sharps infect. anato pharma chemical recyclin
139 scores scores Code scores Code e of scores scores scores Code scores waste Average Averag mic Average Average g Code
140 #DIV/0! #DIV/0! 0 #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0! 0 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0
141 #DIV/0! #DIV/0! 1 #DIV/0! 1 #DIV/0! #DIV/0! #DIV/0! 1 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 1
142 #DIV/0! #DIV/0! 2 #DIV/0! 2 #DIV/0! #DIV/0! #DIV/0! 2 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 2
143 #DIV/0! #DIV/0! 3 #DIV/0! #DIV/0! 3 #DIV/0! 3
144 #DIV/0! 4 #DIV/0! 4 #DIV/0! 4
145
146
147
BL BM BN BO BP BQ BR BS BT BU BV BW BX BY BZ CA CB CC CD CE CF CG CH CI
124
125 No. of Answers
126 0 0 0 0 0 0 0 0 0 0 0 0 0 Sum 0 0 0 0 0 0 0 0 0
127 0 0 0 0 0 0 0 0 0 0 0 0 0 Large HCF
Me 0 0 0 0 0 0 0 0 0
128 0 0 0 0 0 0 0 0 0 0 0 0 0 diu 0 0 0 0 0 0 0 0 0
Sm
all
HC
129 0 0 0 0 0 0 0 0 0 0 0 0 0 F 0 0 0 0 0 0 0 0 0
130
1. HCW final disposal
131 12. HCW regulations 14.
13. policy & budget sanitation 15. personal opinion RESULTS
132 1101 1102 1103 1202 1204 1205 1209 1301 1302 1401 1402 1502 1503 1504 Section 3 5 6 7 8 10 11 12
Enforced Monito Used Budget Suffici Safe HCWM
nat. Used Monitori ring budget HCWM ent HCWM Env. Collection
secure regulatio SOP ng authori HCWM Averag funds? ? Friendl waste and onsite HCW Legal
disposal ns Averag regulati ties Averag e Averag Averag y? HCW container HCW Transport. HCW Disposal Regulation
133 Yes Average e Score ons Yes Yes e US$/be e e Score Averag HCF staff % segregation % % storage % % Treatment % % s%
134 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Large No input No input No input No input No input No input No input No input
135 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Medium No input No input No input No input No input No input No input No input
136 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Small No input No input No input No input No input No input No input No input
137 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! All (Average) #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
1101: 1401:
kind 1103: connecti
haz kind of on
waste domestic waste 1402:
disposa waste water sewerage
138 l disposal system leads to..
Prevale Prevalen Prevalen Prevalenc
nce of ce of ce of e of
139 scores Code scores Code scores scores
140 #DIV/0! 0 #DIV/0! 0 #DIV/0! #DIV/0!
141 #DIV/0! 1 #DIV/0! 1 #DIV/0! #DIV/0!
142 #DIV/0! 2 #DIV/0! 2 #DIV/0! #DIV/0!
143 #DIV/0! 3 #DIV/0! 3 #DIV/0!
144 #DIV/0!
145
146
147
CJ
124
125
126
127
128
129
130
131
132 15
Personal
133 Opinion %
134 No input
135 No input
136 No input
137 #DIV/0!
138
139
140
141
142
143
144
145
146
147
Healthcare waste management • Results healthcare facilities
Results of all Tool D questions
n° topic question
3 staff
302 training responsible of HCWM what kind of training has this person followed ? 0
305 medical staff numbers could I have a break down of the medical staff ? 0
please provide numbers, diagrams….
10 HCW treatment
1003 failure of HCW treatment syst. what do you do when it doesn't function ? 0
12 HCWM regulations (code of conduct; management plan, policy…)
1203 national HCWM regulations does their application cause any problems ? 0
13 policy and budget
1305 annual report of activities could I obtain a copy of your annual report(s) 0
regarding transport, treatment, disposal of how?
please obtain copies of the last 1-2 years
15 personal opinion
1501 personal opinion What kind of short-comings, weak points regarding 0
HCWM in your country can you point out?
No. Category Question Results Codes, Points, comments
2 healthcare facility (HCF)
large medium small sum
200 HCF which category is it (are they) ? 0 0 0 0 [1] small; [2] medium; [3] large hospital
201 HCF which type is it (are they) ? Public 0 0 0 0 [1] public; [2] private
Private 0
large medium small average
204 bed capacity how many beds do you have in total (average)? #DIV/0! #DIV/0! #DIV/0! #DIV/0!
205 occupancy what is the average bed occupancy ? No input No inputNo input #DIV/0!
206 outpatients how many outpatients come each day on average? #DIV/0! #DIV/0! #DIV/0! #DIV/0!
3 staff
large medium small average
300 medical staff training is training of med. staff available regarding HCWM ? Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! if yes, what kind of training is given?
large medium small average
a responsible person for HCWM is identified and [0] not identified; [1] planned; [2] identified but not
301 staff for HCWM operational #DIV/0! #DIV/0! #DIV/0! #DIV/0! operational; [3] operational
large medium small average
[0] non-existent; [1] bad (low); [2] insufficient; [3]
303 staff for HCW awareness awareness of risks of person(s) handling HCW ? #DIV/0! #DIV/0! #DIV/0! #DIV/0! satisfactory; [4] good; [5] excellent (high)
large medium small average
304 hepatitis B and tetanus do you vaccinate your personnel against them ? Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0!
306 medical staff training Is the participation in the trainings documented? Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! Please provide participation sheets
staff is trained on monitoring and supervising of
307 staff training on monitoring HCWM Yes 100% 50% 100% 83%
large medium small average
Summary HCF (D1-D4) #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Summary personal observation (D5) No input No inputNo input #DIV/0!
4 HCW generation
[1] general, [2] recyclables, [3] radioactive, [4]
infectious, [5] sharps; [6] chemicals (liquid and
solid); [7] pharmaceutical waste; [8] anatomic
1 2 3 4 5 6 7 8 waste;
which kind of waste is generated in the healthcare
400 HCW kinds facility (%)? large #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! ##### #####
medium #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! ##### #####
small #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! ##### #####
average #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! ##### #####
large medium small average
401 domestic waste quantity produced/day (estimated, in kg) kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0!
402 sharps quantity prod/day (in kg or number of sharps boxes) kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0!
403 infectious (non-sharp) waste quantity produced/day (estimated, in kg) kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0!
404 anatomic waste quantity produced/day (estimated, in kg) kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0!
405 pharmaceutical waste quantity produced/day (estimated, in kg) kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0!
406 chemicals (liquid and solid) quantity produced/day (estimated, in litres) l/day #DIV/0! #DIV/0! #DIV/0! #DIV/0!
407 radioactive waste quantity produced/day (estimated, in kg) kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0!
408 number of injections performed how many are done in average per day ? kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0!
5 HCW segregation & handling
large medium small average
500 segregation categories how many waste categories are segregated? % #DIV/0! #DIV/0! #DIV/0! #DIV/0!
501 needle stick injuries how many cases reported in the past 12 months? per year#DIV/0! #DIV/0! #DIV/0! #DIV/0! if yes, what measure do you take when it happens?
0 1 2 3
[0] disposable; [1] sterilisable; [2] auto-disable; [3]
502 type of syringes used what type of syringes do you use? % #DIV/0! #DIV/0! #DIV/0! #DIV/0! safety syringe
large medium small average
sufficient personal protective equipment for the
503 protective equipment handling of waste is available? Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! B
large medium small average
[0] non-existent; [1] bad (low); [2] insufficient; [3]
504 segregation proper segregation of waste is: Q #DIV/0! #DIV/0! #DIV/0! #DIV/0! satisfactory; [4] good; [5] excellent (high)
[0] non-existent; [1] bad (low); [2] insufficient; [3]
505 handling Safe handling of waste is: Q #DIV/0! #DIV/0! #DIV/0! #DIV/0! satisfactory; [4] good; [5] excellent (high)
large medium small average
Summary HCF (D1-D4) #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Summary personal observation (D5) No input No inputNo input #DIV/0!
6 HCW waste handling equipment
0 1 2 3 4 5 6
[0] no specific container;
600 infectious waste containers what kind of specific containers do you use ? % #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! ##### [1] plastic; [2] metallic; [3] cardboard; [4] bag; [5]
box; [6] other
[0] no specific container; [1] puncture-proofed
single use; [2] puncture-proofed multiple use, [3]
601 sharp containers what kind of specific containers do you use ? % #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
not puncture-proof single use; [4] not puncture-
proof multiple use
[0] no shortages; [1] budget; [2] logistical; [3] other
602 shortage of sharps containers for what reasons are there shortages, if any ? % #DIV/0! #DIV/0! #DIV/0! #DIV/0! (specify)
large medium small average
603 colour coding do you have a specific colour coding system? Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! B
604 infectious waste containers infectious waste container are lidded? Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! B
large medium small average C
sufficient equipment for proper HCWM is available [0] not available; [1] partly available; [2] widely
605 equipment and properly used #DIV/0! #DIV/0! #DIV/0! #DIV/0! available; [3] available and properly used
large medium small average
Summary HCF (D1-D4) #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Summary personal observation (D5) No input No inputNo input #DIV/0!
page 43 • Results Quest D
n° topic question
7 HCW storage area
large medium small average
700 storage area do you have a specific area for HCW ? Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! B
701 storage area access Is the area only accessible for authorised pers. Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! B
are different kind of waste stored in separated
702 storage area organisation storage areas? Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! B
large medium small average
Summary HCF (D1-D4) #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Summary personal observation (D5) No input No inputNo input #DIV/0!
8 HCW collection & on-site transport
large medium small average
Is hazardous and non-hazardous waste collected
800 collection and transport and transported separately? Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! B
0 1 2
801 HCW on-site transport what kind of means do you use ? % #DIV/0! #DIV/0! #DIV/0! [0] open device; [1] closed device; [2] other (specify)
large medium small average
802 HCW collection & on-site trans. do you think current practices offer enough security? Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! B
large medium small average
Summary HCF (D1-D4) #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Summary personal observation (D5) No input No inputNo input #DIV/0!
9 HCW off-site transport
0 1 2 3
900 transport services are there any transport documents used? % #DIV/0! #DIV/0! #DIV/0! [0] none; [1] transport form; [2] other (specify)
who generally transports hazardous healthcare [0] the HCF; [1] municipal service; [2] private
901 type of transport waste? % #DIV/0! #DIV/0! #DIV/0! #DIV/0! company (name ?)
10 HCW treatment
0 1 2 3 4
[0] none; [1] open fire; [2] incinerator; [3] chem.
1000 type of on-site HCW treatment syst.
which kind of system is used ? % #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! disinf.; [4] other
large medium small average
1001 capacity of HCW treatment syst. what is the current capacity of the system(s) (kg/day) ?
kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0! in kg/day
0 1 2 3 4 C
[0] none; [1] money; [2] maintenance; [3] spare-
1002 operation HCW treatment syst. any operation problems; if so for what reasons ? % #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! parts; [4] other
0 1 2 C
[0] no treatment; [1] on-site; [2] off-site (which
1004 domestic waste is it treated onsite or off-site? % #DIV/0! #DIV/0! #DIV/0! treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
1005 sharps is it treated onsite or off-site? % #DIV/0! #DIV/0! #DIV/0! treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
1006 infectious (non-sharp) waste is it treated onsite or off-site? % #DIV/0! #DIV/0! #DIV/0! treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
1007 anatomic waste is it treated onsite or off-site? % #DIV/0! #DIV/0! #DIV/0! treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
1008 pharmaceutical waste is it treated onsite or off-site? % #DIV/0! #DIV/0! #DIV/0! treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
1009 chemicals (liquid and solid) is it treated onsite or off-site? % 0% 0% 0% treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
1010 waste recycling is it treated onsite or off-site? % 0% 0% 0% treatment technology is used)
large medium small average
[0] non-existent; [1] bad (low); [2] insufficient; [3]
1013 treatment quality how is the quality of treatment technology #DIV/0! #DIV/0! #DIV/0! #DIV/0! satisfactory; [4] good; [5] excellent (high)
[0] non-existent; [1] bad (low); [2] insufficient; [3]
1014 maintenance how is the maintenance status of the technology #DIV/0! #DIV/0! #DIV/0! #DIV/0! satisfactory; [4] good; [5] excellent (high)
large medium small average
Summary HCF (D1-D4) #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Summary personal observation (D5) No input No inputNo input #DIV/0!
11 HCW final disposal
large medium small average
1100 hazardous HCW final disposal site it on or off-site ?
is onsite #DIV/0! #DIV/0! #DIV/0! #DIV/0! [0] on-site; [1] off-site
0 1 2 3 4
[0] none, [1] open dump; [2] sanitary landfill; [3]
1101 type of hazardous waste disposalwhich kind of disposal site is used for the HCW ?
site % #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! small burial pit; [4] other
large medium small average
1102 protection of disposal site is the area secured ? Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! B
0 1 2 3 C
[0] at the HCF [1] off site: open dump; [2] off site:
1103 domestic waste where is it disposed off? % #DIV/0! #DIV/0! #DIV/0! #DIV/0! sanitary landfill; [3] other
large medium small average
Summary HCF (D1-D4) #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Summary personal observation (D5) No input No inputNo input #DIV/0!
12 HCWM regulations (code of conduct; management plan, policy…)
large medium small average
[0] not available; [1] not enforced; [2] partly
1202 national HCWM regulations (HCF) available and enforced?
are #DIV/0! #DIV/0! #DIV/0! #DIV/0! enforced; [3] available and enforced
[0] not available; [1] partly available; [2] widely
1204 HCF HCWM regulations Internal guidelines and SOP are available and used? #DIV/0! #DIV/0! #DIV/0! #DIV/0! available; [3] available and used
large medium small average
B if yes, could I obtain the legal document and
1205 national monitoring regulations are monitoring regulations available? Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! checklists?
1209 monitoring regulations HCWM is monitored regularly by the relevant authorities?
Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! B
large medium small average
Summary HCF (D1-D4) #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Summary personal observation (D5) No input No inputNo input #DIV/0!
13 policy and budget
large medium small average
[0] not identified; [1] planned; [2] available but not
1301 budget allocation for HCWM is available and used? #DIV/0! #DIV/0! #DIV/0! #DIV/0! used; [3] available and used
1302 budget allocation for HCWM budget per bed and year? US$ #DIV/0! #DIV/0! #DIV/0! #DIV/0! US $ per bed and year
14 sanitation & wastewater
0 1 2 3 C
[0] sewer; [1] septic tank; [2] open water source; [3]
1401 waste water drains to what is the waste water system connected? % #DIV/0! #DIV/0! #DIV/0! #DIV/0! other
[0] wastewater treatment plant; [1] open water
1402 sewer connection where does the sewerage system lead to ? % #DIV/0! #DIV/0! #DIV/0! source; [2] other:
15 personal opinion
large medium small average
[0] non-existent; [1] bad (low); [2] insufficient; [3]
1502 personal opinion Do you think sufficient funds are allocated to HCWM ?Q #DIV/0! #DIV/0! #DIV/0! #DIV/0! satisfactory; [4] good; [5] excellent (high)
[0] non-existent; [1] bad (low); [2] insufficient; [3]
1503 personal opinion Do you think HCWM is safely managed? Q #DIV/0! #DIV/0! #DIV/0! #DIV/0! satisfactory; [4] good; [5] excellent (high)
Do you think HCWM is environmental friendly [0] non-existent; [1] bad (low); [2] insufficient; [3]
1504 personal opinion managed? Q #DIV/0! #DIV/0! #DIV/0! #DIV/0! satisfactory; [4] good; [5] excellent (high)
large medium small average
Summary HCF (D1-D4) #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Summary personal observation (D5) No input No inputNo input #DIV/0!
page 44 • Results Quest D
Healthcare waste management • Rapid assessment tool name of country
Tool E Rating at national level
Rating made by: date of rating:
Explanations
• This rating system is here to give you a set of indicators of how good/bad is the situation regarding HCWM per topic (staff, HCW generation, segregation, etc.) for healthcare facilities according to their size
(big, medium and small) as well as at national level (to be read in the last column "total").
• healthcare facilities are divided into three size categories: large hospitals (big); (sub-)district hospitals (medium); ambulant services (small).
• The data which are entered into the table "Input Quest D" are automatically summerised (total points ) and calculated according to the percentage of HCFs visited to give an equivalent number of points at
national level (national equivalent points ).
• The national equivalent percentage is calculated as follows: "national equivalent points" / (total number of HCFs for each size category * number of questions in the topic). This produces a result in percentage
that can be read as follows: 0-10% (critical situation); 11-30% (problematic situation); 31-60% (satisfactory situation); 61-80% (good situation); >81% (excellent situation).
• At the bottom of the page a summary per topic can be found: This summary table applies the results of the data entry table of the questionnaires on national and hcf level (Input Quest D). The two results of
answeres of the hcf and the interviewer are weighted 50 % : 50 % in order to receive an as realistic result as possible. The weighted percentages can be changed by the team leader.
• This evaluation is based on key issues that need to be fulfilled to ensure a safe management of HCW.
Summary table
Results
n° topic level / category Questionnairs D1- Result Personal Weighted
D4 Observation D5 Result Verbal result comments / suggestions
Weight 50% 50%
All over average #DIV/0! #DIV/0! #DIV/0! #DIV/0!
big = large hospitals #DIV/0! No input #DIV/0! #DIV/0!
3 staff (and training)
medium = (sub-)district hospitals #DIV/0! No input #DIV/0! #DIV/0!
small = ambulant services #DIV/0! No input #DIV/0! #DIV/0!
All over average #DIV/0! #DIV/0! #DIV/0! #DIV/0!
big = large hospitals #DIV/0! No input #DIV/0! #DIV/0!
5 HCW segregation & handling
medium = (sub-)district hospitals #DIV/0! No input #DIV/0! #DIV/0!
small = ambulant services #DIV/0! No input #DIV/0! #DIV/0!
All over average #DIV/0! #DIV/0! #DIV/0! #DIV/0!
big = large hospitals #DIV/0! No input #DIV/0! #DIV/0!
6 HCW waste handling equipment
medium = (sub-)district hospitals #DIV/0! No input #DIV/0! #DIV/0!
small = ambulant services #DIV/0! No input #DIV/0! #DIV/0!
All over average #DIV/0! #DIV/0! #DIV/0! #DIV/0!
big = large hospitals #DIV/0! No input #DIV/0! #DIV/0!
7 HCW storage area
medium = (sub-)district hospitals #DIV/0! No input #DIV/0! #DIV/0!
small = ambulant services #DIV/0! No input #DIV/0! #DIV/0!
All over average #DIV/0! #DIV/0! #DIV/0! #DIV/0!
big = large hospitals #DIV/0! No input #DIV/0! #DIV/0!
8 HCW collect. & on-site transp.
medium = (sub-)district hospitals #DIV/0! No input #DIV/0! #DIV/0!
small = ambulant services #DIV/0! No input #DIV/0! #DIV/0!
All over average #DIV/0! #DIV/0! #DIV/0! #DIV/0!
big = large hospitals #DIV/0! No input #DIV/0! #DIV/0!
10 HCW treatment
medium = (sub-)district hospitals #DIV/0! No input #DIV/0! #DIV/0!
small = ambulant services #DIV/0! No input #DIV/0! #DIV/0!
All over average #DIV/0! #DIV/0! #DIV/0! #DIV/0!
big = large hospitals #DIV/0! No input #DIV/0! #DIV/0!
11 HCW final disposal
medium = (sub-)district hospitals #DIV/0! No input #DIV/0! #DIV/0!
small = ambulant services #DIV/0! No input #DIV/0! #DIV/0!
All over average #DIV/0! #DIV/0! #DIV/0! #DIV/0!
HCWM regulations (code of
big = large hospitals #DIV/0! No input #DIV/0! #DIV/0!
12 conduct; management plan,
policy…) medium = (sub-)district hospitals #DIV/0! No input #DIV/0! #DIV/0!
small = ambulant services #DIV/0! No input #DIV/0! #DIV/0!
All over average #DIV/0! #DIV/0! #DIV/0! #DIV/0!
big = large hospitals #DIV/0! No input #DIV/0! #DIV/0!
15 personal opinion
medium = (sub-)district hospitals #DIV/0! No input #DIV/0! #DIV/0!
small = ambulant services #DIV/0! No input #DIV/0! #DIV/0!
All over average #DIV/0! #VALUE! #DIV/0! #DIV/0!
big = large hospitals #DIV/0! #VALUE! #DIV/0! #DIV/0!
overall situation at national level
medium = (sub-)district hospitals #DIV/0! #VALUE! #DIV/0! #DIV/0!
small = ambulant services #DIV/0! #VALUE! #DIV/0! #DIV/0!
Personal comments/remarks of the interviewer
page 45 • Tool E
page 46 • Tool E
