Review of Biomedical Waste Management Practices in the OECS

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					Review of Biomedical Waste
Management Practices in the
OECS
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Dr. Martin Forde
June 26, 2008
      Definition: Biomedical Waste
            Any waste from
            healthcare, research,
            lab facilities that
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            poses a hazard to
            the environment and
            human health




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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      Background
            For the OECS
            region, no overall
            Biomedical Waste
            Management
               Policy
               Strategy
               Model Legislation




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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      Background (cont’d)
            Caribbean Cooperation in Health Phase II, solid
            waste management identified as priority issue
            CEHI has received multiple requests from
            member states to address BMW disposal
            Reality of CSME forcing/encouraging regional
            gov’t working on unified, structured approach to
            deal with regional challenges
               Biomedical Waste Management should be included



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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      Background (cont’d)
            In 2007, with PAHEF grant, situational audit of
            BMW practices in OECS islands conducted
            Objectives
               Provide clear picture of BMW management practices
               in OECS
               Gather baseline data
               Make recommendations for
                     Regional BMW policy, legislation, regulations
                     Training
                     Infrastructure
                     Standardized color coding classification system

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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      Methodology
            All nine members of the OECS visited
            On-site tours of all major healthcare
            facilities on island (public & private)
            On-site tours of major waste disposal
            sites on island
            Interviews with MOH, SWMA, Hospital
            Administrators, others

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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      Results Summarized
            Within most OECS islands, no clear policies,
            legislation, regulations to address Biomedical
            Waste Management
            BMW Management systems vary widely
            throughout nine member OECS states
            BMW Management systems developed based
            on
                   Available resources
                   Available level of expertise
                   Convenience

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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      Results: Some Details
      Regulatory Environment
            Out of 10 islands, number which have
                  Gov’t BMW Policy/Plan:                                                         1
                  BMW-specific legislation/Regulations                                           1
                  Proposed BMW-specific legislation                                              2




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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      Results: Some Details
      Current Practices
            Out of 10 islands, number which have
                  Facility-specific BMW policies/manual                                           2
                  Waste minimization (RRR) observed                                               0
                  Waste segregation practices observed                                           10
                  Internal waste audits performed                                                 1
                  Observed use of color-coded bags                                                8
                  Color-coded bags used appropriately                                             2
                  Appropriate cytotoxic waste m’gt                                                0
                  BMW signage observed/reported                                                   3
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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      Results: Some Details
      BMW Training
            Out of 10 islands, number which have
                  Given as a stand-alone topic                                                      3
                  Frequency BMW m’gt issues taught                                               Rare




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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      Results: Some Details
      BMW Treatment Technology
            Out of 10 islands, number which use
                  Incinerators                                                                                                      7
                  Incinerators that work reliably                                                                                 4/7




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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      Results: Some Details
      Handling and Transport of BMW
            Out of 10 islands, number which use/have
                  Specialized vehicle                                                             2
                  Trained driver and handlers                                                     3
                  Documented Landfill disposal procedure                                          1



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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
   Results: Some Details
   BMW Recording & Tracking Systems
            Out of 10 islands, number which
                  Record amount and type of BMW                                                  4?
                  Audit current BMW M’gt procedures                                               1




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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      (Potential) Study Limitations
            Lack of full support from relevant MOH/E
            Unwillingness of private healthcare
            institutions to provide information/on-site
            access
            Unavailability of key personnel to provide
            key information



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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      (Potential) Study Limitations
            Mitigated by
                  Informing key persons well in advance of
                  study objectives, date of visit
                  Stakeholders informed on how data would be
                  collected and used
                  Draft copies of each island vetted by
                  personnel in that island before being made
                  final
                  Secondary data sources obtained and
                  reviewed
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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      Recommendations
       1.    Enact BMW management specific legislation
       2.    Promote reduction of BMW
       3.    Enhance and implement BMW management
             specific training for all healthcare personnel
       4.    Implement systems to quantify and track BMW
             stream
       5.    Implement a BMW management audit
             mechanism
       6.    Promote adoption of non-incineration
             technology
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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      Conclusions
            Effective BMW management within the
            OECS region realistically, attainable goal
            This issue should be viewed more of as a
            regional necessity since environmental
            and public health of peoples inhabiting
            and visiting this region will be adversely
            affected if it is ignored.


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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada
      Conclusions (cont’d)
            Full report (with
            pictures!) available
            online at
            www.sgu.edu/windre
            f




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Presented at the Caribbean Environmental Forum (CEF-4), 2008, St. George’s University, Grenada