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1、WHO Health Care Waste Management,Protection of the Human Environment(PHE),Richard M.Carr,WHO Health Care Waste Management,Protection of the Human Environment(PHE),Content of PresentationNeeds AssessmentNational Action PlansRelative RisksTechnology Options,WHO Health Care Waste Management,Protection
2、of the Human Environment(PHE),Needs AssessmentWHY Needed?Identifies health risksDescribes current management practicesRaises awarenessProvides information on amounts and types of waste generatedSupports development of a National Action Plan,WHO Health Care Waste Management,Protection of the Human En
3、vironment(PHE),Needs AssessmentHow?Assess HCWM at representative facilities of all sizes and in typical settingsInterview facility staff at all levelsInterview staff from key government agencies,NGOs,and municipalitiesEvaluate curriculums at School of Public Health,MedicineNursing,etc.Assess current
4、 laws governing HCWM,WHO Health Care Waste Management,Protection of the Human Environment(PHE),Needs AssessmentTools/ResourcesWHO Rapid Assessment Tool(RAT)Aide-Memoire Safe health-care waste managementWebsites:www.healthcarewaste.org www.safeinjection.org Technical option database on website,WHO He
5、alth Care Waste Management,Protection of the Human Environment(PHE),National Action PlanSuccessful HCWM Strategies Include:National policy for safe HCWMComprehensive system of HCWMAwareness and training Selection of options for HCWM,WHO Health Care Waste Management,Protection of the Human Environmen
6、t(PHE),National Action PlanNational policy for safe HCWMDesignate responsible authorityRegulatory framework&guidelinesAssessment of status&problems Overall waste management planMonitoring&evaluation,WHO Health Care Waste Management,Protection of the Human Environment(PHE),National Action PlanCompreh
7、ensive system for HCWMAssign waste management responsibilities to staffAllocate ResourcesMinimization of waste(procurement)Segregation of wasteSafe collection,handling and storageSafe treatment and disposal,WHO Health Care Waste Management,Protection of the Human Environment(PHE),National Action Pla
8、nAwareness and TrainingAdd waste management to the curricula for health-care personnel Develop national training packageDevelop train the trainers programmesEducation on health risksEducation on safe practicesIncrease community awareness,WHO Health Care Waste Management,Protection of the Human Envir
9、onment(PHE),National Action PlanManagement Options for HCWReview available options for different size facilities and different settingsEvaluate safety and environmental aspectsEnsure workers safetyEvaluate sustainabilityAssess acceptabilityMonitoring of safety and efficiency,WHO Health Care Waste Ma
10、nagement,Protection of the Human Environment(PHE),Relative Health RisksReuse of needles and syringes pose the greatest health risks to patients,staff and the communityRisks to health-care workers and the community can still be significant even without reuseBurning HCW at low temperatures produces di
11、oxins:persistent toxins which effect human health and the environmentBurning HCW can release mercury and other heavy metalswhich effect human health and the environmentRisks from dioxin and mercury due to burning HCW are unknown,WHO Health Care Waste Management,Protection of the Human Environment(PH
12、E),Risk:ReuseStaff&CommunityDioxinMercury,Relative Health Risks,Strategies for reducing risk:AD syringes,Over-supply needles and syringes,Good management and disposal,Hepatitis B vaccination of staff and childrenSharps boxes,protective clothing,training,Community awareness programmes,good management
13、 and disposal Hepatitis B vaccination of staff and childrenNon-incineration disposal options,high temperatureIncineration,procurementWaste segregation,non-incineration disposal options,procurement,WHO Health Care Waste Management,Protection of the Human Environment(PHE),Managing WasteNo one-size-fit
14、s-all solutionSolutions do exist for many situations“non-availability”of technologies is often a“wrong problem”-or not a technical one Allocated resources?Regulatory compliance?Social acceptance?Environmental concerns,pressure groups,Kyoto,bans on burning in some countries“polluter pays”principle-,W
15、HO Health Care Waste Management,Protection of the Human Environment(PHE),Technical Options for Managing WasteSafety boxes-first line of defense Bundled with vaccinesWork well in vaccination campaigns and for some routine programme needs Reusable plastic sharps boxes can be used for routine needsDisp
16、osable boxes require frequent re-supplyDisposal requires burning or incineration limits options,WHO Health Care Waste Management,Protection of the Human Environment(PHE),Technical Options for Managing WasteNeedle Cutters and Destroyers Reduce risks by removing the sharp before disposalPrevent reuse
17、and community exposureReduce most dangerous waste significantlyManual needle cutters may still pose health risks from splashingExpensiveNeedle destroyers very expensive and require electricity,WHO Health Care Waste Management,Protection of the Human Environment(PHE),Technical Options for Managing Wa
18、steBurning Low temperature Open pit Brick enclosures and open brick incinerators“Drum”incineratorsLow costsCreate maximum pollutionIncomplete combustion does not destroy all sharpsLeast desirable option,WHO Health Care Waste Management,Protection of the Human Environment(PHE),Technical Options for M
19、anaging WasteBurning High temperature Locally built brick incinerators e.g.“De Montford”Small factory built pre-fabricated steel incineratorOther industrial incinerators,WHO Health Care Waste Management,Protection of the Human Environment(PHE),Technical Options for Managing WasteBurning High tempera
20、ture Appropriate for medium to large facilities better for less densely populated areasReduce harmful emissions by high temperature incinerationComplete combustion of all sharpsModerately expensive to build US$1500 5000May require fuel to operateRequires training to operate and maintainRequires wast
21、e segregation heavy metals,WHO Health Care Waste Management,Protection of the Human Environment(PHE),Technical Options for Managing WasteBurning High temperature,De MontfordLocally built brick IncineratorUS$1500Installed,WHO Health Care Waste Management,Protection of the Human Environment(PHE),Techn
22、ical Options for Managing WasteBurning High temperature,Factory builtPrefabricated IncineratorUS$5000Installed,WHO Health Care Waste Management,Protection of the Human Environment(PHE),Technical Options for Managing WasteSteam Sterilizers e.g.“Hydroclave”Appropriate for medium to large facilitiesEss
23、entially no emissions Good for densely populated areasComplete destruction of all sharpsExpensive Requires training to operate and maintainRequires waste segregation heavy metals,WHO Health Care Waste Management,Protection of the Human Environment(PHE),Technical Options for Managing WasteWaste Buria
24、l PitSuitable for small clinicsEasy to build,operate and maintainRequires space on-siteProper segregation of sharps can increase lifeMay not be suitable for areas with high water tables,WHO Health Care Waste Management,Protection of the Human Environment(PHE),Technical Options for Managing WasteWast
25、e Burial Pit,WHO Health Care Waste Management,Protection of the Human Environment(PHE),Technical Options for Managing WasteOther OptionsEncapsulation Melting ovensProfessional recovery and recycling,WHO Health Care Waste Management,Protection of the Human Environment(PHE),Technical Options for Manag
26、ing WasteWaste MinimizationReduce injection overuseNew delivery systemsBiodegradable syringes and needlesReduce packagingEliminate use of toxic components,WHO Health Care Waste Management,Protection of the Human Environment(PHE),ConclusionSafe HCWM requires a comprehensive system Lack of resources can be overcome with creativity and the will tomanage HCW safelyTechnology is only part of the solutionRaising staff and community awareness are keys to success,
