WASTE AND WATER

MANAGEMENT SYSTEMS :
“WASH/Waste during the Covid-19
pandemic and the impact”

Guy Mbayo K.
Technical Officer Water, Sanitation and Hygiene - WASH
World Health Organization – AFRO
PRESENTATION OUTLINE
• Waste generated in a health care facility
• Medical waste management processes
• Healthcare waste staff
• Covid-19 and waste management
• Examples of activities in Tanzania and South Sudan
• Conclusion
WASTE GENERATED IN A HEALTH CARE
FACILITY
Between 75% and 90% of the waste produced is similar to
domestic waste and usually called ‘non-hazardous’ or ‘general
health care waste’

10-25% of health care waste is regarded as ‘hazardous’ and may

pose a variety of environmental and health risks

Non-hazardous waste is usually similar in

characteristics to municipal solid waste.
More than half of non-hazardous waste
from hospitals is paper, cardboard and
plastics, whilst the rest comprises
discarded food, metal, glass, textiles,
plastics and wood.

Safe management of waste from health-care activities, WHO, 2014

https://www.who.int/water_sanitation_health/publications/safe-management-of-wastes-from-healthcare-activities/en/
POOR MANAGEMENT PRACTICES
MEDICAL WASTE MANAGEMENT PROCESSES
Start: Waste
minimization

Final disposal Segregation

Treatment
Collection

Storage Transport
MWMP- SEGREGATION/SOURCE SEPARATION
Health care
Waste

• Different types of waste

require different General
waste
Infectious
Sharp
waste

handling, treatment
and disposal 3-bin Standard System

• Segregation must start

at the source, i.e.
where waste is
generated
Black container Yellow container Sharps box
(lined) (lined)
MWMP- COLLECTION
Colour and Collection
Waste categories Type of container
markings frequency
Leak-proof strong plastic bag placed When three-quarters filled
in a container (bags for highly or at least once a day.
Infectious waste infectious waste should be capable of
being autoclaved).

Puncture-proof container. When filled to the line or

three-quarters filled.
Sharp waste

Leak-proof strong plastic bag placed When three-quarters filled

Pathological waste in a container. or at least once a day.

Plastic bag or rigid container. On demand.

Chemical and
pharmaceutical waste
Lead box. On demand.
Radioactive waste

Plastic bag inside a container or When three-quarters filled

Black or grey
General health-care waste container which is disinfected after or at least once a day.
coloured bag use.
MWMP- COLLECTION
MWMP- STORAGE
• Only infectious and sharp waste should
be stored here – no mixture with other
waste.
• Inaccessible to unauthorized persons,
animals, insects and birds
• Marked with biohazard symbol
• Floor and walls are sealed or tiled to
allow easy disinfection
• Keep well ventilated & protected from
rain Temperate climate: Warm climate:
▪ 72 hours in winter ▪ 48 hours during the cool season
▪ 48 hours in summer ▪ 24 hours during the hot season
MWMP- TRANSPORT
• Waste handlers should wear appropriate PPE
and perform hand hygiene after handling
waste
• Transport waste with covered trolley,
wheelbarrow, wheeled bin or cart
• Separate transport of hazardous and non-
hazardous waste (yellow - black)
• Transport equipment should be dedicated for
waste transportation only
• The equipment must be cleaned and
disinfected at the end of each working day.
MWMP- FINAL DISPOSAL

Municipality: Lined landfill (preferable)

Source: Safe management of waste from health-care

activities, WHO, 2014

Protected Pits for ash and placenta waste

Source: Technical Specifications, Healthcare Without Harm / MSF

MWMP- TREATMENTS OPTIONS

https://www.who.int/water_sanitation_health/publications/technologies-for-the-treatment-of-infectious-and-sharp-waste/en/
 HEALTHCARE WASTE STAFF
▪ A responsible person for the
management of healthcare waste
should be appointed and trained
(Healthcare Waste Officer – HWO)
▪ This person is often from the Infection
Control Committee
▪ The HWO should be adequately
equipped (PPE) and trained on
HCWM
Data recording
Introduction of supervision
of safe handling methods
Regular training of
Development and revision
medical and logistic
of a waste management plan
staff

Observing
Supervision of safe waste
legal regulations
treatment and disposal
COVID-19 PANDEMIC EPI UPDATE
COVID-19 IMPACT ON WASTE MANAGEMENT
• Sustainable management of medical waste is problematic and
amplified, especially in emergencies like the COVID-19 pandemic
• 30-50 % increase in volume of waste generated (delivery of quality
care, Health workers and patients’ protection, laboratory tests,
vaccination, cleaning of facilities…)
• Types of waste to account for: cartridges for PCR tests and others,
vials carrying vaccines, syringes, packaging, masks, bottles of hand-
rubbing gels, soiled clothes and bedding, paper and registers, other
utensils and equipment, medical equipment, medicines/drugs, etc.
COVID-19 KEY GUIDANCE DOCUMENTS
INCLUDING WASTE MANAGEMENT

COVID-19
technical note
and FAQs

Baseline
reports and
practical
actions
COVID-19 IMPACT ON WASTE MANAGEMENT
• Best practices for safely managing health care waste should be
followed, including assigning responsibility and sufficient human
and material resources to dispose of waste safely.

• There is no evidence that direct, unprotected human contact during

the handling of health care waste has resulted in the transmission of
the COVID-19 virus.

• All health care waste produced during the care of confirmed COVID-
19 patients is considered as infectious (infectious, sharps and
pathological waste) and should be collected safely in clearly marked
lined containers and sharp boxes.

• This waste should be treated, preferably on-site, and then safely

disposed.

• If waste is moved off-site, it is critical to understand where and how it

will be treated and disposed.
GENERAL FLOW OF COVID-19 WASTE
MANAGEMENT

Source: From Response to Recovery (UNEP, 2020)

EXISTING PRACTICES OF STORAGE AND TRANSPORT
OF HEALTHCARE WASTE IN SELECTED COUNTRIES
DURING COVID-19 PANDEMIC
COMPLIANCE TO HCWM REGULATIONS IN
MAINLAND TANZANIA (Source: WHO Country Office)
HEALTHCARE WASTE MANAGEMENT ACTIVITIES
UNDERTAKEN IN SOUTH SUDAN SINCE THE COVID 19-
RESPONSE (Source: WHO Country Office)
1. Supported 24 health facilities on waste
segregation through procurement of colour
coded foot paddle waste-bin to facilitate
waste segregation in Covid -19 treatment.
2. Training of 60 laboratory technicians on how
to manage properly Gen-xpert cartridges,
Covid-19 infectious waste.
3. Establishment of temporary 4 waste-
burners in Juba, Yei, Nimule and Wau Covid
19 isolation units.
4. Procurement of high temperature
incinerator to manage medical waste
effectively.
5. Review of the country draft policy and
guidelines on waste management.
6. Systematic operational plan and SOP
develop for COVI-19 Gen-xpert used
cartridges destruction.
TAKE AWAY MESSAGE
1. Reduce/minimize waste by a self-aware supply chain of goods for the
facility (promoting bulk orders, goods with less packaging, etc.)
2. Segregate hazardous and non-hazardous waste at the point of
generation
3. Use sharp boxes – never recap or reuse needles
4. Keep infectious and sharp waste away from patients and public
5. Treat infectious and sharp waste before disposal
6. Plan for incremental improvement of your waste management
system
CONCLUSION
• Proper waste management within the COVID-19 pandemic ensures
continuity and functionality of waste services and workers, the safety
of waste service workers, adjustments of recycling services to
incorporate safety measures that contain the spread in the collection,
disposal and treatment of medical waste (Source: ISWA 2020).

• Good governance and policy-making responsibility play an important

role throughout the emergency management cycle – from
preparedness and readiness to response to eventual evidence-based
recovery from COVID-19.
ADDITIONAL RESOURCES/REFERENCES
UNEP (2003). Technical guidelines on the environmentally sound management of biomedical and healthcare waste.
http://archive.basel.int/pub/techguid/tech-biomedical.pdf

UNEP (2007). Guidelines on best available techniques and provisional guidance on best environmental practices relevant to Article 5 and
Annex C of the Stockholm Convention on Persistent Organic Pollutant.
http://chm.pops.int/Implementation/BATandBEP/BATBEPGuidelinesArticle5/tabid/187/Default.aspx

WHO (1999). Guidelines for safe disposal of unwanted pharmaceuticals in and after emergencies.
http://apps.who.int/medicinedocs/en/d/Jwhozip51e/

WHO (2003a). Aide-memoire for a strategy to protect health workers from infection with bloodborne viruses.
http://www.who.int/occupational_health/activities/1am_hcw.pdf

WHO (2014). Safe management of wastes from health-care activities.

http://www.who.int/water_sanitation_health/publications/wastemanag/en/

WHO (2017). Safe management of wastes from health-care activities - A summary;”

https://www.who.int/water_sanitation_health/publications/safe-management-of-waste-summary/en/

WHO (2019). Overview of technologies for the treatment of infectious and sharp waste from health care facilities”;
https://www.who.int/water_sanitation_health/publications/technologies-for-the-treatment-of-infectious-and-sharp-waste/en/index.html