We saw this as a great opportunity to discuss some of the challenges we, as a service provider to generators of medical waste, encounter when providing services.
Central Storage Area
It is essential that every healthcare facility has at least one dedicated central healthcare risk waste storage area (CSA), serving as an interface from where Compass will collect the healthcare risk waste (HCRW) for off-site treatment and disposal.
The CSA should be large enough to cope with the amount of HCRW generated by the facility and should meet the required standards in terms of fixtures and fittings e.g. good drainage connected to sewer, water supply for cleaning and disinfecting purposes, hand basin, hand soap and hand towel, good lighting etc.
If the CSA is not large enough to hold the amount of HCRW generated by the facility, the facility therefore requests more frequent collections of their HCRW. The more frequent the collections the more costly to the facility.
If the CSA is not built to the requirements it poses a health risk to the healthcare workers as there is no facility to wash their hands after handling HCRW etc.
The CSA is placed too far away from the facility and majority of their wards where HCRW is being generated in high volumes. This results in the waste officer/s having to transport the full containers over long distances which is high risk.
Sufficient space and a dedicated loading / off-loading zone is required for the Compass truck to park on site to deliver the stock and collect the HCRW. In some circumstances there is insufficient space at the facility to allow for the Compass truck to park whilst completing service delivery. This has a negative impact on costs as the service team are having to spend additional time on site manoeuvring the truck to accommodate for arriving and leaving vehicles.
In some instances, the dedicated loading bay is positioned far way from the stores / warehouse and CSA therefore the service teams are having to transport the containers, stock and waste over long distances. This impacts on the time the team spend on site as well as increases risk due to the transporting of the full containers over long distances.
Temporary Storage of HCRW
Once the wards have filled the HCRW container, it is taken to the sluice room for temporary storage. The responsible waste officer assigned by the facility, is responsible to move the full containers to the CSA for collection by Compass.
Similarly, the waste officer will place the clean HCRW containers in the sluice rooms in readiness for the ward to utilise during the day or week.
Unfortunately, in some instances, the sluice rooms are too small to cope with their main responsibility as well as temporarily hold the full HCRW containers generated by the ward/s as well as the clean HCRW containers.
This poses a risk to the healthcare worker/s as there is overcrowding of clean and full HCRW containers leaving little or no space in the sluice for the healthcare worker to carry out their respective tasks. Working in a confined space creates a risk to the healthcare worker.
The nominated waste officer is responsible to transport the full HCRW containers to the CSA and collect the clean containers from stores and return them to the ward/s.
In order to ensure transportation of the clean and full HCRW containers the waste officer should be issued with a working trolley of suitable size, clearly sign posted in order to carry out the transportation.
The lifts should always be in working order to allow for prompt transportation of the containers.
The facility should be adequately fitted with ramps to allow for transportation of the clean and full containers thereby allowing the waste officer to transport maximum quantities of containers.
By not moving the full containers to the CSA promptly and in time for collection by Compass, the facility puts pressure on the Compass team to remain on site until the waste is collected from the various sluice rooms. Additional time on site waiting for the waste to be removed from the facility wards results in an increase in costs to Compass as the team are unable to fulfil their service route therefore customers missed, have to be rerouted to the following day, in turn causing a negative impact on service delivery.
In some facilities the corridors and passageways are not wide enough to allow for transportation of the full containers therefore resulting in the waste manager having to manually transport these containers to the CSA. This is deemed high risk and time consuming.
Brackets should be installed so sharps containers are located as close to the point of care as possible. This reduces needle stick injuries (NSI) and helps with correct segregation and containerisation.
All sharps containers should be placed into brackets on the walls and/or trolleys. It is important to ensure the brackets are secured promptly and when broken / damaged they are removed and replaced. Failure to install bracketry throughout the hospital results in the healthcare workers placing the sharps containers onto table-tops, counters and in some instances they are tied onto the trolley – which is high risk to the healthcare worker as well as patient.
Fridges and/or freezers for the temporary storage of anatomical waste should be mandatory at facilities that generate this waste stream. They should be large enough to hold the waste generated before collection. If not, this places unnecessary pressure on the generator and Compass, as lack of sufficient storage requires additional collections which has a negative impact on costs.
Insufficient lockable space is provided in the pharmacy to hold sufficient number of containers for the containment of expired or unused pharmaceuticals.
Pharmaceuticals need to be separated into schedules 0 - 4 and 5 & 6 and disposed of into the appropriately marked container. One cannot mix these schedules.
The Good Pharmacy guidelines of 2012 suggests that pharmaceutical waste should be separated further into six types and labelled accordingly:
· solid dosage form
· creams, ointments and powders
· ampoules and liquids in glass
· radioactive drugs
· cytostatic and cytotoxic medication and schedules substances
The lack of space in the pharmacy does not allow for the correct segregation and containerisation of unused / expired pharmaceuticals as per the requirements, therefore incorrectly segregating the waste at source.
Poor IT Infrastructure
Individuals accountable and responsible to manage and oversee the HCRW are not provided with computers with internet connection and are therefore unable to log onto the waste portal to access their waste generation reports (to be used with submitting the volumes generated to SAWIC, IPWIS, GWIS platforms), invoices, PODs, safe disposal certificates etc.
In this instance the waste manager/s are required to manually capture, record and manage the HCRW through manual means which is time consuming.
Fortunately, more new builds are taking into consideration the needs and requirements around HCRW, ensuring to build adequately sized CSAs (and in some instances taking into account future growth plans of the facility therefore ensuring the CSA is large enough to cope with the increase in wards and thus the increase in HCRW).
The location of the CSA is taken into account ensuring to place these as close to the wards as possible thereby reducing risk through transportation of HCRW from wards to CSA. Furthermore, the CSA is built inclusive of separate cordoned off areas where cardboard is stored, plastic, general waste etc – therefore all waste streams, including those that can be recycled, is in one area of the facility as opposed to spread over a number of areas.
The challenge is in respect to existing facilities – how can the challenges faced be overcome when the facility is limited to its erf?
When doing a new build or an expansion to an existing hospital, why not contact your Compass sales executive who can provide you with invaluable input when it comes to infrastructure and its impact on HCRW management.
SANS 10248-1:2008 Management of HCRW from a Health Care Facility
Gauteng HCW Regulations 2004
HCRW Management Policy KZN 2008