Table of Contents

1.2 Introduction...........................................................................................................................................2
1.3.objectives..............................................................................................................................................2
1.4.Purpose of the plan...............................................................................................................................2
1.5.Scope Of The Health Care Waste Management Plan.............................................................................3
1.6.Formulation Of The Committee.............................................................................................................3
1.6.1.Responsibilities And Duties................................................................................................................3
The Head of Hospital...................................................................................................................................3
Waste Management Officer (WMO.............................................................................................................5
The Matron (or Senior Nursing Officer) and the Hospital Manager............................................................7
Infection Control Officer..............................................................................................................................7
.Chief Pharmacist.........................................................................................................................................7
Supply Officer..............................................................................................................................................8
Hospital Engineer........................................................................................................................................8
1.7.Training of stuffs....................................................................................................................................8
1.8.Waste segregation.................................................................................................................................8
1.9. Collection and on-site transportation.................................................................................................11
2. Waste handling......................................................................................................................................11
2.2. On-site storage...................................................................................................................................12
2.3.Transportation.....................................................................................................................................12
2.4.Health care handling practices............................................................................................................14
A1 Recyclable waste..................................................................................................................................14
A2 Biodegradable health care wastes.......................................................................................................14
A3 Other non-risk waste............................................................................................................................14
B Biomedical and health-care waste requiring special attention...............................................................15
B2 Waste sharps........................................................................................................................................15
3. Procedures in case of accidents and spillages.......................................................................................17
4. Implementation of the plan...................................................................................................................18
5. BUDGET.................................................................................................................................................20
APPENDIX..................................................................................................................................................21
Abbreviation..............................................................................................................................................21

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1.0. Introduction
Major hospital wastes are generated as a result of clinical and housekeeping activity. Hospital
waste is a potential reservoir of pathogenic microorganism and requires appropriate, safe and
reliable handling. Proper management of hospital waste can minimize the risks both within and
outside healthcare facility. It is essential that hospital waste should be collected, stored and
disposed in a proper process with standard technique. This assignment is aimed at formulating a
waste management plan.

The plan recommends safe, efficient, sustainable, affordable and culturally acceptable methods
for the treatment and disposal of health care waste, both within and outside health-care facilities.
Proper hospital waste management is a prerequisite to minimize hospital acquired infection.
However, Zambia has continued recording poor waste management in the health sector. Waste
from the health department is a major challenge which if not properly managed can lead to
spread of diseases. For effective healthcare waste management in a hospital, it is important to
have a guiding document as a reference document to improve healthcare waste management
measures of hospital. Zambia has continued recording poor waste management in the health
sector.

1.2. Objectives
The main objective is to

 Formulate a health care waste management plan

Specific objectives

 Reduce the risk of other people getting in contact with infectious waste such as patients,
vistors, the public, scavenging at landfills.
 Improve the occupational health conditions for the employees in the system such as health
workers, waste collectors and landfill staff.
 Enable the environmentally sound treatment and final disposal of health care waste to be
established and operated

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1.2.1 Mission
To promote high standards of Health Care Waste Management in order to reduce the risk of
exposure to Hazardous waste and improve the safety of patients, clients, Health Care Waste, and
the general public

1.4. Purpose of the plan

This plan has been developed to ensure wastes are reduced, reused and recycled wherever
possible.

1.5. Scope of the Health Care Waste Management Plan

Wastes generated at health care facilities have the potential to cause harm if not managed
correctly. The risk originates from waste that may be hazardous due to infectious agents, heavy
metals (such as mercury), radioactivity (from oncology treatments), as well as redundant and
expired pharmaceuticals. General waste, which includes the waste produced from activities in the
kitchen, in offices and from other nonhazardous sources, may be safely minimized by recycling
and reuse and the residual amount disposed of by landfilling. If risk waste and nonrisk waste
(general waste) are combined, they must be treated as risk waste, thus larger volumes of waste
than necessary are submitted for treatment, which may overload the treatment capacity, leading
to stockpiling of untreated risk waste. Waste that is incorrectly segregated leads to increased
costs of waste management.

This plan integrate all aspects of managing waste, from avoidance and minimization, proper
segregation and containment, safe handling, storage and transport, to treatment and disposal

1.7. Responsibilities
Every member of the facility is responsible for the waste they generate; however, certain
personnel will have specific waste management tasks and responsibilities assigned to them.

1.1. Facility manager: overall responsibility and accountability for waste generated and
managed on site, as well as for transport from the facility for treatment and/or disposal
off-site. The manager is also responsible for ensuring that sufficient resources are
allocated to waste management to ensure compliance with legal and other requirements.

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 1.2. Facility management and supervisors: responsible for checking that appropriate
standards are set and maintained on a daily basis in their areas and ensuring that
problems are resolved.

1.3. Waste generators :ensure that only they handle the waste and also ensure that it is
properly segregated at the source and suitably contained to reduce risk of exposure to
others.

1.4. Waste handlers : ensure that waste in the intermediate storage areas is properly
segregated, contained and labeled. Any problems noted must be immediately brought to
the attention of the responsible person in that area.

1.5. Waste management officers : responsible for ensuring that waste is managed according
to legal and other requirements, checking that standards are maintained, that everyone is
aware of these requirements, that relevant personnel are appropriately trained to safely
deal with waste in their areas and that all necessary data are recorded and transmitted to
the waste management committee and regulatory authorities.

1.6. Waste management committee: comprised of representatives from senior management,

those who generate waste, waste handlers, infection control, procurement and stores,
catering, long-term or resident contractors and waste management service providers.
This committee should meet monthly to discuss the key performance indicators (e.g.,
volume of waste generated, hazardous versus general waste ratio, incidents, audit
findings, etc.) and to plan awareness programs and other initiatives to improve
compliance with legal and other requirements. For smaller facilities, this committee can
be the infection control/safety or health (and environmental) committee.

Health Care Waste at the health facility

Health facility were assessed to verify the health care waste generation capacity per month. It
was estimated that, health facilities have the potential of generating upto 0.12 tonnes within the
period of five months of infectious health care waste. Currently the estimated waste generation
is at 1131 Kg in a period of five months.

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1.8. QUANTITIES OF WASTE GENERATED

Based on Health Care Waste Management assessment report. A one day waste generation
survey was conducted at the health facility on 20 th of June, 2023 with the objective of identifying
current situation of hospital on healthcare waste management. With the average patient
occupancy of 63%, it is revealed that the waste generated within five(5) months periods from the
health facility 1131Kg out of which 409 Kg (36.2%) is general healthcare waste (Non-
hazardous) while, Chemical, radiological, cytotoxic and pharmaceutical( Harzadous health care
waste) 397Kg (35.1%) and the Infectious, sharps and pathological( Harzadous health care waste)
325Kg (28.7%) is healthcare risk waste. As per WHO standard, Waste in Health Care Facilities
should be around 20% hazardous and 80% non-harzadous waste.
Estimate of waste generation at Health Care Facility

Pie chart below shows the percentages of

typical waste compositions at health facility

General ( Non- Hazardous health

care waste) 36.2%
29% Chemical, radiological,cytotoxic
and pharmaceutical( Hazardous
health care waste) 35.1%
36%
Infectious,sharps and pathological(
Hazardous health care waste)
28.7%

35%

Based on the information demonstrated on the pier chart, the following precaution should
be taken;
 Highly infectious waste should be autoclaved or incinerated on site whenever possible and
should be handled only by trained and authorized staff.
 If on-site treatment is impossible or uneconomical, cooled storage facilities should be
provided and there should be a regular collection by a contractor who has suitable
incineration facilities.

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 Animal carcasses that cannot be destroyed immediately after experimentation should be
stored at a temperature below -20°C.

2.0. WASTE MINIMIZATION AND REUSE.

Protecting public health through the management of wastes can be achieved by a variety of
methods. These can be summarized in an order of preference called the ‘waste hierarchy with the
most desirable method at the top to the least desirable at the base.

Most preferable

Prevent

Reduce

Reuse

Recycle

Recover

Treat

Least preferable

1.8. HEALTH CARE WASTE HANDLING PRACTICES

The Practice of Waste Segregation
Segregation is one of the most important steps to successfully manage health care wastes. Given
the fact that only about 10-25% of the health care wastes is hazardous, treatment and disposal
costs could be greatly reduced if a proper segregation were performed. Segregating hazardous
from non- hazardous waste reduces also greatly the risks of infecting workers handling health
care waste.

Segregation will:

 Always take place at the source, that is at the ward bedside, Operation Theatre, Medical
Analysis Laboratory, or any other room or ward in the hospital where the waste is
generated.

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  Be simple to implement for the medical and ancillary staff and applied uniformly
throughout the country.
 Be safe and guaranty the absence of infectious health care wastes in the domestic waste
flow.

1.9. Collection and on-site transportation

In order to avoid accumulation of the waste, it will be collected on a regular basis and
transported to a central storage area within the Health care facility before being treated or
removed. The collection will follow specific routes through the facility to reduce the passage of
loaded carts through wards and other clean areas.

The carts should be, easy to load and unload, have no sharp edges that could damage waste bags
or containers and easy to clean

2.1. Waste handling

Great care will be taken when handling health care wastes. The most important risks are linked
with the injuries that sharps can produce.

When handling health care wastes, sanitary staff and cleaners should always wear protective
clothing including, as minimum, overalls or industrial aprons, boots and heavy duty gloves.

2.2. On-site storage

The wastes will be temporarily stored before being treated or disposed of on-site or transported
off-site. A maximum storage time should not exceed 24 hours. Non-risk wastes will always be
stored in a separate location from the infectious / hazardous wastes in order to avoid cross-
contamination.

2.3. Transportation
Transportation will be required when hazardous waste will be treated outside the facility. The
transportation will always be properly documented and all vehicles will be carrying a
consignment note from the point of collection to the treatment facility. Furthermore, the vehicles
to be used for the collection of hazardous / infectious waste should not be used for any other

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purpose. They shall be free of sharp edges, easy to load and unload by hand, easy to clean /
disinfect, and fully enclosed to prevent any spillage in the hospital premises or on the road
during transportation.

The waste producer is then responsible for the proper packaging and labelling of the containers
that are transported. One of the reasons for labelling wastes bags or containers is that in case of
an accident, the content can be quickly identified and appropriate measures taken.

2.4. MONITORING AND EVALUATION

The set-up of a monitoring plan as well as adequate control procedures at health facility levels is
a key issue to ensure sustainability. Regular reporting and field visits as well as a good
information system to store and analyse the data are the basis of an efficient monitoring plan.
The monitoring plan should aim at providing relevant information for two different but
complementary objectives:

 Progress in the implementation of the Health Care Waste Management plans within the
Health Care Facility and evaluation of the impact of the Health Care Waste Management
Plan.
 Measure the Operation and Maintenance performance of the health services to maintain a
good standard of Health Care Waste Management within the Health Care Facility.

Control Procedures
The primary chemical spill emergency control measure will be the adequate provisioning of
containment areas.
Access to and housekeeping of each department shall be the responsibility of the organization
that is the end user. The end user shall monitor the building to ensure chemical waste storage
capacity is not exceeded and that all materials are stored with compatible materials.

2.6. EMERGENCY PROCEDURES IN CASE OF SPILLAGES OR ACCIDENTS

In case of accidents or spillages, the following action shall be taken:

 The emergency procedures mentioned in the Waste Management Plan shall be implemented
immediately;
 The contaminated area shall be immediately evacuated, if required;

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 The contaminated area shall be cleared and, if necessary, disinfected;
 Exposure of staff shall be limited to the extent possible during the clean-up operation, and
appropriate immunization carried out, as may be required and emergency equipment used
shall be immediately replaced in the same location from which it was taken.
 All vehicles carry adequate supply of plastic bags, protective clothing, cleaning tools and
disinfectants to clean and disinfect any spillage;

2.7. RECORDING KEEPING

The Waste Management Officer shall immediately investigate, record and review all such
incidents to establish causes and where necessary shall amend the Waste Management Plan to
prevent recurrence. The transportation of waste is properly documented, and all vehicles carry a
consignment note from the point of collection to the incinerator or landfill or other final disposal
facility, and all vehicles are cleaned and disinfected after use.

2.8. TRAINING OF STAFFS

Capacity building of health care workers through comprehensive training and orientation. All
healthcare staff should be aware of the technical aspect of hospital’s basic healthcare waste
management and their role in the plan. They shall be properly trained and prepared for
emergency response. For this hospital will arrange training on waste management and on its
implementation plan.

2.9. ESTIMATION OF COST RELATING TO WASTE MANAGEMENT

The costs of construction, operation, and maintenance of systems for managing health-care waste
represent a significant part of the overall budget of a hospital or health-care establishment. They
are covered by a specific allotment from the hospital budget.
Cost estimation
Health facility will need to establish accounting procedures to document the costs they incur in
managing health-care waste. Accurate record-keeping and cost analysis must be undertaken by a
designated individual. Health-care waste costs should be the subject of a separate budget line.
This allows costs for different periods to be compared and helps to reduce management costs.

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3.0 STRATEGY FOR THE IMPLEMENTATION OF THE PLAN
Implementation of waste management plan is the responsibility of the head of a health care
facility and the following shall be the steps of implementation of the waste management plan:
 Provision for future expansion of the hospital or of waste storage facilities shall be made.
 The officer in charge appoints personnel to the post with the responsibility for waste
management.
 The Infectious Control Officer shall organize and supervise training programs for all staffs,
in collaboration with Waste Management Officer and other members, including medical
staff, who shall urged to be vigilant in monitoring the performance of waste disposal duties
by non-medical staff, shall attend initial training sessions.
3.1. SECURITY MEASURES
A range of measures will be developed in relation with the handling and the treatment or disposal
of Health Care Waste to promote personal hygiene and protective measures. These measures will
also concern municipal staff operating in solid waste management at the city level.
Personal hygiene
Basic personal hygiene is important in reducing the risks that occur from handling Health Care
Waste. Hospital administrators and planning officers should ensure that washing facilities are
made available to people handling Health Care Waste. This is particularly important at storage
and treatment facilities.
Personal protection
As already mentioned, staff which are in contact with Health Care Waste should wear the
following personal
Protective clothing:
 Suitable heavy-duty gloves when handling HCW containers;
 Safety shoes or industrial boots to protect the feet against the risk of containers being
accidentally dropped;
 Industrial apron or leg protectors when container handling could cause wounds.
3.2. MANAGEMENT INFORMATION SYSTEMS
Standard documents should be used to manage health care waste at the health facility as follows:
 Standardize recording and management procedures to be followed.
 Set-up a reliable information system.
 Establish adequate control and backstopping procedures.

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3.4 BUDGET AND EXPENDITURES

S/N BUDGET ITEMS UNIT COST MULTIPLYI TOTAL

NG COST
3.5.
FACTORS

Logistics

1 Phone Credit Recharge 20.00 5 x 20.00 100.00

2 Allowances during 400 10x 400 4000

meetings

2 Transport 18.00/Litre 18 x 15.00 270.00

3 Bins 100.00/day 5 x 100.00 500

Subtotal 780.00

Stationary

4 Gloves 20 per box 100x20.00 2000

5 Pens 2.00 20 x 2.00 40.00

Subtotal 2040.00

Secretarial work

6 Printing 2.500/page 500 x 2.50 1250.00

7 Printing of charts with 10 10 x 100 100

lebellings

Grant Total 15 194

PROCUREMENT PROGRAMMES

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The Procurement Officer or department should liaise with the Focal point Person to ensure a
continuous supply of the items required for waste management (plastic bin liners in approved
colours and containers of the right quality, spare parts for on-site health-care waste treatment
equipment, purchase of waste transport tricycles, bin trolleys, hand-held thermometers and it
should be based on the budget constituted.

3.6. CONCLUSION
The absence of or improper management measures to prevent exposure to hazardous health-care
waste (HCW) results in important health risks to the general public, in and outpatients as well as
the medical. However, the lack of resources in the health sector tends to affect negatively the
way Health Care Waste is managed. Therefore, implementations of health care waste
management plan will in the managing of health care waste generated in the health care facility.

APPENDICES

Chemical waste

Period 1 2 3 4 5
Chemical volume 34 42 43 46 48
weight
waste
Accumulative 34 76 119 165 213
wastes

Sharp waste

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 Period 1 2 3 4 5
Sharp volume 29 25 33 32 29
waste weight
Accumalative 29 54 87 119 148
waste

Infectious waste

Period 1 2 3 4 5
Infectious volume 19 22 25 33 21
weight
waste
Accumulative 19 41 66 99 120
waste

Accumulative
Waste

13
250

200

150
Chemical waste
Sharp waste
100 Infectious waste

50

0
Month 1 Month 2 Month 3 Month 4 Month 5 Period

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APPENDIX

Abbreviation
EMS Environmental Management System

EMA 2011 The Environmental Management Act of 2011

CSO Central Statistical Office

MOH Ministry of heath

HCF Health care facility

HCWMS Health care waste management system

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