MODULE 22:

Contingency Planning and Emergency

Response on Healthcare Waste
Management
 Module Overview
• Present examples of contingencies related to
HCWM

• Describe steps in developing a contingency plan

• Describe procedures for dealing with spills

• Describe procedures for dealing with injuries and

exposures

• Discuss contingency measures in the event of an

epidemic, major emergency or disaster in the
community
 Learning Objectives
• Discuss how to develop plans for contingencies related to
HCWM

• Define and create procedures for dealing with infectious

waste or chemical waste spills, including the use of PPE

• Describe post-exposure prophylaxis (PEP) procedures for

waste-related injuries and procedures related to needle-
stick injuries, in particular

• Reproduce a response to a simulated emergency spill or

waste-related exposure
 Examples of Contingencies Related to
Healthcare Waste
• Contingencies related to waste handling
– Lack of color-coded bags, bins or sharps containers
– Lack of PPE (gloves, face masks, etc.)

• Contingencies related to waste storage

– Overfilled storage; lack of capacity
– Flooding or fire in the waste storage area

• Contingencies related to waste treatment/disposal

– Breakdown of waste treatment autoclave or incinerator
– Downtime due to maintenance or repair of treatment technology or
lack of spare parts
– Temporary closure of the landfill, no waste picked by waste collector
for final disposal
 Examples of Contingencies Related to
Healthcare Waste
• Contingencies related to spills
– Spills of blood, breakage or leaks of infectious waste bags or
containers, breakage of mercury-containing devices, spills of
chemicals (e.g., laboratory solvent, cytotoxic agent or
pharmaceuticals)

• Contingencies related to labor

– Lack of human resources, impact of strikes or illness among
waste workers or waste collectors, illness of waste supervisor

• Exposure incidents
– Needle-stick injuries, exposure to blood splashes, exposure to
pathogenic aerosols from infectious waste, acid burns
 Contingency Planning
• A systematic approach to identify what could go
wrong and make preparations in response to
those events

• Contingencies should be prioritized since it is not

possible to plan for all possible contingencies
• Contingency planning is also an opportunity to
identify activities or resources that minimize the
risks or avoid contingencies
 Steps in Contingency Planning

• Identify events or scenarios that could disrupt

the normal function of healthcare waste
management in the facility

• Assess the likelihood of those events or

scenarios and the risks they pose
• Prioritize the contingencies based on their
probabilities and risk impact

• Prepare contingency plans

 Steps in Contingency Planning
• When developing contingency plans:
– Identify the trigger that would start implementation of
the plan
– Obtain input from staff and other stakeholders
– Break down the plan according to time frame (e.g.,
actions to take during the first hour, actions for the first
day, first week, etc.)
– Write down the plan in clear terms
– Communicate the plan and provide training
– Review the plan on a regular basis
 Examples of Possible Responses to
Some Contingencies
• Lack of color-coded bags, bins or sharps containers
 Use markings or labels as a temporary substitute for color-coding; use
make-shift containers that provide a similar level of safety (e.g., labeled
bleach bottles as sharps containers)
• Overfilled storage area
 Designate an unused space for backup storage; modify the space to
prevent public access

• Breakdown of the on-site waste treatment system

 Make prior arrangements with another hospital or waste treatment plant to
treat the facility’s waste in the event of a breakdown
• Temporary closure of the landfill
 Make prior arrangements with another landfill as a backup to accept the
facility’s waste
 Examples of Possible Responses to
Some Contingencies
• Contingencies related to spills
 Prepare spill clean-up procedures, conduct training
including practice clean-up of simulated spills

• Illness among waste workers

 Train other employees or part-time workers in
healthcare waste handling and collection as backup
• Exposure incidents
 Develop clear procedures for exposure incidents
 Response to Spills

• Small spills
– Can be handled by a small group of trained
employees and when spills are not
immediately hazardous

• Large spills
– Remove personnel from immediate danger
and bring in properly trained first responders
to clean spill up
 Infectious Waste Spills
• To reduce the number of employees at risk of exposure:
– Restrict access to the spill area
– Provide warnings of hazards and advice
about special requirements
– Ensure staff is trained to respond to these spills

• You may clean up small spills if you:

– Have the supplies to absorb and bag the spilled material
– Are familiar with the properties of the spilled material
– Have the proper personal protective equipment
– Are trained to respond to a biohazard spill
 What To Do When There Is An
Infectious Waste Spill
• Workers should wear :
– eye protectors or face shields
– gloves
– coveralls
– respirators or face masks depending on the risks
of exposure
• Residues should be recovered using hand tools and
then packed safely
• The floor should be cleaned and disinfected after
most of the waste has been recovered
 What To Do When There Is An
Infectious Waste Spill
• Cover spilled area with
absorbent pad or paper
towels
• Decontamination - use
bleach, diluted to 1:10 with
water:
– to decontaminate the spill area
– to clean/decontaminate equipment
used in spill response
– pour diluted bleach over towels, let
stand for 30 minutes
 Spill Clean-Up Kit
CONTENTS:
 Disposable gloves, face mask and safety glasses
 Small scoop or dust pan and brush, shovel
 Absorbent pads or powders for liquid spills
 Cleaning rags or paper towel
 Chlorine disinfectant (1:10 chlorine)
 Germicidal wipes
 Extra color-coded infectious waste bags
 First-Aid kit
 Biohazard labels
 Aspirator bottle, spatula or mercury amalgam powder for mercury
spills
 Mercury Spills
• Can you tell me what steps are taken if you have a broken
thermometer in your facility?
– Who do you call
– Who cleans or responds first
– Do you receive any training
– Is there a spill response kit
– What does the kit contain
– Do you have a protocol for safe disposal
– Any medical monitoring
– Any incidents in the past?
 Examples of Personal Protective Equipment
(PPE)
• Helmets
• Face masks
• Eye protectors (safety goggles)
• Overalls (coveralls)
• Industrial aprons
• Leg protectors and/or industrial boots
• Disposable gloves (medical staff) or
heavy-duty gloves (waste workers)
 Simulation

• Conduct a clean-up
of a simulated
infectious waste
spill or chemical
waste spill
 Response to Injury and Exposure

All staff should be knowledgeable

about procedures, first line of
response and WHOM TO CALL
What to do in Emergency Injury or Exposure

• Self-protection with appropriate PPE

• Immediately assist victim with first-aid measures:
– Bleed the wound (needle-stick injury)
– Wash area under clean running water
– Clean wounds and skin
– Splash eyes with clean water (e.g., for eye
exposure to biohazard)
– Splash the body (e.g., for chemical exposure)
• Seek prompt medical attention
What to do in Emergency Injury or Exposure

• Report the incident to a designated person

• Retain the item involved in the incident
• Identify source of possible infection
• Seek additional medical attention in emergency
• Maintain medical surveillance
• Record and investigate incident
• Identify causes and implement action to prevent similar
incidents in the future
 Incident Reporting

• All incidents including near misses (or no

injuries), must be reported to the OHS
committee or a specific representative
• A report should be filed and kept on record
– review to make work place or practice
changes
 Incident Report

• Name(s) • Any witnesses

• Date • Hospital visit
• Time • Contributing factors
• Where • Contact info
• Type of injury • Recommendations
• How
 Post-Exposure Prophylaxis

• Ensure all staff have access to post-exposure

information, education, and communication
• Required by WHO
• Initiate PEP as soon as possible within first few
hours of exposure and no later than 72 hours
after exposure
 Post-Exposure Prophylaxis
• Post-exposure prophylaxis protocol must include:
o Who to contact
o Check patient status (HIV positive or not)
o Check immediate health status of worker
 Pregnant, hypertensive
o Provide necessary medications as soon as possible
o Provide support & counseling to those exposed
o Maintain confidentiality
o Analyze reported cases of exposure to improve
practices
 Medical Surveillance
• Mercury
• Needle stick injuries (NSI)
• Blood-borne pathogens
• TB surveillance
– MDR TB
• Noise and radiation
– May be an issue with loud equipment
• Chemical
– Formaldehyde, benzene
– Very rare in hospitals
Questions You Should be Able to Answer

• What are the guidelines or protocols to respond to

a waste spill?

• How should you respond to a patient who has a

needle-stick injury?

• What should you do if you have a needle-stick

injury?
 Training

• Outline all emergency, spill and injury

response procedures
• PPE use
• Annual refreshers
 Fire Safety

• What is the protocol for fire in your facility?

• Is there a plan related to hazardous equipment,
chemicals and wastes?
• Is there regular training related to fire safety?
 Contingency Planning for Epidemics,
Disasters and Other Major Emergencies in
the Community
 Contingency Measures for Major
Emergencies in the Community
• Preparation for emergencies should be made at health care facility
and regional/central government levels.

• Healthcare facility level

– action plans on healthcare waste management should include
emergency measures to apply during emergency situations
(e.g., epidemics in the community could lead to significant
increases in the amounts of healthcare waste generated)

• Regional/national level or disaster prone area

– prepared by a responsible cluster (inter-agency cluster
composed of national or international agencies/organizations).
 Questions to Ask?
• What standards will be used to guide the response?
• What are the current capacities of the agencies/organizations to
respond?
• What initial assessment arrangements are needed?
• What actions will be taken as an immediate response to the
situation? Who does what and when? And who is coordinating and
leading?
• What resources would be needed?
• How will information flow between the various levels (local and
national and vice versa)?
• Have specific preparedness actions been agreed on?
• What follow-up actions are required?
 Planning as an Ongoing Process

• Regularly reviewed and updated to ensure:

– all partners are familiarized with their various
roles and responsibilities and preparedness
actions are undertaken.
– plans should be in line with existing national
policies, strategies and legislations on
healthcare waste management
– Updated when there is a change in process,
equipment, construction, etc.
 Contingency Measures for Major
Emergencies in the Community
• Rapid Initial Assessment
– Inform personnel in charge or emergency responders
about critical and immediate needs
– Secure the area
– Collect data
o Area affected, number of people affected, any
injuries that need immediate attention, types of
hazards and their locations
– Should be improved as more time and data become
available
 Contingency Measures for
Emergencies in the Community
• Emergency Response
– Based on rapid assessment, emergency response
should be pre-planned with clear roles and
responsibilities
– Plans for the management of larger than usual
quantities of healthcare waste should be implemented

• Recovery
– Return to normal situation prior to the emergency
– Lessons learned
Treatment and Disposal Options During
Major Emergencies
• If resources are available, infectious and sharp wastes could be
disinfected in a small autoclave. Non-sharp disinfected wastes then
join the general waste stream.
• On-site burial in pits or trenches, or disposal in special controlled
cells in municipal dumping sites are other options.
• Sharps wastes or small quantities of pharmaceuticals can be
encapsulated followed by on-site burial or burial in special cells in
municipal dumping sites.
• Incineration in high-temperature industrial incinerators or cement
kilns with air pollution control is an option if there is a safe means of
transportation.If standard is not maintained, incinerator may create
another public health problems.
• Alternative method of waste disinfection needs to be explored and
tested for emergencies.
Treatment and Disposal Options During
Major Emergencies
• Mercury thermometers → collect for mercury
recovery, store safely
• Pressurized containers → recycle
• PVC plastics such as IV sets, catheters and PVC
containers for sharps → disinfection & recycling
• Vials of vaccines → disinfection & recycling
• Anatomical wastes/body parts → safe burial in
pits, bio-digestion
Emergency response to health care
waste after Nepal Earthquake 2015
 Nepal Earhquake 2015

• Date: 25th April 2015

• Magnitute: 7.8 W
• 1085 health facilities (402 completely and 683 partially) damaged
 Nepal Earhquake 2015

The overall damage is estimated to be at about $10 billion, 

according to the Nepal government: nearly half of its gross domestic
product.
 Nepal Earhquake 2015

Displaced: 2.8 million

Killed: about 9,000 people
Injured: 23,000 people
 Nepal Earhquake 2015

Health Care Waste Management in

existing Health Care Facilities
Post Earthquake situation of HCWM:
Bir Hospital
 Post Earthquake: Bir Hospital
Old building was damaged due to earthquake
Hospital was evacuated into the street nearby
Subsequently hospital was shifted to new building: trauma center
which was ready to operate before earthquake.

Shifted
 Post Earthquake Situation of HCWM:
Bir Hospital
• Waste segregation items (buckets, neeedle cutter,
segregation trolley) shifted to new building
• Some of the units of the hospital couldn't take their
buckets out from the ward because of buildign damage
• Housekeeping had stock of waste management items
such as buckets, sitckers and needle cutters
• Staff of waste collection and treatment center were
irregular
Autoclave Log

Maximum amount of waste

was autoclaved in May. This
was due to improper
segregation
Recycling is being hit:
Year 2071: NRs. 25687
Year 2072: NRs. 7846
214,092/year is being lost
Only 30% of total waste is being send for
recycling
 Post Earthquake Situation of HCWM:
Kathmandu Model Hospital
• Patient was shifted to the
ground floor and outside
from wards.
• Waste management was
not affected
• Segregation was as
before
• Security helped for proper
segregation by educating
patient and visitors.
• Effective monitoring
 Nepal Earhquake 2015

Health Care Waste Management in Temporary on site Health

camps runned by International and National Medical Teams
 Post Earthquake Situation of Health
Care Waste Management
• 141 Foreign Medical team are officially deployed at 14
earthquake affected districs
• None of the medical team were arrived with
preparedness on safe medical waste disposal.
• Some FMTs had brought their waste bins with labels
for waste segregation but no solution for final disposal.
• All team came without knowledge on local waste
disposal system so they wanted to send all there risk
waste to the regular municipal waste management
stream.
Post Earthquake Situation of Health
Care Waste Management

Observing health
care waste disposal
Field hospital at field hospital
 Piloting Health Care Waste
Management system at Field
Hospital at Singati, Dolakha, after
Nepal Earthquake 2015
Organized Jointly by:
The Dutch Aid Team
Health Care Foundation Nepal

In collaboration with:
Ministry of Health and Population (MoHP), Nepal

(From 29th May 2015 to 13th June 2015)

Dolakha, Singati
• Singati is a small village in
Northern part of Dolakha
• This village was one of the
severly hit by Nepal
Earthquake 2015
DOLAKHA • It was one of the the most
affected area where many
houses including health
facilities damaged
 Segregation System

Waste segregation
trolley

Segregation trolley is being used at

health camp

General waste segregation

Orientation of Waste Management to
Dutch Aid Team
 Treatment of Infectious Waste

Biomass autoclave
was found the
ideal solution for
treating infectious
waste in the field
hospital and also
during disaster
situation
Biomass Autoclave

• Gasket-less aluminium autoclave set into a

high efficiency biomass cook-stove
• Potential for disinfecting waste in remote
areas and post-disaster situations
• Being tested in Kathmandu May/June
2014
• Effective with wood, and various biomass
briquettes
• 60 litres of waste can be disinfected with
as little as 800g of fuel.
 Waste Management System at Singathi became
center of attraction for all viistors

Dutch Aid team learning

waste management

Visitors from WHO

documenting waste Team from district
management system understanding
autoclaving system
 Segregation

Segregation by the Team

Percentage of waste composition
generated at medical camp
 Discussion
• What are some healthcare waste-related contingencies that might occur in
your facility?
• Discuss your facility’s spill response plans for chemicals and infectious
agents.
• Are spill clean-up kits available in your facility? For what specific chemicals?
• What are the strengths and weaknesses of your facility’s emergency injury
or exposure procedures?
• What are the strengths and weaknesses of your facility’s incident reporting
system?
• Discuss your facility’s plans for major emergencies in the community?
• Have you received any training in emergency response? What training is
needed?
 Thank You
Contact email:
saruthakuri09@gmail.com