COMPOSITION AND GENERATION OF HEALTH CARE WASTE IN SOUTH AFRICA

Torben Kristiansen, MSc. Civ. Eng (Chief Technical Advisor, RAMBØLL A/S, Teknikerbyen 31, 2830 Virum, Denmark, Email:

tok@ramboll.dk)

 

Eugenius Senaoana, DMSA, Specialists in Data Management and Statistical Analysis, Tel: +27 11 717-1687, Fax: +27 11 403-2373,

Email: euginius@dmsa.wits.ac.za

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Overview of presentation1. Purpose of the Health Care Waste Composition

and Generation Study

2. Availability of data internationally

3. Methodology to Safety and Sampling

4. Problems encoutered

5. Findings

6. Conclusions

7. Source of further information and documentation

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Purpose of Composition Study1. Assess the pre-and post intervention efficiency of the health care

waste segregation and compare that against the general segregation efficiency for public and private health care facilities in Gauteng in general

2. Assess the scope for reducing quantities of HCRW requiring expensive containerisation and treatment by improving the availability of containerisation and receptacles and staff awareness of correct waste segregation principles

3. Assess the impact of the interventions made at Leratong Hospital in terms of the waste segregation efficiency

4. Determine the main constituents and the composition and generation rates for health care risk waste requiring special treatment and health care general waste being disposed to communal landfills

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Key Changes from Pre- to Post intervention situation:

1) No cardboard2) Vials sorted3) Training4) Skills posters5) Monitoring6) HCW Officers

International Data Available

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Two types of Studies: I) Calorific Value (treatment focus), II) Segregation Efficiency (cost and safety focus)

Material HCRW HCRW HCRW HCRW HCRW HCRW HCRW HCRW HCW% w/w % w/w % w/w % w/w % w/w % w/w % w/w % w/w % w/w

Vietnam Thailand Italy USA China China China USANepal (11 hospitals)

Year 1998 2002 1992 1997 1993 1993 1993 1989 1997

Paper&cardboard 0.8 34.0 45.0 16.0 34.0 51.0 31.0Plastic 10.1 14.3 46.0 15.0 50.0 21.0 18.0 29.0Rubber - 19.3 12.0Textiles - 16.3 10.0 14.0 2.0 5.0Food 10.0 21.0 17.0 7.0 1.0Yard waste - 3.0Glass 20.9 7.5 7.0 1.0 11.0 8.0 3.2Metals 2.9 18.2 0.4 10.0 0.5 1.0 9.0 1.1Fluids 12.0 17.7Misc. Organics 52.9 0.1 10.0 1.5 2.0 5.0Anatomical 0.6 15.4 0.1

Infections waste 12.0 16.6 30.2%General Waste 69.8%TOTAL 100.2 100.0 100.1 100.0 100.0 100.0 100.0 100.0 100.0%

Health & Safety Approach1. All personnel trained in the risks, the types of waste

2. All personnel on site went through an inoculation programme prior to the commencement of work

3. The work place was divided into a ‘Cold Zone’, a ‘Warm Zone’ and a ‘Hot Zone’ + ‘Decontamination Zone’.

4. An specialised medical practitioner on call

5. A strict policy of ‘no touch’.

6. Forms used for recording observations in the ‘Warm Zone’ where photocopied to clean pages

7. All samples where disposed in the incineratoror located at the sorting site immediately after processing of the samples

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Methodology1. Random sampling, 14 (12) consecutive days in a period with no

holidays2. No. of samples: manageable, affordable workload, resulting in an

acceptable level of precision. 10 daily random samples of each type of receptacle. If less than 10: All sampled. 6.5-10% level of precision (d) with 95% confidence level

3. Sampled pathological waste not emptied and sorted in detail.All other sampled receptacles were opened and emptied and sorted completely

4. All waste weighed daily incl. outsourced third parties namely i) the blood bank, ii) the laboratory as well as iii) segregated recyclables, but not sampled.

5. Trial Study to test systems working!6. Training of all staff before sorting

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2

22/ )(

d

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Problems Encountered1. One needle stick injury! (> 2100 samples over 42 days)

2. Difficult to sort PVC and non PVC plastics

3. Change of classification of vials in pre- and post-internvetion study caused mis-recording

4. Sampling of public & private generators was causing excessive workload for sorters – Working into the night.

5. E.g. mass of sharps misplaced can be very low and mass alone may not be an appropriate indicated

6. Tedious and challenging work that is not for the faintharted – requires well motivated staff.

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Results Public Facilities

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Public Health Facilities in GautengHealth Care Risk Waste Only HCGW

Other HCW Infectious Pathological Total

Container Type kg/Day kg/Day kg/Day kg/Day kg/Day

General Infectious Waste 2556.9 2026.62 3684.94 . 8268.46Sharps Containers 3.98 72.34 . . 130.98Anatomical W Containers . . . 97.19 228.17Total 2560.88 2098.96 3684.94 97.19 8627.61Percent 29.68% 24.33% 42.71% 1.13% 100.00%

.54.660.63%

Incorrectly Disposed Correctly Disposed

Sharps

Kg/Day

.54.66

Results Private Facilities

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Private Health Facilities in Gauteng

Health Care Risk Waste Only HCGW

Other HCW Infectious Pathological Sharps Total

Container Type kg/Day kg/Day kg/Day kg/Day kg/Day kg/DayGeneral Infectious Waste 1705.37 576.8 4226.07 . . 6508.24Sharps Containers 13.07 395.2 . . 325.9 734.17Specican Containers 13.89 22.12 . 13.94 . 784.12Total 1732.33 994.12 4226.07 13.94 325.9 8026.53Percent 21.58% 12.39% 52.65% 0.17% 4.06% 100.00%

Incorrectly Disposed Correctly Disposed

Results Pre/Post Leratong H

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Waste Type Waste Component N W/W Total kg kg/day N W/W Total kg kg/day

Infectious 74.17% 224.62 92.72% 276.54Sharps 0.12% 0.36 0.12% 0.35Chemical 0.49% 1.49 0.01% 0.02HCGW 25.22% 76.36 6.36% 18.98Sealed Sharps . . 0.78% 2.33Other 0.00% 0 0.01% 0.03

Total Incorrect 25.83% 78.21 7.28% 21.71Infectious 12.06% 2.4 21.48% 0.44Sharps 85.89% 17.07 77.51% 1.61Chemical 1.99% 0.4 0.07% 0HCGW 0.06% 0.01 0.94% 0.02

Total Incorrect 14.11% 2.8 94 22.49% 0.47

Pre-Intervention Study Post-Intervention Study

General Infectious Waste

120 3634 204 4175.39

Total Correct120 74.17% 3634 224.62 204 92.72% 4175.39 276.54

Sharps71 238.55 94 29

Total Correct (Sharps)71

85.89%29

1.61238.55

17.07 94 77.51%

NOTE: Contents of Sharps Containers (Post) have errors.

6%93%

Results Pre/Post Leratong H

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Waste Type Waste Component N W/W Total kg kg/day N W/W Total kg kg/day

Pathological 13 1 1 16.64Other 1 1

Infectious 4.35% 78.07 2.48% 47.72Sharps 0.07% 1.26

Chemical 0.11% 1.94 0.01% 0.21HCGW 95.54% 1713.86 97.07% 1869.86Other 0.38% 7.24

Total Incorrect 4.46% 80.01 2.93% 56.42

Lab . 165.65 13.80 259.38 18.53

Morgue . 116.65 9.72 198.62 14.19

Blood . 82.45 6.87 31.38 2.24

Pigswill Drums . . 2072.7 172.73 . 2174 155.29Vials Vials . . . 37 2.64

Grand-total 27903.45 2325.32 34105.72 2436.13

1869.86

Lab, Morgue &

Blood Waste

56

General Waste

(HCGW) 21526 129 26968Total Correct (HCGW)

12095.54%

21526.51713.87

12997.07%

26968

120

Pathological 67.45 5.62 31 232.95

Pre-Intervention Study Post-Intervention Study

Results Pre/Post Leratong H

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Pre Post Pre Post Pre Post Pre Post Pre Post Pre Post

Gen Infectious W 224.6 276.5 76.4 19.0 1.9 2.7 76.4 19.0 226.5 279.3Sharps 17.0 1.6 0.0 0.0 2.8 0.5 0.0 0.0 19.8 2.1Laboratory 13.8 18.5 13.8 18.5Morgue 14.2 14.2Pathological 5.6 16.6 5.6 16.6Blood bank 6.9 2.2 6.9 2.2Sub-total 268.0 329.8 76.4 19.0 4.6 3.2 76.4 19.0 272.6 332.9Percentage 76.8% 93.7% 21.9% 5.4% 1.3% 0.9% 21.9% 5.4% 78.1% 94.6%General Waste 1713.9 1869.9 80.0 56.4 1713.9 1869.9 80.0 56.4Percentage 95.5% 97.1% 4.5% 2.9% 95.5% 97.1% 4.5% 2.9%GRAND TOTAL 1713.9 1869.9 268.0 329.8 76.4 19.0 84.7 59.6 1790.2 1888.9 352.6 389.4Percentage 80.0% 82.1% 12.5% 14.5% 3.6% 0.8% 4.0% 2.6% 83.6% 82.9% 16.5% 17.1%Kg/patient/day 3.37 3.74 0.53 0.66 0.15 0.04 0.17 0.12 3.52 3.78 0.69 0.78

HCRW HCGW HCRW

Leratong Pre- and Post-Intervention StudiesCorrectly Disposed Incorrectly Disposed Total

HCGW HCRW HCGW

Results Pre/Post Leratong H

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kg/day % (w/w) kg/day % (w/w)

General Infectious Waste 302.83 14.1% 298.25 13.1%Sharps & Vials 19.84 0.9% 4.72 0.2%Laboratory 13.8 0.6% 18.53 0.8%Pathological waste 5.62 0.3% 30.83 1.4%Blood bank 6.87 0.3% 2.24 0.1%Sub-total 348.96 16.3% 354.57 15.5%General Waste (HCGW) 1793.87 83.7% 1926.29 84.5%GRAND TOTAL 2142.83 100.0% 2280.86 100.0%Kg/patient/day 4.218 4.557

Waste componentsPre-intervention Post-Intervention

NOTE: Excluding food waste (pig swill)

Summery of Conclusions

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1. There is widespread poor segregation of HCW in the Gauteng at both private and public health care facilities. This in turn compromises occupational health and safety, cost-efficiency and public safety, in particularly in respect of health care risk waste being disposed at communal landfills.

2. It is possible improve significantly the segregation

3. Approximately 84% is general waste (HCGW) and approximately 16% is medical waste (HCRW). This corresponds well with usual international figures.

4. Vials are a major and heavy components of the health care risk waste tream.

5. Waste generation at Leratong H is in the range of:

kg/patient/day % (w/w)

General Infectious Waste 0.60 14.1%Sharps & Vials 0.04 0.9%Laboratory 0.03 0.6%Pathological waste 0.01 0.3%Blood bank 0.01 0.3%Sub-total 0.69 16.3%General Waste (HCGW) 3.53 83.7%GRAND TOTAL 4.22 100.0%

Waste componentsPre-intervention

NOTE: Excluding food waste (pig

swill)

THANK YOU!Further information at:

• Documents available at : http://www.csir.co.za/ciwm/hcrw

• By email from:

Torbenk@gpg.gov.za

Fax: 011 4653616

Tel: 082 3323720

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