SFG2188 V13
FEDERAL REPUBLIC OF NIGERIA
COMMUNITY AND SOCIAL DEVELOPMENT
PROJECT (CSDP)
ENVIRONMENTAL AND SOCIAL MANAGEMENT PLAN
(ESMP)
For
THE CONSTRUCTION OF A DISPENSARY, DRUG/EQUIPMENT
AT
KUKUWA COMMUNITY IN GOJBA LGA OF YOBE STATE
DRAFT FINAL REPORT
May, 2016
CSDP-HCWMP for Micro Project 2016
Executive Summary
Kukuwa Community in Gojba LGA of Yobe state has identified the construction of a health
centre/maternity clinic, VIP toilet and provision of drugs and equipment as a priority project in their
community which they believe will help in the improvement of sanitation and hygiene and reduce
the incidences of water borne diseases. The community seeks the assistance of CSDP to fund the
project.
As part of the credit agreement with the World Bank, projects suppo rted by Bank’s funding are
usually subjected to safeguard screening to determine the environmental and social risk before
approval. Although the micro-project of concern is at the implementation stage, the operational
Policy (OP) 4.01 on Environmental Assessment is triggered given the potential environmental
concerns around the handling of Health care waste resulting from project related activities such as
the Vaccination and Routine Immunization that generate healthcare waste such as expired vaccines
and sharps.
The environmental and social screening checklist analysis carried out by CSDP categorized the sub-
project as “B�?. The volume of health care waste from wasted vaccine, immunization and other
primary health treatments is small and because they are sterilized vaccines which do not present a
public health or environmental risk. This implies that the magnitude and scope of the project is
small and site specific which can be readily addressed by mitigation measures contained in this
HCWMP.
The overall social impacts of the project are likely to be positive with main issue being utilization of
services. No land requirements or restriction of access to sources of livelihoods or involuntary
resettlement of any kind under the project.
This HCWMP identified healthcare waste sources, their bio-hazardous risks and classifications.
Section 2.4 outlined the best practices of HCW management process that will be used to manage
healthcare waste under the CSDP project. It is also important that a VIP toilet be included as a
complementary project to ensure hygiene and sanitation in the facility
A summary template described as healthcare waste management plan (HCWMP) is presented in
section 2.5. This HCWMP identified the activities that give rise to HCW, the impacts/hazards and
mitigation measures. The overall cost of implementing the HCWMP including cost of mitigation,
monitoring and training is N1, 908,000 equivalent of USD9540. The summary of the cost
component is as follows:
Cost
Item Responsibility Cost Estimate in (USD)
Estimate(N)
Mitigation CDA, CPMC, 860,000 4300
Monitoring CPMC, SA 180,000 900
Training & Capacity
Consultant 550,000 2500
Building
Sub-Total 1,590,000 7950
Management (10%) SA 159.000 795
Contingency (10%) 159,000 795
Total 1,908,000 9540
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CSDP-HCWMP for Micro Project 2016
Table of Contents
Executive Summary 2
LIST OF ABBREVIATIONS AND ACRONYMS 4
CHAPTER 1:INTRODUCTION 5
1.1 Background 5
1.2 CSDP Project Development Objectives and Components 5
1.3 Environmental Classification and Rationale for Preparing a Health care Waste Management Plan 5
1.4 Objectives of the HCWMP 6
CHAPTER 2:MICRO PROJECT DESCRIPTION AND HEALTHCARE WASTE MANAGEMENT
PROCESS 7
2.1 Micro Project Description 7
2.2 Healthcare Waste Management Process for Micro/Primary Health Facilities 7
2.3 Risks associated with health care waste 8
2.4 The Healthcare Waste Management Process 8
2.5 Summary of Healthcare Waste Management Plan 10
2.6 Capacity Building Need and Targets 12
REFERENCES 13
APPENDIX 1:PRIMARY HEALTHCARE FACILITY HCWM ASSESSMENT CHECKLIST 14
APPENDIX 2:SAMPLE WASTE DEPOSIT RECORD 17
APPENDIX 3:SUGGESTED OPTIONS FOR TREATMENT OF “SHARPS�? HCW FOR THE
NIGERIA POLIO ERADICATION PROJECT 18
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CSDP-HCWMP for Micro Project 2016
LIST OF ABBREVIATIONS AND ACRONYMS
AF Additional Financing GO Gender Officer
BH Boko Haram GRM Grievance Redress Mechanism
CBO Community Based Organization IDA International Development
Association
CDA Community Development IDPs Internally Displaced Persons
Association
CDD Community Driven Development LGA Local Government Area
CPMC Community Project Management LGRC Local Government Review Committee
Committee
CSDA Community and Social M&E Monitoring & Evaluation
Development Agency
CSDP Community and Social OO Operation Officer
Development Project
EA Environmental Assessment OP Operational Policy
EIA Environmental Impact Assessment PO Project officer
ESMF Environmental and Social PRA Participatory Rural Appraisal
Management Framework
ESMP Environmental and Social RPBA Recovery and Peace Building
Management Plan Assessment
ESSF Environmental and Social Screening SA State Agency
Form
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CSDP-HCWMP for Micro Project 2016
CHAPTER 1: INTRODUCTION
1.1 Background
The Federal Government of Nigeria has received financing from the World Bank (WB) for
implementing a 2-year World Bank Assisted Additional Financing (AF) of Community and Social
Development Project (CSDP). The thrust of the Community and Social Development Project
(CSDP) is to contribute to the realization of the Nigerian government’s strategy for poverty
reduction by improving the welfare and living conditions of many poor and vulnerable communities
in most states of Nigeria. The project has the objective to increase access by the poor to improved
social and natural resources infrastructure services in a sustainable manner throughout Nigeria. This
will be achieved through the provision of grant support to benefiting Communities for the
implementation of community-driven micro projects under approved Community Development
Plan (CDP). To commence State-level implementation of the additional financing, the Project
intends to use part of the proceeds for consultancy services for the review/upgrade of
Environmental and Social Management Plan (ESMP) and prepare Abbreviated Resettlement Action
Plan (ARAP) for the participating States in the North East Geopolitical Zone.
1.2 CSDP Project Development Objectives and Components
The initial consultation suggest that the Project Development Objective (PDO) for the CSDP AF
will remain unchanged as the original PDO- “to sustainably increase access of poor people to social
and natural resource infrastructure services�?, but the key performance indicators (KPIs) will be
revised. The CSDP AF KPIs will put some emphasis on support to vulnerable and disenfranchised
household and individuals expand scope of assistance to such households beyond public goods
(schools, health center, water etc.). It will also include demand side support i.e. a safety net. The use
of a community managed approach and emphasis on local government active partnership with
community groups will be retained and strengthened during CSDP AF period. The new emphasis
on safety net will result in an additional component, for ‘vulnerable groups’ transfers, to the original
design. In essence, the additional financing will now have 4 components:
Component 1: Coordination and Program Support Component (Federal and State Level)
Component 2: LGA/Sectoral Ministries Capacity and Partnership building Component
Component 3: Community-Driven Investment Component
Component 4: Vulnerable Groups livelihood investment grants/transfers component.
1.3 Environmental Classification and Rationale for Preparing a Health care Waste
Management Plan
As part of the credit agreement with the World Bank, projects supported by Bank’s funding are
usually subjected to safeguard screening to determine the environmental and social risk before
approval.
Although the micro-project of concern is at the implementation stage, the operational Policy (OP)
4.01 on Environmental Assessment is triggered given the potential environmental concerns around
the handling of Health care waste resulting from project related activities such as the Vaccination
and Routine Immunization that generate healthcare waste such as expired vaccines and sharps.
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CSDP-HCWMP for Micro Project 2016
The environmental and social screening checklist analysis carried out by CSDP categorized the sub-
project as “B�?. The volume of health care waste from wasted vaccine, immunization and other
primary health treatments is small and because they are sterilized vaccines which do not present a
public health or environmental risk. This implies that the magnitude and scope of the project is
small and site specific which can be readily addressed by mitigation measures contained in this
HCWMP.
The overall social impacts of the project are likely to be positive with main issue being utilization of
services. No land requirements or restriction of access to sources of livelihoods or involuntary
resettlement of any kind under the project.
1.4 Objectives of the HCWMP
The main objective of this HCWMP is to:
Identify potential impacts that may occur during implementation stage of the healthcare
facility
Develop a micro healthcare waste management plan that is detailed and specific to provide
direction on how to manage healthcare wastes
Develop detailed specific mitigation measures with relevant costs implication that will need
to be achieved during and after sub-project implementation;
Specify responsibilities and institutional arrangement that will be put in place to ensure that
the mitigation measures are implemented
Tracking to ensure the effectiveness of the mitigation measures at meeting the discharge
standards.
Provide implementation and monitoring schedule
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CSDP-HCWMP for Micro Project 2016
CHAPTER 2: MICRO PROJECT DESCRIPTION AND HEALTHCARE WASTE
MANAGEMENT PROCESS
2.1 Micro Project Description
The micro-project is the construction of a dispensary/maternity, drugs and equipment in Kukuwa
community in Gojba LGA of Yobe state.. Dispensary or primary healthcare is of great priority to
the people of Kukuwa community in view of the fact that there is no dispensary or public health
centre in the community which subjects the people to traveling to over 10km distance to access
medical care in the city. Their pregnant women and children are vulnerable to morbidity due to
absence of a dispensary and/or a primary health centre.
2.2 Healthcare Waste Management Process for Micro/Primary Health Facilities
Healthcare Waste (HCW) is all waste generated by health-care establishments (human or
veterinary), including research facilities and laboratories. It can include waste generated in the course
of healthcare in homes. Table 2.1 below illustrates the major categories of medical wastes.
Table 2.1: Major Categories of Medical Waste
Waste type Description
1.Infectious waste Infectious wastes are susceptible to contain pathogens (or their toxins) in
sufficient concentration to cause diseases to a potential host. Examples
include discarded materials or equipment, used for the diagnosis, treatment
and prevention of disease that has been in contact with body fluids
(dressings, swabs, nappies, blood bags etc). It also includes liquid waste such
as faeces, urine, blood or other body secretions.
2.Pathological and Pathological waste consists of organs, tissues, body parts or fluids such as
anatomical waste blood. Anatomical waste consists in recognizable human body parts,
whether they may be infected or not.
3. Hazardous pharmaceutical Pharmaceutical waste includes expired, unused and contaminated
waste pharmaceutical products, drugs and vaccines. This category also includes
discarded items used in the handling of pharmaceuticals like bottles, vials and
connecting tubing.
4. Hazardous chemical waste This consists of discarded chemicals (solid, liquid or gaseous) that are
generated during disinfecting procedures. They may be hazardous (toxic,
corrosive, flammable or reactive) and must be used and disposed of
according to the specification formulated on each container.
5. Waste with a high content Waste with high contents of heavy metals and derivatives are highly toxic
of heavy metals (e.g. cadmium or mercury from thermometers or manometers).
6. Pressurized containers Pressurized containers consist of full or emptied containers or aerosol cans
with pressurized liquids, gas or powdered materials
7. Sharps Sharps are items that can cause cuts or puncture wounds (e.g. needle stick
injuries). They are highly dangerous and potentially infectious waste. They
must be segregated, packed and handled specifically within the HCF to
ensure the safety of the medical and ancillary staff.
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CSDP-HCWMP for Micro Project 2016
8. Highly infectious waste This includes microbial cultures and stocks of highly infectious agents from
medical laboratories. They also include body fluids of patients with highly
infectious diseases.
9.Genotoxic/cytotoxic waste Genotoxic waste includes all the drugs and equipment used for mixing and
administration of cytotoxic drugs. Cytotoxic drugs or genotoxic drugs are
drugs that have the ability to reduce the growth of certain living cells and are
used in chemotherapy for cancer.
10. Radioactive waste Radioactive waste includes liquids, gas and solids contaminated with radio
nuclides whose ionizing radiations have genotoxic effects. These include x-
and g-rays as well as a- and b- particles.
Source: Safe Management of Wastes from Health-Care Activities, WHO 1999
2.3 Risks associated with health care waste
Health care waste management is an integral part of hygiene and infection control within a health
care facility and safe HCWM will help control infections and occupational hazards. All individuals
and workers exposed to HCW are potentially at risk of being injured or infected.
The general public can be infected by HCW either directly or indirectly through several routes of
contamination. Dumping HCW in open areas is a practice that can have major adverse effects on
the population. Reuse of improperly disposed injection equipment is another route of infection by
HCW. WHO estimates that over 20 million infections of hepatitis B, C and HIV occur yearly due to
unsafe injection practices (reuse of syringes and needles in the absence of sterilization). Furthermore,
there is a risk for public health as regards the sale of recovered drugs in the informal sector and the
lack of controls.
The dumping of HCW in uncontrolled areas can have a direct environmental effect by
contaminating soils and underground waters. During improper burning or incineration of HCW, air
can also be polluted causing illnesses to the nearby populations. This has to be taken into
consideration when choosing a treatment or a disposal method.
2.4 The Healthcare Waste Management Process
Below are some critical steps that must be considered when managing healthcare waste for this
project.
Table 2.2: Steps in managing health care wastes
Waste Management Key Elements for Safe and Effective HCWM
Component
Generation Identification & classification of HCW material
Segregation of HCW at source based on categories ( general wastes,
sharps, infectious wastes, highly infectious wastes, pharmaceuticals)
Cleaning & Disinfection of personnel and surfaces that have come in
contact with hazardous HCW
Collection Handling and Storage based on Colour Coding
In-Facility Storage Separate storage facility
Appropriate storage temperature
Waste not to be stored for more than 48 hours
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CSDP-HCWMP for Micro Project 2016
Documentation and Assessment of the waste quantity
Packaging and Labelling
Monitoring
Transport Monitoring during Transportation
Documentation
Off-Facility Storage Separate Storage Facility
Documentation and Assessment of waste quantity
Monitoring
Treatment and Disposal Appropriate treatment using appropriate and affordable technology
option
A schematic representation of the ideal situation is shown below.
Waste minimization
Segregation
Collection/Codification
Handling
Transportation
(internal and external)
Treatment
Disposal
Schematic representation of health care waste management
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2.5 Summary of Healthcare Waste Management Plan
ACTIVITY IMPACT/HAZARD MITIGATION COSTS MONITORI COST RESPONSIBILITY
MEASURES NG MITIGAT. MONITOR.
MEASURE
Ensure that special Needle-stick injuries from -Puncture resistant safety Facility
healthcare waste is used needles and syringes; boxes/Impermeable inspection for Nurses,
segregated from other Unsafe disposal can containers for the safe at least once immunizat OO, EPA,
waste for disposal. spread some of the very disposal of used syringes in a month 30,000 ion WB
same diseases that we are and needles and other officers
Sub-activities trying to prevent; contaminated sharps; Check the (IOs),
i) Immediate “at source Leaving used syringes and -Immunization Post waste programm
segregation of needles in the open puts Exposure Prophylaxis; management e officers
healthcare wastes the community at risk; Procure appropriate PPE record (POs),
(sharps, infectious Possible infection of for specific health risks; 15,000 Cleaners,
wastes, highly infectious personnel by infectious or -Create a waste scavengers
wastes, pharmaceutical highly infectious wastes, management record for
wastes, e.t.c. inventory of daily waste
volumes and handling.
ii) Waste collection Spillage or droppings due Provision of high quality 25,000 Facility 30,000 Nurses,
to breaking of waste sharps boxes, waste bags inspection for IOs
collection bags/bins and bins at least once Pos, OO, EPA,
in a month Cleaners, WB
scavengers
Vaccinators should place - 30,000 Nurses,
iii) Waste storage Foul Odour, leaching all used needles and IOs
syringes in a safety box Pos, OO, EPA,
immediately after Cleaners, WB
administering the vaccine, scavengers
without recapping them,
tape the nearly (i.e. not
more than 3/4) full box
securely
shut and store the box in a
safe place until it can be
properly disposed;
Ensure containment is air-
tight and leakage proof;
CSDP-HCWMP for Micro Project 2016
Locate storage facility
away from healthcare
delivery areas within
facilities
Determination and procurement of appropriate treatment technology(s) CSDP
Sub-activities
i) Selection of type of
incinerator facility to be No negative impact No mitigation required
installed.
CSDP,
ii) Construction of loss of vegetation and Minimize site clearance 50,000 30,000 CPMC, EPA ,
hard-standing and fauna Plant trees/grasses in the CSDP,
incinerator house affected area Contractor
iv) Healthcare waste Collapse of incinerator Develop and implement 20,000 30,000 CPMC CSDP,
treatment during off-loading, safe-work procedures; Contractor EPA ,
Musculoskeletal disorders provide haulage and heavy
of heavy duty personnel duty equipment for
installation of incinerator;
implement training and
Standard Operating
Procedures for Incinerator
installation
Emissions releases Install emissions control 750,000 30,000 CPMC, CSDP,
systems; procure Contractor EPA ,
incinerators with
emissions control systems.
Total N860,000 N180,000
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CSDP-HCWMP for Micro Project 2016
2.6 Capacity Building Need and Targets
Correct attitudes for effective health care waste management result from knowledge and awareness
regarding the potential risk of health-care and administrative procedures for handling the waste.
Each category of personnel (immunization officers, nurses, ward attendants, cleaners, waste
transporters, scavengers, etc.) needs to be trained. For the training to be successful and to lead to the
desired objective, participants must become aware of the risks linked to medical waste management.
Training and Schedule for Staff and Support Staff of Health Care Facilities
Capacity Content Target Participant Duration Resource Estimated
Needs Person Cost (USD)
Basic Waste categories; Immunization 8 hours Medical 200,000
knowledge Hazardous potential of Officers (SIO); waste
about certain waste categories Program officers, management
medical Health risk for health care Immunization consultant
waste personnel Officers &
Scavengers
Proper Environmentally sound State Immunization 7 hours Medical 175,000
behaviour handling of residues; Officers (SIO); waste
of wasteWaste avoidance and Program officers, management
generators reduction possibilities; Immunization consultant
Identification & Officers &
separation of waste Scavengers
categories;
Knowledge about
appropriate waste
containers
Proper Safe collection, storage & State Immunization 7 hours Medical 175,000
handling of disposal of wastes; Officers (SIO); waste
health care Handling of infectious Program officers, management
waste laundry & outdated drugs; Immunization consultant
Maintenance of septic Officers &
tanks and other sewage Scavengers
treatment facilities;
Maintenance and
operation of incinerator;
Maintenance and
operation of waste pits
and landfill site.
Total 550,000
Note: The cost of training is inclusive of module or training material development and after training
report writing for submission to CSDP, but does not include cost of mass production.
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CSDP-HCWMP for Micro Project 2016
REFERENCES
Environmental and Social Management Plan Framework for CSDP-AF (2014)
ESMP for the Construction of Alternative Bridge No 2 at Emene, Enugu (2012); RSDT
Federal Ministry of Works, Nigeria
Federal Ministry of Agriculture and Water Resources (2003): Third National Fadama
Development Project (Fadama III), Rural Infrastructure, Manual No. 4, August
IFC General Environmental Health and Safety Guidelines: Occupational Health and Safety
Lochner, P. (2005): Guideline for Environmental Management Plans. CSIR Report No ENV-S-C
2005-053 H. Republic of South Africa, Provincial Government of the Western Cape,
Department of Environmental Affairs & Development Planning, Cape Town.
Ministry Of Agriculture And Animal Resources (Minagri) (2010): Environmental
Management Plan (EMP) For Nyanza 23 Sub Project , Land Husbandry, Water Harvesting
And Hillside Irrigation Project (LWH) Prepared by Green and Clean Solution Ltd
Project Appraisal Document (PAD) for CSDP-AF
Pollution Prevention and Abatement Handbook (World Bank Group) 1998
Resettlement Policy Framework for CSDP-AF, (2014)
Revised Nigeria Healthcare Waste Management Plan (NHCWMP) for REDISSE Project,
2016)
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CSDP-HCWMP for Micro Project 2016
APPENDIX 1: PRIMARY HEALTHCARE FACILITY HCWM ASSESSMENT
CHECKLIST
The information for the checklist is adapted from the WHO Rapid Assessment Toolkit.
General facility information
Healthcare facility (HCF)
How many beds do you have in total?
How many outpatients come each day on average?
Staff
Is there a staff responsible for HCWM, identified and operational?
HCWM regulations (code of conduct; management plan, policy…)
National HCWM regulations (HCF) are available and enforced (YES/NO)
National HCWM regulations (does their application cause any problems ?) (YES/NO)
Internal guidelines and SOP are available and used (YES/NO)
Policy and budget
Budget allocation for HCWM is available and used (YES/NO)
Budget allocation for HCWM (budget per bed and year) (YES/NO)
Annual report of activities(can you obtain a copy of your annual report(s) regarding HCWM?)
(YES/NO)
Wastewater
Waste water drains to what (is the waste water system connected?) (YES/NO)
Sewer connection (where does the sewerage system lead to)
……………………………………………………………………………………………..
Tick the kind of waste that is/are generated in the healthcare facility?[1] general, [2] recyclables, [3]
radioactive, [4] infectious, [5] sharps; [6] chemicals (liquid and solid); [7] pharmaceutical waste; [8]
anatomic waste;
quantity produced/day (estimated, in kg)
quantity prod/day (in kg or number of sharps boxes)
quantity produced/day (estimated, in kg)
quantity produced/day (estimated, in kg)
quantity produced/day (estimated, in kg)
quantity produced/day (estimated, in litres)
quantity produced/day (estimated, in kg)
Into which categories are HCW separated? [0] no segregation, [1] general, [2] recyclables, [3] radioactive,
[4] infectious, [5] sharps; [6] chemicals (liquid and solid); [7] pharmaceutical waste; [8] anatomic
Proper segregation of waste is:[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good;
[5] excellent (high)
Safe handling of waste is:[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5]
excellent (high)
What kind of specific containers do you use ? [0] no specific container; [1] plastic; [2] metallic;
[3]cardboard; [4] bag; [5] box; [6] other
What kind of specific containers do you use ?[0] no specific container; [1] puncture-proofed single use;
[2] puncture-proofed multiple use, [3] not puncture-proof single use; [4] not puncture-proof multiple use
For what reasons are there shortages, if any ?[0] no shortages; [1] budget; [2] logistical; [3] other (specify)
Do you have a specific colour coding system? (YES/NO)
Infectious waste containers are lidded? Yes/No
Sufficient equipment for proper chum is available and properly used? [0] not available; [1] partly
available; [2] widely available; [3] available and properly used
Do you have a specific area for HCW? (YES/NO)
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CSDP-HCWMP for Micro Project 2016
Is the area only accessible for authorised pers.
Are different kinds of waste stored in separated storage areas? (YES/NO)
Is hazardous and non-hazardous waste collected and
transported separately? Yes/No
What kind of means do you use? [0] open device; [1] closed device; [2] other (specify)
Do you think current practices offer enough
security?
Is there any transport documents used? [0] none; [1] transport form; [2] other (specify)
[0] the HCF; [1] municipal service; [2] private
Who generally transports the HCW? company (name ?)
[0] none; [1] open fire; [2] incinerator; [3] chem.
Which kind of system is used? disinf.; [4] other
What is the current capacity of the system(s)? in kg/day and how often treatment is done per week
[0] none; [1] money; [2] maintenance; [3] spare-parts;
Any operation problems; if so for what reasons? [4] other
What do you do when it doesn't function?
[0] no treatment; [1] on-site; [2] off-site (which
Is it treated onsite or offsite? treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
Is it treated onsite or offsite? treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
Is it treated onsite or offsite? treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
Is it treated onsite or offsite? treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
Is it treated onsite or offsite? treatment technology is used)
[0] no treatment; [1] on-site; [2] off-site (which
Is it treated onsite or offsite? treatment technology is used)
[0] non-existent; [1] bad (low); [2] insufficient; [3]
How is the quality of treatment technology satisfactory; [4] good; [5] excellent (high)
[0] non-existent; [1] bad (low); [2] insufficient; [3]
How is the maintenance status of the technology satisfactory; [4] good; [5] excellent (high)
[0] no treatment; [1] on-site; [2] off-site (which
Is it treated onsite or offsite? treatment technology is used)
Is it on or off-site? [0] on-site; [1] off-site
[0] none, [1] open dump; [2] sanitary landfill; [3]
Which kind of disposal site is used for the HCW? small burial pit; [4] other
Is the area secured?
[0] at the chef [1] off site: open dump; [2] off site:
Where is it disposed of? sanitary landfill; [3] other
STAFF
Hepatitis B and Do you vaccinate your personnel [0] none; [1] only tetanus; [2] only
tetanus against them? HBV; [3] both
HCW GENERATION
Number of injections performed How many are done in average per day?
HCW SEGREGATION & HANDLING
Needle stick How many cases reported in the past
injuries 12 months (average)?
Type of [0] Disposable; [1] sterilisable; [2] auto-
syringes used What type of syringes do you use? disable; [3] safety syringe
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CSDP-HCWMP for Micro Project 2016
Sufficient personal protective
Protective equipment for the handling of waste
equipment is available
PERSONAL OPINION
What kind of short-comings, weak points regarding HCWM
Personal opinion in your country can you point out
Personal opinion Do you think sufficient funds are allocated to HCWM?
Personal opinion Do you think HCWM is safely managed?
Personal opinion Do you think HCWM is environmental friendly managed?
STAFF
Medical staff training Is training of med. Staff available regarding HCWM?
Training responsible of HCWM What kind of training has this person followed?
Staff for HCW awareness Awareness of risks of person(s) handling HCW?
Medical staff training Is the participation in the trainings documented?
Staff training on monitoring Staff is trained on monitoring and supervising of chum
HCWM REGULATIONS (CODE OF CONDUCT; MANAGEMENT PLAN, MONITORING…)
National monitoring regulations Are monitoring regulations available?
Monitoring regulations Is a monitoring system stipulated and established?
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CSDP-HCWMP for Micro Project 2016
APPENDIX 2: SAMPLE WASTE DEPOSIT RECORD
Health facility: Month/Year:
Location & Type of Waste Disposal Facility: Name of Healthcare Waste
Management Officer:
Day Waste deposited Origin of waste (Ward/Dept., etc) Name & Sign. of Name & Sign of
of the person depositing person Receiving
mont Sharps Infectious Highly Other (kg) Means of transport to Type of Disposal waste Waste
h (kg) (kg) Infectious (State) Disposal Site Facility and
Address
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CSDP-HCWMP for Micro Project 2016
APPENDIX 3: SUGGESTED OPTIONS FOR TREATMENT OF “SHARPS�? HCW
FOR THE NIGERIA POLIO ERADICATION PROJECT
Disinfection of syringes with bleach
Household bleach can be used to disinfect sharps and other wastes at an appropriate concentration
(0.5% chlorine solution). Disinfection is aimed at reducing the pathogenicity of infectious health-
care wastes. Disinfecting procedures must be followed carefully to be effective. Disinfection only
serves to reduce the risk from accidental exposure to sharps prior to treatment or disposal and can
serve as a pre-treatment prior to employing subsequent treatment technologies, e.g. sending to a
centralized incinerator or burial in pits.
Needle remover
The used needle is inserted into a device, which cuts or pulls the needle off from the syringe.
Various designs available are shown in the figure below. The devices are inexpensive and can be
made locally. Removal of needles from used syringes with needle removers can render them unfit
for reuse and safe for disposal after disinfection. Subsequently the plastic syringes can be disinfected
and sent to a centralized incinerator for further actions.
Encapsulation
Encapsulation involves filling containers with waste, adding an immobilizing material (plastic foam,
bituminous sand, cement mortar, or clay)and sealing the containers. After the medium has dried, the
containers are sealed and disposed of in a landfill. The main advantage of the process is that it is
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CSDP-HCWMP for Micro Project 2016
very effective in reducing the risk of scavengers gaining access to the hazardous health-care waste.
Encapsulation of sharps however, be envisaged in temporary settings, such as camps, or mass
campaign, and provided that raw materials are available. Encapsulation of used sharps is generally
not practiced and not a long-term solution. The sharps can then be incinerated at the centralized pit.
Procedure for “Sharps�? Disposal
The recommended methods of managing HCW in primary and secondary health facilities have been
presented in the main body of this report.
The following technology options are recommended for the disposal of “Sharps�?:
Use of Centralized Incineration
Incineration presents a good option for good disposal and destruction of sharps-wastes. However,
concerns such as availability of technical knowhow, maintenance, environmental pollution, etc
should be considered. Incineration has the potential for toxic emissions, particularly if the waste
stream is not regulated, as is usually the case if the equipment is not properly operated and
maintained, and if the emissions management system is inadequate. Large-scale incinerators tend to
pollute less than small-scale incinerators because the combustion temperature is higher and
combustion efficiency (gas residence time) is better.
Rather than having an incinerator in several facilities, a centralized, large-scale health care waste
incineration plant should be located in a tertiary or secondary healthcare facility in a region. Sharps
wastes from healthcare facilities in the region are then transported to the incinerator site for
incineration. The sharps should be transported in sharps boxes.
2. Pit Burial for Sharps
Pits for sharps can be constructed in the facilities. The sides of the pits should be covered with a low
permeability material, and fenced. The pit should be sealed with cement once it is three-quarters full
or at least the last 50cm should be filled with compacted soil and the area identified with a red
coloured flag. This approach is simple and adequate for health facilities that generate small amount
of waste.
3. Cemented sharp pit
Pit-well covered with a narrow access for sharps should be filled with cement once full.
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