A survey conducted by the Department of Health found that the majority (79%) of Gauteng public healthcare facilities have a healthcare waste management policy (HCWMP) in place; however, the policy was not always integrated with the various environmental, occupational health and safety as well as community aspects.
The findings of the survey were presented at WasteCon 2018, on Wednesday, by the department’s healthcare waste and occupational hygiene risk management officer Tumi Ramodipa.
Heathcare waste is described as all the waste generated within a healthcare facility, with 85% being domestic waste and 15% being hazardous/healthcare-risk waste (HCRW). HCRW could be infectious, sharp, anatomical, cytotoxic, chemical and radioactive.
The overall responsibility for HCRW vests with professional individuals including nurses (31%), environmental health practitioners (69%) and occupational health coordinators (8%), the survey found.
In some facilities, it was found that general assistants also shared the responsibility.
Only 31% of individuals interviewed confirmed that healthcare committees have been appointed at the healthcare facility. Some healthcare facilities admitted that no training on waste management and occupational health and safety is offered.
Only 11.7% of healthcare facilities used the Occupational Health and Safety Act (OHSA) to develop its HCWMP, with none using the National Environmental Management: Air Quality Act, National Environmental Management Act, nor the General Control of Human Bodies, Tissue, Blood Products and Gametes Amendment in the World Health Organisation guideline.
Ramipoda recommended that an HCWMP should incorporate the OHSA, with appointment and training of safety representatives and regular health risk assessments.
She said an HCWMP should cater for community participation. For example, with recycling initiatives, it is necessary to train waste reclaimers on appropriate HCRW practices, should they come across it. “There should also be committees appointed to monitor HCWMPs.”
Meanwhile, Averda head of healthcare Eugene Barnard spoke on how technology can enhance healthcare facilities’ management of HCRW.
Legally, the responsibility for waste management compliance resides with the waste generator, which presents challenges when entrusting HCRW waste management activities to external service providers.
To monitor compliance, the Department of Environmental Affairs requires that waste generators keep accurate and up to date records. “From there, the track-and-trace liability starts. Every time the waste changes hands, the risk escalates. If you do not have a control process that guides this channel, reputations can be damaged, and social and environmental impacts can be dire.”
The healthcare risk management process starts with sacrificial waste receptacles and documented waste transactions, including information on type, volume and weight. The process then includes transport and designation to a treatment facility, next waste consignments are verified and prepared on a processing platform.
Items are treated or destroyed in bulk format, and some are rendered to Class A landfill for final residue disposal. Throughout the process, proper documentation and recordkeeping, as well as monitoring and evaluation, are necessary between service providers and waste generators.
“There is a physical process and a documental process, and in between is hope,” Barnard quipped.
Technology can be used to improve transparency and give waste generators more control over the waste management process. “Healthcare institutions that prioritise compliance should demand to have oversight of waste management activities, to ensure their legal obligations are being met.”
Digital marking and tagging, instead of barcoding, aids in tracking waste materials. Digital scales then read those tags, which verifies according to the weight, which will help lessen the number of human mistakes made in terms of units scanned and quantities thereof.
The control process has a transactional loop, which has billing information, and a tracking loop monitoring the movement of the material, and verifies as it goes along, which is often tricky when all administration and processing is done manually by different parties.
Digital identification can also provide information about the drivers and waste operators at a certain time, should an incident be investigated.
Barnard said Averda’s TRU(e) Compliance Verification device offering can offer this capability. “Digital technology can guarantee consistent and reliable throughput rates and offer efficiency that no manual, labour-intensive process can offer.”