1. National Orientation Guide: Steps to a successful roll-out of HCWM Training September 23, 2013 Preparing to Roll-out Health Care Waste Management (HCWM) Training at Male Circumcision (MC) Sites

2. PEPFAR Implementing Partner Topics Covered in This Guide 1.Training Resources: Resources for a Successful Roll- out of HCWM Training to MC Sites 2.Training Modules: HCWM Training Modules and Associated Tests 3.Tailoring the HCWM Training: Working with the Customization Guide 4.Training the Trainers: Preparing Infection Control Officers to Deliver the HCWM Training 5.Monitoring HCWM Training: Following-up After MC Site Staff Training 2

3. PEPFAR Implementing Partner Objectives After completing this orientation, you will: Be able to use a standardized approach and standardized materials when preparing Infection Control Officers to deliver HCWM training at the country’s MC sites. Be prepared to manage the successful roll-out of HCWM training at the country’s MC sites. Be able to successfully oversee HCWM training that helps ensure Health Care Waste (HCW) at all MC sites is managed in accordance with Campaign and national policies and guidelines. 3

4. PEPFAR Implementing Partner Background on HCWM Training for MC Sites Adequate training is a critical step in achieving an efficient and safe HCWM system. Your responsibility as national Campaign Infection Control Manager includes: Ensuring that all MC site Infection Control Officers receive training (Training of Trainers) to prepare them to deliver HCWM training to the MC site staff members. Keeping up-to-date records on HCWM trainings. 4

5. PEPFAR Implementing Partner The Training Component of Voluntary Medical Male Circumcision Toolkit To help you with those responsibilities, you are being provided with the training component of Voluntary Medical Male Circumcision (VMMC) Toolkit. The toolkit is designed to bring staff at all levels of a VMMC campaign to a critical level of HCWM competency. The training program in the toolkit is appropriate for all types of VMMC sites. 5

6. PEPFAR Implementing Partner The Training Component of Voluntary Medical Male Circumcision Toolkit Training should be conducted before the start of a campaign to orient staff in HCWM best practices. All staff members, even those with previous HCWM experience, should attend the training to ensure that they adopt the latest best practices and understand the standards that will be observed by the VMMC campaign. Beyond teaching the MC site staff about HCWM, the training also opens dialogue about HCWM to develop a sense of ownership and to instill commitment to the campaign’s responsibility for HCWM. 6

7. PEPFAR Implementing Partner Roll-out Scheme for All HCWM Training 7

8. PEPFAR Implementing Partner Roll-out Scheme for All HCWM Training 8

9. PEPFAR Implementing Partner Roll-out Scheme for All HCWM Training 9

10. PEPFAR Implementing Partner Total Time Investment for YOU to Train Infection Control Officers & Site Managers Training you will deliver Minimum Classroom Hours Required Train the Trainer sessions: Preparing Infection Control Officers to Train MC Site Staff (Modules 1-7 and Review of Trainers’ Guide) 17* Training to Prepare Site Managers to Manage the Site’s Quality Management System (QMS) (Module 8:QMS) 3 Total Minimum Classroom Hours Required 20 10 * Add an additional hour per participant to allow the participants to practice their training delivery skills.

11. PEPFAR Implementing Partner Total Time Investment for Infection Control Officers to Train MC Site Staff on HCWM 11 Modules/Job Role Hours required per Module Site Manager Clinical Staff Orderlies Transport Team Module 1:Basic HCWM for MC2:15XXX Module 2:Worker Health & Safety2:05XX Module 3: Weighing and Recording HCRW1:30XXX Module 4: Requirements for Transport of HCRW1:45X Module 5: Decontamination1:25X Module 5X: Decontamination and Sterilization * 2:30X Module 6: Supply Chain Principles for HCWM Commodities 2:30XX Module 7: Incident Reporting1:30XXX Total time in training / Job Role13:308:20 8:45 or 9:50* 3:15 * For sites performing sterilization

12. PEPFAR Implementing Partner Topic 1: Training Resources Resources for a successful roll-out of HCWM training to MC Sites 12

13. PEPFAR Implementing Partner Training Resources HCWM SOPs associated with HCWM Training HCWM training modules, tests and answer sheets Customization Guide Trainers’ Guide 13

14. PEPFAR Implementing Partner Resource #1: SOPs Associated with the HCWM Training Modules SOP-PQAU001-001 HCRW Worker Health & Safety SOP-PQAU001-002 Incident Management SOP-PQAU001-003 Injury on Duty and Needle-stick Injury Procedures SOP-PQAU001-004 General and Antiseptic Hand Hygiene SOP-PQAU001-005 Decontamination of General Surfaces SOP-PQAU001-006 Decontamination of Disposable Metal Instruments SOP-PQAU001-007 Sterilization of Reusable Instruments. SOP-PQAU001-008 Identification, Segregation & Packaging SOP-PQAU001-009 Handling & Packing Procedures SOP-PQAU001-010 On-site Transport SOP-PQAU001-011 Spill Management SOP-PQAU001-012 Storage Criteria & Guidance SOP-PQAU001-013 Waste Quantification SOP-PQAU001-014 Document Flow SOP-PQAU001-015 HCRW Transport Requirements SOP-PQAU001-016 Transport Emergency Response 14

15. PEPFAR Implementing Partner Resource #2: HCWM Training Modules The HCWM training you will roll out to the country’s MC sites is contained in 8 Training Modules. Six of those modules are to be delivered to the staff at each of the MC sites by the Infection Control Officer. Module 4 is provided only for outsourced transport companies to train their staff. Module 8 is delivered only to the Site Manager Each training module has an associated test and answer sheet. 15

16. PEPFAR Implementing Partner HCWM Training Modules Module 1:Basic Health Care Waste Management (HCWM) for Male Circumcision (MC) Module 2:Worker Health and Safety Best Practice Module 3:Weighing and Recording Health Care Risk Waste (HCRW) Module 4:Requirements for the Transport of Health Care Risk Waste Module 5:Decontamination at the MC Site or Module 5X: Decontamination and Sterilization at the MC Site Module 6:Basic Supply Chain Principles for HCWM Commodities Module 7:Incident Reporting Module 8:Quality Management System (QMS) 16

17. PEPFAR Implementing Partner Resource #3: Customization Guide The Customization Guide provides the national Campaign Infection Control Manager and /or the national Director of Clinical Services with suggestions in where the HCWM training modules may need to be tailored to meet specific country needs or requirements Each training module contains the following icon highlighting locations where such customization may be needed. 17

18. PEPFAR Implementing Partner Resource #4: Trainers’ Guide The Trainer’s Guide is a companion to the HCWM training modules. It provides detailed guidance to the Infection Control Officers at the MC site to assist them in delivering the training. The guide contains information about each module’s: Topics On-the-job performance objectives Time required to deliver each portion of the class Trainer materials Participant materials Learning activities 18

19. PEPFAR Implementing Partner Topic 2: Training Modules HCWM Training Modules and Associated Tests 19

20. PEPFAR Implementing Partner Introduction to HCWM Training Modules and Associated Tests In order to successfully roll out HCWM training, it is important for you to experience the training the way it will be experienced by the ultimate audience - the MC site staff. The first step in the process of preparing to roll out HCWM training is for you to personally review all of the training modules and to complete all the associated tests. 20

21. PEPFAR Implementing Partner Topic 3: Tailoring the HCWM Training Working with the Customization Guide 21

22. PEPFAR Implementing Partner Introduction to the Customization Guide The Customization Guide identifies portions of the training modules which can be tailored to meet your specific country needs/requirements. When customizing the training materials to reflect customized SOPs, replace the original SOPs that are embedded in the PowerPoint training modules with the customized versions. After the customization has been completed, this customization icon should be removed to avoid confusion and the materials should be checked for consistency across all modules. 22

23. PEPFAR Implementing Partner Why Customize the Training Modules? The training modules contain only generic information and generic forms to serve as examples. Country programs with more specific information and country specific forms need to train staff in the use of their own forms. Customization of the training materials should be completed by the National Campaign Infection Control Managers, National Directors of Clinical Services, and, if applicable, implementing partner organizations. Customization of the HCWM training modules should be completed prior to providing them to the MC Site Infection Control Officers to use when delivering the training. 23

24. PEPFAR Implementing Partner Example from the Customization Guide 24

25. PEPFAR Implementing Partner Alternative to Customizing the Training Modules Compile all the country-specific forms and procedures and provide them to the Trainers along with the Trainers’ Guide. Direct the Trainers to deliver the generalized training and follow-up by providing the country-specific information and highlighting the differences. Follow-up to ensure that training did include the country– specific information and examples. 25

26. PEPFAR Implementing Partner Topic 4: Training the Trainers Preparing Infection Control Officers to Deliver the HCWM Training 26

27. PEPFAR Implementing Partner Train the Trainers: Your Role You are responsible for modeling the training that the Infection Control Officers will give to the MC Site Staff You will impart key skills to the Infection Control Officers on the following: How to train Modules 1-7 to MC Site Staff And How to deliver quality stand-up training skills with customized resources 27

28. PEPFAR Implementing Partner Roll-out Scheme for All HCWM Training 28

29. PEPFAR Implementing Partner Train the Trainers: Modeling How to Train on the Modules When preparing the Infection Control Officers for delivering HCWM Training at the MC sites: First, introduce them to the Trainers’ Guide so that they may follow along as you train. Deliver all of the modules to them in a classroom setting as they will do Have them complete all of the tests to experience what the MC site staff will experience. Schedule at least two and a half days (17 classroom hours) to deliver the training of all 8 modules and tests (Allow 1 additional hour per participant if including practice stand-up training by the participants). 29

30. PEPFAR Implementing Partner Train the Trainers: Introduction to the Trainers’ Guide The Trainers’ Guide enhances the Infection Control Officer’s / Trainer’s confidence about delivering HCWM training because knowing: which job functions should attend each session will assist the Infection Control Officer with invitations and scheduling of the training sessions. which participant materials need to be duplicated in advance will make the preparation process easier for the Infection Control Officer. the time required to deliver each portion of the modules will help the Trainer set an appropriate pace for delivery. 30

31. PEPFAR Implementing Partner Review of Trainers’ Guide 31 Needs to be replaced by a link to an updated version that contains Modules 7 and 8 and Class register

32. PEPFAR Implementing Partner Train the Trainers: Suggested Training Session Format Introduce Module Note Trainer Guide page and review contents Train the module as the participants should Have participants complete test and review correct answers Distribute Module PPT and Test Answers to all participants for their files End with Q&A to answer questions from the future trainers 32

33. PEPFAR Implementing Partner Train the Trainers: Be prepared! Make sure to identify and invite the participants well in advance of the sessions. Best group size is 12 or less Arrange for internet access at the location where you will be delivering the sessions. Have all hand-outs printed in advance and shipped to the location. Make sure all modules, trainer guides, and handouts have been customized! 33

34. PEPFAR Implementing Partner Topic 5: Monitoring HCWM Training Following-up After MC Site Staff Training 34

35. PEPFAR Implementing Partner Why Monitor and Follow Up on Training? It is important to follow up on the HCWM training as it is happening to ensure that Infection Control Officers are supported and delivering quality training. It is also important to follow up on the HCWM training after it has happened to assess impact of the training on HCWM practices! 35

36. PEPFAR Implementing Partner Monitoring the Delivery of the Training Basic Steps: Verify that the training was delivered. Determine how records of staff attendance at training and signature pages of SOPs (indicating that staff read and understand them) are maintained at the MC site. Institute a mechanism for Infection Control Officers to provide you with training attendance records. Determine how training is provided to new staff members who are hired after the training was delivered to the staff or to staff members who were not able to attend all of the original training sessions. 36

37. PEPFAR Implementing Partner Training Follow up: Assessing Impact While “evaluation forms” filled out by class participants are often used to assess the quality of the training, on- the-job application of the knowledge and skills learned in the training is really the key indicator of the training’s effectiveness. Data on the application of skills and knowledge about HCWM can be best obtained through Monitoring and Evaluation and the Incident Management System. If you determine that proper HCWM techniques are not being used on the job, some refresher training sessions may be warranted. 37

38. PEPFAR Implementing Partner Orientation Conclusion 38

39. PEPFAR Implementing Partner Campaign Infection Control Manager’s Steps to Successful HCWM Training Roll-out 39 7. Follow up to assess the HCWM training presented at the MC sites 1. Review all of the training modules and take all of the tests 2. Determine which portions of the training to customize 3. Customize the training modules, if necessary 4. Present the training modules to Infection Control Officers (Train-the-Trainers) 5.Familiarize Infection Control Officers with the Trainers’ Guide (Train-the-Trainers) 6. Be available to support Infection Control Officers as they deliver HCWM training at the MC sites

40. PEPFAR Implementing Partner Rate Your Confidence Now that you have completed this orientation, please rate your level of confidence in being able to: achieve the orientation objectives successfully implement and oversee the roll-out of HCWM training for your country’s VMMC campaign 40

41. PEPFAR Implementing Partner Rate Your Confidence In 41 Not Confident Somewhat Confident ConfidentVery Confident Being able to use a standardized approach and standardized materials when preparing Infection Control Officers to deliver HCWM training at the country’s MC sites. Being prepared to manage the successful roll-out of HCWM training at the country’s MC sites. Being able to successfully oversee HCWM training that helps ensure Health Care Waste (HCW) at all MC sites is managed in accordance with Campaign and national