1. 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 DANIDA

2. Overview of presentation 1.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 DANIDA

3. Purpose of Composition Study 1.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 DANIDA

4. Key Changes from Pre- to Post intervention situation: 1) No cardboard 2) Vials sorted 3) Training 4) Skills posters 5) Monitoring 6) HCW Officers

5. International Data Available DANIDA Two types of Studies: I) Calorific Value (treatment focus), II) Segregation Efficiency (cost and safety focus)

6. Health & Safety Approach 1.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 DANIDA

8. Methodology 1.Random sampling, 14 (12) consecutive days in a period with no holidays 2.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 DANIDA

9. Problems Encountered 1.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. DANIDA

10. Results Public Facilities DANIDA

11. Results Private Facilities DANIDA

12. Results Pre/Post Leratong H DANIDA NOTE: Contents of Sharps Containers (Post) have errors. 6% 93%

13. Results Pre/Post Leratong H DANIDA

14. Results Pre/Post Leratong H DANIDA

15. Results Pre/Post Leratong H DANIDA NOTE: Excluding food waste (pig swill)

16. Summery of Conclusions DANIDA 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: NOTE: Excluding food waste (pig swill)

17. 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 DANIDA