Health Care Waste Management (HCWM) Baseline

Ohrid,Ana Petrovska

Legal Base – EU Directives• Biological Agents Directive 90/679/EEC • Hazardous Waste Directive 91/689/EEC• Health and Safety Framework Directive 89/391/EEC• Waste Directive 75/442/EEC• Waste Oils Directive 75/439/EEC• Packaging Waste Directive 94/62/EC • Carcinogens Directive 90/394/EEC • Dangerous Substances Directive 76/769/EEC • Natural Habitats Directive 92/43/EEC • Protective Equipment Directive 89/656/EEC • PPE Directive 89/656/EEC

Legal Base – National Framework Law on Waste (OGRM no. 68/04; 71/04) Law on Environment (OGRM no 53/05) Law on Public Health Protection (OGRM no no 17/97,

11/02, 10/04, 84/05, 111/05, 65/06, 05/07). Law on Veterinary Health (OGRM no 28/98) Law on Sanitary and Health Inspection (OGRM no 71/06) Basel Convention on the Control of Transboundary

Movements of Hazardous Wastes and their Disposal (OGRM no 49/97)

Ordinance on Integrated Pollution Prevention and Control, IPPC (OGRM no 89/05)

Regulation on the Procedure for Issuing of A Integrated Environmental Permit (OGRM no 04/06)

Legal Base – National Framework (II) List of types of waste (OGRM no 100/04) Regulation on Conditions for Handling Hazardous Waste and

the Manner of Packaging and Labelling the Hazardous Waste (Draft)

Regulation on the Methods and Conditions for Storage of Waste (OGRM no 29/07)

Regulation on the form and content of the Request and Permit for processing, treatment and/or storage of waste, form and content of the permit and the technical conditions for performing the activity (OGRM no 23/07)

Regulation on the form and content of the journal for waste handling, the forms and content of the forms for identification and transport of waste and content of forms for annual reports for handling waste (OGRM no 7/06)

Regulation on the Manner of Handling HCW, Labelling and Forms for Handling HCW and on Types of HCW for which Processing is prohibited (OGRM no 146/07)

Stakeholders

Parliament

Government

MoH MoAFWE MoEPP MoTC / LSG

HC Institutions internal HCWM

Veterinary Establishments

Dog Pounds Waste collection & transport companies

Waste storage facilities

Waste disposal facilities

SEI

SSHI

SVI SCI

Current Gaps Regulation on Conditions for Handling Hazardous

Waste and the Manner of Packaging and Labelling the Hazardous Waste will be put into effect in the beginning of 2008

Regulation on the Manner of Handling HCW, Labelling and Forms for Handling HCW and on Types of HCW for which Processing is prohibited has been put into effect in he end of 2007, thus closing the major legal gap; waste originating from veterinary establishments has also been regulated with this piece of legislation

Secondary legislation regulating the emission thresholds for the incineration is still missing

Main Generators of HCWType of Healthcare Institution Number Tertiary healthcare level institutions comprises: University clinics and institutes, Skopje Clinical Centre Dental Clinical Centre Clinic for Maxillofacial Surgery Institutes of the Medical Faculty Institute for radiotherapy and oncology Republic Institute for Health Protection, Skopje

5 1

Secondary level healthcare institutions comprises: Regional Institutes for Health Protection Specialised Hospitals and Institutes Public General Hospitals Private Hospitals (incl. Military Hospital, Skopje)

10 18 15 4

Primary level healthcare institutions comprises: Health Centres Health Stations

34 2

Other HIs comprises: Private healthcare for elderly people Private healthcare laboratories

5 7

Healthcare Institutions (HIs) in total 101

Annual HCW generation

Healthcare facility HCW amounts Tons/year

% of total

Hospitals and Specialised Institutions 730 78.7%

Institutes for Health Protection 22 2.4%

Health Centres 102 11.0%

Dentist Ambulatories outside health centres 20 2.2%

Veterinary Healthcare Facilities 43 4.6%

Pharmacies and Laboratories 10 1.1%

In total 927 100%

Present Practice• Segregation in hospitals is carried out for three

waste streams: non-hazardous, hazardous HCW and sharps. No other (either hazardous or non-hazardous) are anticipated so far.

• Coverage of the collection service for HCW is estimated to be close to 100% in the Skopje urban area, covering all types of HIs (hospitals, health centres, ambulatories, private GPs, etc.).

• Approximately 70% of HCW is collected in Kumanovo; remaining quantities are collected as an ordinary municipal waste.

• In other towns collection of HCW is provided by Public Enterprises servicing generators of municipal waste. Consequently, the HCW is collected together with the MSW and dumped at the municipal landfills.

Present Practice(within hospitals)

• 82.9% of the HIs have appointed a responsible person for infection control

• The generated amount of medical waste is not reported (100%) at a regular basis to the State Environmental Inspectorate, Ministry of Environment and Physical Planning.

• Minimum once per day at a scheduled time they transport HCW in e.g. yellow plastic containers on wheels (70 kg) or other types of trolleys in 58.5% of hospitals; in 41,5% waste is handled within the premises manually

• 73.2% of hospitals use colour code marking for segregated wastes

Present Practice within hospitals (II)• 100% of waste collection equipment has fixed places

at ward and facility level. • 56.1% of the HIs use instructive posters (developed

by WHO and RIHP) describing the way of separation of medical waste.

• 87.8% of the special storage containers are used for HCW

• 63.4% of the HIs have special storage room/facilities for HCW.

• 100% of sweepers and orderlies use protective clothing handling medical HCW

• Since 2005 health staff professionally exposed to HCW (during diagnostic, therapeutic and research work) is protected by vaccination against Hepatitis B.