RAT-v2-en

Healthcare waste management Rapid assessment tool
Version - 2011
for country level Content
Section 1. Introduction 2. 3. 4. 5. 6. 7. Preparation Guide Glossary + abbrev Questions sum Tool A Tool B B-1 B-2 Tool C Tools D D-1 D-2 D-3 D-4 D-5 Input Quest D HCF Results Quest D HCF
Scope
Content Provides basic information on this Rapid assessment tool Checklist for chronological preparation of the assessment. Guidance on how to get prepared - how to train the interviewer and on what results can be expected. Listing of all specific terms used Summary of allto questions used in the tool. Questionnaire collect data from associations, NGOs and universities or other research institutes which have had relevant activities in HCWM in different settings of the country. Questionnaire to collect data at Ministerial level Questionnaire for the Ministry of Health Questionnaire for the Ministry of Environment Questionnaire to collect data at Municipal Authority level Questionnaire to collect data regarding different areas in healthcare facilities Area: Management, Finance, Legal Regulations Area: Application of Healthcare Waste Management Area: Occupational Safety Area: Training & Monitoring Personal private observations made during visits of healthcare facilities (filled by the interviewer) The results of the questionnaires D1 to D5 are gathered by the interviewer in one table The results of the table "Input Quest D HCF" are summarised and evaluated (Text to be inserted manually. Other results are generated automatically) Rating system for the HCWM situation assessed at the HCF
Terminology National National
8. 9.
Local Local
10. 11.
Local Local Local
12. Tool E (D1 - D5)
We are interested in your data

Thanks to send to WHO a software copy of the spreadsheets containing the data you will have collected with this tool
Contacts
Contact: World Health Organization: http://www.healthcarewaste.org / E-mail: hcwaste@who.int
page 1 cover

1

Introduction
In many (mainly low income) countries, improper management of wastes generated in healthcare facilities causes direct health impacts on the community, the personnel working in healthcare facilities, and on the environment. In addition, pollution due to inadequate treatment of waste can cause indirect health effects to the community. healthcare wastes (HCW) include sharps (syringes, disposable scalpels, blades, etc.), non-sharps (swabs, bandages, disposable medical devices, etc.), blood and anatomic waste (blood bags, diagnostic samples, body parts, etc.), chemicals (solvents, disinfectants, etc.), pharmaceuticals, and others, and may be infectious, toxic, create injuries or be radioactive. This rapid assessment tool is a part of an overall strategy developed by WHO which aims at reducing the disease burden caused by poor healthcare waste management (HCWM) through the promotion of best practices and the development of safety standards.
Basic assumptions and objectives

The basic assumption is that it is possible - in a short period of time (7-15 days), by questioning main stakeholders and by selecting a number of healthcare facilities representative of the country - to gather the essential data necessary to have a sufficient understanding of the situation regarding HCWM at a national level. By analysing the role of each stakeholder along the HCWM stream it should be possible to identify where problems remain and what simple, practical actions should be undertaken to solve them. The aim of this tool is to gather sufficient relevant information so as to provide decision makers/experts, etc. with the necessary data to help them elaborate a national action plan. An example of such a plan can be found at the following address: www.healthcarewaste.org
Who can/should use this rapid assessment questionnaire ?

Senior management personnel (or other trained personnel) r esponsible for the design, implementation, evaluation and update of national policy and plans for healthcare waste management constitute the primary audience of this rapid assessment toolbox. Assistance from appropriate national or international persons or group should be sought before conducting the proposed assessment if senior management staff do not have the required expertise and experience. International experts will find this toolbox useful when being asked for assistance to conduct assessments or evaluations of waste management systems in countries where poor healthcare waste management is suspected. National policy makers may find this rapid assessment tool useful to better understand data for decision-making requirements in safe and appropriate waste management.
How to use this rapid assessment questionnaire ?

Assessment of healthcare waste management practices should follow 4 steps to ensure that the procedure will be useful, feasible, ethical and accurate. 1) Engaging all relevant stakeholders by using tools A, B 1-2, C, D 1-5 2) Describing the situation by the interviewer using Results Quest D. 3) Gathering credible evidence of defined quality and quantity by filling in as precisely and completely as possible all questions in each tool. 4) Justifying conclusions in your final report by giving access to readers of field data collected with each tool.
To ensure that information collection is a process conducted and analysed appropriately, this toolbox has been organised in several parts which follow a logical and chronological frame which you are invited to follow. This frame goes from national (organisations, ministries) to local (the health facilities) and from the start of the HCWM stream (waste generation) to the end (final disposal). It is recommended that you start by going through each tool to make sure you understand the questions. Data collected should be as complete, short and precise as possible. It can be of several types: [C] multiple choice; [N] numerical (quantitative); [Q] qualitative (ranking from 1-5); Boolean [B] (yes/no) or [T] text.
page 2 intro
Description of the tools

The tools are all structured in the same way and the numbering of topics and questions are made in such a way that data can be easily retrieved and analysed. Each tool is described shortly below with its main stakeholder and the kind of information which it is hoped they can provide you. Associations, NGOs, Universities: these actors can provide interesting elements which can help you to complete your understanding of how the system works linked to their practice of how HCWM is practised in places they have visited/worked in. This tool is text based, aiming to insert them into the national assessment report in order to provide an overview of the activities others than on authority or facility level. Ministries (Health, Environment): these key interlocutors should assist you and provide you with a complete picture of how the system (should) function on both a practical, technical, financial and legislative level. This tool is text based, aiming to merge the answers and insert them into the national assessment report. Municipal/local political authorities: confronted on a daily basis with general waste management issues, they can provide good information about waste collection, transport and final disposal as well as eventual recycling habits, etc. Area: Management, Financing, Legal Regulations : Those questions can be answered e.g. by the Hospital managers like the director, accountancy, administration. T hey are in a good position to give you an overall view of the healthcare facility structure and data. Area: Application of Healthcare Waste Management. Those questions can be answered by the person(s) responsible for waste management, the waste handlers , medical staff or logistic staff. Persons answering these questions should have deep and detailed knowledge about waste management processes in the facility. Area: Occupational safety. The occupation safety of ficer, infection control committee, head nurses or the responsible person for healthcare waste management can answer these questions. Area: Training & Monitoring. The responsible person for training, the responsible person for healthcare waste management, infection safety committee can answer these question. The questioner: the questioner can rate by himself what he has seen during the onsite visit in each facility. The questioner can rate areas like the status of awareness, segregation, equipment, transport & storage, treatment, disposal etc. This to influence the final result in order to reflect a situation analysis as close as possible to reality.
B C D1 D2 D3 D4 D5
Input All questions of the Tools D (D1-D5) answered by the participating healthcare facilities / interviewer can be filled into this form, in order to receive all results automatically. Quest D Results Summarised Results of the Tools D: This tool is displaying all results of the Tools D. Quest D E Rating system: this last tool is displaying summarised and rated results by topic automatically, if the "Input Quest D" form is filled.
page 3 intro
Identifying & engaging relevant stakeholders

Most problems and solutions are found at a human level. It is therefore essential to identify all relevant stakeholders, consult them and engage them by convincing them of the importance/interest of having a simple and efficient HCWM system. The existing tools deal with the major stakeholders. Nevertheless it may be possible that, for example other important injection providers outside healthcare establishments should be included in the analysis, etc. In such cases, we recommend you use the listing of all questions and choose those you believe are the most relevant. In certain (especially small) facilities, you may find out that the same person will have to be interviewed for several tools !
Selection of healthcare facilities

So as to be able to extrapolate collected data, a sufficient number of healthcare facilities representative of the country must be visited. To keep things simple, choose between one and two healthcare facilities per size and category of structure (private, public, religious), type of area (urban, peri-urban, rural) and by distinct ethnical and/or geographical area (topographic or climatic zone). This should normally lead you to visit between 6 and 12 health establishments. Specialised healthcare facilities such as psychiatric, geriatric institutes, etc. are not considered as important HCW producers and are therefore left out of this study.
Information & Contacts

To comment on this tool, please contact WHO: hcwaste@who.int Potential partners with international or regional outreach who are interested in advancing the agenda of safe HCWM and wish to cooperate in the further development and implementation of activities can contact WHO [E-mail: hcwaste@who.int]. Visit our web site www.healthcarewaste.org or www.who.int/peh for additional information
page 4 intro

weeks time needed count about 15-20 Before hours in total 8 8-7 3 hours 6 x 30 min. action done remarks The success of your field assessment will depend greatly on how well it has been prepared beforehand. Having all logistical aspects settled; meetings with key interlocutors agreed upon and authorisations from the ministry of Health provided or promised in a written form will save you lots of time and energy. The following points are not exhaustive, but give most of the main points. Go through the entire Rapid Assessment Tool (RAT) to make sure both its structure and content are clear If you have any questions don't for you. hesitate to contact us ! Get in touch with the Ministry of Health (if not already done), so check when is the most appropriate period to perform the field assessment. Ask for their support in the preparation of this assessment: can they suggest a list of HCF (Healthcare facilities) that you could visit Try and find a local counterpart both for the organisation of the logistics (driver, hotel, etc), assistance during the mission and follow up once it is finished (there are always some bits of information one would need and can only get if someone is on the spot. Once you have a fair amount of information about where you will be going, try to make up a realistic plan according to distances to be driven, road status, size of HCF to be visited, etc. Make a list of all the key interlocutors you should/must meet. Enter their coordinates in the contact sheet so as to have it at all times with you. Request from the Ministry of Health that they provide you with a document giving you full access to all documentation you may need. According to the number of HCFs you intend to visit, make the corresponding number of paper copies of the tools you will need (D1-D4), unless you are sure to be able to make photocopies on site. The success of your field assessment will depend greatly on how well it has been prepared. Having all logistical aspects settled, meetings with key interlocutors agreed upon and authorisations from the ministry of Health will save you lots of time and energy. At the end of each day, make a summary of the day and check your field notes. Prepare the plan of the next day according to data collected, planned meetings Confirm the meetings for the next day Enter data collected on your computer on a daily basis. Sending this information on regularly by e-mail ensures data to be stored in an other place than your computer only (for security reasons). 2 days before the end of your field mission, go through the entire documentation you have managed to collect. Think about any information you believe would be important to have and try and get hold of it while you are in the country. The quality of your report and proposals depends on both the quality and amount of representative data you managed to collect during your field visits as well as the possibility to get, via a local counter part, any further data needed. Go through the entire documentation. Write the report. An example of such a report can be found at: www.healthcarewaste.org or http://www.who.int/water_sanitation_health/en/ under healthcare waste Envisage organising a workshop 3-6 months after your field assessment so as to implement it. People convened to this reunion are both local (Ministry of Health + Environment; resp. of medical staff training; representatives of the medical staff) and foreign (potential donors, cooperation agencies already working in the country)
2 - 5 hours
7 6 6 1
2 hours 2 hours 2 hours 1 hour
1-2 hours per day During to sum up and prepare the next day
After 1 1-2
count about 2-3 weeks of full time work
page 5 preparation
Rapid Assessment Tool
RAT

In this "guide" table you find some examples how to get started, the tasks and duties of the team leader and interviewers, how the interviewers can be prepared on the job and which results can be received from the gathered data. Furthermore it highlights also gaps and difficulties which may be faced.
1. Getting started
The identification of the participating authorities and healthcare facilities is an important factor for the quality of the results of this assessment tool. Key persons from relevant authorities who have the position and knowledge to answer your questions have to be identified. It is recommended that the assessment team meet at least the day before the assessment starts, in order to go through the interview schedule together. A master copy of the assessment tool is printed out for detailed discussion. For every day in the week, a precise schedule should be available. The questionnaire is explained in detail by the team leader and each interviewer receive a complete set of the tool. Furthermore the team should received a short training on the topic "healthcare waste management" in order to receive relevant background information for the visits during the assessment tour. It is recommended to conduct an introducing training on background and the use of the tool. The following topics should be targeted: Duration Topic Content / Description This module should educate the participants about the potential risks inside an outside of their sphere of action and about the principle of disease transmission cycle. This module should outline international regulation as well as relevant national laws, regulations and guidelines. To ensure the trainees understand the need for effective waste segregation and are able to implement this key component of waste management, this module includes the principles for segregation and the associated measures such as colour coding, labelling, packaging and collection supported by practical samples. This module should include information about basic principles and practical instructions for safe waste collection, storage and transport. This module should build awareness and capacity in safe and environmental friendly on-site treatment methods including definition of relevant terms (incineration, autoclaving, microwaving etc.). This module should outline the importance of Personal Protective Equipment (PPE), which safety measures are needed during waste handling procedures and how to use it. In this module it is recommended to go through all tables of the tools and to outline the meaning and usage of all tables. At this point of introduction the schedule of conducting the assessment and the procedure should be discussed in detail. Highlight the table "preparation" and "glossary + abbrev" in order to ensure that all interviewers are aware about the terminology of the tool and preparation needed also during the assessment. A workshop will help the interviewers to understand the procedure completely and to identify problems and questions. In this workshop the use of the questionnaires is played through. The following set up could be used during the workshop: For each area of concern of the questionnaires D1 to D4 one participant sits at a desk for answering the questions of the questionnaires (they present the healthcare facility). Other participants take one of the questionnaires D1, D2, D3 or D4 and are interviewing the participants at the desks. The interviewers are filling out the questionnaire. After finalising the first questionnaire, the position of each participant is shifting one position to the right in order to ensure that all participants have experienced each position. At the end all participants are filing "Quest D5". Afterward the gained experiences are discussed and questions answered. After clarification the team leader supports the participants how to fill the "INPUT Quest D" table.
30 min Risks of healthcare waste 45 min 45 min 45 min 45 min 30 min Legal Background Segregation Logistics Treatment of Waste Occupational Safety
30 min
Introduction RAT Tool
120 min
Workshop RAT
Some presentations on the topics above are available at WHO (3 day basic training on healthcare waste management).
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After the interviewers are briefed the following RAT tables are to be copied for the interviewer (Quest A to D5) Questionnaire A : Number of printed table "Quest A" in accordance with the number of visiting relevant NGO, associations etc. . The results are gathered by the team leader and summarised in the final report. Questionnaire B1: Number of printed table "Quest B1" in accordance with the planned interviewed persons in the Ministry of Health. The results are gathered by the team leader and summarised in the final report. Questionnaire B2: Number of printed table "Quest B2" in accordance with the planned interviewed persons in the Ministry of Environment or other relevant ministries. The results are gathered by the team leader and summarised in the final report. Questionnaire D1-D5: Number of printed tables "Quest D1 to Quest D 5" in accordance with the planned interviewed healthcare facilities. D1- D4 will be answered by the staff of the healthcare facility and D5 will be filled by the interviewer in order to enable the interviewer to have an effect on the results of the assessment, the received training will help to fill out this table. The results of these questionnaires are filled by the interviewer into the table "Input Quest D". The "Input Quest D" table will be filled by each interviewer directly into the excel sheet: Input Quest D: All results of D1-D5 of all healthcare facilities are summarised. First the questions which is answered in text form are summarised - the other questions can be summarised in a numeric way. The interviewer is filling this form every day - or after each visit in a healthcare facility by taking the answers of the questionnaires D1-D5 and transfer the results into the template of the table "Input Quest D". This filled table is handed over to the team leader regularly - or at the latest at the end of the interview tour. It is possible to enter the results of 100 healthcare facilities. The rows 110 to 122 are analysing the results automatically and should not be manipulated. Gathering of data by the team leader Input Quest D : The team leader is gathering all results from the Quest A, Quest B1, Quest, B2, Quest C and "Input Quest D" from all interviewers every day or at the end of the interviews. The results of the table "Input Quest D" from all interviewers are assembled in a summarised Input Quest D table. Furthermore the questions which are answered in text form are gathered and assembled. In case of malfunction of the calculations please contact: www.healthcarewaste.org Automatically generated results Results Quest D and Tool E: From the data summarised by the team leader in a table "Input Quest D" from all interviewers, the table "Result Quest D" will be generated automatically. The results apply in text form or quantitative (by numbers or percentages). Also Tool E is generated automatically by the input of the table "Input Quest D". This summarising rating system is to give you a set of indicators of how good/bad is the situation regarding HCWM per topic. It can be decided how to the influence of the results from the staff of the hospital and the personal evaluation of the interviewers by changing the weighted percentages of E15 and F15 of Tool E . Out of this results also graphical accounts can be generated like outlined below (3.).
2. Results receiving from the Questionnaire A, B and C

In questionnaires A, B and C the data which are collected are either quantitative [N] (number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (one or several numbers which correspond to the answer) or text [T]. As there are only one or two questionnaires filled of each questionnaire type (A, B or C) the evaluation can be done manually. The results can directly be summarised in the report by the team leader.
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3. Exemplary Results received from the Questionnaires D (trial test Uzbekistan)

Example of result for question 400: Which waste kinds are generated in the healthcare facility (%) General Pharmaceuti Waste Recyclables Radioactive Infectious Sharps Chemicals cal Anatomical large 100% 67% 0% 100% 100% 33% 67% 100% medium 100% 0% 0% 100% 100% 100% 100% 100% small 100% 0% 0% 33% 100% 0% 33% 0% average 100% 22% 0% 78% 100% 44% 67% 67%
Quest 400: Generated waste kinds 100% 80% 60% 40% 20% 0%
large medium small
Example of result for question 501: How many needle stick cases reported in the past 12 months (average per person)? number of large medium small average big = large hospitals needle 0.33 0.00 3.00 1.43 medium = (sub-)district hospitals sticks small = ambulant services The results on this example clearly indicates urgent mitigation measurements regarding injection safety, especially in small scale healthcare facilities. Injection safety should be targeted by MoH. Example of result for questions 1301 and 1302: Dedicated budget available for healthcare waste management Explanation large medium small No. Question Budget for [0] not identified; healthcare [1] planned; 1301 waste 3 3 2 [2] available but not used; management [3] available and used is available Budget per US $ per bed and year 1302 $0.77 $0.00 $0.00 bed and year In this example a contradictory result is shown. At question 1301 it was answered that budget for healthcare waste management is available and partly used. On the other hand at question 1302 only the large healthcare facilities indicated to have in average 0,77 US$ available. The medium and small facilities do not have a budget available. It is important to cross check the questions on reliability and to decide if these questions should be excluded - or the contradictions should be explained.
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4. Result Tool E (trial test in Uzbekistan) In Tool E 12 different areas of healthcare waste are summarised: staff (and training), HCW segregation & handling, HCW waste handling equipment, HCW storage area, HCW collection & on-site transport, HCW treatment, HCW final disposal, HCWM regulations (code of conduct; management plan, policy), personal opinion. The summarised results are outlining the results of questionnaires D1- D4 gathered from the staff of the healthcare facilities and the personal observation of the interviewer. Below the weighted results are applied with a weight of 50 % to 50 % - the weight can be adapted by the team leader to the situation in the country. In the table below all results of all answers are applied. The all over average of this example is "satisfactory". The results are differentiated in big, medium and small facilities, as there can be found very different healthcare waste management situations.
Result Personal Observation D5 50% 18% 45% 10% 0% Result Personal Observation D5 50% 50% 62% 37% 50%
Example: Healthcare waste final disposal Weight All over average big = large hospitals medium = (sub-)district hospitals small = ambulant services
Results Questionnair es D1-D4 50% 44% 67% 0% 67%
Weighted Result 31% 56% 5% 33%
Verbal result satisfactory satisfactory critical satisfactory
Possible verbal results: 0-10% equivalent "critical situation" 11-30% equivalent "problematic situation 31-60% equivalent "satisfactory situation" 61-80% equivalent "good situation" >81% equivalent "excellent situation"
Example: All over result on national level Weight All over average big = large hospitals medium = (sub-)district hospitals small = ambulant services
Results Questionnair es D1-D4 50% 56% 63% 43% 63%
Weighted Result 53% 63% 40% 57%
Verbal result satisfactory good satisfactory satisfactory
For a better understanding please try to change the percentages of E78 to E80 and F78 to F80. Also change the weights 50%:50% to e.g. 100 % to 0% (if you do not want influence by the interviewers).
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5. Drawbacks and gaps that render its use difficult

A crucial point of the RAT tool is its complexity. As the objectives of healthcare waste management are intersectoral and touching topics like occupational safety, hygiene, public health, environment and economics, an assessment of the current situation in a country is multilayered. Furthermore a critical number of information has to be gathered in order to receive a reliable Therefore the collection of data should be well prepared. A team of interviewers should be well chosen and should have a fundamental knowledge about healthcare waste management or be trained on the relevant topics. Information which are gathered by interviewers who know exactly what's the meaning of the questions in order to explain the questions accordingly aiming to receive the correct and realistic answer of the interviewee. Furthermore the interviewer should provide sufficient self confident to persuade higher positions in the hierarchy in order to be taken serious and to receive high quality answers. While visiting healthcare facilities the interviewers should be able to weight the situation correctly, in order to evaluate if the interviewed persons are hiding information or do not have the awareness to provide high quality answers and to be able to fill out "Quest D5". The assessed results generated by this tool are comprehensive and need rating and explanation to the relevant stakeholder like authorities. It is important to find incoherent data and to identify and highlight the most important data. This tool needs a knowledgeable team leader / team and furthermore a dedicated budget for implementation (daily rates, transport, accommodation, per diems). After the assessment phase, the next step is the planning and implementation of a national strategy on healthcare waste management or specific measures aiming to improve the situation. The RAT can be repeated after some years or if a national strategy on healthcare waste management was implemented the "Monitoring Tool (MT)" on healthcare waste management developed by WHO can be used in order to evaluate the improvements.
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Glossary and abbreviations
n Term 1 Anatomic waste 2 Auto-disable Syringe 3 Bloodborne pathogens 4 Burden of disease 5 Chemical waste 6 Colour coding 7 Container 8 Cytotoxic waste 9 Disinfectant 10 Disposable syringe 11 Disposal 12 Handling 13 healthcare wastes with high content of heavy metals 14 Hepatitis B 15 Hepatitis C 16 HIV / AIDS 17 Incineration 18 Infection control 19 Infectious healthcare waste Definition & [includes] Consists of recognizable body parts. A specially modified disposable syringe with a fixed needle which is automatically disabled by plunger blocking after a single use. Infectious agents transmitted through exposure to blood or blood products. The health and socio-economic cost of a given medical condition on a society. Consists of/or containing chemical substances. [Includes: laboratory chemicals; film developer; disinfectants expired or no longer needed; solvents, cleaning agents and other]. Designates the use of different colours for the storage of various categories of HCW. Vessel in which waste is placed for handling, transportation, storage and/or eventual disposal. The waste container is a component of the waste package. Drugs possessing a specific destructive action on certain cells. Chemical agent that is able to reduce the viability of microorganisms. An all-plastic syringe designed for a single use, with a separate, steel needle. Because there is no mechanism to prevent re-use, this type of syringe may be used more than once. Intentional burial, deposit, discharge, dumping, placing or release of any waste material into or on any air, land or water. The functions associated with the movement of waste materials. Consists of materials and equipment which include heavy metals and derivatives in their structure. [Includes: batteries; broken thermometers; manometers]. Hepatitis caused by a virus and transmitted by exposure to blood or blood products or during sexual intercourse. It causes acute and chronic hepatitis. Chronic hepatitis B can cause liver disease, cirrhosis, and liver cancer. Hepatitis caused by a virus and transmitted by exposure to blood or blood products. Hepatitis C is usually chronic and can cause cirrhosis and primary liver cancer. Human Immunodeficiency Virus, a virus transmitted through exposure to blood or blood products or during sexual intercourse. HIV causes the Acquired Immunodeficiency Syndrome (AIDS). The controlled burning of solid, liquid or gaseous wastes to produce gases and residues containing little or no combustible material. The activities aiming at the prevention of the spread of pathogens between patients, from healthcare workers to patients, and from patients to healthcare workers in the healthcare setting. Discarded materials from healthcare activities on humans or animals which have the potential of transmitting infectious agents to humans. These include discarded materials or equipment from the diagnosis, treatment and prevention of disease, assessment of health status or identification purposes, that have been in contact with blood and its derivatives, tissues, tissue fluids, or wastes from infection isolation wards. [Includes: cultures and stocks; tissues; dressings, swabs or other items soaked with blood; blood bags. Sharps, whether contaminated or Characterized by the uncontrolled and scattered deposit of wastes. Consisting of/or containing pharmaceuticals. [Includes: pharmaceuticals expired, no longer needed; their containers, items contaminated by or containing pharmaceuticals (bottles, A microorganism capable of causing disease. Consists of containers (full or empty) with pressurized liquid, gas or powdered materials. [Includes: gas cylinders and cartridges; aerosol cans]. Consisting of/or containing radioactive substances. [Includes: unused liquids from radiotherapy or laboratory research; contaminated glassware, packages or absorbent paper; urine and excreta from patients treated or tested with unsealed radionuclides; sealed sources]. A term embracing the recovery and reuse of scrap or waste material for manufacturing or other purposes. Probability that a hazard will cause harm and the severity of that harm. An injection that does not harm recipients neither exposes health workers to risks or results in waste that puts communities at risk. A puncture proof/liquid proof container designed to hold used sharps safely during disposal and destruction. Modified, disposable plastic syringe designed for the HC worker to disable it in a way that the needle is protected & cannot be re-used. Characterized by the controlled and organized deposit of wastes which is then covered regularly (daily) by the staff present on site. Appropriate engineering preparations of the site and a favourable geological setting (providing an isolation of wastes from the environment) The systematic separation of waste into designated categories. Sharps are a subcategory of infectious healthcare waste and include objects that are sharp and can cause injuries. [Includes: syringe needles, scalpels, infusion sets, knives, blades, broken glass]. Either all plastic or all glass syringe with steel needle. This type of syringe is designed for re-use after proper cleaning and sterilisation in a steam sterilizer or autoclave. The placement of waste in a suitable location where isolation, environmental and health protection and human control (e.g. radiation control, limitation of access) are provided. This is done with the intention that the waste will be subsequently retrieved for treatment and conditioning and/or disposal (or clearance of radioactive waste). Any method, technique or process for altering the biological, chemical or physical characteristics or waste to reduce the hazards it presents and facilitate, or reduce the costs of, disposal. The basic treatment objective include volume reduction, disinfection, neutralization or other change of composition to reduce hazards, including removal or radionuclides from radioactive waste. All the activities - administrative and operational - involved in the handling, treatment, conditioning, storage, transportation and disposal of waste
20 Open dump 21 Pharmaceutical waste 22 Pathogen 23 Pressurized containers 24 Radioactive healthcare waste 25 Recycling 26 Risk 27 Safe injection 28 Safety (sharps) box 29 Safety syringe 30 Sanitary landfill 31 Segregation 32 Sharps 33 Sterilisable syringe 34 Storage
35 Treatment
36 Waste management
Abbreviations
n abbreviation 1 HCW 2 HCWM 3 HCF definition healthcare waste healthcare waste management healthcare facility
page 11 glossary + abbrev.
local authority
Inventory of all B, C and D questions

MoH MoE
topic
question
type
data
comments / multiple choice
B1 B2
C x x x x
D1 D2 D3 D4
1 geographical situation & population 100 area type 101 area geography 102 cultural practices 103 population 104 population 2 healthcare facility (HCF) 200 HCF 201 HCF 202 HCFs 203 services 204 bed capacity 205 occupancy 206 outpatients 3 staff 300 medical staff training 301 staff for HCWM 302 training responsible of HCWM 303 staff for HCW awareness 304 hepatitis B and tetanus 305 medical staff numbers 306 medical staff training 307 staff training on monitoring 4 HCW generation [1] general, [2] recyclables, [3] radioactive, [4] infectious, [5] sharps; [6] chemicals (liquid and solid); [7] pharmaceutical waste; [8] anatomic waste; is training of med. staff available regarding HCWM ? B if yes, what kind of training is given? [0] not identified; [1] planned; [2] identified but not operational; [3] operational x x x x please provide numbers, diagrams. Please provide participation sheets x x x x x x x which category is it (are they) ? which type is it (are they) ? could I obtain a list of all HCFs in the country ? which services do you have in your HCF how many beds do you have in total ? what is the average bed occupancy ? how many outpatients come each day on average? C C T C N N N [1] small (ambulant service); [2] medium ((sub-)district hospital); [3] large hospital [1] public; [2] private if possible by category & type (Nbr. bed), by locality / district [1] medicine; [2] gynaecology; [3] surgery; [4] children services [5] emergencies; [6] radiology; [7] laboratory; [8] other (specify) x x x x x x x in which area is the facility located ? in which area is the facility located ? are there any that must be taken in consideration? how many people live in your locality ? could I get detailed demographic data / country? C T T N N x [1] urban, [2] peri-urban, [3] rural climatic, topographical specifications if relevant
a responsible person for HCWM is identified and operational C what kind of training has this person followed ? awareness of risks of person(s) handling HCW ? do you vaccinate your personnel against them ? could I have a break down of the medical staff ? Is the participation in the trainings documented? T Q B T B
staff is trained on monitoring and supervising of HCWM B
400 HCW kinds 401 domestic waste 402 sharps 403 infectious (non-sharp) waste 404 anatomic waste 405 pharmaceutical waste 406 chemicals (liquid and solid) 407 radioactive waste 409 quantities of HCW produced
which kind of waste is generated in the HCF 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) do you have any figures at the national/local level?
C N N N N N N N N B
Management
Healthcare waste management data collection
x x x x x x x x x x x x
408 number of injections performed how many are done in average per day ?
page 12 questions sum
Training /Monitoring
Application HCWM
Occupation Safety
topic
question
type
data
comments / multiple choice [0] no segregation, [1] general, [2] recyclables, [3] radioactive, [4] infectious, [5] sharps; [6] chemicals (liquid and solid); [7] pharmaceutical waste; [8] anatomic waste; if yes, what measure do you take when it happens? [0] disposable; [1] sterilisable; [2] auto-disable; [3] safety syringe Yes / No [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high) [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high) [0] no specific container; [1] plastic; [2] metallic; [3] cardboard; [4] bag; [5] box; [6] other [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 [0] no shortages; [1] budget; [2] logistical; [3] other (specify)
B1 B2
D1 D2 D3 D4
5 HCW segregation & handling ask to be allowed to take photos of the system ! 500 segregation categories 501 needle stick injuries 502 type of syringes used 503 protective equipment 504 segregation 505 Handling 6 HCW handling equipment 600 infectious waste containers 601 sharp containers 602 shortage of sharps containers 603 colour coding 604 infectious waste containers 605 Equipment 7 HCW storage area 700 storage area 701 storage area access 702 storage area organisation 800 Collection and transport 801 HCW on-site transport 9 HCW off-site transport 900 transport services 901 type of transport into which categories are HCW separated ? how many cases reported in the past 12 months ? what type of syringes do you use? sufficient personal protective equipment for the handling of waste is available proper segregation of waste is: safe handling of waste is: ask to be allowed to take photos of the system ! what kind of specific containers do you use ? what kind of specific containers do you use ? for what reasons are there shortages, if any ? do you have a specific colour coding system ? infectious waste container are lidded sufficient equipment for proper HCWM is available and properly used ask to be allowed to take photos of the system ! do you have a specific area for HCW ? Is the area only accessible for authorised pers. B B x x x x x x [0] the none; [1] transport form; [2] other [0] HCF; [1] municipal service; [2](specify) private company (name ?) x x x x x C C C B B C [0] not available; [1] partly available; [2] widely available; [3] available and properly used . x x x x x x x C N C B N N x x x x x x
are different waste kinds stored in separated storage areas? B is hazardous and non-hazardous waste collected and transported B separately? what kind of means do you use ? ask to be allowed to take photos of the system ! are there any transport documents used? who generally transports hazardous healthcare waste C C C B [0] open device; [1] closed device; [2] other (specify)
8 HCW collection & on-site transport ask to be allowed to take photos of the system !
802 HCW collection & on-site trans. do you think current practices offer enough security?
topic
question ask to be allowed to take photos of the system !
type
data
B1 B2
D1 D2 D3 D4
10 HCW treatment
1000 type of on-site HCW treatment syst. which kind of system is used ? 1001 capacity of HCW treatment syst. what is the current capacity of the system(s) ? 1002 operation HCW treatment syst. any operation problems; if so for what reasons ? 1003 failure of HCW treatment syst. 1004 domestic waste 1005 sharps 1006 infectious (non-sharp) waste 1007 anatomic waste 1008 pharmaceutical waste 1009 chemicals (liquid and solid) 1010 waste recycling 1011 on-site treatment 1012 on-site treatment 1013 Treatment quality 1014 Maintenance 11 HCW final disposal 1100 hazardous HCW final disposal site is it on or off-site ? 1101 type of hazardous waste disposalwhich site kind of disposal site is used for the HCW ? 1102 protection of disposal site 1103 domestic waste 1104 off-site: hazardous waste is the area secured ? where is it disposed off? what kind of hazardous disposal types are available? what do you do when it doesn't function ? is it treated on-site or off-site? is it treated on-site or off-site? is it treated on-site or off-site? is it treated on-site or off-site? is it treated on-site or off-site? is it treated on-site or off-site? is it treated on-site or off-site? is general waste treated on-site? is hazardous waste treated on-site? how is the quality of treatment technology how is the maintenance status of the technology (Technical level/Quality)
C N C T C C C C C C C B B N N C C B C T
[0] none; [1] open fire; [2] incinerator; [3] chem. disinf.; [4] other in kg/day [0] none; [1] money; [2] maintenance; [3] spare-parts; [4] other [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) if yes, which treatment technologies are used? if yes, which treatment technologies are used? [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high) [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high) [0] on-site; [1] off-site [0] open dump; [1] sanitary landfill; [2] small burial pit; [3] other [0] at the HCF [1] off-site: open dump; [2] off-site: sanitary landfill; [3] other x x x
x x x x x x x x x x x x x x x x x x x
x x x x x x x x
topic
question
type
data
B1 B2
D1 D2 D3 D4
12 HCWM regulations (code of conduct; management plan, policy) 1200 hazardous waste regulations 1201 national HCWM regulations can we have copies of existing (draft) documents? can we have copies of existing (draft) documents? B B C T C B B T T [0] not available; [1] partly available; [2] widely available; [3] available and used if yes, could I obtain the legal document and checklists? Please provide detailed information x x x x x try to obtain a flowchart of the health system + responsibilities [0] not identified; [1] planned; [2] available but not used; [3] available and used US $ per bed and year x x x x x x x x x x x x x [0] not available; [1] not enforced; [2] partly enforced; [3] available and enforced x x x x x x x x
1202 national HCWM regulations (HCF) are available and enforced 1203 national HCWM regulations 1204 HCF HCWM regulations 1206 monitoring regulations do their application cause any problems ? internal guidelines and SOP are available and used is a monitoring system stipulated and established?
1205 national monitoring regulations are monitoring regulations available? 1207 Incineration / waste treatment regulation can we have copies of existing (draft) doc. ? 1208 Hazardous goods / waste Transport canregulation we have copies of existing (draft) doc. ? 1209 monitoring regulations 13 policy and budget 1300 health system 1301 budget allocation for HCWM 1302 budget allocation for HCWM 1303 purchase practises 1304 relations with other ministries 1305 annual report of activities 14 sanitation & wastewater 1401 waste water drains 1402 sewer connection 15 personal opinion 1501 personal opinion 1502 personal opinion 1503 personal opinion 1504 personal opinion what kind of short-comings, weak points regarding HCWM in your country can you point out? to what is the waste water system connected? where does the sewerage system lead to ? could you outline how it is organised ? is available and used budget per bed and year is there a national policy for items used in HCWM ? with which ministry(ies) do you work on HCWM ?
HCWM is monitored regularly by the relevant authoritiesB T C N B T
please obtain could I obtain a copy of your annual report(s) regarding transport, T treatment, disposal ofcopies hcw? of the last 1-2 years C C [1] sewer; [2] septic tank; [3] open water source; [4] other [1] wastewater treatment plant; [2] open water source; [3] other
x x x x
x x x
x x x x
do you think sufficient funds are allocated to HCWM ? Q do you think HCWM is safely managed? Q do you think HCWM is environmental friendly managed? Q
Explanations Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down one or several numbers which correspond to the answer) or text [T ] (write essential relevant points told to you by the interviewee). All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below ! Comments: enter any relevant comments made by the interviewee which can help better understand the problematic.
Legend for [Q] excellent (high) = 5 good = 4 satisfactory = 3 insufficient = 2 bad (low) = 1

Tool A (recommended)
Interview Active in the field of: person in charge of association, NGO Address: Function: Tel. n: Date of assessment: type T Answer
name of country
Duration: 30"
Organisation: Name of interviewee: Assessment made by: question
General Information 1 Please provide a general Description of your organisation:
Activities and Project regarding healthcare waste management 2 Which activities or projects have been implemented so far by your organisation in this country?
3 Did your organisation develop any documents, guidelines etc. on healthcare waste management? If available, would it be possible to receive these documents?
4 Do you know other organisations which are active in the field of healthcare waste management?
Future Strategies / Plans 5 Which areas will your organisation be focused on in future (e.g. Climate change, health improvement, environment, healthcare waste,)?
6 If healthcare waste is one of the envisaged areas, which activities are planned?
7 Would your organisation be interested to be part of the national planning and implementation process?
Personal comments/remarks of the interviewer
page 16 Quest A

Tool
Ministry: Name of interviewee: Assessment made by: n topic question type
name of country
Person in charge of Ministry of Health Address: Function: Date: data comments / multiple choice
B-1
Interview Department:
1 geographical situation & population 104 population 2 healthcare facility (HCF) 202 HCFs 3 staff 300 medical staff training 301 staff for HCWM 305 medical staff numbers 4 HCW generation 409 quantities of HCW produced 603 colour coding 9 HCW off-site transport 900 transport services 10 HCW treatment 1011 on-site treatment 1012 on-site treatment 11 HCW final disposal 1101 type of hazardous waste disposalwhich site kind of disposal site is used for the HCW ? 12 HCWM regulations (code of conduct; management plan, policy, monitoring) 1201 national HCWM regulations 1205 national monitoring regulations 1206 monitoring regulations 13 policy and budget 1300 health system 1301 budget allocation for HCWM 1303 purchase practises 1304 relations with other ministries could you outline how it is organised ? is available and used is there a national policy for items used in HCWM ? with which ministry(ies) do you work on HCWM ? T C N B T try to obtain a flowchart of the health system + responsibilities [0] not identified; [1] planned; [2] available but not used; [3] available and used US $ per bed and year can we have copies of existing (draft) documents? are monitoring regulations available? is a monitoring system stipulated and established? T B B if yes, could I obtain the legal document and checklists? Please provide detailed information C [1] open dump; [2] sanitary landfill; [3] small burial pit; [4] other is general waste treated on-site? is hazardous waste treated on-site? B B if yes, which treatment technologies are used? are there any control measures ? C [0] none; [1] transport form; [2] other (specify) do you have any figures at the national/local level? do you have a specific colour coding system ? T B please provide available figures 6 HCW waste handling containers is training of med. staff available regarding HCWM ? B if yes, what kind of training is given ? What training structure is available? [0] not identified; [1] planned; [2] identified but not operational; [3] operational please provide numbers, diagrams. could I obtain a list of all HCFs in the country ? T if possible by category & type (Number of beds), by locality / district could I get detailed demographic data of the country ? N
a responsible person for HCWM is identified and operational C could I have a break down of the medical staff ? T
1302 budget allocation only for HCWMbudget per bed and year
1305 annual report of activities regarding could HCWM I obtain a copy of your annual report(s) regarding transport, B treatment, disposal please obtain of how? copies of the last 1-2 years 15 personal opinion 1501 personal opinion 1502 personal opinion 1503 personal opinion 1504 personal opinion Explanations which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).
All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below ! Comments: enter any relevant comments made by the interviewee which can help better understand the problematic.
what kind of short-comings, weak points regarding HCWM in your country can you point out? do you think sufficient funds are allocated to HCWM ? do you think HCWM is safely managed? do you think HCWM is environmental friendly managed?
T Q Q Q Legend for [Q] good = 4 satisfactory = 3 insufficient = 2 bad (low) = 1 non-existent = 0
Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down one or several numbers excellent = 5
page 17 Quest B-1

Tool
Ministry: Name of interviewee: Assessment made by: c n topic 2 healthcare facility (HCF) 203 services which services do you have in your HCF C question type
name of country
person in charge of Ministry of Environment Address: Function: Date: data comments / multiple choice
B-2 (optional)
Interview Department:
[1] medicine; [2] gynaecology; [3] surgery; [4] children services [5] emergencies; [6] radiology; [7] laboratory; [8] other (specify) if yes, please provide figures. [0] none; [1] transport form; [2] other (specify) [0] the HCF; [1] municipal service; [2] private company (name ?) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] at the HCF [1] off site: open dump; [2] off site: sanitary landfill; [3] other e.g. none; open dumps; secured hazardous waste landfills; mines, other (specify)
4 HCW generation 409 quantities of HCW produced 9 HCW off-site transport 900 transport services 901 type of transport 10 HCW treatment 1004 domestic waste 1005 sharps 1006 infectious (non-sharp) waste 1007 anatomic waste 1008 pharmaceutical waste 1009 chemicals (liquid and solid) 1010 waste recycling 11 HCW final disposal 1103 domestic waste 1104 off-site: hazardous waste 1200 hazardous waste regulations are there any control measures ? who generally transports hazardous healthcare waste ask to be allowed to take photos of the system ! is it treated on-site or off-site? is it treated on-site or off-site? is it treated on-site or off-site? is it treated on-site or off-site? is it treated on-site or off-site? is it treated on-site or off-site? is it treated on-site or off-site? ask to be allowed to take photos of the place ! where is it disposed of? what kind of hazardous disposal types are available? can we have copies of existing (draft) doc. ? C T T T T T T please obtain copies of the last 1-2 years C C C C C C C C C do you have any figures at the national/local level ? T
12 HCWM regulations (code of conduct; management plan, policy) 1207 Incineration / waste treatment regulation can we have copies of existing (draft) doc. ? 1208 Hazardous goods / waste Transport canregulation we have copies of existing (draft) doc. ? 13 policy and budget 1304 relations with other ministries 1305 annual report of activities 15 personal opinion 1501 personal opinion 1503 personal opinion 1504 personal opinion Explanations Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down one or several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee). All the information noted down corresponds to what the interviewee tells you. what kind of short-comings, weak points regarding HCWM in your country can you point out? do you think HCWM is safely managed in your country? do you think HCWM is environmental friendly managed? T Q Q Legend for [Q] with which ministry(ies) do you work on HCWM ? could I obtain a copy of your annual report(s) regarding transport, treatment, disposal of how?
excellent (high) = 5 good = 4
satisfactory = 3 Your personal comments are to be put separately in the box below ! Comments: enter any relevant comments made by the interviewee which can help better understand the problematic. insufficient = 2 bad (low) = 1 non-existent = 0
page 18 Quest B-2

Tool C
Interview Address: Function: Tel. n: Date of assessment: question type data comments / multiple choice Person in charge of Municipal Authority
name of country
Duration: 15"
Municipality: Name of interviewee: Assessment made by: c n topic
1 geographical situation & population 103 population 400 quantities of HCW produced 10 HCW treatment 1007 domestic waste 1202 national HCWM regulations how many people live in your locality ? ask to be allowed to take photos of the system ! how is it generally treated ? does their application pause any problems ? T T N do you have any figures at the national/local level ? B
Explanations
Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write
Legend for [Q] excellent (high) = 5 good = 4 satisfactory = 3 insufficient = 2 bad (low) = 1 non-existent = 0
down one or several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).
All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below ! Comments: enter any relevant comments made by the interviewee which can help better understand the problematic. Never leave a field empty ! If something doesn't exist or is not applicable, put a " 0" (zero); if the interviewee doesn't know, put a " ?". c (code): questions only necessary to ask when: HCW is segregated ( =); when HCW in taken off-site (<>).
page 19 Quest C

Tool D-1
Interview Management, Finance, Legal Regulations District: Function: Assessment made by: c n topic 2 healthcare facility (HCF) 200 HCF 201 HCF 204 bed capacity 205 occupancy 206 outpatients 3 staff 301 staff for HCWM a responsible person for HCWM is identified and operational C C T C C N which category is it (are they) ? which type is it ? how many beds do you have in total ? what is the average bed occupancy ? how many outpatients come each day on average? C C N N N question type data Date of assessment: comments / multiple choice
country
Duration: 30"
[1] small (ambulant service); [2] medium ((sub-)district hospital); [3] large hospital [1] public; [2] private
[0] not identified; [1] planned; [2] identified but not operational; [3] operational [0] not available; [1] not enforced; [2] partly enforced; [3] available and enforced [0] not available; [1] partly available; [2] widely available; [3] available and used [0] not identified; [1] planned; [2] available but not used; [3] available and used US $ per bed and year please obtain copies of the last 1-2 years
12 HCWM regulations (code of conduct; management plan, policy) 1202 national HCWM regulations (HCF) are available and enforced 1203 national HCWM regulations 1204 HCF HCWM regulations 13 policy and budget 1301 budget allocation for HCWM 1302 budget allocation for HCWM 1305 annual report of activities 14 wastewater 1401 waste water drains 1402 sewer connection Explanations
Type: data is either quantitative [N] (enter a number or percentage); Boolean [B] (yes/no); multiple choice [C] (write down one or several numbers which
does their application cause any problems ? Internal guidelines and SOP are available and used is available and used budget per bed and year
could I obtain a copy of your annual report(s) regarding HCWM? T
to what is the waste water system connected? where does the sewerage system lead to ?
C C
[0] sewer; [1] septic tank; [2] open water source; [3] other [0] wastewater treatment plant; [1] open water source; [2] other
correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).
page 20 Quest D-1
Healthcare waste management Rapid assessment tool country:

Tool D2 Interview
Application of Healthcare Waste Management District: Function: Assessment made by: n 4 Which kind of waste is generated in the healthcare 400 facility 401 quantity produced/day (estimated, in kg) 402 quantity prod/day (in kg or number of sharps boxes) 403 quantity produced/day (estimated, in kg) 404 quantity produced/day (estimated, in kg) 405 quantity produced/day (estimated, in kg) 406 quantity produced/day (estimated, in litres) 407 quantity produced/day (estimated, in kg) 5 C 500 into which categories are HCW separated ? 504 proper segregation of waste is: 505 safe handling of waste is: 6 600 what kind of specific containers do you use ? C C 601 what kind of specific containers do you use ? 602 for what reasons are there shortages, if any ? 603 do you have a specific colour coding system ? 604 infectious waste container are lidded C B B [0] no specific container; [1] plastic; [2] metallic; [3] cardboard; [4] bag; [5] box; [6] other [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 [0] no shortages; [1] budget; [2] logistical; [3] other (specify) N N [0] no segregation, [1] general, [2] recyclables, [3] radioactive, [4] infectious, [5] sharps; [6] chemicals (liquid and solid); [7] pharmaceutical waste; [8] anatomic waste; [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high) [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high) [1] general, [2] recyclables, [3] radioactive, [4] infectious, [5] sharps; [6] chemicals (liquid and solid); [7] pharmaceutical waste; [8] anatomic waste; question type Date: data comments / multiple choice duration 30"
C N N N N N N N
[0] not available; [1] partly available; [2] widely available; [3] 605 sufficient equipment for proper HCWM is available and Cproperly used available and properly used 7 700 do you have a specific area for HCW ? 701 Is the area only accessible for authorised pers. are different kind of waste stored in separated 702 storage areas? 8 800 Is hazardous and non-hazardous waste collected and transported B separately? 801 what kind of means do you use ? 9 900 are there any transport documents used? 901 who generally transports the HCW ? 10 1000 which kind of system is used ? 1001 what is the current capacity of the system(s) ? 1002 any operation problems; if so for what reasons ? 1003 what do you do when it doesn't function ? 1004 is it treated onsite or offsite? 1005 is it treated onsite or offsite? 1006 is it treated onsite or offsite? 1007 is it treated onsite or offsite? 1008 is it treated onsite or offsite? 1009 is it treated onsite or offsite? 1013 how is the quality of treatment technology 1014 how is the maintenance status of the technology 1010 is it treated onsite or offsite? 11 ask to be allowed to take photos of the place ! 1100 is it on or off-site ? 1101 which kind of disposal site is used for the HCW ? 1102 is the area secured ? 1103 where is it disposed of? C C B C [0] at the HCF [1] off site: open dump; [2] off site: sanitary landfill; [3] other [0] on-site; [1] off-site [0] none, [1] open dump; [2] sanitary landfill; [3] small burial pit; [4] other C N C T C C C C C C N N C [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high) [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] none; [1] open fire; [2] incinerator; [3] chem. disinf.; [4] other in kg/day and how often treatment is done per week [0] none; [1] money; [2] maintenance; [3] spare-parts; [4] other B C [0] none; [1] transport form; [2] other (specify) [0] the HCF; [1] municipal service; [2] private company (name ?) C [0] open device; [1] closed device; [2] other (specify) 802 do you think current practices offer enough security? B B B B
Explanations Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down one or several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee). All the information noted down corresponds to what the interviewee tells you. Your personal comments are to be put separately in the box below !
Comments: enter any relevant comments made by the interviewee which can help better understand the problematic.
page 21 Quest D-2

Tool D-3
Interview Occupational Safety District: Function: Assessment made by: c n topic 3 staff 304 hepatitis B and tetanus 4 HCW generation 408 number of injections performed how many are done in average per day ? 5 HCW segregation & handling 501 needle stick injuries 502 type of syringes used 503 protective equipment 15 personal opinion 1501 1502 1503 1504 personal opinion personal opinion personal opinion personal opinion what kind of short-comings, weak points regarding HCWM in your country can you point out do you think sufficient funds are allocated to HCWM ? do you think HCWM is safely managed? do you think HCWM is environmental friendly managed? T Q Q Q how many cases reported in the past 12 months (average)? what type of syringes do you use ? sufficient personal protective equipment for the handling of waste is available N C B N do you vaccinate your personnel against them ? C question type data Date of assessment: comments / multiple choice
name of country
Duration: 10"
[0] none; [1] only tetanus; [2] only HBV; [3] both
[0] disposable; [1] sterilisable; [2] auto-disable; [3] safety syringe
Explanations
Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down one or
Legend for [Q] excellent (high) = 5 good = 4 satisfactory = 3 insufficient = 2 bad (low) = 1 non-existent = 0
several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).
page 22 Quest D-3

Tool D-4
Interview Training & Monitoring district: Function: Assessment made by: c n topic 3 staff 300 medical staff training 302 training responsible of HCWM 303 staff for HCW awareness 306 medical staff training 307 staff training on monitoring is training of med. staff available regarding HCWM ? B what kind of training has this person followed ? awareness of risks of person(s) handling HCW ? Is the participation in the trainings documented? T Q B Please provide participation sheets question type data date of assessment: comments / multiple choice
name of country
Duration: 10"
if yes, what kind of training is given ? How often is trained?
staff is trained on monitoring and supervising of HCWM B B B B Legend for [Q] if yes, could I obtain the legal document and checklists?
12 HCWM regulations (code of conduct; management plan, monitoring) 1205 national monitoring regulations are monitoring regulations available? 1206 monitoring regulations 1209 monitoring regulations Explanations one or several numbers which correspond to the answer) or text [T] (write essential relevant points told to you by the interviewee).
is a monitoring system stipulated and established? HCWM is monitored regularly by the relevant authorities
Type: data is either quantitative [N] (enter a number or percentage); qualitative [Q] (see legend); Boolean [B] (yes/no); multiple choice [C] (write down excellent (high) = 5
good = 4 satisfactory = 3 insufficient = 2 bad (low) = 1 non-existent = 0
page 23 Quest D-4

Tool D5
healthcare facility: Assessment made by: n topic 3 staff 304 staff for HCW awareness awareness of risks of person(s) handling HCW ? monitoring quality of HCWM is Summary 5 HCW segregation & handling how is the quality of waste segregation? is risk and non-risk waste segregated appropriately? Summary 6 HCW containers how is the availability of waste container? how is the quality of waste container? Summary 7 HCW storage area how is the all over quality of the waste storage area? is the storage area safe and in accordance to national and international rules? Summary 8 HCW collection & on-site transport how is the collection frequency? how is the quality of transport equipment? how is the safety of collection and on-site transport? Summary 10 HCW treatment how is the quality of treatment technology? how is the maintenance status of the technology? is the treatment technology safe for staff and public? is the treatment technology environmental friendly? Summary 11 HCW final disposal how is the quality of the used disposal site? is the disposal method safe for staff and public? is the disposal environmental friendly? Summary 12 HCWM regulations (code of conduct; management plan, policy) how is the implementation level of national regulations? HCWM is monitored appropriately and regularly? Summary 15 personal opinion do you think sufficient funds are allocated to HCWM ? do you think HCWM is safely managed? do you think HCWM is environmental friendly managed? Summary Personal comments, remarks N N N N 0% N N N 0% N N N N 0% N N N N N 0% N N N N 0% N N N 0% N N N N N N 0% N N N 0% question Personal observations district: date of assessment: type data (0-100 %)comments / multiple choice
name of country
duration: non defined
Legend for [N] 0-10% (critical situation) 11-30% (problematic situation) 31-60% (satisfactory situation) 61-80% (good situation >81% (excellent situation)
page 24 Quest D_5
A 1 2 3 4 5 6 7 8 302
Evaluation of questionnaires D Date: Name: Country:

n topic question TEXT INPUT of questions D1-D4
3 staff training responsible of HCWM
what kind of training has this person followed ?
9 305 10 11 93 medical staff numbers could I have a break down of the medical staff ? please provide
10 HCW treatment failure of HCW what do you do treatment syst. when it doesn't function ?
12 13 1203 12 HCWM regulations (code of conduct; management plan, policy) national HCWM does their regulations application cause any problems ?
14 15 1305 13 policy and budget annual report of could I obtain a activities copy of your annual report(s) regarding transport, treatment, 15 personal opinion personal opinion What kind of shortcomings, weak points regarding HCWM in your country can you point out?
16 17 1501
18 19
N 1 2 3 4 5 6 7 8
AA
AB
AC
AD
AE
AF
AG
AH
AI
AJ
10 11
12 13
14 15
16 17
18 19
AK 1 2 3 4 5 6 7 8
AL
AM
AN
AO
AP
AQ
AR
AS
AT
AU
AV
AW
AX
AY
AZ
BA
BB
BC
BD
BE
BF
BG
BH
BI
BJ
BK
10 11
12 13
14 15
16 17
18 19
BL 1 2 3 4 5 6 7 8
BM
BN
BO
BP
BQ
BR
BS
BT
BU
BV
BW
BX
BY
BZ
CA
CB
CC
CD
CE
CF
CG
CH
CI
Evaluation Questionnaire E - personal observation
10 11
12 13
14 15
16 17
18 19
CJ 1 2 3 4 5 6 7 8
10 11
12 13
14 15
16 17
18 19
A 20 21 22
INPUT
D1 - Management, Finance, Legislation

201 204 205 206 301 Points 0-3 1202 Points 0-3 1204 Points 0-3 1301 Points 0-3 1302 1401 1402 0 - code 0-2 Number Occ.r Outpatient of beds ate% s per year US$/bed/ code day 3
23 24 25 26 27 28
Question 200 No. Questionn aire Kind of HCF 1 2 3 4 5
Type
N 20
AA
AB
AC
AD
AE
AF
AG
AH
AI
AJ
21 D2 - Application of Healthcare 22 400 Which waste is generated?
Waste Management
401 402 403 404 Pharma Sum domestic infectious Chemica ceutical Pathologic generated waste (kg / sharps (kg waste (kg / anatomic l Waste s al Waste waste day) / day) day) (kg / day) 405 406 pharmace chemical utical (kg / waste (kg / day) day) 407 radioactive waste (kg / day) 500 504 505 Points 0-5 Number 0- Points 8 0-5 408 600 No. Injections/ code day -6 601 0 code 0-4 602 code 0-3
23 24 25 26 27 28
General Recyclin Radioacti Infectiou Sharp Waste g Waste ve Waste s Waste Waste
AK 20 21 22
AL
AM
AN
AO
AP
AQ
AR
AS
AT
AU
AV
AW
AX
AY
AZ
BA
BB
BC
BD
BE
BF
BG
BH
BI
BJ
BK
603 Yes / No
604 Yes / No
605 Points 0-3
700 Yes / No
701 Yes / No
702 Yes / No
800 Yes / No
801 code 2
802 0 - Yes / No
900
901
1000
23 24 25 26 27 28
code 0 code 0 code 0 -2 -3 -4
1001 1002 1004 treatment capac. code 0 Points kg/day -4 0-2
1005 Points 0-2
1006 Points 0-2
1007 Points 0-2
1008 Points 0-2
1009
1010
1013 Points 0-5
1014 Points 0-5
1100 Points 0 or 1
1101 code 0 4
1102 Yes / No
1103 code 0 3
Points Points 0-2 0-2
BL 20 21 22
BM
BN
BO
BP
BQ
BR
BS
BT
BU
BV
BW
BX
BY
BZ
CA
CB
CC
CD
CE
CF
CG
CH
CI
D3 - Occupational Safety
304 Yes / No 501 Number needle sticks/a 502 code 0- 3 503 1502 Points 0-5 1503 Points 0-5 1504 Points 0-5
D4 - Training & Monitoring

300 Yes / No 303 306 307 1205 Yes / No 1209 Yes / No Points 0 - 5 Yes / No
INPUT D5 - personal observation

Section HC F 1 2 3 4 5 3 5 segregatio n% 6 waste container % 7 8 collec, onsitetrans. % 10 treatment % 12 15 Legal Regulation Personal Disposal % s% Opinion % 11
23 24 25 26 27 28
Yes / No
Yes / No
staff %
storage %
CJ 20 21 22
23 24 25 26 27 28
A 124 125 126 127
No. of Answers Sum Large HCF Medium 128 HCF
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
129 Small HCF 130
0 3. staff 300
131 RESULTS 2. Healthcare Facility 132 No. 200 201
204
133 Question 134 135 136 137
Number of participated HCF 0 0 0 0
Number of public HCF 0 0 0 0
Average No. Of beds
4. Generation 303 304 306 307 400 Which waste is generated? Risk Resp Awarene Training Occ. Outpatient Training Person ss Vaccina Training on Rate s / year on how: Average Average tion: document Monitorin General % Average Yes Score Score Yes ed: Yes g: Yes Waste 205 206 301 #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 100% 50% 100% 83% #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Large Medium Small All (Average)
#DIV/0! No input #DIV/0! #DIV/0! No input #DIV/0! #DIV/0! No input #DIV/0! #DIV/0! #### #DIV/0!
138
139
140 141 142 143 144 145 146 147
N 124 125 126 127 128
AA
AB
AC
AD
AE
AF
AG
AH
AI
AJ
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
129 130
0 5. Segregation 500 501
0 6. HCW handling equipment 600
4. Generation 131 400 Which 132 waste is generated?
401 Sum domestic Patholo generated Average Chemic Pharmac gical waste per bed al Waste euticals Waste kinds and day #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
402 sharps Average per bed and day #DIV/0! #DIV/0! #DIV/0! #DIV/0!
403 infectious Average per bed and day #DIV/0! #DIV/0! #DIV/0! #DIV/0!
404 anatomic Average per bed and day #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Radioact Recyclin ive Infectious Waste 133 g Waste Waste

134 135 136 137
Sharp Waste #DIV/0! #DIV/0! #DIV/0! #DIV/0!
405 pharmace utics Average per bed and day #DIV/0! #DIV/0! #DIV/0! #DIV/0!
406
407
408
502
503
504
505
chemical radioactive Average Average Average Average Injection % of No. Of per bed per bed Average per segregate needle Average and day and day bed and day d classes sticks / a Score #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Average Score #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Average Score (0- Average 5) Score (0-5) #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
Average Score #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
138
139
Code
502: type of syringe 503: PPE Prevalen ce of Prevalenc scores e of scores
Code
600: waste container Prevalenc e of scores
140 141 142 143 144 145 146 147
0 1 2 3 4 5 6
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
0 1 2 3 4 5 6
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
AK 124 125 126 127 128
AL
AM
AN
AO
AP
AQ
AR
AS
AT
AU
AV
AW
AX
AY
AZ
BA
BB
BC
BD
BE
BF
BG
BH
BI
BJ
BK
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
129 130
0 11. HCW final disposal 1100
6. HCW131 handling equipment 132 601 602
7. HCW storage area 8. HCW collection & onsite transport 9. offsite transport 10. HCW treatment 604 605 700 701 702 800 801 802 900 901 1000 1001 1002 inf. sufficie Sep. Safe HCW colour Cont nt specific authori coll. collecti treatme coding lidded equipm storage sed separate And on & nt Averag Averag Average Averag ent How access storage trans Average trans Average Average Average capacit Yes Yes Yes Yes Score Yes Score Score Score y 133 e Score e Score Score e Score Averag 603
134 #DIV/0! 135 #DIV/0! 136 #DIV/0! 137 #DIV/0!
1004
1005
1006
1007
1008
1009
1010
1013 1014 Treatment System Monitor Quality ing Average Averag Score e Score #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
disposal on-site #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 602: availabi lity sharp cont. Prevale nce of scores
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 801: transpo rt equipm ent Prevale nce of scores
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 901: off site transpo rt Prevale Prevalenc nce of e of scores scores 900: transport control
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 1000: kinds of how treatme nt Prevale nce of scores Code
601: sharp contain 138 er Prevale nce of 139 scores
Code
Code
1002: HCW treatme nt problem s 1004 1005 1006 1007 Prevale treat treat treat treat nce of general sharps infect. anato scores waste Average Averag mic
1008 treat pharma Average
1009 1010 treat treat chemical recyclin Average g
Code
140 141 142 143 144 145 146 147
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
0 #DIV/0! 1 #DIV/0! 2 #DIV/0!
0 1 2 3 4
#DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
0 1 2 3 4
#DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0!
0 1 2 3 4
BL 124 125 126 127 128
BM
BN
BO
BP
BQ
BR
BS
BT
BU
BV
BW
BX
BY
BZ
CA
CB
CC
CD
CE
CF
CG
CH
CI
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
129 130
No. of Answers Sum Large Me HCF diu Sm all HC F RESULTS Section
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
0 0 0
11. HCW 131 final disposal 132 1101 1102
1103
133 134 135 136 137
secure disposal Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! 1103: kind of domestic waste disposal Prevalen ce of Code scores
12. HCW regulations 13. policy & budget 14. sanitation 1202 1204 1205 1209 1301 1302 1401 1402 Enforced Monito Used Budget nat. Used Monitori ring budget HCWM regulatio SOP ng authori HCWM Averag ns Averag regulati ties Averag e Average e Score ons Yes Yes e US$/be #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
15. personal opinion 1502 1503 1504 Suffici Safe HCWM ent HCWM Env. funds? ? Friendl Averag Averag y? e e Score Averag #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
10
11
12
HCF Large Medium Small All (Average)
staff % No input No input No input #DIV/0!
HCW segregation % No input No input No input #DIV/0!
waste container % No input No input No input #DIV/0!
Collection and onsite HCW Transport. HCW storage % % Treatment % No input No input No input #DIV/0! No input No input No input #DIV/0! No input No input No input #DIV/0!
HCW Disposal % No input No input No input #DIV/0!
Legal Regulation s% No input No input No input #DIV/0!
1101: kind haz waste disposa 138 l Prevale nce of 139 scores
Code
1401: connecti on waste 1402: water sewerage system leads to.. Prevalen Prevalenc ce of e of scores scores
140 141 142 143 144 145 146 147
0 1 2 3
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
0 1 2 3
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0!
CJ 124 125 126 127 128
129 130 131 132
15
Personal
133 Opinion % 134 135 136 137
No input No input No input #DIV/0!
138
139
140 141 142 143 144 145 146 147
Healthcare waste management Results healthcare facilities

Results of all Tool D questions
n topic question
302
3 staff training responsible of HCWM
what kind of training has this person followed ?
305
medical staff numbers
could I have a break down of the medical staff ? please provide numbers, diagrams.
10 HCW treatment 1003 failure of HCW treatment syst.
what do you do when it doesn't function ?
12 HCWM regulations (code of conduct; management plan, policy) 1203 national HCWM regulations does their application cause any problems ?
13 policy and budget 1305 annual report of activities
could I obtain a copy of your annual report(s) regarding transport, treatment, disposal of how? please obtain copies of the last 1-2 years
15 personal opinion 1501 personal opinion
What kind of short-comings, weak points regarding HCWM in your country can you point out?
No.
Category
2 healthcare facility (HCF)
Question
Results
large medium small sum 0 0 0 large medium small average
Codes, Points, comments
200 HCF 201 HCF
which category is it (are they) ? which type is it (are they) ? Public Private
0 0
0 0
0 0
[1] small; [2] medium; [3] large hospital [1] public; [2] private
204 bed capacity 205 occupancy 206 outpatients 3 staff
how many beds do you have in total (average)? what is the average bed occupancy ? how many outpatients come each day on average?
#DIV/0! #DIV/0! #DIV/0! #DIV/0! No input No inputNo input #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! large medium small average
300 medical staff training
is training of med. staff available regarding HCWM ? a responsible person for HCWM is identified and operational
Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! large medium small average
if yes, what kind of training is given? [0] not identified; [1] planned; [2] identified but not operational; [3] operational [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high)
301 staff for HCWM
#DIV/0! #DIV/0! #DIV/0! #DIV/0! large medium small average
303 staff for HCW awareness
awareness of risks of person(s) handling HCW ?
304 hepatitis B and tetanus 306 medical staff training 307 staff training on monitoring
do you vaccinate your personnel against them ? Is the participation in the trainings documented? staff is trained on monitoring and supervising of HCWM
Yes Yes Yes
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! Please provide participation sheets
100%
50%
100%
83%
large medium small average Summary HCF (D1-D4) Summary personal observation (D5) 4 HCW generation [1] general, [2] recyclables, [3] radioactive, [4] infectious, [5] sharps; [6] chemicals (liquid and solid); [7] pharmaceutical waste; [8] anatomic waste; #DIV/0! #DIV/0! #DIV/0! #DIV/0! No input No inputNo input #DIV/0!
1 400 HCW kinds which kind of waste is generated in the healthcare facility (%)?
large #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! ##### ##### medium #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! ##### ##### small #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! ##### ##### average #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! ##### ##### large medium small average
401 domestic waste 402 sharps 403 infectious (non-sharp) waste 404 anatomic waste 405 pharmaceutical waste 406 chemicals (liquid and solid) 407 radioactive waste 5 HCW segregation & handling
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)
kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0! kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0! kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0! kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0! kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0! l/day #DIV/0! #DIV/0! #DIV/0! #DIV/0! kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0! kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0!
408 number of injections performed how many are done in average per day ?
large medium small average 500 segregation categories 501 needle stick injuries how many waste categories are segregated? how many cases reported in the past 12 months? % #DIV/0! #DIV/0! #DIV/0! #DIV/0! if yes, what measure do you take when it happens? [0] disposable; [1] sterilisable; [2] auto-disable; [3] safety syringe
per year#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 1 2 3
502 type of syringes used
what type of syringes do you use? sufficient personal protective equipment for the handling of waste is available?
503 protective equipment
Yes
504 segregation 505 handling
proper segregation of waste is: Safe handling of waste is:
Q Q
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! large medium small average
[0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high) [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high)
Summary HCF (D1-D4) Summary personal observation (D5) 6 HCW waste handling equipment
#DIV/0! #DIV/0! #DIV/0! #DIV/0! No input No inputNo input #DIV/0!
0 600 infectious waste containers what kind of specific containers do you use ? %
6 [0] no specific container; [1] plastic; [2] metallic; [3] cardboard; [4] bag; [5] box; [6] other [0] no specific container; [1] puncture-proofed single use; [2] puncture-proofed multiple use, [3] not puncture-proof single use; [4] not punctureproof multiple use [0] no shortages; [1] budget; [2] logistical; [3] other (specify)
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #####
601 sharp containers
what kind of specific containers do you use ?
602 shortage of sharps containers 603 colour coding 604 infectious waste containers
for what reasons are there shortages, if any ?
% Yes Yes
#DIV/0! #DIV/0! #DIV/0! #DIV/0! large medium small average #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! large medium small average
do you have a specific colour coding system? infectious waste container are lidded?
B B C [0] not available; [1] partly available; [2] widely available; [3] available and properly used
605 equipment
sufficient equipment for proper HCWM is available and properly used
Summary HCF (D1-D4) Summary personal observation (D5)
page 40 Results Quest D
topic 7 HCW storage area
question
large medium small average 700 storage area 701 storage area access 702 storage area organisation do you have a specific area for HCW ? Is the area only accessible for authorised pers. are different kind of waste stored in separated storage areas? Yes Yes Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! large medium small average Summary HCF (D1-D4) Summary personal observation (D5) 8 HCW collection & on-site transport large medium small average 800 collection and transport Is hazardous and non-hazardous waste collected and transported separately? Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 801 HCW on-site transport what kind of means do you use ? % Yes 1 2 [0] open device; [1] closed device; [2] other (specify) B B #DIV/0! #DIV/0! #DIV/0! #DIV/0! No input No inputNo input #DIV/0! B B B
#DIV/0! #DIV/0! #DIV/0! large medium small average #DIV/0! #DIV/0! #DIV/0! #DIV/0! large medium small average
802 HCW collection & on-site trans. do you think current practices offer enough security?
Summary HCF (D1-D4) Summary personal observation (D5) 9 HCW off-site transport
#DIV/0! #DIV/0! #DIV/0! #DIV/0! No input No inputNo input #DIV/0! 0 1 2 3 [0] none; [1] transport form; [2] other (specify) [0] the HCF; [1] municipal service; [2] private company (name ?)
900 transport services 901 type of transport 10 HCW treatment
are there any transport documents used? who generally transports hazardous healthcare waste?
% %
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 1 2 3 4
1000 type of on-site HCW treatment syst. which kind of system is used ?
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! large medium small average
[0] none; [1] open fire; [2] incinerator; [3] chem. disinf.; [4] other
1001 capacity of HCW treatment syst. what is the current capacity of the system(s) (kg/day) ? kg/day #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 1002 operation HCW treatment syst. any operation problems; if so for what reasons ? % 1 2 3 4
in kg/day C [0] none; [1] money; [2] maintenance; [3] spareparts; [4] other C [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used) [0] no treatment; [1] on-site; [2] off-site (which treatment technology is used)
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 1 2
1004 domestic waste 1005 sharps 1006 infectious (non-sharp) waste 1007 anatomic waste 1008 pharmaceutical waste 1009 chemicals (liquid and solid) 1010 waste recycling
is it treated onsite or off-site? is it treated onsite or off-site? is it treated onsite or off-site? is it treated onsite or off-site? is it treated onsite or off-site? is it treated onsite or off-site? is it treated onsite or off-site?
% % % % % % %
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0% 0% 0% 0% 0% 0%
large medium small average 1013 treatment quality 1014 maintenance how is the quality of treatment technology how is the maintenance status of the technology Summary HCF (D1-D4) Summary personal observation (D5) 11 HCW final disposal large medium small average 1100 hazardous HCW final disposal site is it on or off-site ? onsite #DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 1101 type of hazardous waste disposalwhich site kind of disposal site is used for the HCW ? % 1 2 3 4 [0] none, [1] open dump; [2] sanitary landfill; [3] small burial pit; [4] other [0] on-site; [1] off-site #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! large medium small average #DIV/0! #DIV/0! #DIV/0! #DIV/0! No input No inputNo input #DIV/0! [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high) [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high)
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! large medium small average
1102 protection of disposal site
is the area secured ?
Yes
#DIV/0! #DIV/0! #DIV/0! #DIV/0! 0 1 2 3
B C [0] at the HCF [1] off site: open dump; [2] off site: sanitary landfill; [3] other
1103 domestic waste
where is it disposed off?
Summary HCF (D1-D4) Summary personal observation (D5) 12 HCWM regulations (code of conduct; management plan, policy)
large medium small average 1202 national HCWM regulations (HCF) are available and enforced? 1204 HCF HCWM regulations Internal guidelines and SOP are available and used? #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! large medium small average 1205 national monitoring regulations are monitoring regulations available? 1209 monitoring regulations Yes #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! large medium small average Summary HCF (D1-D4) Summary personal observation (D5) 13 policy and budget large medium small average 1301 budget allocation for HCWM 1302 budget allocation for HCWM 14 sanitation & wastewater 0 1401 waste water drains 1402 sewer connection 15 personal opinion large medium small average 1502 personal opinion 1503 personal opinion 1504 personal opinion Do you think sufficient funds are allocated to HCWM ?Q Do you think HCWM is safely managed? Do you think HCWM is environmental friendly managed? Q Q #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! large medium small average Summary HCF (D1-D4) Summary personal observation (D5) #DIV/0! #DIV/0! #DIV/0! #DIV/0! No input No inputNo input #DIV/0! [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high) [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high) [0] non-existent; [1] bad (low); [2] insufficient; [3] satisfactory; [4] good; [5] excellent (high) to what is the waste water system connected? where does the sewerage system lead to ? % % 1 2 3 C [0] sewer; [1] septic tank; [2] open water source; [3] other [0] wastewater treatment plant; [1] open water source; [2] other: is available and used? budget per bed and year? US$ #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! [0] not identified; [1] planned; [2] available but not used; [3] available and used US $ per bed and year #DIV/0! #DIV/0! #DIV/0! #DIV/0! No input No inputNo input #DIV/0! B if yes, could I obtain the legal document and checklists? B [0] not available; [1] not enforced; [2] partly enforced; [3] available and enforced [0] not available; [1] partly available; [2] widely available; [3] available and used
HCWM is monitored regularly by the relevant authorities? Yes
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
page 41 Results Quest D

Tool E
Rating at national level
name of country
Rating made by:
date of rating:
Explanations This rating system is here to give you a set of indicators of how good/bad is the situation regarding HCWM per topic (staff, HCW generation, segregation, etc.) for healthcare facilities according to their size (big, medium and small) as well as at national level (to be read in the last column "total"). healthcare facilities are divided into three size categories: large hospitals (big); (sub-)district hospitals (medium); ambulant services (small).
The data which are entered into the table "Input Quest D" are automatically summerised (total points ) and calculated according to the percentage of HCFs visited to give an equivalent number of points at
national level (national equivalent points ).

The national equivalent percentage is calculated as follows: "national equivalent points" / (total number of HCFs for each size category * number of questions in the topic). This produces a result in
percentage that can be read as follows: 0-10% (critical situation); 11-30% (problematic situation); 31-60% (satisfactory situation); 61-80% (good situation); >81% (excellent situation).
At the bottom of the page a summary per topic can be found: This summary table applies the results of the data entry table of the questionnaires on national and hcf level (Input Quest D). The two results of
answeres of the hcf and the interviewer are weighted 50 % : 50 % in order to receive an as realistic result as possible. The weighted percentages can be changed by the team leader.
This evaluation is based on key issues that need to be fulfilled to ensure a safe management of HCW.
Summary table
n topic level / category Results Questionnairs D4 Weight All over average 3 staff (and training) big = large hospitals medium = (sub-)district hospitals small = ambulant services All over average 5 HCW segregation & handling big = large hospitals medium = (sub-)district hospitals small = ambulant services All over average 6 HCW waste handling equipment big = large hospitals medium = (sub-)district hospitals small = ambulant services All over average 7 HCW storage area big = large hospitals medium = (sub-)district hospitals small = ambulant services All over average 8 HCW collect. & on-site transp. big = large hospitals medium = (sub-)district hospitals small = ambulant services All over average 10 HCW treatment big = large hospitals medium = (sub-)district hospitals small = ambulant services All over average 11 HCW final disposal big = large hospitals medium = (sub-)district hospitals small = ambulant services All over average 12 HCWM regulations (code of conduct; management plan, policy) big = large hospitals medium = (sub-)district hospitals small = ambulant services All over average 15 personal opinion big = large hospitals medium = (sub-)district hospitals small = ambulant services 50% #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
D1-
Result Personal Observation D5 50% #DIV/0! No input No input No input #DIV/0! No input No input No input #DIV/0! No input No input No input #DIV/0! No input No input No input #DIV/0! No input No input No input #DIV/0! No input No input No input #DIV/0! No input No input No input #DIV/0! No input No input No input #DIV/0! No input No input No input
Weighted Result
Verbal result comments / suggestions
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0! #DIV/0!
All over average overall situation at national level big = large hospitals medium = (sub-)district hospitals small = ambulant services
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#VALUE! #VALUE! #VALUE! #VALUE!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
#DIV/0! #DIV/0! #DIV/0! #DIV/0!
page 42 Tool E
page 43 Tool E

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Healthcare waste management Rapid assessment tool

for country level Content

Terminology National National

Local Local Local

12. Tool E (D1 - D5)

We are interested in your data

Healthcare waste management Rapid assessment tool

Basic assumptions and objectives

Who can/should use this rapid assessment questionnaire ?

How to use this rapid assessment questionnaire ?

Description of the tools

Identifying & engaging relevant stakeholders

Selection of healthcare facilities

Information & Contacts

Healthcare waste management Rapid assessment tool

2 hours 2 hours 2 hours 1 hour

count about 2-3 weeks of full time work

Rapid Assessment Tool

Healthcare waste management Rapid assessment tool

Introduction RAT Tool

Rapid Assessment Tool

2. Results receiving from the Questionnaire A, B and C

Rapid Assessment Tool

3. Exemplary Results received from the Questionnaires D (trial test Uzbekistan)

large medium small

Rapid Assessment Tool

Results Questionnair es D1-D4 50% 44% 67% 0% 67%

Weighted Result 31% 56% 5% 33%

Verbal result satisfactory satisfactory critical satisfactory

Results Questionnair es D1-D4 50% 56% 63% 43% 63%

Weighted Result 53% 63% 40% 57%

Verbal result satisfactory good satisfactory satisfactory

Rapid Assessment Tool

5. Drawbacks and gaps that render its use difficult

Healthcare waste management Rapid assessment tool

Inventory of all B, C and D questions

comments / multiple choice

staff is trained on monitoring and supervising of HCWM B

Healthcare waste management data collection

page 12 questions sum

page 13 questions sum

question ask to be allowed to take photos of the system !

comments / multiple choice

page 14 questions sum

comments / multiple choice

HCWM is monitored regularly by the relevant authoritiesB T C N B T

page 15 questions sum

Healthcare waste management Rapid assessment tool

Organisation: Name of interviewee: Assessment made by: question

General Information 1 Please provide a general Description of your organisation:

Personal comments/remarks of the interviewer

Healthcare waste management Rapid assessment tool

T Q Q Q Legend for [Q] good = 4 satisfactory = 3 insufficient = 2 bad (low) = 1 non-existent = 0

Personal comments/remarks of the interviewer

page 17 Quest B-1

Healthcare waste management Rapid assessment tool

excellent (high) = 5 good = 4

Personal comments/remarks of the interviewer

page 18 Quest B-2

Healthcare waste management Rapid assessment tool

Municipality: Name of interviewee: Assessment made by: c n topic

Personal comments/remarks of the interviewer

Healthcare waste management Rapid assessment tool