Environmental health hygiene

Staff pocket guide

Published in 2016
The information included in this pocket guide does not replace the information
found in the Environmental heath management for voluntary medical male
circumcision services site management guide. Please refer to that guide for
detailed information on procedures and best practices. The purpose of this
pocket guide is to serve as a quick reference for health care staff.

Published in 2016

For more information, contact pfscm@pfscm.org.

 Hand washing with liquid soap and clean water

Washing should last 40-60 seconds.

Wet hands with clean Apply enough soap to Rotate rubbing hands
water. cover all hand surfaces. palm to palm seven times.

Rub right palm over left Rub palm to palm with Rub back of fingers to
dorsum with interlaced fingers interlaced seven opposing palms with fingers
fingers and vice versa times. and vice versa seven times.
seven times.

Rotate rubbing of left Rotate rubbing backwards Rinse hands with clean
thumb clasped in palm and and forwards with clasped water; keep water running.
vice versa seven times. fingers of right hand in palm
and vice versa seven times.

12
Dry hands thoroughly Use towel to turn off Your hands are now clean.
with single-use towel. faucet and open door,
then discard towel into
a waste receptacle.

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 How to use alcohol hand rub*

Washing should last 20-30 seconds.

OR

Apply a palmful of the product in a cupped hand, Rub hands palm to palm.
covering all surfaces.

Rub right palm over left Rub palm to palm with Rub back of fingers to
dorsum with interlaced fingers interlaced. opposing palms with
fingers and vice versa. fingers interlocked.

8
Rotate rubbing of left Rotate rubbing backwards Once dry, your hands are
thumb clasped in palm and forwards with clasped now clean.
and vice versa. fingers of right hand in
palm and vice versa.

*Alcohol rub should only be used on visibly clean and dry hands to remove
contaminants that cannot be seen.

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Personal protective equipment for waste handlers

Cap
Goggles

Mask

Scrubs or coveralls

Plastic or rubber apron

Utility gloves

Rubber boots

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
Personal protective equipment for incinerator operators

Face shield or goggles

Mask with filter

Coveralls

Leather apron

Leather gloves

Thick-soled,
steel-toed
safety boots

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Sharps safety

Place sharps in yellow sharps safety box. Seal off securely when 3/4 full.

Deposit syringe with needle down. Do not recap.

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Packaging considerations

Sometimes specific waste streams don’t fit into conventionally available hazardous waste
packaging. In this instance, the figure below can help health care facility staff in making
educated packaging decisions.
Waste is: Packaging considerations:
Potentially sharp when broken
Use a puncture-proof, sealable, rigid
plastic container.

Heavy
Use smaller containers that can
withstand relative load.

Light

Use larger volume containers or bags.

Wet
Use containers/packaging that are
leak-proof and liquid-proof (e.g., a
cardboard box would not be suitable).

Dry
Use lightweight packaging or bags as
there is no risk of leakage or seepage.

Clumsy, large, or oddly shaped

Use the right-sized container for the
waste stream and use the prescribed
color-coding and labeling requirements.

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Labeling

Labeling of waste containers and bags is used to identify the source, record the type and
quantities of waste produced in each area, and allow problems with waste segregation to be
traced back to source.

Label containers/bags with proper hazard symbol and type of waste if applicable
(pathological, infectious, etc.).
Using an international hazard symbol on each waste container and bag is
recommended. See Annex 1 for all hazardous waste symbols.

Use the caution symbol Use biohazard symbol for pathological Use biohazard Use the toxic
for non-reusable metal and infectious waste. A symbol is not symbol for symbol for
instruments. required for general waste. sharps waste. chemical waste.

During collection, place stickers on

containers/bags with waste details.
A simple approach is to attach a label to
each filled container/bag with the details
of the medical area, date, and time of
closure of the container, and the name
of the person filling out the label.

Origin /
Medical
Area

Date and
time of container
closure

Name and
surname
of person
Origin

closing
off container
/ Medica
Date

l Area
and
time
Name

of
contain
and
surnam

er
closure
e
of
person

closing

off
contain

er

Origin / Medical Area

Date and time of container closure

Name and surname of person closing off container

Origin /
Medical
Area

Date and
time of container
closure

Name and
surname
of person
Origin

closing
off container
/ Medica
Date

l Area
and
time
Name

of
contain
and
surnam

er
closure
e
of
person

closing

off
contain

er

Origin / Medical Area

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
Date and time of container closure
 Waste segregation

Pathological Infectious Sharps Chemical Non-hazardous

(General)

/14
: 08
EXP

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Spill management

Responding to a spill:
Remain calm.
Evacuate all unnecessary personnel and quarantine the spill area.
Assess the nature of the spill (see the following pages).
Contact management and/or emergency services.
Put on necessary PPE.
Follow protocol for your type of spill.
Work efficiently and carefully.
Be aware of the surroundings at all times.
Once the emergency has been identified, contact the appropriate
departments.

l Only staff trained in spill Cap

management can conduct
these procedures. Goggles
l Personal protective
equipment (PPE) must be Mask
used as part of infection
prevention and control. Plastic or rubber apron

Utility gloves

Rubber boots

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Infectious waste – dry spill

Place collected dry spill

into a yellow bag.

Collect dry spill with brushes,

pans, or suitable equipment.

Decontaminate spill area by

carefully spraying with a chlorine
solution and wiping the area dry.

Place used cloths or paper

towels into a yellow bag,
close securely, and label.

Dispose of or decontaminate
all PPE or equipment used.

Take yellow bags to

designated
waste storage area.

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Infectious waste – wet spill

Continue to wipe the area

with cloth or paper towels
until all contaminants are
removed.

Place cloth or paper towels Place saturated cloth

on wet spill to absorb it or paper towels into
(approximately 5 minutes). a red bag.

Place used cloth

or paper towels Decontaminate spill area by
into red bag. carefully spraying with a chlorine Place used cloth or
solution and wiping the area dry. paper towels into
the red bag, close
securely, and label.

7
Take red bags to Dispose of or decontaminate
designated all PPE or equipment used.
waste storage area.

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Infectious waste (sharps) – sharps spill

Collect the sharps with a brush and

long-handled dust pan or use forceps Place collected sharps
or tweezers where necessary. into a sharps safety box
and close securely.

Decontaminate spill area by

carefully spraying with a chlorine
solution and wiping the area dry. Place used cloth or paper
towels into a yellow bag, close
securely, and label correctly.

Dispose of or decontaminate
Take the sharps safety box(es) and yellow all PPE or equipment used.
bag to designated waste storage area.

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Chemical – general spill

Consult the material safety data

sheet (MSDS) issued with the
chemical in question for guidance.

Collect chemical spill

with suitable means and
equipment as directed
by the MSDS.

Place contaminated materials into

a brown bag or container (where
applicable), close securely, and
label correctly, as per MSDS.

Take brown bag or container to

designated waste storage area.
Once spill is cleared, decontaminate
spill area as per MSDS.

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Heavy metal – mercury spill

Retrieve the mercury Place any broken glass Collect all visible drops of
spill kit. into a heavy-duty self- mercury using one of the
sealing plastic bag. Label following:
the bag as containing a. Aspirator with a narrow tube
mercury contaminant. b. Syringe (without a needle)
c. Pasteur pipette or rubber bulb
d. Strips of adhesive tape

Place collected mercury Use cardboard sheets or Place disposable gloves

in jar with enough masking tape to capture any and all cleaning aids into
clean water to cover spilled beads, using your a self-sealing bag and
the mercury, close the torch for optimal visibility. label accordingly.
lid securely, and label
correctly.

Make arrangements with Wash protective visors with Wash hands thoroughly
responsible person with liquid soap and warm clean with soap and warm
regards to storage and/ water, and dry with paper clean water.
or disposal procedures towel before returning to
for mercury waste. Mercury Spill Kit.
trol
ll Con
ry Spi
Mercu

Return the mercury spill

kit to the proper person.
Replace any used items
Document details in the logbook or control in the spill kit.
sheet found in the mercury spill kit.
For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Making chlorine solution from liquid bleach

Determine the percentage of active

chlorine solution by reading the active
ingredients on the label of the bottle.
Note: Chlorine solution concentration will
vary from approximately 2.4% to 15%.

Mixing chlorine solution

PARTS OF CLEAN WATER TO 1 PART OF BLEACH
CHLORINE % AVAILABLE
0.5% SOLUTION 0.1% SOLUTION
2.4% 4 23
3.5% 6 34
3.6% 6 35
5% 9 49
6% 11 59
8% 15 79
Put on required 10% 19 99
personal protective 15% 29 149
equipment (PPE).
Using the table above, determine the correct amounts of
concentrated bleach and clean water required to make the
decontamination solution.

Measure the appropriate Pour the clean water Measure the appropriate
clean water as indicated into the bucket. volume of chlorine
in Step 3. solution found on the
chart in Step 3.

Pour corresponding Use a mixing To dispose of the solution, dilute by adding

amount of chlorine spoon to gently clean water to top off the bucket. Pour
solution concentrate mix the solution. diluted chlorine solution down a utility sink
into the bucket Solution is now drain or latrine or into a flushable toilet.
that contains the ready for use. Avoid splashing. Rinse the toilet or sink with
measured clean clean water to remove residual wastes.
water. Note: The chlorine solution should not be reused;
a new solution must be made for each cleaning.

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Making chlorine solution from powders
Put on required
personal protective
equipment (PPE).
Measure the
appropriate volume
of clean water as
indicated in Step 3.
Use a mixing
spoon to gently
mix the solution.
Solution is now
ready for use.
For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
Determine the Check concentration of the powder you
percentage of active are using.
% Dilute
hypochlorite by reading Grams/Liter = % Concentrate x 1,000
the active ingredients on Mix measured amount of bleach with 1 liter
of clean water.
the label of the container.
Example: Make a dilute chlorine-releasing
Note: Hypochlorite solution (0.5%) from a concentrated
concentration will vary from powder (35%).
approximately 2.4% to 15%. 0.5%
Step A:Grams / Liter = 35% x 1,000 = 14.2 g/L
Step B: Add 14.2 grams to 1 liter of water.
Mixing chlorine solution
CHLORINE % AVAILABLE Grams of chlorine powder per liter of water
0.5% SOLUTION 0.1% SOLUTIONb
Calcium hypochlorite (70%) 7.1 g/La 1.4 g/L
Calcium hypochlorite (35%) 14.2 g/L 2.8 g/L
NaDCCc (60%) 8.3 g/L 1.5 g/L
Chloramine tablets (1 g per tablet) 20 (tablets) g/Ld 4 (tablets) g/Ld
NaDCC tablets (1.5 g per tablet) 4 tablets/L 1 tablets/L
a
For dry powders, read x grams per liter (example: Calcium hypochlorite 7.1 grams mixed with 1 liter water).
b
Use boiled clean water when preparing a 0.1% chlorine solution for high-level disinfection (HLD)
because tap water contains microscopic organic matter that inactivates chlorine.
c
Sodium dichloroisocyanurate.
d
Chloromine releases chlorine at a slower rate than does hypochlorite. Before using the solution,
be sure the tablet is completely dissolved.
Using the table above, determine the correct amounts of concentrated
bleach and clean water required to make the decontamination solution.
Pour the clean Measure the Add corresponding
water into the appropriate number amount of powder into the
bucket. of grams of powder bucket that contains the
found in Step 3. measured clean water.
After use, dilute the solution by Pour the diluted chlorine solution
adding water to top off the bucket. down a utility sink drain or latrine, or
Note: The chlorine solution should into a flushable toilet. Avoid splashing.
not be reused; a new solution must be Rinse the toilet or sink with clean
made for each cleaning. water to remove residual waste.
 Processing reusable metal instruments

Receive the instruments Decontaminate

Wrap the instruments Sterilize

Store

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Decontaminating reusable metal instruments

Put on
required
personal
protective Determine the proper
Mix chlorine solution
equipment procedure for mixing the
according to procedures
(PPE). chlorine solution.
found on pages 44 and 46.*

Place reusable metal

Fill a second bucket 3/4 full
instruments in the prepared
with water and detergent.
decontamination solution
Fill a third bucket 3/4 full
for 10 minutes.
with clean water.

SOLUTION

CLEAN

WATER

BATH

DETERGENT

AND CLEAN

WATER

Place the three buckets
next to each other: one
bucket with pre-soaked
instruments, one bucket
with detergent and clean
water, and one bucket with
clean water for the bath.
Remove half the instruments Place the scrubbed
from the pre-soak solution and instruments into the clean
place them in the bucket of water bath for rinsing.
detergent and clean water. Scrub
the instruments with a nylon
bristle brush until all signs of
contaminants have been removed.

Remove instruments Place decontaminated After use, dilute the Pour diluted chlorine
from clean water bath reusable instruments in solution by adding water solution down a utility
and place them on containers for storage or to top off the bucket. sink drain or latrine,
a clean, dry towel. sterilization. Reusable Note: The chlorine solution or into a flushable
Inspect instruments instruments can be should not be reused; a toilet. Rinse the toilet
for rust, blunting, or sterilized following the new solution must be made or sink with clean
residual contamination. procedure on page 56.* for each cleaning. water to remove
residual waste.
For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Wrapping of reusable metal instruments

Inspect instruments for Place instruments in Place closed

contamination and verify that autoclave container or container or carton
all required instruments are carton. in center of steam
present for kit assembly. sterilization wrapper.

Lift one corner of Lift left corner of Lift right corner of

wrapper, fold over, and wrapper and fold over wrapper and fold over
tuck under long side of container or carton so container or carton
container or carton. that the wrapper is flush until wrapper is flush
against the short side. against the short side.

Fold extended Fold long V Secure this fold Secure both sides
wrapper inward back over top with sterilization of the wrapper with
to make a of container or indicator tape. sterilization indicator
long V shape. carton and tuck tape. Do not use
underneath into other tape, pins,
folds. clips, staples, or
sharp objects.

For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
 Decontaminating single use instruments

Put on
required
personal
protective Determine the proper
Mix chlorine solution
equipment procedure for mixing the
according to procedures
(PPE). chlorine solution.
found on pages 44 and 46.*

Place reusable metal

Fill a second bucket 3/4 full
instruments in the prepared
with water and detergent.
decontamination solution
Fill a third bucket 3/4 full
for 10 minutes.
with clean water.

SOLUTION

CLEAN

WATER

BATH

DETERGENT

AND CLEAN

WATER

Place the three buckets
next to each other: one
bucket with pre-soaked
instruments, one bucket
with detergent and clean
water, and one bucket with
clean water for the bath.
Remove half the instruments Place the scrubbed
from the pre-soak solution and instruments into the
place them in the bucket of clean water bath for
detergent and clean water. Scrub rinsing.
the instruments with a nylon
bristle brush until all signs of
contaminants have been removed.

Remove instruments After use, dilute the Pour diluted chlorine Place properly
from clean water bath solution by adding water solution down a utility decontaminated
and place them on a to top off the bucket. sink drain or latrine, or instruments in a
clean, dry towel. Note: The chlorine solution into a flushable toilet. labeled and sealable
should not be reused; a Rinse the toilet or sink plastic drum or
new solution must be made with clean water to plastic container.
for each cleaning. remove residual waste.
For more information, refer to the Environmental health management for voluntary medical male circumcision services site management guide.
This pocket guide is made possible by the generous support of the American
people with support from the US President’s Emergency Plan for AIDS
Relief (PEPFAR) with the US Agency for International Development (USAID)
under the terms of Supply Chain Management System contract number
GP0-I-00-05-00032-00 and Cooperative Agreement Strengthening High Impact
Interventions for an AIDS-free Generation, number AID-OAA-A-14-00046.
The information provided in this publication is not official U.S. Government
information and does not represent the views or positions of the USAID,
PEPFAR, or the US Government.