Health technologies : Safe injection : Health care waste management

Health care waste management resources

PATH has gathered available resources on health care waste management to provide easy access to the information. This web page is intended to serve as a resource for countries and programs working to improve health care waste management. Included in these resources are some essential pieces of information for planning and decision-making:

National policy and planning

Framework for Conducting a Self-Assessment of National Progress In Injection Waste Management, Version 1
PATH, 2008
This self-assessment tool was developed by PATH to meet the need for a simple, efficient framework for conducting a self-assessment of health care waste management (HCWM) planning at the national level. By collecting data on key achievements, knowledge, and practices regarding injection waste management in two tiers, at the district and national levels, the framework allows data to be quickly aggregated, trends highlighted, and gaps identified. A national-level workshop then provides the opportunity to outline next steps for moving the revised HCWM planning agenda forward. This approach ensures that national-level changes have innate support and immediate momentum.

Achieving Effective Sharps Waste Management In GAVI Host Countries
PATH, 2006
This document presents an analysis of sharps waste management approaches that would reduce infections associated with unsafe injection practices. The analysis considers the risk of infection related to each sharps waste management approach and proposes short- and long-term solutions for health care waste management challenges specific to different levels of infrastructure.

Guiding Principles for Managing Medical Waste
PATH, 2005
This guidance document provides a brief overview of key considerations for developing a medical waste management plan at the facility, district, and national levels.

Preparation of National Health-Care Waste Management Plans in Sub-Saharan Countries
WHO, 2005
This document provides background information and assessment and planning tools to assist health care waste management advisors with developing and implementing national-level plans.

National Health-Care Waste Management Plan: Final Report
The State of Eritrea/Ministry of Health, 2003
The national plan for health care waste management developed by Eritrea is an example of a comprehensive strategy that may be a useful reference for other countries. This plan was developed with the support of the World Bank.
Download/view file in English (3.46 MB PDF) from World Bank website.

“First, do no harm,” Introducing auto-disable syringes and ensuring injection safety in immunization systems of developing countries
WHO, 2002
This document was developed to assist policymakers and program managers in planning the introduction of autodisable syringes as part of a comprehensive national policy and plan of action to improve injection safety, both for routine immunization and for mass campaigns. Needle removers are listed among the methods for managing sharps waste.

Aide-Mémoire for a National Strategy for Health-Care Waste Management
WHO, 2000
This document was developed to assist health care planners at the national level. It provides an overview of the main aspects that have to be dealt with and a checklist for actions at the national and local levels.

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District- and facility-level policy and planning

Management of Waste From Injection Activities at District Level: Guidelines for District Health Managers
WHO, 2006
This guide is designed as a simple and practical tool to help district health managers develop a realistic district-level plan to reduce improper disposal of waste from injection activities. An accompanying poster is also available.

Management of Solid Health-Care Waste at Primary Health-Care Centres: A Decision-Making Guide
WHO, 2004
This document provides guidance for selecting the most appropriate method for safely managing solid waste generated at primary health care centers in developing countries. It includes six decision trees aimed at assisting the user in identifying appropriate waste management methods. It is intended for staff working in primary health care centers and technical staff working in local, state, or central administration.

Planning for Safe Syringe Disposal: Making Medical Injections Safer
PATH, 2004
This guide is designed to help health workers plan disposal systems for sharps waste. The document details critical planning steps including mapping the district, reviewing sharps collection options and needle removal, reviewing options for disposal, developing a disposal system, and creating a district planning guide to calculate needs and plan implementation.

Basic Steps in the Preparation of Health Care Waste Management Plans for Health Care Establishments
WHO, 2002
This document provides basic steps and a simple and practical approach for the preparation of a health care waste management plan in small, medium, and large health care establishments. It is hoped this will assist managers of health care establishments in developing plans to optimize and sustain the operation of HCWM systems in their health care institutions.
Download/view file (274 KB PDF) from WHO website.

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Technical resources

The Incinerator Guidebook: A Practical Guide for Selecting, Purchasing, Installing, Operating, and Maintaining Small-Scale Incinerators in Low-Resource Settings
Making Medical Injections Safer, 2010
This guidebook captures lessons learned by PATH over the course of the Making Medical Injections Safer project, in both Centers for Disease Control and USAID countries, on selecting, procuring, and installing a small-scale incinerator for health care waste management.

Small-Scale Autoclaves to Manage Medical Waste: A Buyer’s Guide to Selecting Autoclaves Manufactured in India
PATH, 2008
This booklet is intended to provide a starting point for managers interested in learning more about autoclaves and to aid in decision-making for purchase of medical waste autoclaves manufactured in India. It includes issues to consider when purchasing an autoclave, technical specifications of some devices, and a list of Indian manufacturers of autoclaves with current contact information. The information is based on desk research and has not been verified through bench testing or field evaluation.

For Proper Disposal: A Global Inventory of Alternative Medical Waste Treatment Technologies
Health Care Without Harm, 2007
Health Care Without Harm (HCWH) developed this inventory to provide a global listing of alternative technologies for the treatment of infectious waste. These alternative technologies operate under conditions that avoid formation of dioxins and furans. The inventory is intended for use by health and environment ministries, international organizations, aid agencies, multilateral lending institutions, national and local planners, policymakers, health care professionals, and nongovernmental organizations involved in health care waste management or in the development of national and local health care waste management plans.
Download file (450 KB PDF) from the Health Care Without Harm website.

Small-Scale Incinerator Construction: Recommendations from the Rwanda Experience
Making Medical Injections Safer (MMIS), 2007
This report documents efforts in Rwanda to support infrastructure and systems development to ensure the safe handling, treatment, and final disposal of infectious medical waste. This document highlights recommendations from the Rwanda experience in an effort to assist stakeholders interested in safe disposal of medical waste in Rwanda and other countries to better plan health care waste management infrastructure projects that include small-scale incinerator construction.

Personal Protective Equipment and Segregation Supply Specifications: For Health Care Waste Management
PATH, 2006
This resource provides guidance on the selection and purchasing of personal protective equipment. These specifications are guidelines that can be adapted to local policies and product availability. Web links provide pictures and product information that demonstrate commercial equipment that meet these specifications.

Managing Health Care Waste Disposal: Guidelines on How to Construct, Use, and Maintain a Waste Disposal Unit
WHO, 2005
These guidelines focus on specifications, installation, and operation and maintenance procedures of a waste disposal unit using the De Montfort incinerator. They include a plan for training waste disposal unit operators. Development of these guidelines were funded by PATH.
Download/view file (2.73 MB PDF) from WHO website.

Managing Health Care Waste Disposal: Operator’s Manual
WHO, 2005
This manual details operation and maintenance procedures of a waste disposal unit, using the De Montfort incinerator. The operator’s manual outlines the best practices for disposing of health care waste. Development of this manual was funded by PATH. The manual is available in English and French.

Treatment Alternatives for Medical Waste Disposal
PATH, 2005
The purpose of this document is to inform the reader about different technology options for the treatment of infectious medical waste, particularly for developing countries. It describes incineration, chemical treatment, autoclaving, microwaving, and shredding/compacting. Performance issues, environmental impact, and perspectives from several developing countries are described.

Safe Management of Wastes From Healthcare Activities
WHO, 1999
This WHO handbook provides comprehensive guidance on safe methods for the handling and disposal of health care waste. It defines the categories of waste and pays particular attention to basic processes and technologies for managing waste in low-resource settings. The guide is aimed at public health managers and policymakers, hospital managers, and environmental health professionals.
Download/view file from WHO website.

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Field evaluations

Managing Sharps Waste in Andhra Pradesh: Introduction and Scale-Up of a Sharps Waste Management Program
PATH, 2007
The Partnership Project on Immunization in Andhra Pradesh, India, worked to strengthen immunization systems throughout the state. Injection safety was one of its major goals. To improve injection safety, the project introduced and scaled up a practical system for sharps waste management. This case study describes the sharps waste management component of the Partnership Project and describes key developments in both the pilot and scale-up phases of the project.

Final Report: Evaluation of Three Reuse-Prevention Feature Reconstitution Syringes in Three Districts of Indonesia
PATH, 2007
This document reports on the findings of a field evaluation of three World Health Organization prequalified syringes with reuse-prevention features used for vaccine reconstitution during a measles campaign in Lombok, Indonesia. The objective of the field evaluation was to identify the training and introduction requirements of these syringes and establish an understanding of their acceptability, performance, and safety during field use. The evaluation was funded by UNICEF.

Evaluation of a Retractable Syringe in South Africa: Acceptability, Safety, and Cost Implications, KwaZulu Natal, South Africa
PATH, 2007
In 2006 and 2007, PATH assessed the acceptability, perception of safety, effect on waste management, and cost implications of using retractable syringes in immunization and curative settings in KwaZulu Natal, South Africa. This report provides a detailed description of the study findings.

Field Evaluation of the Acceptability and Feasibility of Syringe Melters in Indonesia
PATH, 2007
This report provides a detailed description of the study findings from a field evaluation of three syringe melters temporarily placed in five health centers in Indonesia. The purpose of the evaluation was to assess the field performance of the devices, acceptability by health workers, fit into the existing waste management system, and potential design modifications.

Protecting Children for a Healthy Tomorrow: Lessons From the Andhra Pradesh Partnership Project on Immunization
PATH, 2006
This document summarizes the practical lessons learned as well as the challenges encountered during implementation of the Andhra Pradesh (AP) Partnership Project on Immunization, an initiative implemented through a partnership between the Government of Andhra Pradesh, India, and PATH. The project’s main objectives were to introduce hepatitis B vaccine as part of routine immunization, improve injection safety, strengthen routine immunization services, establish a name-based registry for effective immunization status tracking, and provide technical support for the control of Japanese encephalitis (JE) in AP.

Medical Waste Management for Primary Health Centers in Indonesia
PATH, 2005
During 2003 and 2004, PATH, working with the Indonesian Ministry of Health, undertook a process of awareness building and modeling to provide policy guidance to Indonesia’s decision-makers. Pilot waste management systems were implemented in three districts of Yogyakarta province, covering a population of 1,677,000 and 67 health centers. These areas contained both rural and urban populations, infrastructures, and physical conditions that were considered representative of many districts in Indonesia. This report describes the process and the lessons learned. It was used to guide waste management policy development in Indonesia and can provide a useful model for other countries.

Field evaluations of needle removers
Needle removers have been evaluated in a number of countries as an approach for managing sharps waste. Reports on these evaluations can be found on our needle remover resources page.

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Advocacy

PATH’s Health Care Waste Management Photo Library’s photostream
PATH, 2010
PATH has gathered select photographs from its field experience in health care waste management (HCWM). This photo library is intended to be a resource for those working in HCWM to help communicate the situation in many countries where we work, documenting the HCWM system from waste generation to final disposal. The library also documents some of the best practices being implemented globally. Use of these photos is permitted for educational or noncommercial use provided that PATH is acknowledged.

Quantifying Infectious Waste Produced by HIV/AIDS, Malaria, and Tuberculosis Programs and the Needs for Injection Safety Equipment
PATH, 2009
This document is intended to start discussions around quantifying the need for safe injection equipment and the amount of infectious sharps waste produced by testing and treatment programs for diseases such as HIV/AIDS, tuberculosis, and malaria. The analysis was developed to support advocacy efforts to integrate injection safety as an essential element of all health care programs.

Helping PEPFAR Partners Manage Health Care Waste: Practical Approaches and Lessons Learning From Uganda and Nigeria
PATH, 2009
Under the Making Medical Injections Safer project, PATH has supported ministries of health and environment to develop the systems needed for effective health care waste management. This paper describes the process, tools, and strategies used to successfully engage PEPFAR partners in Uganda and Nigeria to improve health care waste management.

Health Care Waste Management: Sharing the Responsibility
PATH, 2009
PATH and JSI developed these brief talking points on HCWM to support advocacy efforts in order to raise awareness about why HCWM is important and how programs can improve current practices.

Global Resources for Health Care Waste Management
Making Medical Injections Safer (MMIS), 2009
This table was developed under the Making Medical Injections Safer project, which PATH partners on in the areas of health care waste management (HCWM) and procurement technical assistance. The table provides brief summaries and contact information on many of the organizations that are actively engaged in HCWM throughout the developing world. It is intended to be a resource for country programs and governments seeking funding to support HCWM activities at the country level.

Guiding Principles for Managing Medical Waste
PATH, 2005
This document provides a brief overview of PATH’s approach and the key considerations for developing a medical waste-management plan at the facility, district, and national levels.

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Training

Incinerator Maintenance Checklist
PATH, 2010
This job aid was developed to support training of small-scale incinerator operators and provides key message about how to perform regular maintenance. Regular maintenance is critical to ensuring the incinerator functions optimally for the projected life of the unit.

Incinerator Operator Guidelines
PATH, 2010
This job aid was developed to support training of small-scale incinerator operators and summarizes safe and effective operation. Key steps are outlined, including preheating and optimal loading instructions. By following these steps, incinerator operators can help ensure the unit operates optimally, reaching desired temperatures and ensuring waste is safely treated.

Training Health Workers in the Management of Sharps Waste
PATH, 2006
This document contains a set of training modules designed to be adapted for use in various health care settings. The purpose of these materials is for use in training health workers in the management of sharps waste. These materials are divided into two training guides, one for training injection providers and one for training waste handlers. By providing the materials in electronic files that can be modified and used in a modular format, PATH is hoping to facilitate local adaptation.

Key Steps in Sharps Waste Disposal
PATH, 2006
This training aid was developed as part of Training Health Workers in the Management of Sharps Waste. The aid includes a graphic representation of the key steps involved in the safe management of health care waste: segregation, containment, handling and storage, transport, treatment or destruction, and disposal.

Segregation of Medical Waste
PATH, 2006
This training aid was developed as part of Training Health Workers in the Management of Sharps Waste. The aid includes a graphic representation of the segregation of medical waste into three categories: noninfectious, infectious, and sharps. Over the last few years a number of countries have adapted the basic concepts and developed country-specific versions of this for use in training as well as posters in health facilities. An example adapted for Kenya is also available.

Personal Protective Equipment for Waste Handlers and Incinerator Operators
PATH, 2008
This training aid was developed as part of Training Health Workers in the Management of Sharps Waste. The aid includes a graphic representation of the key equipment needed to help protect waste handlers and incinerator operators during the collection, treatment, and final disposal of health care waste.

Giving Safe Injections: Using Auto-Disable Syringes for Immunization
PATH, 2001
This manual is intended for health workers and covers five different lessons related to safe injection of vaccine: disease transmission through unsafe injection, safe selection and reconstitution of vaccine, preventing needlestick injuries through safe injection practices, and an introduction of the autodisable syringe. This manual can be presented by a trainer or reviewed by health workers alone or in groups. The manual is available in English, French, and Russian.

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Procurement of safe injection equipment

Guidelines for Implementing a National Procurement Policy to Integrate Safe-Injection Equipment
Making Medical Injections Safer, 2010

This document identifies key steps and information relevant to the development and implementation of a national procurement policy on safe-injection equipment. The intention is to increase patient and health worker safety, and especially to avoid medical transmission of bloodborne infections such as HIV, hepatitis B, and hepatitis C.

Landscape for Safe Injection, Phlebotomy, and Waste Management
Making Medical Injections Safer, 2010
This document provides guidelines for implementing a procurement policy for safe injection and brings together issues that countries should consider when developing and implementing the procurement aspect of a national injection safety policy. The document points out issues to consider in transitioning from policy to implementation, regulatory factors, public-sector considerations, and the need to sensitize private-sector manufacturers. It also includes a landscape of manufacturers of safe injection equipment.

Procurement Guidance for Countries: A User's Guide for Resources on Procuring Safe Injection Equipment
Making Medical Injections Safer, 2010
This document provides practical illustrations on how to use key global resources related to the procurement of safe-injection equipment. It is intended for use by country decision-makers responsible for selecting and procuring good-quality safe-injection equipment.

Online resources

Health Care Without Harm
Health Care Without Harm is an international coalition of 473 organizations in more than 50 countries working to transform the health care sector so it is no longer a source of harm to people and the environment.
Visit the Health Care Without Harm website.

Making Medical Injections Safer Project
The Making Medical Injections Safer (MMIS) Project is a five-year initiative funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the US Agency for International Development and the Centers for Disease Control and Prevention. MMIS is implemented by John Snow, Inc. in collaboration with PATH, the Academy for Educational Development, and the Manoff Group. By the end of the five-year project in 2009, MMIS and national counterparts will have established an environment where patients, health care workers, and the community are better protected from the medical transmission of HIV and other bloodborne pathogens.
Visit the Making Medical Injections Safer website.

Needle Remover Resources
This web page was developed by PATH and is intended to serve as a resource for countries and programs considering the introduction of needle removers. Included in these resources are some essential pieces of information for planning and decision-making.
Visit the Needle Remover Resources web page.

Safe Injection Global Network Alliance
The Safe Injection Global Network (SIGN) Alliance is coordinated through the World Health Organization. SIGN is a voluntary coalition of stakeholders aiming to achieve safe and appropriate use of injections throughout the world.
Visit the Safe Injection Global Network website.

Technical Network for Strengthening Immunization Services
Technical Network for Strengthening Immunization Services (TechNet21) is a professional network of experts in logistics who are involved in the management of immunization and other primary health care operations at the country and international levels. It serves as a forum where issues relevant to implementation of immunization services can be discussed, debated, and clarified. The forum is maintained by the World Health Organization.
Visit the TechNet21website.

Vaccine Resource Library
PATH’s Vaccine Resource Library offers a wide variety of high-quality, scientifically accurate documents and links on vaccine-preventable diseases and topics on immunization. In addition to resources developed at PATH, the library contains materials published by international leaders in public health, including the US Centers for Disease Control and Prevention, the World Health Organization, the GAVI Alliance, and many others.
Visit the Vaccine Resource Library website.

WHO Healthcare Waste Management Resource
This website is managed by the World Health Organization. It is a resource for policy, planning, and management of health care waste and includes a number of databases that can be searched for technical reference material.
View the WHO Healthcare Waste Management Resource website.

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Acknowledgments

PATH’s work in the area of health care waste management is supported by the US Agency for International Development through funding under the HealthTech Program, the President's Emergency Plan for AIDS Relief under the Making Medical Injections Safer Project, and others.

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