Health Care Waste Management (HCWM) Regional Approach

1. Health Care Waste Management (HCWM)Regional Approach Ohrid, Ana Petrovska STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

2. Minimum Requirements for single generators • Small generators: • Segregation following the requirements of the Regulation (OGRM no 146/07). • Obligatory use of a yellow (as receptacle), plus special boxes for pharmaceuticals, amalgam boxes, etc. • Storage room should as a minimum be equipped with shelves for storage of the boxes STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

3. Minimum Requirements for single generators (II) • Large generators: • Segregation following the requirements of the Regulation (OGRM no 146/07), via the use of colour coding and identification labels. Also the use of special receptacles is recommended. • When full the receptacles shall be collected and transported to a central storage facility. For the infectious and biological (pathological) waste collection should take place minimum once a day. Collection and transportation is done using a hand-pushed trolley or similar • The central storage facility shall in the basement or at ground level of the HI, with easy access to the outside of the building. Ventilation and easy cleaning of surfaces should be enabled. Unauthorised access must be avoided. STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

4. Collection Frequency • Large generators: • 1-2 times each week in order to maintain proper sanitary conditions in the storage room. • Small generators: • 1-2 times per month or on request. At collection the boxes used at smaller HIs will be transferred to containers used as the secondary packaging required for transport. STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

5. Standard Wheeled Plastic Containers • By introducing standard plastic containers on wheels as the main transport packaging two important objectives are achieved: • Skilled staff will perform loading of the containers and no reloading takes place before the container is emptied at the treatment facility; • Compliance with the ADR rules specifying the use of a combination (inner and outer) packaging for transport of dangerous goods by road. STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

6. Collection Vehicles • Large generators: • Collection of HCRW from hospitals and health centres is performed by larger trucks equipped with a closed cargo compartment large enough to hold approx. 40 containers (size 240 litres). The truck is equipped with a back-lift for easy loading of the containers. Both containers and the truck must be marked with a label according to the ADR Convention (Class 6.2, UN 2814 and UN 3291). • Small generators: • Collection of HCW from the smaller HIs, i.e. ambulatories, private GPs, dentists, etc. is done by a small truck or van operated by the local general hospital or health centre transporting the collected HCW to the central storage facility at the general hospital or health centre. STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

7. Regional HCWM System • Collection and transportation of HCW in the Skopje area could be provided by PE “Komunalna Higiena” – Skopje, using larger trucks for the transport of the standard plastic containers on wheels from the central storage facilities at hospitals and health centres. • Small trucks or vans can be delivered to the health centres for the provision of the collection service towards the smaller His. STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

8. Regional HCWM System (II) • Outside the Skopje area the 15 general hospitals and the 32 health centres may function as collection points for HCW generated in the smaller HIs in their respective areas. • Received waste at the general hospitals and the health centres may be stored in the respective central storage facilities until the transport to the treatment facility is carried out. The central storage facilities at hospitals will be cooled with maximum temperature of 8 Co, while this is not necessary for immediate storage facilities. • Transport from regional storage centres to the treatment facility will take place minimum once a week by a company having the proper permit and license to carry out transport of hazardous waste. STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

9. Organizational (Institutional) Issues • Regional Centres (Health Care Institutes or General Hospitals) provide collection to smaller generators • Similarly, these Centres provide also the transport to the treatment facility. • Hospitals are organized at regional level and can decide on the contracting out of the collection and transport. • A special arrangement for the primary collection service could be considered for Skopje, due to the fact that PE “Komunalna Higiena” – Skopje already is performing this collection service. Existing contracts between PE “Komunalna Higiena” – Skopje HIs must be revised in accordance with the change in services; in addition, the company must obtain a proper permit and license for collection and transport of hazardous waste STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

10. New Duties of Regional Systems / Organizations • Collection and transport of HCW from central storage facilities (general hospitals and health centres) • Registration and reporting of all waste types and amounts collected (preparation of Waste Transportation Lists to be used as consignment documents); • Division of waste collected, for in-house treatment and/or for treatment and disposal at regional treatment/disposal facilities; • Operation of the medical waste treatment facility (incinerator or autoclave(s)) including all necessary maintenance, monitoring and reporting activities; • Transport of medical waste treatment residues for final disposal including registration of types, amounts and final destination. STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

11. Ownership of Regional Systems / Organizations • Joint Ownership • Shareholding • Association of hospitals • Individual Ownership • Ownership over the collection and transportation equipment by the regional centers • Ownership over the regional treatment facilities • Public Private Partnerships • Tendering out of the collection & transportation • Tendering out of the treatment STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE