Medical Waste Mangement Compliance.

6th of october central hospital .

 IPC PROJECT
PROBLEM STATMENT :

 Medical Waste Mangement Compliance Among Hospital HCWs During

March 2024 Was 40 %.
 The term “medical waste” covers all wastes produced in health-care or
diagnostic activities.75 % to 90 % of hospital wastes are similar to
household refuse or municipal waste and do not entail any particular
hazard.
 Poor waste management can jeopardize care staff, employees who handle
medical waste, patients and their families, and the neighbouring population.
In addition, the inappropriate treatment or disposal of that waste can lead
to environmental contamination or pollution.
 Classification of hazardous medical waste.

1. Sharps > Waste entailing risk of injury.

2. a. Waste entailing risk of > Waste containing blood,
contamination secretions or excreta entailing a
b. Anatomical waste risk of contamination.
> Body parts, tissue entailing a risk of
c.Infectious waste contamination
> Waste containing large quantities

of material, substances or cultures

3. a.Pharmaceutical waste
b. Cytotoxic waste
entailing the risk of propagating
infectious agents (cultures of
infectious agents, waste from
infectious patients placed in
isolation wards).
> Spilled/unused medicines,
expired drugs and used
medication receptacles.
> Expired or leftover cytotoxic

c. Waste containing drugs, equipment contaminated

heavy metals with cytotoxic substances.
> Batteries, mercury waste (broken
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 thermometers or manometers,
d. Chemical waste
fluorescent or compact fluorescent
light tubes).
> Waste containing chemical
substances:
leftover laboratory solvents,
disinfectants, photographic
developers and fixers.
4. Pressurized containers > Gas cylinders, aerosol cans.

5. Radioactive waste > Waste containing radioactive

substances: radionuclides used in
laboratories or nuclear medicine,
urine or excreta of patients
treated.

GOAL and objectives:

1. TO Improve compliance of medical waste management from 40% to

90% over 3 months .period from 1st of April to 30 of June 2024.
2. To improve sorting of medical waste.
3. To deacrease financial cost of medical waste .
4. To prevent harmes to health workers,patients,vistors and
environment
5. To improve quality of care for accreditation.

ORGANIZE ATEAM :

Team leader: Infection control consultant

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 DR:

Facilitator: Quality coordinator .

DR:

Members:

Hospital manger :

Lab. Manger :

I.C Officer :

Nursing Director :

Sales Manger:

Housekeeping :

Clarify the current process :

 According to WHO, the average quantity of waste per bed per day is estimated
to range from 0.7–1.7 kg/bed .
 Flow chart shows the different stages of proper medical waste management
from the start to the end .
 Stages of waste management include sorting, collection, transportation ,
storage, treatment and final disposal .

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Understand the cause of variation :

A. Acause and effect diagram (Fishbone diagram).

An error of performance in waste disposal was considered to exist if there is

(1) Inappropriate segregation.

(2) Inappropriate handling (transport).

(3) Lack of supplies (trash trolleys, bins, sharps containers, and black and red plastic
waste bags) .

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(4) Defective personal protective equipment (PPE).

(5) Inappropriate sharp disposal.

(6) Inappropriate interim waste storage.

B. Data collection (in depth studies).

 Data collected from .

 A checklist was developed to gather information about wrong performance in
waste disposal process according to the National Infection Control Manual and
CDC guidelines for medical waste.
 The checklist was reviewed and evaluated.
 Then, the IP worked daily to collect data from all departments starting with
waste segregation till interim storage of waste

 Check list of performance of waste disposal

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 Subject Yas No
1 Presence of red and black waste bags in all patient care areas
2 Red bags present near places of infectious waste production
3 Waste bags are tied and changed per shift or when 3/4th full
4 There is waste segregation at the origin
5 Presence of scattered waste outside waste bags
6 Regulated medical waste is transported in rigid, leak-proof containers,
strong enough to avoid tearing or bursting during handling, and sealed during
transport
7 There is data sticker (biohazard symbol, generator name, and type of waste)
attached to each package of regulated medical waste.
8 Containers, used to hold regulated medical waste, decontaminated when
necessary
9 Workers are wearing personal protective equipment PPE
10 Workers use safe method of waste manipulation and transportation to
interim store
11 Interim storage room is cleaned daily, protected from animals, pests, and
rodents
12 The door of interim storage room is kept closed to prevent unauthorized
access
13 Sharp containers are put as near as possible to the origin of sharp waste
14 Sharp containers are closed and disposed when 3/4th full
15 There are waste bags stored outside storage room
16 There is log documenting waste delivery out of hospital
17 There is schedule of daily transfer of hazardous waste by car to incineration

Data interpretation:
The results were collected and analyzed by team members, and five main variables
were encountered. These included

1. No rigid containers to transport the waste bags to storage place.

2. Deficient training of workers in waste management process.
3. Insufficient number of workers mostly with bad general health condition who
carry out steps of waste disposal.
4. Segregation of waste at origin of production was sometimes wrong in
addition to faulty sharp disposal.
5. Defective interim storage using the old incinerator room for this purpose.
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This table show Total effect of the ranked causes according to their frequency.

Category Frequency Percent of total % Cumulative %

Lack of supply 100 50 50

Deficient training 50 25 75

Insufficient workers 35 17.5 92.5

Segregation/ Sharp 12 6 98.5

disposal
Interim storage 3 1.5 100

Grand total 200 100 100

Medical waste non compliance pareto analysis

120 120

100 100

80 80
cumulativ %
frequency

60 60

40 40

20 20

0 0
lack of supply deficient training insuff.worker segg./sharp disp.interim storage

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 From pareto analysis 80% of the cause of medical waste non compliance is
deficient training of workers.

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 The improvement of medical waste management :
The team listed several creative new improvement solutions

 All nursing staff , workers, and even physicians were submitted to

training and education on the proper steps of safe waste management,
how to avoid stick injury and blood and body fluid exposure, and
how to manage if the exposure happened, with a referral comparison
be- tween previous performance which was unsafe for the health of
patients, all employees, and even visitors, in addition to the
surrounding environment, and the new improved safe waste
management steps.
 Increase adherence to waste management policy.
 The team requested contracting with proficient house- keeping company
through the administration as the workers of the facility were not enough
to carry the entire workload, becoming more and more elder, and having
increased absence due to chronic diseases.
 Put a schedule for waste collection, transport to interim storage room, and
final hand-over out of the facility .
 Materials and supplies including red bags, trollies, and personal protective
equipment had been checked to be available any time.
 The interim storage room was checked for inaccessible to neither insects
nor animals, good ventilation , hand hygiene station (a sink with water
supply and drainage connection)
 Sharp waste should be placed into puncture-proof containers located as
close as possible to the point of use. Used syringe needles should not be
bent, recapped, or broken before discarding them into a container.

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Do-Action Plan :

Action Responsible person Time frame

Focus training program IC team. From 1 of May.
Interactive training,
Schedule lectures and on job
training .
Monitoring implementation of IC consultant. May 2024
waste management policy .
Apply new educational posters . IC team. May 2024
Availability the needed supply. Finanicial June 2024
department .
Adherence of workers to PPE. IC team. On going
Contracting with proficient house- the administration . June 2024
keeping company.
Notice to non compliant staff . IC team. On going

Adequate ventilation of the Engineering May 2024

storage room by applying big department.
wall exhaust fan .
Involvement of patients and IC team . 15 th May
families.

Check :
 The outcome was very successful. The improving project showed
remarkable increase in adherence to waste management policy.
 The team designed a control chart to weekly monitor errors in
performance in waste management process using checklist to assess the
stability of the improvement.

 The team instituted the following measures:

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– Orientation programs for physicians, nurses, and workers, including
inservice training.
– Continuing audit tool of chick list for waste disposal performance.
– Visual education by posters and signs on proper waste management
steps.
– Ongoing training and orientation for new residents, nurses, and
housekeeping workers.
– The team had determined the actual standard for the process steps to go
through quality control follow-up.

Act :
 Continuous monitoring should be done.
 The solution should modified when needed.
 The quality team repeats the PDCA cycle as often as necessary until
they determine adequate and appropriate changes in the processes.

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