Newsletter- Issue 2 f - UN/GEF Global Healthcare Waste Project

Demonstrating and Promoting Best
Techniques & Practices for Reducing Health‐
Care Waste to Avoid Environmental
I S S U E 2
J U L Y 2 0 1 1
Selection of 2 Hospitals to Demonstrate Best Practices
in Healthcare Waste Management in Lebanon
INSIDE THIS
ISSUE:
The project launched a call
for applications from May
1, 2010 till June 20, 2010 to
select pilot facilities to
demonstrate best environmental
practices and best
available technologies at
healthcare facilities that are
interested to serve as models
to protect public health
and the global environment
from the impacts of
dioxin and mercury releases.
The project aimed at
selecting one hospital, one
dental clinic and one medical
laboratory.
The project received in total
8 applications from hospitals
only.
An evaluation committee
consisting of representa‐
tives from the Ministry of
Public Health, Ministry of
Environment, Syndicate of
Hospitals, UNDP and
WHO and the project was
formed and two hospitals
(one medium rural public
and one large urban private)
were selected.
Selection of 2 hospitals
to demonstrate
best practices
in healthcare
waste management
in Lebanon
1
Baseline Assessment
at the two
Model Hospitals
Rapid Assessment
of Healthcare
Waste Management
in a Number
of Hospitals In
Lebanon
2
3

PAGE 2
Baseline Assessment at the Two Model Hospitals
Mixing of segregated
healthcare
waste during final
storage
ʺ“Knowing is
not enough; we
must apply.
Willing is not
enough; we
must do.”
—Goethe
A baseline assessment was
conducted at the two model
facilities in order to:
• Establish an initial reference
point for assessing
and quantifying waste
reduction, improvements
in waste management
practices and techniques,
decreases in dioxin and
mercury releases, training
improvements, enhanced
occupational safety, costeffectiveness,
and cost
savings, if any;
• Develop performance
indicators and compare
with existing national or
international indicators
and averages;
• Describe current good
practices and techniques
and identify potential
gaps;
• Help define goals and
milestones to gauge progress
and evaluate the
success of the model facility
component of the project.
The results of the baseline
assessment came as follows:
• None of the hospitals
have a person or a committee
in charge of healthcare
waste management.
• Some policies and procedures
are available for
waste collection and
transport but these need
to be more comprehensive
and complemented
by other procedures.
• The hospitals have a color
‐coding system and the
basic equipments for
waste segregation. Unfortunately
at both hospitals
bins distribution among
departments was not performed
based on a needs’
assessment. And waste
containers were not labeled
according to the
waste categories.
• Waste storage areas are
not available in all departments.
And those available
weren’t compliant
with international requirements.
• Inspection rounds were
conducted for 3 days to
examine segregation practices.
The results varied
between 96% and 100% of
poor segregation between
the two hospitals.
• Healthcare waste at the
two hospitals are mixed
all together at the final
storage area and picked
up by the municipalities
for final disposal without
prior treatment.
• Waste weighing was conducted
at both hospitals
for a period ranging between
14 and 21 days.
Associated results were
summarized in table below.
• The average recurring
monthly cost for waste
management ranged between
USD 5,000 and
USD 20,500 corresponding
to USD 6 and 11 USD
per patient.
• Mercury waste generated
at both hospitals as a result
of thermometers and
fluorescent lights usage.
The percentage of broken
thermometers ranged
between 3 and 4.5% of the
total number of purchased
thermometers per
year. The hospitals don’t
have any policies and
procedures related to
management and disposal
of mercury containing
products or mercury
spills. Current practices in
the event of thermometer
breakage involves collection
of the glass and mercury
in sharps boxes to be
disposed of with different
types of wastes.
After the completion of the
baseline assessment, planning
for healthcare waste
management in the two
model facilities was initiated
with the formation of
healthcare waste management
committees.
Recapping
of needles
placed in
sharp containers
Indicator
Average total waste generation rate in kg per occupied
bed per day
Average infectious waste generation rate in kg per
bed per day
Average percentage of infectious waste from total
waste (%) 37.3
Hospital
1
Hospital
2
Bench
Mark
3.09 5.3 0.8‐ 6
1.07 1.15 0.3‐0.4
39 37 16%

ISSUE 2
PAGE 3
Rapid Assessment of Healthcare Waste Management (HCWM) in a
Number of Hospitals In Lebanon
The project team in collaboration with students from the Lebanese University conducted a rapid
assessment for healthcare waste management in around 48 hospitals (46 private and 2 public hospitals).
The average number of beds in these hospitals was around 112 beds with an average occupancy rate of
63%. The average score of the rapid assessment was 57%. Results of the Rapid Assessment were as follows:
Organizational Structure
• Around 83% of the hospitals have a person in charge of
HCWM, while only 54% have a committee dealing with
HCWM;
Financing
• Around half of the hospitals don’t have a financing plan
for sustainable health care management as shown in below
Graph.
Policies and Procedures
• 96% of the hospitals have written policies and procedures
related to HCWM;
• Only 17% of the hospitals are mercury free.
Training
• 31% of the hospitals have a training program on health
care waste management targeting all working groups;
• 88% hospitals train their newly recruited staff on HCWM
and only 77% conduct yearly refresher training sessions
for all staff.
Occupational Safety
• Only 82% of hospitals provide personal protective equipments
to staff handling waste;
• Necessary vaccination is provided to staff exposed to occupational
risks through healthcare waste handling in
72% of the surveyed facilities.
Example of personal protective equipments
used during waste handling
ʺʺGrowth for the sake of growth is the ideology of the cancer cell.ʺ— Edward Abbey

PAGE 4
Rapid Assessment of Healthcare Waste Management
in a Number of Hospitals In Lebanon
Healthcare Waste Management Practices
Classification
and Segregation:
• Staff are familiar with the healthcare waste classification
in 68% of the facilities. While waste is properly
segregated in only 42% of facilities.
Color Coded
Wheeled Waste Bins
Generation
Data:
• More than 90% of hospitals generate infectious, hazardous
and special wastes.
• Waste weighing is only common in 37% of the hospitals.
In those hospitals infectious waste was estimated
around 20% of the total waste.
Collection
Handling:
&
• Around 50% of the hospitals use low density plastic
waste bags and don’t train their waste workers for accidental
spills management.
"In the long
term, economic
sustainability
depends on
ecological
sustainability.ʺ
—
“America’s
Living
Oceans
[Pew
Oceans
Report,
2003]
Color Coding
and Labeling:
Internal Transport
As a General Practice, hospitals
transport the waste in
a closed and clean transport
cart away from patient areas
as shown in graph.
• 58% of facilities use a system of color coding for different
type of waste.
Waste Storage Areas
Only 16% hospitals have
storage areas that meet the
proper requirements as
shown in Graph.
Improper Waste
Storage Area

ISSUE 2
PAGE 5
Rapid Assessment of Healthcare Waste
Management in a Number of Hospitals In Lebanon
Waste Treatment and Disposal:
• 53% of facilities treat it
infectious waste prior
to disposal;
• 32% of the hospitals
adopted some kind of
treatment technologies
on site as opposed to
10% treating in off‐site
center .
• 9% of the hospitals are
still using incineration
technologies, although
these are not licensed
by the Ministry of the
Environment.
Wastewater Treatment
• Only 12% of healthcare
facilities treat their
wastewater before being
released into the
main sewer network..
Non‐burn healthcare waste
treatment technology
Mercury Use
Around 84 % of the surveyed hospitals are still using mercury containing products, mainly mercury
containing thermometers and sphygmomanometers. Other mercury containing products generally used
include items listed in table below.
Product type used
Percentage of
hospitals
Dental amalgam 5%
Gastrointestinal tubes (Cantor tubes, esophageal dilators, Miller‐Abbott
35%
tubes)
Phenyl mercuric acetate preservative 8%
Mercury‐containing stains 25%
Thermostat probes 27%
Barometers 18%
Fluorescent tubes 55%
Others (specify) 12.5%
Spilled Mercury is considered
a serious health risk
due to the physical characteristic
of the compound
and its toxic properties.
Although the majority of hospitals are aware of the health risks associated with
the use of mercury and have mercury spill clean‐up and disposal policies and
procedures, only 17% are ready to become mercury‐free without financial
assistance, while 67% showed interest in phasing out mercury in the presence of
financial assistance.

Project Objectives:
Demonstrating Best Techniques and
Practices for Reducing Health Care Waste
to Avoid Environmental Releases of
Dioxins and Mercury
Ministry of Environment
Lazarieh Bldg., P.O.Box: 11‐2727
Beirut, Lebanon
Phone: +961‐1‐976555 Ext. 419 or 469
Fax: +961‐1‐976530
E‐mail: s.khalil@moe.gov.lb or
d.mawla@moe.gov.lb
The overall goal of this project is to protect public health and the global
environment from the impacts of dioxin and mercury releases. To achieve
this, the project is demonstrating best environmental practices and best
available technologies at healthcare facilities that have been selected to
serve as models. The project focuses primarily on activities such as promoting
the use of non‐burn waste treatment technologies, improved
waste segregation practices and the use of appropriate alternatives to
mercury‐containing devices. These activities are reflected in the following
seven project objectives:
• Establish model facilities and programs to exemplify best practices in
healthcare waste management.
• Deploy and evaluate commercially available, non‐incineration healthcare
waste treatment technologies appropriate to the needs of each
country.
• Introduce and evaluate the use of mercury‐free devices in model facilities.
• Establish or enhance training programs to build capacity for the implementation
of best practices and technologies both within and beyond
the model facilities and programs.
• Review and update relevant policies.
• Disseminate project results and materials to stakeholders and hold
conferences or workshops to encourage replication.
• Make project results on demonstrated best techniques and practices
available for dissemination and scaling‐up regionally and globally.
The projectʹs ultimate benefit is the protection of the global environment
and public health, as well as patients, healthcare workers, and communities,
from the impacts of dioxin and mercury releases.