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  3. mardi 20 juin 2000
Post00259 WASTE MANAGEMENT 20 June 2000 CONTENTS 1. HEALTH CARE WASTE MANAGEMENT: WHO STRATEGY, REPORT, AIDE MEMOIRE 2. ENVIRON.COM:Free Waste Management Software 3. KIDS ILL AFTER SMALLPOX VACCINE EXPOSURE AFTER FINDING IN WASTE - RUSSIA 1. HEALTH CARE WASTE MANAGEMENT: WHO STRATEGY, REPORT, AIDE MEMOIRE Annette Pruess, Coordinator of the strategy on health-care waste management, WHO/PHE, has kindly posted the recently developed joint strategy to reduce the disease burden caused by improper health care waste management. A draft Aide-mé­¯ire on the key elements of the strategy was posted in Technet Forum post Post00237, Waste Management + Injection Safety, on 30 March 2000. In this posting the text of the "Strategy For Safe Health-Care Waste Management Who And Partners" is reproduced below and follows Annette's introduction. * Please note that the table of the Action Plan has not been reproduced as it would not fit into the plain text format of Technet Forum. Annette has sent 3 files which have been converted to Adobe acrobat PDF files for download: WhoWasteManagementStrategyPartners3-June2000.PDF AideMemoire-HealthCWaste-3a.PDF HealthCareWasteMGTReport-26may.PDF To get the files go to the website ftp://ftp.acithn.uq.edu.au/Technet/1-ClickHereForTECHNETfiles/Waste then click on the file names as above. or Send an email to: [email=listserv@acithn.uq.edu.au]listserv@acithn.uq.edu.au[/email] To get the file - send the message: get technet WhoWasteManagementStrategyPartners3-June2000.PDF get technet AideMemoire-HealthCWaste-3a.PDF get technet HealthCareWasteMGTReport-26may.PDF __________________________________________________________________________ Moderators Note: The three files have been prepared and emailed to the server at the ACITHN. The ACITHN is in the midst of a conference this week and the files may or may not be available for immediate download. If you fail to obtain the files on your first attempt - PLEASE TRY later in the week. If you need the files urgently - please send the moderator and email and I'll send them directly to you. ___________________________________________________________________________ From: [email=pruessa@who.ch]pruessa@who.ch[/email] Date: Thu, 15 Jun 2000 11:36:17 +0200 To: Subject: WASTE MANAGEMENT WHO proposes to coordinate a strategic action plan aiming at reducing the disease burden caused by poor health-care waste management, which has recently been reviewed and further developed by a group of experts. This strategy also aims at promoting best practices and developing safety procedures. It is a medium term strategy for a sustainable improvement of the situation at country level. Several activities of the plan, including country activities are starting immediately. This is not (only) a WHO action plan, but is aimed at involving interested partners to jointly advance in this largely unfinished agenda. I'm attaching the meeting report of the external review meeting of 26 May, the strategy on health-care waste management, and the final draft (before editing) of the Aide-mé­¯ire. The necessary funds for most activities of the strategic action plan still have to be raised. We're now approaching potential partners wishing to contribute to part of the plan. Contributions can be made in several ways: * Development of activities of the action plan * Funding of activities * Fund raising activities Please contact me at [email=pruessa@who.ch]pruessa@who.ch[/email] for suggestions and possibilities of cooperation. Annette Pruess Coordinator of the strategy on health-care waste management Protection of the Human Environment World Health Organization, Geneva ___________________________________________________________________________ STRATEGY FOR SAFE HEALTH-CARE WASTE MANAGEMENT WHO AND PARTNERS 1. BACKGROUND In many countries, improper management of wastes generated in health care facilities causes direct health impacts on the community, the personnel working in health-care facilities, and on the environment. In addition, pollution from inadequate treatment of waste can cause indirect health effects to the community. Wastes produced in health facilities include sharps (syringes, disposable scalpels, blades etc.), non-sharps (swabs, bandages, disposable medical devices etc.), blood and anatomic waste (blood bags, diagnostic samples, body parts etc.), chemicals (solvents, disinfectants etc.), pharmaceuticals, and others, and may be infectious, toxic, create injuries or radioactive. One example of important exposure occurs through the widespread reuse of disposable materials (especially syringes) in developing countries and results in the main disease burden caused by inadequate health-care waste management. Worldwide, 8-16 million hepatitis B, 2.3 to 4.7 million hepatitis C and 80'000 to 160'000 HIV infections are estimated to occur yearly from re-use of syringe needles without sterilization. Many of these infections could be avoided if syringes were disposed of safely. Exposure to other parts of the health-care waste stream can also be hazardous, but has been less well assessed. Unintentional injuries may occur when the community is exposed to inadequately disposed waste, for example through scavenging on waste sites. The risks to waste workers and hospital personnel who handle health- care wastes are currently being investigated. If adequate measures are taken, the risks to this segment of the population should be low. Also, most cultures are sensitive to the aesthetics of health-care wastes or perceive the risk as being high to the point that waste workers sometimes refuse to handle the wastes. 2. DEVELOPMENT AND ORGANIZATION OF THE STRATEGY WHO has developed a draft strategy aiming at reducing the disease burden caused by poor health-care waste management. This strategy also aims at promoting best practices and developing safety standards. It is a medium term strategy for a sustainable improvement of the situation at country level. WHO invites potential partners with international or regional outreach who are interested in advancing this agenda to cooperate in the further development and implementation of activities of the action plan. Coordinated action among partners is important to maximize the impact, and ensure effective resource allocation. This strategy has been prepared by several WHO programmes, and has been reviewed and further developed in the external review meeting in May 2000, with participants in health-care waste management with expertise for developing countries. Most elements of the strategy are directly relevant to SIGN (Safe Injection Global Network), WHO's Immunization Safety Priority Project of the Department of Vaccines and Biologicals (VAM) and the Blood Safety and Clinical Devices Department (BCT). The sharps waste management activities of SIGN are integrated in this strategy. WHO's Department of Protection of the Human Environment proposes to coordinate the strategic action plan. Activities of the action plan are not necessarily funded nor performed by WHO. It rather represents a compilation of proposed activities to be performed to fulfill the objectives. Possible ways of contribution are described in section 5. The strategic action plan can still be modified according to requirements perceived by partners. It should be built on consensus among partners. 3. KEY ELEMENTS OF THE STRATEGY Targets, indicators, products and activities are listed in the attached action plan. The strategy relies on the following elements: * Develop evidence base and information for policy, including review of scientific information and monitoring of country progress * Prepare guidance material for various settings and situations and compilation of successful projects * Achieve safety and availability of waste management options, by improving access to information on health-care waste management options which have been implemented and tested, and development/ adaptation/ testing of options where needed * Support the development of country plans by conducting pilot projects to develop country plans, developing regional networks and centres and provide guidance on the development of a national policy 4. COOPERATION FOR IMPLEMENTATION OF THE STRATEGY Any individual or person representing an organization, sharing common interests and having recognized expertise may become an active partner and contribute to advancing the agenda of implementing safe systems of health- care waste management. Partners are invited to contribute in areas of their expertise, or to support activities of the strategy. Elements of the strategy are reviewed by a group of experts before release or implementation. The strategy is initially being reviewed by an ad hoc advisory group of experts in waste management for developing countries and health-care providers. The development and implementation of the strategy will require experts in the area of both health-care waste management and health-care provision (e.g. immunization, injection safety or health systems programmes), as well as networks of professional organizations or NGOs with regional outreach. Cooperation and contributions can be made in the following ways: * In-kind or financial contribution to selected activities * Provision of expertise for the review of draft products 5. ACTIVITIES OF PARTNERS To advance the agenda of health-care waste management, partners will need to collaborate in the following areas: * Develop a common strategic framework * Develop activities required to implement the strategy * Mobilize resources to implement the strategy * Foster the development of innovative solutions * Raise awareness and advocate * Exchange information 6. INFORMATION EXCHANGE An information exchange mechanism will be set up, addressing the progress of activities related to the strategic action plan, and various other issues related to the subject. In addition, the SIGNpost (list server set up by SIGN) may also serve as information exchange mechanisms. 7. COMPLETED PRODUCTS AND PRODUCTS CLOSE TO FINALIZATION Various products have been produced by WHO or are close to finalization. They are integral part of the strategy, but are not listed in the action plan, as their development is prior to the period of the action plan. - Products completed to date include: * Comprehensive handbook on health-care waste management * Teacher's Guide * Guide for drug disposal in and after emergencies - Products close to finalization include: * Review of the evidence of health impacts from various types of health- care waste on various population groups * Decision-making guide at PHC (primary health care) level * Blood disposal guide A number of additional products have been prepared by other organizations, including the following: * SKAT: How are we managing our health-care wastes (collection of case studies/ local assessments and suggestions); * World Bank: Guidance notes (internal World Bank working document); * Shristi: Emerging experiences in medical waste management in India; Compilation of fact sheets; * NHS Estates: Clinical waste disposal/treatment technologies alternative to incineration; * Basel Convention: Technical guidelines on biomedical and hospital wastes; * Small Scale Medical Waste Incinerator Evaluation Trials in South Africa; Etc 8. Action plan for implementation of a strategy to reduce disease burden caused by inadequate HCWM (health-care waste management) ___________________________________________________________________________ Moderators Note: The Action Plan is in tabular form and been deleted in this posted text but is included in the full file available for download. ___________________________________________________________________________ 10. Preliminary immediate agenda End 2000 (in addition to already available products): * Evidence base and information for policy * Review of evidence of health impacts from microbiological hazards * Estimation of disease burden from injections with unsterilized syringes Guidance material * Decision-making guide for primary health centres * Multi-level guide with field tested country assessment tool * Guide on blood disposal * Compilation of case studies - Safety and availability of options * Availability of database on HCWM options for developing countries, coupled to assessment tool and information exchange mechanism * Field testing results for selected incinerators and needle destroyers Country plans * Two country plans (C?d'Ivoire and another one to be defined) * Strengthened capacity of African network ____________________________________*______________________________________ 2. ENVIRON.COM:Free Waste Management Software ___________________________________________________________________________ ENVIRON.COM Celebrates Earth Day 2000 with Free Waste Management Software MESA, Ariz., April 3 -/E-Wire/-- Mesa, Arizona-based Environmental Support Solutions, Inc. (ENVIRON.COM) announced today that Waste Manager Software can be downloaded from their website for free. CONTACT: Robin Suzelis of ENVIRON.COM, 480-964-5043 ext 24, Robin_Suzelis@environ.com/ /Web site: http://www.environ.com/ For Full Text Visit: http://ens.lycos.com/e-wire/April00/03April0001.html --- ENVIRON.COM Extends Free Waste Management Software Offer MESA, Ariz., June 8 -/E-Wire/-- Mesa, Arizona-based Environmental Support Solutions, Inc. (ENVIRON.COM) announced today that they will be extending their Free Waste Management Software offer until August 30th. Waste Manager Software, the company's easy to use solution for waste management, manifesting, and tracking, can be downloaded from their website for free at http://www.environ.com. ENVIRON.COM Celebrates Earth Day 2000 with Free Waste Management Software --- MESA, Ariz., April 3 -/E-Wire/-- Mesa, Arizona-based Environmental Support Solutions, Inc. (ENVIRON.COM) announced today that Waste Manager Software, the company's easy to use solution for waste management, manifesting, and tracking, can be downloaded from their website for free in honor of Earth Day 2000 at http://www.environ.com. Robert Johnson, President and CEO of Environmental Support Solutions describes their company's intention: "Since hazardous waste is such a serious problem, we decided to make managing it easy and free. Initially designed for sale to waste generators, we decided it is important to give back to the community. It is the right thing to do." "Now anyone can easily track their hazardous wastes at no cost. Ultimately, it is the responsibility of the generator of the waste to meet the regulatory requirements established by EPA and State agencies, regardless if they use an Environmental Service company or not. With our free Federal Biennial reporting software and now our free waste management software, ENVIRON.COM provides generators with a quality waste compliance solution," says Craig Schwartz, of Environmental Support Solutions. Waste Manager is a software solution that simplifies the burden of waste tracking and management. Its functionality models day-to-day activities for ease of use. The Waste Manager Series was developed with over 50 hazardous waste generators participating in an intensive "preview" program to insure a quality waste management solution. Participants of the program have reported that this is the easiest program to use for complete waste tracking. Environmental Support Solutions (ENVIRON.COM) is a web-based aggregator of environmental compliance information and data. It sells this information and data in the form of software, subscription information services, customized and online training, market research and compliance plans. Download the free Waste Manager and Waste Reporter software at http://www.environ.com/software_waste.htm. Waste Manager is free for a limited time. For additional information contact Craig Schwartz at Craig_Schwartz@environ.com or at 480-964-5043 x34. Visit the ESS compliance information center for free checklists, software, and other compliance tools at http://www.environ.com or call 800-289-6116 x8. SOURCE Environmental Support Solutions, Inc. CONTACT: Robin Suzelis of ENVIRON.COM, 480-964-5043 ext 24, Robin_Suzelis@environ.com/ Web site: http://www.environ.com/ ____________________________________*______________________________________ 3. KIDS ILL AFTER SMALLPOX VACCINE EXPOSURE AFTER FINDING IN WASTE - RUSSIA Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html Contributions, comments and additions please: [email=technet@acithn.uq.edu.au]technet@acithn.uq.edu.au[/email] or use your reply button ___________________________________________________________________________ Kids ill after smallpox vaccine exposure VLADIVOSTOK, Russia (AP) 19/06/2000 - Eight children were hospitalized with high fevers and skin eruptions after playing with smallpox vaccine they found at a garbage dump, officials said Monday. Dmitry Maslov, a public health official in Russia's Far East, said the children, ages 11 to 14, were not seriously ill. There was no risk of the children catching smallpox, he said, and they should be able to go home within a few days. The children found glass ampules containing expired smallpox vaccine at a garbage dump in Vladivostok, Maslov said. They mixed the powder from the ampules and sprinkled each other with the mixture, he said. Maslov said the children were suffering fever and discomfort associated with smallpox vaccinations. Police said the ampules were found near a public health station, and surmised that staff at the facility had not followed proper procedure and disposed of the ampules at a special medical waste dump. --- Date: Mon, 19 Jun 2000 11:33:32 -0400 From: Marjorie P. Pollack Source: Reuters Online, 19 Jun 2000 [edited] [Crossposted from ProMED Mail] The World Health Organization expressed concern Monday over the careless way a Russian clinic discarded smallpox vaccine ampoules, causing the infection of eight children. The children aged six to 12 were diagnosed with a mild form of smallpox [vaccinia virus] when doctors discovered that they had played with glass ampoules they found in a dustbin of a local epidemiological center in Russia's Far East, Russian officials said Monday. The children had been taken to hospital with fever and severe rashes. Smallpox was officially eradicated worldwide in 1980 when countries stopped vaccinating against it. The last case of the disease was registered in 1977 in Africa. Spokesman Valery Abramov of the Geneva-based WHO said that although the infections were not life-threatening, the vaccine ampoules should have been incinerated before being discarded. "Smallpox has been eradicated but the virus has not been destroyed completely due to the remaining stocks in Russia and the United States. The stocks are there because of fears about terrorist use of smallpox virus,'' Abramov said. "The concern is how these vaccines are disposed of. Throwing them away is against the rules. They need to be incinerated.'' The center kept dozens of boxes of smallpox vaccine to combat a possible enemy germ attack, as required by civil defense rules. When the vaccine expired the medics threw the ampoules away instead of destroying them. Russian NTV television said the discarded boxes were strewn over a large area. ____________________________________*______________________________________ ____________________________________*______________________________________


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