Healthcare Establishment Waste Management and Education Programme (HEWMEP)

Healthcare Establishment Waste Management and Education Programme (HEWMEP) is the flagship programme of WaRM group of CEE in the field of biomedical waste management (BMWM) which involves addressing the biomedical waste issues of hospitals, nursing homes, clinics, dentists, private and state funded health centres including veterinary healthcare establishments, diagnostic laboratories, blood banks and domiciliary treatment homes such as households, hostels, schools and colleges.

It is very well known that many organizations like CPCB, CEE, Toxic Links, M.S. Ramaiah Medical College, Hospital Infection Society, India etc have developed several manuals for methods on disinfection of hospital wastes and source segregation.  In the light of the fact that there are these manuals which have been developed, the HEWMEP programme has not restricted itself to the preparation of a manual on BMWM but has aimed at testing the efficacy of some of these manuals in practical implementation of BMWM. The social relevance of the programme lies in the fact that this programme does not merely address itself to the control of infection inside the hospital, which is of course of prime importance but more importantly, it addresses the problem of spread of infection in the general community through waste discarded from hospitals, other healthcare establishments and research centres.

HEWMEP is an integrated programme and comprises of several components mentioned below. Either all the components can be implemented in an HCE of larger geographical area like a city, town etc:

  • Strategy for assessment of existing levels of information, training, practices, quantity of biomedical waste generated treat and disposed of bio-medical waste.
  • Integrated Healthcare Waste Management Plan (IHWMP) which can be adopted by a healthcare establishment anywhere in the country
  • Devising proper protocols and implementation schedule giving proper directions to different levels of healthcare management personnel.
  • A completely operational facility for BMWM, which could be implemented, with some locale specific modifications.
  • Development of IEC Material and dissemination of this material to create awareness.
  • Training of HCE managers, doctors, nursing staff, workers and other medical and non medical personnel.
  • On the basis of the programme, external audit of the BMWM systems of the HCEs and CBWTFs done.
  • Administrative reforms required for setting up and / or improving the BMWM system in HCEs are drafted and the same are recommended to other HCEs.
  • Policy inputs on of various aspects of biomedical waste management at regional and national level undertaken.

The above mentioned components of the HEWMEP have been implemented at Bangalore, Ahmedabad, Tirupur, Kannur, Coimbatore, Gulbarga, Delhi, Tirupathi, Vrindavan, Ujjain, Puri, Pune, Agra, Lucknow, and in many cities in Rajasthan and in the district of Coorg, Karnataka. The benefits of the programme are evident to all those involved in handling and managing biomedical waste and specifically by the:

  • Sweepers, Class IV employees in hospitals, ward boys and nurses who deal with the wastes and are often injured by it within the hospital.
  • Ragpickers, Municipal Sweepers and poor children who come in contact with the infectious bio medical wastes and sharps dumped haphazardly in the city.
  • General community in villages, cities and towns who are benefited by healthier living conditions.
  •  HCEs because streamlining the waste movement now have reduced risks of infection as well as illegal trading in used and discarded items such as infected needles, rags and cotton.
  • State Pollution Control Board and the Municipal Corporation have benefited by the training and expertise has been provided in the respective regions for efficient waste management programmes.
  • Medical Colleges and other Training Centres are studying the various components of the programme and incorporating the learnings into their curricula.
  • Many schools and colleges – teachers and students are being involved in the education and motivation, thereby ensuring their own education and involvement in the programme.
  • All Hospitals, Nursing Homes, Clinics and Private Practitioners are to be benefited in the long run because they are complying to the Government of India’s Rules and were trained by resource persons to implement biomedical waste management programmes in their own areas and locations.

Some of the important projects undertaken under the HEWMEP are-

  • A survey of hospital waste management health care practices under the aegis of the Hazardous Substances Management Division of the MoEF Govt of India in 1998-1999, which was completed in 2001
  • Designing and setting up a completely operational common facility for bio-medical waste collection, transportation, treatment and disposal of biomedical waste of all the HCEs in Gulbarga city. The CBWTF is titled ‘Common Healthcare waste Appropriate Management Plant’ or in short ‘CHAMP’ and is in operation since 2005.
  • In 2002 designed and developed educational material and training manual on BMWM with the support from World Health Organisation (WHO).
  • CEE was designated as the Environment Management Capacity Building (EMCB) node for EE on Biomedical Waste Management (BMWM) in 2002-2004. As part of this, CEE launched HEWMEP website and printed and distributed four issues of HEWMEP newsletter.
  • A CIDA – ICEF grant supported assessment of the role of BMW management practices in infection control in 4 hospitals in Delhi, which was completed in 2002
  • A Delhi Govt. and Department of Environment funded project for assessing, implementing and evaluating five large Govt. hospitals in Delhi for Healthcare Establishment Waste Management & Education Programme (HEWMEP) in 2002-03.
  • Under EMCB ENVIS node on Healthcare Waste Management project, conducted similar studies as done in Delhi in 2001 in 2002-03 in Delhi, Pune, Bhubaneswar and Kannur and submitted report to MoEF in 2003. 
  • A series of regional consultations followed by a national consultation on status of compliance to the BMWM Rules and status of implementation of biomedical waste management which revealed a range of practices and actors engaged in this sphere; conducted in five regions in the country and national one in New Delhi in March 2004.
  • Designed and developed an integrated Healthcare Establishment Waste Management and Education Programme (HEWMEP) which is the flagship programme of WaRM group of CEE in the field of biomedical waste management and involves addressing the biomedical waste issues (at all levels) of hospitals, nursing homes, clinics, dentists, private and state funded health centres including veterinary healthcare establishments, diagnostic laboratories, blood banks and domiciliary treatment homes such as households, hostels, schools and colleges. The various components of the HEWMEP have been implemented at Bangalore, Ahmedabad, Tirupur, Kannur, Coimbatore, Gulbarga, Delhi, Tirupathi, Vrindavan, Ujjain, Puri, Pune, Agra, Lucknow, and in many cities in Rajasthan and in the district of Coorg, Karnataka. 
  • Conducted external audit of IMAGE CBWTF at Kannur, Kerala.
  • Collaborated with ISHWM for external audit of BMWM system and technologies in 10 major govt controlled hospitals in Delhi.
  • Conducted profile study, KAP in 66 nursinghomes in Delhi to assess status done training and assesd effectiveness of HEWMEP after training in 2005-2006
  • Conducted training programmes for different healthcare personnel like doctors and admin, nursing, paramedical and class IV staff in 52 training programmes of Delhi and assessed efficacy of HEWMEP in all.
  • Several training programmes in many parts of India on request done by the group and several queries answered and aspects clarified as part of ENVIS node and ENVIS centre activity of CEE till date.
  • Implemented HEWMEP Tamil Nadu & HEWMEP Rajasthan

 

HEWMEP Tamil Nadu-

HEWMEP Coinmbatore Zone project in Tamil Nadu was implemented in 2008 wherein the most important component of all is the education and training aspect of the integrated waste management plan which involves the training of several medical and para-medical employees of the establishment for source reduction, segregation, disinfection, transportation, treatment and disposal.

Objectives:
The main objectives of the project were-

To implement a healthcare establishment waste management education programme (HEWMEP) through an integrated healthcare waste management plan (IHWMP) in the healthcare establishments in Coimbatore Region having 9 districts in Tamil Nadu and establish practices for waste minimization, segregation, collection, transportation, storage, treatment before transport to Common Treatment Facility or final disposal of healthcare waste.

  1. To conduct sensitization and training classes along with on-spot demonstration for effective waste management in these five demonstration units and through them in all HCEs in Tamil Nadu.
  1. To conduct awareness and training programmes for a team of Master trainers comprising nodal officers, NGOs, Municipal Health officials from each district and equip them with suitable educational material.
  1. To establishment a continuous monitoring & record keeping mechanism in the HCEs in all the locations using profile and KAP method and regularly checking them to note improvements, deterioration etc.
  1. To test the efficacy of HEWMEP by constantly implementing and monitoring the IHWMP and evaluating the plan for technical and educational efficacy by testing and evaluation methods evolved specially for monitoring these.
  1. To modify the IHWMP based on evaluation and feedback mechanisms and make it most suitable for the HCEs and the common facility.
  1. To evolve a training module and schedule for induction as well as in-service training which can be used by the master trainers in each of the districts to continuously motivate train new and interned health care personnel.

Achievements:
Training, sensitization and monitoring programmes of various functionaries in the health care systems as well as outside the health care systems, since it is vital for the successful implementation of hospital waste management plan in the Tamil Nadu state.
The main achievements are:

  • Training of Trainers
  • training of MT’s Master Trainers
  • Training of all Health care providers including class iv staff and cleaners.

Zone covered by CEE
CEE Coimbatore was the appointed consultant for Coimbatore Zone. The Coimbatore Zone consisted of the following nine districts of Tamil Nadu


Coimbatore Zone

  • The Nilgiris District
  • Coimbatore District
  • Erode District
  • Salem District
  • Namakal District
  • Dharmapuri District
  • Krishnagiri District
  • Karur District
  • Dindigul District

Training was to be conducted by Master Trainers and Trainers under the supervision of the Consultant. A total of 126 people (including Doctors, nurses, lab technicians, therapists, Medical officers, etc.,) were trained as Trainers through 4 training programmes of two days duration each; and 34 Master Trainers were identified

HEWMEP Rajasthan-

Presently going on 2009-2010 in PHCs of Rajasthan in two phases, first phase package-2 comprising of 16 districts wherein first round is for motivating and informing the PHCs and organising equipment infrastructure like pits etc. Second round for reinforcement of training along with all equipments and infrastructure.

GOAL:

  • The aim of such support service will be to “bring effectiveness in the implementation of BMWM & providing quality trainings at facility level”.
  • To highlight present constraints towards implementation, both Infrastructure / hardware and willingness to implement BMWM system.
  • To suggest to Department for improvements of effective implementation of BMWM system. 

AIM & OBJECTIVES:

  • To provide training of Bio Medical Waste management is to bring effectiveness in the implementation of BMWM by:
  • To sensitize and train the trainees in sound & effective Health Care Waste management System,
  • To make total staff working at Hospital / health care institution aware about Government of India’s Bio Medical Waste Management & Handling Rules and the responsibilities involved,
  • To provide hands on experience to trainees by demonstrating cradle-to-grave steps of waste management – segregation, handling, collection, transportation, treatment and disposal of infectious and non-infectious waste generated from healthcare facilities,
  • To sensitize trainees on infection control measures in the hospital,
  • To identify “master trainers” and designated officials in healthcare facilities who will be responsible for continued and sustained training,
  • To highlight constraints in continued implementation of HCWM practices and make appropriate recommendations to Department of Medical & Health, 
  • To establish a monitoring system that quantifies and monitors the progress of implementation of HCWM, generating periodic reports for the department,
  •  To develop institutional capacity to sustainably follow the HCWM system.

Achievements:
Onsite training on Biomedical Waste Management and infection control at 759 PHCs of 16 districts of Rajasthan.
The main achievements are:

  • Training of MT’s Master Trainers
  • Training of all Health care providers including class iv staff and cleaners.
  • First round of training has completed in all 759 PHCs
  • Completed reinforcement training for strengthening the project at 250 PHCs in 7 districts
  • Ongoing reinforcement training at 9 distrcits.
  • Submitted all the reports of first round of training to Rajasthan Health System Development Project.
  • Submitted the proposal to RHSDP for monitoring, which includes KAP of onsite demonstration, Sharps Management and Hand Washing procedure.
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