Managing Sharps Waste In Cambodia SIGN Meeting, 25 October 2002 Cambodiana Hotel, Phnom Penh Dr. Chea Kim Ly, Deputy Director National Immunization Program

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Managing Sharps Waste In CambodiaSIGN
Meeting, 25 October 2002Cambodiana Hotel, Phnom
Penh Dr. Chea Kim Ly, Deputy DirectorNational
Immunization Program
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Current safe injection interventions in Cambodia

• Relatively new still in Cambodia since 1999
• Ensuring safe injection and waste management is a
  collaborative effort in Cambodia, involving
• Safe Injection Committee
• HIV Prevention Programme
• Essential Drugs
• National Immunization Programme
• Reproductive Health
• Health System
• National, Operational District, Province, Health
  Centres, Village and Commune levels
• Ministry of Environment

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Cambodia management of sharps waste by proper use
of safe injection equipment in all levels of the
health system
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Three key safe injection equipment A-D syringes
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Three key safe injection equipment Local safety
boxes
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Three key safe injection equipment Incinerators
SICIM 13 in CAM
VULCAIN
DISTRICT REFERRAL HOSPITAL BURNERS - Safety
boxes not burned here, only medical waste
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Overview NIP goals for safe injection
interventions

• Every immunization is done with a sterile needle
  and syringe
• All used injection material is properly disposed
  of in an appropriate way
• The program discourages the use of disposable
  equipment that can be re-packaged without proper
  sterilization
• The NIP will transition to auto-disable syringes
  and safety boxes for all immunization by the end
  of 2002

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NIP role

• NIP has implemented the national safe injection
  policy by developing the following into its
  strategic plan
• Introduction and distribution of donated A-D
  syringes and safety boxes into immunization
  programme activities
• Supplementary immunization activities (SIAs)
• Routine immunization activities
• Training for SIAs and routine
• A-D syringes
• Safety boxes
• Incinerators
• Distribution Exchange system
• Monitoring and supervision into integrated
  supervision activities

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Safe injection equipment introduction plan

• A-D syringes and safety boxes are already being
  used for all supplementary immunization
  activities (SIAs) since 1999
• A-D syringes and safety boxes have been
  introduced to the routine program in Kg. Chhnang
  OD with the DPT-Hep B introduction since 4Q
  2001
• A phased introduction of A-D syringes and safety
  boxes will follow after Kg. Chhnang so that all
  areas will have A-D syringes by the end of 2002!
• First shipment of A-D syringes arrived in May,
  1998
• Training for A-D syringes were provided from
  August to October 2002
• A-D syringes will be expanded for use to all
  provinces in November and December
• Incinerators in all provinces

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A-D syringes used from 1999 - 2002

• Includes syringes used in all SIA activities and
  SIAs and routine activities in K. Chhnang (data
  from K. Chhnang from January to June 2002)
• Includes both 0.5 cc and 0.1 cc syringes
• All A-D syringes were sent to incinerators
• Number of A-D syringes used higher than number of
  injections given due to
• Staff new to use A-D syringes
• System to use safety boxes new
• Some A-D syringes were of not good quality

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Safety boxes used from 1999 - 2002

• Safety boxes are now used in supplementary
  immunization activities, hospitals, blood
  collection sites, and HIV/AIDS Treatment Centers
• Average number of A-D syringes in safety boxes
  120
• Safety boxes 5-litre capacity

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Distribution system of A-D syringes and safety
boxes

• Referral Hospitals only disposable syringes
• Central level distributes safety boxes to
  district pharmacists for use at referral
  hospitals
• District pharmacists store new and used safety
  boxes
• Each department of referral hospitals collects
  and change old safety boxes from district
  pharmacists when safety boxes are full
• Full safety boxes are sent to the incinerator
• K. Chhnang Bundling of A-D syringes exchange
  system
• Health centre workers take full safety boxes from
  the health centre to the district centres during
  monthly meetings at the district centres
• Full safety boxes are exchanged for new A-D
  syringes and new safety boxes
• SIAs Bundling of A-D syringes exchange system
• For provinces with incinerators
• Safety boxes are burned every day during the
  campaign
• For provinces with no incinerators
• Safety boxes are stored at one place, the
  designated sub-district site, until transported
  to the nearest incinerator at the end of the
  campaign

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Training materials

• Training materials
• Injection safety movie produced
• Immunization safety movie (in progress)
• Posters (see pictures)
• Guidelines for injection safety in routine
  immunization and SIAs and for referral hospitals

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Training for use and assembly of A-D syringe

• Conduct training activities to assemble, use and
  prevent recapping of A-D syringe to all health
  workers

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Training for use and assembly of safety boxes

• Training for assembly and use of safety boxes and
  A-D syringes is provided to all health workers
• Training is also given on the exchange system
  full safety boxes are exchanged for new safety
  boxes and A-D syringes (when available)

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Training of preparation, use and maintenance of
incinerators

• Training on operational use and maintenance of
  incinerators is provided to the appropriate
  incinerator operator (one for each incinerator)

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Problems still encountered
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however, much better than before
View of waste before safety boxes were introduced
before the waste management system in 1998
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however, much better than before
View of waste from a typical medical waste
disposal pit prior 1998
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Ongoing improvement through monitoring and
supervision
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Future activities

• Conduct national assessment of injection safety
  system to include
• Assessment of operational capacity and conduct
  any necessary maintenance of incinerators in each
  province
• Ongoing training
• Ongoing monitoring and supervision of use of safe
  injection equipment, and distribution and
  exchange system

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Final note Waste management system for the first
five year time period in K. Chhnang Overview of
costs
Data Source Estimates based on information
provided by the WHO Cambodia Country Office,
Ministry of Health EPI Department and field
visits to Kompong Chnang and Takeo