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JIS News

The Ministry of Health is advancing plans to replace the present incineration system used in the disposal of medical waste in the public health sector with autoclave and shredding technology.
The implementation of a revised medical waste collection and treatment process is due to come on stream by late 2007 on a phased basis, with the new technology providing the capacity to sterilise infectious particles, viruses, or bacteria and then shred the contagious material.
In a recent interview with JIS News STI/HIV Specialist and Senior Medical Officer in the Ministry, Dr. Kevin Harvey explains that the autoclave system, for which tender notice was given three weeks ago, is a more environmental friendly alternative to incineration.

Director of the Environmental Health Unit at the Ministry of Health, Peter
Knight

The autoclave, Dr. Knight advises, “uses steam under high pressure.so the [medical] waste is in an enclosed chamber mixed with steam at a very high pressure with the temperature being high enough to destroy all the infectious particles within that waste.”
Further detailing the process, the Senior Medical Officer notes: “[the waste] becomes sterile and is then shredded. So what you get in an unrecognisable, sterile mass that can then be buried in a landfill and has no infectious properties. There is no burning, no emission . the steam is then cooled and then you get back water.”
In March of this year, Cabinet gave approval to implement a regional medical waste collection and treatment system, which is expected to cost some $400 million. It is projected that the system would be put into service in two phases, beginning in the 2007/2008 financial year, when $114.6 million will be spent in the first phase.
Dr. Harvey says following the procurement process to acquire the autoclave technology, which should be completed within the next six months, it is anticipated that the mechanism would first be introduced in the Ministry’s South East Region.
“We are starting the process with the South East region where all the major hospitals are: University Hospital of the West Indies, Kingston Public, Bustamante Hospital for Children, Victoria Jubilee, as well as the National Public Health Lab,” he explains.
The overarching plan, Dr. Harvey adds, is to eventually extend the autoclave system on a regional basis to the island’s three other health regions.
“Autoclave and shredding is one of the major technologies now being used and it is being implemented on a wide scale in Europe and the United States, and even in the Caribbean,” the Senior Medical Officer says, noting that the technology is already operational in the Bahamas and St. Lucia.
Indicating that the twin-island Republic of Trinidad and Tobago is also exploring the possibility of integrating the autoclave technology into its waste management and treatment system, Dr. Harvey emphasises that “it is an internationally-used equipment that has been around now for 20 years or more and it is really stepping up now into that fore.
So we are not new in implementing this, we are actually behind but it is a standard technology that is being used internationally because of its environmental and health friendly status.”
Turning to Jamaica’s current state of medical waste disposal, Dr. Harvey says stemming from findings by an international consultant who was contracted to review the existing status and processes, it was discovered that many of the incinerators across the island are not functioning adequately.
“In light of the new environmental policy and the guidelines being proposed by the National Environment and Planning Agency (NEPA) to look at air quality, we recognised that a majority of these burn boxes or incinerators would not meet international or our current local standards now for air quality emission.
Therefore one of the recommendations of the consultant who looked at all of this, was that we identify and explore the use of alternative technologies, which may be more cost effective and does not include necessarily burning of medical waste, and also to centralise the management of medical waste,” he informs.
The Ministry’s path to reform its waste disposal procedures began in earnest in 2004 with the undertaking of a comprehensive development policy which involved a review of the existing waste management plan.
Director of the Environmental Health Unit in the Ministry, Peter Knight explains that against the background of government health facilities being the largest generators of medical waste in the island, it was recognised that difficulties were in fact, being experienced in the overall management of medical waste.
“We also had concerns raised by other stakeholders, including the National Solid Waste Management Authority, NEPA, the then Ministry of Local Government and Community Development, several other bodies that deal with medical waste as well as regulatory agencies,” Mr. Knight discloses. As a proactive measure, he says the Ministry developed a policy through a six-month series of consultations which included stakeholder input.
“We went and found all the other stakeholders which are non-medical, so we had the professional groups also, the Medical Association of Jamaica, the Nurses Association of Jamaica, the Jamaica Association of Public Health Inspectors, the dental professional group and so on. So we consulted with all the groups and we had input from all the groups into the development of the policy,” the Director tells JIS News.
Mr. Knight notes that the Pan American Health Organisation (PAHO) provided technical support and cooperation in the formulation of the final policy position which was titled ‘A National Medical Policy for Jamaica’.
He discloses that the key recommendation that emanated from the consultancy found that “the country had in region of some 200 burn boxes. and [the proposal is that] we should phase out these boxes and we should regionalise the system and look for treatment modalities in four regions”.
With the revised waste treatment system for the local health sector on the horizon, Dr. Harvey reiterates that although the long term plan is to institutionalise autoclave machines in all four health regions, the previous process of incineration would not be entirely abolished.
“We would still maintain some incineration for certain types of highly infectious medical waste such as cytotoxins but the incinerators that we have cannot manage the cytotoxin waste now, so we still have to have backup incinerators for some of the things we have to burn. but in terms of managing medical waste, autoclave and steam sterilisation is going to be the mainstay,” he explains.
Asked if the Ministry is entertaining the possibility of allowing the autoclave to be utilised by facilities and doctors in the private health sector, as a commercially viable enterprise, he responds: “we are considering that but the first thing is that we have to sort out our waste first.”
He informs that “We did have discussions and meetings with the private sector hospitals about implementing this system.they are very enthusiastic and I am sure they would be willing to access the system.”
Shifting focus to general waste management as practised in the health institutions around the island, Dr. Harvey tells JIS News that the Health Ministry is cognisant of the fact there is a need to improve the separation, storage, and transportation of medical waste in facilities.
He points out that an immediate challenge facing the Ministry is the need to increase financial allocation for waste supply equipment such as disposal bags.
“We need to look at the proper handling of medical waste, buying the appropriate bags, storage containers, and trolleys for the movements of waste within the facilities,” he says.
Dr. Harvey asserts that benefits can be derived from improving the procedural handling of waste. “The transportation of waste between facilities is very important because medical waste management if done properly can lead to significant reductions in hospital acquired infections.even simple things like urinary tract infections,” he notes.
A number of initiatives are being undertaken in the area of medical waste disposal, he says. “We have been having systematic training.we have a manual in facilities which speaks to management of medical waste, and that has recently been updated; and we have a consultant who goes around and helps with some of the training in the various health facilities.”
In addition, he says, “We also developed labels for hazardous waste and we have procured an initial amount of supplies in terms of the different coloured bags and bins”.