Answers to Case Studies
The staff who dispose of the waste, the laborers who cart the waste away, and members of the community in the neighboring town who scavenge or play in the waste are at risk. The community at large is also at risk from the spread of infection by animals that have access to the waste.
The waste disposal problems here can be solved by:
The incorrect waste-disposal practices here are:
- Dumping medical waste outside of the fence instead of in the pit
- Using the pit for nonmedical waste, while leaving medical waste exposed
- Improper disposal of sharps
- Exposing the gardener and others to contaminated waste
Ms. Gomez should point out the problem she noticed to the sanitation officer and find out the reasons for the inappropriate practices. She should work with the sanitation officer to correct the waste-disposal practices and follow up to make sure the proper practices are maintained.
The incorrect practices here are:
- The improper disposal of syringes and needles at the site of use
- The disposal of medical waste in a shallow pit that is easily accessible to the community
- The lack of knowledge of appropriate practices by staff
The providers, other clinic staff, and members of the community (including the teenage girls who scavenge in the pit, the people they give the syringe barrels to, and others who could contract an infection through exposure to one of the girls or those using the syringe barrels) are all at risk of infection by these incorrect practices.
Ms. Oludara should inform the staff of the situation and organize an infection prevention update for all staff to review the safe use and disposal of needles and syringes. The clinic should then develop a plan to:
- Improve the waste-disposal site so that it is not easily accessible to members of the community
- Appropriately burn or bury the needles and syringes so that both the needles and syringes are no longer usable
- Hold educational sessions for the clinic's clients and others in the community about the potential hazards of medical waste
The inappropriate practices here are improper sharps disposal and the dumping of medical waste in areas that are accessible to the community.
After treating the injury and explaining the potential risk to the injured man, Dr. Asante should:
- Hold a meeting with the staff members responsible for waste disposal, sharing the incident and describing the risk to the community from such accidents
- Immediately assess the overall waste-disposal practices among all levels of staff
- Institute a program to get staff to sort waste so that the only waste going to the incinerator is medical waste that can cause infection or injury if not properly disposed of
- Set up an in-service refresher course immediately for all staff to reinforce their roles in waste disposal for infection prevention, including the safe use and disposal of sharps
- Conduct periodic follow-up evaluations to assess the consistency of correct waste-disposal practices after the refresher course
The inappropriate practices are:
- Lack of staff knowledge about what happens to the generated waste for disposal, where it goes, and how it is destroyed
- Improper disposal of sharps and other medical waste
To correct the situation, Mr. Andreyev should:
- Perform a thorough assessment of the facility's waste-disposal practices, sharing findings with the facility's supervisors and policy-makers
- Develop a plan for refreshing staff about the appropriate waste-disposal practices
- Explore the possibility of burning or burying medical waste on site
- Conduct periodic follow-up evaluations to assess the consistency of waste-disposal practices after the refresher course
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