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The Development of a Sustainable Hospital

Providing free high quality healthcare to Cambodia’s children is Angkor Hospital for Children’s mission since 1999 – so why should a hospital be so concerned about waste management?

Health-care waste contains potentially harmful microorganisms, which can adversely affect the health of hospital patients, health workers and the general public. Other potential infectious risks may include the spread of drug-resistant microorganisms from the hospital into the environment – which is another indirect health risk. Of the total amount of waste generated by health-care activities, about 85% is general, non-hazardous waste comparable to domestic waste. However, the remaining 15% is hazardous and infectious materials.

“Good waste management is the best way to prevent infection of diseases related to medical waste. When we have a fresh, clean environment, we will have better health of our patients. And we will not see any pests such as mice, mosquitos, bugs around our staff and patients” says Seng Soklin, Infection Prevention and Control Nurse at AHC.

Nurse Soklin has attended several World Health Organization (WHO) and Ministry of Health (MoH) trainings, designed to assist hospitals and clinics to develop better waste management systems. Read more about this here: www.who.int/mediacentre/factsheets/fs253/en/. Here she learned about the seven kinds of hospital waste which a sustainable hospital must carefully manage. Broadly, these are categorised into three key areas – general, hazardous and infectious waste.

Throughout 2016 the hospital has been developing its own organisation-wide policies to reduce and reuse general waste. We are also working with GAEA, the local waste collection service to ensure it is properly disposed of. As you walk around our hospital now you will see separate bins to collect drinks cans and bottles, for example, and in our offices we have started separating waste.

In a hospital setting, however, medical waste management is the key challenge – especially in countries like Cambodia. At the city level, Siem Reap currently does not have an operational system for the proper disposal of hazardous and infectious materials. For this reason a number of hospitals in Cambodia have begun to develop their own environmental management methodologies, including AHC.

To manage our waste AHC has created a new waste management unit and instigated hospital-wide trainings to educate our staff on how they can support this process. AHC uses seven different kinds of rubbish bins, to reflect the seven above-mentioned types of waste – staff are trained to use the appropriate bins for the different waste types. Additionally, a waste management committee constantly monitors budget for and governing of medical and general waste inside the hospital. The committee, from 2016, has implemented a new waste management policy developed by a volunteer waste management specialist, Amy Howard. In line with the new policy, the waste management committee cooperates closely with the provincial health department on all waste management issues.

At present, AHC typically collects 40kg of infection waste per day. If a heart operation is scheduled this rises to 60kg. This includes used IV bags, bandages, diapers and chemotherapy bags. AHC generates and disposes an additional 30kg of sharp waste, such as used suture needles and syringes, in the separate, specially designed incinerator.

In 2016 the hospital installed a new incinerator with partial funding from the Rosebud Charitable Trust and the SAL Charitable Trust. This incinerator is designed to eliminate our infectious waste – it has a high-tech air filter that ensures minimal carbon emissions; no smoke or odours and is able to safely eliminate near 100% of AHC’s infectious waste. The new incinerator and AHC’s Waste Management new policies are all in compliance with the Ministry of Health, Stockholm Convention and WHO guidelines on Medical Waste Management.

As AHC makes further development in its waste management approach, including developing strategies to address hazardous waste, and reduce and recycle general waste, it has also began to evaluate hospital water usage. An initial assessment has identified key weaknesses in the hospital’s current water system, including suspected significant pipe and groundwater leakage. The outcome of this exercise has been developed into a sustainable water management programme which AHC intends to implement in 2017.

At its core are strategies aiming to facilitate the full monitoring and management of clean water supply. This will include activities such as structural renovations to the piping, and a new maintenance strategy and training. Such activities will provide hospital management with the tools to identify safe and appropriate water reduction strategies without compromising healthcare activities – a philosophy which will also underpin AHC’s subsequent sustainable energy management programmes.

All of this is crucial to the hospital’s aim of becoming a responsible and sustainable hospital. Stay tuned to find out about further steps the hospital is taking on this journey.

For more information on this innovative programme, or to find out how you can support this initiative, please contact our Development Department at [email protected].

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