The goal of the programme is to prevent hospital-acquired infections by implementing sustainable health-care waste management and by infection control mechanisms. A specific aim is to dramatically reduce the number of preventable maternal and neonatal fatalities. The project thus fully complements the national reforms focused on improving the delivery and quality of health services. Special care was taken to develop a system with low investment and operating costs that could thus be replicated throughout the country and sustained by hospitals without further support.
Preventing dangerous needlesticks
Medical needle cutters were positioned in all health institutions targeted. Needles and syringes are cut and destroyed immediately after use, without exposing the staff to the risk of infection. Needles and syringes are rendered unusable by this procedure and are then disinfected under high pressure in an autoclave. Remaining pieces of needles are sold to metal recyclers and the syringes to plastic recycling firms. This provides the hospital with a small amount of additional income.
Buckets for infectious waste
Infectious waste is collected in buckets, which are marked with the international biohazard symbol, the type of waste and a number to keep track of each of them. The use of buckets considerably reduces operating costs as it eliminates the need for more expensive plastic bags.
All containers with infectious waste are stored in designated areas. For the sterilisation process, they are put directly in the autoclave. The material can then be mixed with regular waste, which is stored on a trailer in a fenced area outside the hospital. When full, the trailer is towed by a hospital vehicle to the municipal rubbish dump.
Inside the fenced area where disinfected waste is stored, every hospital has a six-metre-deep pit, divided into three compartments. Each compartment is lined with cement and closed by a thick slab. Anatomical waste such as placentas is dumped into one of these three compartments, gradually filling one after another. It will take an estimated 20 years before the third pit is full. This time is enough for complete composting in the first one which then can be emptied and reused.
Training and monitoring
Awareness-raising workshops with all stakeholders and training for the hospital staff accompany the equipment. Every hospital creates a committee which periodically reviews the procedures related to the treatment of waste and monitors related activities. Additionally, a trained specialist is responsible for infection control. He or she takes charge of implementing specified sanitary standards and trains all hospital staff to use new respective guidelines.
Main achievements so far
The model was piloted in five facilities of one region in 2006, which have successfully maintained the systems on their own for the last eight years. From 2008 on, the model was expanded throughout the country and since 2013 it has been implemented in 203 governmental facilities, including hospitals and outpatient services. This covers about 67.3 % of all hospital beds in the country and the model has now been included in the national medical waste strategy of Kyrgyzstan. The broad acceptance of the new system by the hospital staff and directors is an important benefit that enhances the sustainability of the project.
A survey in three hospitals in Naryn oblast showed that after the implementation of the project in 2013 fewer newborns acquired infections (6.5 %) than two years before (17 %). In the same period, the number of infected mothers decreased from 3.9 % to 0 %.
The operating costs are today approximately one third lower than the average amount the hospitals had previously been paying for waste treatment. This is mainly because they no longer have to pay for transportation or for disinfection chemicals. Money saved in the hospital budget is directed towards improving infection control measures. This allows hospitals to maintain their health-care waste management models without further donor contributions.
The goal of the third and last phase of the project is to apply the infection control system to the totality of Kyrgyzstan’s hospitals. It has to be ensured that the systems are institutionalised and sustained in all facilities without the project’s support in the future.