MEDICAL POLLUTION CONTROL COMMITTEE

Environmental Management System   |     PDCA Cycle

         Preliminary Audit Checklist

The next step generally follows the PDCA cycle 

PLAN: Developing a plan to fulfill its environment policy

DO: Implement by developing capabilities and support mechanisms to achieve policy, objectives and targets

CHECK: Develop a mechanism to measure, monitor and evaluate the performance.

ACT: Review and improve continually 

PLAN: The team should begin by conducting a walk-through survey of the institution for understanding the existing systems in each functional area and documenting them. The document should cover the following:

•     Roles and responsibilities of each member in the institution
   

•     Type and quantity of waste generated in each functional area
   

•     Description of methodology practiced under each activity such as segregation, internal and external transportation, pretreatment, storage, post treatment and final disposal
   

•     One should verify whether the activities are adequate as per standard practices. Reference should be made to the appropriate sections in this website such as Technology and Activities under Good Management practices.
   

•    The existing methodology should be modified appropriately, consistent with the type, quantity and frequency of waste generated, accessibility to common treatment facility and other technology etc. 

CHECK: The institution should be audited to evaluate the efficacy of the measures developed and suggest corrective and preventive action. A plan indicating the functional area and dates of audit shall be finalized and communicated to all concerned. A team of internal experts, not directly linked to the audit area, will carry out the audit. The preliminary audit checklist given in this section can be down loaded into your PC for convenience

ACT: The audit results should throw light on the areas of deficiency or suggest areas for improvement. The biomedical waste website should be reviewed to arrive at the right approach. Reference can be made to the Frequently Asked questions (FAQs) or the Ask An Expert feature for obtaining specific advice. The documented procedure should be modified if necessary. The Audit results along with the corrective actions and preventive action should be communicated to all the individuals in the institution. If trainings are warranted as a preventive measure, you have to visit the section on training.  

The exercise should be repeated as per the stated audit plans. The improvement and benefits derived should be highlighted to all the stakeholders. A bench-marking exercise will help in monitoring the progress of improvement as a result of this EMS. The audit records and other relevant documents should be controlled and the latest data available with all the concerned staff. Obsolete documents shall be promptly withdrawn from circulation.  

Once the audit reveals that the bio-medical waste management is satisfactory, then scope of the systems could be enlarged to cover other operations like:

1.      Purchase: Past data of items purchased, quantity, dispensation and their consumption pattern should be analyzed to arrive at the optimal quantity to be purchased. This will minimize the wastage due to excess purchase. Preference should be given to companies following EMS conforming to ISO 14000. Feedback from the store will help in planning purchases such that the loss due to expiry of shelf lives can be reduced. For example the use of gloves and the size required should be monitored to arrive at the optimum quantity of various sizes to be procured. Purchase of right dispensations of goods is also very important. For example in a maternity hospital, goods like lactose-free milk powders are purchased in bulk. They normally have a restriction that it should be used within a period of one month from the date of opening not withstanding its expiry date. Since, these are consumed very rarely, it is advisable to purchase in smaller dispensations rather than bulk in order to minimize wastage.

2.      Stores: The stores should follow proper inventorisation of materials. It should follow a First In First Out (FIFO) protocol wherever appropriate. Information on the stock, consumption pattern, waste generated due to expiry of the shelf life, etc., should be made available to the purchase department to take preventive actions. A proper documentation regarding the inventory, expiry date and their useful shelf life should be maintained. Commercial softwares, barcoding etc, will be useful in this regard. For example disinfectants should be consumed in the order of their expiry dates.

3.      Handling, packing and preservation of goods: The goods should be handled as advised by the manufacturers to prevent wastage due to improper handling, packing and preservation.

Examples:

Handling: In an institution when gas cylinders are to be handled, the cylinders must be kept vertical. This is recommended both from safety considerations and so that the gas can be used to the maximum. Similarly containers marked fragile should be handled delicately to avoid breakages.

Packing: When goods are repacked into smaller containers from a bulk container, recommended procedures should be followed. Chemical disinfectants which are normally purchased in bulk have to be redistributed to individual users in a smaller quantity depending on their usage. When acidic disinfectants like carbolic acids are to be dispensed to individual users, they should not be packed in metal containers, as the acid will react with metals and be rendered useless causing waste. If a certain composition has to be freshly prepared as for hypo , only the required quantity has to made and bottled for immediate use.

Preservation: Care should be taken to preserve goods as per the manufacturers advice. The conditions of temperature, light should be maintained. Most of the chemicals will have specifications wherein it has to be stored in amber colour bottles and or refrigerated or far away from sunlight. For instance, potassium permanganate should be stored away from sunlight and in amber coloured bottles.

4.      Research and Development: It is better to use a shared facility for research and development facilities, instead of developing an individual capability. This will directly reduce the cost and wastage. Sharing of data on waste generated, remedial and innovative practices, case studies including success and failures will help in bench marking, reducing waste by learning from others experience , encourage research in grey areas etc. You could use the facility of share your experience, Ask an expert and FAQ features provided in this website. To reduce the consumption without reduction in efficiency, research can be carried out to minimize the use of chemicals or resources. For example in the treatment of waste effluent, arising in an institute, research on chlorine dosage and retention time will help in the reduced usage.

5.      Customer service: It is not enough for the institutions to minimize the waste generated in its control but should also take care of the waste generated in its premises by external sources. For example in health care institutions, provision of collection boxes for excess medicines will help in recycling and reuse and safe disposal of waste. Provision of canteen facilities will help in minimizing food waste in the wards. Awareness can be created among patients and attendants via posters, audio-visuals and word of mouth by the institution staff.

6.      Acquisition, construction or modification of property and facilities: During the planning of an institute, or expansion to an existing facility, care should be taken to minimize the routing of waste, handling of waste. Planning for new equipments or technology should be done after considering its need, user friendliness, customer support, availability of spares etc. Quantity and quality of waste generated is of paramount importance for selection of right technology and its capacity. To aid this an audit form – 4 could be used and mailed to the web site.  The right technology without proper customer support or down due to lack of spares will render the management of waste ineffective and potentially dangerous. The selection of technology should be complete by itself and not convert one form of waste to another which is equally dangerous.