GEMS: Sector Environmental Guidelines: Healthcare Facilities

Partial Update 2014
Last Full Update: 2009
PDF (1.3 MB)

Small-scale healthcare facilities play a vital role in public health and are a key part of integrated community development.

The staff at rural health posts (including immunization and reproductive health posts), mobile and emergency healthcare programs, urban clinics and small hospitals are not only tasked with treating the sick. They are also responsible for disease prevention, and health communication and education and serve as the front line of defense against epidemics such as AIDS, malaria, and cholera. Health service professionals at these facilities provide family planning, nurture child and adult health, prevent disease, cure debilitating illnesses, and alleviate the suffering of the dying.

However, environmentally poor design and management of these facilities can adversely affect patient and community health countering the very benefits they are intended to deliver.

This Guideline describes the mechanisms by which environmental and health risks arise and recommends mitigation and monitoring measures to reduce them and otherwise strengthen project outcomes. It also includes a number of checklists for environmentally sound design and management (ESDM) of small health facilities.

Resources

Other USAID Small-Scale Guidelines

A number of the issues summarized in this guidance are treated in more detail in other chapters of the Sector Environmental Guidelines. Refer to these specific guidelines listed below for detailed information on specific issues:

Additional references and suggested resources include:

S. Batterman. Assessment of Small-Scale Incinerators for Health Care Waste. WHO. Geneva, Switzerland. 2004. http://www.who.int/immunization_safety/publications/waste_management/en/assessment_SSIs.pdf

This report provides an analysis of low cost small-scale incinerators used to dispose of health care waste in developing countries, specifically sharps waste (used and possibly infected syringes and needles). The report includes a situation analysis, a “best practices” guide to small-scale incineration, a screening level health risk assessment for ingestion and inhalation exposure to dioxin-like compounds, and other information related to the operation and evaluation of the incineration option for health care waste.

Consumer Product Safety commission, US EPA, and American Lung Association, Asbestos in the Home http://www.cpsc.gov/CPSCPUB/PUBS/453.html
Belinda Greenwood-Smith (MBBS). Environmental Health Issues in a Basic Health Care Center in Ghurian, Afghanistan. http://www.tropmed.org/rreh/vol1_1.htm

This is the report of measures taken to ensure proper inclusion of environmental health issues while rehabilitating a clinic in rural Afghanistan.

T. Grayling. Guidelines for Safe Disposal of Unwanted Pharmaceuticals In and After Emergencies. WHO. Geneva, Switzerland. 1999. http://www.who.int/entity/water_sanitation_health/medicalwaste/unwantpharm.pdf

These guidelines provide advice on the implementation of safe disposal of unusable pharmaceuticals in emergencies and in countries in transition where official assistance and advice may not be available. A number of methods for safe disposal of pharmaceuticals are described. These are methods which involve minimal risks to public health and the environment, and include those suitable for countries with limited resources and equipment. The adoption of the guidelines by ministries of health, environment and other relevant ministries, and their practical application, will contribute to the safe and economical elimination of stockpiles of unusable pharmaceuticals.

B. Hirsch, C. Gallegos, W. Knausenberger, and A. Arata. Programmatic Environmental Assessment for Insecticide-Treated Materials in USAID Activities in Sub-Saharan Africa. U.S. Agency for International Development, Bureau for Africa, Office of Sustainable Development, Agriculture, Natural Resources and Rural Enterprise Division. 2002. http://pdf.usaid.gov/pdf_docs/PNACP696.pdf
Environmentally Responsible Management of Health Care Waste With a Focus on Immunization Waste. Washington, DC. 2002. http://www.bvsde.paho.org/bvsacd/cd48/reponsible.pdf

The document was prepared by Health Care Without Harm (HCWH) A coalition of international NGOs, scientists, and medical professionals) thatadvocates for safe handling, treatment and disposal of medical waste. HWCH works to discourage antiquated approaches to waste management that produce harmful environmental and public health impacts, and replace them with innovative thinking and approaches that makes the best use of technology and management skills to solve this problem.

Health Care Without Harm. MedWaste Management resources. http://www.noharm.org/us_canada/issues/waste/resources.php

A collection of resources on proper medical waste management including fact sheets on: Waste Minimization, Segregation, and Recycling in Hospitals; 10 Ways to Reduce Medical Wastes; Guidelines for Optimizing Waste Segregation; and Waste Minimization Resources.

Jimenez, A. and K. Olson. Renewable Energy for Rural Health Clinics. National Renewable Energy Laboratory. Golden, Colorado. 1998. http://www.greenstar.org/NREL%20Solar%20Health.pdf

The National Renewable Energy Laboratory’s (NREL) Village Power Program has commissioned this guidebook to help communicate the appropriate role of renewables in providing rural health care services. It combines technical analysis and practical design, deployment, and training experience with renewables as a serious option for electrifying rural health clinics. It is useful to renewable energy practitioners in defining the parameters for designing and deploying their products for health clinic needs.

Kevens, RM, J Edwards, C Richards, T Horan, R Gaynes, D Pollock, and D Cardo. “Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002.” Public Health Reports. March–April 2007 Volume 122 pp 160–166. Available at http://www.cdc.gov/ncidod/dhqp/pdf/hicpac/infections_deaths.pdf.
Pruss, A, E. Giroult, and P. Rushbrook (Eds). Safe Management of Wastes from Health-Care Activities. ISBN 92 4 154525 9. WHO, Geneva. 1999. http://www.who.int/water_sanitation_health/medicalwaste/wastemanag/en/

This handbook is a comprehensive, user-friendly guide for practical management of health-care waste in local facilities. It provides guidelines for the responsible national and local administrators, and offers globally relevant advice on the management of health-care waste.

Sehulster LM, Chinn RYW, Arduino MJ, Carpenter J, Donlan R, Ashford D, Besser R. Fields B, McNeil MM, Whitney C, Wong S, Juranek D, Cleveland J. Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago IL; American Society for Healthcare Engineering/American Hospital Association; 2004. http://www.cdc.gov/ncidod/dhqp/gl_environinfection.html

This is an environmental infection-control guideline that reviews and reaffirms strategies for the prevention of environmentally-mediated infections, particularly among health-care workers and immuno-compromised patients. The recommendations are evidence-based whenever possible. The contributors to this guideline reviewed predominantly English-language articles identified from MEDLINE literature searches, bibliographies from published articles, and infection-control textbooks.

The Sphere Project. Humanitarian Charter and Minimum Standards in Disaster Response: Minimum Standards in Water Supply, Sanitation, and Hygiene Promotion. Geneva, Switzerland. 2004. http://www.sphereproject.org/handbook/

This chapter is divided into six main sections: Hygiene Promotion, Water Supply, Excreta Disposal, Vector Control, Solid Waste Management and Drainage. Each contains the following:

The minimum standards: these are qualitative in nature and specify the minimum levels to be attained in the provision of water and sanitation responses;

Key indicators: these are ‘signals’ that show whether the standard has been attained. They provide a way of measuring and communicating the impact, or result, of programs as well as the process, or methods, used. The indicators may be qualitative or quantitative;

Guidance notes: these include specific points to consider when applying the standard and indicators in different situations, guidance on tackling practical difficulties, and advice on priority issues. They may also include critical issues relating to the standard or indicators, and describe dilemmas, controversies or gaps in current knowledge.

WHO. Laboratory Biosafety Guidelines (3rd edition). ISBN 92 4 154650 6. Geneva, Switzerland. 2004 http://www.who.int/csr/resources/publications/biosafety/Biosafety7.pdf

For more than 20 years, since it was first published in 1983, the Laboratory Biosafety Manual has provided practical guidance on biosafety techniques for use in laboratories at all levels. Laboratory biosecurity concepts are introduced, and the latest regulations for the transport of infectious substances are reflected. Material on safety in health-care laboratories, previously published elsewhere by WHO, has also been incorporated for the 3rd edition.

WHO. Management of Solid Health-Care Waste at Primary Health-Care Centres: A Decision-Making Guide. ISBN 92 4 159274 5. Geneva, Switzerland. 2005. http://www.who.int/entity/water_sanitation_health/medicalwaste/decisionmguiderev221105.pdf

This document is to provide guidance for selecting the most appropriate options for safely managing solid waste generated at Primary Health-Care centers (PHCs) in developing countries. The main tool of this guide consists of six decision-trees aimed at assisting the user in identifying appropriate waste management methods. The guide takes into consideration the most relevant local conditions, the safety of workers and of the general public as well as of environmental criteria.

WHO, Pesticide Evaluation Scheme. http://www.who.int/whopes/en/

Excerpt from the website: “The WHO Pesticide Evaluation Scheme (WHOPES) was set up in 1960. WHOPES promotes and coordinates the testing and evaluation of pesticides for public health. It functions through the participation of representatives of governments, manufacturers of pesticides and pesticide application equipment, WHO Collaborating Centres and research institutions, as well as other WHO programmes, notably the International Programme on Chemical Safety.
In its present form, WHOPES comprises a four-phase evaluation and testing programme, studying the safety, efficacy and operational acceptability of public health pesticides and developing specifications for quality control and international trade.”

Worker’s Health Centre, Asbestos Removal Fact Sheet, http://www.workershealth.com.au/images/pdf_uploads/002AsbestosRemoval.pdf

Climate Change-Specific

Note: USAID's Global Climate Change (GCC) Office can provide support on the climate change aspects of this Guideline. To contact the GCC office, please email: climatechange@usaid.gov

USAID. 2007. Adapting to Climate Variability and Change: A Guidance Manual for Development Planning. http://pdf.usaid.gov/pdf_docs/PNADJ990.pdf
USAID. 2009. Adapting to Coastal Climate Change: A Guidebook for Development Planners. http://pdf.usaid.gov/pdf_docs/PNADO614.pdf

The guidances provide information to assist planners and stakeholders as they cope with a changing climate throughout the project cycle.

AGC of America. 2009. Climate Change and the Construction Industry. http://www.agc.org/galleries/advy/ClimateChangeandConstruction.pdf
U.S. Green Building Council. http://www.usgbc.org/
Leadership in Energy and Environmental Design (LEED). https://www.leedonline.com/irj/servlet/prt/portal/prtroot/com.sap.portal.navigation.portallauncher.anonymous
International Association for Impact Assessment (IAIA). FasTips #3. February 2013. Climate Smart Decisions. http://www.iaia.org/publicdocuments/special-publications/fast-tips/Fastips_3%20Climate%20Smart%20Decisions.pdf
National Institute of Building Sciences. Whole Building Design Guide. 2013. Passive Solar Heating. http://www.wbdg.org/resources/psheating.php
World Health Organization. Health Care Without Harm. Discussion Draft. Healthy Hospitals, Healthy Planet, Healthy People: Addressing Climate Change in Health Care Settings. 2009. http://noharm.org/lib/downloads/climate/Healthy_Hosp_Planet_Peop.pdf
Lomas, K. J., and J. Yingchun. Resilience of Naturally Ventilated Buildings to Climate Change: Advanced Natural Ventilation and Hospital Wards. Science v. 41, 6. 629-653. 2009. http://www.sciencedirect.com/science/article/pii/S0378778809000036

Documentos disponibles en español

Guias sobre medio ambiente salud y seguridad para la instalaciones de atencion sanitaria. Corporación Financiera Internacional. 30 Abril 2007. http://www1.ifc.org/wps/wcm/connect/65b19780488555b1b7b4f76a6515bb18/Healthcare_-_Spanish_-_Final-%2Brev%2Bcc.pdf?MOD=AJPERES&CACHEID=65b19780488555b1b7b4f76a6515bb18

Documents disponible en Francais

Directives environnementales, sanitaires et sécuritaires pour les établissements. Société financière internationale. Avril 2007 http://www1.ifc.org/wps/wcm/connect/5606648048855559b644f66a6515bb18/013_Health%2BCare%2BFacilities.pdf?MOD=AJPERES
&CACHEID=5606648048855559b644f66a6515bb18