MED-3R measures to improve the collection of home generated medical waste
WHERE: France – Metropolis Nice, Cote d’Azur
WHEN: Ongoing – since 2015
WASTE MANAGEMENT HIERARCHY: Disposal (treatement)
TYPE OF INSTRUMENT: Voluntary
WASTE STREAMS: Medical waste („sharps waste”, as per World Health Organization – WHO)
About: By the Decree of 12 December 2012, a national approved eco-organization called DASTRI was nominated to collect and treat the home generated medical sharps waste from the determined collection points over the French territory. Thus, these wastes and their containers shall be incinerated or sanitized and destroyed.
The Metropolis of Nice Cote d’Azur conducted a communication campaign through the MED-3R project, to inform and raise users’ awareness about the risks of these hazardous waste. It provided them with the contact details of the 112 pharmacies that can collect their medical waste.
Photo Source: Dastri
The free availability of specific collectors to be used by patients and users of self-tests to store their waste
– The collection and disposal of these needle boxes
– Communication and awareness for all actors in the sector.
o When launched, the project benefitted by a communication campaign among popula-tion
o Currently, patients have a free number to call DASTRI in order to get competent in-structions on the collection of home generated medical waste.
2. Funding/budget: the communication campaign has been funded under the “MED-3R pro-ject” – MED-3R Euro-Mediterranean Strategic Platform for a Suitable Waste Management – a strategic project of the ENPI CBC MED Programme included in the topic “Waste treatment and recycling” (EU funds).
3. Material resources:
– 13.200 flyers
– The distribution points: the places where the BBA (Needle Boxes to be used by beneficiaries) are distributed free of charge. These distribution points are exclu-sively pharmacies and pharmacies for indoor use (PUI).
There are 1.4 million of self-managing patients on the French territory, producing annually 360 tons of home generated medical waste. Within the Metropolis of Nice Cote d’Azur territory, the number of such patients stands at 11,800, representing around 3 tons per year of such hazardous waste. Those high numbers justify the frequent occurrence of accidental cases and require subsequently the establishment of adequate regulations.
The quantities of home generated medical waste collected and disposed together with the residual waste decreased since project implementation.
Following to the awareness actions for pharmacies, 112 geo located collection points for the home generated medical waste have been assigned over the metropolitan area.
Urban metabolism relevance
When disposed together with household waste, medical waste generated by self-managing patients, represent a health threat for the waste collecting and sorting employees. Numerous accidental cases are recorded each year in France. Potentially lethal virus such as the HIV that causes AIDS, the HBV and the HCV that cause hepatitis B and C may be transmitted through sharp medical waste, due to perforating infested material.
Therefore, in order to maximize the efficiency of this waste flow and reduce the environmental impact, the patient must return the DASTRI needle boxes in one of the pharmacies participating to the collection scheme, when the box is full (or at the end of treatment).
Initially intended for health industry actors, DASTRI innovated by addressing to citizens (self-managing patients), in order to reduce environmental impacts, considering the specificities and constraints of the sector.
Also, the platform MED-3R, under which the communication campaign has been made for this project, is an operational reference tool to apply and adapt waste management innovations in the Mediterranean region. The platform suggests innovation in approaches and services, in order to meet with the specific needs of the beneficiary territories experiencing great difficulties in defining or implementing efficient and sustainable waste management plans.
Engaged participatory processes
During the project implementation, communication events have been organized:
– The first awareness campaign deployed in May 2015 among 44% of the pharmacies on the territory of Nice Cote d’Azur Metropole (a total of 112 pharmacies), where explanatory leaflets were distributed to patients buying medical sharps.
– A MED-3R stand communicating on home generated medical waste was held on the 14th of November 2015, in Nice, on the occasion of the World Diabetes Day. This event has been organized by the City of Nice, in collaboration with the Primary Sickness Insurance Fund (Caisse Primaire d’Assurance Maladie), diabetes associations, the Alpes-Maritimes Departmental Fire and Emergency Service and Nice Cote d’Azur Metropole and brought together a large number of people with diabetes in self-care, generating considerable amounts of medical sharps waste.
In the participatory process, DASTRI has a great importance due to its relevance in both health and waste industries. DASTRI is the national eco-organization that collects and treats infectious and related risk-related healthcare waste (DASRI) from two categories of beneficiaries: self-treatment patients and users of disease diagnostic self-tests infectious diseases. It is an atypical eco-organism, financed entirely by health industry, drug companies and medical device manufacturer.
There are 54 members/producers and represent almost the entire area covered by the regulations. They chose to set up a global system, shared and optimized for patients in self-treatment throughout the territory.
The engagement process is also a key factor of the new-started collaboration between the French eco-organization DASTRI and the Principality of Monaco. In this respect, the involvement of all Monaco industry stakeholders (health professionals and their representatives, the Directorate of Health Action) with DASTRI will raise awareness and support all patients to adopt the right sorting gesture. In the Principality of Monaco there will be 16 pharmacies participating to the new-established collaboration scheme.
Sustainability and replicability
1. DASTRI provides self-treatment patients and users of diagnostic self-tests with a simple and secure proximity solution for the disposal of the perforating waste they produce, which represents a risk for the community. This solution can be applied in any commu-nity from all over Europe and globe.
2. The points of collection are placed in accessible points: pharmacies, waste disposal cen-ters, health facilities, medical analysis laboratories, etc. There are currently nearly 18,000 points of collection in France, that can be easily located (www.dastri.fr/nous-collectons).
3. At the end of September 2018, a new collaboration for self-treatment patient waste management and self-test users has been initiated between the French association DASTRI and the Principality of Monaco. By signing the agreement, all pharmacies in the Principality are now able to distribute free needle boxes to patients and then collect them.
1. According to the French finance Act 2009, applicable as from 1 January 2011, regarding the treatment of this type of waste, pharmacies, hospital pharmacies and medical laboratories have to collect, free of charge, the home generated medical sharps waste, produced by self-managing patients. Patients should be supplied with medical sharps containers upon presentation of their medical subscription. It should be noted that healthcare professionals whose intervention generates sharp medical waste, are responsible for their disposal (excluded from the DASTRI services).
2. One of the keys to success in the industry is communication between local authorities, patient associations, liberal health professionals, members of the eco-organization, pharmacies, PUIs, medical laboratories, collection operators.
3. Easy process: Upon simple presentation of a prescription, or when purchasing a self-test for the diagnosis of communicable infectious diseases, yellow boxes with green covers are made available free of charge to the beneficiaries of the DASTRI device: patients in self-treatment or users of infectious disease diagnostic self-tests.
4. The DASTRI needle boxes are freely distributed to all dispensary network.
5. On DASTRI website, patients can find clear instructions on how to separately collect the home generated medical waste (especial needles) and the geolocation of collection points, so that it would be easy for them to follow the entire process. Also, a FAQ section is available.
Monitoring the quantities of home generated sharp waste collected from the collection points is very important for both the project progress and for communicating the results to population, so that new diagnosed patients who have to administrate self-treatments with syringes and needles (e.g. diabetics patients) should immediately know how to collect and dispose the sharp waste.
Also, the citizens’ awareness on which are the sharp wastes and what are the possible risks of mixing it with the municipal waste is a continuous challenge.
The information presented above was taken from public sources, and assessed by UrbanWINS experts according to the project requirements, field research, deductions and analytical process. Key assumptions and projections may deviate from the opinions presented by author, this may typically be the result of differing time horizons, methodologies, contexts or other factors.
We do not assume any rights or guarantees, the sources of all data can be found in the „References” section, in the document. At the time of publishing, we did not received a point of view from the owners/beneficiaries of the practice (although have been requested an official position to the authors, via e-mail), and it can be withdrawn simply by email notification.
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