MPH (Occupational Hygiene), Faculty of Health Sciences, University of the Witwatersrand, 2009 / The study of medical waste management practices in Ekurhuleni Metropolitan Municipality clinics in South Africa took place in the absence of the relevant parliamentary law governing such waste, but governed by the final published Gauteng Health Care Waste Management Regulations 3003 of 2003. In accordance with the Gauteng Health Care Waste Management Regulations 303 of 2003, Medical Waste Management Practices are such that where medical waste is generated, it should be segregated at the point of generation, be properly containerised, labelled, stored, treated and finally be disposed of. The researcher studied 29 out of 112 clinics in Ekurhuleni Metropolitan Municipality on whether medical waste management practices in these clinics comply with the Gauteng Health Care Waste Management Regulations 3003 of 2003. The study also intended to help practising and managing nurses to reduce occupational health risks, while further increasing the safety of clinic service users from unforeseen infections by communicable diseases. Materials and methods The study followed a cross-sectional descriptive survey method wherein data acquisition was by means of interviewing clinic managers with regard to medical waste management iii practices in their clinics using a structured questionnaire; and by observations of medical waste management practices through a walkthrough survey checklist. The study sample composed of 30 clinics selected from a total of 112 clinics, where a total population of 7 maternity and 23 day clinics were included through random selection. A response rate of 29 out of 30 clinics selected was obtained. The interview questionnaire consisted of six dimensions of measurement of medical waste management practices, while the walkthrough survey checklist consisted of twenty six items measuring medical waste management practices. Both were developed in line with the stipulations of the Gauteng Health Care Waste Management Regulations 3003 of 2003. A pilot study was conducted to further refine the contents of the above two measuring tools. The study setting comprised individual sections of each clinic such as primary health care, maternity, HIV/AIDS, mental health, antenatal care, family planning and the communicable diseases section, wherein a nurse is assigned per shift to examine patients and to administer injections and medicines. Observations were done on all medical waste management practices in the examination rooms of all sections of the clinics in order to carefully record both negative and positive practices. Such observations made followed the required medical waste management process as per the Gauteng Health Care Waste Management Regulations 3003 of 2003. iv Results The operations of Ekurhuleni municipal clinics revealed a 67 percent (4 out of 6 required documentation) non-existence of the required documentations, predominantly in the areas of medical waste policy; written safe work procedures; a training programme; and conducting of risk assessments. Specifically, The majority (65.5%) of clinics in Ekurhuleni Metropolitan Municipality have no medical waste management policy. The majority (69%) of clinics in Ekurhuleni Metropolitan Municipality have no safe work procedures. The majority (93%) of clinics in Ekurhuleni Metropolitan Municipality have no waste management training programme. The majority (69%) of clinics in Ekurhuleni Metropolitan Municipality do not conduct risk assessment for their operations. Of the 26 medical waste management practices observed, positive medical waste management practices were observed in 46 percent of the observations compared to 50 percent of negative observations, made in operating conditions of clinics. Discussion The findings of the study revealed a high degree of non-compliance of Ekurhuleni Metropolitan Municipality with the Gauteng Health Care Waste Management Regulations v 3003 of 2003 with regard to the required documents and the acceptable observed practices. Conclusions Medical waste management training in Ekurhuleni Metropolitan Municipality does not happen due to both the lack of policy documents and budgetary problems. Health care workers are exposed to both ergonomic and biological hazards due to a lack of proper medical waste storage, storage signage and incorrect handling of medical waste. No medical waste management audits and risk assessments are conducted in Ekurhuleni Metropolitan Municipality clinics. Non accountability over disposal of medical waste may promote illegal dumping of medical waste generated from Ekurhuleni municipal clinics. Recommendations Managers of clinics in Ekurhuleni Metropolitan Municipality need to be informed of the stipulations of Gauteng Health Care Waste Management Regulations 3003 of 2003. Based on the developed policies, clinic managers need to develop medical waste management training programmes wherein the stipulations of Gauteng Health Care Waste Management Regulations 3003 of 2003 will be incorporated. Designated medical waste management storage facilities to be provided for all Ekurhuleni Metropolitan Municipality clinics. vi Clinic management and appointed medical waste management officers to ensure that medical waste management audits and risk assessments are conducted and that corrective measures are implemented in Ekurhuleni Metropolitan Municipality clinics.