ABSTRACT Introduction: The Gauteng Province in South Africa is home to four large hospitals which generate enormous amounts of waste. However, no formal study has been done to asses the magnitude of this problem. Health care waste falls under a cluster of waste which is regarded as hazardous due to its composition and therefore ability to transmit disease. It has become an important type of waste mainly because of its ability to transmit HIV/AIDS, Hepatitis B and C among other infectious diseases. This study attempted to address the knowledge and practices of doctors and nurses, which are just some of the factors which influence health care waste management. Aims: The main aim of this study was to evaluate the current knowledge and practices of doctors and nurses regarding the management of health care waste. Methods: This was a descriptive cross sectional study. A self administered questionnaire was used to collect the data. A total sample of 128 doctors and nurses was drawn from the Johannesburg Hospital, an academic hospital in the Gauteng Province. Results: Although there was overall lack of awareness about the existence of the international, national, provincial and local documents (Act, Regulation, Manual, Code of Practice and Policies) regulating heath care waste management, the majority of the respondents (84%) knew about the existence of the Johannesburg Hospital’s policy on waste management. Generally, knowledge of nursing staff was significantly higher than that of doctors. Although some good practices such as use of gloves were reported, there is generally a lack of knowledge about key documents regulating health care waste, particularly among the doctors. Conclusion: This study was the first of its kind to be done at the Hospital. As the Hospital policy is more accepted and accessible to the health professionals than the other documents investigated in this study, it should be updated regularly to incorporate new changes. The Hospital should not only make that policy document more easily accessible and visible but also strive to reach doctors with training in health care waste management. Continuous monitoring and evaluation is also necessary to ensure that policies and procedures are followed.

Esta tese de doutorado teve como foco principal das análises, as atividades de gestão e gerenciamento dos resíduos de serviços de saúde na Unidade de Gerenciamento de Recursos Hídricos 22, Pontal do Paranapanema - SP. A hipótese formulada foi de que não havia conhecimento técnico em manejo de resíduos de serviços de saúde. Nos municípios, foram analisados a gestão e o gerenciamento dos resíduos de serviços de saúde em 19 municípios bem como as atividades das vigilâncias sanitárias municipais e o gerenciamento interno e externo dos resíduos de serviços de saúde de 77 estabelecimentos geradores, distribuídos nesses municípios, a saber: unidades básicas de saúde, prontos socorros e laboratório de análises clínicas. O estudo abrangeu também as atividades da Companhia Ambiental do Estado de São Paulo e do Comitê de Bacia Hidrográfica. As técnicas empregadas para a realização desta pesquisa foram: coleta de dados (emprego de questionário, formulário e observação); pesquisa bibliográfica (teses, livros, artigos) e documental (leis, normas, contratos, planos municipais de saúde e plano de gerenciamento dos resíduos de serviços de saúde - PGRSS); caracterização gravimétrica e classificação dos resíduos de serviços de saúde gerados pelos estabelecimentos municipais, durante o período de oito dias, como preconiza a Organização Pan-Americana de Saúde, aliada à Resolução CONAMA nº. 358/05. A pesquisa demonstrou que todos os 19 municípios contrataram empresas especializadas, terceirizando a coleta, o transporte, o tratamento e a disposição final dos resíduos de serviços de saúde. Além disso, foram verificadas dificuldades das vigilâncias sanitárias municipais em relação, às atividades de fiscalização, monitoramento e controle de resíduos de serviços de saúde, principalmente devido à transferência da gestão plena às vigilâncias sanitárias municipais pelo governo do Estado de São Paulo. Quanto ao gerenciamento interno dos resíduos de serviços de saúde nos estabelecimentos geradores, constatou-se a dificuldade em segregar resíduos do grupo A (infectantes) dos integrantes do grupo D (comuns), tendo sido constatada uma média de 15% de resíduos considerados comuns junto aos infectantes. A pesquisa revelou ainda, em relação aos procedimentos adotados, um aspecto preocupante do ponto de vista do cumprimento da RDC ANVISA nº 306/04, uma vez que 97,4% dos estabelecimentos não possuíam o PGRSS. A infraestrutura para abrigar os resíduos de serviços de saúde dentro das normas técnicas nos estabelecimentos geradores é quase inexistente, considerando que tal instalação foi verificada em somente 6,49% dos 77 estabelecimentos geradores. Diante dos resultados, confirmou-se, por fim, a ausência de capacitação técnica voltada ao manejo dos resíduos de serviços de saúde, na área de estudo desta pesquisa, corroborando a hipótese inicialmente estabelecida. / This thesis had as main focus of the analysis, management activities and management of health care waste at the division of water resources unit 22, Pontal do Paranapanema - SP. The hypothesis was that there was not any technical knowledge about health care waste management. It was analyzed the management and health care waste of 19 municipalities as well as all the activity of sanitary surveillance and the internal and external management of health care waste from 77 generators institutions within these municipalities namely: basic health units, emergency rooms and clinical laboratories. The study also focused on the activities of the Environmental Company of S ão Paulo and Watershed Committee. Among the methodological procedures for the research were used: data collection, bibliographic and documental research, gravimetrical characterization and classification of the waste generated by municipal health facilities, for eight days, based on the Pan American Health Organization together with CONAMA Resolution 358/05.The research found that all counties had hired specialized companies, outsourcing the collection, transportation, treatment and disposal of health care waste. The survey also revealed difficulties in the municipal health surveillance regarding the fiscalization activities, health care waste monitoring and controlling, mainly due to the transition of the full management to municipal health surveillance of the State of Sao Paulo. Regarding internal the health care waste, the survey found that municipalities had difficulties in the procedure for waste segregation between group A and group D, since it was observed approximately 15% of common waste among infectious waste. Regarding the procedures adopted to carry out the internal management of health care waste, the study showed an worrying aspect from the standpoint of compliance with ANVISA RDC 306/04, since 97,4% of the health facilities had no waste management plan. The infrastructure to shelter the health care waste was almost nonexistent, visits to these facilities found the existence in only 6,49% of 77 waste generators. Considering the results, we concluded the absence of technical training focused on waste management of health facilities in the researched area, supporting the hypothesis initially established.

Esta tese de doutorado teve como foco principal das análises, as atividades de gestão e gerenciamento dos resíduos de serviços de saúde na Unidade de Gerenciamento de Recursos Hídricos 22, Pontal do Paranapanema - SP. A hipótese formulada foi de que não havia conhecimento técnico em manejo de resíduos de serviços de saúde. Nos municípios, foram analisados a gestão e o gerenciamento dos resíduos de serviços de saúde em 19 municípios bem como as atividades das vigilâncias sanitárias municipais e o gerenciamento interno e externo dos resíduos de serviços de saúde de 77 estabelecimentos geradores, distribuídos nesses municípios, a saber: unidades básicas de saúde, prontos socorros e laboratório de análises clínicas. O estudo abrangeu também as atividades da Companhia Ambiental do Estado de São Paulo e do Comitê de Bacia Hidrográfica. As técnicas empregadas para a realização desta pesquisa foram: coleta de dados (emprego de questionário, formulário e observação); pesquisa bibliográfica (teses, livros, artigos) e documental (leis, normas, contratos, planos municipais de saúde e plano de gerenciamento dos resíduos de serviços de saúde - PGRSS); caracterização gravimétrica e classificação dos resíduos de serviços de saúde gerados pelos estabelecimentos municipais, durante o período de oito dias, como preconiza a Organização Pan-Americana de Saúde, aliada à Resolução CONAMA nº. 358/05. A pesquisa demonstrou que todos os 19 municípios contrataram empresas especializadas, terceirizando a coleta, o transporte, o tratamento e a disposição final dos resíduos de serviços de saúde. Além disso, foram verificadas dificuldades das vigilâncias sanitárias municipais em relação, às atividades de fiscalização, monitoramento e controle de resíduos de serviços de saúde, principalmente devido à transferência da gestão plena às vigilâncias sanitárias municipais pelo governo do Estado de São Paulo. Quanto ao gerenciamento interno dos resíduos de serviços de saúde nos estabelecimentos geradores, constatou-se a dificuldade em segregar resíduos do grupo A (infectantes) dos integrantes do grupo D (comuns), tendo sido constatada uma média de 15% de resíduos considerados comuns junto aos infectantes. A pesquisa revelou ainda, em relação aos procedimentos adotados, um aspecto preocupante do ponto de vista do cumprimento da RDC ANVISA nº 306/04, uma vez que 97,4% dos estabelecimentos não possuíam o PGRSS. A infraestrutura para abrigar os resíduos de serviços de saúde dentro das normas técnicas nos estabelecimentos geradores é quase inexistente, considerando que tal instalação foi verificada em somente 6,49% dos 77 estabelecimentos geradores. Diante dos resultados, confirmou-se, por fim, a ausência de capacitação técnica voltada ao manejo dos resíduos de serviços de saúde, na área de estudo desta pesquisa, corroborando a hipótese inicialmente estabelecida. / This thesis had as main focus of the analysis, management activities and management of health care waste at the division of water resources unit 22, Pontal do Paranapanema - SP. The hypothesis was that there was not any technical knowledge about health care waste management. It was analyzed the management and health care waste of 19 municipalities as well as all the activity of sanitary surveillance and the internal and external management of health care waste from 77 generators institutions within these municipalities namely: basic health units, emergency rooms and clinical laboratories. The study also focused on the activities of the Environmental Company of S ão Paulo and Watershed Committee. Among the methodological procedures for the research were used: data collection, bibliographic and documental research, gravimetrical characterization and classification of the waste generated by municipal health facilities, for eight days, based on the Pan American Health Organization together with CONAMA Resolution 358/05.The research found that all counties had hired specialized companies, outsourcing the collection, transportation, treatment and disposal of health care waste. The survey also revealed difficulties in the municipal health surveillance regarding the fiscalization activities, health care waste monitoring and controlling, mainly due to the transition of the full management to municipal health surveillance of the State of Sao Paulo. Regarding internal the health care waste, the survey found that municipalities had difficulties in the procedure for waste segregation between group A and group D, since it was observed approximately 15% of common waste among infectious waste. Regarding the procedures adopted to carry out the internal management of health care waste, the study showed an worrying aspect from the standpoint of compliance with ANVISA RDC 306/04, since 97,4% of the health facilities had no waste management plan. The infrastructure to shelter the health care waste was almost nonexistent, visits to these facilities found the existence in only 6,49% of 77 waste generators. Considering the results, we concluded the absence of technical training focused on waste management of health facilities in the researched area, supporting the hypothesis initially established.

Embora os conceitos logísticos geralmente sejam associados aos processos de manufatura, eles podem ser aplicados a outras áreas, como é o caso do presente trabalho. Os resíduos de serviços de saúde (RSS) compõem uma parcela pequena do total de resíduos sólidos produzidos por um município, mas são particularmente importantes, pois constituem fontes de disseminação de doenças. Desta forma o correto tratamento destes resíduos é importante para a manutenção da saúde e da qualidade de vida da população. Como toda operação de movimentação, o transporte dos RSS gera despesas que os municípios têm que arcar. Racionalizar processos, reduzir custos, aproveitar a sinergia entre os municípios permite que os recursos economizados possam ser gastos com outros benefícios à população. Este trabalho teve como objetivo fazer um estudo logístico, utilizando como ferramenta um Sistema de Informação Geográfica (SIG), e propor alternativas para a resolução do problema do tratamento dos RSS, buscando reduzir o custo de transporte envolvido neste processo. Foi realizado um estudo de caso na Área de Proteção Ambiental Corumbataí, o qual abrangeu doze municípios de pequeno porte. O trabalho considerou quatro alternativas, apresentando nos resultados os pontos positivos e negativos das mesmas. Foi sugerida a formação de um consórcio intermunicipal, como forma de baratear os custos envolvidos no problema abordado. / Although the logistic concepts generally are associates to the manufacture processes, they can be applied in other areas, like in this work. The health care waste constitutes a small parcel of the total of solid residues produced by a city; therefore they are sources of diseases dissemination. The correct treatment of these residues is important for the maintenance of the health and life\'s quality of the population. As all movement\'s operations, the transport of these residues generates expenditures for the cities. Rationalize processes, reduce costs using the synergy advantages between the cities, allow that the saved resources may be expended with others benefits for the population. This work had as objective to make a logistic study, using as tool a Geographic Information System (GIS), and to propose alternatives for the resolution of the treatment\'s problem for the health care waste, searching to reduce transportation\'s costs involved in this process. A case study was developed in Corumbataí Environment Protection Area, which enclosed twelve small cities. The work considered four alternatives, presenting in the results the positive and negative aspects of each one. The formation of a consortium between the cities was suggested, as form to reduce costs in the boarded problem.

Embora os conceitos logísticos geralmente sejam associados aos processos de manufatura, eles podem ser aplicados a outras áreas, como é o caso do presente trabalho. Os resíduos de serviços de saúde (RSS) compõem uma parcela pequena do total de resíduos sólidos produzidos por um município, mas são particularmente importantes, pois constituem fontes de disseminação de doenças. Desta forma o correto tratamento destes resíduos é importante para a manutenção da saúde e da qualidade de vida da população. Como toda operação de movimentação, o transporte dos RSS gera despesas que os municípios têm que arcar. Racionalizar processos, reduzir custos, aproveitar a sinergia entre os municípios permite que os recursos economizados possam ser gastos com outros benefícios à população. Este trabalho teve como objetivo fazer um estudo logístico, utilizando como ferramenta um Sistema de Informação Geográfica (SIG), e propor alternativas para a resolução do problema do tratamento dos RSS, buscando reduzir o custo de transporte envolvido neste processo. Foi realizado um estudo de caso na Área de Proteção Ambiental Corumbataí, o qual abrangeu doze municípios de pequeno porte. O trabalho considerou quatro alternativas, apresentando nos resultados os pontos positivos e negativos das mesmas. Foi sugerida a formação de um consórcio intermunicipal, como forma de baratear os custos envolvidos no problema abordado. / Although the logistic concepts generally are associates to the manufacture processes, they can be applied in other areas, like in this work. The health care waste constitutes a small parcel of the total of solid residues produced by a city; therefore they are sources of diseases dissemination. The correct treatment of these residues is important for the maintenance of the health and life\'s quality of the population. As all movement\'s operations, the transport of these residues generates expenditures for the cities. Rationalize processes, reduce costs using the synergy advantages between the cities, allow that the saved resources may be expended with others benefits for the population. This work had as objective to make a logistic study, using as tool a Geographic Information System (GIS), and to propose alternatives for the resolution of the treatment\'s problem for the health care waste, searching to reduce transportation\'s costs involved in this process. A case study was developed in Corumbataí Environment Protection Area, which enclosed twelve small cities. The work considered four alternatives, presenting in the results the positive and negative aspects of each one. The formation of a consortium between the cities was suggested, as form to reduce costs in the boarded problem.

Submitted by Alexandre Sousa (alexandre.sousa@incqs.fiocruz.br) on 2015-02-09T12:29:00Z No. of bitstreams: 1 Mestrado_Anna_Guimarães.pdf: 3265126 bytes, checksum: 35bf39a86d954bae863fd02ad6aaeca9 (MD5) / Approved for entry into archive by Alexandre Sousa (alexandre.sousa@incqs.fiocruz.br) on 2015-02-09T12:29:11Z (GMT) No. of bitstreams: 1 Mestrado_Anna_Guimarães.pdf: 3265126 bytes, checksum: 35bf39a86d954bae863fd02ad6aaeca9 (MD5) / Approved for entry into archive by Alexandre Sousa (alexandre.sousa@incqs.fiocruz.br) on 2015-02-09T12:29:21Z (GMT) No. of bitstreams: 1 Mestrado_Anna_Guimarães.pdf: 3265126 bytes, checksum: 35bf39a86d954bae863fd02ad6aaeca9 (MD5) / Made available in DSpace on 2015-02-09T12:29:21Z (GMT). No. of bitstreams: 1 Mestrado_Anna_Guimarães.pdf: 3265126 bytes, checksum: 35bf39a86d954bae863fd02ad6aaeca9 (MD5) Previous issue date: 2014 / Instituto Nacional de Controle de Qualidade em Saúde / Os Resíduos de Serviços de Saúde (RSS) representam um desafio para os prestadores de serviços de saúde humana e animal, em função do risco que representam, necessitando de tratamento diferenciado se comparado aos resíduos sólidos urbanos. Com uma larga gama de produtos e serviços, os laboratórios analíticos, são locais que geram RSS de amplo espectro quanto à natureza e grau de risco. Este trabalho se propõe a levantar na bibliografia especializada e em artigos científicos, requisitos e peculiaridades parao monitoramento do Gerenciamento de Resíduos de Serviços de Saúde (GRSS) para um laboratório de análise da área da Saúde Pública – o Instituto Nacional de Controle de Qualidade em Saúde (INCQS). O objetivo principal deste documento é oferecer, de maneira sistemática e em linguagem simples, os procedimentos básicos para o monitoramento do manejo intralaboratório dos RSS, através de indicadores de desempenho. Foram definidas etapas para concepção de um modelo de avaliação e monitoramento, para reduzir a geração dos RSS, para minimizar os impactos ambientais, para reduzir os acidentes de trabalho e auxiliar os administradores na gestão dos recursos financeiros. A pesquisa pôde contribuir para uma análise crítica do gerenciamento dos RSS no INCQS, fornecendo dados consistentes para auxiliar na tomada de decisões, nos níveis tático e operacional. / The health-care wastes represents a challenge for the service of animal and human health, in function of the risk, needing handling differentiated compared to the urban solid residues. In function of the broad variety of products and services, the analytic laboratories generate a spectrum of health-care wastes which may differ in regard of nature and rank of risk. This study aims to carry out a bibliographic review to point peculiarities and requirements for monitoring the health care waste management of National Institute of Quality Control in Health -INCQS. The main objective of this document is to provide basic coming for monitoring through performance indicators. Steps were here defined to design a monitoring model in order to reduce the generation of waste, minimize environmental impacts, reduce accidents and assist administrators in the management of financial resources. Our research could contribute to a critical analysis of the HCWM of INCQS, providing consistent data, which are important to decision making in tactical and operational levels.

Submitted by isabela.moljf@hotmail.com (isabela.moljf@hotmail.com) on 2017-07-04T10:49:24Z No. of bitstreams: 1 thiagocesarnascimento.pdf: 6704668 bytes, checksum: 0e0db297bca1e923e15facfe0e7b0aa7 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-08-08T13:57:09Z (GMT) No. of bitstreams: 1 thiagocesarnascimento.pdf: 6704668 bytes, checksum: 0e0db297bca1e923e15facfe0e7b0aa7 (MD5) / Made available in DSpace on 2017-08-08T13:57:09Z (GMT). No. of bitstreams: 1 thiagocesarnascimento.pdf: 6704668 bytes, checksum: 0e0db297bca1e923e15facfe0e7b0aa7 (MD5) Previous issue date: 2009-08-31 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / Acredita-se que os resíduos de serviços de saúde (RSS) possam atuar como veículos de disseminação de microrganismos potencialmente patogênicos e de marcadores de resistência a drogas antimicrobianas. Assim, considerando-se os riscos para saúde humana e ambiental associados ao fenômeno da resistência microbiana a drogas, nossos objetivos foram identificar linhagens de Staphylococcus coagulase negativo (SCN) isoladas do chorume percolado dos RSS no aterro sanitário de Juiz de Fora, MG, determinar o seu perfil de susceptibilidade a antimicrobianos de interesse clínico-microbiológico e detectar o marcado molecular mecA. Linhagens bacterianas presuntivamente caracterizadas como SCN (n=109) foram identificadas utilizando-se sistema comercial semiautomatizado e o seu perfil de susceptibilidade a antimicrobianos, determinado pela técnica de diluição em ágar, de acordo com as recomendações do Clinical and Laboratory Standards Institute (CLSI). Apenas 26,6% das amostras de SCN foram identificadas pelo sistema comercial, distribuídas em S. sciuri (31%), S. epidermidis (27,6%), S. lentus (20,7%), S. vitulinus (10,3%) S. saprophyticus (6,9%), S. haemolyticus (3,5%). As outras linhagens foram identificadas como Staphylococcus spp. (73,4%). Entre os antimicrobianos avaliados, a penicilina e a oxacilina foram as drogas menos efetivas (61,4% de resistência), seguidas pela eritromicina e azitromicina (27,3% e 22,7% de resistência respectivamente). Os antimicrobianos mais eficazes foram a gentamicina e levofloxacina, para os quais apenas resistência intermediária foi observada (21,6% e 1,1% respectivamente). Todas as amostras foram susceptíveis à vancomicina. Considerando as linhagens resistentes 14 (25,9%) amplificaram o gene específico, enquanto que 40 (74,1%) mostraram-se resistentes à oxacilina por outros mecanismos. Nossos resultados suscitam reflexões relacionadas à sobrevivência de microrganismos potencialmente patogênicos e linhagens resistentes aos antimicrobianos, carreando importantes marcadores de resistência e sua possível disseminação via RSS, contribuindo para seu trânsito intra-hospitalar. / It is accepted that health-care waste may act as vehicle for spreading potentially pathogenic microorganisms and their genetic resistance markers. Thus, considering the risks for human and environmental health associated with the phenomenon of microbial drug resistance, our objectives were to identify Coagulase-negative Staphylococcus (CoNS) strains isolated from the sanitary landfill disposal of healthcare waste of Juiz de Fora, MG; to determine the antimicrobial susceptibility patterns against antimicrobials of clinical and microbiological relevance; and to evaluate the occurrence of mecA gene. Bacterial strains presumptively characterized as CoNS (n= 109) were identified using a commercial system and the antimicrobial susceptibility patterns determined by the agar dilution technique, according to the recommendations of Clinical and Laboratory Standards Institute (CLSI). Only 26.6% of the bacterial samples were identified as follows: S. sciuri (31%), S. epidermidis (27.6%), S. lentus (20.7%), S. vitulinus (10.3%) S. saprophyticus (6.9%), S. haemolyticus (3.5%). The other strains were identified as Staphylococcus spp. (73.4%). Considering the minimal inhibitory concentrations of the antimicrobials, penicillin and oxacillin drugs were the less effective drugs (61.4% resistance) followed by erythromycin and azithromycin (27.3 and 22.7% resistance, respectively). The most effective antimicrobials were gentamicin and levofloxacin, for which only intermediate resistance was observed (21.6 and 1.1% respectively). All samples were susceptible to vancomycin. Considering the resistant strains, 14 (25,9%) showed to harbour mecA gene and in 40 (74,1%) were resistant to oxacillin by other mechanisms. Our results raise considerations related to the survival of potentially pathogenic microorganisms and strains resistant to antibiotics harboring genetic markers. It is possible that these bacteria might spread via health-care waste, contributing dissemination into hospitals.

This master's thesis deals with current situation of medical waste management in the Czech Republic and it also analyzes the quality of existing units for thermal treatment of the medical waste. In the second part of the thesis, available off-gas cleaning methods were described as well as the emission limits for waste incineration, which correspond to the legislative regulations effective in the Czech Republic. These emission limits are considered as input data for off-gas cleaning system design. In the main part of this thesis, two technological solutions of off-gas cleaning methods for Up-to-Date medical waste incineration unit were designed. The unit is designed for energy utilization of 1400 tons of medical waste accumulated during one year in a regional hospital of model region. From given input parameters, two appropriate apparatus concepts were created. After that, both concepts were evaluated either form energetic point of view as well as from material one. From these evaluations, key apparatuses of both concepts were designed which provided necessary design dimensions for further investment price estimation of each individual key apparatus. In the conclusion of this thesis, the best solution of an off-gas cleaning method was picked according to the comparison of operating and investment costs.

This master thesis deals with the current situation of medical waste management in the Czech Republic and available medical waste treatment methods. The first part summarises the legislation of waste treatment and contains an analysis of the current situation of medical waste management in the Czech Republic and comparison to the situation in the European Union. The second part describes medical waste treatment methods and following technologies for energy utilization when thermal treatment method is applied. In the main part of this thesis, a complex medical waste-to-energy system in a model region is designed according to the input data. The design includes description of the collecting and transportation system of the waste, capacity of the unit and suitable thermal treatment and heat utilization technology choice. A calculation model is created for the proposed unit and based on this model, an analysis on energy utilization effectivity is made. As a result of the thesis, environmental, technical and economical assessment is created based on the estimation of the investment and operating costs.

The South African Waste Information System (SAWIS) was developed by the Department of Environmental Affairs and Tourism (DEAT) in 2005. This is a system used by government and industry to capture routine data on the tonnages of waste generated, recycled and disposed of in South Africa on a monthly and annual basis. All waste producers and waste management organisations should contribute to this national waste database and should accurately monitor the types and quantities of waste produced and handled. According to DEAT (2006) the need for Data verification is important. DEAT (2006:59) defined the term Data Verification as: "assessing data accuracy, completeness, consistency, availability and internal control practices that serve to determine the overall reliability of the data collected." The aim of the study is to determine a procedure, as well as the nature and extent of internal and external source documents, which could be used in the reconciliation of medical waste quantities from generation to disposal. The key objectives are to determine whether the selected hospitals keep internal records of the quantities of medical waste generated; to reconcile the waste quantities on the internal records with the external records, such as the collection certificates, invoices and waste incineration certificates; to ascertain whether the quantity of medical waste generated is equal to the quantity of waste incinerated and disposed of to determine the ratio factor between the quantity of medical waste before incineration and the quantity of the residue (ashes) after incineration, and to make recommendations on the reconciliation of waste quantities from the point of generation to the point of disposal. The results of the study indicate that the destruction certificate is the proof that the waste that was on-site collected by the service provider has been disposed /treated. Especially as an internal control measure. The health care risk waste (HCRW) management record keeping of quantities of weight as per Hospital A, Hospital B and Hospital C allows the opportunity to analyse the weight per month and per Hospital and per category and to make comparisons. The weakness or the gap however still exist that the waste is not weighed at the point of origin, but at the point where the waste service provider collects the waste onsite. It is from this point onwards that the service level agreement between the hospital and the waste service provider and the document management system and the tracking receipt and the waste collection documents (WCD) becomes relevant and where the quantities of waste per category are for the first time recorded. The hypothesis as stated in Chapter 1 was proven valid. The study concludes that reconciliation and comparison between the collection certificate and the destruction certificate and the monthly invoice is therefore possible, but the risk of mixing of waste and the understating or overstating of waste quantities is still not overcome. / Environmental Sciences / M. Sc. (Environmental management)