Environmental & Social Review Summary
Project Number
8293
Company Name
Lesedi Private Hospital Limited
Date ESRS Disclosed
Feb 5, 2010
Country
South Africa
Region
Africa
Last Updated Date
Dec 31, 2016
Environmental Category
B - Limited
Status
Completed
Previous Events
Approved : Sep 11, 1997
Signed : Sep 11, 1997
Invested : Dec 29, 1997
Sector
Hospitals and Clinics
Industry
Health, Education and Life Sciences
Department
Regional Industry - MAS Africa
Project Description
ENVIRONMENTAL REVIEW SUMMARY
Project Name South Africa-Lesedi Private Hospital Ltd.
Region Sub-Saharan Africa
Sector Hospitals
Project No. 008293 May 22, 1997
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1. This project, which is to be financed through the Africa Enterprise Fund (AEF), involves the acquisition of equipment for a 9 bed Intensive Care Unit (ICU), which is to be established in an existing ward in the 220 bed Lesedi Private Hospital (LPH), located in Soweto. The facility and hospital will provide a much-needed and easily accessible service to Soweto residents, who currently rely on more expensive and distant services in Johannesburg.
2. This is a Category B project according to IFC''s environmental review procedure because specific impacts may result which can be avoided or mitigated by adhering to generally recognized performance standards, guidelines, or design criteria. The key environmental health and safety issues that were analyzed are as follows:
• handling and disposal of medical materials;
• disposal of medical and bio-hazardous waste;
• liquid waste and sewage disposal;
• power and water supply;
• hygiene and implementation of good hospital management practices;
• professional hospital management team;
• CFCs;
• employee health and safety training; and
• fire protection.
IFC has reviewed information provided by both the hospital and appraisal consultant regarding environmental, health and safety practices. Major elements of these practices, as regards the key issues listed above, are described below.
3. Handling and disposal of medical materials: LPH has in place a detailed set of Policies and Procedures Manuals which lay out clearly how the hospital should handle and dispose of all types of wastes. These documents were prepared for LPH by African Oxygen Ltd. (Afrox), a South African company which holds a 10% interest in the hospital and has a contract to manage the facility. Afrox is a subsidiary of British Oxygen Ltd. The policies and procedures are clearly written and comprehensive, and outline handling and disposal procedures for specific kinds of medical materials. Contaminated linen is bagged in water-soluble bags which are sealed and rebagged in yellow plastic bags (which indicates that they are to be sent to the laundry or autoclave). Thus, although the yellow bags are removed before the linen goes is washed, laundry staff are prevented from being exposed to the contaminated linen by the presence of the water-soluble bags. Non-hazardous wastes are bagged in black plastic bags and removed by the municipal refuse disposal authorities.
4. Disposal of medical and bio-hazardous waste: The clinic has in place a comprehensive plan, developed in conjunction with Afrox, for disposing of both hazardous and non-hazardous wastes. All contaminated sharps are disposed of in special containers from which they cannot be removed. When full, these containers are sent to the hospital''s high temperature incineration to be destroyed. Contaminated dressings and other potentially hazardous wastes are bagged in red plastic bags (indicating they are to be incinerated), sealed, and sent to the hospital incinerator for disposal. Small items of equipment such as respirators are sealed in a double set of yellow plastic bags, labeled as to their contents, and sent to the autoclave for gas sterilization. Non-hazardous solid waste is disposed of in heavy duty plastic bags which are removed by the municipal refuse collection authority on a weekly basis.
5. Liquid waste and sewage disposal: All non-hazardous liquid wastes and sewage are disposed of to the municipal sewerage system. Hazardous or potentially hazardous liquid wastes such as blood or other bodily fluids on linens, clothing or other absorptive materials are placed in red plastic bags, sealed and incinerated on site.
6. Power and water supply: Power for the hospital is supplied by the South African electric utility, Eskom. Although power cuts are not frequent, the hospital has a backup diesel generator to supply power for emergency lighting, specific small power circuits and critical equipment in the wards, theaters, maternity, pharmacy, reception and selected corridors. Additional fuel supplies for the generator are not stored on site as there are a number of petrol stations in the vicinity of the hospital. Nonetheless, a breach in the generator itself could result in a spill of up to 200 liters?? of diesel fuel. AT IFC''s request, LPH has agreed to construct bunds around the concrete slab on which the generator is placed, to provide effective secondary containment in the event of a fuel spill or leak. Water for the hospital is supplied by the Soweto municipal water authority. As the water supply meets all relevant South African standards for drinking water, the water does not need to be pre-treated prior to use.
7. Hygiene and implementation of good hospital management practices: Afrox policy in force at LPH is to use "universal precautions" as its infection control system. This approach assumes that all patients are potentially infectious and that appropriate precautions must be taken in all instances. All staff are offered immunization against Hepatitis B; staff who opt not to be immunized must sign a waiver form indicating that they have chosen not to be immunized. All employees take part in a comprehensive occupational health and safety training program. Employees are required to complete a comprehensive medical questionnaire at the time they are hired. All employees are given annual chest X-rays to monitor for tuberculosis (TB); staff working in wards where their is a high incidence of TB are required to undergo chest X-rays every six months throughout their period of employment. Housekeeping and maintenance staff are given strict training in the policies and procedures outlined above for handling and disposing of medical and other potentially hazardous wastes.
8. Professional hospital management team: As noted above, Lesedi Clinic is managed by Afrox Ltd., a subsidiary of British Oxygen, which holds a 10% interest in the clinic as well as the management contract for the facility. All of LPH''s policies and procedures have been developed by Afrox, based on relevant British Oxygen policies and procedures. The hospital administrator in charge of the facility is a licensed and experienced medical practitioner and holds a master’s degree in business management.
9. CFCs: The project sponsors have confirmed that all cold storage facilities and air conditioning equipment will utilize non-chlorofluorocarbon (CFC) refrigerants acceptable under the terms of the 1987 Montreal Protocol on Substances that Deplete the Ozone Layer.
10. Employee health and safety training: The hospital does not intend to hire new nurses to staff the ICU initially but, rather, to phase in staff gradually in line with demand. Staff currently working in the high-care nursing ward will move over to the unit and be supplemented as required. Nurses who work in ICU require special training, generally a one-year course. Lesedi''s current matron and high-care charge nurse have both received ICU training and will oversee the recruitment and site-specific training of any new staff hired. One part of the training encompasses personal health and safety, as well as the maintenance of hygienic standards in the ICU. Other staff (orderlies, nurses'' aides, housekeeping) will be provided with the hospital''s comprehensive health, safety and hygiene training, as described above.
11. Fire protection: At IFC''s request, the hospital undertook an independent fire safety audit, conducted by a registered professional engineer. The audit found that although the hospital was designed to comply with South Africa''s National Building Regulations, certain measures could be implemented which would improve the hospital''s fire safety preparedness. These include replacing the glass in all doors leading into the main corridor with wire reinforced glass to increase the fire resistance to 0.5 hours, in conformance with both British and South African regulations; treating all curtains with fire retardants; modifying the double width swing doors leading outside to meet the requirements for fire escape doors; improving the signage with regard to fire escape doors; and installing smoke doors in the main egress corridor. In addition, the report recommended that the hospital recruit a maintenance manager (the position is currently vacant) who can effectively implement and monitor fire prevention management, including training and drilling of staff, implementing effective building evacuation procedures, and carrying out routine testing of fire detection and emergency power supplies. The report further recommended that once these improvements have been made, they be inspected and evaluated by the consultants who carried out the fire safety audit, to ensure compliance. LPH has agreed to implement all of these recommendations. In addition, LPH has committed to bringing the facility up to the fire safety standards for new buildings stipulated by the US National Fire Protection Association (NFPA) at such time as the hospital is substantially expanded or renovated.
12. Based on its review of Lesedi''s environmental, health and safety practices, IFC concludes that the proposed project is being designed and will be operated to meet Government of South Africa requirements, as well as all relevant World Bank policies and environmental, health and safety guidelines. IFC will monitor ongoing compliance with World Bank policies and guidelines during the life of the project by evaluating monitoring reports submitted annually to IFC by the sponsor and by conducting periodic site reviews during project supervision.
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May 22, 1997 11:03 AM
Environmental and Social Mitigation Measures
Broad Community Support
Related SII
