National Orientation Guide:

1. National Orientation Guide: Preparing to Roll-out Health Care Waste Management (HCWM) Training at Male Circumcision (MC) Sites Steps to a successful roll-out of HCWM Training September 23, 2013

2. Topics Covered in This Guide • Training Resources: Resources for a Successful Roll-out of HCWM Training to MC Sites • Training Modules: HCWM Training Modules and Associated Tests • Tailoring the HCWM Training: Working with the Customization Guide • Training the Trainers: Preparing Infection Control Officers to Deliver the HCWM Training • Monitoring HCWM Training: Following-up After MC Site Staff Training

3. Objectives After completing this orientation, you will: • Be able to use a standardized approach and standardized materials when preparing Infection Control Officers to deliver HCWM training at the country’s MC sites. • Be prepared to manage the successful roll-out of HCWM training at the country’s MC sites. • Be able to successfully oversee HCWM training that helps ensure Health Care Waste (HCW) at all MC sites is managed in accordance with Campaign and national policies and guidelines.

4. Background on HCWM Training for MC Sites Adequate training is a critical step in achieving an efficient and safe HCWM system. Your responsibility as national Campaign Infection Control Manager includes: • Ensuring that all MC site Infection Control Officers receive training (Training of Trainers) to prepare them to deliver HCWM training to the MC site staff members. • Keeping up-to-date records on HCWM trainings.

5. The Training Component of Voluntary Medical Male Circumcision Toolkit To help you with those responsibilities, you are being provided with the training component of Voluntary Medical Male Circumcision (VMMC) Toolkit. The toolkit is designed to bring staff at all levels of a VMMC campaign to a critical level of HCWM competency. The training program in the toolkit is appropriate for all types of VMMC sites.

6. The Training Component of Voluntary Medical Male Circumcision Toolkit Training should be conducted before the start of a campaign to orient staff in HCWM best practices. All staff members, even those with previous HCWM experience, should attend the training to ensure that they adopt the latest best practices and understand the standards that will be observed by the VMMC campaign. Beyond teaching the MC site staff about HCWM, the training also opens dialogue about HCWM to develop a sense of ownership and to instill commitment to the campaign’s responsibility for HCWM.

7. Roll-out Scheme for All HCWM Training

8. Roll-out Scheme for All HCWM Training

9. Roll-out Scheme for All HCWM Training

10. Total Time Investment for YOU to Train Infection Control Officers & Site Managers * Add an additional hour per participant to allow the participants to practice their training delivery skills.

11. Total Time Investment for Infection Control Officers to Train MC Site Staff on HCWM * For sites performing sterilization

12. Topic 1: Training Resources Resources for a successful roll-out of HCWM training to MC Sites

13. Training Resources • HCWM SOPs associated with HCWM Training • HCWM training modules, tests and answer sheets • Customization Guide • Trainers’ Guide

14. Resource #1: SOPs Associated with the HCWM Training Modules • SOP-PQAU001-001 HCRW Worker Health & Safety • SOP-PQAU001-002 Incident Management • SOP-PQAU001-003 Injury on Duty and Needle-stick Injury Procedures • SOP-PQAU001-004 General and Antiseptic Hand Hygiene • SOP-PQAU001-005 Decontamination of General Surfaces • SOP-PQAU001-006 Decontamination of Disposable Metal Instruments • SOP-PQAU001-007 Sterilization of Reusable Instruments. • SOP-PQAU001-008 Identification, Segregation & Packaging • SOP-PQAU001-009 Handling & Packing Procedures • SOP-PQAU001-010 On-site Transport • SOP-PQAU001-011 Spill Management • SOP-PQAU001-012 Storage Criteria & Guidance • SOP-PQAU001-013 Waste Quantification • SOP-PQAU001-014 Document Flow • SOP-PQAU001-015 HCRW Transport Requirements • SOP-PQAU001-016 Transport Emergency Response

15. Resource #2: HCWM Training Modules The HCWM training you will roll out to the country’s MC sites is contained in 8 Training Modules. • Six of those modules are to be delivered to the staff at each of the MC sites by the Infection Control Officer. • Module 4 is provided only for outsourced transport companies to train their staff. • Module 8 is delivered only to the Site Manager Each training module has an associated test and answer sheet.

16. HCWM Training Modules Module 1: Basic Health Care Waste Management (HCWM) for Male Circumcision (MC) Module 2: Worker Health and Safety Best Practice Module 3: Weighing and Recording Health Care Risk Waste (HCRW) Module 4: Requirements for the Transport of Health Care Risk Waste Module 5: Decontamination at the MC Site or Module 5X: Decontamination and Sterilization at the MC Site Module 6: Basic Supply Chain Principles for HCWM Commodities Module 7: Incident Reporting Module 8: Quality Management System (QMS)

17. Resource #3: Customization Guide The Customization Guide provides the national Campaign Infection Control Manager and /or the national Director of Clinical Services with suggestions in where the HCWM training modules may need to be tailored to meet specific country needs or requirements Each training module contains the following icon highlighting locations where such customization may be needed.

18. Resource #4: Trainers’ Guide The Trainer’s Guide is a companion to the HCWM training modules. It provides detailed guidance to the Infection Control Officers at the MC site to assist them in delivering the training. The guide contains information about each module’s: • Topics • On-the-job performance objectives • Time required to deliver each portion of the class • Trainer materials • Participant materials • Learning activities

19. Topic 2: Training Modules HCWM Training Modules and Associated Tests

20. Introduction to HCWM Training Modules and Associated Tests In order to successfully roll out HCWM training, it is important for you to experience the training the way it will be experienced by the ultimate audience - the MC site staff. The first step in the process of preparing to roll out HCWM training is for you to personally review all of the training modules and to complete all the associated tests.

21. Topic 3: Tailoring the HCWM Training Working with the Customization Guide

22. Introduction to the Customization Guide The Customization Guide identifies portions of the training moduleswhich can be tailored to meet your specific country needs/requirements. When customizing the training materials to reflect customized SOPs, replace the original SOPs that are embedded in the PowerPoint training modules with the customized versions. After the customization has been completed, this customization icon should be removed to avoid confusion and the materials should be checked for consistency across all modules.

23. Why Customize the Training Modules? The training modules contain only generic information and generic forms to serve as examples. Country programs with more specific information and country specific forms need to train staff in the use of their own forms. Customization of the training materials should be completed by the National Campaign Infection Control Managers, National Directors of Clinical Services, and, if applicable, implementing partner organizations. Customization of the HCWM training modules should be completed prior to providing them to the MC Site Infection Control Officers to use when delivering the training.

24. Example from the Customization Guide

25. Alternative to Customizing the Training Modules Compile all the country-specific forms and procedures and provide them to the Trainers along with the Trainers’ Guide. Direct the Trainers to deliver the generalized training and follow-up by providing the country-specific information and highlighting the differences. Follow-up to ensure that training did include the country–specific information and examples.

26. Topic 4: Training the Trainers Preparing Infection Control Officers to Deliver the HCWM Training

27. Train the Trainers: Your Role • You are responsible for modeling the training that the Infection Control Officers will give to the MC Site Staff • You will impart key skills to the Infection Control Officers on the following: • How to train Modules 1-7 to MC Site Staff And • How to deliver quality stand-up training skills with customized resources

28. Roll-out Scheme for All HCWM Training

29. Train the Trainers: Modeling How to Train on the Modules When preparing the Infection Control Officers for delivering HCWM Training at the MC sites: • First, introduce them to the Trainers’ Guide so that they may follow along as you train. • Deliver all of the modules to them in a classroom setting as they will do • Have them complete all of the tests to experience what the MC site staff will experience. • Schedule at least two and a half days (17 classroom hours) to deliver the training of all 8 modules and tests (Allow 1 additional hour per participant if including practice stand-up training by the participants).

30. Train the Trainers: Introduction to the Trainers’ Guide The Trainers’ Guide enhances the Infection Control Officer’s / Trainer’s confidence about delivering HCWM training because knowing: • which job functions should attend each session will assist the Infection Control Officer with invitations and scheduling of the training sessions. • which participant materials need to be duplicated in advance will make the preparation process easier for the Infection Control Officer. • the time required to deliver each portion of the modules will help the Trainer set an appropriate pace for delivery.

31. Review of Trainers’ Guide Needs to be replaced by a link to an updated version that contains Modules 7 and 8 and Class register

32. Train the Trainers: Suggested Training Session Format • Introduce Module • Note Trainer Guide page and review contents • Train the module as the participants should • Have participants complete test and review correct answers • Distribute Module PPT and Test Answers to all participants for their files • End with Q&A to answer questions from the future trainers

33. Train the Trainers: Be prepared! • Make sure to identify and invite the participants well in advance of the sessions. • Best group size is 12 or less • Arrange for internet access at the location where you will be delivering the sessions. • Have all hand-outs printed in advance and shipped to the location. • Make sure all modules, trainer guides, and handouts have been customized!

34. Topic 5: Monitoring HCWM Training Following-up After MC Site Staff Training

35. Why Monitor and Follow Up on Training? It is important to follow up on the HCWM training as it is happening to ensure that Infection Control Officers are supported and delivering quality training. It is also important to follow up on the HCWM training after it has happened to assess impact of the training on HCWM practices!

36. Monitoring the Delivery of the Training Basic Steps: • Verify that the training was delivered. • Determine how records of staff attendance at training and signature pages of SOPs (indicating that staff read and understand them) are maintained at the MC site. • Institute a mechanism for Infection Control Officers to provide you with training attendance records. • Determine how training is provided to new staff members who are hired after the training was delivered to the staff or to staff members who were not able to attend all of the original training sessions.

37. Training Follow up: Assessing Impact While “evaluation forms” filled out by class participants are often used to assess the quality of the training, on-the-job application of the knowledge and skills learned in the training is really the key indicator of the training’s effectiveness. Data on the application of skills and knowledge about HCWM can be best obtained through Monitoring and Evaluation and the Incident Management System. If you determine that proper HCWM techniques are not being used on the job, some refresher training sessions may be warranted.

38. Orientation Conclusion

39. Campaign Infection Control Manager’s Steps to Successful HCWM Training Roll-out 7. Follow up to assess the HCWM training presented at the MC sites 6. Be available to support Infection Control Officers as they deliver HCWM training at the MC sites Familiarize Infection Control Officers with the Trainers’ Guide (Train-the-Trainers) 4. Present the training modules to Infection Control Officers (Train-the-Trainers) 3. Customize the training modules, if necessary 2. Determine which portions of the training to customize 1. Review all of the training modules and take all of the tests

40. Rate Your Confidence Now that you have completed this orientation, please rate your level of confidence in being able to: • achieve the orientation objectives • successfully implement and oversee the roll-out of HCWM training for your country’s VMMC campaign

41. Rate Your Confidence In