High Tech Centralized Facilities in Developing

Countries

TechNet/SIGN Injection & Waste Management Technology Day

New Delhi, India 29 August 2001

Jorge EmmanuelHealth Care Without Harm

www.noharm.org

Outline

• Framework for medical waste management

• Types of alternative treatment technologies

• Factors to consider in selection

Framework

• Waste Segregation

• Waste Minimization

• Environmental Protection

• Occupational Safety and Health

Waste Segregation/Minimization:Typical Hospital Waste Stream

Hazardous or Radioactive

Waste

Potentially Infectious

Waste

Municipal Solid Waste

Particulate Matter

Carbon Monoxide

Other Organic Compounds

Acid Gases

Dioxins & Furans

Trace Metals including

Lead, Cadmium, Mercury

Toxic Incinerator

Ash

Environmental Protection

Environmental Protection:Toxic Pollutants From Incinerators

• Air Emissions– trace metals: As, Cd, Cr, Hg, Ni, Pb– acid gases: HCl, SO2, NOx– dioxins and furans, including

2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)– other organic compounds: trichloroethylene,

tetrachloroethylene, trichlorotrifluoroethane, etc.– carbon monoxide– particulate matter– pathogens

• Toxic Bottom Ash– leachable metals, dioxins/furans, other organics

Occupational Safety & Health

• Needle sticks and other sharps injuries

• Blood splatter

• Aerosolized pathogens

• Chemicals in the workspace

• Noxious odors

• Hot surfaces

• Ergonomic problems

Elements of Proper Management

• Waste stream analysis

• Waste management and contingency plans

• Waste segregation

• Waste minimization

• Proper collection, transport and storage

• Worker training, awareness programs

• Alternative treatment technologies

Types of Alternative Technologies

• Thermal

• Chemical

• Irradiative

• Biological

Realistic Alternatives

• Low-Heat Thermal Technologies– Autoclaves or Retorts– Advanced Autoclaves– Microwave Units– Dry Heat Systems

• Chemical– Non-Chlorine Technologies

AutoclaveVacuumAir

Filter

Pressure Gauge

Safety Valve

Release Valve

Jacket

Autoclave Chamber

Charging Door

SteamSteam Trap

Steam Trap

Drain

Thermocouple

Steam Disinfection Temperature-Minimum Exposure Time Requirements

T oF T oC Spore Kill Time (min)

Min. Exposure Time (min)

240 116 30 60

245 118 18 36

250 121 12 24

257 125 8 16

270 132 2 4

280 138 1 2

From E. Hanel, Jr., “Chemical Disinfection,” in Control of Biohazards in the Research Laboratory, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD, 1981.

Example: Centralized Facility Autoclave, 8’ dia x 32’ long

Source: Bondtech Corporation, Somerset, Kentucky

Advanced Autoclaves: Examples

• Vacuum / steam treatment / shredding / compaction

• Shredding / steam treatment & mixing / drying

• Stream treatment, fragmenting & mixing / drying

Advanced Autoclave: Vacuum / steam treatment / shredding / compaction

Source: San-I-Pak, Tracy, California

Advanced Autoclave: Shredding / steam treatment & mixing / drying

Source: STI Chem-Clav, West Chester, Pennsylvania

Example: Microwave Disinfection

Source: Sanitec, West Caldwell, New Jersey

Example: Dry Heat Disinfection

Source: KC MediWaste, Dallas, Texas

Chemical: Alkaline Hydrolysis

Source: Waste Reduction by Waste Reduction, Inc. (WR2), Indianapolis, Indiana

Other Technologies

• Medium and High Heat Thermal Systems– Issues: emissions, performance, costs

• Chlorine-Based Chemical Systems– Issues: wastewater discharges

• Irradiative Technologies– Issues: ionizing radiation, costs

• Biological Systems

Factors to Consider in Selecting Alternative Technologies

• Microbial Inactivation Efficacy– Minimum: Level III Disinfection

• Inactivation of vegetative bacteria, fungi, lipophilic/hydrophilic viruses, parasites, and mycobacteria at a 6 Log 10 reduction or greater; and

• Inactivation of B. stearothermophilus spores and B. subtilis spores at a 4 Log 10 reduction or greater

– Biological Indicators:• 6 Log 10 reduction of Mycobacterium phlei and

Mycobacterium bovis (BCG) (ATCC 35743)• 4 Log 10 reduction of B. stearothermophilus (ATCC 7953)

and B. subtilis (ATCC 19659)

Factors to Consider in Selecting Alternative Technologies

• Environmental Emissions and Residues– air emissions– wastewater discharges– solid residue– ambient (workspace) air– others

• Reduction of Waste Volume• Occupational Safety & Health

Factors to Consider in Selecting Alternative Technologies

• Throughput Capacity• Types of Waste Treated• Space Requirements/Siting Requirements• Process Monitoring and Documentation• Equipment Safety and Worker Safety During Repairs• Ease of Use/Training Requirements• Reliability/Track Record• Cost

Resource

Non-Incineration Medical Waste Treatment Technologies: A Resource for Hospital Administrators, Facility Managers, Health Care Professionals, Environmental Advocates, and Community Members

Health Care Without Harm (HCWH) P.O. Box 6806, Falls Church, VA 22040 USA<www.noharm.org>

Note: HCWH does not endorse any technology, company, or brand name.