Practical Waste Management in The Healthcare Environment Training 2011... · US EPA has determined...

IRAQ Waste Management

Practical Waste Management in

The Healthcare Environment

http://www.iswa.org/


Treatment of the HCW

Main target is to eliminate the hazards from the waste.

Preventing from infection on the place of generation

Different types of waste have different method

Considering implementation of the In house method

Hazards from non compatible treatment!!!

It is better to prevent than to cure.



Treatment (disinfection) efficiency;

health and environmental considerations;

volume and mass reduction;

occupational health and safety considerations;

quantity of wastes for treatment and disposal/capacity of the system;

types of waste for treatment and disposal;

infrastructure requirements;

locally available treatment options and technologies;

Treatment of the HCW-Important factors (1)



Options available for final disposal;

Training requirements for operation of the method;

Operation and maintenance considerations;

Available space;

Location and surroundings of the treatment site and disposal facility;

Investment and operating costs; maintenance requirements

Public acceptability;

Regulatory requirements.

Treatment of the HCW-Important factors (2)



Not proper Treatment of HCW

Storage

Internal Transport

External

Transport

Waste generator

De-centralcollection Points

Pollution

Landfill and

treatment

Risk



In - House

treatment

plant

Storage

Internal Transport

Safe Disposal

Recycling

Recovery

External

Transport

Waste generator

De-centralcollection Points

Risk

No Risk

Sustainable Treatment of HCW



Today, following main treatment methods are available on the international market for infectious, hospital waste:

Incineration

•Chemical disinfection

•Steam disinfection/sterilization

• Systems without vacuum (Microwaving, etc.)

• Single stage vacuum cycle

• Fractionated cycle (several pulse system)

•Other treatments

Suggested treatment methods



By incineration, hospital waste and the pathogen agents are oxidized. State of the art incinerators are two chamber systems equipped with a two stage flue gas treatment and a CEM-System. While in the first chamber the waste is incinerated at a temperature higher than of 600°C, in the second chamber the exhaust gas is treated at a temperature of 800 – 1200°C.

Parameters to be obtained:

Temperature, Time, Turbulency

Emissions: SO2, CO, NO2, Dioxin, …

Way of working: Incineration



Dioxin - Generation

Dioxin has no commercial use. It is a toxic waste product formed when

waste is burned and when other organic chemicals that contain chlorine

are present (e.g. PVC). US EPA has determined that medical waste

incinerators are among the top three sources of contamination.

Dioxin will not disappear by burning waste at a higher temperature.

Dioxin is actually formed after waste containing a chlorine source is

burned, as the temperature drops to around 200 to 450°C.

Best method to reduce dioxin:

-Avoiding of the incineration of hospital waste containing chlorine

Special - The Problem of Dioxin



Overview: Incineration

• High investment costs for the

incinerator flue gas treatment system

and the CEMS

• High environmental impact

• High maintenance and operation costs

• Inflexible capacity

• Long waiting times before repair

and maintenance is possible

• Highly trained personal is needed

• Problematic disposal of fly ash and ash

•Non-recognizable residues

•Reduction of the volume to 90%

•Safe elimination of the

biological agents

DisadvantagesAdvantages



Notice: According to the UN technical guidelines on hospital waste management, chemical treatment methods are NOT RECOMMENDED due to the combined environmental and work safety problems!

During the chemical disinfection process, disinfectants (e.g. dissolved chlorine dioxide, sodium hypochlorite, peracetic acid, etc.) are used to disinfect the waste. To ensure contact between the chemicals and the pathogens, waste normally has to be shredded prior to disinfection.

To ensure a good disinfection result, parameters like pH, temperature, presence of other chemicals, etc. must be obtained and the system must be able to replenish the chemical disinfection lost.

Way of working: Chemical disinfection



• High operation costs due to the use of

chemicals

• Low and unsure disinfection level

• Difficult repairs at the shredder,

blocking of the shredder

• Risk of occupational exposure to

the workers

• Low maximum capacity

• May result in disposal problems of

the treated waste

• May result in waste water roblems

(long-term environmental consequences)

Overview: Chemical disinfection systems

• Reduction of the volume up to

80% (depending on the used

shredder system)

•Non-recognizable residues

Advantages Disadvantages



Steam sterilization by autoclaving is listed as the

PREFERRED METHOD

for the treatment of healthcare waste

„ … Methods other than steam

sterilization should be selected only,

if this is impracticable or inappropriate”

The worldwide trend seems definitely be moving

towards autoclaving as a preferred alternative to the problematic

incineration.

Basel Convention



Steam treatment system

Today, different alternative thermal healthcare waste

treatment systems are available. The systems can be

categorized in:

Systems without removing the air (Non-vacuum Systems)

Microwave, Sterilizers with integrated shredder, etc.

Pre-vacuum systems

“Classical”, old autoclave cycle

Fractionated cycle (several pulse system)

New and advanced Autoclave cycle for sterilization instead of disinfection



Overview: Fractionated autoclave systemDisadvantages

• Air filter is needed (HEPA Filter)

•Temperature of >120°C, pressure of

2 bars and a treatment time of 15

minutes must be guaranteed.

•Vacuum/Steam/Vacuum process is

recommended and a post-vacuum

must be available

Advantages

• Moderate investment costs

• Low operation costs

• Highest sterilization level(>6 Log 10)

• No environmental impact

• Proven system even for hygienically most difficult waste (Level IV waste)

• Reduction of the waste volume to

50% and reduction of the waste

• Easy to monitor by the authority

• Operation by low-skilled worker

• Accepted by all authorities



Disposal Systems



Benefits of the sustainable treatment concept:

•Long-term solution and securing the way of disposal

•“State-of-the-Art” advanced treatment technology

•Minimization of the environmental impacts

•High transparency in disposal and logistic costs

•Reduction of transportation risks

•Low disposal and logistic costs for hazardous waste.

•Healthier work environment for the employees.

•Better risk and safety management for hazardous waste.

•Enables generators and the plant operator to introduce controlling

systems.

Economical and Environmental benefits



Central Treatment Facility Concept

10

Km

15

Km

10

Km

Prima

ry

HCF

Hospi

tal B

Hospi

tal A

Clinical

Centre

Central

Treatment

facility

Hospi

tal C



Waste management at Treatment Facility

Upon the arrival of the waste:

Visual (external) inspection of the waste

Waste transfer documentation handling

Measuring of the quantity

Maintain records of the waste income

Preparation for the treatment

Treatment of the waste

Maintain records of the waste treatment process

Maintain records of the waste logistics equipment



Waste Reception Procedure

Waste Reception procedure

Waste Assessment / Inspection

Waste Measurement



Waste Handling procedure

and PPE

Waste Treatment

Waste Treatment Procedure

Waste Shredding



Waste Treatment Log

Process logs

Waste Income Log

Process Documentation

Waste flows and documentation points


http://www.amazon.com/gp/product/images/B0002ZW880/ref=dp_image_0/103-7130013-1275059?ie=UTF8&n=3760901&s=hpc


Always Consider Hierarchy of Waste Management Options

Landfill Worst for Environment

Incineration

Recovery

– Recycling

– Composting

– Waste to energy

Reuse

Waste Minimisation Best for Environment



Some Key Issues to Consider

Waste Generation how much waste

What types of Waste

What Specialities exist in the Healthcare Premises

Internal control mechanism

Training and who to train

Policies and Procedures

Costs of Disposal

Confidentiality

Storage

Recycling ideas

WEEE Waste

Segregating Waste

Duty of care and traceability

Some Health and Safety Ideas

Religious Issues Regarding Body Parts/ HumanTissue.



Waste Generation in the Hospital Setting

For a standard acute medicine hospital the following is an approximation of potential waste generation, per hospital bed in one year.

Clinical Waste- One Tonne

Household Waste – One and a Quarter Tonnes.

Packaging Waste – 150 Kgs.

Paper Waste- 50 Kgs.

Therefore 500 Bed Hospital could produce 500 Tonnes Clinical waste per year.



Internal Areas To Consider

Wards

Theatres

Maternity

Pathology

Mortuary

X-Ray

Nuclear Medicine

Pharmacy

Administration

Estates

Domestics

Porters

Transport

Procurement

I.T.Department

Catering

Note – Each of these areas would have unique wastes specific to

that area example I.T. Dept= Computers



Some Waste Streams to Consider

Needles/Scalpels

Body Parts

Blood Stained Dressings

Infectious Waste

Nappies /incontinent Pads

Medicine Wastes Liquid and

Solids

Cytotoxic and Cytostatic Waste

Food Waste

Office Waste Including paper

Packaging – plastic/cardboard

Building Wastes

Electrical (WEEE)

Confidential Material

Chemicals

Glass



Waste Identification

. There are a number of different waste streams in the Hospitals that need to be identified

and kept separate due to their hazardous nature. These two colours are just examples

,Yellow is for Clinical waste and black is for household waste. Other colours used

sometimes are Orange in the U.K. for alternative treatment, Red for incineration. In

addition clear bags for recyclable products. Some areas may also use opaque bags with

the appropriate tint to assist in identifying any contaminants. These bags are used in

appropriate internal bins which can be colour coded as well.



Bins for Internal Use –Colour Coded for Waste Streams

Bins can be Metal or Plastic.

Colour coded to suit bag colour

and supported by label .Front

opening bins assist in the internal

cleaning.



Bins used for external transportation

Bins can be metal or plastic but should conform to UN standards for transportation purposes

if being taken on public highway. Also labelled up for purpose of use. Good cleaning and

maintenance programs should be considered. Bins can also have drop fronts to assist in

emptying when used for other waste streams e.g. green bin used for Cardboard recycling.



Internal Storage Areas

This example utilised surplus circulation area

without affecting office/ward area demand. Access

was controlled by electronic swipecard. Shelving

at bottom was used for Sharp boxes and glass

bottles. Bins sizes are standard 880 litre.



External Storage Compounds (Metal Construction)

Waste bins are hidden from sight and colour of compound selected to help it blend

in to the backgound. Area used for storage was surplus space and not required for

other use such as parking. Design of structure and material used was such to

enable construction to be taken down and re-used elsewhere if need be.



Timber Construction Storage Areas

Note that once again area that is used is not required for any other purpose.

Timber is used to blend in with the natural grassed areas.

When considering external storage areas there is a need to think about vehicle

access for collections and also accessability for staff bringing the waste out and

security of the area. Warning signs should be displayed advising of the

hazards. Staff should be guided on which receptacles to use. See following

slide.



Signage for Waste Storage Areas and Security

Bin types identifying

purpose for each

colour

Location name and

number of location for

identification purpose

Digital locks used with key

override as padlocks will be no

use as keys get lost. Sliding bolt

just to add support to lock



What are Sharps ?



Sharps Containers

Sharps boxes can come in different sizes to suit situation and also different

colours to help in segregation. Made of rigid plastic material prevent injuries

when correctly used.Modified versions used for Medicinal wastes also body

parts.



Guidance to Using The Sharps Container

Close temporary

closure when not

in use

Assemble it

correctly.

Snap lid on all

round

Place on bracket,

securely fitted to

wall or trolley

Identify your

dept or ward

& tag it

Lock when

contents

reach the fill

line

Note that completion of

label assists Traceability



I don’t want to go into a plastic bag I might hurt someone !!No thank you Yes Please



Tagging

Tagging of waste can be by using plastic cable ties.Name of organisation

with post/zip code and telephone number is included. Each tag is numbered

using a unique serial number.This number would be part of a batch of

67,599,424 (26x26x99,999).Individual batches of multiples of 100 tags

would issued to individual Departments. See following slide.

Tags would be tied around neck of bag to help seal it as well.

Waste can then be traced back to a Hospital plus the internal unit.



Tag Recording System

Date Issue/Receipt No. From No. To Location Quantity Issued Quantity Received

24/11/2006 E65601 E66600 Renal 1000

24/11/2006 E64601 E65600 Renal 1000

24/11/2006 E61601 E62600 Main Theatres 1000

24/11/2006 E62601 E63000 Ortho Theatres 400

25/11/2006 E63701 E63800 Delivery 100

25/11/2006 E63601 E63700 Delivery 100

25/11/2006 E63801 E63900 ITU 100

25/11/2006 E63901 E64000 ITU 100

25/11/2006 E64201 E64300 Post Room 100

25/11/2006 E64101 E64200 Post Room 100

28/11/2006 E63001 E63300 Ward 14 300

28/11/2006 E63301 E63600 Ward 15 300

28/11/2006 E64301 E64600 Ward 16 300

01/12/2006 F00001 F10000 Stock In 10000

28/11/2006 E64001 E64100 Ward 1 100

28/11/2006 E60601 E60800 Ward 1 200



Recycling Schemes



Recycling Banks



Fluorescent Tubes

The big No !!



Battery Disposal

The No’s Yes !!

Bulk Storage

awaiting

collection



WEEE Recycling Computers

When recycling/disposing of computers

confidential information erased before leaving

site. Inventory list drawn up and certificate of

correct destruction received after items are

shredded pending recovery of the various

components.



Effective Bailing- Used for Plastic and Cardboard for

Recycling (For Small Hospital Units 50- 200 beds)

The Cardboard in left

picture reduced in

volume to this bale on

right which weighs

approximately 20Kgs.

Plastic bottles were

crushed and baled

again weighed

approximately

20Kgs.Machine is

electrically operated.



For Larger Hospital Units Consider Compactors

Compactors can take up to 20 skip loads of the size shown if not more.

Savings on cost of transport. Capital outlay can soon be recovered.



Waste Minimisation Ideas

Paperless meetings – use lap tops

-Power Point Presentations

Good Stock control.

Consider durability of items – pay more for an item that last longer.

Internal Swop Shop on Intranet.

Consider Refurbishment

Ensure Proper Maintenance Program for Equipment in line with

Manufacturers guidelines



Alternative Products

Instead of continually throwing away damaged items consider a different option

like substituting fabric for metal seating



Training of Staff

Medical staff

Nurses

Doctors

Laboratory staff

Administration staff

Building maintenance

Patients/visitors

Cleaners

Porters

Waste Handlers

Waste contractors

Waste Managers

Waste auditors

Different staff will need different type of awareness training. Group on left

regarding which receptacles to use on the right how to move the waste



The Waste Policy

Required to establish control mechanisms in the organisation.

Clearly establishes ownership.

Provides guidance to procedures

Needs to have ownership

Program of regular review

Establishes principles of waste management in the organisation


Practical Waste Management in The Healthcare Environment Training 2011... · US EPA has determined...

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