THE “SEGREGATION” ISSUE The Impact of Segregation on HCW ... · of segregation and the costs savings. Due to mis-segregation, large quantities of HCRW disposed with general waste,

Solid Waste Technologies SA

SOLID WASTE TECHOLOGIES SA (PTY) LTD

THE “SEGREGATION” ISSUE - The Impact of Segregation on HCW Treatment

Facilities and HCW Management Agnetha Arendse Environmental Manager

The Question:

“Are HCW Non- Burn treatment facilities, treating the correct HCRW

Definition for HCRW: SANS 10248:2008

‘’Human and animal anatomical, infectious human and animal waste, sharps, chemical

waste, pharmaceutical waste and radioactive waste generated by the health care

professionals, healthcare facilities and non-healthcare and other non healthcare

professionals e.g. tattooist’’

HCW Forum

“Over recent years there have been numerous press statements of health care risk waste being

disposed of in an incorrect manner”

HCW Forum

“claims were also made stipulating that the biggest problem in the effective

management of Heath Care Waste lies with risk awareness, public exposure,

incinerator capacity and the increasing need for awareness of the problem

within the health sector”

WHAT IS HCW?

HAZARDOUS HCRW is broken into the following components: • Infectious Waste • Sharps • Anatomical (pathological) waste • Hazardous Chemical, Pharmaceutical and Radioactive waste

Non-hazardous Hazardous

75-90% 10-25%

HEALTH CARE WASTE

• NON-HAZARDOUS HCGW is

generated during administrative and housekeeping functions of the hospital and include food preparation, cleaning, repairs, office services, packaging, damaged containers, discarded flowers, wrappings and so on.

DEFINITION- WASTE SEGREGATION

• The process of keeping source separated wastes apart during handling, accumulation (interim storage), storage and transport and to assist resource recovery and ensure appropriate designated treatment and/or disposal methods are utilised. Waste segregation should be practised both by generators and waste handling companies at the source for efficient waste management.

SEGREGATION: Legal Framework

• Sans Code of Practice for HCRW

Management within the Health Care Facility 10248:2008;

• National Acts: NEMA & NEMWA, NHA, HTA • The Minimum Requirements for the

Handling, Classification and disposal of Hazardous Waste;

• Provincial Regulations • Municipal By - Laws

LEGAL FRAMEWORK….

• The Occupational Health and Safety Act 85 of 1993 can be referenced and revised, in this regard, in terms of the Duties of the Employer (Section 8) who thus has the obligation and their responsibilities in specifically, Section 13: Duty to Inform.

CONTINUED…

• Most hospitals besides the documents specified above would have a set of guidelines represented by a Code of Practice for HCW Management within the facility, which would incorporate the general instructions for how to handle all solid and liquid wastes arising from activities taking place within their premises.

NWMS: First Draft 2010

“Once a waste has been classified as hazardous or general waste, the generator then needs to consider the management options that apply to that waste. These will determine whether the waste is suitable for reuse, recycling, recovery, treatment or whether it must be disposed of.

NWMS: Proposed Primary Categories for waste categorisation

Waste Categories

Gaseous waste (CFCs, Nitrogen, HCl-pressure bottles)

Oxidizing waste (organic peroxides, strong oxidising compounds)

Reactive waste (react with water to generate flammable or acidic gasses)

Mercury waste, or mercury-containing waste (batteries, fluorescent lamps, thermometers)

‘Various’ waste (low volumes, e.g. small packaging, aerosol cans, medicine, iso-cyanates)

Pesticides

POPs Waste

Inorganic chemical waste (acids, sodium hydroxide, metal salts)

Asbestos

Waste Oils

Batteries

Shredder waste

Tarry Waste

Halogenated solvents and compounds with sulphur

Halogenated organic solids

Solvents without halogens and sulphur

Other organic hazardous waste

Fly Ash & Bagfilter dust

Bottom ash

Foundry sand

Mineral waste (refractory waste)

Reprocessed mining waste

Polluted soil

Health care risk waste

WEEE: Waste of Electric and Electronic Equipment

End-of-life vehicles

Others/Miscellaneous

Continue…

Before disposing of waste the generator will need to consider landfill acceptance criteria. If the waste does not meet these criteria, the generator will need to consider other waste management options. When sending waste for the appropriate identified waste management option, the waste generator will be required to complete a waste manifest document (tracking doc) so that the waste can be tracked from the generator to the waste management facility and back.

SANS Code on Colour Coding WASTE WASTE SUB-CATEGORY COLOUR CODING &

INT. HAZARD LABEL

Human or animal Anatomical Waste

Infectious human anatomical RED + Int hazard label

Infectious animal Anatomical ORANGE + Int hazard label

Non- infectious animal anatomical

Infectious Non-Anatomical waste

None RED

Sharps None YELLOW , the words DANGER CONTAMINATED SHARPS

Chemical Waste & Pharmaceutical Waste

Chemical or Pharmaceutical DARK GREEN + Int hazard label

Cytotoxic Pharmaceutical DARK GREEN + Cytotoxic hazard label

Radioactive None No Colour coding only appropriate Int

Colour coding Containers Pics

See Circular

SEGREGATION

• Segregation of materials would not

only assist with the reduction of the HCW stream but ensure that the various waste are dispose of in the correct manner or the correct method of destruction

Continued…

• On a broad spectrum of statistics over the past 10 years, it can approximately be speculated that 60% - 90% of the waste generated by major generators of waste is General waste.

• Systems to support the proper segregation of HCRW waste are not always in place in hospital wards and clinics. Solid Waste Technologies SA

Generation Capacity and Growth

Golder Associates (Status quo report) DEADP/April 2010 > Questions the increase in waste figures/production from two prominent waste facilities in Western Cape- The report made assumptions on: • the increase of population; improved record

keeping; • closure of provincial incinerators; • an increasingly less healthy society;

Continued….

• the addition of hospitals and clinics that were constructed;

• improved and correct disposal of HCRW, all of which could have led to an increase in HCW

“Alternatively it could have simply have been an increase in poor controls in terms of waste segregation that resulted in additional general waste entering the HCW stream. “

COST EVALUATIONS IN HCW MANAGEMENT

“Opting for the cheapest HCRW management system and thereby putting workers at risk is in particular a problem in private HC facilities that are profit-driven, with HCRW generators expecting 1st world solutions at 3rd world prices” (KO&A+JC)

Table Showing Results on Segregation at various levels of inspection and analysis

Government Departments Health Care Facilities (public/private)

National Provincial Local Government Urban areas Rural / remote

Segregation efficiency

Limited guidance on segregation of waste and financial implications

Due to mis-segregation, large quantities of HCRW disposed with general waste, also large quantities of general waste treated at high cost as HCRW. Lack of awareness on the importance of segregation and the costs savings

Due to mis-segregation, large quantities of HCRW disposed with general waste, also large quantities of general waste treated at high cost as HCRW. Lack of awareness on the importance of segregation and the costs savings Landfills receiving untreated HCRW due to poor segregation

Excessive costs of treatment due to general waste disposed as HCRW.

General waste services may be erratic resulting in all waste treated as HCRW.

Common Problems

The common problems that have been experienced in South Africa in most studies include the following which have been referenced from a paper, written by Llewellyn Leonard, for groundwork (SA NGO), 2005:

• No Segregation / On-site incinerators/fear • Education and Awareness amongst public • Training of Health Care Staff • Most hospitals lack proper Waste minimisation

plans • Rural clinics areas are not provided with

proper services Solid Waste Technologies SA

Vice versa roles of Waste Management

MOTORS FOUND IN HAMMER-MILLS OF ETD PROCESS

SEGREGATION

ANATOMICAL WASTE???

IMPROPER SEGREGATION PRACTICES (International pictures)

• Trolleys are:

• crowded with medical equipment (uncovered laryngoscopes, face masks adult & pediatrics and the register

• stationed in places easily accessible to unauthorized people • drawers are without labels

• Safety boxes secured with bandages

SEGREGATION Continued….

• Unsatisfactory segregation of waste: HCRW mixed

with general waste (food disposable plates and cups were in red bags- yellow color-coded bags seem not to be available)

SEGREGATION

• Unsatisfactory segregation

RED OR BLACK???

Sharps??

Sharps Container: Exceeded fill line

The ETD: Electro Thermal Deactivation

• The process utilizes three principles to reduce • the bio-burden in the medical waste to an • acceptable level.

• This Results in ZERO EMISSIONS of any • liquids, solids or regulated Air Emissions, It • has no fires, there it is NON-BURNING and • Totally ENVIRONMENTAL FRIENLY

HCRW DISPOSAL METHODS

• Electro Thermal Deactivation treatment process

• changes the character of hazardous wastes to • render them harmless to the public.

• The main purpose of waste treatment is to

disinfect • or sterilize the waste so that it is no longer the • source of pathogenic organisms.

• This process renders the material non-reusable

and • safe for disposal to the authorized disposal site.

The ETD Process

Disposal methods for Mercury

‘Certain waste streams which are either highly toxic or are not readily biodegradable need to be handled in a way that will ensure these wastes are kept out of the environment and do not pose a threat to nature or to the health and safety of people. Examples of such wastes include poisons, herbicides, pesticides and toxic materials such as mercury, cyanide andarsenic’’

Alternatives Methods for disposal

•One method to deal with this type of waste is called encapsulation. In this method, waste contained in specified drums is placed inside specially designed and constructed concrete structures, which are 18 m in diameter and 11.2 m high. •Another method is Incineration whereby the waste is incinerated at a temperature of 1000ºC and above

Training is very important no matter what job you do. :)

• “There was a case in one of Hospital's ICU, where

patients always died in the same bed, every Sunday morning at 11am regardless of their medical condition. This puzzled the doctors and some even thought that particular bed was the work of the Devil..... as to why the deaths at 11am on Sunday mornings?

….….

• A world-wide team of experts were constituted and they decided to go to the ward to investigate the cause of the incidents. So on the next Sunday morning, a few minutes before 11am, all doctors and nurses nervously waited outside the ward to see for themselves what the terrible phenomenon was all about.

• Some were holding wooden crosses, prayer books and other holy objects to ward off any evil spirits.

• Just then the clock struck 11 and............ .....Precious Tshabalala walked in (part-time cleaner) unplugged the life support machine and plugged in the vacuum cleaner. LOL!

CONCLUSION

• The segregation issue is very dynamic and

impacts broadly on the spectrum of HCW Management therefore our key concerns must be based on effective segregation for minimisation therefore enhancing the ethics of the NEMWA, Act 59 of 2008, in reduction re-use, recycling and recovering. Solid Waste Technologies SA

Continued…

• The last inspired model of Waste management was fully based on waste avoidance and reduction/minimisation. It therefore must be the core goal to focus on the strategies as to how we as the HCW industry>>improve on this aspect on all levels of governance, the public and the private sector as well as all socio-economic aspects of life…..

SUSTAINABILITY

• The sustainability of this industry lies in

our ability to presently alter the systems which have waned from ethical environmental practices, and constantly work to achieve sustainable economic, social and environmental practices within the HCW industry for our present and future generations.

The message we carry around for Health Care Waste Management should always attract the public’s attention

(INFO ‘BAG: PRICELESS)

Questions??

Questions???

THANK YOU!!!

Thank You!

THE “SEGREGATION” ISSUE The Impact of Segregation on HCW ... · of segregation and the costs savings. Due to mis-segregation, large quantities of HCRW disposed with general waste,

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