High Tech Centralized Facilities in Developing Countries TechNet/SIGN Injection & Waste Management Technology Day New Delhi, India 29 August 2001 Jorge Emmanuel Health Care Without Harm www.noharm.org
Dec 25, 2015
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.