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Healthcare Waste Management

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					HCRW Management.ppt

7/03

HCRW Management.ppt

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• Recent media attention has increased the public’s apprehension that medical wastes are not properly controlled. The prospect of AIDS contaminated medical waste have compounded this fear, so that panic can be created by the mere mention of the words “infectious waste” or “hospital waste”. IS THIS FEAR JUSTIFIED? • World Health Organisation, infection control guidelines:

“Most hospital waste is no more infective than residential waste, and hospital wastes disposal practices have not caused disease in the community.”

• Not all waste from a health care facility poses a risk. Only between 10 and 15% of medical waste is considered infectious.

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• The word “infectious”, “pathological” and “biomedical” imply a degree of hazard and may cause unnecessary alarm as they are also used to describe material, which is neither human nor animal tissue.
• The SABS proposed code of practice says that all waste contaminated with blood or body fluids are classified as infectious waste. This enormously increase the volume of waste requiring expensive handling and disposal. Identical items of waste are disposed of from homes with no special handling or decontamination.

• The modern trend in hospital infection control is to build safe practices into all clinical procedures, the precaution taken is dictated by the risk accompanying the procedure, not by the diagnosis.
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• The simple presence of viable organisms does not constitute a hazard; a mechanism by which these organisms can infect a host must coexist.
• Absolute elimination of all risks is impossible. A realistic goal is a reasonable degree of safety at all times without compromising efficiency and priorities.

• The safe and effective management of medical waste depends on appropriate segregation, packaging, in house transport, storage and finally treatment and disposal.
• This can only be achieved by all health care facilities having a documented policy and procedures and the staff is properly trained.
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• Disposal in a landfill site is a common method, and is appropriate for many varieties of medical waste. (Infectious non-anatomical waste) (WHO) • If some infectious material is present in the waste transported to the landfill, the concentration of pathogens is reduced by soil filtration. • An organism passing further into the soil bed is denied the nutrients, oxygen and other conditions necessary for survival. The only special requirement for the disposal of infectious wastes in a landfill is that the wastes be rendered unrecognisable and unreusable.
• The sanitary sewer system is a safe and acceptable method of disposal for untreated bulk blood, suctioned fluids excretions, secretions, and other infectious wastes that can be ground and flushed into the sewer.
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• The sewer system is designed to attenuate sewage which is already an infectious material and is, therefore effective in attenuating infectious agents found in blood and other body fluids.
• Grinding and sewering of wastes constitutes immediate removal of the infectious waste, eliminating storage, transport, handling and treatment costs.

• When wastes are treated in this manner, the waste should be poured carefully to eliminate spills and the formation of vapours. The municipal sewerage treatment system should have secondary treatment available, and the practice should meet with the approval of all applicable local sewerage by laws.
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• The mission of any medical treatment technology should be three fold: 1. Render the material non-infections and the processed waste 100% recyclable. 2. Render the material unrecognisable, unreusable. 3. Be environmentally friendly. It should address the entire spectrum from point of generation to final disposal, all within an infectious control paradigm. It should provide maximum security against nosocomial risks and provide maximum safety to the health worker, from clinician to janitor. It should guarantee comprehensive training, safety for the communities and zero negative environmental interfaces, i.e. be environmentally friendly.
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• Present management systems are still largely based on a “dispose, dilute and disperse” approach. A fundamental switch is required towards a “recycle, concentrate and contain” approach.
• However, recycling is not an end in itself, it should not be carried out if there is no net environmental gain – when more fuel and material usage and more pollution occur through reuse than would have occurred if new products were made with virgin resources. • We can not enjoy zero-environmental risk founded in zero exposure to pollution. A balancing process is required, in which “acceptable” trade-offs between risk levels and the costs of reducing exposures are struck.
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Environmental health risks, natural or of human origin, are an ever-present feature of human life. Waste disposal facilities have suffered from the NIMBY (not in my backyard) syndrome.
Why is it that people perceive the health risks to be unacceptable when formal analysis does not confirm these perceptions?

Experts tend to use the “relative-risk” approach – the risk posed by toxic chemical exposure from a waste site versus risks like smoking, alcoholism, poor diet, traffic accidents. On this basis the medical waste hazard can be shown to be a relatively low risk. Individuals, however, continue to see risks as absolutes and often involuntary, perhaps because of misinformation and misperception.
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The main issue with incinerators is emissions.

Burning waste does not make it disappear. Depending on the type of waste, up to 100 chemicals can be emitted into the atmosphere.

A common emission is “Dioxins”, the toxic component of “Agent Orange” which was used during the Vietnam War. Dioxins are carcinogenic, depress the immune system, and disrupt the reproductive and hormonal systems. Dioxin is one of 12 persistent organic pollutants “pops” that have been prioritised for immediate action under the global POPS Convention, to which SA is a signatory. SA intends to be on the forefront in meeting the objectives set in Rio, in the Kyoto Protocol and more recently in the UN Convention on Sustainable Development.
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Health vs Health Care Projects

“Health Care” implies having to remedy sickness “Health”: A state of freedom from all that illness brings.

Between 70 and 80% of diseases is caused by incorrect lifestyles and inappropriate environment.
So, shouldn’t we think deeply about how we are living to avoid the lowered quality of life and greater financial costs that serious disease can bring?
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Preventive Healthcare

Biology 27% (6.9%) Environment 19% (1.5%) 13 most important causes of death
Lifestyle 43% (1.2%)

Healthcare 11% (90.6%)

% = Distribution of causes of death (%) = Distribution of public budget

Dever, 1976 Hjort, 1984

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Causes of Health
A+B Lifestyle + Environment Activities within the working, living, recreation

C. D.

Contribution of health care Genetical causes B = 20%
C = 10% D = 20% A = 50%

Kalla; Ingemar Norling Gotenborg University
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The existence of more than 1 billion people worldwide without drinking water and 2.8 billion without sanitation and in contaminated and polluted environments, is a pungent example of the urgent need for preventive health to be seen in its entirety, tackling the causes of ill health instead of the symptoms.
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WASTE MANAGEMENT FAILURES
• Poor segregation of waste Up to 80% of “infectious waste” consisted of cans and bottles of cooldrinks, magazines, food, CSSD sterilized paper and other general waste. • Clear directives and commitment related to waste minimisation and management of waste, including the monitoring of volume generated and the financial implications for each waste stream.

• No clear understanding of “medical waste” Only between 10 and 15% of medical waste is considered infectious.
• “Cradle to grave” protocols not available • No policy and procedure regarding requisitioning or rotation of stock, to prevent overstocking and lapsed expiry dates of consumables and pharmaceuticals.
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• Education of the staff and public is not getting through • No structured orientation and induction in service education programmes that include waste management for all categories of staff.
• Collection of waste from the various areas not always satisfactory. • Lack of continuity due to rotation of staff and leave.

• Lack of commitment by institutional managers to manage and monitor the entire medical waste flow, from initiation to disposal.
• Institutional managers either do not see it as high priority or are powerless to enforce good medical waste segregation.

• A non care less attitude by the staff concerned.

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HCRW Treatment Technologies
• Incineration

• Chemical treatment
• Microwave treatment

• Plasma Arc • Steam based thermal treatment
STEAM BASED THERMAL TECHNOLOGY
Incineration as long been the preferred disposal method of medical waste, in South Africa besides dumping it!!! Concerns about, emission, the composition of the resulting ash and its disposal, and social and environmental responsibility awareness have prompted the development of cleaner, more environmentally friendly alternatives in line with the Internation Convention on Sustainable Development.
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• One of the new technologies based on Steam Thermal Treatment is the so-called ETD, Electro Thermal Deactivation. • It uses low frequency radio waves and an imposed high-energy field to inactivate medical waste and destroy pathogens such as viruses, vegetative bacteria, fungi, yeast and spores, without combusting the waste. • The processed waste, with a microbial level reduced by 6 logs, can then be recycled. The sterilising agent renders HCRW sterile to the level of a 6 log 10 kill (99.999%). The term “kill” means microbial inactivation. Log kill is defined as the difference between the logarithms of number of viable test micro organisms before and after treatment.
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A log kill of 6 is equivalent to a millionth (0.000001) survival probability in a population of a 99.999% reduction of the population. The ETD process converts the HCRW into treated decontaminated solid waste. This process involves the pre-shredding of the waste, addition of water, compaction of the waste and exposure to a low frequency oscillating electric field (10 mHz field at 50.000 volts), which takes place in an insulated fully enclosed tube, and is operated under vacuum. The treated waste is cooled and compacted before disposal. This process generated no liquid effluent. There are no emissions, effluent or harmful material of any kind.
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In the compacting room, the treated waste is delivered into a standard compactor box, reducing the volume by as much as 85%. Operating ETD plants can process up to 50 tons per day HCRM.
The material can now either be disposed of at a general landfill site or, wherever possible recycled.

There is no harmful interface with the environment, as the processed waste is 100% recyclable.
A cradle to grave control of each individual container is conducted through electronic readers, capturing the identity of each container and its total mass.

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HCRW Management.ppt

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THE RECEIVING ROOM
• Incoming waste is received in

approved Steri-Tubs.

• Manually loaded onto a conveyor that will feed the bins onto a weighing station.
• The identity of each container will

be captured electronically together with its total mass.
• Manually opened for further visualization.

• Passed onto an electronic sniffing area that will detect for the presence of hydro-carbons and radio-active materials. • Fed to an automated tipping system which will discharged the contents of the bin, complete with red liners into the fully enclosed and sealed processing room via a receiving chute.
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THE RECEIVING CHUTE

• A dual screw conveyor transfers the waste to the process room.
• The containers and lids are diverted to the wash bay for a stringent cleaning process.
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THE WASH BAY
• The container sanitation system consists of the following six steps.

1. An anti-microbial soap solution
2. A high temperature (82ºc) high pressure spray

3. A second high temperature, high pressure spray 4. A biocide disinfectant
5. The container/lid is then air-dried at 71ºc

6. Manual visualization and inspection
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THE PROCESSING ROOM

• The size reduction system – the material is ground to a uniform scale.

• The size reduction occurs under negative pressure.
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THE CYCLONES
• Ground up material

transferred via sealed high-velocity ducts to the low energy cyclone where by centrifugal force, the material is separated from the transport air. • Transferred to a high energy cyclone for further separation of material. • Then passes through a dust collector equipped with fixed prefilter panels.
• Then goes through a HEPA filter and an air wash system prior to exiting the process room.

NOTE: The air that goes to atmosphere is cleaner than the air even breathed in the plant.
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ELECTRO THERMAL DEACTIVATION TUBE – THE MAGIC TUBE
• Bio-Burden Reduction
• Microbes are organic material composed of individual cells. Cells consist of a nucleus in a lipid solution enclosed within a membrane wall. The ETD process applies three principles, which result in cellular lysis and subsequent bio-burden reduction. • Selective Absorption of Energy

• Dipolar Rotation of Liquid Molecules • Imposed High Voltage Field.
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CONVEYOR TO COMPACTION – COMPRESSOR ROOM

• The waste cools along this conveyor. •Compaction at a rate of 86% takes place in the compaction room.
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