Title: Environmentally Responsible Management of Health-Care Waste With a Focus on Immunization Waste
1Environmentally Responsible Management of
Health-Care Waste With a Focus on Immunization
Waste
Working Draft, October 2002
- Comments and suggestions on the document are
welcome. Send comments to ltfiruzeh_at_essential.org
gt
Health Care Without Harm 1755 S Street NW, Suite
6B Washington, DC 20009 USA
2Waste Management Strategies
- First Things First
- Eliminate unnecessary injections
- Product selection and purchasing
- Workers as the front-line of defense
- Rigorous training
- Immunization
- Segregation is key
- Proper containerization, secure transport
storage - Non-burn treatment technologies
- Proper disposal
3Guidelines
- Guidelines for Central Planners
- Guidelines for Local Managers
- Practical Procedures
- Treatment and Disposal Options
- Guidelines are adapted from valuable existing
documents - Management of wastes from immunization campaign
activities (UNICEF) - Safe Management of Wastes from Health Care
Activities (WHO) - First, do no harm (SIGN, draft 2002)
4Toxic Pollutants From Medical Waste Incinerators
- Air Emissions
- trace metals As, Cd, Cr, Cu, Hg, Mg, Ni, Pb
- acid gases HCl, SO2, NOx
- dioxins furans, including 2,3,7,8-tetrachlorodib
enzo-p-dioxin - other organic compounds benzene, toluene,
xylenes, chlorophenols, vinyl chloride,
polycyclic aromatic hydrocarbons, etc. - carbon monoxide
- particulate matter
- pathogens (under conditions of poor combustion)
- Ash Residues metals, dioxins furans, other
organics
Medical waste incinerators are a major source
of dioxins mercury in the environment.
5Health Impacts of Incinerator Emissions
Incinerator emissions have been linked to
- lung, laryngeal, stomach and other cancers
- ischemic heart disease
- urinary mutagens and promutagens
- elevated blood levels of various toxic organic
compounds and metals
6Stockholm Convention on POPs
- Stockholm Convention on Persistent Organic
Pollutants (POPs Treaty) - Adopted in May 2001
- Article 5 countries will take measures to
further reduce releases of POPs with the goal of
ultimate elimination - Annex C
- First in the list of POPs from unintended
production Dioxins and Furans - Source with the potential for comparatively high
formation and release of dioxins and furans
Medical Waste Incinerators
7De Montfort Combustion Efficiencies
- Organic Emissions are 20 to 400 times above the
South African limit
India
S. Africa
Organic Emission Fraction 1 - Combustion
Efficiency
Field Test DM1, DM2, DM3, DM4 Lab Test DM5,
DM6
8De Montfort Incinerator Does Not Meet
Environmental Standards
- Fails to meet combustion temperatures limits
- Fails to meet residence time requirements
- Exceeds opacity limits
- Fails to meet combustion efficiency standards
- Exceeds limits on particulate matter
- Exceeds some limits on metals
- Violates stack height requirements without
modification - Has no pollution control, no controls on
temperature and air input, no safe ash removal
system - Could release significant quantities of dioxins,
furans, mercury and other toxic pollutants
9Summary of Field Investigations
- Incinerators (1-2 yrs old) poorly maintained
operated - Broken ash doors and/or chamber doors, heavily
corroded, clogged air vents, sharps waste around
incinerator, etc. - All waste burned including
- PVC plastics (e.g., IV bags) and mercury
thermometers - Non-infectious, recyclable and compostable waste
(despite segregation practices or policies) - Large quantities of unburned material in the ash
- Ash improperly disposed of in every case
- Smoke visible from incinerators in some cases,
smoke coming out of chamber door and air inlets - Incinerators near populated areas
10Heavy Smoke From Incinerator Operator Using
Motorcycle Helmet
Courtesy of P. Madhavan
11Soot Molten Plastic (?) Coming Out of Ash Door
Courtesy of Bradley Hersh
12Undestroyed Needles On the Ground Around
Incinerator
Courtesy of Shibu K. Nair
13Problems of Promoting Incineration
- Results in Adverse Health Impacts on Health
Workers and Communities - Pollutes the Environment
- Weakens Enforcement of Environmental Laws
- Threatens Worker Safety
- Undermines Good Waste Management Practices
- Promotes Dumping of Obsolete Technologies
- Hampers Deployment of Cleaner Technologies
14Low-Cost Options
CE Cement Encasing EI Encapsulation With
Immobilizing Materials BP Waste Burial Pit or
Sharps Pit With Concrete Cover PU Portable
Autoclave or Microwave ND Point-of-Use Needle
Destruction Technologies ND/m Mechanical Needle
Destruction CT Storage, Transport and Centralized
Treatment TG Traditional Grinders S Shredders or
Hammermills Disposal in Sanitary
Landfill Burial in Restricted Sites
15Decision Tree 2
16Cement Encasing
17Encapsulation With Immobilizing Materials
18Sharps Waste Burial Pit With Concrete Cover
19Basic Autoclave (Simple Retort Design)
20Estimates for Cement Encasing
Trench volume and cement needed for DTP-HepB-Hib
vaccination waste
21Comparative Costs for Treating 50,000 Syringes
22Capital Costs to Treat 1,600 kg/day of Medical
Waste in a Region
23Environmentally Responsible Management of
Health-Care Waste With a Focus on Immunization
Waste
Working Draft, October 2002
- Comments and suggestions on the document are
welcome. Send comments to ltfiruzeh_at_essential.org
gt
Health Care Without Harm 1755 S Street NW, Suite
6B Washington, DC 20009 USA