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Title: Environmentally Responsible Management of Health-Care Waste With a Focus on Immunization Waste


1
Environmentally 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
2
Waste 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

3
Guidelines
  • 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)

4
Toxic 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.
5
Health 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

6
Stockholm 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

7
De 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
8
De 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

9
Summary 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

10
Heavy Smoke From Incinerator Operator Using
Motorcycle Helmet
Courtesy of P. Madhavan
11
Soot Molten Plastic (?) Coming Out of Ash Door
Courtesy of Bradley Hersh
12
Undestroyed Needles On the Ground Around
Incinerator
Courtesy of Shibu K. Nair
13
Problems 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

14
Low-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
15
Decision Tree 2
16
Cement Encasing
17
Encapsulation With Immobilizing Materials
18
Sharps Waste Burial Pit With Concrete Cover
19
Basic Autoclave (Simple Retort Design)
20
Estimates for Cement Encasing
Trench volume and cement needed for DTP-HepB-Hib
vaccination waste
 
21
Comparative Costs for Treating 50,000 Syringes
22
Capital Costs to Treat 1,600 kg/day of Medical
Waste in a Region
23
Environmentally 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
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