High Tech Centralized Facilities in Developing Countries

1
High Tech Centralized Facilities in Developing
Countries
Jorge Emmanuel Health Care Without
Harm www.noharm.org

• TechNet/SIGN Injection Waste Management
  Technology Day
• New Delhi, India 29 August 2001

2
Outline

• Framework for medical waste management
• Types of alternative treatment technologies
• Factors to consider in selection

3
Framework

• Waste Segregation
• Waste Minimization
• Environmental Protection
• Occupational Safety and Health

4
Waste Segregation/MinimizationTypical Hospital
Waste Stream
5
Environmental Protection
6
Environmental ProtectionToxic 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-tetrachloro
  dibenzo-p-dioxin (TCDD)
• other organic compounds trichloroethylene,
  tetrachloroethylene, trichlorotrifluoroethane,
  etc.
• carbon monoxide
• particulate matter
• pathogens
• Toxic Bottom Ash
• leachable metals, dioxins/furans, other organics

7
Occupational Safety Health

• Needle sticks and other sharps injuries
• Blood splatter
• Aerosolized pathogens
• Chemicals in the workspace
• Noxious odors
• Hot surfaces
• Ergonomic problems

8
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

9
Types of Alternative Technologies

• Thermal
• Chemical
• Irradiative
• Biological

10
Realistic Alternatives

• Low-Heat Thermal Technologies
• Autoclaves or Retorts
• Advanced Autoclaves
• Microwave Units
• Dry Heat Systems
• Chemical
• Non-Chlorine Technologies

11
Autoclave
12
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.
13
Example Centralized Facility Autoclave, 8 dia x
32 long
Source Bondtech Corporation, Somerset, Kentucky
14
Advanced Autoclaves Examples

• Vacuum / steam treatment / shredding /
  compaction
• Shredding / steam treatment mixing / drying
• Stream treatment, fragmenting mixing / drying

15
Advanced Autoclave Vacuum / steam treatment /
shredding / compaction
Source San-I-Pak, Tracy, California
16
Advanced Autoclave Shredding / steam treatment
mixing / drying
Source STI Chem-Clav, West Chester, Pennsylvania
17
Example Microwave Disinfection
Source Sanitec, West Caldwell, New Jersey
18
Example Dry Heat Disinfection
Source KC MediWaste, Dallas, Texas
19
Chemical Alkaline Hydrolysis
Source Waste Reduction by Waste Reduction, Inc.
(WR2), Indianapolis, Indiana
20
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

21
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)

22
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

23
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

24
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
• ltwww.noharm.orggt
• Note HCWH does not endorse any technology,
  company, or brand name.