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Healthcare Waste Management


The safe and effective management of medical waste depends on appropriate segregation, packaging, in house transport, storage and finally treatment and disposal. – PowerPoint PPT presentation

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Title: Healthcare Waste Management

Healthcare Waste Management
We can meet the challenge.
HCRW Management.ppt 7/03
This World belongs to me. And to you. And to
your children. It's ours.
HCRW Management.ppt 7/03
  • Recent media attention has increased the
    publics 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.

HCRW Management.ppt 7/03
  • 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

HCRW Management.ppt 7/03
  • 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.

HCRW Management.ppt 7/03
  • 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
  • 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.

HCRW Management.ppt 7/03
  • 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.

HCRW Management.ppt 7/03
  • 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.
HCRW Management.ppt 7/03
  • 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
  • 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.

HCRW Management.ppt 7/03
Environmental health risks, natural or of human
origin, are an ever-present feature of human
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.
HCRW Management.ppt 7/03
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
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
HCRW Management.ppt 7/03
Health vs Health Care Projects
Health Care implies having to remedy
sicknessHealth A state of freedom from
all that illness brings.
Between 70 and 80 of diseases is caused by
incorrect lifestyles and inappropriate
So, shouldnt we think deeply about how we are
living to avoid the lowered quality of life and
greater financial costs that serious disease can
HCRW Management.ppt 7/03
Preventive Healthcare Biology 27
(6.9) Environment 13 most
important Healthcare 19 (1.5)
causes of death
11 (90.6) Lifestyle 43 (1.2)
Distribution of causes of death
Dever, 1976() Distribution of public
budget Hjort, 1984
HCRW Management.ppt 7/03
Causes of Health A B Lifestyle -
Activities within the working, living,
Environment recreation C.
Contribution of health care D.
Genetical causes B
20 C 10 A 50
D 20 Kalla Ingemar
Norling Gotenborg University
HCRW Management.ppt 7/03
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.
HCRW Management.ppt 7/03
  • 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
  • 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

HCRW Management.ppt 7/03
  • Education of the staff and public is not getting
  • 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
  • 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.

HCRW Management.ppt 7/03
HCRW Treatment Technologies
  • Incineration
  • Chemical treatment
  • Microwave treatment
  • Plasma Arc
  • Steam based thermal treatment

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
HCRW Management.ppt 7/03
  • 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.

HCRW Management.ppt 7/03
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
This process generated no liquid effluent.There
are no emissions, effluent or harmful material of
any kind.
HCRW Management.ppt 7/03
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
There is no harmful interface with the
environment, as the processed waste is 100
A cradle to grave control of each individual
container is conducted through electronic
readers, capturing the identity of each container
and its total mass.
HCRW Management.ppt 7/03
HCRW Management.ppt 7/03
  • Incoming waste is received in approved
  • 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.

HCRW Management.ppt 7/03
  • 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.

HCRW Management.ppt 7/03
  • 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
HCRW Management.ppt 7/03
  • The size reduction system the material is
    ground to a uniform scale.
  • The size reduction occurs under negative

HCRW Management.ppt 7/03
  • 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 pre-filter 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.
HCRW Management.ppt 7/03
  • 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.

HCRW Management.ppt 7/03
  • The waste cools along this conveyor.
  • Compaction at a rate of 86 takes place in the
    compaction room.

HCRW Management.ppt 7/03