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Veronica Di Bella
Potential and Challenges of Healthcare Disposal:
A case study of De Montfort incinerators
University of Bristol
Sustainable Water Supply & Sanitation in Developing Countries
Research carried out at CeTAmb – Research centre for appropriate technologies for environmental management
in Developing Countries, University of Brescia, Italy
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Healthcare Waste (HCW)
Management in Developing
Countries
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Outline
Healthcare waste includes all the waste generated by healthcare
establishments, research facilities and laboratories (WHO,1999).
8 categories
General waste
Chemical waste
Pathological waste
Radioactive waste
Infectious waste
Sharps
Pharmaceutical waste
Pressurized containers
HCW Mangement in Developing
Countries
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Category
General waste
Examples
Domestic waste, packing material, non-infectious animal
waste, bedding, wastewater from laundries, etc.
Pathological waste Tissues, organs, body parts, human foetuses, animal
carcasses, blood and body fluids.
Radioactive waste Waste containing radioactive substances: unused liquids
from radiotherapy or laboratory research, contaminated
glassware, packages, etc.
Chemical waste Discarded solid, liquid and gaseous chemicals, for example
generating from diagnostic and experimental work, cleaning,
housekeeping and disinfecting procedures.
HA
ZA
RD
OU
S
NO
T
MA
YB
E
YE
S
HCW Mangement in Developing
Countries
Infectious waste Waste suspected to contain pathogens: laboratory cultures,
tissues, excreta, etc.
Pharmaceutical
waste
Pharmaceutical products, drugs and chemicals that have
been returned from wards, have been spilled or outdated or
contaminated, or are to be discarded because they are no
longer required.
Pressurized
containers Gas cylinders, gas cartridges, aerosols cans; they may
explode if incinerated or accidentally punctured.
Sharps Needles, syringes, scalpels, blades, saws, glass, nails and
any other item that could cause a cut or puncture.
Y
ES
HCW Mangement in Developing
Countries
Category Examples
HA
ZA
RD
OU
S
75 - 90% of general waste (similar to domestic waste)
10 - 25% is hazardous (infectious, toxic etc.)
HCW Mangement in Developing
Countries
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
HCW Mangement in Developing
Countries
Hargeisa, Somaliland
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
HCW Mangement in Developing
Countries
Hargeisa, Somaliland
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
HCW Mangement in Developing
Countries
Juba, South Sudan
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
HCW Mangement in Developing
Countries
Juba, South Sudan
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
HCW Mangement in Developing
Countries
Juba, South Sudan
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
HCW Mangement in Developing
Countries
People at risk
Hazard Category of waste
Infectious waste, sharps,
pathological waste
Chemical and pharmaceutical waste
General public Patients
Health-care
personnel Waste workers
Infections
Intoxications and burns
Toxicity and damage to
genetic material Radioactive waste
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
HCW Mangement in Developing
Countries
Activity Hazard
Storage at health-care
establishments
Transportation
Dirt, proliferation of
rodents and insects
Waste blown on the streets
Release of hazardous gases Incineration
Disposal in water
bodies
Contamination of water
resources
Disposal in dumps Contamination of water
and soil
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
HCW Mangement in Developing
Countries
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Treatment of HCW
3 categories of process for the treatment of hazardous waste
Thermal processes (dry and wet)
Chemical processes
Containment processes
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Treatment of HCW - Incineration
Type of incinerator Adequate for
Pyrolytic incinerator -All infectious waste
- Most pharmaceutical
waste
- Most chemical waste
Single-chamber incinerator -General healthcare waste
- Infectious waste
BUT significant emissions
Drum or brick incinerator
-General healthcare waste
- Infectious waste
BUT it should be used only
in case of emergency
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
De Montfort Incinerators
Main features
- Designed at De Montfort University, Leicester
- Cheap but effective
- Able to reach T > 800°C
- Primary and secondary combustion chambers
- Possibility to build it in developing country
- It should be used for sharps and infectious waste
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
De Montfort Incinerators
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Model Capacity Remarks
Mark 1 12 Kg/h Basic model; now superseded by M. 8a
Mark 2 12 Kg/h Larger combustion chamber compared to M.1; only used for
experimental purposes
Mark 3 50 Kg/h Designed for large hospitals (up to 1000 beds); now superseded by M.
9
Mark 5 50 Kg/h Higher chimney compared to M. 3; design under modification
Mark 7 12 Kg/h Specifically for emergencies
Mark 8
and 8a
12 Kg/h Similar to M.7, but with a brick built model. M. 8a recommended for
most applications
Mark 9 50 Kg/h Similar to M. 3, but simplified for manufacture and to eliminate
operational faults
Operation and Maintenace
-Trained, qualified and equipped operators
-Operators on-site while the incinerator is working
- Supervision essential
- Regular maintenance (e.g. ash removal) + annual inspections and rectifications
Case study – Hargeisa, Somaliland
Project SUDP SISDISC
Period 2005-2008 2008-2009
Aims Support the development of
urban areas through
strengthening urban institutions
Providing priority basic services
in the waste management
sector.
Funds European Commission, UNDP European Commission, Italian
cooperation agency, UN-
Habitat
Leader UN-Habitat Cesvi NGO
Partners UNA Consortium, UNICEF,
ILO, UNDP, NOVIB, CeTAmb
CeTAmb, Boroma University
The project
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Study area
Somalia - East Africa
Capital City: Mogadiscio
18 regions and 3
“independent” states:
1991 Somaliland
1998 Puntland
2006 Galmudug
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Study area: Hargeisa
Capital city and the biggest urban setting in Somaliland
Population: about 650,000 inhabitants
Concentration of public administration, private sector and
international community
Hosting 10 hospitals (1 private), 3 specialised centres, 20
health centres and 26 health posts
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Study area: Hargeisa
The three hospitals in Hargeisa: 1. General Group Hospital
- One of the biggest hospitals in
Hargeisa; public
- Capacity of 300-350 people
- Main departments: surgery and
mental health
- Total staff: 250 people
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Study area: Hargeisa
The three hospitals in Hargeisa: 1. General Group Hospital
General waste Placentas
Needles and sharps Syringes
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Study area: Hargeisa
The three hospitals in Hargeisa: 1. General Group Hospital
Single-chamber incinerator not in use
Used incinerator
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Study area: Hargeisa
The three hospitals in Hargeisa: 2. TB Hospital
- One of the biggest tubercolosis
hospitals in East Africa; public
- Capacity of 200 people
- Mainly for outpatients
- Departments: male and female
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Study area: Hargeisa
The three hospitals in Hargeisa: 2. TB Hospital
General waste
Hazardous waste
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Study area: Hargeisa
The three hospitals in Hargeisa: 3. Edna Adan Maternity Hospital
- Only private hospital in
Somaliland
- Capacity of 69 people
- Main departments: medical,
maternity and paediatric wards
- Close to international standards
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Study area: Hargeisa
The three hospitals in Hargeisa: 3. Edna Adan Maternity Hospital
Sharps
Hospital waste
General waste
Storage of safety boxes
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
De Montfort Incinerator
Model: Mark 8a
Capacity: 12 kg/h
General Group
Hospital
TB Hospital
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
De Montfort Incinerator
De Montfort Incinerator at TB Hospital Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
De Montfort Incinerator
De Montfort Incinerator at TB Hospital Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
Trainings and workshops
Trainings and workshops
Safe practices for
HCWM
Operation and
maintenance of
incinerators
Health-care personnel
Waste collectors
Waste workers
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
De Montfort Incinerator
Issues during the construction: availability of materials
Fire bricks
Deber stones
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
De Montfort Incinerator
Issues during operation and maintenance
- Lack of supervision
- Irregular de-ashing procedures
- Isssues of separation and collection
- Misuse of safety gears
What was the perception of local stakeholders?
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
De Montfort Incinerator
Outline
HCWM in DCs
Treatment of HCW
De Montfort Incinerators
Case study - Hargeisa
LACK OF SUPERVISION
NON-OPTIMAL MANAGEMENT OF INCINERATORS
PROCEDURES MATERIALS
LACK OF SUPERVISION
LOW ENFORCEMENT
CHANGE IN ADMIN
BRICKS FLAKING OFF
BAD QUALITY OF
MATERIALS
LOW
AVAILABILITY SUNLIGHT
METHODS
IRREGULAR
DE-ASHING
INEFFICIENT
COLLECTION
INEFFICIENT
SEPARATION
LACK OF SUPERVISION
LACK OF KNOWLEDGE
TRAININGS NOT
REPEATED
PEOPLE
MISUSE OF SAFETY
GEARS
LACK OF KNOWLEDGE
TRAININGS NOT
REPEATED
LACK OF SUPERVISION
For further information: [email protected]