Medical Waste Management
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Transcript of Medical Waste Management
Health Care Waste Incineration
Sunday Times
Waste Classification
Municipal Solid waste Health-Care Waste
Non-risk – health care waste Hazardous health – care waste Highly hazardous health – care waste
Other Hazardous Waste Industrial hazardous waste Domestic hazardous waste
Health Care Waste
Total waste generated by hospitals, healthcare establishments and research facilities in the diagnosis, treatment, immunization and associated research
Risky Waste
Inadequate health care waste Management… Mixing health care waste with general waste make the whole
waste stream hazardous
Cause environmental pollution by unpleasant smell
Growth & multiplication of vectors like insects, rodents and worms
Transmission of diseases like typhoid, cholera, hepatitis etc.
Increase BOD of draining water near to land fills and make surface and ground water pollution
Make additional cost & difficulty to the municipals
Difficulties at the collection & transportation of waste
Direct Health harm Community
Environment
Peoples working in hospitals
Patients attending to the hospitals
Hospitals & Their Bed strength Sri Lanka
Type of institution Total Number of Institutions
Average Number of
Patient Beds
Teaching Hospitals 18 1191
Provincial General Hospitals 2 1249
District General Hospitals 17 566
Base Hospitals Type A 22 353
Base Hospitals Type B 46 199
Divisional Hospital Type A 46 101
Divisional Hospital Type B 134 71
Divisional Hospital Type C 300 26
Primary Care Unit and Maternity Homes
9 17
Other 1 27 185Medical Static Unit: 2012 publication
Average Production of Health Care waste Sri Lanka
Health Care Waste Management Report, Ministry of Health
Health Care Waste Generation in Sri Lanka…
Type of institution
Average Number of
Patient Beds
Average Health Care Waste Generation
Kg/day
Total Number of Institutions
Teaching Hospitals 1191 429 18
Provincial General Hospitals
1249 450 2
District General Hospitals
566 204 17
Base Hospitals Type A
353 127 22
Base Hospitals Type B
199 72 46
Divisional Hospital Type A
101 36 46
Divisional Hospital Type B
71 26 134
Divisional Hospital Type C
26 9 300
Primary Care Unit and Maternity Homes
17 6 9
Other 1 185 67 27
Health Care Waste Management Sri Lanka
Management of health care waste is a responsibility of the institution that generates it.
Disinfection of waste by autoclaving is identified by the ministry of Health for the Colombo CMC area which is now in operation.
The National color code on health care waste has been established for waste separation
Methods for final disposal of clinical waste are being explored for implementation.
Budgetary allocation is provided for hospitals for health care waste management under the regular budget.
Medical Static Unit: 2012 publication
Health Care waste Management Sri Lanka
CMC defined a 25 year plan to treat MSW composting plan with private sector participation, it stipulated that no medical waste should be present
NEA No 47 of 1980 and its amendments are the basic legal documents that regulate hazardous waste and consequently HC WM in the country
Medical institutions weren’t included in the list of institutions for which an environmental protection license must be requested from CEA
Popular Hospitals & Their waste disposalName Bed
Strength
Quantity Infectious waste generated (kg/d)
Method of waste disposal
NHSL 3300 500 Auto clave, disposal by CMC
TH-CSHW 485 160 Steam.Ster. CMC
Lady Ridgeway hospital
901 125 Steam. Ster. shredding
TH-Colombo South 1093 200 Treatment outsourced
TH- Peradeniya 954 125 Out sourced
De Soyza Maternity hospital
343 100 Out sourced
National cancer institute
876 177 Out sourced
Popular Hospitals & Their waste disposal
Name Bed Strength
Quantity Infectious waste generated (kg/d)
Method of waste disposal
TH- Karapitiya 1606 175 Incinerator available- not adequate
TH – Chest Hospital 671 80 Incineration not adequate
TH- Jaffna 1228 1000 No
TH-Kurunegala 1650 2000 Incineration- Not adequate
National institute of mental health
1514 130 Out sourced
S.J.P 1046 100 Incineration
TH-Kandy 2286 470 Out sourced
Rapid Survey with MOH on 33 hospitals
2012, Rapid Survey with MOH
Rapid Survey with MOH on 33 hospitals
3 hospitals use steam sterilizers
13 hospitals use incinerators
5 hospitals outsource to a private sector
8 open burn
Treatment infrastructure & Funding for some hospitals…
Summery of HCWM strategies addressed in National Health Development Plan
Establish health care waste treatment facilities Island wide
Develop required guidelines and standards for heath care waste management
Obtain EPL and Hazardous Waste License for healthcare institution
Treatment Technologies available in Sri Lanka
Burial
Open Burning
Barrel Incinerators
Sharp pits
Needle Burners
Incinerators
Steam sterilization
Chemical disinfection
Placenta Pits
Treatment Technologies Comparison
Incineration
Advantages
Complete destruction & sterilization of waste/sharps
Available for high capacities
Significant reduction in waste volume & weight
Very disinfection efficiency
Destroys all types of liquid, pharmaceutical & other organic waste
Large quantities of waste can be treated
Disadvantages
Considerably high investment
Need extensive flue gas emission control system
Depending of the flue gases, discharge waste water
Expensive to operate
Generates Hazardous Ash residues
Autoclaving
Advantages Simple to operate
Low environmental impact
Disadvantages Relatively expensive to install
& operate
Large autoclaves may need boiler
Requiring regular maintenance
Efficiency of disinfection is very sensitive to the operational conditions
Generate waste water
Waste volume/ weight reduction is very low
Large quantities of disinfected waste needs final disposal to a landfill
Microwave Irradiation
Advantages
Good infection efficiency under optimal operating conditions
Environmentally sound
Good reduction in waste volume due to shredding & compacting involved
Disadvantages
High investment & operation cost
Sophisticated and complex technology
Cannot treat certain categories of waste such as cytotoxic waste, Pharmaceutical waste
Only solids can be treated and that too only once shredded
No reduction of weight of the waste
Frequent break down & poor functioning
Chemical Disinfection
Advantages Shredding, when
carried out, reduce the volume of waste
High disinfection efficiency
Effective for highly infectious liquid wastes
Disadvantages Use of hazardous
chemicals ha the potential to cause environmental contamination
Polluted waste water produced in the process
Require highly trained technicians
Inadequate for pharmaceutical, chemical and some types of infectious waste
Land Disposal
Advantages Simple & inexpensive
to operate
No specific construction cost is involved if operated within available landfill systems
Protected from scavengers gaining access to HCW
Disadvantages HCW is not treated and
remains hazardous
Strong co-ordination between waste collector and landfill operator required
Potentially high transportation cost that may be involved
Disposal in special HCW cells need conscientious operation according to specific guidelines
HAAT
DefinitionOld
The process of burning, setting fire to or destroying
New
An engineered process using controlled flame combustion to thermally degrade waste materials
Incinerator evolution Open burning
Single chamber incinerator
Multi – chamber incinerators
Addition of gas scrubbing equipment
Increase in temperature and residence time
Heat recovery
Continuous emission monitoring
Complete automation
Why incineration preferred
Waste volume reduction less than 5%
At sufficiently high temperature and residence time, any hydrocarbon vapor can be oxidized to carbon dioxide and water
Heat can be recovered
Avoid contamination by reducing infectiousness/ pollutant levels
Only solution for certain waste types
Incinerator Emission requirements on EPA-USAAir Pollutant Emission Limit Unit
Particulate Matter
46 mg/d.cu.m
CO 5.5 ppm
Dioxins/furans 0.85 ng/d.cu.m
HCl 7.7 ppm
SO2 4.2 ppm
NO 190 ppm
Lead 0.018 mg/d.cu.m
Cd 0.013 mg/d.cu.m
Hg 0.025 mg/d.cu.m
Incinerator system components
Waste pre- heating or shredding system (Op
Waste loading system
Burner management system
Combustion chambers
Heat recovery unit
Air pollution control device
Stack discharge
Ash disposal system
Emission monitoring system
Incineration process for a teaching hospital Average infectious waste generation per day = 200
kg/day
Req. incineration rate for 8 eight working hours = 25 kg/hr
LPG consumption required for incineration = 2.75 kg/hr
Daily LPG consumption= 22 kg
Monthly LPG consumption per hospital = 660 kg
= 17.6 Nos. of 37.5kg Cyl.
Monthly cost of LPG for institution= Rs.118,800.00
LPG cost per one kg of waste= Rs.19.8
No. of Teaching Hospitals in Sri Lanka = 18
LPG on Oil fired incinerators No requirement of oil supply system infrastructure
Rapid achievement of required operational temperature
Operational reliability on emission control
No operational cost for oil pressurizing pump
No maintenance cost for oil feeding system
Minimum air pollution compared to oil burning
No contaminated waste water generation
Can be made as mobile incinerators
Benefits to Institution Make environment pleasant and clean by reducing water, air, soil
pollution
Essential qualification for acquire environmental protection license
Uplift the institute image and quality of the service
Strong contribution for environmental protection
Ensure restriction of transmission of diseases
Reduce requirement of janitor staff
Save high cost incorporated with handling and transportation
No land requirements for landfilling
Benefits to LAUGFS Enhance company image and honor by removing a headache of
a community
CSR project for company
LPG Market Penetration through a new channel
Further developments Expand concept for non hazardous waste incineration in hospitals
Waste gas heat recovery and generation of steam, electricity for hospitals
Combined incineration & autoclave systems with incorporated incinerator waste heat recovery unit
THANK YOU…..