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
Outline
• Framework for medical waste
management
• Types of alternative treatment
technologies
• Factors to consider in selection
Framework
• Waste Segregation
• Waste Minimization
• Environmental Protection
• Occupational Safety and Health
Waste Segregation/Minimization:
Typical Hospital Waste Stream
Potentially
Infectious
Waste
Hazardous or
Radioactive
Waste
Municipal
Solid Waste
Environmental
Protection
Other Organic
Compounds
T race Metals
including
Lead,
Cadmium,
Mercury
Dioxins &
Furans
Acid Gases
Carbon
Monoxide
Particulate
Matter
T oxic
Incinerator
Ash
Environmental Protection:
Toxic 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-tetrachlorodibenzo-p-dioxin (TCDD)
– other organic compounds: trichloroethylene,
tetrachloroethylene, trichlorotrifluoroethane, etc.
– carbon monoxide
– particulate matter
– pathogens
• Toxic Bottom Ash
– leachable metals, dioxins/furans, other organics
Occupational Safety & Health
•
•
•
•
•
•
•
Needle sticks and other sharps injuries
Blood splatter
Aerosolized pathogens
Chemicals in the workspace
Noxious odors
Hot surfaces
Ergonomic problems
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
Types of Alternative
Technologies
• Thermal
• Chemical
• Irradiative
• Biological
Realistic Alternatives
• Low-Heat Thermal Technologies
–
–
–
–
Autoclaves or Retorts
Advanced Autoclaves
Microwave Units
Dry Heat Systems
• Chemical
– Non-Chlorine Technologies
Autoclave
Pressure Gauge
Release
Valve
Air
Safety
Valve
Vacuum
Filter
Jacket
Autoclave Chamber
Charging
Door
Steam
Trap
Thermocouple
Steam
Trap
Drain
Steam
Steam Disinfection Temperature-Minimum Exposure
Time Requirements
T oF
T oC
240
116
Spore Kill
Time (min)
30
Min. Exposure
Time (min)
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.
Example: Centralized Facility Autoclave,
8’ dia x 32’ long
Source: Bondtech Corporation, Somerset, Kentucky
Advanced Autoclaves: Examples
• Vacuum / steam treatment / shredding /
compaction
• Shredding / steam treatment & mixing /
drying
• Stream treatment, fragmenting & mixing /
drying
Advanced Autoclave: Vacuum / steam
treatment / shredding / compaction
Source: San-I-Pak, Tracy, California
Advanced Autoclave: Shredding / steam
treatment & mixing / drying
Source: STI Chem-Clav, West Chester, Pennsylvania
Example: Microwave Disinfection
Source: Sanitec, West Caldwell, New Jersey
Example: Dry Heat Disinfection
Source: KC MediWaste, Dallas, Texas
Chemical: Alkaline Hydrolysis
Source: Waste Reduction by Waste Reduction, Inc. (WR2), Indianapolis, Indiana
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
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)
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
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
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
<www.noharm.org>
Note: HCWH does not endorse any technology,
company, or brand name.