Waste Management in Health Care Sector
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O F W E R D Way back in 2004, in the capacity of District Surgeon, I, suggested then Medical Superintendent, DHQ Hospital Jhang that the hospital should buy an incinerator for waste disposal. To my surprise Late Dr. Ajmal Ahmdani came up with a big no. He said “ Never think of buying an incinerator, it is more a harm than help. You should go for Autoclave”. A totally unexpected answer I was never ready to accept. “Look at the person. He seems totally ignorant”. But I did not have enough knowledge to prove my point. I decided to study the literature to find arguments for proving my point. I searched books, internet and all available resources. I lost and Dr. Ahmdani won the debate. Now I had already developed interest in the subject. Literature consistently advocated Autoclave for the predisposal management of Hospital waste. Then I visited World Wild Life Fund office in Lahore, where, I was told about presentation of a doctor named Sudheer Joseph from St. Stephens Hospital, Delhi. I contacted the doctor; planned the trip and visited the hospital in Nov. 2006. In New Delhi I had the opportunity to visit the central waste disposal facility managed by the private company Synergy. The facility was catering for 1500 hospitals and was located outside Delhi 3Km away from all the residential areas. A local NGO with the name of Toxic Links helped me a lot. After that visit I read the literature again and things became clear in my mind. I realized that very few people in Pakistan have the idea about waste management. On my return I sought appointment with Dr. Shagufta ShahJahan, now Director General Environment and discussed the idea of NO BURNING WASTE with her. She listened to me patiently and finally agreed with my point. With her help my name was included in WHO collaborated project being run under Dr. Shakeela Zaman, then Director Health Services Academy Islamabad. In One and half year after surveys and workshops a national plan was prepared for waste management in Pakistan. Meanwhile National Programme for Hepititis Control sent a team to Jhang. This comprised Dr. Rustam and Dr. Mumtaz. I discussed the syringe disposal programme (Indian model) with them and they liked it very much. Now the Healthcare waste management became my passion and I founded a society called “Waste Watch &Works” in Jhang. 15 clinics participated in our syringe disposal programme. When you started discussion some hear, out of them few listen and very few act. It is amazing that Dr. Mazhar ul Khaliq caught the point and started studying about the subject. He went forward and decided to write a book. Not an easy decision but finally the product has come in our hands. At this point of time when Pakistan is seriously considering Healthcare Waste Management, the problem needs an exhaustive theoretical workup before launching a comprehensive plan for the country. In order to understand the depth of subject we should try to take a multidimensional view of current state of affairs in the World with particular reference to its application in Pakistan. 1. Paradigm Shift: In the last decade there has been global concern about incineration hazards due to toxic emissions like DIOXIN & FURANS and high Capitol and recurring costs for minimizing the pollution problems in this system of Healthcare Waste Management. Therefore developed countries started adopting alternative methods e.g. Autoclaving, Microwaving and Chemical Disinfection.
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2. Difference in Circumstances: Third World Countries have limited Resources and other operational constraints along with peculiar circumstances making it impossible to replicate the exact models of HCWM of developed nations. 3. Questionable Compliance: New patterns of HCWM e.g. reduction and segregation of hazardous waste necessitate change in the attitude of the people, which is a big undertaking in a society of relatively low literacy rate with longstanding ignorant practices. Thus, In PAKISTAN we need to:1. Benefit from the research and experiences of developed countries with customization of methods to fit in our environment. 2. Study HCWM practices in developing countries. In this respect the closest country with similar environment is India. In INDIA:• The country is updating the system of HCWM. • They have started alternative techniques like CHEMICAL DISINFECTION and AUTOCLAVING. • PVC and other plastics are not incinerated and only body parts are incinerated. • Central Facilities have been developed in many cities. These cater for many hospitals and are located outside the cities. These have INCINERATOR, AUTOCLAVES, SHREDDERS and EFFLUENT TREATMENT PLANTS. • SEGREGATION with color coding is being adhered to. They are using four colors for incinerator, autoclave, recyclable and common waste respectively with separate system for sharps. *Pictures of St. Stephens Hospital Delhi. • They are considering MERCURY free environment. • The hospitals are establishing EFFLUENT TREATMENT PLANTS. This Book is going to fill the gap of reference material locally written on the subject and will be useful to individuals (doctors & Allied personnel) as well as institutions.
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IN O R T D U C In a developing country like Pakistan, the need for a proper Hospital Waste Management System was long over due. With the given limited physical, human and financial resources we have the target of improving health conditions countrywide. The importance of reliable database for planning and management of hospital waste cannot be overemphasized. It is a matter of pleasure that we have prepared this important national issue by writing a book on Hospital Waste Management. This book would not only provide informations about our needs for prevention of ever growing burden of communicable diseases by a prompt mechanism of hospital waste management but would also enable to reader to redefine and prioritize our this health problem on rationale estimates. The author of the book is directly involved in the management of hospital waste at the institute of cardilogy Multan as chairman of the hospital waste management committee. In this book the reader will find basic knowledge about hospital waste & its management according to the international standards with available scarce resources in a country like Pakistan. It is my pleasure to extend my personal appreciations for Dr. Mazhar-Ul-Khaliq for the splendid work in accomplishing this highly extensive and invaluable task.
Dr.Mohammad Mohsin Khan M.B.B.S., MPH.,PhD Approved PhD Supervisor Higher Education Commission Government of Pakistan
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DEDICATED TO MY FATHER ABDUL KHALIQ & MY DAUGHTER AYESHA MAZHAR
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1.1 - INTRODUCTION Dealing with waste is a challenge common to all human societies. Nature makes no waste: in healthy ecosystems, one species’ waste becomes food for the next, in an endless cycle. Modern societies interrupt this cycle in three ways. First, technology has created a wide range of substances that do not exist in nature. Human discards are thus increasingly comprised of plastics, metals, and natural materials laced with hazardous substances (for example, bleached and inked paper), which, in many cases, are difficult or impossible for natural ecosystems to break down. Second, industrial societies use and dispose of much more material per person than their predecessors, and than their counterparts in the less industrialized world. Third, rapid population growth increases the number of people and the total amount of waste generated. As a result, the global ecosystem is overwhelmed, both quantitatively and qualitatively, with what we discard. Ultimately, human societies rely on the natural environment for all their material needs, including food, clothing, shelter, breathable air, drinkable water, and raw materials for manufacturing and construction. At the same time, all human discards go to the environment. When humans were few and of limited technological capability, we could afford to ignore the relationship between these two processes. Now that we dominate the global ecosystem, that is no longer the case. At the same time that we are confronted with rapid destruction and growing scarcity of natural resources — deforestation, declining fisheries, contaminated groundwater, and
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so on — we are producing ever-larger quantities of waste that is more hazardous than ever.
1.2 - WASTE Waste is defined as material which no longer has any value to its original owner, and which is discarded. Wastes are those materials no longer required by an individual , institution or industry and thus are regarded as by products or end products of the production & consumption process respectively. NATIONAL DEFINITION OF WASTE According to Pakistan Environmental Protection Act - 1997, "waste" means any substance or object which has been, is being or is intended to be, discarded or disposed of, and includes liquid waste, solid waste, waste gases, suspended waste, industrial waste, agricultural waste, nuclear waste, municipal waste, hospital waste, used polyethylene bags and residues from the incineration of all types of waste.
Figure 1 - Open area waste site.
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The main constituents of waste in urban areas are organic waste (Including kitchen waste and garden trimmings), paper, glass, metals and plastics. Ash, dust and street sweepings can also form a significant portion of the waste. Waste is generated by a range of stakeholders including: pedestrians, households, businesses, markets, industries and healthcare facilities. Therefore solid waste can also include toxic waste (e.g. chemicals from industry), biological waste (e.g. dressings from hospitals) and occasionally feaces (e.g. from nappies). These hazardous wastes require specialized treatment and disposal, not discussed in this technical brief. The source of waste often determines its quantities and characteristics. In developing countries waste generated from various sources is often combined at collection and disposal, so due care required to ensure the health and safety of those involved in waste management.
1.3 - TYPES OF WASTE:Wastes can be divided into many different types which include •
Solid Wastes
•
Liquid Wastes
•
Gaseous Wastes
•
Hazardous Wastes
•
Radioactive Wastes
•
Medical Wastes
All the industrial, municipal and Medical wastes consist of the above mentioned types.
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1.3.1 - SOLID WASTE Waste materials which contain less than 70% water contents. Solid waste generation in Pakistan ranges between 0.283 to 0.612 kg/capita/day and the waste generation growth rate is 2.4% per year. Source: - (Draft Environmental Assessment Report, Stockholm, November, 1993).
•
Pakistan generates 47,920 tons of solid waste per day.
•
Urban waste: 19,190 tons
•
Rural waste: 28,730 tons
•
The industries of chemicals, fertilizers, tanneries, textile units produce 21,173 tons of toxic waste.
•
Collection efficiency of solid wastes is about 54% in the urban centers.
TYPES OF SOLID WASTE:Solid waste can be classified into different types depending on their source for example:•
Municipal Waste
•
Industrial Waste
•
Hospital Waste
MUNICIPAL WASTE:Municipal Solid Waste (MSW) is useless or unwanted material discarded as a result of human or animal activity. Most commonly it is solids, semisolids or liquids in containers thrown out of houses, commercial or industrial premises. Municipal Solid Waste Management (MSWM) is the generation, separation, collection, transfer, transportation and disposal of waste in a way that takes into account public health, economics, conservation, aesthetics, and the environment, and is responsive to public demands.
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SOURCES OF MSW Houses: Appliances, newspapers, clothing, disposable tableware, food packaging, cans, bottles, food scraps, yard trimming. Commercial buildings: Corrugated boxes, food wastes, office paper, and disposable tableware. Institutions: Office paper, cafeteria and restroom waste, classroom wastes, yard trimmings. Industries: Corrugated boxes, lunchroom wastes, and office papers, wood pallets. Municipal solid waste consists of household waste, construction and debris, and waste from streets. This garbage is generated mainly from residential and commercial places. With the change in lifestyle and food habits, the amount of municipal solid waste has been increasing rapidly.
GARBAGE: THE FOUR BROAD CATEGORIES Organic waste: Waste from kitchen, vegetables, flowers, leaves, fruits etc.
Toxic waste: Used & expired medicines, paints, chemicals, bulbs, spray cans, fertilizer and pesticide containers, batteries, shoe polish. The importance placed upon waste and toxicity minimization in the health care sector is reflected in a 1997 memorandum of understanding between the American Hospital Association and USEPA (US environmental protection agency). This agreement includes a commitment to reduce total waste by onethird by the year 2005 and by 50 percent by 2010; to virtually eliminate mercurycontaining waste by 2005; and to minimize the production of persistent, bioaccumulative, and toxic (PBT) pollutants.
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Recyclable: Paper, glass, metals, and plastics, etc.
Soiled Waste: Hospital waste such as cloth soiled with blood and other body fluids. TABLE 1 - CONTRASTS TYPICAL WASTE CHARACTERISTICS IN LOW & HIGH INCOME COUNTRIES Generation per household Density Composition Organic Paper Metals Plastics Glass Moisture Contents
Low Income Country 0.5 Kg 500 Kg cubic meter
High income Country 2 Kg 100 Kg per cubic meter
Up to 80% 5% Less than 1% Less than 1% Less than 1% High
30% 40% 10% 2% 10% Low
INDUSTRIAL WASTE:Unwanted materials from an industrial operation; may be liquid, sludge, solid, or hazardous waste.
FACT SHEET OF INDUSTRIAL CHEMICALS MANAGEMENT IN PAKISTAN •
Our industry imports chemicals worth Rs. 4,500 million and dyes/colors worth Rs. 5,000 million every year.
•
Over 500 types of chemicals are being imported in the country for use in different processing industries.
•
Local production of chemicals is limited to only a few categories viz. Soda Ash, sulphuric acid, caustic soda, chlorine, fertilizers, pesticides, paint/varnishes and polishes and creams.
•
Import data of 1997-98 indicates that industry imported
•
3,000 tones of formic acid (a carcinogenic chemical),
•
2,052 tons phenols,
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•
4,200 tons isocyanides,
•
31 tons of mercury,
•
22,817 tons inks/dyes,
•
234 tons Arsenic,
•
1,615 tons chromium salt and so on
•
Tanneries located in Kasur and Sialkot have been discharging effluent with chrome concentration
•
Ranging between 182-222 mg/liter against the standard of 1 mg/liter and
•
Chemical Oxygen Demand 5,002-7320 mg/liter against limit of 150 mg/liter prescribed in the NEQs.
•
Biological Oxygen Demand (BOD) of river Ravi has been found as high as 300 mg/liter as compared to acceptable limit of 9 mg/liter
•
About 3,600 tons per year of chemical fertilizer is produced in the country.
•
18,000 tons of pesticides are imported every year.
•
Another serious issue is that of high content of led in petrol which is presently 0.35 gms/litre as compared to 0-0.15 gms/litre in other countries of the region.
•
Pakistan Medical Association has found dangerous levels of lead in blood samples of traffic police, children and adults in Karachi, Islamabad and Peshawar cities.
•
Sulphur in Diesel is also much higher i.e. 1% as compared to 0.05-0.50% in other countries of the region.
•
Sulphur in furnace oil is 3% as compared to 0.5% - 1% in other countries of the region.
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TABLE 2 – WASTE GENERATION ESTIMATE IN DIFFERENT CITIES OF PAKISTAN A
B C DE C F E
E
F
E
EA C DE C CA E
EA
C DE CA ED
FEDE DE E E AE E E A E ED B DEC EE E ECC E
E 1.3.2 – LIQUID WASTE:Liquid wastes, originating from a community. They may have been composed of domestic wastewaters or industrial discharges. 1.3.3 - GASEOUS WASTE:Waste in form of gas is called gaseous waste. 1.3.4 – HAZARDOUS WASTE:Hazardous Waste is a "waste" which because of its quantity, concentration, or physical, chemical, or infectious characteristics may posses a substantial or potential hazard to human health or the environment when improperly treated, stored or disposed of, or otherwise mismanaged; or Cause or contribute to an increase in mortality, or an increase in irreversible or incapacitating illness.
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C
NATIONAL DEFINITION Pakistan Environmental Protection Act 1997 defines “Hazardous waste" as waste which is or which contains a hazardous substance, and includes hospital waste and nuclear waste. Pakistan Environmental Protection Act 1997 defines " Hazardous substance" as a substance or mixture of substance, other than a pesticide which, by reason of its chemical activity is toxic, explosive, flammable, corrosive, radioactive or other characteristics causes, or is likely to cause, directly or in combination with other matters, an adverse environmental effect. 1.3.5 – RADIOACTIVE WASTE:Liquid, solid ,or gaseous waste resulting from mining of radioactive ore, production of reactor fuel materials, reactor operation, processing of irradiated reactor fuels, and related operations, and from use of radioactive materials in research, industry, and medicine.
Figure 2 - Radioactive waste container with symbol
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These materials contain the unusable radioactive byproducts of the scientific, military, and industrial applications of nuclear energy. Since its radioactivity presents a serious health hazard, disposing of such material is a great problem. Methods of disposal include dumping concrete-encased containers filled with radioactive waste in the ocean and burying the waste underground in old salt mines. In 1996 the United States opened a waste processing plant in Aiken, S.C. at the Savannah River nuclear-weapons complex. The waste will be converted into cylinders of radioactive glass, which will then be encased in steel containers that will be stored in an underground concrete vault.
Figure 3 - Packing Of Radioactive waste
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Table 3 - WASTE COMPOSITION IN SELECTED COUNTRIES
AB D
C CE
C A
C
D EFA A
D A
C
CC
FA
F
D A
DE
CE ED
C EC C F C C E
C
C E
CE
C CE
D EC E EC D DE E EC D EC
A C
E
A C
E
CE
CE
CE
CE
D EC EE AE E FE
EC
C A
EC E
D
EC
AA E
DE D E
E
EC
E
EC
E EC EC C FC E A D C
C
E A
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CE
C
HOSPITAL WASTE 2.1 - INTORDUCTION Hospital waste is generated during the diagnosis, treatment, or Immunization of human beings or animals. It is also generated in research activities in these fields or in the testing of biological materials It may include sharps, soiled waste, disposables, anatomical waste, cultures, discarded medicines, chemical wastes, etc. These are in the form of disposable syringes, swabs, bandages, body fluids, human excreta, etc. This waste is highly infectious and can be a serious threat to human health if not managed in a scientific and discriminate manner. It has been roughly estimated that of the 4 kg of waste generated in a hospital at least 1 kg would be infected. Undestroyed needles and syringes are being circulated back to recycling, through unscrupulous traders who employ the poor and the destitute, to collect such waste for repackaging and selling in the market. Reuse of disposable like syringes, needles, catheters, IV and dialysis sets are causing spread of infection from healthcare establishments to the general community. Disposal of hospital waste and veterinary hospital waste in municipal dumpsite resulting in animals especially cows feeding on the blood soaked cotton and plastics, and this in turn leading to diseases like bovine tuberculosis which through milk can infect humans. The indiscriminate dumping of untreated hospital waste in municipal bins is increasing the possibility of survival, proliferation and mutation of pathogenic microbial population in the municipal waste. This leads to
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epidemics and increased incidence and prevalence of communicable diseases in the community. Incidence and prevalence of diseases like AIDS, Hepatitis B&C tuberculosis and other infectious diseases increasing due to inappropriate use, storage, treatment, transport and disposal of biomedical waste. Chances of vectors like cats, rats, mosquitoes, flies and stray dogs getting infected are becoming carriers which also spread diseases in the community.
Figure 4 - Hospital Waste
Pakistan is also facing this problem. Around 250,000 tones of medical waste are annually produced from all sorts of health care facilities in the country. This type of waste has a bad affect on the environment by contaminating the land, air and water resources. According to a report, 15 tones of waste are produced daily in Punjab. The rate of generation is 1.8 kilograms per day per bed. The province houses 250 hospitals with a total capacity of 41,000 beds. Various studies have shown that the rate of hospital waste generation in USA is 5.9 to 10.4 Kg/bed/day. The possible reason for this high rate of hospital waste generation is use of disposable items.
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In the Western Europe this rate varies to 3-6 Kg/bed/day. The daily production of solid waste in rural hospitals in Sub-Saharan Africa ranges between 0.3 to 1.5 Kg/bed/day. A study conducted at District Headquarter Hospital Kusur revealed that the average waste generation was 2.5 Kg/ Patient / Day.
2.2 – WHAT HOSPITAL WASTE IS? HOSPITAL WASTE is also known as “Clinical Waste “. Redefining it scientifically, Hospital Waste is defined as “any solid, fluid or liquid waste, including its container and any intermediate product, which is generated during diagnosis, treatment or immunization of human beings or animals, in research or in the production or testing of biological and the animal wastes from slaughter houses or any other like establishments.
Figure 5 - Worker colleting the Hospital waste
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2.3 - CLASSIFICATION OF HOSPITAL WASTE Hospital Wastes are classified into following categories. 1. Infectious Wastes ( Bio-hazardous Waste ) 2. Sharps Waste 3. Pharmaceutical Waste 4. Plastics 5. Mercury 6. GLUTARALDEHYDE/ CIDEX
Figure 6 - Healthcare waste characterization
1 - INFECTIOUS WASTE Infectious wastes are those biomedical wastes which contain sufficient population of infectious agents that are capable of causing and spreading infections among people, livestock and vectors. Infectious wastes include human tissues, anatomical waste, organs, body parts, placenta, animal waste (tissue / cell cultures), any pathological / surgical waste, microbiology and biotechnology waste (cultures, stocks, specimens of micro-organism, live or attenuated vaccines, etc.), cytological, pathological wastes, solid waste (swabs, bandages, mops, any item contaminated with blood or body fluids), infected
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syringes, needles, other sharps, glass, rubber, metal, plastic disposables and other such wastes.
Figure 7 - Infectious waste
Figure 8 - Risk Waste
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Figure 9 - Packed infectious waste
2 - SHARP WASTE Sharps consist of needles, syringes, scalpels, blades, glass etc., which have the capability to injure by piercing the skin. As these sharps are used in patient care, there is every chance that infection can spread through this type of injury. Nurses can get a sharp injury before and after using a sharp on a patient. Further, sharps discarded without any special containment or segregation can injure and transmit disease to those who collect waste (including municipal sweepers and rag pickers). There have been reports that waste collected from the hospitals are resold, this creates an additional occupational and community health hazard.
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Figure 10 - Sharp waste
Sharp Wastes are of two types:•
Chemical Sharps Waste which are contaminated with chemicals.
•
Radioactive Sharps Waste which are contaminated with radio actives.
3 - PHARMACEUTICAL WASTE Cytotoxic substances, as the word suggests are toxic to cells and are often anti-neoplastic which inhibit cell growth and multiplication. These drugs when come in contact with normal cells can damage them and cause severe disability or even death of those affected. These drugs could be present in the waste generated from the treatment of cancer patients or from other work related to testing and control of cancerous cells. The importance placed upon waste and toxicity minimization in the health care sector is reflected in a 1997 memorandum of understanding between the American Hospital Association and USEPA.
4 - PLASTICS IN HEALTHCARE Hospitals use plastics because they fear a spread of infection through the use of reusable medical equipment. Thus, plastic use has grown with increasing concern for infection control. However, there have been cases where even with the use of plastics there has been a spread of infection in wards. Nurses complained of nosocomial infections in wards even though disposable
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equipment was used — they related it to improper waste disposal of disposable equipment within the wards. PVC is a thermoplastic, with approximately 40 percent of its content being additives. Plasticizers are added to make PVC flexible and transparent. •
Medical equipment made from PVC:
•
Blood bags, breathing tubes
•
Feeding tubes, Pressure monitor tubes
•
Catheters, Drip chamber
•
IV Containers, Parts of a syringe
•
IV Components, Lab ware
•
Inhalation masks, Dialysis tubes
Figure 11 - Plastic Waste in Hospital Theater
Infected plastics are those biomedical plastics which have been used for administering patient care or for performing related activities and may contain blood or body fluids or are suspected to contain infectious agents in sufficient number which may lead to infections among other humans or animals. These generally include IV tubes / bottles, tubing, gloves, aprons, blood bags /
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urine bags, disposable drains, disposable plastic containers, endo-tracheal tubes, microbiology and biotechnology waste and other laboratory waste.
5 - MERCURY: A HEALTH HAZARD Sources of Mercury in hospitals: 1. Thermometers 2. Blood pressure cuffs 3. Feeding tubes 4. Dilators and batteries 5. Dental amalgam 6. Used in laboratory chemicals like Zenkers solution and histological fixatives.
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Figure 12 - Manometers
6 - GLUTARALDEHYDE/ CIDEX Glutaraldehyde is a colorless, oily liquid, which is also commonly available as a clear, colorless, aqueous solution. It is a powerful, cold disinfectant, used widely in the health services for high-level disinfection of medical instruments and supplies and available with trade names such as: Cidex, Totacide, korsolex and Asep. Glutaraldehyde is a widely used disinfectant and an agent (commonly available in 1 percent and 2 percent solutions) in medical and sterilizing dental settings. It is used in embalming (25% solution), as an
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intermediate and fixative for tissue-fixing in electron microscopy (20 percent, 50 percent and 99 percent solutions) and in X-ray films.
Figure 13 - Cidex
As regards its type and composition, most hospital waste is similar to household waste and can be disposed of in the same way. In addition to this, however, hospitals generate certain special types of waste which should not be handled by domestic refuse collection services, because of the risk of infection, because they are hazardous in other ways, or for ethical reasons. Such waste must be collected separately at the places where it is generated, and disposed of in specially approved plants, e.g., incinerators. Hence, types of hospital waste may be classified according to the disposal method.
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2.4 - TYPES OF HOSPITAL WASTE ON THE BASIS OF DISPOSAL On the basis of disposal method hospital waste can be classified as follows.
Type A: Waste which does not require any special treatment. This is the waste produced by the hospital administration, the cleaning service, the kitchens, stores and workshops. It can be disposed of in the same way as household waste.
Type B: Waste with which special precautions must be taken to prevent infection in the hospital. This is usually taken to include all waste from inpatient and casualty wards and doctors' practices, e.g. used dressings, disposable linen and packaging materials. It only constitutes a risk for patients with weakened defenses while it is still inside the hospital. Once it has been removed from the wards it can be handled by the local domestic refuse collection service.
Type C: Waste which must be disposed of in a particular way to prevent infection. This is waste from isolation wards for patients with infectious diseases; from dialysis wards and laboratories, in particular those for microbiological investigations, which contains pathogens of dangerous infectious diseases, e.g. tuberculosis, hepatitis infectious diarrheas and diseases which constitutes a real risk of infection when disposing of this waste. It includes needles and sharp objects coated with blood, or disposable items contaminated with stool.
Type D: Parts of human bodies: limbs, organs etc. This waste originates in pathology, surgical, gynecological and obstetric departments. It has to be disposed of separately, not to prevent infection but for ethical reasons.
Type E: Other waste materials.
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The improper handling, treatment, storage, transport and disposal of hospital waste can lead to serious problems like: The entire waste from a healthcare establishment, which includes noninfectious as well as infectious waste, if unsegregated and untreated is mixed with the rest of the waste in a healthcare establishment, will convert the entire non infectious general waste (75-80%) also into infectious waste. The indiscriminate disposal of sharps within and outside institutions leading to occupational hazards like needle stick injuries, cuts, and infections among hospital employees, municipal workers and rag pickers. Injuries due to the sharp especially among rag pickers and hospital / municipal workers increase the incidence of Hepatitis B, C, E and HIV. Incidents and prevalence of infectious diseases are increasing due to inappropriate use, storage, treatment, transport and disposal of biomedical waste. Chance of vectors for spread of diseases in the community is an important factor.
3.1 - SHARPS Sharps consist of needles, syringes, scalpels, blades, glass etc., which have the capability to injure by piercing the skin. As these sharps are used in patient care, there is every chance that infection can spread through this type of injury. Nurses can get a sharp injury before and after using a sharp on a patient. Further, sharps discarded without any special containment or segregation can injure and transmit disease to those who collect waste (including ward cleaners, municipal sweepers and rag pickers). There have been reports that waste collected from the hospitals are resold, this creates an additional occupational and community health hazard.
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In developing countries a trend to make money easily has destroyed all our ethical values. It is a common practice that sanitary staff sells used syringes to junk buyers. These syringes are then repacked just after boiling. These used repacked syringes are root cause of AIDs & Hepatitis. WHO estimated that, in 2000, contaminated injections with contaminated syringes caused:•
21 million hepatitis B virus (HBV) infections (32% of all new infections);
•
Two million hepatitis C virus (HCV) infections (40% of all new infections);
•
At least 260 000 HIV infections (5% of all new infections).
Figure 14 - Disposal of syringes (wrong method as performed without gloves)
3.2 - MEDICAL WASTE INCINERATION Acid gases include nitrogen oxide, which has been shown to cause acid rain formation and affect the respiratory and cardiovascular system. As large amount of plastic are incinerated, hydrochloric acid is produced. This acid attacks the respiratory system, skin, eyes and lungs with side effects such as coughing, nausea and vomiting. Heavy metals are released during incineration of medical
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waste. Mercury, when incinerated, vaporizes and spreads easily in the environment. Lead and cadmium present in the plastics also accumulates in the ash. Acute and chronic exposure to lead can cause metabolic, neurological and neuro-psychological
disorders.
It
has
been
associated
with
decreased
intelligence and impaired neurobehavioral development in children. Cadmium has been identified as a carcinogen and is linked to toxic effects on reproduction, development, liver and nervous system.
Figure 15 - Estimated Hospital waste generation in South Asia
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Figure 16 - Estimated per bed waste generation in south asia
3.3 – EFFECT OF PLASCTICS: Disposal of PVC via incineration leads to the formation of dioxin and furans. Dioxin and furans are unwanted by-products of incineration with carcinogenic and endocrine-disrupting properties. They are toxic at levels as low as 0.006 pictograms per Kg of body weight.
3.4 - MERCURY HEALTH HAZARD: When products containing mercury are incinerated, the mercury becomes airborne and eventually settles in water bodies from, where via biomagnifications in the food chain and bioaccumulation, it reaches humans. If it is flushed, it enters water bodies directly, and if it is thrown in bins it could enter the body of animals via skin or inhalation, or permeate into the ground causing soil and groundwater poisoning. This metal accumulates in the muscle tissues.
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Three major types of mercury are found in the environment – methyl mercury, mercury (zero), mercury (two). Out of these, methyl mercury is the most toxic; it bio accumulates and has the capability to interfere with cell division and cross the placental barrier. It also binds to DNA and interferes with the copying of chromosomes and production of proteins. Pregnant women and children are most vulnerable to the effects of mercury. The Mina Mata disaster in Japan is an example of mercury-poisoning via biomagnifications and bioaccumulation. Mercury exposure can lead to pneumonitis, bronchitis, muscle tremors, irritability, personality changes, gingivitis and forms of nerve damage. HOW ARE PEOPLE EXPOSED TO MERCURY? Many scientists believe the most common way people are exposed to any form of mercury is by eating fish containing methyl mercury, a highly toxic form of mercury. Microscopic organisms convert mercury into methyl mercury, accumulating up the food chain in fish, fish eating animals, and people. However, recent research indicates that mercury from amalgam tooth fillings pose a far greater hazard. Between three and seventeen micrograms per day are secreted as mercury vapor from slow corrosion, chewing, brushing and grinding of fillings. Also, while methyl mercury ingested from fish is generally excreted quickly, mercury vapors from amalgams are secreted slowly over years. Lesser sources of exposure include mercury vapors in air, ingestion via drinking water, vaccines, occupational exposures, home exposures including fluorescent light bulbs, thermostats, batteries, red tattoo ink, skin lightening creams, and over-the-counter products such as contact lens fluid and neosynephrine. The EPA warns that “metallic mercury is often found in school laboratories as well as in thermometers, barometers, switches, thermostats, and other devices found.” And, because the effects of mercury toxicity are much more severe for infants and children, even “lesser” exposure sources such as thermometers, vaccines and amalgam tooth fillings are extremely hazardous to them.
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Studies show that today in the United States the average person’s body contains about 10-15 milligrams of mercury. Inhaled mercury fumes go into the blood, as mercury is soluble and passes through the lungs. Some mercury is retained in body tissues, mainly in the kidneys, which store about 50% of body mercury. The blood, bones, liver, spleen and fat tissues retain mercury; it also gets into the brain and nerve tissue, causing many of the previously mentioned nervous system disorders. HOW DOES MERCURY ENTER THE ENVIRONMENT? The largest source of mercury in the air (40%) comes from coalfired power plants. Industrial boilers are second (10%). Municipal waste incinerators are third. Medical waste incineration places the health care sector as the fourth-largest source of mercury air emissions. WHY IS MERCURY DANGEROUS? The neurological hazards of mercury were first noticed when women gave birth to severely impaired infants after being exposure to high levels of mercury. The EPA notes it is “clear that the developing nervous system of the fetus may be more vulnerable to methyl mercury than the adult nervous system.” The toxic effects of mercury include autism, Alzheimer’s, ALS, multiple sclerosis, Parkinson’s, other neurodevelopment problems, Nephrotoxicity and cancer. A link between mercury and cardiovascular disease has also been recently established.
INDUSTRIES WITH HIGH POTENTIAL FOR MERCURY EXPOSURE • Manufacture of barometers and thermometers • Ink and dyes • Dentistry • Dental amalgam fabrication • Hospitals and medical waste • Paint • Neon lights • Mirror manufacturing
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• Paper • Insecticides • Pesticides • Embalming • Explosives and fireworks • Jewelers • Wood preserving • Photography WHAT CAN YOU DO? The following recommendations are particularly important for women who are or might become pregnant, nursing mothers, infants and children. Only use products that are mercury-free. Make sure that you properly dispose of any mercury containing items in your home (thermometers, fluorescent lamps) Avoid mercury fungicides and fungicide-treated foods by eating only organically grown grains and produce. Do not eat shark, swordfish, king mackerel, Chilean sea bass, albacore (white) tuna or tilefish because they contain high levels of mercury. Eat no more than 12 ounces (2 average meals) a week of fish and shellfish that are lower in mercury: shrimp, salmon, Pollock, catfish, sole, wild Alaskan salmon, some sardines, and California red snapper. Check local advisories about the safety of fish caught in local lakes, rivers, and coastal areas. Women who eat fish should get mercury levels tested before becoming pregnant. If you have amalgam fillings, talk to your dentist about safe ways to remove and replace them with alternative materials. If you work with mercury, report spills or other exposure; wear protective equipment; and avoid taking mercury home with you (shower and change clothes at the end of the day at work).
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Contact your legislator and demand adequate labeling and identification of mercury content of fish products and any other food containing mercury. Oppose the continued use of coal burning power plants as an energy source.
3.5 - GLUTARALDEHYDE/ CIDEX Aqueous solution is not flammable. However, after the water evaporates the remaining material will burn. During a fire, toxic decomposition products such as carbon monoxide and carbon dioxide can be generated.
3.6 - RADIOACTIVE WASTE Accidents due to improper disposal of nuclear therapeutic material from unsafe operation of x-ray apparatus, improper handling of radio isotopic solutions like spills and left over doses, or inadequate control of radiotherapy have been reported world over with a large number of persons suffering from the results of exposure. In Brazil while moving, a radiotherapy institute a left over sealed radiotherapy source resulted in an exposure to 249 people of whom several either died or suffered severe health problems (International atomic Energy Agency, 1988). In a similar incidence four people died from acute radiation syndrome and 28 suffered serious radiation burns. (Brazil, 1988)
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The fight against hospital infection demands the cooperation of all those employed in the hospital: doctors, technicians, nursing and cleaning staff. This is why one of the most urgent tasks is to convince, train and monitor the personnel responsible for refuse disposal. Unless they are convinced of the need, trained and monitored, all efforts to improve the situation will be doomed to failure. Hospital waste should always be collected in disposable containers which satisfy the following requirements: they must be moisture-resistant and nontransparent; sellable in such a way as to prevent egress of micro-organisms; safe to transport; and color-coded to distinguish them from household refuse bags. The waste must be collected in such containers at the point where it is generated, and removed from the wards daily without being sorted or transferred to other containers. The containers must be carefully sealed. Generally, plastic bags are used for Type B and C waste, and plastic buckets for Type D waste. The material these disposable containers are made of must be appropriate for the next treatment stage. If the waste is subsequently incinerated, for example, combustible materials with a low level of toxicity must be used; if it is heat-disinfected the materials must be steampermeable. This requirement also applies, incidentally, to all disposable items purchased by hospitals. The waste must be transported to a central incineration plant outside the hospital in specially designed vehicles which do not compress it. The interior of the vehicle body must be easy to clean and it must be adequately ventilated. A variety of methods, chemical and physical, can be used for disinfection. To disinfect waste, however, only thermal systems in which the
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waste is steam treated at temperatures above 105°C have so far proved successful. Disinfection in pressure-resistant installations involves approximately the same amount of work as incineration, but has the disadvantage that it is not possible to check visually whether the treatment has been a complete success. With incineration this is of course possible. For this reason incineration is to be preferred in countries which have no trained inspection personnel. There are also devices on the market which shred waste and then disinfect it with liquid chemicals. These devices are only suitable for small quantities, mostly prone to breakdowns, and there is no guarantee that the disinfectant fluid will reach all the waste. They are not suitable for handling all the waste generated by a hospital.
4.1 - SHARPS HANDLING: Make needle reuse impossible: Auto disable syringes, like Solo Shot device, cannot be used more than once and therefore cannot carry infection from one patient to another. Take the sharp out of sharps waste: Needle removers “de-fang” syringes, immediately removing the needles after injection and isolating them in secure containers. The syringe cannot be reused, and there’s no risk of accidental needle sticks. Keep needles away from vulnerable hands: Special stick proof containers capture used needles and other medical waste until they can be destroyed. PATH is working to increase access to these “safety boxes,” identifying low-cost options and making them available for all types of injections. Using a needle cutter/destroyer: 1. Place used needle in the cutter/destroyer. 2. Cut/destroy the needle and the nozzle of syringe in the destroyer/cutter. 3. Separate syringe’s barrel and plunger and put in liquid disinfectant. 4. After every shift empty the contents of needle container/destroyer into liquid disinfectant, remove through pouring out contents through a sieve. 4.2 - MEDICAL WASTE INCINERATION Due to poor operation and maintenance, these incinerators do not destroy the waste, need a lot of fuel to run, and are often out of order. There is a lot of difference between the theory and practice of incinerator operation. This is true around the world. The problem of medical waste needs a systematic approach, with investments in training of staff, segregation, waste minimization
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and safe technologies, as also centralized facilities. Merely investing in unsafe incinerators cannot solve it.
4.3 - PLASCTICS IN HELTH CARE Do’s and Don’ts: Ensure 1. That the used product is mutilated. 2. That the used product is treated prior to disposal. 3. Segregation Do not 1. Reuse plastic equipment. 2. Mix plastic equipment with other waste. 3. Burn plastic waste.
4.4 - ALTERNATIVES TO MERCURY BASED INSTRUMENTS Digital instruments are available as substitutes to the mercury containing instruments. Costs: The cost of the blood pressure instruments ranges from Rs. 2000 to 7000 and the cost of thermometers range from Rs 200 to 300
4.5 - WHY ARE THE ALTERNATIVE TECHNOLOGIES BETTER? These less harmful, non-toxic substitutes pose no environmental or health hazards and last for a longer duration. The life span of the mercury instruments, on the other hand, is short because of their fragility. Even though the initial investment cost of the alternative technologies is high, the assets associated with them are lifelong.
4.6 - GLUTARALDEHYDE/ CIDEX – PRECAUTIONS & SAFETY Identify All Usage Locations: All departments that use glutaraldehyde must be identified and included in the safety program. Eliminate as many usage locations as possible and centralize usage to minimize the number of employees involved with the handling of glutaraldehyde Monitor Exposure Levels: Measurement of glutaraldehyde exposure levels must be conducted in all usage locations. Training: An in-depth education and training program should be conducted for all employees who work with hazardous chemicals. Use Personal Protective Equipment: All employees who work with glutaraldehyde must be provided appropriate personal protective equipment. This equipment includes proper eye/face protection, chemical protective gloves, and protective clothing.
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Engineering controls: Rooms in which glutaraldehyde is used should have an arrangement to exchange fresh air for at least 10 times. For this purpose an active & efficient HVAC System is very important
4.7 - SAFETY MEASURES: A chain is as strong as the weakest link in it, thus, not even one person in the hospital should be missed while training is given. The entire staff is involved in waste management at some point or the other, including administrators, stores personnel and other, seemingly uninvolved, departments. To ensure that the waste is carried responsibly from cradle to grave, and to see that all the material required for waste management is available to the staff, it is important to involve everyone, including: • Doctors • Administrators • Nurses • Technicians • Ward Boys and ward cleaners
4.8 - INFECTION CONTROL 1. Universal Precautions: All the healthcare workers being exposed directly or indirectly to infectious diseases must take Universal Precautions to reduce the chance of spread of infection. 2. Sterilization and cleaning: Ensure that the hospital has adequate procedures for the routine, cleaning, and disinfection of environmental surfaces, beds, bed rails, bedside equipment, and other frequently touched surfaces, and ensure that these procedures are being followed. Routine microbiology tests for air and water contamination should be carried out in all parts of the hospital. Sterilize and disinfect instruments that enter tissue, or through which blood flows, before and after use. Sterilize devices or items that touch intact mucus membranes. In all the autoclave cycles, spore strips need to be placed to check the efficacy of the machine. Recommended chemical disinfectants should be used for the storage of instruments and fumigation of rooms. All the rooms must have proper ventilation. 3. Managing Body Fluid Spillages: Urine, Vomit , Blood & Feaces : All spillages of body fluids (urine, blood, vomit or feaces) should be dealt with immediately. Gloves (ideally disposable) should be worn; spillage should be mopped up with absorbent toilet tissue or paper towels: this should be
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disposed of into the waste bin meant for soiled waste. Pour 10 percent hypochlorite solution and leave it for 15 min. Clean the area with a swab. For spillages outside (e.g. in the playground) wash the area with water. Do not forget to wash the gloves and then wash your hands after you have taken the gloves off. Disposal of blood requires special care and protocol. 4. Patient Placement: A separate room is important to prevent direct/indirect contact transmission when the patient is with highly transmissible microorganisms, or the patient has poor hygienic habits. 5. Immunization programmes: Since hospital personnel are at risk of exposure to preventable diseases, maintenance of immunity is an essential. Optimal use of immunizing agents will not only safeguard the health of personnel but also protect patients from becoming infected by personnel. The most efficient use of vaccines with high risk groups is to immunize personnel before they enter high-risk situations.
4.9 - HANDLE MERCURY WITH CARE: NEVER TOUCH MERCURY WITH BARE HANDS. WEAR ALL PROTECTIVE GEARS. GATHER MERCURY USING STIFF PAPER AND SUCK IT IN THE SYRINGE WITHOUT THE NEEDLE POUR CONTENTS OF THE SYRINGE IN A BOTTLE CONTAINING WATER. PUT SCOTCH TAPE AROUND THE BOTTLE KEEP THE SYRINGE FOR FURTHER USE.
4.10 - RADIOACTIVE WASTE Facilities and procedures described in the rules: (a) Collection: It is mandatory to mention the facilities available e.g. polythene lined waste bins for collection of solid wastes, and corrosion resistant cardboards or delay tanks for collection of liquid wastes. (b) Transfer: it is important to state the type of container employed during transfer of waste/sources e.g. cardboards, sturdy polythene bags, radio-graphy camera. (c) Disposal: Identify the disposal methods for solid, liquid and gaseous wastes briefly such as for:
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i). Solids: Burial pits, municipal dumping site or waste management agency. ii). Liquids: Sanitary sewerage system, soak-pit, waste management agency etc. iii). Gaseous wastes: Incineration facility, fume hood etc.
4.11 - SAFETY CLOTHING: A set of safety clothing and equipment for waste handlers was identified and provided. It included cap, eye protection goggles, mask, apron, gloves and boots. Disposable caps and masks were used. Gloves and aprons selected were of no permeable material to prevent contact with blood & body fluids. However gloves selected were malleable enough to permit finger movement. Handling,
segregation,
mutilation,
disinfection,
storage,
transportation and final disposal are vital steps for safe and scientific management of Hospital waste in any establishment. The key to minimization and effective management of biomedical waste is segregation (separation) and identification of the waste. The most appropriate way of identifying the categories of Hospital waste is by sorting the waste into color coded plastic bags or containers.
Figure 17 - Worker collecting hospital waste
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The fight against hospital infection demands the cooperation of all those employed in the hospital: doctors, technicians, nursing and cleaning staff. This is why one of the most urgent tasks is to convince, train and monitor the personnel responsible for refuse disposal. Unless they are convinced of the need, trained and monitored, all efforts to improve the situation will be doomed to failure. For an effective waste management system it is necessary to educate all the employees of the hospital about waste and its effect to our life. GUIDE LINES There are Guidelines for Hospital Waste Management In Pakistan since 1998 prepared by the Environmental Health Unit, of the Ministry of Health, Government of Pakistan, giving detailed information and covering all aspects of safe hospital waste management in the country, including the risk associated with the waste, formation of a waste management team in hospitals, their responsibilities, plan, collection, segregation, transportation, storage, disposal methods, containers, and their color coding & waste minimization techniques. A project was implemented in January, 2000 in the biggest hospital in every province by the Ministry of Health in Islamabad, in collaboration with WHO. IMPROPER DISPOSAL Hospitals and public health care units are supposed to safeguard the health of the community. However, the waste produced by the medical care centers if disposed off improperly, can pose an even greater threat than the original diseases themselves. Pakistan is also facing such problems. There are no systematic approaches to medical waste disposal. Hospital wastes are simply mixed with the municipal waste in collecting bins at roadsides and
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disposed off similarly. Some waste is simply buried without any appropriate measure. The reality is that while all the equipment necessary to ensure the proper management of hospital waste probably exists, the main problem is that the staff fails to prepare and implement an effective disposable policy. In Lahore, like most of the cities in Pakistan, there are no proper measures taken for the management of hospital waste. The standard practice of hospital waste disposal is dumping it in the M.C.L. container wherever situated. Disposable syringes and needles are also not disposed off properly. Some patients, who routinely use syringes at home, do not know how to dispose them off properly. They just throw them in a dustbin or other similar places, because they think that these practices are inexpensive, safe, and easy solution to dispose off a potentially dangerous waste item.
Figure 18 - Improper waste disposal
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5.1 - WASTE MANAGEMENT PRACTICES IN HCF 1 5.1.1 - LADY HEALTH WORKER (LHW) In most of the rural area of Pakistan LHW is responsible for the community health. They provide basic health facilities to community members at their door step. Their houses are their clinics where they treat the community members. Their home clinics are also sources of health care waste. 5.1.2 - RURAL DISPESARIES Rural health dispensaries are major set up for health care facilities in small villages. Although they provide small & limited services yet they produce health care waste which is not small and negligible. 5.1.3 - MUNICIPAL DISPENSARIES Municipal dispensaries are major health services provider in different areas of cities. These dispensaries provide basic health facilities. 5.1.4 - BASIC HEALTH UNITS (BHU) The BHU is the basic unit in the HCF hierarchy. It is a composite structure comprising a consulting space, dispensary, beds for resident patients (in sub urban locations) and ancillary spaces. Being a free healthcare facility, it generates a large number of patients per day. The waste generated during these activities comprises used bandages, gauzes, swabs, bottles, syringes, drip injections, catheters, tissue papers etc. The BHU normally has plastic buckets for in-house collection of these materials. The main recyclable material is separated by the junior staff members for selling to waste buyers. The infectious materials such as syringes are also sold with the other related items. The non-saleable waste is disposed in a similar manner as the municipal waste. It may be noted that the organic waste so disposed is of highly infectious nature, which mixes with municipal waste and remains exposed for extended periods of time.
1-HCF : Health Care Facilities Page 45 of 224 45
5.1.5 - Consulting Clinics (CCs) These facilities exist in multiple formats. In certain cases, CCs are part of the hospital scheme. In such case the waste management of CCs is linked to the overall collection and disposal system of the hospital. The other and more common format of consulting clinics is along independent locations. In this form, an individual doctor or a panel sits in a unit with a waiting space, examination room, small storage space and supplies room. The wastes generated during the operation of the Consulting Clinics comprise used syringes, used medicine bottles, bandages and plasters (in case of orthopedic clinics etc), paper waste and X-ray films. Much of the material generated from the consulting clinics is re-cycled and separated by the janitors / junior management staff of the CCs. 5.1.6 - Laboratories and Diagnostic Establishments Pathological and radiology labs are two dominant categories of this facility. The types of waste generated in pathological labs comprise specimen of excreta / body fluids, bandages, syringes, swabs and linen shreds. In addition, a significant amount of highly infectious liquid waste is generated which is mixed with routine sewage without any kind of treatment. The solid waste is divided into re-salable and non-saleable entities. The saleable articles are separated at source and sold to waste buyers. The organic waste is disposed with the regular municipal waste. In case of radiology labs, used X-ray films are the most attractive item which is burnt to produce small amounts of precious metals that fetch some revenue. This waste is disposed with the normal municipal waste stream.
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TABLE 4:- BASIC DATA REGARDING HEALTH FACILITIES VERSUS POPULATION RATIO IN PAKISTAN
INDICATOR
SITUATION IN PAKISTAN
WHO CRITERIA
Population Per Doctor
1578
200 / Doctor
Population Per Dentist
35557
1000/ Dentist
Population Per Nurse
3822
150 / Nurse
Population Per Hospital Bed
1610
200
Population Per Postgraduate Doctor
11000
800
TABLE 5 - HEALTH CARE DELIVERY SYSTEM IN PAKISTAN
Type / Category
Pakistan
Total Hospitals
830
MCH Centers
864
Rural Health centers
542
Basic Health Units
5147
Total Hospital Beds
86921
Total Doctors
90000
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TABLE 6 - HEALTH CARE DELIVERY SYSTEM IN PAKISTAN
Type / Category
Pakistan
Postgraduate Doctors
11160
Dentists
3000
Midwives
21304
Lady Health Visitors
4250
Trained Birth Attendant
57744
Lady Health Workers
65000
5.2 – WASTE COLLECTING STAFF Usually waste colleting staff consists of Ayas, Ward Boys and Ward Cleaners who are mainly responsible for the collection of waste from wards and different departments of the hospital. Waste collecting staff has some interesting names all over the world. In India they are called “Safai Karamchari”. In Pakistan we call them “Bhangi”, “Jamedar”, “Chamar” and “Kutana”.
It is
necessary to have specially trained staff with their specific uniform and gloves during handling of waste. PRIMARY COLLECTION OF HOSPITAL WASTES Within hospitals, the wastes stored in primary containers and bags at source are collected by in-house nurses’ aides, cleaners . ‘Sweepers’ (sanitary staff) employed by the hospitals collect waste from each ward in three shifts. The waste then transported on trolleys to a central storage area in the hospital premises or outside the building. One supervisor for each shift is responsible for hospital cleaning and waste collection.
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It is very important for the health of these workers to vaccinate them against Typhoid and Tetanus. They should also immunize against Hepatitis B. Their training & education about waste is also very important. Without proper training and education they are completely blind to the dangerous effects of medical waste to human life. In developed countries, a proper system has been adopted for this purpose. Situation is quite different in developing countries and especially in Pakistan. During a study conducted in CMH Rawalpindi by Mr. Naeem Mehmood (2000 – 2001), it was revealed that sanitary workers were not aware of the infectious and non-infectious waste. It was quite interesting that 30% consider left food and vegetables and 18% consider paper as infectious waste. In Pakistan, low literacy rate is the main reason for poor perception of sanitary workers towards hazards of hospital waste. During this study, it was revealed that 73% were illiterate, 20% had attended the primary school and remaining 7% had education up to secondary school level. Joint Advisory Notice on the Protection against Occupational Exposure to Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV)–Training Program Recommendations According to the Joint Advisory Notice, “The employer should establish an initial and periodic training program for all employees who perform Category I and II tasks. No worker should engage in any Category I or II task before receiving training pertaining to the Standard Operating Procedures (SOPS), work practices, and protective equipment required for that task.” The training program should ensure that all workers: •
Understand the modes of transmission of HBV and HIV.
•
Can recognize and differentiate Category I and II tasks.
•
Know the types of protective clothing and equipment generally appropriate for Category I and II tasks, and understand the basis for selection of clothing and equipment.
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•
Are familiar with appropriate actions to take, and persons to contact, if unplanned Category I tasks are encountered.
•
Are familiar with and understand all the requirements for work practices and protective equipment specified in SOPS covering the tasks they perform.
•
Know where protective clothing and equipment is kept; how to use it properly; and how to remove, handle, decontaminate, and dispose of contaminated clothing or equipment.
•
Know and understand the limitations of Protective clothing and equipment. For example, ordinary gloves offer no protection against needle stick Injuries.
•
Employers and workers should be on guard against a sense of security not warranted by the protective equipment being used.
•
Know the corrective actions to take in the event of spills or personal exposure to fluids or tissues, the appropriate reporting procedures, and the medical monitoring recommended in cases of suspected potential exposure.
SOURCE: U.S. Department of Health and Human Services, Centers for Disease Control,
E
E C Polyethylene bags are frequently used for containing bulk wastes
(e. g., contaminated disposable and residual liquids); they may have to be doubled bagged with polypropylene bags that are heat resistant if steam sterilization is used. These bags, however, must be opened or of such a nature as to allow steam to penetrate the waste. Color coded bags are frequently used to aid in the segregation and identification of infectious wastes. Most often red or red-orange bags are used for infectious wastes (hence the term ‘‘red bag’ waste). An ASTM Standard (#D 1709-75) for tensile strength based on a dart drop test and the mil gauge thickness of the plastic determine its resistance to tearing.
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Color coding is used according to the availability of the polythene bags. As red, orange, yellow and black polythene bags are easily available in Pakistan so in most hospitals red or orange bag is used for infectious waste, yellow or blue bag is used for sharps and black or grey bag is used for non infectious waste. Use of the biological hazard symbol on appropriate packaging used is recommended by the EPA to assist in identifying medical wastes. In addition, EPA recommends that all of these packages close securely and maintain their integrity in storage and transportation. In general, compaction or grinding of infectious wastes is not recommended by EPA before treatment. Even though it can reduce the volume of waste needing storage, compaction is not encouraged due to the possibility of packages being violated and the potential for aerosolization of microorganisms. Commercially available grinding systems that first involve sterilization before shredding or compaction may alleviate this latter concern. Sharps are of concern, not only because of their infectious potential, but also because of the direct prick/stab type of injury they can cause. For sharps, puncture-proof containers are currently the preferred handling package. EPA recommends these types of packages for solid/bulk wastes and sharps; bottles, flasks, or tanks are recommended for liquids. 4 In the past, needles were re-capped, chopped, or disposed of by other practices that are no longer common due to their potential for worker injury and, in the case of chopping, for aerosolization of microorganisms during the chopping procedure. New technologies for containing needles and facilitating their safe handling continue to emerge. For example, one company has announced a process which uses polymers to sterilize and encapsulate sharps (and other infectious wastes) into a solid block-like material. A number of companies have also developed encapsulating systems and other sharp disposal processes (e. g., a shredder with chemical treatment of needles and other sharps). These processes may potentially be cost-effective disposal options for doctor offices and other small
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generators of sharps and other infectious wastes, provided landfill operations would accept the encapsulated wastes.
5.4 – COLOR CODING FOR WASTE PACKING Color coded bags are frequently used to aid in the segregation and identification of infectious wastes. Most often red or red-orange bags are used for infectious wastes (hence the term ‘‘red bag’ waste). An ASTM Standard (#D 1709-75) for tensile strength based on a dart drop test and the mil gauge thickness of the plastic determine its resistance to tearing. Use of the biological hazard symbol on appropriate packaging is recommended by the EPA to assist in identifying medical wastes. In some hospitals red polyethylene bags are used for infectious waste, which includes soiled surgical dressing, cotton swabs , blood , body fluid , pus , sputum , culture of infectious agents and other contaminated wastes. Blue Polyethylene bags are used for all sharps irrespective of whether infectious or otherwise which includes needles, hypodermic needles, scalpel and other blades, knives, infusion sets, saws and broken glasses. Black or Grey Polyethylene bags are used for all non infectious waste, which includes paper, cigarette packets, cardboard, packing material, left over food and garbage etc.
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Figure 19 - Color Coded bags
COLOR CODING IN DIFFERENT HOSPITALS OF THE WORLD.
1:- COLOR CODING AT THE CAPITAL MEDICAL CENTER (CMC) MANILA CMC requires the use of three waste cans lined with three (3) colored plastic bags for every patient room, emergency room-out patient department, operating room-recovery room, delivery room-nursery, intensive care unit-coronary care unit, floor nurses station, x-ray and CT scan areas to separate infectious, noninfectious and biodegradable wastes.
•
Waste cans (8"x10"x12") lined with black plastic bags are for nonbiodegradable and noninfectious wastes such as cans, bottles, tetra brick containers, styropor, straw, plastic, boxes, wrappers, newspapers.
•
Waste cans lined with green plastic bags are biodegradable wastes such as fruits and vegetables’ peelings, leftover food, flowers, leaves, and twigs.
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•
Waste cans lined with yellow plastic bags are for infectious waste such as disposable materials used for collection of blood and body fluids like diapers, sanitary pads, incontinent pads, materials (like tissue paper) with blood secretions and other exudates, dressings, bandages, used cotton balls, gauze, IV tubings, used syringes, Foleys catheter/tubings, gloves and drains.
2;- Color Coding along with disposal method at St.Stephen’s Hospital.
5.5 – WASTE STORAGE IN HOSPITAL Storage of the waste needs to be in areas which are disinfected regularly and which are maintained at appropriate temperatures (particularly if wastes are being stored prior to treatment). EPA recommends that storage time is minimized, storage areas be clearly identified with the biohazard symbol, packaging be sufficient to ensure exclusion of rodents and vermin, and access to
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the storage area be limited. The importance of the duration and temperature of storing infectious wastes is noted, due to their association with increases in rates of microbial growth and putrefaction. The recommendation by EPA for storage of infectious waste is limited, however, to suggesting that ‘‘storage times be kept as short as possible’. EPA does not suggest optimum storage time and temperature because it finds there is ‘‘no unanimity of opinion’ on these matters. As the EPA Guide notes, there is State variation in specified storage times and temperatures. State requirements often stipulate storage times of 7 days or less for infectious wastes that are unrefrigerated. Sometimes longer periods are allowed for refrigerated wastes.
A BC D A B A
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EPA recommendations with respect to the transportation of infectious wastes briefly address the movement of wastes while on-site and in an even more limited way address the movement of wastes off-site. The recommendations are largely limited to prudent practices for movement of the wastes within a facility, such as placement of the wastes in rigid or semi-rigid and leak-proof containers, and avoidance of mechanical loading devices which might rupture packaged wastes. Broader issues, such as record keeping and tracking systems for infectious or medical wastes once they are taken off-site, and the handling and storage of wastes at transfer stations, have not yet been addressed. EPA does recommend that hazard symbols “should be in accordance with municipal, State and Federal regulations”.
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Figure 20 - Unsafe transportation of solid waste
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Figure 21 –Cost effective Waste Vehicle used in India
The sanitary staff should be trained properly for the handling of the waste. It is necessary for them to wear their specific uniform, to use special gloves during handling of waste. It is very important for the health of these workers to vaccinate them against Typhoid and Tetanus. They should also immunize against Hepatitis B. B
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Figure 22 – Purpose built vehicle used for transportation of waste safely.
Figure 23 - Workers bringing waste out of the wards in covered trolley.
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D
D
C A
A
C
D
A
B
B
D
AB
D
A E
E AE
AB
B
C
E
D
D
A
AB AB B B
F
B
B
F
C A
D
AD F
B
E
D
AB
EA A
E
DA
D
AB
B
A B D
D
E A F
A
D AB
AB D
B
ABAB B
E
B D F DA
D
B
F
F
DAB B
B
D
E A B
E
D
B
A
E
D
D
B
FAB A
E B
F
DAED A
B
A
A
B
E
BA
AB F
F
AD
E
A
AB E
BA
F
A
A
AB
AB B
F
B D A D B
AB B
BA
A
D
B
B
F
AEA B
EA AE FAB AB
D
F
BE C A A
E
B
AD F
B
D
A
E
A
D
A B
F
A
E
A B
AB C
B
A
D
AB
A
F E
F
F
AB D
A B E B
A
AB B
A D
B D
E AB
F B
D
DA C
A B
F
AB
E D
B
A B D B
B
D B D E
E A B AB D B
D B
A
AB A
D A
AB D
B E
A E
C D D
C
AB
F
B
Table 7 - COMPOSITION AND PER BED WASTE GENERATION IN A TERTIARY CARE ARMY HOSPITAL IN PAKISTAN
Category
Kg / Day
% age / day
Kg / Bed / Day
Infectious Waste
197.82
9%
0.309
Sharps
65.94
3%
0.103
Infectious Waste
1934.24
88 %
3.022
Total Waste
2198
100 %
3.434
Table 8 - ESTIMATES OF MEDICAL WASTE GENERATION IN SOUTH ASIA
Country Bangladesh
Waste generation (kg/bed/day) 0.8 -1.67
Total waste generation (tons/year)
93,075 (255 ton/day) (only in Dhaka)
Bhutan
0.27
73
India
1 -2
330,000
Maldives
NA
146
Nepal
NA
365
Pakistan
1.06
250,000
Sri Lanka
0.36
Page 61 of 224 61
6600 (only in Colombo)
Pre disposal treatment of medical waste is very important. Treatment prior to final disposal makes infectious waste non infectious. In this way we reduce the chance of infectious spread. There are several methods for the treatment of medical waste. Some modern and latest methods are as under: Electron Beam Irradiation (EB) OR Ionizing Radiation Microwave Irradiation (MW) OR Non – Ionizing Radiation Autoclave Hydroclave Chemical Disinfection 6.1 - ELECTRON BEAM IRRADIATION (EB) This method is also known as “Ionizing Radiation”. This is the latest technique used for the treatment of biological waste & especially medical waste. It is a sterilization technique based on the radiation ability to alter physical, chemical and biological properties of materials. Irradiation with EB was put forth as a very effective method for material biological decontamination because can produce ions, electrons, and free radicals at any temperature in the solid, liquid and gas. EB radiation processes are very effective for sterilization but the required radiation dose is still high. Low irradiation doses are required for the process efficiency and a high dose rate must be used to give large production capacities. The main idea of this work was to combine the advantages of both, EB irradiation and Micro Wave irradiation, i.e. high EB irradiation efficiency and high Micro Wave selectivity and volumetric heating for biological waste processing.
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METHOD & TECHNIQUE EB disinfection/sterilization processing is based on the radiation ability to alter biological properties of microorganisms especially due to the water presence in the living cells. Water is known to be a component of every biological system and a constituent present in most chemical processes. Due to the presence of water, EB irradiation can much enhance the microorganism death rate. The EB processing uses the Coulomb interaction of the accelerated electrons with atoms or molecules of irradiated matter. By these interaction ions, thermalized electrons, excited states and radicals are formed. Thus, the water irradiation by the EB produces radicals such as e aq, OH*, H*, H2*, H2O2*, OHaq*, H2O* and O2 -*. The free radicals react with cell membranes, enzymes and nucleic acids to destroy microorganisms. The fact that the interaction by the radicals is effective to a wide range of microorganisms is one of the advantages of the ionizing irradiation. The various products formed during radiolysis of water may, in this way, influence directly or indirectly the chemical processes and biological effects occurring in the individual compounds dissolved in water.
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MICROWAVE IRRADIATION (MW) This method is also known as “Non- Ionizing Radiation”. This is a technique used for the treatment of biological waste prior to final disposal. Microwave
(MW)
treatment
is
one
of
the
most
emerging
biological
decontamination technique because in many cases provides distinct advantages over conventional processes in terms of product properties, process time saving, increased process yield and environmental compatibility. The MW processing is a relatively new technology that provides new approaches to improve the decontamination process compared with classical methods. The frequency range of MW is (300 MHz - 300 GHz) . Hence, MW cannot interact with atoms by generating transitions between principal energy levels, e.g. between a base state and an excited state. Instead of this, microwaves couple to transitions within the hyperfine structure of the dynamical state. Hyperfine splitting of the principal energy levels may be due to the interaction of magnetic moments of the electron shell and of the nucleus. Most reports suggest that for various microorganisms, the death rate is enhanced by
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MW heating more than by conventional heating and the more intense the microwave electric field, the more is the death rate enhancement. Also, due to the presence of water, which absorbs MW energy very strongly due its exceptional polarizability, it is possible to pump vibration modes of DNA leading to unwinding and strand separation. MW TECHNIQUE MW is a method to disinfect micro organisms present in biomedical waste materials. Due to Microwave radiations, biological properties of these micro organisms are changed. Due to the presence of water, MW irradiation can much enhance the microorganism death rate. Most reports suggest that for various microorganisms, the death rate is enhanced by MW heating more than by conventional heating and the more intense the microwave electric field, the more is the death rate enhancement.
6.2 - AUTOCLAVING OF HOSPITAL WASTE Autoclave was invented by Charles Chamberland in 1879, although a precursor known as the steam digester was created by Denis Papin in 1679. Autoclaving, or steam sterilization, is a process to sterilize medical wastes prior to disposal in a landfill. Since the mid-1970s, steam sterilization has been a preferred treatment method for microbiological laboratory cultures. Other wastes (e. g., pathological tissue, chemotherapy waste, and sharps) may not be adequately treated by some sterilization operations, and thus require incineration.
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Figure 24 - Steam Autoclave
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Figure 25 - Staff opening the door of Autoclave
AUTOCLAVING PROCESSING RESULTS:Typically, for autoclaving, bags of infectious waste are placed in a chamber (which is sometimes pressurized). Steam is introduced into the container for roughly 15 to 30 minutes. The 'cooking' process causes plastics to soften and flatten, paper and other fibrous material to disintegrate into a fibrous mass, bottles and metal objects to be cleaned, and labels etc. to be removed. The process reduces the volume of the waste by 60%. Steam temperatures are usually maintained at 250 ‘F. Some hospital autoclaves, however, are operated at 270 ‘F.
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This higher temperature sterilizes waste more quickly, allowing shorter cycle times. After 'cooking', the steam flow is stopped and the pressure vented via a condenser. When depressurised, the autoclave door is opened, and by rotating the drum the 'cooked' material can be discharged and separated by a series of screens and recovery systems. In early systems, the primary product was cellulose fibres. This comprises the putrescible, cellulose and lignin elements of the waste stream. The biodegradability of the waste has not been affected by the autoclave and so must undergo further treatment to reduce its reactivity prior to landfilling. The fibres can be fed into anaerobic digesters to reduce the biodegradability of the waste and to produce biogas. Alternatively the fibre could be used as biofuel. Newer technology systems wash out hydrolysed hemicellulose sugars and most of the protein as water-solubles. The remaining materials, after simple physical separation (trommel screen) has several valuable uses. One newer system is able to dry the cellulose during processing using heat, and another newer system is able to dry the cellulose (much more economically) using pressure and steam kinetics. After fibre separation, the secondary streams comprise of mixed plastics, which have normally been softened and deformed which eases separation, a glass and aggregate stream, which can be exceptionally clean of both plastic and paper, and separate errous and non ferrous metals. The heat, steam and rotating action of the autoclave vessel strip off labels and glues from food cans leaving a very high quality ferrous/non-ferrous stream for recycling. With the removal of water, fibre, metals, and much of the plastics, the residual waste stream for disposal may be less than 10% by weight of the original stream, and is essentially devoid of materials that decompose to produce methane. Systems in Europe meet and exceed all of the European waste treatment and recycling requirements.
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The full process of loading, treatment and sorting is normally completed within 90 minutes in earlier models, and with the advent of newer technology, the cycle time has been decreased to one hour. In a typical "new" configuration, 210-ton units operating side by side would treat over 400 tons per day with time for preventative maintenance. The size of the vessel varies between vendors. Experience shows that "small" vessels are not productive enough; while if the vessel is too large, the pressures in the vessel and the heavy weight of the vessel can cause equipment failures. Several studies indicate that the type of container (e.g., plastic bags, stainless steel containers), the addition of water, and the volume and density of material have an important influence on the effectiveness of the autoclaving process. Each of these factors influences the penetration of steam to the entire load and, consequently, the extent of pathogen destruction. Autoclaving parameters (e.g., temperature and residence/cycle time) are determined by these factors. Since there is no such thing as a “standard load” for an autoclave, adjustments need to be made by an operator based on variation in these factors. Proper operation of autoclaves is key to effective functioning (i.e., in this case, sufficient pathogen destruction to render wastes non-hazardous). One method of assuring that pathogen destruction has taken place is the use of biological indicators, such as Bacillus stearothermophilus. Elimination of this organism (as measured by spore tests) from a stainless steel container requires a cycle time of at least 90 minutes of exposure. This is considerably longer than is currently provided by standard operating procedures. This conservative approach, however, may provide more pathogen destruction than is necessary to reduce microbiological contamination to non-infectious
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levels. Chemical disinfection (e. g., with formaldehyde, xylene, and alcohol) is used to sterilize reusable items. Recently, sodium hypochlorite has been used in a process to disinfect disposable products. Partial destruction of the material is achieved, but additional incineration and high capital costs are associated with the process as well. Several factors have led some hospitals to abandon autoclaving. For example, problematic operating conditions can lead to incomplete sterilization. In addition, landfill and off-site incinerator operators are increasingly refusing to receive such wastes, questioning whether the waste has actually been treated. The refusals are partly in response to the fact that most autoclave “red bags’ do not change color and thus appear no different from non-autoclaved red bags (even though they often are labeled or in some way identified as “autoclave”). This also has led to more cumbersome documentation and/or identification requirements in an effort to avoid refusals. Modern autoclaves, also referred to as converters, can operate in the atmospheric pressure range to achieve full sterilization of pathogenic waste. Super heating conditions and steam generation are achieved by variable pressure control, which cycles between ambient and negative pressure within the sterilization vessel. The advantage of this new approach is the elimination of complexities and dangers associated with operating pressure vessels. TYPES OF AUTOCLAVES: There
are
several
different
"types"
of
autoclave;
gravity
displacement, positive pressure displacement, and negative pressure (vacuum) displacement: •
GRAVITY DISPLACEMENT AUTOCLAVE, OR TYPE "N". The autoclave at your local tattoo or piercing studio (in the US) is
most likely a gravity displacement autoclave, or type "N". This design of
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autoclave generally has a heating element fully or partially submerged in a pool of water in the bottom of the autoclave chamber, along with a fill hole that transfers water from a reservoir to the autoclave chamber. As the water in the pool is heated it begins to evaporate, forming steam. Steam is lighter then air, as the chamber fills with steam the majority of air in the chamber is pushed to the bottom of the chamber, and escapes via the fill hole which is connected to a temperature sensitive diaphragm that closes once it is sufficiently heated. Once the diaphragm closes pressure builds up inside the autoclave chamber. The benefit of this type of autoclave is it's simplicity, the drawback with gravity displacement autoclaves is they are only designed to function properly with solid unwrapped instruments, however there has been no indication that a gravity displacement autoclave, properly loaded with properly processed instruments is unsafe for use in the modification industry. •
A POSITIVE PRESSURE DISPLACEMENT AUTOCLAVE improves on the design of a gravity displacement autoclave (see above) by creating the steam in a separate internal unit, sometimes called a "steam generator". Once the amount of steam needed to displace air in the chamber is produced a valve opens and a pressurized burst of steam enters the autoclave chamber, resulting in a higher percentage of air from the chamber being removed then with a gravity displacement autoclave, this decreases autoclave cycle times. Currently the most widely distributed and used if not the only positive pressure displacement autoclave is the Statim
line
of
autoclaves.
The
drawbacks
to
positive
pressure
displacement autoclaves are the high initial cost, and the fact they generally have a smaller chamber. •
NEGATIVE
PRESSURE,
OR
VACUUM
DISPLACEMENT
AUTOCLAVES, also known as type "S", have a separate internal "steam generator", as well as a vacuum pump. After the autoclave chamber is closed the vacuum pump removes all air form the chamber, and as above, steam is injected into the chamber. Negative pressure displacement
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autoclaves are able to attain some of the highest sterility assurance level or SAL. Negative displacement autoclaves generally have a forced filtered air drying system that allows the autoclave packages to be throughly dries before contacting any ambient air. The drawback back to negative pressure displacement autoclaves is the cost, and sometimes the size of these systems. •
THE LAST "TYPE" OF STEAM AUTOCLAVE IS TYPE "B" for Big, and the name speaks for itself. These systems are more or less enlarged negative pressure displacement autoclaves (there are enormous gravity displacement autoclaves as well, but they are still type "N", and not usually used in the medical or modification industries). The steam generator for Type "B" autoclaves is usually a separate stand alone unit, and the autoclave chamber is sometimes large enough to physically enter. Due the large scale and astronomical price tag of these autoclaves they are rarely, if ever used in the modification industry.
COMMERCIAL APPLICATION
Sterecycle is the first company to build a full scale commercial plant, which has been operational in Yorkshire since June 2008 and is operating 24/7. This plant can process 100,000 tonnes per annum of waste, treating waste from Rotherham council under a long term contract. Sterecycle builds, owns and operates waste recycling plants, processing residual waste as a substitute for landfill.Other companies are looking to build autoclave plants in the UK but all are at an embrionic stage.
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INCINERATION VS AUTOCLAVING; AND THE IMPORTANCE OF PROPER OPERATION 1- Temperature Autoclaves must achieve minimum temperatures and be operated according to appropriate cycle times to ensure adequate destruction of pathogens. Primary and secondary chamber temperatures of 1,400 ‘F and 1,600 ‘F, respectively, must be reached in hospital incinerators to ensure adequate combustion and minimum air emissions. Normally, these temperatures would ensure the destruction of pathogens in the waste; however, if an incinerator is loaded and fired-up cold, pathogens could conceivable escape from the stack. Data is not readily available to evaluate this point further. At the typical operating temperature of an autoclave (250 “F), the cycle time of 45 to 90 minutes is necessary to reduce pathogen concentrations in most hospital waste below infectious levels. 2- Cost Autoclaves do provide some advantages over incinerators, which may increase their attractiveness as a disposal option, particularly if incineration regulations become much more stringent and thereby increase incineration costs. For example, operation and testing of incinerators is more complex and difficult than that for autoclaves. Autoclaves are also less costly to purchase & require less space. 3 – Environmental Releases In addition, environmental releases from incinerators probably contain a broader range of constituents (e. g., dioxins, and heavy metals) than autoclaves.
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4 – Training The proper operation of incinerators and autoclaves is critical to their effective functioning. Proper operation is dependent on at least four conditions: •
Trained operators;
•
Adequate equipment (i.e., proper design, construction, controls and instrumentation);
•
Regular maintenance;
•
Repair. For example, trained operators need to be knowledgeable in the
operation of the incinerator and in the proper handling of medical wastes. It is not clear; however, that workers are consistently receiving adequate training in the operation of incinerators or autoclaves, and consequently that most units are operating properly.
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6.3 - HYDRO CLAVE Hydroclave is a device like Autoclave which sterilizes the waste utilizing steam, similar to an autoclave, but with much faster and much more even heat penetration. It hydrolyzes the organic components of the waste such as pathological material. Removes the water content (dehydrates) of waste. Breaks up the waste into small pieces of fragmented material and reduces the waste substantially in weight and volume. Accomplishes the above process within the totally sealed vessel, which is not opened until sterilization of waste. THE HYDROCLAVE PROCESS – AND HOW IT WORKS The Hydroclave is essentially a double-walled (jacketed) cylindrical, pressurized vessel, horizontally mounted, with one or more side or top loading doors, and a smaller unloading door at the bottom. The very small Hydroclave units have a single side door for both loading and unloading. The vessel is fitted with a motor driven shaft, to which are attached powerful fragmenting/mixing arms that slowly rotate inside the vessel. When steam is introduced in the vessel jacket, it transmits heat rapidly to the fragmented waste, which, in turn, produces steam of its own. A temperature sensor is located in the bottom inside part of the vessel, which measures the temperature of the waste as it is agitated and mixed, and this sensor reports back to the main computerized controller, which automatically sets treatment parameters ensuring complete waste sterility – even liquid infectious waste. After sterilization, the liquid but sterile components of the waste are steamed out of the vessel, re-condensed and drained to sewer. The remaining waste is dehydrated, fragmented, and self-unloaded via a reverse rotation of the mixer/agitator. There is no correlation between waste characteristics and treatment efficacy. All the waste is consistently sterilized. Liquid and heavy loads,
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however, will take somewhat longer to reach the temperature and pressure required to initiate the sterilization cycle, but sterilization automatically occurs. There is no need for “pre-and post-vacuum”, that is, pull infectious air and liquids of the vessel, as is the case with autoclaves. Pulling air and liquids out of an infectious environment increases the risk of live pathogen emission. The Hydroclave eliminates this risk due to the vigorous dynamic activity within the Hydroclave, which mixes and heats any entrained air with the steam and waste material.
DETAILED DESCRIPTION OF THE TREATMENT CYCLE a) LOADING The waste can be loaded into the Hydroclave treatment vessel by various means, depending on your requirements: In smaller units dropping the waste bags manually into a side or end door. In medium-sized units by tipping waste containers into top or angled loading doors. Electric or hydraulic tipping devices are an available option with the Hydroclave. In medium to large sized units, for large scale commercial operation, a combination of conveyors, hoppers and tippers are available to load the waste into large top loading doors. The Hydroclave can be fitted with loading doors to suit your requirements, from small side doors to multiple angled or top doors, which are sized to accommodate your infectious waste stream – small doors for bagged biomedical waste, to very large doors for disinfecting large objects such as large animal carcasses. No special operator skill is required, since over-loading or loading too tightly is not an issue with this type of process.
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b) HEAT-UP AND FRAGMENTATION After loading, the vessel doors are closed, and the outer jacket of the vessel is filled with high temperature steam, which acts as an indirect heating medium for heating the waste. The jacket steam condenses into clean, hot condensate, which is returned back to the steam boiler. This unique feature makes the Hydroclave so efficient in operation – no steam or hot condensate is lost. During heat-up, the shaft and mixing arms rotate, causing the waste to be fragmented and continuously tumbled against the hot vessel walls. At this point, the waste is broken up into small fragments, and all material heats up rapidly, being evenly and thoroughly exposed to the hot inner surfaces. The moisture content of the waste will turn to steam, and the vessel will start to pressurize. Initially, no steam will be injected into the waste. If there is not enough moisture in the waste to pressurize the vessel, a small amount of boiler steam is added until the desired pressure is reached. The uniform jacket heat and the location of the temperature sensor ensures that even liquid waste will be heated up uniformly. At the end of this period, the correct sterilization temperature and pressure are reached, and the sterilization period is initiated automatically. c) STERILIZATION PERIOD By computer or PLC control, the temperature and pressure are maintained for the desired time to achieve sterilization. If for any reason the sterilization parameters drop below desired levels, the sterilization cycle is stopped, and re-initiated. This ensures sterilization prior to commencement of the next stage. The mixing/fragmenting arms continue to rotate during the entire sterilization period, to ensure thorough heat penetration into each waste particle.
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d) DE-PRESSURIZATION AND DE-HYDRATION After the sterilization period ends, the vessel is de-pressurized via a steam
condenser,
which
causes
initial
waste
dehydration
due
to
depressurization. The steam to the jacket will remain on, agitation continues, and the waste loses its remaining water content through a combination of heat input from the jacket and continued agitation. All waste, no matter how wet initially, even liquid waste, will be dehydrated by this process. e) UNLOADING At the end of the depressurization/dehydration period, jacket steam is shut off, the discharge door is opened, and the powerful mixing arms are reversed to a clockwise rotation. Due to the unique construction of the mixing arms, the opposite rotation causes the fragmented waste to be pushed out of the vessel discharge door, into a waste container, or onto a conveyor. If desired, the waste can be further fine-shredded prior to final disposal, by a separate shredding system. The dry, sterile, fragmented waste is well suited for further fine shredding. The vessel is now ready for another treatment cycle, having retained most of its heat for the treatment of the next batch.
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TREATMENT PROCESS How it works… STAGE ONE - LOADING The Hydroclave can process:
Bagged waste, in ordinary bags. Sharps containers. Liquid containers. Cardboard containers. Metal objects. Pathological waste.
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STAGE TWO – STERILIZING
Powerful rotators mix the waste and break it into small pieces. Steam fills the double wall (jacket) of the vessel and heats the vessel interior. The liquid in the waste turns to steam. After 20 minutes the waste and liquids are sterile. STAGE THREE – DEHYDRATION
The vent is opened, the vessel de-pressurizes via a condenser, and sterile liquid drained into sanitary sewer. Steam heat and mixing continue until all the liquids are evaporated and the waste is dry.
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STAGE FOUR – UNLOADING
The unloading door is opened. The mixer now rotates in the opposite direction, so angled blades on the mixer can push the waste out the unloading door. The dry sterile waste can be fine-shredded further or dropped in a waste disposal bin. The waste is now ready for safe disposal! 6.4 - CHEMICAL DISINFECTION Waste which is contaminated through contact with, or having previously contained, chemotherapeutic agents shall be segregated for storage. This type of waste must be placed in a secondary container, which shall be labeled on the lid and the sides with the words “Chemotherapy Waste” or “CHEMO”. The label must be visible from any lateral direction to ensure treatment of the Biohazardous waste. Chemotherapeutic waste can be taken directly to one of the Medical Waste Collection Sites.
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It is very important to dispose off the hospital waste in a proper way. Due to improper disposal many diseases are spreading very rapidly all over the world. Here we will discuss the modern & old technologies which are being used in different countries for HCW disposal.
7.1 – DISPOSAL OF MEDICAL WASTES There are different methods for the disposal of hospital waste depending upon types of waste i.e. solid, liquid & radioactive waste.
A ) – DISPOSAL OF SOLID HOSPITAL WASTE Methods for disposal of solid hospital waste are :• • • •
Incineration Recycling 3 - R Concept Land Fill
7.2.1 - INCINERATION METHOD FOR DISPOSAL OF SOLID HOSPITAL WASTE Incineration Incineration is a waste treatment and disposal method that involves the combustion of waste at high temperatures. Incineration of waste materials converts the waste into heat, gases, particulates and solid residue (ash). Large Scale Incineration Incineration can be used to destroy certain hazardous wastes such as medical wastes where pathogens and toxins must be destroyed by high temperatures.
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Incinerators that burn municipal wastes are often referred to as ‘MSWI’s: Municipal Solid Waste Incinerators. There are no municipal solid waste incinerators in New Zealand. A waste-to-energy plant is an incinerator that burns wastes in highefficiency furnace/boilers to produce steam and/or electricity and incorporates modern air pollution control systems and continuous emissions monitors. This is often used as a waste disposal method in countries where landfilling is too difficult or expensive because land is a scarce resource. Small Scale Incineration Small scale incinerators include backyard burners or '44-gallon drum incinerators' that may be used to dispose of garden and household waste. The amount of household waste burned in backyard fires is only about 1% of the total amount of household waste land filled in New Zealand. Bans on outdoor fires of all kinds are common in Canterbury in summer because of the fire risk. Because of other adverse air quality effects, outdoor burning is not permitted from 1 May to 31 August in Christchurch Clean Air Zones 1 and 2.
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Figure 26 - Municipal Solid waste incinerator in USA
Figure 27 - Medical Waste Incinerators in USA
Page 84 of 224 84
INCINERATION HAZARDS •
There are arising economic problems because ash is not an ideal fuel.
•
The incineration of certain waste product produces some acidic gases.
•
Polyvinyl Chloride (PVC), a plastic used in the manufacturing of toys, rainwear & garden hoses. When it is burnt Hydrogen Chloride Gas is produced. This gas reacts with water to produce Hydrochloric Acid (HCL) which is a strongly corrosive liquid.
•
What’s threatening is the fact that some of the PVC decomposes before it burns completely. Decomposition products such as vinyl chloride, or suspected ones such as, dioxin are known carcinogens. Most of these can be removed from the exhaust stream if proper air pollution controls are installed, but these measures are never 100 percent effective and so expensive.
•
Incinerators typically release a wide variety of other toxic metals, including lead, cadmium, arsenic, chromium, beryllium, nickel and others. Health effects of these metals include:
•
Lead: -nervous system disorders, lung and kidney problems, and decreased mental abilities in children.
•
Cadmium: -kidney disease, lung disorders; high exposures severely damage the lungs and can cause death
•
Arsenic: -arsenic damages many tissues including nerves, stomach, intestines and skin, causes decreased production of red and white blood cells and abnormal heart rhythm
•
Chromium: -damages nose, lungs and stomach
•
Beryllium: -chronic lung problems Incinerators are significant sources of these forms of air.
® - In 1999, the Philippines became the first country in the world to prohibit all forms of waste Incineration, including open burning. This environmental milestone was achieved after years of campaigning by environmental and community groups opposing proposals for incinerators, landfills and dumpsites in various parts of the country.
Page 85 of 224 85
Figure 28 - Industrial Incinerator
Figure 29 - Medical Waste incinerator
Page 86 of 224 86
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INCINERATOR BANS AND MORATORIA 1. INTERNATIONAL: • • •
1996: the Protocol to the London Convention banned incineration at sea globally. 1996: the Bamako Convention banned incineration at sea, on territorial or internal waters in Africa. 1992: the OSPAR Convention banned incineration at sea in the north-east Atlantic.
ARGENTINA: • •
• • • •
• •
2003: the city Council of Granadero Baigorria, Santa Fe province, outlawed medical waste incineration. 2002: the Buenos Aires City Council passed a law that bans incineration of medical waste. This includes medical waste generated in the city and sent outside for treatment. 2002: the City Council of Villa Constitución, Santa Fé province, banned the construction of incinerators. 2002: the City Council of Coronel Bogado, Santa Fé province, banned the construction of incinerators. 2002: the City Council of Marcos Juarez, Cordoba province, outlawed the construction of incinerators. 2002: the Municipal Council of Casilda, Santa Fe province, banned hazardous waste incineration for 180 days. The resolution was extended for another 180 days in November 2002. 2002: the City Council of Capitan Bermudez outlawed all type of waste incineration. 2001: the province of San Juan banned crematoria in urban and semiurban areas.
BRAZIL: • 1995: the Municipality of Diadema, State of Sao Paulo, approved a law banning incinerators for municipal waste. The city council states that the waste problem should be tackled using reduce, reuse, and recycling policies. CANADA: • 2001: the Province of Ontario enacted a hazardous waste plan that includes the phase out of all hospital medical waste incinerators. CHILE: • 1976: Resolution 07077 banned incineration in several metropolitan areas of the country.
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CZECH REPUBLIC: • 1997: Cepi, district Pardubice banned construction of new waste incinerators. GERMANY: • 1995: the largest, most populated and most industrialized state in Germany — North Rhine/Westfalia — bans municipal solid waste incinerators. GREECE: • 1994: the national government approved legislation declaring it illegal to burn hazardous waste in waste-to-energy plants. In 2001, the Minister for the Environment formally declared a policy of prohibiting municipal waste incineration. INDIA: • 1998: the central government banned incineration of chlorinated plastics nationally. The city of Hyderabad in the state of Andhra Pradesh banned on-site hospital waste incineration. IRELAND: • 1999: although no formal ban is in place, Ireland closed all of its medical waste incinerators. JAPAN: • 1998: the Ministry of Health and Welfare revised the laws to allow disposal of PCBs using chemical methods. Although there is no formal ban on incineration of PCBs, there is an informal proscription on PCB incineration. MALTA: • 2001: all public and private hospitals were to eliminate clinical waste incineration by 2001. PHILIPPINES: • 1999: the Clean Air Act was passed which bans all types of waste incineration. The law extends to municipal, medical and hazardous industrial wastes. SLOVAKIA: • 2001: banned waste importation for incineration. SPAIN: • 1995: the regional government of Aragon established autoclaving as the required form of treatment for medical waste, effectively eliminating medical waste incineration.
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2. UNITED STATES: STATES •
Delaware, 2000: state prohibited new solid waste incinerators within three miles of a residential property, church, school, park, or hospital.
•
Iowa, 1993: state enacted a moratorium on commercial medical waste incinerators. Moratorium still in place. Moratorium does not extend to incinerators operated by a hospital or consortium of hospitals.
•
Louisiana, 2000: state revised its statute Title 33, which prohibits municipalities of more than 500,000 from owning, operating or contracting garbage incinerators in areas zoned for residential or commercial use.
•
Maryland, 1997: state prohibited construction of municipal waste incinerators within one mile of an elementary or secondary school.
•
Massachusetts, 1991: state enacted a moratorium on new construction or expansion of solid waste incinerators.
•
Rhode Island, 1992: state banned the construction of new municipal solid waste incinerators. First U.S. state to enact such a ban.
•
West Virginia, 1994: state banned the construction of new municipal and commercial waste incinerators. Permits pilot tire incineration projects.
3. COUNTIES •
Alameda County, California, 1990: voter initiative “Waste Reduction and Recycling Act” passed, banning waste incinerators in the county. A later court ruling limits the ban to the unincorporated areas of the county, however, there are no operating municipal waste incinerators in Alameda county.
•
Anne Arundel County, Maryland, 2001: county banned solid waste and medical waste incinerators.
4. CITIES •
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Brisbane, California, 1988: city banned new construction of waste incinerators.
•
Chicago, Illinois, 2000: city banned municipal waste incineration. The ban extends to burning waste in schools and apartment buildings.
•
San Diego, California, 1987: ordinance stipulates that waste incinerators cannot be sited within a certain radius of schools and daycare centers, which results in no eligible land being available for incinerators.
•
Ellen burg, New York, 1990: town banned waste incinerators.
•
New York City, 1989: Banned all apartment house incinerators by 1993. By 1993, all 2,200 apartment house incinerators that were in operation in 1989 were shut down.
5. MORATORIA: Several states in the United States, including Arkansas, Wisconsin and Mississippi, have enacted moratoria on medical or municipal waste incinerators that have since expired or been lifted. The US EPA enacted a nationwide, 18-month freeze on new construction of hazardous waste incinerators in 1993. Two unsuccessful bills were introduced in the US Congress during the 1990s to enact a moratorium on new waste incinerators. Other examples of incinerator moratoria worldwide include: •
1982: Berkeley, California passes a ballot initiative banning garbage burning plants for five years. The moratorium allowed the city to develop recycling programs which became national models.
•
1985: Sweden implemented a 2-year moratorium on new incinerators.
•
1990: In the Flemish-speaking part of Belgium, public pressure resulted in a 5-year moratorium on new municipal waste incinerators.
•
1992: Ontario, Canada banned new municipal incinerators. In 1996 a new conservative government overturned the ban.
•
1992: Baltimore, Maryland passed 5-year moratorium on new municipal incinerators.
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SOME NON INCINERATION TECHNOLOGIES FOR HAZARDOUS WASTE TREATMENT Technology
Process Description
Potential Advantages
Current Uses
Base Catalyzed Dechlorination
Wastes reacted with alkali metal hydroxide, hydrogen and catalyst material. Results in salts, water and carbon.
Reportedly high destruction efficiencies. No dioxin formation.
Licensed in the United States, Australia, Mexico, Japan, and Spain. Potential demonstration for PCBs through United Nations project.
Biodegradation
Microorganisms destroy organic compounds in liquid solutions. Requires high oxygen/nitrogen input.
Low temperature, low pressure. No dioxin formation. Contained process.
Chemical Neutralization
Waste is mixed with water and caustic solution. Typically requires secondary treatment.
Low temperature, low pressure. Contained and controlled process. No dioxin formation.
Chosen for destruction of chemical weapons neutralent in the United States. Potential use on other military explosive wastes. Typically used for commercial wastewater treatment. Chosen for treatment of chemical agents in the United States.
Electrochemical Oxidation (Silver II)
Wastes are exposed to nitric acid and silver nitrate treated in an electrochemical cell.
Low temperature, low pressure. High destruction efficiency. Ability to reuse/recycle process input materials. Contained process. No dioxin formation.
Under consideration for chemical weapons disposal in the United States. Assessed for treatment of radioactive wastes.
Electrochemical Oxidation (CerOx)
Similar to above, but using cerium rather than silver nitrate.
Same as above; cerium is less hazardous than silver nitrate.
Gas Phase Chemical Reduction
Waste is exposed to hydrogen and high heat, resulting in methane and hydrogen chloride.
Contained, controlled system. Potential for reprocessing byproducts. High destruction efficiency.
Solvated Electron Technology Supercritical Water Oxidation
Sodium metal and ammonia used to reduce hazardous wastes to salts and hydrocarbon compounds. Waste is dissolved at high temperature and pressure and treated with oxygen or hydrogen peroxide.
Reported high destruction efficiencies.
Demonstration unit at the University of Nevada, United States. Under consideration for destruction of chemical agent neutralent waste. Used commercially in Australia and Japan for PCBs and other hazardous waste contaminated materials. Currently under consideration for chemical weapons destruction in the United States. Potential demonstration for PCB destruction through United Nations project. Commercially available in the United States for treatment of PCBs.
Contained, controlled system. Potential for reprocessing byproducts. High destruction efficiencies.
Under consideration for chemical weapons destruction in the United States. Assessed for use on radioactive wastes in the United States.
Wet Air Oxidation
Liquid waste is oxidized and
Contained, controlled system. No dioxin formation.
Vendor claims 300 systems worldwide, for treatment of hazardous sludge and wastewater.
Hydrolyzed in water at moderate temperature .
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7.2.2 - RECYCLING OF MEDICAL WASTE The definition of recycling is to pass a substance through a system that enables that substance to be reused. Hospital Waste recycling involves the collection of hospital waste materials , the separation and clean-up of those materials. Recycling waste means that fewer new products and consumables need to be produced, saving raw materials and reducing energy consumption. SEGREGATION FOR RECYCLING AT HOSPITALS Varying degrees of segregation of recyclable components of hospital wastes occur at hospitals. In general, these activities are not organized by the hospital management and have grown out of opportunities available to the workers involved in handling the hospital wastes. The quantities of recyclable materials in waste from minor health care establishments are small. In general, any segregation for recycling will be carried out by the workers handling the waste in clinics and health centers, etc. but the minimal quantities generated limit the opportunities for sale. SEGREGATION FOR RECYCLING AT MUNICIPAL LANDFILLS At all landfills, a large number of waste pickers rely on recycling for their survival. They do not differentiate between general solid waste and hazardous health care waste and go through all wastes looking for recyclable materials. Most of the recycling is achieved by urban recyclers, and at the landfills only relatively small quantities of bone, paper, plastics and glass are retrieved. Health care wastes in developing countries , are likely to contribute only a small amount of such recyclable materials at landfills because of the atsource segregation of the most valuable components.
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THE RECYCLERS THE INITIAL PLAYERS IN HOSPITAL WASTE RECYCLING The initial players in hospital waste recycling are the workers responsible for handling waste in the hospitals. In developing countries , the nurses’ aides, sweepers and janitors are employed by the hospitals and are controlled by hospital supervisors with little support or advice from senior management. Much of their recycling activity is informal and benefits only the workers involved. THE SECOND TIER OF HOSPITAL WASTE RECYCLERS Municipal waste collection workers often serve as the second tier of hospital waste recyclers. They frequently receive recyclable materials segregated by the hospital waste handlers and sell them on. In addition, they scavenge the waste collected at hospitals before dumping it at the landfill site. THE THIRD TIER OF HOSPITAL WASTE RECYCLERS Municipal waste collection workers and itinerant junk buyers sell on the recyclable materials segregated from health care wastes to middle dealers in the form of junk shops. Middle dealers serve the purpose of storing and, sometimes, further separating recyclable materials until a sufficient quantity has accumulated to make it worthwhile selling it on to main dealers. MAIN DEALERS IN HOSPITAL WASTE RECYCLING The main dealer purchases all the recyclable products by minor dealers. The specification of main dealer varies from country to country i.e. the main recycling dealers in Karachi have decentralized due to ‘pressure on space and working environment’. The main dealers usually deal in one single waste item only and have personal contacts with middle dealers. Vietnam has a long history of recycling waste materials and, in Hanoi’s case, many villages in the suburbs and in nearby Provinces have
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developed skills which now make them main dealers in the solid waste recycling system. One of the main locations for main dealers is close to an industrial trading estate, making it convenient to access end-users. Bulk quantities of recyclable materials are collected, prepared and sold on. Even though the premises of such main dealers have a legal status the operators are not registered and have to pay protection money to enforcing agencies. The ultimate industrial receivers of recycled materials tend to be located near the main dealers and produce end-products for which there is a market. An example of a recycled end-product is ‘dana’, which are the plastic pellets produced after molten waste plastic extrusion, cooling and cutting. Waste glass and paper are likewise converted into useful products in specialist enterprises. HEALTH AND ENVIRONMENTAL IMPACTS OF HOSPITAL WASTE RECYCLING Workers segregate paper, cardboard and glass for recycling at any stage of waste handling. In doing so, they are not careful and recyclable materials are generally contaminated with blood and infectious fluids leaking from red bags. Waste pickers at landfill sites are also singled out as being vulnerable to flies, mosquitoes and air-borne dust. Leachate from landfills is claimed to pollute surface and ground waters. Work as a recycler in Hanoi is said to be arduous and to pose risks to health through traffic accidents and contact with waste. In health care establishments, particularly in government hospitals in developing countries, the storage and transport of waste give rise to serious concern about pollution of wards and storage areas and the potential for spread of communicable diseases. During transport to disposal sites, health care wastes are often blown onto streets, creating environmental pollution and health risk. Burning of waste at dumps causes severe air pollution and exposure of waste pickers to infectious material and sharps is a serious threat to health.
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Disposal of wastes in waterways create obnoxious odors and look aesthetically unattractive, as well as having an adverse effect on fisheries. It is therefore stressed that the health risks to these poorly-paid workers could be reduced with better and more responsible management. Workers should be immunized against Tetanus and Hepatitis B and undergo a medical examination before starting work at a clinic or hospital. It is very horrible that some black sheep sell the used syringes, drip bags, blood bags and other plastics material to merchants who sell them on large scale. After just washing, these syringes, needles, blood bags and tubing are available in repacking for reuse. These repacked equipments are most dangerous to health. It is therefore very necessary to make them non reusable by cutting the plastics bags and completely destroying both syringes & needles. RECYCLING IN THE U.K In the UK, the household and commercial sectors have relatively low recycling rates. This is in comparison to some other wastes, such as construction and demolition waste and sewage sludge. The Government is hoping to increase the amount of household waste that we recycle to 33% by 2015. Some of the materials that we can recycle include paper, plastics, metals (such as aluminum cans) and tyres. The paper industry generates vast quantities of waste in the form of paper off-cuttings and damaged paper rolls. This paper can be put back into the pulping process and recycled. Paper recycling in the UK became popular during the 1990s. Nearly a million tones of paper from household waste is now recycled each year. Although paper makes up over one third of all household waste recycled, this is still no more than about 10% of the total paper consumed. In contrast, over 50% of paper waste paper produced by the newspaper industry is currently being recycled. To encourage the public to recycle waste paper, many council have arranged house to house collection schemes. Separate bins and containers are provided specifically for paper. They are collected at regular
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intervals and taken to be recycled. Other recycling depots for paper can be found at municipal centers and supermarkets. Approximately 6 to 8% of UK household waste comprises of glass jars and bottles. However, the largest producers of waste glass bottles are hotels and pubs, as the vast majority of drinks are bottled. A large proportion of glass is collected in bottle banks and taken to be recycled. There are over 20,000 bottle banks in the UK, and they are mainly found in car parks and at supermarkets. There are usually three bottle banks, one for each color of glass: clear, green and brown. The UK currently recycles about one third of its glass. This is far behind glass recycling rates in other European countries. Switzerland and the Netherlands for example have recycling rates as high as 80%. Plastics make up a large amount of waste, since they are available in numerous forms. There are two main types of plastic: thermoplastics, which are the most common; and thermo sets. Thermoplastics melt when heated and can therefore be remolded. This enables thermoplastics to be recycled relatively easily. In Western Europe the largest amounts of plastic occur in the form of packaging. Plastic waste tends to be sorted by hand, either at a materials recycling facility or the householder can separate it. This may then be taken to a plastic recycling point or collected by the council. The UK produces approximately about 4.5 million tones of plastic waste each year. Most of this waste arises from packaging. The UK has a plastics recycling rate of only 3%. In Germany the recycling rate for plastic is 70%. The UK has a recycling rate of approximately 60% for iron and steel. Most of this waste comes from scrap vehicles, cooker, fridges and other kitchen appliances. It is estimated that the metal content of household waste is between 5 and 10%. It is mainly made up of aluminum drinks cans and tin-plated steel food cans. Aluminum recycling is widely established in the UK. It is an expensive metal and can therefore produce high incomes for recycling schemes. Copper, zinc and lead are also recycled in the UK. At present, over a third of
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aluminum drinks cans are recycled. Some other countries have very high recycling figures for aluminum drinks cans. The USA and Australia for example, recycle nearly two thirds. Every year in the UK between 25 and 30 million scrap tyres are generated. Approximately 21% of these tyres are retreated and reused. The old tread is ground off the tyre and replaced with a new tread. However, about half of all used tyres are dumped in landfill sites throughout the country. Other tyres may be incinerated.
TABLE 9 - MARKET PRICES OF HOSPITAL WASTE RECYCLABLES IN KARACHI
Waste Material
Swabs/Dressings Placenta Plastic bags and Drips Urine bags Syringes Glassware Plastic and Polythene Paper TOTAL
Page 98 of 224 98
QUANTITY in kg/day
MIDDLE
DEALERS
MAIN
DEALERS
1300.5 120.00 1175.5
Prices Total Rs Rs 5 6502.50 80 94040
Prices Total Rs Rs 7 9103.50 100 117550
80.0 630.4 411.8
80 8 6
6400 5043.2 2470.80
100 10 8
8000 6304 3294.40
592.6
6
3555.6
8
4740.80
749.3 5060.10
10
7493 125505.10
12
8991.6 157984.30
Figure 30 - Waste Recycling rates in USA
Figure 31 - Recycling Rates of selected materials in USA in 2001
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Figure 32 - Recycling Process Of a plastic bottle
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TABLE 10 - Recycling Versus Incineration: An Energy Conservation Analysis FAB
C F
AF
FA
C
F
A
CFA F A AB
B
C FA
B
FAB
F FA FA
C B
D EFA
F AE
AB
D D
E E F
C
C
C
C
C
C
C
C
C C
D A
C
C
B AB
C
C
AB
C
C
C
C
E D
C
A A CC
B AB
C D
F AB
C
B AB D D AB B D
C
AB B A
C B
C C
AB
C C
C
C
C
C
C
FA A D F
FF
C
C
C
C
F B
C
C
B D AE
C
C
FAC
C
Page 101 of 224 101
C
F
A
7.2.3 - 3-R CONCEPT & THE EUROPEAN WASTE HIERARCHY IN WASTE MANAGEMENT Waste policy in the EU widely accepts the waste hierarchy of waste management to be (in order of priority) as: • Reduce
(Waste prevention)
• Re-use • Recycling • Thermal
decomposition with energy recovery (i.e. incineration with energy
recovery).
Figure 33 - Waste Hierarchy
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REDUCE It means to reduce the amount of waste during the production process. The amount of solid waste produced during production process can be reduced as:
•
We should buy a product without extra packing.
•
We should buy long lasting products.
•
Old newspapers, bottles and other plastic materials should sale instead of throwing them here & there.
REUSE We can reuse many things before we throw them away. Therefore we could:
•
Reuse bags (paper and plastic), containers, paper and other items.
•
Sell or donate things you no longer use to people who will use them, e.g. clothing and shoes.
•
Repair shoes, boots, handbags and other items before you consider ‘throwing away’.
•
Convert cans and plastic containers into plant pots.
RECYCLE
•
To separate a given waste material from other wastes and to process it so that it can be used again in a form similar to its original use.
•
Recycling involves the collection of used and discarded materials processing these materials and making them into new products.
•
It reduces the amount of waste that is thrown into the community dust bins thereby making the environment cleaner and the air fresher to breathe.
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Reduction
Reuse
Recycle The EU waste hierarchy in waste management. In spite of this general consensus, and a growing coherence of this hierarchy in policy lines of individual EU member states as a consequence of EUDirectives, the majority of waste in Europe is either land filled or incinerated. Importantly, these are the methods which also entail the highest and most serious environmental and health risks. The waste hierarchy Within the hierarchy, the Governments do not expect incineration with energy recovery to be considered before the opportunities for recycling and composting have been explored
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The proximity principle Requires waste to be disposed of as close to the place of production as possible. This avoids passing the environmental costs of waste management to communities which are not responsible for its generation, and reduces the environmental costs of transporting waste The self-sufficiency principle. The Governments believe that waste should not be exported from one country to another for disposal. Waste Planning Authorities and the waste management industry should aim, wherever practicable, for regional selfsufficiency in managing waste. With regards to the EU Waste hierarchy, not everything has gone well, however. A move towards a waste policy aimed at reducing health effects should put more emphasis on prevention and re-use. Presently, EU waste policy is not founded upon health data. Fortunately the available data on health effects from waste management do not conflict, and in important aspects even coincide with the hierarchy proposed by the EU. For example, waste prevention is deemed to be the most important (no waste equals no health effects), followed by re-use and recycling. Despite this, the lack of consideration of the environment and human health is clearly visible in EU policy. For instance, regulations put in place for incineration by the EU together, with national limits on this issue, are based on what is technically achievable rather than on health and environmental data. Although emission limits set in the new EU directive have resulted in the closure and upgrading of some older incinerators in European countries, the policy itself is already outdated with regard to the OPSPAR agreement to phase out the releases of all hazardous substances within one generation. The EU directive is based on the conception that small releases of hazardous
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substances are acceptable. This is the conventional (though misguided) approach, which proposes that chemicals can be managed at "safe" levels in the environment. However, it is already known, or is a scientific opinion, that there are no "safe" levels of many environmental chemical pollutants such as dioxins, other persistent, bio accumulative and toxic chemicals and endocrine disruptors. In addition, the abandonment of the principle is increasing in political circles.
Figure 34 - Waste hierarchy
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The Way Forward: Adoption of the Precautionary Principle and Zero release Strategy The
precautionary
principle
acknowledges
that,
if
further
environmental degradation is to be minimized and reversed, precaution and prevention must be the overriding principles of policy. It requires that the burden of proof should not be laid upon the protectors of the environment to demonstrate conclusive harm, but rather on the prospective polluter to demonstrate no likelihood of harm. The precautionary principle is now gaining acceptance internally as a foundation for strategies to protect the environment and human health. Current regulation for incinerators is not based on the precautionary principle. Instead it attempts to set limits for the discharge of chemicals into the environment which are designated as "safe". In the current regulatory system the burden of proof lies with those who need to ‘prove’ that health impacts exist before being able to attempt to remove the cause of the problem and not with the polluters themselves. Based on knowledge regarding the toxic effects of many environmental chemical pollutants, which has accumulated over recent decades, a more legitimate viewpoint is that "chemicals should be considered as dangerous until proven otherwise". We have now reached a situation, and indeed did some time ago, where health studies on incineration have reported associations between adverse health effects and residing near to incinerators or being employed at an incinerator. These studies are warning signs that should not result in government inactivity, but rather to decisions being taken which implement the precautionary principle. There is already sufficient human health and environmental contamination evidence to justify a phase out of the incineration process based on the precautionary principle. To wait for further proof from a new generation of
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incinerators from an already harmful and dirty technology would probably be a blatant disregard for the environment and human health. The aim of "zero discharge" is to halt environmental releases of all hazardous substances. Although it is sometimes discussed as being simplistic or even impossible, it is a goal whereby regulation can be seen as resting places on the way to achieving it.
Zero discharge necessitates the adoption of clean production techniques both in industry and agriculture. It is essential that the change to clean production and material use should be fully supported by fiscal incentives and enforceable legislation. The principle of clean production has already been endorsed by the Governing Council of the UNEP and has received growing recognition at nation level. The way forward for waste management in line with a zero emissions strategy and hence towards sustainability, lies in waste prevention, re-use and recycling. In other words the adoption of the already well-known principle of "REDUCE, RE-USE AND RECYCLE". IMPLEMENTATION OF REDUCE, RE-USE AND RECYCLE We live in a world in which our resources are generally not given the precious status by industry and agriculture which they deserve. In part, this has led to the creation, particularly in industrialized countries, of a "disposable society" in which enormous quantities of waste, including "avoidable waste" are generated. This situation needs to be urgently changed so that the amount of waste produced both domestically and by industry is drastically reduced.
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However, far more action is presently required to stimulate the change needed for much more waste reduction to become a reality. Current levels of recycling in European countries vary considerably. For instance, the Netherlands recycles 46% of municipal waste whereas the UK only manages 8%. Intensive re-use and recycling schemes could deal with 80% of municipal waste. It is recognized that fiscal measures can play a considerable role in encouraging re-use and recycling schemes whilst discouraging least desirable practices such as incineration and landfill. Measures to be taken in the drive towards increased waste reduction, re-use and recycling, and therefore towards lessening the adverse health effects from waste management should include:
•
The phase out of all forms of industrial incineration by 2020, including MSW incineration. This is in line with the OSPAR Convention for the phase out of emissions, losses and discharges of all hazardous substances by 2020.
•
Financial and legal mechanisms to increase re-use of packaging (e.g. bottles, containers) and products (e.g. computer housings, electronic components).
•
Financial mechanisms (such as the landfill tax) used directly to set up the necessary infrastructure for effective recycling.
•
Stimulating markets for recycled materials by legal requirements for packaging and products, where appropriate, to contain minimum amounts of recycled materials.
•
Materials that cannot be safely recycled or composted at the end of their useful life (for example PVC plastic) must be phased out and replaced with more sustainable materials.
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In the short term, materials and products that add to the generation of
•
hazardous substances in incinerators must be prevented from entering the waste stream at the cost of the producer. Such products would include electronic equipment, metals and products containing metals, such as batteries and florescent lighting, and PVC plastics (Vinyl flooring, PVC electrical cabling, PVC packaging, PVC-u window frames etc) and other products containing hazardous substances. TABLE 11 - JOB CREATION: REUSE & RECYCLING VERSUS DISPOSAL IN THE UNITED STATES EF
EFA
DA
C DFA EFA F A
F CF A
C D EF
A
B
F
EB
E F BA
FF F
B
B
A
E
CF
AFAC
EFFB F BB B F B E B F
C
B E E
E EFFE
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C
7.2.4 - LANDFILL METHOD OF SOLID HOSPITAL WASTE DISPOSAL Landfill is a site for the disposal of waste materials by burial. In the past there have been problems with old, poorly managed landfills contaminating waterways and releasing dangerous landfill gases. However, modern municipal landfills are better managed with greater emphasis on avoiding environmental effects. Modern municipal landfills still work by burying waste, but in contrast they are highly engineered, controlled and monitored. They have liners to contain leachate, a leachate collection and treatment system, a cap to reduce rain infiltration and a monitoring system to assess the environmental effects.
Components of a Modern Landfill 1.
Landfill liners: The first stage is to construct a landfill liner in order to
contain the landfill material and leachate. The most suitable sites will have a natural clay liner; however the minimum acceptable is 6000mm of compacted clay with a low permeability coefficient. This acts as a barrier, preventing leachate from the landfill seeping into nearby aquifers or surface water bodies where it could cause contamination. In addition to a clay liner, a plastic liner may also be required for further protection of the surrounding environment. 2.
Leachate collection and treatment systems: A series of pipes is installed above the liner to collect the leachate at the bottom of the landfill. The leachate is then piped to a leachate storage pond or holding tanks for further treatment.
3.
Landfill gas collection system: Landfill gas is produced from organic waste disposed of in landfill. A landfill gas collection system is also installed and consists of a series of perforated pipes laid within the waste connected to a gas well from which the gas will be extracted. Collecting landfill gas is important because it is high in methane, a potent greenhouse gas. The gas may then be used by burn off or flares, or it may be used to generate electricity.
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4.
Monitoring system: This is in order to assess the environmental effects of the landfill and may include leachate and landfill gas monitoring, an odor control programme and a vermin control programme.
5.
Landfill cap: When a landfill reaches the end of its life, it is closed and capped with a layer of compacted clay and sometimes plastic sheeting. The capping must be at least 600mm think and have a finished slope to minimize water infiltration.
Clean fill A clean fill is another means of landfilling waste. However, unlike modern municipal landfills, there are little or no containment measures for a cleanfill. A clean fill disposal site is usually an active or old quarry site in which inert material is used to fill in the hollow created by excavation. Inert material means material that will not cause significant adverse environmental or health effects i.e. gravels, clays, soils, concrete, bricks, asphalt, chip seal, pavers and similar construction and demolition wastes. Clean fills should not take garden waste, timber, metals or other waste that could undergo any significant physical, chemical or biological reaction to cause leachate or gas. In June 2006 there were 33 cleanfill sites within Canterbury. 12 of these are within the Christchurch City area. In Christchurch they can serve the purpose of protecting groundwater resources by infilling old gravel pits with inert material. Cleanfill sites within Christchurch City are governed by their resource consent conditions from Environmental Canterbury and by the Christchurch City Council Cleanfill Licensing Bylaw.
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The Christchurch City Council Cleanfill Licensing Bylaw The Christchurch City Council Cleanfill Licensing Bylaw 2003 came into effect 1 March 2004 and sets out to encourage resource recovery. The Bylaw regulates the types of materials that can be disposed of at a cleanfill and promotes materials recovery, reuse and recycling.
Monofills A B B C D
A
BAA BA B E
F
DB A
BD C F AF
BAD
AB
BAD
BD
B
E
D
AD B
A DE
A
F A C
D
D
D B DEBD
F CB DE
C B F F
D DE
B
Page 113 of 224 113
D
DB A
A DEBD DE
BAD
A
BCB C
AB
BC B DB
C
B D
CA
DE
E
CA
DE C
DEBD F
A A A
C
D
B D
F CA
E A
BAD
B DE
BFF C DBF DE A B C
D
D DE C
BD
BAD
B A A FE BA
Figure 35 - Landfill site in Africa
PROBLEMS OF LANDFILLS Leachate: Leachate is the liquid that drains or 'leaches' from a landfill; it varies widely in composition regarding the age of the landfill and the type of waste that it contains. It can usually contain both dissolved and suspended material. The organic material decomposes, producing acids. These acids mix with rainwater, dissolve heavy metals and other toxics from the waste, and then percolate down through the landfill. If not stopped by a liner, this Leachate will eventually contaminate groundwater or surface water supplies. If a liner and collection system is in place, Leachate treatment becomes an additional problem and expense. However, even with a liner, all landfills eventually leak.
Page 114 of 224 114
Figure 36 - Leachate Pond
Greenhouse gases: The decomposition of organic material under anaerobic (without Oxygen) conditions produce large quantities of methane. Methane is a contributor to the “greenhouse effect,” which is driving global climate change. Landfill fires: Methane is also highly flammable, and landfill fires are common and difficult to put out. The uncontrolled burning of wastes in a landfill is likely to result in air emissions similar to those from incinerators. Vermin: The organic material can attract rodents and other pests. This is particularly problematic when landfills are located close to areas where people live or work.
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Odor: The rotting organics produce a strong, unpleasant odor. Waste of land: Landfills consume huge areas of land, often near metropolitan areas where available land is scarce. Waste of materials: Landfills remove resources, both organic and inorganic, from the economy in much the same way as do incinerators. In Southern countries, landfills are even worse than in the North, as they are often no more than unlined open dumps, scavenged by both people and animals. The precarious living of such resource recoverers has been dramatically demonstrated by the Payatas landfill disaster in the Philippines, where 200 people were killed in a landfill collapse in 2000.
Figure 37 - Sanitary Landfill - Area Method
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Figure 38 - Sanitary Landfill - Area Method
Figure 39 - Sanitary Landfill - Trench Method
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Figure 40 - Sustainable Landfill
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PVC: THE POISON PLASTIC PVC is a commonly used plastic found in baby shampoo bottles, packaging, saran wrap, shower curtains and thousands of other products yet there is little public awareness of its serious health and environmental impacts. Hospitals use plastics because they fear a spread of infection through the use of reusable medical equipment. Thus, plastic use has grown with increasing concern for infection control. However, there have been cases where even with the use of plastics there has been a spread of infection in wards. Nurses complained of nosocomial infections in wards even though disposable equipment was used — they related it to improper waste disposal of disposable equipment within the wards. PVC is a thermoplastic, with approximately 40 percent of its content being additives. Plasticizers are added to make PVC flexible and transparent. •
Medical equipment made from PVC:
•
Blood bags, breathing tubes
•
Feeding tubes, Pressure monitor tubes
•
Catheters, Drip chamber
•
IV Containers, Parts of a syringe
•
IV Components, Lab ware
•
Inhalation masks, Dialysis tubes In the U.S., an estimated 300 billion pounds of longer-lasting PVC
products, such as construction materials that last 30 to 40 years, will soon reach the end of their useful life and require replacement and disposal. As much as 7 billion pounds of PVC are discarded every year in the U.S. PVC disposal is the largest source of dioxin-forming chlorine and phthalates in solid waste, as well as
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a major source of lead, cadmium and organ tins-which pose serious health threats. Short-lived products account for more than 70% of PVC disposed in America's solid waste with 2 billion pounds discarded every year, including "blister packs" and other packaging, plastic bottles and plastic wrap. PVC was promoted in industries as a replacement of metals. Therefore its use increased in all types of industries very rapidly. But side effects are so dangerous that we should avoid its use.
Figure 41 - Trends in U.S PVC Consumption
8.1 - SUMMARY OF KEY FINDINGS OF THE FIVE EU STUDIES PVC WASTES ON THE INCREASE: The amounts of PVC wastes are projected to increase more than 80% over the next 20 years, from 4.1 to 7.2 millions tones/year. Almost 90% of these wastes are post consumer wastes. CONSUMPTION OF PVC IN EUROPE The consumption of final PVC products according to application sectors in Europe and in some Member States is shown below: Page 120 of 224 120
Europe Building Packaging Electronics/cable Transport/cars Furniture Others
53 % 16 % 9% 3% 3% 16 %
Austria
Germany
Denmark
France
81 % 2% 8% 4% 2% 3%
60 % 11 % 8% 4% 3% 14 %
69 % 8%
50 % 30 % 8% 6%
23 %
6%
TABLE 12 - Source: Europe, Austria, Germany (AgPU, 1997), Denmark (Moeller et al., 1996), France (PVC working Group, 1999)
8.2 - INCINERATION – MAKING THINGS WORSE: Incineration of 1 kg of PVC in the EU creates on average 0.8-1.4 kg of hazardous wastes (in incinerators with non-wet flue gas treatment) and 0.4-0.9 kg of residues in liquid effluent (in incinerators with wet flue gas treatment). Hazardous waste from PVC incineration will also be more likely to contaminate the environment, as PVC increases the amount of Leachate and leach able salts in this waste significantly. Incineration of PVC creates additional costs between 20-335 Euro/tonne. PVC is responsible for 38 to 66% of the chlorine content in Municipal solid waste. The formation of dioxins due to PVC has been beyond the scope of the study. Diverting PVC from incineration always leads to environmental improvements. Nevertheless, PVC incineration is estimated to increase more than fivefold over the next 20 years in a business-as-usual scenario, from currently 0.5 million tones/year to 2.6-2.9 million tonnes/year. DON'T BURN IT: THE HAZARDS OF BURNING PVC WASTE •
More than 100 municipal waste incinerators in the U.S. burn 500 to 600 million pounds of PVC each year, forming highly toxic dioxins and releasing toxic additives to the air and in ash disposed of on land.
•
Open burning of solid waste, which contains PVC, is a major source of dioxin air emissions. Backyard burning of PVC household trash is
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unrestricted in Michigan and Pennsylvania, partially restricted in 30 states and banned in 18 states. •
The incineration of medical waste is being steadily replaced by cleaner non-burn technologies.
•
When burned, PVC plastic forms dioxins, a highly toxic group of chemicals that build up in the food chain, can cause cancer and harms the immune and reproductive systems.
•
PVC is the leading contributor of chlorine to four combustion sources municipal solid waste incinerators, backyard burn barrels, medical waste incinerators and secondary copper smelters that account for an estimated 80% of dioxin air emissions (USEPA).
TOP TEN STATES INCINERATING PVC AMOUNT OF PVC INCINERATED (TONS)
NUMBER OF INCINERATORS
PERCENT INCINERATED(AFTER RECYCLING)
FLORIDA
45,364
13
37.1%
NEW YORK
37,517
10
24.4%
MASSACHUSETTS
28,145
7
54.6%
VIRGINIA
18,806
5
27.9%
PENNSYLVANIA
17,746
6
22.6%
CONNECTICUT
16,257
6
55.4%
MINNESOTA
14,432
15
46.1%
MARYLAND
12,486
3
22.6%
MAINE
5,448
4
66.2%
HAWAII
3,454
1
32.7%
NEW HAMPSHIRE
1,675
2
22.2%
REMAINING STATES *
49,075
32
VARIES
TOTAL
250,405
104
STATE
TABLE 13 – TOP TEN STATES INCINERATING PVC
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10.5%
PVC PRODUCTS + WASTE INCINERATORS OR OPEN BURNING = DIOXIN EMISSIONS
Dioxin formation is the Achilles heel of PVC. Burning PVC plastic, which contains 57% chlorine when pure, forms dioxins, a highly toxic group of chemicals that build up in the food chain. PVC is the major contributor of chlorine to four combustion sources—municipal solid waste incinerators, backyard burn barrels, medical waste incinerators and secondary copper smelters—that account for a significant portion of dioxin air emissions. In the most recent USEPA Inventory of Sources of Dioxin in the United States, these four sources accounted for more than 80% of dioxin emissions to air based on data collected in 1995. Since then, the closure of many incinerators and tighter regulations have reduced dioxin air emissions from waste incineration, while increasing the proportion of dioxin disposed of in landfills with incinerator ash. The PVC content in the waste steam fed to incinerators has been linked to elevated levels of dioxins in stack air emissions and incinerator ash. Incineration and open burning of PVC-laden waste seriously impacts public health and the environment. More than 100 municipal waste incinerators in the U.S. burn 500 to 600 million pounds of PVC each year, forming highly toxic dioxins that are released to the air and disposed of on land as ash. The biggest PVC-burning states include Massachusetts, Connecticut, Maine—which all burn more than half of their waste— Florida, New York, Virginia, Pennsylvania, Maryland, Minnesota, Michigan, New Jersey, Indiana and Washington. The incineration of medical waste, which has the highest PVC content of any waste stream, is finally being replaced across the U.S. by cleaner non burn technologies after years of community activism and leadership by environmentally-minded hospitals. Backyard burning of PVC-containing household trash is not regulated at the federal level and is poorly regulated by the states. There are no restrictions on backyard burning in Michigan and Pennsylvania. It is partially restricted in 30 states, and banned in 18 states. Page 123 of 224 123
8.3 - RECYCLING – NOT SOLVING THE PROBLEM: Recycling was found not to be qualified to contribute significantly to the management of PVC waste in the next decades, reaching at most 18% of total waste in 2020. Assuming that the maximum potential of PVC recycling is achieved, incineration of PVC waste would still increase more than fourfold to 2.2-2.5 million tones in 2020. Current recycling rates are at less than 3%. Most current recycling (2%) is down cycling - the recycling of PVC into low quality recycled that do not replace virgin PVC – and therefore has no environmental benefits. Almost all PVC wastes contain hazardous additives. Recycling these wastes leads to a spreading of these hazardous substances into new products. High-quality recycling of PVC wastes without spreading lead, cadmium or PCBs into the recycled is estimated to reach a maximum of 5% by 2020. Chemical recycling was found to be not economically viable. PVC PRODUCTS + RECYCLING = CONTAMINATION OF THE ENTIRE PLASTICS RECYCLING PROCESS Unfortunately, PVC recycling is not the answer. The amount of PVC products that are recycled is negligible, with estimates ranging from only 0.1% to 3%. PVC is very difficult to recycle because of the many different formulations used to make PVC products. Its composition varies because of the many additives used to make PVC products. When these different formulations of PVC are mixed together, they cannot readily be separated which is necessary to recycle the PVC into its original formulation. It’s also virtually impossible to create a formulation that can be used for a specific application. PVC can never be truly recycled into the same quality material—it usually ends up being made into lower quality products with less stringent requirements such as park benches or speed bumps. When PVC products are mixed in with the recycling of non-chlorinated plastics, such as in the “all-bottle” recycling programs favored by the plastics industry, they contaminate the entire recycling process. Although other types of non-chlorine plastics make up more than 95% of all plastic bottles, introducing
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only one PVC bottle into the recycling process can contaminate 100,000 bottles, rendering the entire stock unusable for making new bottles or products of similar quality. PVC also increases the toxic impacts of other discarded products such as computers, automobiles and corrugated cardboard during the recycling process.
8.4 - PVC PRODUCTS + LANDFILL DISPOSAL =GROUNDWATER CONTAMINATION Land disposal of PVC is also problematic. Dumping PVC in landfills poses significant long-term environmental threats due to leaching of toxic additives into groundwater, dioxin-forming landfill fires, and the release of toxic emissions in landfill gases. Land disposal is the final fate of between 2 billion and 4 billion pounds of PVC that are discarded every year at some 1,800 municipal waste landfills in the U.S. Most PVC in construction and demolition debris ends up in landfills, many of which are unlined and cannot capture any contaminants that leak out. An average of 8,400 landfill fires is reported every year in the U.S., contributing further to PVC waste combustion. LAND FILLING - THE TICKING TIME BOMB: Land filling of PVC results in the release of hazardous softeners. Releases of hazardous stabilisers cannot be excluded. Stabilisers are ingredients that are generally added to the PVC polymer in order to prevent thermal degradation and hydrogen chloride evolution during processing and to give the finished article optimum properties (heat and UV stability). Approximately 1-8 % may be added to PVC formulation depending on other components and the final application.
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The most important group of stabilisers are (based on Moeller et al, 1996) •
Metal salts (i.e. calcium and zinc stearates, basic lead sulphate and lead phosphate)
•
Organo metals (i.e. mono- and diorganotin, tin thioglycolate)
•
Organo phosphites (i.e. tri alkyl-phosphites)
•
Epoxy compounds (i.e. epoxidised Soya bean oil, sunflower oil and linseed oil)
•
Antioxidants, polyols (i.e. BHT, pentaerythritol) These releases will occur for a very long period of time - longer
than the guarantee of the technical barrier of the landfill. PVC waste will furthermore contribute to the formation of dioxins and furans in landfill fires. Ettala et al (1996) have investigated landfill fires in Finland. On average, there are 633 sanitary landfills in operation in Finland. In the period of 1987-92 between 360 and 380 landfill fires occurred annually. One-quarter were deep fires at a depth of more than 2m and a maximum depth of 8m. Deep fires are difficult to extinguish and last longer than surface fires. The most severe deep fires lasted for 2 months. Only four fires occurred in waste older than 2 years. In 400 sanitary landfills in Sweden, 200250 fires have been reported. According to international experts11, landfill fires are common in Iceland because of arson. Other replies considered that landfill fires are very uncommon but reliable statistics were lacking. Disposal of ash, deliberate fire starting and insufficient covering or compacting were reported to be the most common causes for landfill fires. Possible air flow through drainage pipes has been one reason for landfill fires in the U.K.
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ESTIMATED AMOUNTS OF PVC DISCARDED IN LANDFILLS ACCORDING TO STATES THAT LANDFILL THE MOST MUNICIPAL SOLID WASTE (MSW) NUMBER OF LANDFILLS
AMOUNT OF PVC LANDFILLED (TONS)
California
161
328,260
Texas
175
176,896
New York
26
116,088
Ohio
44
100,509
Illinois
51
98,896
Michigan
52
96,241
Florida
100
76,817
Georgia
60
69,177
Pennsylvania
49
60,844
New Jersey
60
56,166
North Carolina
41
54,842
Indiana
35
52,986
Washington
21
49,128
Virginia
67
48,636
Maryland
20
42,722
Remaining States *
805
610,553
STATE
Total
1,767
2,038,761
TABLE 14 – TOP STATES USING LANDFILL METHOD
By comparing the above data of incineration & land filling, the writer is of the opinion that land filling of PVC is a lesser evil as compared to the incineration. As incineration of PVC results in pollution of world’s atmosphere while land filling of PVC results in pollution of a specific piece of land.
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THE BEHAVIOR OF PVC UNDER SIMULATED LANDFILL CONDITIONS 1. METHODOLOGICAL APPROACH All investigations into the impact of landfill conditions on different materials or substances have to take two major factors into consideration: time and scale. To evaluate the behavior of PVC in landfills suitable methods had to be developed to overcome these factors. Investigations in earlier studies showed that the final state of organic substances in a staunch free landfill is always the same: an aerobic stabilised humic-like substance, nearly water insoluble. The same result can be reached by aerobic degradation within a much shorter time span. To achieve comparability between tests and the real behavior of PVC in landfill, PVC samples from a landfill were analyzed. At the second stage, examinations were carried out at container size under aerobic thermophilic conditions at a biological waste treatment plant. In laboratory scale the samples were exposed to aerobic thermophilic conditions, to anaerobic thermophilic conditions and to alternating aerobic-anaerobic conditions. CONCLUSION On the basis of performed analysis it is to conclude that PVCadditives during staying for more than 20 years in a landfill will neither degrade completely nor release completely from PVC products. 2. INVESTGATION OF BEHAVIOR OF PVC IN A BIOLOGICAL WASTE TREATMENT PLANT IN TECHNICAL SCALE Due to operation control of the plant the heat production which causes high temperature during aerobic degradation processes was restricted. Therefore the temperatures were generally lower than in lysimeter investigations. The intensive degradation phase in the waste treatment plant usually takes about 12 days dependent on the amount of waste to be treated. This phase is carried out in containers which will be emptied after that time. Therefore the PVC samples could not be stored in the waste continuously. The intervals of temperature of about 20°C in figure below show the times the PVC was stored while waiting for the next run of waste treatment.
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The PVC-materials changed during the incubation in the biological waste treatment plant. Both, optically and mechanically they showed differences to the raw materials. Analysis of the materials was carried out similarly to investigations during the lysimeter tests. Changes in materials were examined by electron scanning microscopy, tensibility tests, and analysis of molecular weight distribution and analysis of the contents of additives. Investigations on the behavior of PVC products in the biological waste treatment plant showed clearly recognizable effects on the PVC.
Figure 42 - Course of temperature and carbon dioxide production in lysimeter (aerobic, without added PVC)
The results show a clear loss of plasticiser during the lysimeter studies under aerobic thermophilic conditions within the short time of examinations. Measured losses from the materials taken from the lysimeters 4 and 6 are within the tolerance of the determination method. The trend towards a decreasing content of plasticiser is probable. A clear loss of plasticiser has occurred to the car interior material in the aerobic biological treatment plant supporting the results from lysimeter 2. The theory to explain the differences between the losses of plasticiser between the used car interior and the
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packaging foil with the dependence on the thickness of the material are strengthened by the results from lysimeter 6 and the biological treatment plant. In these investigations too the percentage of loss of plasticiser is higher from the thin material. The content of the plasticiser DIDP in both flooring materials shows no decrease following the aerobic treatment in lysimeter 2. On the one hand it could be explained with the fact that DIDP will leach much slower than DEHP or it would not leach out. Any loss of stabiliser leads to emissions in Leachate. The stabiliser content was investigated by analysis of the heavy metal contents before and after storing the PVC-materials in the lysimeters. In this investigation only the samples containing stabilisers based on heavy metals were tested. These are PVC II, PVC VI, PVC V, PVC VI and PVC VII. In spite of its content of Ba/Znstabiliser PVC III was not investigated because PVC II contains the same elements. The results are summarized in table below. Material
Examined condition
Contents of heavy metals in % by weight
Raw material Lysimeter 2; aerobic Lysimeter 6; Anaerobic
PVC II
PVC IV
Raw material Lysimeter 2; Aerobic Lysimeter 6; Anaerobic
PVC V
Raw material Lysimeter 2; Aerobic Lysimeter 6; Anaerobic biol. waste treatment plant
PVC VI
Raw material Lysimeter 2; Aerobic Lysimeter 6; Anaerobic Biol. Waste Treatment Plant
PVC VII
Raw Material Lysimeter 2; Aerobic
Ba
Zn
-
0,01 0,09 0,03
0,02 0,02 0,01
-
-
-
--
--
--
0,18 0,13 0,16 0,16
-
0,33 0,33 0,33 0,31
-2,8 1,2 1,8
TABLE 15 – PVC EXAMINATION RESULTS
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Pb
-
-----
-
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