Healthcare Waste Management

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Healthcare Waste Management
We can meet the challenge.
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This World belongs to me. And to you. And to
your children. It's ours.
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• Recent media attention has increased the
  publics apprehension that medical wastes are
  not properly controlled. The prospect of AIDS
  contaminated medical waste have compounded this
  fear, so that panic can be created by the mere
  mention of the words infectious waste or
  hospital waste.IS THIS FEAR JUSTIFIED?

• World Health Organisation, infection control
  guidelines Most hospital waste is no more
  infective than residential waste, and hospital
  wastes disposal practices have not caused
  disease in the community.

• Not all waste from a health care facility poses
  a risk. Only between 10 and 15 of medical
  waste is considered infectious.

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• The word infectious, pathological and
  biomedical imply a degree of hazard and may
  cause unnecessary alarm as they are also used to
  describe material, which is neither human nor
  animal tissue.

• The SABS proposed code of practice says that all
  waste contaminated with blood or body fluids are
  classified as infectious waste.This enormously
  increase the volume of waste requiring expensive
  handling and disposal.Identical items of waste
  are disposed of from homes with no special
  handling or decontamination.

• The modern trend in hospital infection control
  is to build safe practices into all clinical
  procedures, the precaution taken is dictated by
  the risk accompanying the procedure, not by the
  diagnosis.

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• The simple presence of viable organisms does not
  constitute a hazard a mechanism by which these
  organisms can infect a host must coexist.

• Absolute elimination of all risks is
  impossible.A realistic goal is a reasonable
  degree of safety at all times without
  compromising efficiency and priorities.

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

• This can only be achieved by all health care
  facilities having a documented policy and
  procedures and the staff is properly trained.

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• Disposal in a landfill site is a common method,
  and is appropriate for many varieties of medical
  waste. (Infectious non-anatomical waste) (WHO)

• If some infectious material is present in the
  waste transported to the landfill, the
  concentration of pathogens is reduced by soil
  filtration.

• An organism passing further into the soil bed is
  denied the nutrients, oxygen and other conditions
  necessary for survival. The only special
  requirement for the disposal of infectious wastes
  in a landfill is that the wastes be rendered
  unrecognisable and unreusable.

• The sanitary sewer system is a safe and
  acceptable method of disposal for untreated bulk
  blood, suctioned fluids excretions, secretions,
  and other infectious wastes that can be ground
  and flushed into the sewer.

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• The sewer system is designed to attenuate sewage
  which is already an infectious material and is,
  therefore effective in attenuating infectious
  agents found in blood and other body fluids.

• Grinding and sewering of wastes constitutes
  immediate removal of the infectious waste,
  eliminating storage, transport, handling and
  treatment costs.

• When wastes are treated in this manner, the
  waste should be poured carefully to eliminate
  spills and the formation of vapours. The
  municipal sewerage treatment system should have
  secondary treatment available, and the practice
  should meet with the approval of all applicable
  local sewerage by laws.

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• The mission of any medical treatment technology
  should be three fold 1. Render the material
  non-infections and the processed waste 100
  recyclable. 2. Render the material
  unrecognisable, unreusable. 3. Be
  environmentally friendly.

It should address the entire spectrum from
point of generation to final disposal, all within
an infectious control paradigm. It should
provide maximum security against nosocomial risks
and provide maximum safety to the health worker,
from clinician to janitor. It should guarantee
comprehensive training, safety for the
communities and zero negative environmental
interfaces, i.e. be environmentally friendly.
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• Present management systems are still largely
  based on a dispose, dilute and disperse
  approach.A fundamental switch is required
  towards a recycle, concentrate and contain
  approach.

• However, recycling is not an end in itself, it
  should not be carried out if there is no net
  environmental gain when more fuel and material
  usage and more pollution occur through reuse than
  would have occurred if new products were made
  with virgin resources.

• We can not enjoy zero-environmental risk founded
  in zero exposure to pollution.A balancing
  process is required, in which acceptable
  trade-offs between risk levels and the costs of
  reducing exposures are struck.

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Environmental health risks, natural or of human
origin, are an ever-present feature of human
life.
Waste disposal facilities have suffered from the
NIMBY (not in my backyard) syndrome.
Why is it that people perceive the health risks
to be unacceptable when formal analysis does not
confirm these perceptions?
Experts tend to use the relative-risk approach
the risk posed by toxic chemical exposure from
a waste site versus risks like smoking,
alcoholism, poor diet, traffic accidents.
On this basis the medical waste hazard can be
shown to be a relatively low risk.
Individuals, however, continue to see risks as
absolutes and often involuntary, perhaps because
of misinformation and misperception.
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The main issue with incinerators is emissions.
Burning waste does not make it disappear.
Depending on the type of waste, up to 100
chemicals can be emitted into the atmosphere.
A common emission is Dioxins, the toxic
component of Agent Orange which was used during
the Vietnam War.
Dioxins are carcinogenic, depress the immune
system, and disrupt the reproductive and hormonal
systems.
Dioxin is one of 12 persistent organic pollutants
pops that have been prioritised for immediate
action under the global POPS Convention, to which
SA is a signatory.
SA intends to be on the forefront in meeting the
objectives set in Rio, in the Kyoto Protocol and
more recently in the UN Convention on Sustainable
Development.
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Health vs Health Care Projects
Health Care implies having to remedy
sicknessHealth A state of freedom from
all that illness brings.
Between 70 and 80 of diseases is caused by
incorrect lifestyles and inappropriate
environment.
So, shouldnt we think deeply about how we are
living to avoid the lowered quality of life and
greater financial costs that serious disease can
bring?
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Preventive Healthcare Biology 27
(6.9) Environment 13 most
important Healthcare 19 (1.5)
causes of death
11 (90.6) Lifestyle 43 (1.2)
Distribution of causes of death
Dever, 1976() Distribution of public
budget Hjort, 1984
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Causes of Health A B Lifestyle -
Activities within the working, living,
Environment recreation C.
Contribution of health care D.
Genetical causes B
20 C 10 A 50
D 20 Kalla Ingemar
Norling Gotenborg University
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The existence of more than 1 billion people
worldwide without drinking water and 2.8 billion
without sanitation and in contaminated and
polluted environments, is a pungent example of
the urgent need for preventive health to be seen
in its entirety, tackling the causes of ill
health instead of the symptoms.
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WASTE MANAGEMENT FAILURES

• Poor segregation of waste Up to 80 of
  infectious waste consisted of cans and bottles
  of cooldrinks, magazines, food, CSSD sterilized
  paper and other general waste.

• Clear directives and commitment related to waste
  minimisation and management of waste, including
  the monitoring of volume generated and the
  financial implications for each waste stream.

• No clear understanding of medical waste Only
  between 10 and 15 of medical waste is considered
  infectious.

• Cradle to grave protocols not available

• No policy and procedure regarding requisitioning
  or rotation of stock, to prevent overstocking
  and lapsed expiry dates of consumables and
  pharmaceuticals.

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• Education of the staff and public is not getting
  through

• No structured orientation and induction in
  service education programmes that include waste
  management for all categories of staff.

• Collection of waste from the various areas not
  always satisfactory.

• Lack of continuity due to rotation of staff and
  leave.

• Lack of commitment by institutional managers to
  manage and monitor the entire medical waste
  flow, from initiation to disposal.

• Institutional managers either do not see it as
  high priority or are powerless to enforce good
  medical waste segregation.

• A non care less attitude by the staff concerned.

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HCRW Treatment Technologies

• Incineration
• Chemical treatment
• Microwave treatment
• Plasma Arc
• Steam based thermal treatment

STEAM BASED THERMAL TECHNOLOGY
Incineration as long been the preferred disposal
method of medical waste, in South Africa besides
dumping it!!!
Concerns about, emission, the composition of the
resulting ash and its disposal, and social and
environmental responsibility awareness have
prompted the development of cleaner, more
environmentally friendly alternatives in line
with the Internation Convention on Sustainable
Development.
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• One of the new technologies based on Steam
  Thermal Treatment is the so-called ETD, Electro
  Thermal Deactivation.

• It uses low frequency radio waves and an imposed
  high-energy field to inactivate medical waste and
  destroy pathogens such as viruses, vegetative
  bacteria, fungi, yeast and spores, without
  combusting the waste.

• The processed waste, with a microbial level
  reduced by 6 logs, can then be recycled.The
  sterilising agent renders HCRW sterile to the
  level of a 6 log 10 kill (99.999).The term
  kill means microbial inactivation.Log kill is
  defined as the difference between the logarithms
  of number of viable test micro organisms before
  and after treatment.

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A log kill of 6 is equivalent to a millionth
(0.000001) survival probability in a population
of a 99.999 reduction of the population.
The ETD process converts the HCRW into treated
decontaminated solid waste.
This process involves the pre-shredding of the
waste, addition of water, compaction of the waste
and exposure to a low frequency oscillating
electric field (10 mHz field at 50.000 volts),
which takes place in an insulated fully enclosed
tube, and is operated under vacuum.
The treated waste is cooled and compacted before
disposal.
This process generated no liquid effluent.There
are no emissions, effluent or harmful material of
any kind.
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In the compacting room, the treated waste is
delivered into a standard compactor box, reducing
the volume by as much as 85.
Operating ETD plants can process up to 50 tons
per day HCRM.
The material can now either be disposed of at a
general landfill site or, wherever possible
recycled.
There is no harmful interface with the
environment, as the processed waste is 100
recyclable.
A cradle to grave control of each individual
container is conducted through electronic
readers, capturing the identity of each container
and its total mass.
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THE RECEIVING ROOM

• Incoming waste is received in approved
  Steri-Tubs.
• Manually loaded onto a conveyor that will feed
  the bins onto a weighing station.

• The identity of each container will be captured
  electronically together with its total mass.
• Manually opened for further visualization.

• Passed onto an electronic sniffing area that
  will detect for the presence of hydro-carbons and
  radio-active materials.
• Fed to an automated tipping system which will
  discharged the contents of the bin, complete with
  red liners into the fully enclosed and sealed
  processing room via a receiving chute.

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THE RECEIVING CHUTE

• A dual screw conveyor transfers the waste to the
  process room.
• The containers and lids are diverted to the wash
  bay for a stringent cleaning process.

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THE WASH BAY

• The container sanitation system consists of the
  following six steps.

1. An anti-microbial soap solution
2. A high temperature (82ºc) high pressure spray
3. A second high temperature, high pressure spray

4. A biocide disinfectant 5. The container/lid
is then air-dried at 71ºc 6. Manual
visualization and inspection
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THE PROCESSING ROOM

• The size reduction system the material is
  ground to a uniform scale.
• The size reduction occurs under negative
  pressure.

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THE CYCLONES

• Ground up material transferred via sealed
  high-velocity ducts to the low energy cyclone
  where by centrifugal force, the material is
  separated from the transport air.
• Transferred to a high energy cyclone for
  further separation of material.

• Then passes through a dust collector equipped
  with fixed pre-filter panels.
• Then goes through a HEPA filter and an air wash
  system prior to exiting the process room.

NOTE The air that goes to atmosphere is cleaner
than the air even breathed in the plant.
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ELECTRO THERMAL DEACTIVATION TUBE THE MAGIC TUBE

• Bio-Burden Reduction

• Microbes are organic material composed of
  individual cells. Cells consist of a nucleus
  in a lipid solution enclosed within a membrane
  wall. The ETD process applies three principles,
  which result in cellular lysis and subsequent
  bio-burden reduction.

• Selective Absorption of Energy
• Dipolar Rotation of Liquid Molecules
• Imposed High Voltage Field.

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CONVEYOR TO COMPACTION COMPRESSOR ROOM

• The waste cools along this conveyor.
• Compaction at a rate of 86 takes place in the
  compaction room.

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