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CAPEGATE
What
Healthcare Waste Management
Aims at
CAPEGATE
Implementing waste
management
Why hospital waste management?
•Protection of the human health by reducing the exposure
of patients and the public to harmful goods
•Enhanced community relations by demonstrating a
commitment to environmental protection (positive press
coverage)
•Avoidance of long term liability (Responsibility of the
generator)
•High efficient, low cost waste logistic and disposal
•Increased employee morale, resulting from a healthier and
safer work environment
•Longterm savings of disposal costs
STEPS OF IMPLEMENTING
STATE OF THE ART
HEALTHCARE WASTE MANAGEMENT
SYSTEM IN HOSPITALS FROM CONSTRUCTION
OF THE HOSPITALS TO FINAL DISPOSAL and
RECYCLING OF THE WASTE
1- MEASURES TAKEN DURING CONSTRUCTION
2- IMPLEMENT OF A PROPER IN-HOUSE
HELTHCARE WASTE MANAGEMENT
PRACTICING
3- EXTERNAL LOGISTICS
4- FINAL DISPOSAL
SOURCES OF MEDICAL WASTE :
• Hospitals
• Diagnostic Centers
• Laboratories
• Blood Banks
• Nursing Homes
• Clinics
• Veterinary Hospitals % clinics
• Pharmacy shops
• Dialysis center
1- MEASURES TO BE TAKEN
DURING CONSTRUCTION OF
HOSPITAL
• Provisions for onsite segregation and
storage of all recyclables as glasses,
pallets, plasterboard, plastic, cardboard, textiles, etc.
• Provisions for internal logistics , storage and interim
storage of hazardous waste streams
• Provisions for hard-core, agricultural waste (green
waste) and general kitchen-like waste ( for instance
composting facilities )
• Provisions for establishing proper infection control
• Provisions for reducing waste generating materials
• Provisions for reducing the environmental impact to
environment
IMPLEMENT OF A PROPER
IN-HOUSE
HEALTHCARE-WASTE
MANAGEMENT PRACTICING
FOR IMPLEMENTING A PROPER
MEDICAL WASTE MANAGEMENT
PRACTICING ; WHICH CONSISTS
OF ;
• Planning
• Projecting
• Implementing
Healthcare Waste
(100 %)
Sharps include:
•Needles
•Scalpels and other blades
•Knifes and saws
•Infusions sets
•Broken glass
•Nails
METAN
Pathological waste
Waste, which should be treated in a special way out
of ethical reasons. Pathological waste is normally
not hazardous but needs special attention.
Consists of:
• Tissues
• Organs, Placentas
• Body parts
• Human fetuses
• Animal carcasses
• Blood
• Body fluids
Pathological Waste
• Human pathological wastes - tissues,
organs, body parts, containers of body
fluids
Animal Waste
• Contaminated animal carcasses, body
parts, animal bedding known to have been
exposed to infectious agents during
research
Definition of Hazardous Medical waste
Discarded biologic product, such as blood
or tissues, removed from operating rooms,
morgues, laboratories, or other medical
facilities. The term may also be applied to
bedding, bandages, syringes, and similar
materials that have been used in treating
patients, and body parts used in research
Simply, any waste–regardless of whether it
is potentially infectious–generated as a
result of Patient (man/animal) diagnosis
and treatment.
More simple, anything (can’t be
disinfected) that comes in contact with the
blood or body fluid .
Examples of hazardous wastes from non-medical operations
Includes:
•Expired-
•Unused-
•Spilt-
•Contaminated-
•-pharmaceutical products, drugs, vaccines and sera
METAN
Chemical waste
Consists out of discarded solid, liquid, and gaseous chemicals.
Chemical waste must be considered as hazardous if the substance
has at least one of the following
properties:
• Toxic
• Corrosive (pH <2 or pH >12)
• Flammable
• Reactive (explosive, water –
reactive, shock – sensitive)
• Genotoxic
• Hazardous for health
• Hazardous for the
METAN
environment
Heavy metal waste
Wastes with a high heavy metal content represent a
subcategory of hazardous chemical waste and are
usually highly toxic.
Includes:
• Broken thermometers
• Blood pressure gauges
• Batteries
• Amalgam
• Etc.
METAN
Genotoxic waste
Genotoxic drugs are mainly used in the anti-tumour
chemotherapy medicine (cancer treatment) and are
Highly hazardous and are showing following
characteristics:
• Mutagenic
• Teratogenic
•Cytotoxic
•Carcinogenic
Radioactive waste
Radioactive waste is mostly created during research,
investigation and cancer treatment. Most radioactive
waste has a short half-life time. Radioactive waste is as
highly hazardous waste
For example:
•Unused liquids from radiotherapy
or laboratory research
•Contaminated glassware
•Packages of absorbent paper
•Urine or excreta from patients
treated or tested with unsealed radio
nuclides
METAN
NOTICE !!!
If non-hazardous and hazardous waste streams are not
segregated properly and put all together, then;
the entire waste volume becomes hazardous and must
be disposed off properly
The path between these two points can be segmented schematically into eight
steps.
1. Waste minimization
2. HCW generation
3. Segregation and containerization
4. Intermediate storage (in the HCF)
5. Internal transport (in the HCF)
6. Centralized storage (in the HCF)
7. External transport
8. Treatment and final disposal
• Segregation
At the hospital the staff to separate
hazardous waste from domestic waste by
company providing different bag colors.
• Packaging and handling
Proper packing of waste according to it’s
nature (liquid, tissue, sharp object, etc..)
By providing different waste containers
(bags, boxes , etc , …)
BAD EXAMPLES TO
IN-HOUSE MEDICAL
WASTE MANAGEMENT
Momentary situation - segregation
If waste is mixed, the entire mixture must be classified as
hazardous waste and the costs will rise up. Momentary, an
efficient segregation system is not implemented.
Problems:
• Large amounts of
hazardous waste
• No segregation
equipment like colour
coded bins and bags are
available
• The waste generator are
missing awarness and
know-ledge
Momentary situation – segregation II
Problems:
• Risk of accidents during
transportation
• Spreading of germs in the
hospitals
• Difficult to interim store
the waste
• Waste is accessible to
strangers and rodents
METAN
Momentary situation - collection
The collection of the waste is done by the nurses or the
cleaning personal. Special training and equipment is not
available.
Problems:
• Untrained personal
• No operational
proceedings for spillages,
accidents, etc.
• High unawareness and
combined “easy going”
• Spreading of waste on the
premise ofMETAN
the hospital
Momentary situation - transportation
In large hospitals, waste chutes for the transportation of
waste are used.
Problems:
• Airborne, infectious diseases can
spread in the hospital
• Feeding and breeding place for insects
• Problematic removal of the waste
Momentary situation – interim storage
METAN
Momentary situation – Disposal
METAN
GOOD
EXAMPLES TO
IN-HOUSE MEDICAL
WASTE MANAGEMENT
Receptacle for highly infectious
waste
Puncture proof
Liquid proof
Irreversible closable
Autoclavable, without PVC
UN, local approved
Easy to handle
Coded
Labelling of receptacles
Classification, Waste-Number, Kind of waste, Responsible
UN-approved
containers
for infectious
waste
Sterilize able
transport
carts
Tiled room,
disinfect able
Temperature: 5-7°C
Practical sample:
storage for chemical waste
Sample of an interim storage for
chemical waste:
Necessary safety equipment
Different sections
Chemical waste is packed in a
suitable packing
Example:
Use of 770 l UN proved containers
Proved for the UN waste class 6.2 –
Bio hazardous waste of class I, II and III
(Low to medium infectious waste =
Typical hospital waste)
Transport of hazardous waste
External Transportation:
Periodically or on request, the
governmental licensed disposal
company comes and takes the
waste to the biomedical cell.
The hazardous waste must be
transported according to the
applicable laws.
The carrier must endorse the
receive of the quantity and quality
of the waste and will be responsible
for the waste after signing.
Transport of hazardous waste
External Transportation:
Periodically or on request, the
governmental licensed disposal
company comes and takes the
waste to the biomedical cell.
The hazardous waste must be
transported according to the
applicable laws.
The carrier must endorse the
receive of the quantity and quality
of the waste and will be responsible
for the waste after signing.
WASTE AMOUNT ???
• TOTAL
• HAZARDOUS
– BIO-MEDICAL
– CHEMICAL , etc.
Table 6.5. Total and Infectious Healthcare Waste Generation Rates by Type of Facility for Low-Income Countries
Type of facility Total HCW generation Infectious waste generation
Vietnam
Central general hospital 0.3 kg/bed-day
Provincial general hospital – cities 0.25 kg/bed-day
Provincial general hospital – other provinces 0.20 kg/bed-day
Provincial/central special hospital 0.05 – 0.30 kg/bed-day
District/branch hospital 0.20 kg/bed-day
Community health centre 0.1 kg/bed-day
Pakistan
Hospitals 2.07 kg/bed-day (range: 1.28-3.47)
Clinics and dispensars 0.075 kg/patient-day 0.06 kg/patient-day
Basic health units 0.04 kg/patient-day 0.03 kg/patient-day
Consulting clinics 0.025 kg/patient-day 0.002 kg/patient-day
Nursing homes 0.3 kg/patient-day
Maternity homes 4.1 kg/patient-day 2.9 kg/patient-day
Tanzania
Hospitals 0.14 kg/patient-day 0.08 kg/patient-day
Health centres (urban) 0.01 kg/patient-day 0.007 kg/patient-day
Rural dispensaries 0.04 kg/patient-day 0.02 kg/patient-day
Urban dispensaries 0.02 kg/patient-day 0.01 kg/patient-day
Table 6.6. Total and Infectious Healthcare Waste Generation Rates by Type of Facility for Middle-
Income Countries
Type of facility Total waste generation Infectious waste generation
South Africa
National central hospital 1.24 kg/patient-bed-day
Psychological Risk
Recycling Recycling
Shredding and Burial Special long
Incineration Landfill
Sterilization Cremation storage plant
8 01
Treatment and Disposal of the hospital waste
Recommended Operation:
• Special cassette for biomedical waste secured by
fence and guard
• Unloading of the waste from the transportation
container direct in the shovel of the wheel loader
• Bedding of the waste in the special cassette by the
wheel loader
• Covering of the infectious waste every evening
with a 0,15 m – 0,20 m thick soil layer
• If necessary, first covering with gypsum
• After one layer is filled, stabilization of the layer
with 0,5 m of construction waste
Landfilling of healthcare waste
Recommended Operation:
• Special cassette for biomedical waste secured by fence and guard
• Unloading of the waste from the transportation container direct
in the shovel of the wheel loader
• Bedding of the waste in the special cassette by the wheel loader
• Covering of the infectious waste every evening with a 0,15 m –
0,20 m thick soil layer
• If necessary, first covering with gypsum
• After one layer is filled, stabilization of the layer with 0,5 m of
construction waste
Example
Proposed Place
Way of working: Incineration
By incineration, hospital waste and the
pathogen agents are oxidized. State of
the art incinerators are two chamber
systems equipped with a two stage flue
gas treatment and a CEM-System.
While in the first chamber the waste is
pyrolsed at a temperature of 300 – 500°C,
in the second chamber the pyrolysis gas
is treated at a temperature of 800 –
1200°C.
The Existing Europeam Incinerating
Directives Require the Implementation
of Very Strict Emission Control and
Monitoring ( Directive 2000/76/EC )
STERILIZATION
HOSPlTAL WASTE SUITABLE
FOR STERILIZATION
METAN
HOSPITAL WASTE NOT SUITABLE
FOR STERILIZATION
Pharmaceuticals
Chemicals
Cytotoxic & Mycotoxic waste
Radioisotopes
Metals,equipment, lamps, furniture , etc.
METAN
WHICH ONE TO CHOOSE
ON-SITE
or
OFF-SITE
TREATMENT
METAN
Reasons for for preferring
OFF-SITE STERILIZATION,
central treatment plants
• More economic total investment cost (compared to the
opposite solution of on-site installations at each hospital ) for
the entire region where the plant is serving
• More economic operating costs compared to the opposite
solution of on-site installations at each hospital )
• So, cheaper solution in cost-concerned countries
• Easier to control by governmental or private authorities
• Possibility of Recovery of Recylable material from central
treatment plants
• Business oppurtunity for operating private companies or
municipalities
METAN
Akar Manufactures Medical Waste
Sterilizers in Two main Categories
• Post-shredding kind of medical waste
sterilizers ( Conventional autoclave
type )
• Pre-shredding kind of medical waste
sterilizers in Two Different Design
Concept
* Vertical
* Vertical + Horizontal ( L Type)
METAN
STANDAR MODELS WITH CAPACITIES
METAN
Post-shredding type
Shredder
METAN
FINALLY ENTIRELY NEW
CONCEPT HAS BECOME A TRUTH
RECYCLING OF STERILE MEDICAL
WASTE
PYROLYSIS TO PRODUCE
OIL AND CARBON BLACK
METAN
PROJECT PROPOSAL
•TRAINING
•PRACTICING HCWM
•STORAGE
•INTERNAL & EXTERNAL
LOGISTICS
•STERILIZATION
•INCINERATION
•PYROLYSIS
MAIN STAGES OF THE PROJECT
DEVELOPMENT OF
IN-HOUSE HCWM PRACTICING
A ) HAZARDOUS WASTE
THE FOLLOWING STEPS WILL BE IMPLEMENTED
1. AWARENESS AND UNDERSTANDING THE CURRENT SITUATION
2. WASTE MINIMIZATION
3. WASTE SORTING
NON-HAZARDOUS
RECYCLABLES
HAZARDOUS
BIO-MEDICAL ( INFECTIOUS, SHARP AND
NEEDLES )
PATHOLOGIC
CHEMICAL
RADIOACTIVE
4. CONTAINERIZATION
5. LABELING
5. INTERIM STORAGE AND IN-HOUSE TRANSPORT FOR
DIFFERENT WASTE STREAMS
B ) HOSPITAL HYGIENE AND SANITATION
ENVIRONMENTAL SAFETY AND CLEANING
DISINFECTION
OHSA AND PERSONAL SAFETY MEASURES
7 7 6 7
5 9
4
3 12 10
8
1
3 13 2
13
11
1 R efrigerated storage 2 Energy/W ater Supply, 3 Delivery Zone 4 S cale/Scanning Zone 5 Social room s
6 Entrance Zone 7 O ffice, A dm inis. 8 C ontainer W ashing P lant 9 Interim S torage 10 Pick U p Zone
4
3 12 10
8
1 13 2
3
11
1 Refrigerated storage 2 Energy/Water Supply, 3 Delivery Zone 4 Scale/Scanning Zone 5 Social rooms
6 Entrance Zone 7 Office, Adminis. 8 Container Washing Plant 9 Interim Storage 10 Pick Up Zone
METAN
HAZARDOUS WASTE
DISPOSAL
STATE OF THE ART
ENVIRONMENTAL FRIENDLY
INCINERATOR
• INCINERATOR
As one of the systems above ( The above prices are net buying prices )
• HOUSING:
Industrial plant specifications, may be steel construction, laminated sandwich panel
side walls and roof,
25 x 30 x 10 m (width x length x height) indoor
10 x 30 m + 20 x 20 m ( w x l ) outdoor
Indoor: Incinerator, operation control room, office, hygiene rooms, laboratory, technical
room
Outdoor: fuel tank, waste un-loading area, truck wash area, truck parking area, ask
storage area,
Waste storage containers room, hazardous waste storage rooms, Scale for waste
weighing
To be detailed alter upon acceptance of the incinerator offer
Requires architectural works and relevant expenses
• Laboratory and technical room:
A chemical analysis laboratory with the below equipment (minimum) is required to be
set up and operated:
• Flash point determination device
• Automatic bomb calorimeter
• Muffle furnace
• Laboratory oven
• Balance
• Moisture balance
• Basic laboratory apparatus and glassware
• Waste transport trucks :
Qty. 2-3-4
With hazardous waste transport compartments, air conditioned, lift and scale
• Waste storage containers & ash storage containers.
Galvanized steel waste bins
Qty. 200 -500 of 0.4 m3 capacity
• Fire fighting, first aid, hygiene equipment and reagents for the plant safety:
(depends on the local directives, regulations and laws)
• Truck wash and container wash unit:
Varies from manual to automatic:
CAPEGATE
WHAT WE NEED TO START THE PROJECT
1-WILLINGNESS
2-MOU TO ENTITLE CAPEGATE
EXLUSIVELY TO IMPLEMENT THE
PROJECT
3- CONTRACT WITH THE WASTE
GENERTATORS FOR 10-15 YEARS
4- LAND FOR INSTALLATION , 5 HECTARS
5-COOPERATION BETWEEN
GOVERNMENTAL AND PRIVATE PARTIES