The Need of an Integrated Waste Management Strategy for Medical Waste

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The Need of an Integrated Waste Management
Strategy for Medical Waste

• Susanne Dittke (EnviroSense CC)
• (M Sc) Chemical Engineering
• Waste Reduction Advisor for
• City of Cape Town (CMC Administration)
• Waste Management Department

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Data on Medical Waste Generation in Southern
Africa

• Occupancy rate per bed per day
• 1-1.2 for government hospitals
• 0.6 for private hospitals (KZN study)
• Medical waste generation data
• 0.4 kg/patient/bed (KZN)
• (data from Lombard and Associates)

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Typical SA hospital scenario (1)

• Government hospital with 900 beds
• Medical waste load going to private waste
  contractor 20 500 kg /month or 675 kg/day
• Disposal cost R 43 800/month
• With occupancy rate of 1 675/900
• 0.75 kg/patient/day
• This is about 1.87 times higher than the KZN
  study suggests
• ?

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Typical SA hospital scenario (2)

• From hospitals waste manager daily experience
  education on prevention and better separation of
  domestic and medical waste in the wards would
  reduce waste output from about
• 675 kg ? 180 kg medical waste/day
• 0.2 kg/patient/day REAL medical waste
• Possible savings R 32 120 per month
• Possible waste reduction 15 000 kg/month

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Dutch medical waste facts
0.25 kg/bed/day (provincial average) 0.12
kg/employer/day In 1996 Slotervaarthospital
accepted increasing social responsibility by
environmental declaration based on prevention,
control measurements, recycling, transport
management and licensing
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Getting the priorities right

• Prevention (product change to multi-usable items)
• Separation (education/better ward management)
• Internal Re-use (wherever possible e.g. pipettes)
• Transport, treatment and disposal/(incineration)
  of remaining real medical waste

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DEATs NWMS Hierarchy
Prevention
Reduce
Minimisation
Re-use
Recycling
Recovery
Composting
Physical
Treatment
Chemical
Destruction
Disposal
Landfill
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Applied Medical Waste Management Strategy
(Netherlands)

• 120 Prevention options identified. About 78
  of options reduce harmful hospital waste/chemical
  waste and 65 result in financial savings
• replacement of products/materials (65),
• better housekeeping (15)
• technological change/internal recycling (10)

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Evaluation of waste prevention (product change)

• Recycling of kidney dishes (rust-resistant or
  synthetic instead of carton)
• Questions to answer Waste amount reduced ?
• Purchase
  costs ?
• Necessary amounts ?
• Frequency of use ?
• Result savings of about R 150 000/annum
  (calculated over 5 year period)

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Medical Waste Incineration Facts

• Increasingly negative public image due to
• high levels of dioxins, furanes and mercury and
  toxic ashes generation
• local and regional health impact
• high cost involved for state of art technology
• difficult to evaluate emission levels in
  start-up/emergency conditions
• waste treatment cost high
• no incentive for medical waste reduction

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Alternatives to Incineration (some are currently
investigated by CCT)

• Gamma Radiation
• Electro-Thermal Deactivation
• Microwaving Technology
• Plasma Torches
• Autoclavation Technology
• Laser Technology

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Electro-Thermal-Deactivation(for general medical
waste)

• Principle Oscillating energy field in a
  di-electric tube of low-frequency radio waves
  heat waste to temperatures (95-100 oC). MOs
  absorb energy due to organic nature (water
  di-pole). Cell content starts to rotate in phase
  with frequency and the cell membranes burst
  destroying the cell completely
• ETD allows recovery/recycling of plastic waste
  fraction due to low temperatures
• Treated waste can be disposed at general LF

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Autoclavation (SteriCOMat)

• Treats waste at source (hospital)
• Eliminates need for costly and risky transport
• does not require huge installation or capital
  outlay
• complies with recent developments in the EU
  environmental law
• safely sterilizes clinical wastes (also
  contaminated with HIV, Hepatitis B)
• Remains can be treated as domestic waste

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The world we have created today has problems
which cannot be solved by thinking the way we
thought when we created them (Albert Einstein)