medical waste in Serbia

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medical waste in Serbia
Doc. Dr Goran Vujic
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Medical waste and infectious medical waste (IMW)/1

• Medical waste is defined as any waste, generated
  in provision of health services
• diagnosis
• prevention
• treatment
• research in the field of human and veterinary
  medicine.
• MW is created in medical institutions, medical
  centers or laboratories.
• It is a heterogeneous mixture of waste, while
  10-25 is hazardous waste.
• In addition to health risk (result of direct
  contact) MW may have irreversible health effects
  through indirect contamination of water and land
  during the treatment and final disposal or air
  pollution due to insineration.

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Medical waste and infectious medical waste (IMW)/2
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Current situation in R.Serbia in terms of MW
management

• Medical waste in health care facilities in the RS
  is generated in uneven amounts, depending on
• the type of facilities,
• numbers of beds,
• type of diseases,
• conditions of care and types of services
  provided.
• In 2007 Ministry of Health of the Republic of
  Serbia started the specific activity in the
  introduction of uniform system of managing
  medical waste, a special category of infectious
  medical waste.
• Only a limited number of health institutions in
  RS carries out sterilization of IMW, mostly in
  very old but regularly maintained autoclaves.
• In individual health facilities used needles and
  syringes, cotton tufers and other IMW are mainly
  mixed with municipal waste without separation nor
  sterilization.

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Current situation in R.Serbia in terms of MW
management

• The goal for treatment of IMW is that it can be
  turned into harmless household waste.
• If the IMW is sterilized first, and then
  comminute in small pieces so it can not be
  recognized then it can be disposed to the MSW
  landfills.
• There are 50,988 beds in hospitals across RS, the
  average use of beds is 72 on a year level.
• There is an additional 2700 beds in military
  hospitals and private clinics.
• Estimated average amount of MW waste generated in
  health care facilities in RS is 1.8kg of MW per
  hospital bed per day, this quantity is valid for
  the countries of Eastern Europe (WHO).
• About 9.600t of the total amount of medical waste
  is considered hazardous waste.

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The concept of "central places for the treatment
of IMW"

• Estimated quantities of IMW generated in health
  facilities do not including the private sector
  and the sector of veterinary medicine.
• Research from 2008. showed that 100 registered
  visits to health centers produce 1kg IMW.
• Central place for treatment of IMW system
  requires the existence of a central treatment
  institutions (CTI) according to model of
  administrative districts.
• Under this system, autoclaves are set in places
  where is the higest production of IMW, which is
  inside the hospitals and clinical centers, which
  are by far the largest producers of waste.

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Plan for distribution equipment for IMW treatment

• Each of the mentioned districts was appointed and
  equipped with at least one health care
  institution, which is the largest manufacturer of
  IMW in a given district. Appointed CTI has the
  obligation to treat its own IMW and IMW generated
  from public sector health facilities in the
  county, and the network of health institutions.
• "Regulation of the plan network of health
  institutions" (article 47 of the Health Care,
  Official Gazette of the RS, No. 107/05).

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Plan for distribution equipment for IMW treatment

• Medical waste management system is based on the
  assessment and analysis of the current situation
  in the Republic of Serbia, which takes into
  account the constraints imposed by equipment that
  was purchased for thermal processing of IMW.

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Conceptual model relies on a generic topic with
the following three variations

• Model for medical waste management for the city
  of Belgrade.

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Conceptual model relies on a generic topic with
the following three variations

• City/area health insti-tution with tertiary
  health care (Ni, Kragujevac and Novi Sad).

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Conceptual model relies on a generic topic with
the following three variations

• The health area with an institution of secondary
  level health care, general hospitals, as well as
  central place of treatment.

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Handling infectious waste by steam sterilization

• Device which is made of waste steam sterilization
  (autoclave) must not carry a risk for personnel
  or general population.
• The basic requirement is that the process of
  steam sterilization leads to a sufficient degree
  of reduction of the biological agents content in
  waste.
• The following categories of waste can be treated
  by steam sterilization
• used sharp objects, syringes, tubes
• broken glass, objects from the smaller health
  facilities
• blood and contaminated fluids
• nonrecognizable tissue from diagnostic
  procedures, nonsurgicla waste originated from
  hemodialysis and peritoneal dialysis
• tufers, materials stained with blood and other
  bodily secretions and excretions, towels, diapers
  messy bodily fluids and/or excretions

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Health institutions equipped with system for
treatment of IMW

• "Technical assistance in management of medical
  waste
• Administrativ district of South Backa
• Clinical center of Vojvodina,
• Institute for Pulmonary Diseases of Vojvodina,
• Institute for Public health of Vojvodina,
• Health center of Novi Sad.
• Clinical center of Vojvodina
• General Hospital in Novi Sad,
• Maternity and nursery in Novi Sad,
• Childrens Hospital in Novi Sad.
• Health center of Novi Sad all health centers in
  administrativ district of Novi Sad.

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Steps in the process of IMW treatment

• Separation of waste in the place of generation
• Transportation of the waste to treatment
  facility
• Measurment of obtained waste
• Treatment of the IMW in autoclaves
• Sterilized IMW is fragmented
• After fragmentation, infectiv medical waste (IMW)
  is ready to be disposed
• Sterilized and fragmented IMW is desoposed in to
  conventional containers for comunal waste and
  then transported to a landfill
• Once closed bages and containers do not have to
  be open throughout the whole treatment proces.

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Clinical center of Vojvodina

• 3 autoclaves in clinical center of Novi Sad are
  donation from EU

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Clinical center of Vojvodina

• equippement for waste fragmentation is also
  donated from EU

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Clinical center of Vojvodina

• Containers and bags for IMW which are in use in
  Clinical center of Novi Sad (yellow colour is
  reserved for IMW)

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Health Center of Novi Sad

• There are 36 Health centers which are included in
  institution of Health center of Novi Sad and
  which use one facility equipped for treatment of
  IMW.
• Employees who work in the plant for treatment of
  IMW are trained technical workers of Health
  Center of Novi Sad.
• Some private clinics have sigened contract with
  Health center of Novi Sad for use of their
  facilitiy, as they do not own the equippementfor
  treatment of IMW.
• Maintenance of equippement for IMW treatment is
  performened by privete thired party licenced for
  this operation.

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Conclusions

• DONATION EU to SERBIA
• who pay now for operational, transport,
  maintenance and how much, why and where
• Landfill?