Health Care Waste Management (HCWM) Alternative Disposal Methods

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Health Care Waste Management (HCWM)Alternative
Disposal Methods

• Ohrid,
• Ana Petrovska

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Present practice

• On-site HCW Treatment by hospitals
• Internal treatment is done in small autoclaves
  and covers only HCW such as sharps, culture
  plates and small glass tubes with blood samples.
• plastic sharps box is used, but it is emptied and
  reused due to the relatively high costs of the
  boxes
• Following autoclaving the waste is without
  further treatment disposed into the municipal
  waste containers for disposal at the municipal
  landfill together with ordinary municipal waste.
• Although the waste has been sterilised via the
  autoclave treatment the sharps will still be
  intact and thereby pose a risk for the staff of
  the municipal waste collection company and
  scavengers at the landfill.

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Present practice (II)

• HCW Transport
• HCW is collected from HIs located in the urban
  area of Skopje using two dedicated trucks for
  this purpose, each equipped with 5 m3 open
  containers.
• The containers are coloured yellow and are marked
  with text informing this is medical waste being
  transported. During transport the open containers
  are covered with a tarpaulin to avoid spillage.
• For smaller HIs (typically private GPs and
  ambulatories) generating only small amounts of
  HCW a special yellow cardboard box is used for
  collection and transport in Skopje
• HCW from the Kumanovo area is collected by the
  General Hospital in Kumanovo using the hospitals
  own van the Health Centres van the same
  vehicles are used for transport to "Drisla".

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Present practice (III)

• HCW Disposal
• Currently the only external treatment and
  disposal of HCW, besides dumping at municipal
  landfills together with ordinary waste without
  pre-treatment except as stated above, is the
  incinerator at Drisla Landfill.
• The incinerator cannot fulfil the requirements
  according to EU directive 2000/76/EC on waste
  incineration, nor will it within reasonable costs
  be possible to up-grade the incinerator to do so.
  
• Faculty of Veterinary Medicine in Skopje has
  installed a small incinerator for animal
  carcasses and other animal by-products.

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Options for future HCW disposalIncineration

• Advantages
• Non-recognizable remnants
• Volume reduction by 90
• Safe elimination of pathogens

• Disadvantages
• Intensive investment and operational costs for
  abatement of emissions in the air
• High maintenance costs
• Requires trained workers
• Ashes as an incineration product are hazardous,
  thus require adequate disposal standards

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Incineration (II)

• It is considered as an all round treatment
  option. Mercury containing waste (e.g. amalgam
  waste from dentists), as well as the radioactive
  waste and waste containing significant amounts of
  heavy metals may not be incinerated.
• There isn't legislation in place regulating
  emission of hazardous substances originating from
  incineration in Macedonia
• Flue gas cleaning unit requires application of
  chemicals
• Ashes are considered hazardous waste, while in
  Macedonia there isn't any dedicated landfill
  accepting such waste
• Setting an Incinerator would require obtaining a
  stringent IPPC permit and regular monitoring upon
  operation

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Options for future HCW disposalAutoclaving

• Advantages
• Comparably lower investment costs
• Comparably lower maintenance costs
• Volume and weight reduction by 50 (shredding and
  evaporation of moisture)
• Comparably simple overseeing of operations
• No requirements for cleaning of flue gases
• Comparably low investment and operational costs

• Disadvantages
• Regular checking and replacement of safety
  modules is required
• Each charge must not be shorter than 15 minutes
  each charge treatment must strictly comply with
  the prescribed parameters regarding the duration
  and temperature
• Requires trained staff for operation

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Autoclaving (II)

• About 90 of the yearly amount of HCW
  (infectuous) can be treated in appropriate
  autoclaves.
• Chemicals, expired or unused pharmaceuticals
  including cytotoxic waste and mercury containing
  waste will remain problematic for disposal.
• Also the biological (pathological) waste may not
  be treated, depending on the selected autoclave
  type
• The HCW will after treatment be sterile and can
  be disposed of at a landfill together with
  ordinary municipal waste in compliance with the
  EU Landfill Directive waste volume is reduced
  due to the shredding.
• Setting an autoclave would require less stringent
  IPPC permit, while monitoring is not as demanding
  as for incineration, due to lower emissions