Evaluation of medical waste incinerators in Alexandria

Medical establishments play important roles in different activities by using of modern technology to serve the humans and the environment through different departments in the establishment and its firms. Medical wastes are considered as a hazardous waste because they contain toxic materials, infectious, or non-infectious wastes and they are considered as a hazard to millions of patients, health care workers, and visitors. Treatment processes for medical wastes comprise autoclaving, microwaving, chemical disinfection, irradiation, plasma system, and incineration. Incineration is a thermal process, which destroys most of the waste including microorganisms. Combustion process must be under controlled conditions to convert wastes containing hazardous materials into mineral residues and gases. Hospital waste incinerators may emit a number of pollutants depending on the waste being incinerated. These pollutants include particulate matter, acid gases, toxic metals, and toxic organic compounds products of incomplete combustion, e.g., dioxins, furans, and carbon monoxide, as well as sulfur oxides and nitrogen oxides. So, there should be a reduction of emissions of most of these pollutants by air pollution control devices. This study was conducted in 51 medical establishments (ME) in Alexandria. To evaluate its incinerators. It was found that only 31.4% of total ME have their own incinerators to treat their medical waste. Also, the incinerators conditions were poor with incomplete combustion. So, the study recommend handling of all medical wastes of ME in Alexandria by the company which is responsible now for management of domestic solid wastes of the city.     

Management of medical waste in Tanzanian hospitals

A survey was conducted to study the existing medical waste management (MWM) systems in Tanzanian hospitals during a nationwide health-care waste management-training programme conducted from 2003 to 2005. The aim of the programme was to enable health workers to establish MWM systems in their health facilities aimed at improving infection prevention and control and occupational health aspects. During the training sessions, a questionnaire was prepared and circulated to collect information on the MWM practices existing in hospitals in eight regions of the Tanzania. The analysis showed that increased population and poor MWM systems as well as expanded use of disposables were the main reasons for increased medical wastes in hospitals. The main disposal methods comprised of open pit burning (50%) and burying (30%) of the waste. A large proportion (71%) of the hospitals used dust bins for transporting waste from generation points to incinerator without plastic bags. Most hospitals had low incineration capacity, with few of them having fire brick incinerators. Most of the respondents preferred on-site versus off-site waste incineration. Some hospitals were using untrained casual labourers in medical waste management and general cleanliness. The knowledge level in MWM issues was low among the health workers. It is concluded that hospital waste management in Tanzania is poor. There is need for proper training and management regarding awareness and practices of medical waste management to cover all carders of health workers in the country.     

Assessment of combustion products of medical waste incinerators in Alexandria

The emissions and ashes from medical waste incinerators might perform a threat to the environment and the public health. The aim of the present work is to evaluate the emissions and ashes of six medical wastes incinerators in six hospitals in Alexandria. Five air pollutants were sampled and analyzed in the emissions comprising smoke, lead, carbon monoxide, sulphur dioxide and nitrogen dioxide .Ash samples were analyzed for bacterial count, volatile substances, lead and cadmium. Shape and color of ash were observed visually. The results of the present study have revealed that all the average values of gases in the six incinerators were within the limits stated in Egyptian environmental law, where as carbonaceous particulate (smoke) averages of the six incinerators have exceeded the maximum allowable limit in the law. On the other hand, lead concentration in emissions were far below the maximum allowable limit in the law. Incinerator No 6 emissions have been significantly higher in CO, NO2, SO2 and smoke concentration than the other five incinerators P<0.001, P<0.0006, P<0.0001, and P<0.002 respectively. There was no significant variation in bacterial count of ash samples at 20 degrees C and 37 degrees C between the six studied incinerators. Volatile substance percentage of ash samples in the six incinerators were much higher than the recommended percentage. There was a highly significant variation between the six incinerators (p<0.005). Lead and cadmium concentrations in ash samples were much higher than those in developed countries, meanwhile, more or less as those in developing countries. It is recommended to state specific realistic emissions limits for medical waste incinerators and to substitute sporadic incinerators in hospitals by two central incinerators in proper places outside the city.     

An international perspective on hazardous waste practices

In developing countries, public health attention is focused on urgent health problems such as infectious diseases, malnutrition, and infant mortality. As a country develops and gains economic resources, more attention is directed to health concerns related to hazardous chemical wastes. Even if a country has little industry of its own that generates hazardous wastes, the importation of hazardous wastes for recycling or disposal can present health hazards. It is difficult to compare the quantities of hazardous wastes produced in different countries because of differences in how hazardous wastes are defined. In most countries, landfilling is the most common means of hazardous waste disposal, although substantial quantities of hazardous wastes are incinerated in some countries. Hazardous wastes that escape into the environment most often impact the public through air and water contamination. An effective strategy for managing hazardous wastes should encourage waste minimization, recycling, and reuse over disposal. Developing countries are especially in need of low-cost technologies for managing hazardous wastes.     

Pattern of medical waste management: existing scenario in Dhaka City,Bangladesh

Background  

Medical waste is infectious and hazardous. It poses serious threats to environmental health and requires specific treatment and management prior to its final disposal. The problem is growing with an ever-increasing number of hospitals, clinics, and diagnostic laboratories in Dhaka City, Bangladesh. However, research on this critical issue has been very limited, and there is a serious dearth of information for planning. This paper seeks to document the handling practice of waste (e.g. collection, storage, transportation and disposal) along with the types and amount of wastes generated by Health Care Establishments (HCE). A total of 60 out of the existing 68 HCE in the study areas provided us with relevant information.     

长沙市医疗垃圾处置现状

目的 了解长沙市医疗坪圾的管理状况。方法 选择长沙市3所综合性医院、1所肿瘤专科和1所儿科专科医院调查医疗垃圾的种类、收集和处理。结果 医疗垃圾的主要成分是玻璃、塑料和棉纱。分别占55%和12%。3所综合性医院的医疗垃圾日产量分别为0.48、0.63、0.43kg/床,儿童和肿瘤专科医院医疗垃圾日产量分别为0.58和0.74kg/床。据此估算长沙市日产医疗垃圾9.390t。医疗垃圾回收率为49.32%（其中主要是玻璃和塑料）,处理率仅1.34%,还有49.34%混入生活垃圾或掩埋。结论 长沙市医疗垃圾管理仍不完善,对环境构成潜在的污染。     

湖北省医疗机构医疗废物管理现状调查

目的调查湖北省医疗机构医疗废物的管理现状,并提出改进对策。方法依据相关规范自行设计调查问卷,采用随机分层抽样方法于2015年4月实地调查湖北省75所医院医疗废物管理情况,获得有效问卷73份。结果73所医院的医疗废物管理软硬件建设基本符合规范要求,组织与制度管理、科室分类处置情况各项合格率均在90%以上;83.56%（61/73）的医院开展了医疗废物最佳环境实践相关宣传;减少使用一次性医疗器械、用品品种达40余种;76.71%（56/73）的医院输液软袋都交由签约公司回收利用;医院病理科的化学性废液交危险废物处置中心处理的仅占21.54%（14/65）;骨科钢板处置方法不一, 56.16%（41/73）的医院将其作为医疗废物,仅35.62%（26/73）的医院告知患者处置方式,与患者签署知情同意书。结论湖北省医疗机构医疗废物管理已逐步得到重视,但对于特殊类别的医疗废物处置,如输液袋（瓶）、骨科钢板、病理科化学性废液处置均存在不同程度的问题,仍需加大培训,进一步规范医疗废物分类处置。     

Medical waste: a minimal hazard.

Medical waste is a subset of municipal waste, and regulated medical waste comprises less than 1% of the total municipal waste volume in the United States. As part of the overall waste stream, medical waste does contribute in a relative way to the aesthetic damage of the environment. Likewise, some small portion of the total release of hazardous chemicals and radioactive materials is derived from medical wastes. These comments can be made about any generated waste, regulated or unregulated. Healthcare professionals, including infection control personnel, microbiologists, public health officials, and others, have unsuccessfully argued that there is no evidence that past methods of treatment and disposal of regulated medical waste constitute any public health hazard. Historically, discovery of environmental contamination by toxic chemical disposal has followed assurances that the material was being disposed of in a safe manner. Therefore, a cynical public and its elected officials have demanded proof that the treatment and disposal of medical waste (i.e., infectious waste) do not constitute a public health hazard. Existent studies on municipal waste provide that proof. In order to argue that the results of these municipal waste studies are demonstrative of the minimal potential infectious environmental impact and lack of public health hazard associated with medical waste, we must accept the following: that the pathogens are the same whether they come from the hospital or the community, and that the municipal waste studied contained waste materials we now define as regulated medical waste.(ABSTRACT TRUNCATED AT 250 WORDS)     

Medical Waste Act. Requires physician compliance

In Michigan, the medical care community has a long history of carefully managing infectious medical wastes within their facilities to control communicable diseases. Never the less, concerns have surfaced about health risks posed by medical waste because of the notoriety of reported incidents of improperly disposed medical waste that led to the promulgation of emergency rules and now permanent statutes. As the environment reemerges as a national issue, the proper disposal of medical waste remains, at the very least, a highly visible and volatile part of this nation's solid waste crisis. To better develop appropriate controls for dealing with regulated medical waste, we will need to work together. Journal articles such as this provide an important opportunity to share and more forward our understanding of this problem so that we may all enjoy a safer and better environment. Proper handling and disposal of medical waste will remain a public issue as long as wastes believed to be of medical origin are found on beaches or at unauthorized storage or disposal locations. Hence, compliance with the regulations for the handling, storing, treating, transporting and ultimate disposal of regulated medical waste by providers of health care in Michigan must be observed.     

武汉市江夏区医疗卫生机构医疗废物管理和处置现状调查

目的通过了解武汉市江夏区医疗卫生机构的医疗废物产生、收集、储存和处置情况,为进一步制定医疗废物的管理措施提供依据。方法采取查、看、问等方式进行现场调查、汇总分析。结果该区内有证医疗卫生机构集中处置医疗废物的为24.50%,自行处置医疗废物的医疗卫生机构为75.50%。结论卫生行政部门应把医疗废物处置与审验医疗机构执业许可证和年终评优挂钩;政府要加大投入,以区级为中心建立医疗废物处置中心;卫生监督部门要履行监管职责,深入实际,加强指导处置医疗废物。     

Hazardous medical waste management as a public health issue

The amount of waste produced is connected with the degree of a country's economic development; more developed countries produce more waste. This paper reviews the quantities, manipulation and treatment methods of medical waste in Croatia, as well as hazardous potentials of medical waste for human health. Medical waste must be collected and sorted in containers suitable for its characteristics, amount, means of transportation and treatment method in order to prevent contact with environment and to protect people who are working with waste. Hazardous medical waste in Croatia is largely produced by hospitals. Even though only one hospital has a licence to incinerate infectious medical waste, many other hospitals incinerate their hazardous waste in inappropriate facilities. Healthcare institutions also store great amounts of old medical waste, mostly pharmaceutical, anti-infectious, and cytostatic drugs and chemical waste. Data on waste treatment effects on human health are scarce, while environmental problems are covered better. Croatian medical waste legislation is not being implemented. It is very important to establish a medical waste management system that would implement the existing legislation in all waste management cycles from waste production to treatment and final disposal.     

The medical waste audit. A framework for hospitals to appraise options and financial implications

The generation, handling, and disposal of medical wastes involve virtually every department in the hospital. To enhance coordination, managers must comprehensively describe the total system and specify the roles of key functions and individuals. Hospitals produce about 77 percent of the approximately 500,000 tons of regulated medical waste produced annually in the United States. The amount produced by different hospitals varies, primarily because of differences in "waste-management practices." The Environmental Protection Agency is trying to develop a greater understanding of the types of medical wastes that are infectious, methods of transmission, and the likelihood of transmission in the handling and disposal of waste within the hospital environment. To ensure that medical waste is being handled and treated in the most cost-effective manner and with the least health risk to employees and the community, hospital administrators must undertake a comprehensive appraisal of the activities associated with the generation, handling, and disposal processes. A "medical waste audit" requires the following steps: Generation profile to identify origination points, categories or types of waste, and associated generation rates. Inventory of handling practices, including existing regulations, procedures and protocols, training programs, definitions regarding waste segregation, and documentation. Review of current disposal practices and existing and developing alternatives. Cost analysis     

医疗垃圾焚烧处理的自动进料和清洗系统

以中型医疗垃圾焚烧处置工程实践为例,设计并介绍1种全自动医疗垃圾焚烧处置工程的自动进料及清洗系统,以有效解决医疗垃圾处理过程中人员接触危险废物的问题。     

Hospital waste management and it's probable health effect: a lesson learned from Bangladesh

A study was conducted to evaluate the current status of hospital waste management (HWM) in Bangladesh. The aim is to recognize the health effect of the existing practice, to determine the awareness level of doctors and nurses about hospital waste, to identify the weaknesses, and to provide suggestions for improvement. Hospital staff, waste pickers, and local residents were interviewed while in depth field observation, which included sample collection and laboratory analysis was also conducted. Through this investigation, it has been quite evident that a satisfactory hospital waste management system in government hospitals and several private clinics is severely lacking. At present, Bangladesh has no rigorous laws or regulation, which are enforced in this area. The waste is generally dumped together in a public place such as the hospital surroundings, the roadside or City Corporation dustbin. Many doctors and nurses are not fully aware about what constitutes as medical waste. Health care workers have only a basic understanding of health care and do not perceive handling or disposal of medial waste as a hazardous work. Laboratory analysis shows existing contamination of infectious agents in the environment. Some staff members interviewed were suffering from various kinds of infectious diseases such as viral hepatitis B/C, typhoid, skin disease/allergy, diarrhea, dysentery, tuberculosis, and malaria. During field observation it was discovered that improved HWM systems have only recently been introduced in a small number of private hospitals and clinics, some of which could be used as references to formulate guidelines for reaching the optimal at the national level. The study indicates that there is a need to improve the handling and disposal methods of hospital waste in almost all the available medical facilities. There are a few NGOs that have started awareness building and training on waste management for selected hospital staff and NGO officials. Based on the analysis of the situation, several suggestions and recommendations have been made to aid in the development of a waste management system.     

Medical waste management: the law and its application

Medical waste management in Croatia is regulated by three fundamental legal acts: Waste Act, Ordinance on Waste Types and Directive on Manipulation of Waste Generated in Health Care. The implementation of these acts and waste management in general are also supported by Transport of Hazardous Materials Act and Toxic Substances Act. Modern trends in waste management promote an integral approach also called "waste chain". This integral approach to medical waste management is based on hierarchical structuring of waste management structure from the point at which the waste is produced to its final disposal. Priority is always given to reducing the amount and the harmfulness of waste by replacing harmful materials with those that are not, but where this is not possible, waste management includes reduction by sorting and separating, pretreatment on site, safe transportation, final treatment and sanitary disposal. Methods of choice for the final treatment should be the least harmful for human health and environment. Integral medical waste management could greatly reduce quantities of medical waste and consequently financial strains. Even though Croatian regulations define and cover all steps in the waste management chain their implementation is one of the country's greatest issues. Improper practice is seen from waste production in healthcare institutions to the final disposal, and includes handling, sorting, use of containers, or treatment in incinerators. Information on quantities, type and flow of medical waste are inadequate, just as sanitary control. In addition, Croatia lacks locations for sanitary landfills. Croatia has signed international conventions on the supervision and control of transfrontier waste shipments. Within the CARDS project, Croatia has started to harmonise its laws with acquis communitaire related to waste management. Although waste management is one of the priorities defined within the National Environment Action Plan, Croatia still has not made a strategy for waste management.     

Management of waste disposal in medical institutions

Recently new regulations were elaborated for the management of medical wastes in Austria, FRG, Canada and USA. There is no rule laying down the requirements of the management of medical wastes in Hungary. On the basis of foreign experiences the medical wastes are proposed to range into categories as follow: I. Waste that should be handled in special way within and outside the health care facilities. II. Waste, that should be handled in a special way within the health care facilities. III. General waste (municial-type waste). Basic requirement is the segregating collection of wastes. Color-coding is proposed to identify the content of containers and bags. Incinerators combined with pyrolysis and emission control unites should be preferred to the disposal of medical wastes. The author proposes to issue a rule setting out definitions and basic principles of management of medical wastes. Individual health care establishments should prepare own written policies and measures for waste handling appropriate to their specific requirements.     

Hospital waste management status in university hospitals of the Fars province, Iran

Hospital waste contains large quantities of hazardous materials. In Iran, as in many developing countries, not much attention has been paid to this matter. Little information is available regarding the generation and disposal of medical waste in Iran, and this fact hinders planning for a better management of the aforementioned waste. This paper describes a survey performed on the collection and disposal of waste in the university hospitals of the Fars province, which are the medical referral centres in the southern half of the country, and the results obtained are fully discussed. The lack of separation between hazardous and non- hazardous waste, an absence of necessary rules and regulations applying to the collection of waste from the hospital wards and the on-site transport to a temporary storage location, a lack of proper waste treatment, disposal of hospital waste along with municipal garbage, insufficient training of personnel, insufficient personal protective equipment and lack of knowledge regarding the proper use of such equipment, were the main findings. For a rapid improvement of existing conditions, performing extensive research for the assessment of present situation in the hospitals of this country, compilation of rules and establishment of standards along with effective training for the personnel is recommended.     

Health services waste management: a biosafety issue

The subject of "health services waste" is controversial and widely discussed. Biosafety, the principles of which include safeguarding occupational health, community health, and environmental safety, is directly involved in the issue of medical waste management. There are controversies as to the risks posed by medical waste, as evidenced by diverging opinions among authors: some advocate severe approaches on the basis that medical waste is hazardous, while others contend that the potential for infection from medical waste is nonexistent. The Brazilian National Health Surveillance Agency (ANVISA) has published resolution RDC 33/2003 to standardize medical waste management nationwide. There is an evident need to implement biosafety procedures in this area, including heath care workers' training and provision of information to the general population.     

Hazardous wastes in eastern and central Europe: technology and health effects

Issues of hazardous waste management are major concerns in the countries of eastern and central Europe. A National Institute of Environmental Health Sciences-supported conference was held in Prague, Czech Republic, as a part of a continuing effort to provide information and promote discussion among the countries of eastern and central Europe on issues related to hazardous wastes. The focus was on incineration as a means of disposal of hazardous wastes, with discussions on both engineering methods for safe incineration, and possible human health effects from incineration by-products. Representatives from government agencies, academic institutions, and local industries from 14 countries in the region participated along with a few U.S. and western European experts in this field. A series of 12 country reports documented national issues relating to the environment, with a focus on use of incineration for hazardous waste disposal. A particularly valuable contribution was made by junior scientists from the region, who described results of environmental issues in their countries.     

Monitoring Metals near a Hazardous Waste Incinerator. Temporal Trend in Soils and Herbage

In recent years, incineration has been demonstrated to be a commercially available technology for hazardous waste (HW) disposal (Richter and Johnke, 2004). However, because of the potential adverse effects of toxic emissions, waste incinerators are still an important cause for concern for the public. In spite of that, compliance with current EU emissions has vastly reduced the probability of adverse health effects (Glorennec et al., 2005). With respect to metals, a number of studies have shown that these elements are emitted by industrial, medical and municipal waste incinerators (Schumacher et al., 1997; Rimmer et al., 2006). Filter ash is an especially problematic residue because it contains high metal concentrations (Lisk et al., 1989). After combustion in modern HW incinerators (HWIs), metals contained in HW are mainly collected in bottom and fly ash, with only small quantity of metals being discharged from the stack as particulate matter or vapor (Jung et al., 2004). However, the atmospheric emission of these elements is a matter of concern.