MEDICAL WASTE MANAGEMENT Ministry of Environmental Protection, Physical Planning and Construction MINISTARSTVO ZAŠTITE OKOLIŠA, PROSTORNOG UREĐENJA I GRADITELJSTVA MEDICAL WASTE MANAGEMENT IN CROATIA Gordana Vešligaj, Waste sector, Ministry of Environmental protection, physical planning and construction, Zagreb - Croatia zeljko.stosic@mzopu.hr

LEGISLATION Instruction on handling waste originated during providing the health care (OG 50/00) by Ministry of Health and Social Care Waste Act (OG 178/04, 111/06) Strategy of Waste Management in the Republic of Croatia (OG 130/05) Waste Management Plan in the Republic of Croatia for the period 2007-2015 (OG 85/07) Ordinance on medical waste management (OG 72/07) by Ministry of Environmental protection, physical planning and construction

86% 14% MEDICAL WASTE NON - HAZARDOUS MEDICAL WASTE HAZARDOUS Mostly similar to municipal waste: paper and cardboard packaging glass food remains etc. infectious chemical waste containing hazardous substances used sharp objects citotoxics and citostatics dental amalgam waste and other hazardous waste 86% 14% zeljko.stosic@mzopu.hr

PRODUCERS OF MEDICAL WASTE Legal or natural persons involved in any activity generating medical waste MAJOR SOURCES MINOR SOURCES > 200 kg/year ≤ 200 kg/year hospitals medical centres etc. as general practitioner offices convalescent homes old people's and nursing homes tattoo and piercing salons acupuncture offices and salons veterinarian’s offices etc.

disinfection/sterilization TREATMENT OF INFECTIOUS MEDICAL WASTE PHYSICAL PROCEDURES CHEMICAL TREATMENT treatment with gaseous fumigants thermal treatment disinfection sterilization disinfection/sterilization

THERMAL STERILIZATION AND DISINFECTION The product of sterilization is sterile, dry, crushed and unidentifiable mass. Energy value: 23.000 - 29.000 kJ/kg (5.000-7.000 kcal/kg) The product of disinfection is wet material that will be packed in bags. Ideal procedure would be energy recovery.

MANAGEMENT OF OTHER TYPES OF POTENTIALLY HAZARDOUS MEDICAL WASTE Pharmaceutical, cytotoxic and chemical or similar hazardous waste incineration Used sharps The same way as infectious waste incineration in crematories burial at cemeteries human Pathological waste in accordance with special regulations animal

CURRENT SITUATION IN CROATIA Clinical hospital Dubrava – Zagreb General hospital Vinkovci 2 internal incineration plants Čakovec (hospital) Zagreb Sisak (hospital) Županja Osijek 5 sterilization plants Incineration plant for hazardous waste – Sisak Cement factory in Split Cement factory in Koromačno Cement factory in Našice 4 potential energy recovery plants Zagreb Rijeka 2 disinfection plants

OBLIGATIONS The producer of medical waste shall ensure: separate collection, record keeping, storage in appropriate containers, temporary storage in specially separated areas until treatment or delivery, take over medical waste generated by home care and similar activities generating medical waste. The employees of home care institutions, home health agencies and institutions engaged in similar activities shall take over medical waste generated by their activities for its treatment, recovery and/or disposal. Pharmacies shall take over expired medical products and similar pharmaceutical waste irrespective of its origin.

hazardous medical waste ESTIMATED QUANTITIES OF MEDICAL WASTE IN TOTAL: 19,500 tons per year hazardous medical waste 2,700 tons per year About 50 to 60% of hazardous medical waste ends up in treatment which amounts to about 1,500 tons per year. Residual amounts ends up in export for treatment or disposal.

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