MANAGEMENT OF MEDICAL WASTE Prepared By: Nihan Isbil Gökçe Alpay Bengi Berker Burcu Yalçınkaya 1

Objectives In our presentation, we’d like to inform you about:  What is medical waste?  Sources of medical wastes  Who’s collecting medical wastes?  Methods for treatment  The treatment methods and application in Turkey  Ways to improve the current applications. 2

What is Medical Waste?  This symbol is the “International Biohazard Symbol”. It is also known as “Trifoil”.  Biohazard materials include “Medical Waste.” 3

What is Medical Waste?  Any solid or liquid waste which is generated in the  Diagnosis,  Research,  Treatment  Immunization of human being or animals are called as Medical Waste. 4

What is Medical Waste?  Medical Waste can’t be considered as general waste.  Since the medical wastes are infectious, bio-hazardous and they could lead to the spread of diseases; they should be collected separately from commercial and residential wastes. 5

What is Medical Waste?  Medical wastes have a risk of transmitting:  Human Immunodeficiency Virus (HIV),  Hepatitis B Virus (HBV)  Other agents that are associated with blood-borne diseases. 6

What is Medical Waste?  Chemical composition of the medical wastes consists of:  50 % of Carbon,  20 % of Oxygen,  6 % of Hydrogen,  Many other trace elements. 7

Sources of Medical Waste  Hospitals and Clinics,  Bio-technology Institutes,  Laboratories,  Medical Research Facilities,  Nursing Homes,  Diagnostic Laboratories 8

Examples for Medical Waste  Blood or body fluid,  Cultures and stocks of agents,  Discarded vaccines, culture dishes and devices used at those actions;  Blood products such as serum, plasma, 9

Examples for Medical Waste  Pathological wastes, such as tissues, organs, body parts, and body fluids that are removed during surgery and autopsy,  Discarded needles, scalpel blades, those have come contact with infectious agents,  Radioactive materials,  Used operation room clothes,  Dialysis wastes. 10

Examples for Medical Waste  Wastes from normal veterinarian activities and from farms or ranches,  Paper towels, which didn’t contact with the infectious agents and does not contain fluid blood, Are not considered as Medical Waste. 11

Generation Rate of Medical Waste in Turkey  For example; medical waste generation rate depends on: o The type of the facility, o The treatment methods and the materials used during those actions  According to the survey that is run throughout Turkey, the most medical waste production is in Istanbul (about 34 tons per day); which contributes 17% of the total waste production. In contrast, Tunceli has the least waste production rate which is approximately 32 kilograms per day. 12

Regulations & Applications Of Medical Waste Management  The aim of Management of Medical Wastes Regulation: To protect human-beings and environment from the hazardous wastes from their generation to final disposal. x NO YES 13

Regulations & Applications Of Medical Waste Management  The Ministry of Environment and Forests has published “Regulation on Control of Medical Wastes” on

Regulations & Applications Of Medical Waste Management According to the regulation; management consists of 6 steps: a. Separate collection at the source, b. Remove from the source in different containers, c. Storing temporarily until collection, d. Collection of wastes with proper licensed medical waste vehicles and transferring to the disposal site, e. Treatment or destruction of wastes by incineration, f. Tracking period. 15

Steps Source Storing temporarily until collection Collection of wastes with proper licensed medical waste vehicles 16

Packages  The potential infectious medical wastes must be coded with color red.  The packing should be strong enough to withstand during handling, storage and transportation.  The packages must have 150 microns thickness.  Also the packaging should be moisture resistant, insect proof. 17

Applications For Medical Waste Treatment In World-wide & In Turkey  The most used method for treatment of medical waste is Autoclaving and Incineration.  Besides those methods, also new technologies are used to improve existing ones; like Microwave & Chemical Disinfections, Plasma Technology. 18

Applications For Medical Waste Treatment In World- wide & In Turkey  Medical Waste Incinerators burn trash and infectious medical waste.  Autoclaving is the usage of superheated, pressurized steam; so that medical waste can be harmlessly buried in landfills. 19

Advantages & Disadvantages of Methods Incineration AdvantagesDisadvantages Volume & Weight ReductionHigh Investment & Operation Costs Heat Recovery for Large SystemsHigh Maintenance Cost Fits for Every Type of WasteAir Pollution Expensive Equipment Hazardous Fly Ash Autoclaving AdvantagesDisadvantages Low Investment CostAppearance & Volume Remain Still Low Operating CostNot Suitable for All Waste Types Low Hazard ResiduePossible Air Pollution Ergonomic Concerns 20

Applications For Medical Waste Treatment In Turkey  The treatment method used in Turkey is Incineration.  In Istanbul, ISTAC is responsible for collection of medical wastes.  There’re 16 licensed medical waste collection vehicles in Istanbul. Medical wastes collected from the hospitals and different health care facilities, are brought the Kemerburgaz Odayeri Landfill Facility. 21

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Applications For Medical Waste Treatment In Turkey  At the gates, the trucks are controlled by 4 radio- activity detectors, in order to locate the radioactivity in the truck if exists.  The incinerator system in Odayeri has a daily capacity of 24 tones. All of the system is controlled by PLC System.  The wastes are incinerated at temperatures of 1000°C to 1200°C. By incineration, 95% reduction in volume and 75% reduction in mass is obtained. Also electricity is obtained from the incineration activity and is used in the complex. 23

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Researches – Government Hospital Our group visited the “Silivri Devlet Hastanesi”.  There’s only one employee for medical waste collection.  He said he is obligated to wear special clothes which are in color orange. Also he has to wear gloves, caps, plastic yellow boots and masks.  There’s a main container that is used for collection of medical wastes from very unit. Wastes are collected in every morning and every evening.  The collected wastes are stored in a storage room which is constructed according to the regulation rules. 25

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Researches – Government Hospital İSTAÇ collects the wastes two times in a week. The wastes wait in the storage room about 3 days. The vehicles are sent to the hospital at evenings. They’re not interested in what is done to wastes at İSTAÇ, they said that they’re just collecting and sending the wastes. They’re using the red medical waste packages. They’re very careful about separate collection of medical wastes from residential wastes. 27

Researches – Clinic Laboratory Also, we visited Kızıltoprak Referans Clinic Laboratory. They gave us the following information: “Since we are a small facility, there’s not much medical waste generation. Because of that reason, İSTAÇ visits us once in two weeks.” They collect their wastes in an red container without any usage of red packages. When we asked the reason, the manager said that “There’s no harmful waste generation in our facility. So, we don’t need to use packages.” But the bad thing is that, the container is put into the street. There’s no special place for the container. 28

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Comments & Recommendations for İSTAÇ  According to our impression at the hospitals and at the technical trip, we saw that İSTAÇ is well-working about medical waste management.  İSTAÇ collects all of the medical waste and brings them to Odayeri for incineration.  But in clinics or local health care centers, generated waste is not that hazardous or pathologic. Instead of incinerate all of the wastes, those kinds of low or non- hazardous wastes can be collected separately and they can be sterilized by autoclaving and could send to the landfills. 30

Autoclaves 31

An incinerator example. Incineration 32

Comments & Recommendations for İSTAÇ  The major disadvantage of incineration is emissions of toxic materials like mercury and dioxin. So, by reducing the amount of waste to be incinerated, we can also reduce the air pollution from those materials. By autoclaving, we can eliminate the generation of dioxin. 33

Comments & Recommendations for İSTAÇ Besides autoclaving and incineration there’re also new technologies. Historical systems can be replaced with those technologies. İSTAÇ can investigate those technologies and use for medical waste treatment. 34

Comments & Recommendations for Waste Generators  Since the collection from source and temporarily storage part belong to hospitals; there should be controllers who are working for government or for İSTAÇ. They should be controls on a regular basis. According to the hospitals we’ve talked and the investigations we’ve made there’s no such a regular- basis control.  Here’s some examples for the bad collection: 35

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With Our Recommendations we Achieve  Less environmental impact  Waste minimization  Strict conformation to the regulations  Recycle & reuse of wastes  Reducing the air pollutant release. 38

Thank You for Listening... 39