1. The effects of Medical Waste on the Environment
Effects on the Environment

2. POINTS OF RISK TO THE ENVIRONMENT ?
GENERATION
SEGREGATION
TREATMENT & DISPOSAL
INTERNAL TRANSPORTATION
EXTERNAL TRANSPORTATION
STORAGE
Points of risk outside the Hospital

3. Groups in risk from healthcare waste
Risks for the environment:
Air pollution:
Next to the special problem of dioxin by medical waste incineration, air will be polluted due to the activities of the healthcare sector by: Emissions from transportation service, electricity consumption, ethylene oxide - EtO (45% of the total emissions in the US), etc.
Soil pollution:
The soil is mainly polluted by the disposal of hospital waste which contains chemicals, pharmaceuticals, incinerator ash, etc. or by sludge form waste water treatment plants which contain heavy metals.
Water pollution:
Next to the waste water from the wards (which can be infectious), laundry, etc. also chemicals are often disposed of via the sink. One problem for wastewater utilities is mercury from dental amalgam which is one of the largest mercury sources in the waste water stream. Other problem are silver from photo processing, etc.

4. Sewage Treatment Plant – what goes into your sewage treatment plant ?
Mercury from dental clinic goes into drain
Drainage from washing of HCW Storage Area
Outlet
Sewage Treatment Plant Inlet
Sewage Treatment Plant

5. Environmental Management with respect to the liquid waste requires :
The management of the waste to ensuring that it is properly treated and disposed of in sound manner for both the environment and the public health.
The development of suitable policies and programs for monitoring and controlling the waste in order ensure conformity to the best practices and the required legislative standards .

6. WHY PROTECT THE WATER ENVIRONMENT ?
Protecting the quality of the water environment ( ie the surface water, groundwater, wadis,creeks etc ) from the pollution of LIQUID WASTE is important in order :
To protect the public health and environment from the risks associated with the waste.
To protect and conserve the biolife ie the biodiversity of animal and marine life.
To enable the water to be used for agricultural uses.
To protect the water that may be abstracted for drinking water supplies.

7. WHAT IS LIQUID WASTE ? Liquid waste can be categorized as :
Domestic / Sewage wastes ie suitable for discharge direct to the septic tanks / sewerage system or
Industrial / Hazardous waste which due its physical, chemical , biological or radioactive properties must be handled and treated and disposed off in a special way.

8. HOW CAN THE WATER ENVIRONMENT BE POLLUTED ? –
PART 1 : DOMESTIC / SEWAGE WASTE
Sources within the Hospital : Toilets, washrooms, car washing * etc
Typical Quality :
A Physio-chemical indicators
 pH units
 Total dissolved solids 3000 mg/l
 Suspended solids : 500 mg/l
B Organic indicators
 Chemical oxygen demand : 3000 mg/l
 Bio-chemical oxygen demand ( 5 day ) : 1000 mg/l
 Tar, Oil or grease (emulsified) : 150 mg/l *
 Tar, oil or grease (non-soluble) : 50 mg/l *
C Non-organic indicators
 Ammonia as N : 40 mg/l
 Total Nitrogen :150 mg/l
 Total Sulphates : 500 mg/l
 Reduced sulphur compounds (Sulphides) : 10 mg/l
 Detergents : 30 mg/l
 Chlorides :1000 mg/l
 Free Chlorine :10 mg/l
 Phosphorous :30 mg/l
 Total cyanides :1 mg/l
 Metals (total) :10.0 mg/l
B Biological Indicators
E coli etc

9. DOMESTIC / SEWAGE WASTE PROBLEMS
Public health risks ie faecal related diseases
Discharge of final “ impartially” treated sewage to the ground from mal-functioning or poorly operated / maintained treatment plants will cause contamination which may leak through to the groundwater table and drift to areas of water abstraction or other beneficial uses ( ie WHO Drinking Water Standards )
Improper / incomplete treatment will produce health / environmental problems . Will also effect possible re-use of treated sewage for irrigation and the associated health standards. ( ie WHO Irrigation Water Standards for drip / spray irrigation systems )

10. DOMESTIC / SEWAGE WASTE PROBLEMS
Problems associated with
HOSPITALS NOT CONNECTED TO THE MUNICIPALITY SEWERAGE SYSTEM ie having their own treatment plants
ISSUES : 1. DESIGN
Design of treatment plants should be to achieve appropiate performance standards – ie conformance to minimum quality standards set by the legislator (ie Ministry of Health / MEPA ) for the discharge of the treated waste after treatment to ground or reuse as irrigation water.
Hydraulic loadings – Sewage treatment plants are sized according to hydraulic or ( flow rates ). Increasing the flow rates or loadings of a plant which it has not been designed too ( for example,this may occur over a period of time by Hospitals expanding in size / increase in patients etc ) will lead to poor performance and problems of overflow / lack of treatment.

11. DOMESTIC / SEWAGE WASTE PROBLEMS
ISSUE 2 : MAINTENANCE & OPERATION
Treatment plants should be maintained and operated in order to achieve ongoing consistent quality in both the standard of health and safety in their operation ( ie public health problems can arise from aerosol / odour realeases ) as well as the quality of the treated water which should conform to minimum quality standards set by the legislator (ie Ministry of Health / MEPA ) for the discharge of the treated waste after treatment to either the ground or reuse as irrigation water.
ISSUE 3 : CONTROL & MONITORING
Treatment plants should be routinely audited – ie laboratory testing of the quality of the treated effluent as well as any underground borehole water testing upstream and downstream of the treatment plant to ascertain the impact of any contamination or leakage to the groundwater.

12. DOMESTIC / SEWAGE WASTE PROBLEMS
Problems associated with
HOSPITALS CONNECTED TO THE SEWERAGE SYSTEM
- ie through uncontrolled and unmonitored non sewage related releases into the general sewerage system :
Effect of high oil levels entering the sewerage system from parking areas or car washing areas without grease / oil interceptors will have negative effects on both the initial screening , settling and subsequent the biological treatment stages in the Municipality sewage system
Similar unregulated and uncontrolled releases of chemicals from laboratories and other locations will cause disruptions to the sewage treatment process as well as having possible flammability / corrosive effects within the sewerage network..

13. LIQUID INDUSTRIAL / CHEMICAL WASTES
WHAT ARE THEY ?
Hazardous liquid waste can be any substance considered to pose a risk to the public health or environment based on its toxic, corrosive, reactive, flammable or radioactive properties.It is waste which can also be deemed to be unsuitable for direct disposal to the environment, sewer or conventional landfill

14. LIQUID INDUSTRIAL / CHEMICAL WASTES
Sources within the Hospital :  
Typical waste chemicals produced from healthcare premises include toluene, chloroform, methylene chloride, chloroethylene, ethanol, isopropanol, ethylene acetate, and acetonitrile etc. Formaldehyde wastes for example as found in many Departments of a Hospital – ie pathology, autopsy, dialysis, nursing units, emergency room, and surgery etc
Printing room wastes – eg chemicals, solvents / stabilisers etc
X ray –spent solutions – developers and fixers

15. Waste Characterization of Liquid / Chemical Waste
Waste Audit Reviews :
General Description
Generating source
Quantity ( Waste minimization )
Packaging & Handling requirements
MSDS or Chemical Analysis

16. Requirements for Recycling / Treatment
LIQUID INDUSTRIAL / CHEMICAL WASTES
Requirements for Recycling / Treatment
eg Formaldehyde Recycling / Silver Extraction
eg Waste Oil Treatment

17. TREATMENT ?
What standards are there for environmental releases for ash and air emmissions ? 1

18. PME Air Emission Standards
Total dust 10
mg/m3
Hydrogen chloride (HCl)
Hydrogen Fluoride (HF) 1
Sulphur dioxide (SO2) 50
Nitrogen monoxide
400
mg/m3 (*)
Daily average values

19. Air Emission Standards (cont.)
Substances
Min of 30 minutes
Max of 8 hours
Cadmium and its compounds, expressed as cadmium (Cd)
0,05 mg/m3
0,1 mg/m3
Mercury and its compounds, expressed as mercury (Hg)
Nickel and its compounds, expressed as manganese (Mn)
0,5 mg/m3
1 mg/m3

20. PME Air Emission Standards
Average values shall be measured over a sample period of a minimum of 6 hours and a maximum of 8 hours. The emission limits value refers to the total concentration of dioxin and furans.
Dioxins & Furans
0,1 ng/m3