1. The Need of an Integrated Waste Management Strategy for Medical Waste Susanne Dittke (EnviroSense CC) (M Sc) Chemical Engineering Waste Reduction Advisor for City of Cape Town (CMC Administration) Waste Management Department

2. Data on Medical Waste Generation in Southern Africa Occupancy rate per bed per day: 1-1.2 for government hospitals 0.6 for private hospitals (KZN study) Medical waste generation data: 0.4 kg/patient/bed (KZN) (data from Lombard and Associates)

3. Typical SA hospital scenario (1) Government hospital with 900 beds “Medical” waste load going to private waste contractor: 20 500 kg /month or 675 kg/day Disposal cost: R 43 800/month With occupancy rate of 1: 675/900 = 0.75 kg/patient/day This is about 1.87 times higher than the KZN study suggests 

4. Typical SA hospital scenario (2) From hospital’s waste manager daily experience: education on prevention and better separation of domestic and medical waste in the wards would reduce waste output from about: 675 kg  180 kg medical waste/day = 0.2 kg/patient/day REAL medical waste Possible savings: R 32 120 per month Possible waste reduction 15 000 kg/month

5. Dutch medical waste facts 0.25 kg/bed/day (provincial average) 0.12 kg/employer/day In 1996 Slotervaarthospital accepted increasing social responsibility by environmental declaration based on: prevention, control measurements, recycling, transport management and licensing

6. Getting the priorities right : Prevention (product change to multi-usable items) Separation (education/better ward management) Internal Re-use (wherever possible e.g. pipettes) Transport, treatment and disposal/(incineration) of remaining “real” medical waste

7. DEAT’s NWMS Hierarchy Reduce Recycling Treatment Disposal Prevention Minimisation Re-use Recovery Composting Physical Chemical Destruction Landfill

8. Applied Medical Waste Management Strategy (Netherlands) 120 Prevention options identified. About 78% of options reduce harmful hospital waste/chemical waste and 65 % result in financial savings replacement of products/materials (65%), better housekeeping (15%) technological change/internal recycling (10%)

9. Evaluation of waste prevention (product change) Recycling of kidney dishes (rust-resistant or synthetic instead of carton) Questions to answer: Waste amount reduced ? Purchase costs ? Necessary amounts ? Frequency of use ? Result: savings of about R 150 000/annum (calculated over 5 year period)

10. Medical Waste Incineration Facts Increasingly negative public image due to: high levels of dioxins, furanes and mercury and toxic ashes generation local and regional health impact high cost involved for state of art technology difficult to evaluate emission levels in start- up/emergency conditions waste treatment cost high no incentive for medical waste reduction

11. Alternatives to Incineration (some are currently investigated by CCT) Gamma Radiation Electro-Thermal Deactivation Microwaving Technology Plasma Torches Autoclavation Technology Laser Technology

12. Electro-Thermal-Deactivation (for general medical waste) Principle: Oscillating energy field in a di- electric tube of low-frequency radio waves heat waste to temperatures (95-100 o C). MOs absorb energy due to organic nature (water di-pole). Cell content starts to rotate in phase with frequency and the cell membranes burst destroying the cell completely ETD allows recovery/recycling of plastic waste fraction due to low temperatures Treated waste can be disposed at general LF

13. Autoclavation (SteriCOMat) Treats waste at source (hospital) Eliminates need for costly and risky transport does not require huge installation or capital outlay complies with recent developments in the EU environmental law safely sterilizes clinical wastes (also contaminated with HIV, Hepatitis B) Remains can be treated as domestic waste