1. High Tech Centralized Facilities in Developing Countries TechNet/SIGN Injection & Waste Management Technology Day New Delhi, India 29 August 2001 Jorge Emmanuel Health Care Without Harm www.noharm.org

2. Outline Framework for medical waste management Types of alternative treatment technologies Factors to consider in selection

3. Framework Waste Segregation Waste Minimization Environmental Protection Occupational Safety and Health

4. Waste Segregation/Minimization: Typical Hospital Waste Stream

5. Environmental Protection

6. Environmental Protection: Toxic Pollutants From Incinerators Air Emissions –trace metals: As, Cd, Cr, Hg, Ni, Pb –acid gases: HCl, SO 2, NOx –dioxins and furans, including 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) –other organic compounds: trichloroethylene, tetrachloroethylene, trichlorotrifluoroethane, etc. –carbon monoxide –particulate matter –pathogens Toxic Bottom Ash –leachable metals, dioxins/furans, other organics

7. Occupational Safety & Health Needle sticks and other sharps injuries Blood splatter Aerosolized pathogens Chemicals in the workspace Noxious odors Hot surfaces Ergonomic problems

8. Elements of Proper Management Waste stream analysis Waste management and contingency plans Waste segregation Waste minimization Proper collection, transport and storage Worker training, awareness programs Alternative treatment technologies

9. Types of Alternative Technologies Thermal Chemical Irradiative Biological

10. Realistic Alternatives Low-Heat Thermal Technologies –Autoclaves or Retorts –Advanced Autoclaves –Microwave Units –Dry Heat Systems Chemical –Non-Chlorine Technologies

11. Autoclave

12. Steam Disinfection Temperature-Minimum Exposure Time Requirements T o FT o CSpore Kill Time (min) Min. Exposure Time (min) 2401163060 2451181836 2501211224 257125816 27013224 28013812 From E. Hanel, Jr., “Chemical Disinfection,” in Control of Biohazards in the Research Laboratory, School of Hygiene and Public Health, Johns Hopkins University, Baltimore, MD, 1981.

13. Example: Centralized Facility Autoclave, 8’ dia x 32’ long Source: Bondtech Corporation, Somerset, Kentucky

14. Advanced Autoclaves: Examples Vacuum / steam treatment / shredding / compaction Shredding / steam treatment & mixing / drying Stream treatment, fragmenting & mixing / drying

15. Advanced Autoclave: Vacuum / steam treatment / shredding / compaction Source: San-I-Pak, Tracy, California

16. Advanced Autoclave: Shredding / steam treatment & mixing / drying Source: STI Chem-Clav, West Chester, Pennsylvania

17. Example: Microwave Disinfection Source: Sanitec, West Caldwell, New Jersey

18. Example: Dry Heat Disinfection Source: KC MediWaste, Dallas, Texas

19. Chemical: Alkaline Hydrolysis Source: Waste Reduction by Waste Reduction, Inc. (WR2), Indianapolis, Indiana

20. Other Technologies Medium and High Heat Thermal Systems –Issues: emissions, performance, costs Chlorine-Based Chemical Systems –Issues: wastewater discharges Irradiative Technologies –Issues: ionizing radiation, costs Biological Systems

21. Factors to Consider in Selecting Alternative Technologies Microbial Inactivation Efficacy –Minimum: Level III Disinfection Inactivation of vegetative bacteria, fungi, lipophilic/hydrophilic viruses, parasites, and mycobacteria at a 6 Log 10 reduction or greater; and Inactivation of B. stearothermophilus spores and B. subtilis spores at a 4 Log 10 reduction or greater –Biological Indicators: 6 Log 10 reduction of Mycobacterium phlei and Mycobacterium bovis (BCG) (ATCC 35743) 4 Log 10 reduction of B. stearothermophilus (ATCC 7953) and B. subtilis (ATCC 19659)

22. Factors to Consider in Selecting Alternative Technologies Environmental Emissions and Residues –air emissions –wastewater discharges –solid residue –ambient (workspace) air –others Reduction of Waste Volume Occupational Safety & Health

23. Factors to Consider in Selecting Alternative Technologies Throughput Capacity Types of Waste Treated Space Requirements/Siting Requirements Process Monitoring and Documentation Equipment Safety and Worker Safety During Repairs Ease of Use/Training Requirements Reliability/Track Record Cost

24. Resource Non-Incineration Medical Waste Treatment Technologies: A Resource for Hospital Administrators, Facility Managers, Health Care Professionals, Environmental Advocates, and Community Members Health Care Without Harm (HCWH) P.O. Box 6806, Falls Church, VA 22040 USA Note: HCWH does not endorse any technology, company, or brand name.