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High Tech Centralized Facilities in Developing Countries

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

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High Tech Centralized Facilities in Developing Countries

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

  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, SO2, 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 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 <www.noharm.org> Note: HCWH does not endorse any technology, company, or brand name.

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