Sustainable Environmental Management of Medical Waste in China

1. Sustainable Environmental Management of Medical Waste in China Zoltan Csizer, Senior Advisor United Nations Development Organization (UNIDO) Kazan, Russian Federation, 14 May 2009

2. Outline • Medical waste in China • Brief Project Introduction • Progress Achieved • Findings • International Experience • Summary of COP4 Decisions

3. MW in China • Annual Production of MW: ~ 670,000 tons (i.e. 1,780 tons/day)! • Incineration is a convenient solution of MW disposal • However, MW incineration is an environmental burden as the release source of DIOXINS and other nonintentionally produced POPs!

4. MW in China • MW Incineration has been identified as one of major source of dioxins release in China • Annual release of dioxins was estimated to be 450g TEQ, accounting for above 8% of the total releases to air from all sources (reference year: 2004). • National Programme for Construction of Facilities for Disposal of Hazardous Waste and Medical Waste • An important program for ESM of HW;

5. MW in China • to construct 332 medical waste disposal facilities, most of which would be incinerators. The construction of most facilities is ongoing; • Dioxins release have been considered, but not meeting the requirements of BAT/BEP Guideline • Emission standard for dioxins is: 0.5 ng TEQ/Nm3 • There’s a gap between the standard and the level in line with BAT/BEP measures (0.1 ng TEQ/Nm3)

6. Various MW

7. Typical cycle MW in China Hospital Collection Disposal Transport

8. Project Introduction • The full-sized PD was formally reported to GEF in March 2007 • GEF-CEO approved in November 2007. • Financial scheme:

9. Project Introduction Project Goal: to introduce BAT/BEP to MW disposal Alternative treatment techniques Recycling Valuable waste Segregated MW Landfilled as municipal waste Treated residue Landfilled as hazardous waste Incinerator Fly/bottom ash Segregated MW Landfilled as municipal waste Bottom slag

10. Project Introduction Major components of the Project: • Upgrade the incineration equipment to the BAT performance level • Replace outdated or non-viable incineration facilities with alternative non-incineration techniques that avoid the formation and emission of dioxins • Promote BEP in medical institutions • Comprehensively apply regulatory, administrative, technical and market instruments to • Promote affordable or commercially available supply of technologies and equipment • Promote the commercialization of MW disposal

11. Environmentally Sustainable Management of Medical Waste Overall Strategy Policy, standard, certifi- cation, training, publicity Environmental Management Policy, standard, certifi- cation, training, publicity Promoting Service Market Upgrading Technology & Equipment Repli- cation Repli- cation BATs/BEPs demonstration BATs/BEPs demonstration Diversified investment Professional operation Joint development of BAT/BEP Institutional strengthening Institutional strengthening Regulatory framework strengthening Regulatory framework strengthening Baseline

12. National MWMSC UNIDO NPMO Prov. MWMSC NDRC MOC SPA MEP MOH National MIs Prov. DRC Prov. DOC Prov. PB Prov. EPB Prov. DOH Muni. MWMSC Prov. MIs Muni. DRC Muni. DOC Muni. PB Muni. EPB Muni. DOH County DOH Muni. MIs MIs in remote areas Central MW Treatment Facility (ies) MWMSC: Medical waste management steering committee; NPMO: National Project Management Office; MI: Medical institutions; Prov.: Provincial; Muni.: Municipal; NDRC: National Development and Reform Commission; MOC: Ministry of Construction; SPA: State Pricing Administration; MEP: Ministry of Environment Protection ; MOH: Ministry of Health; DRC: Development and Reform Commission; DOC: Department of Construction; PB: Pricing Bureau; EPB: Environment Protection Bureau; DOH: Department of Health; MW: Medical waste

13. Progresses up to now • Gaps between National Program and requirements of Stockholm Convention identified • Relevant stakeholders actively participate in the project to take timely and joint actions by: • Experience learning from other countries on MW • Involving environmental protection planning agencies to implement the project • Cooperation with policy makers and regulators • Medical institutions and disposal operators welcome the incentive packages of the project

14. Progresses up to now • Regulations of MEP changed to allow the use of non-combustion technologies – A leap forward • Over 50 non-combustion disposal facilities are being planed or built, accounting for about 35% of Project goal • Biggest Winners: GEF (the catalytic role )

15. Findings • Project fits to and reorients the National Program though it is regretted that the Project started only after the National Program being launched • Dioxins control may not be a priority at current stage and needs to be main-streamed in national actions for environmental protection • Application of BAT is always very costly Upgrade incinerators to meet project requirements of 0.1 ng TEQ/Nm3 release limits; retrofitting cost is quite high and lack of cost effective technologies • Changing human mentality is always the most difficult matter

16. MEDICAL WASTE MANAGEMENT AND TREATMENT - INTERNATIONAL EXPERIENCE

17. WASTE ANALYSIS IS AN IMPORTANT STEP IN SELECTING A DISPOSAL TECHNOLOGY HOSPITAL WASTE STREAM CONTAINS LESS THAN 15 % OF MATERIALS THAT COULD BE CONSIDERED "POTENTIALLY INFECTIOUS" IF PROPERLY SEGREGATED, THE CONTENT OF INFECTIOUS WASTE CAN BE REDUCED TO 1-5 %.

18. AUTOCLAVING THE WASTE IS EXPOSED TO HIGH TEMPERATURE STEAM (135 TO 150 °C) IN A CLOSED, EVACUATED CHAMBER AFTER THE REQUIRED TREATMENT PERIOD, THE STEAM IS ROUTED THROUGH A CONDENSATE TANK TO REMOVE ODOURS THE WASTE IS THEN SHREDDED AND COMPACTED FOR DISPOSAL, NORMALLY IN A MUNICIPAL SOLID WASTE LANDFILL TWO TRADITIONAL TYPES OF EQUIPMENT USED : AUTOCLAVES AND RETORTS. OTHER SYSTEMS, CALLED ADVANCED AUTOCLAVES, HAVE BEEN DEVELOPED IN RECENT YEARS: ECODAS, HYDROCLAVE, STERIVAL, STICHEMCLAV, STS, SYSTEM DRAUSCHKE.

19. OPERATING CONDITIONS TYPICAL EXPOSURE TIMES ARE BASED ON TWICE THE MINIMUM TIME REQUIRED TO ACHIEVE AN ALMOST TOTAL KILL OF BACTERIAL SPORES UNDER IDEAL CONDITIONS A COMMON EXPOSURE TEMPERATURE - TIME IS 121°C FOR 30 MINUTES. USE OF : BIOLOGICAL MONITORS (E.G., B. STEAROTHERMOPHILUS OR B. SUBTILIS SPORE STRIPS) COLOUR-CHANGING CHEMICAL INDICATORS PLACED AT THE CENTRE OF TEST LOADS SHOULD BE USED TO VERIFY THAT SUFFICIENT STEAM PENETRATION AND EXPOSURE TIME HAVE OCCURRED.

20. MICROWAVE IN THE MICROWAVING PROCESS, INFECTIOUS WASTE IS EXPOSED TO HIGH-TEMPERATURE STEAM, SHREDDED, AND THEN HEATED BY A SERIES OF MICROWAVE GENERATORS (MAGNETRON) TYPICALLY,2 TO 6 MAGNETRONS ARE USED WITH AN OUTPUT OF ABOUT 1.2 KW EACH. MICRO-ORGANISMS ARE KILLED IN THE PROCESS AND THE WASTE IS CHANGED INTO A SLIGHTLY MOIST RESIDUE SOME SYSTEMS ARE DESIGNED AS BATCH PROCESSES AND OTHERS ARE SEMICONTINUOUS THE MICROWAVE TREATMENT SYSTEMS COMMERCIALLY AVAILABLE IN EUROPE ARE: MEDISTER, SANITEC, SINTION, STERIFANT

21. JAPAN AND EUROPE ACTIVATED COKE FIXED BED SYSTEM DIOXINS AND OTHER ORGANIC POLLUTANTS AS WELL AS HEAVY METALS SUCH AS MERCURY ARE ABSORBED IN THE PROCESS LARGE AMOUNT OF ACTIVATED COKE MUST BE USED ACFB IS LOCATED USUALLY DOWNSTREAM OF FILTERS AND SCRUBBERS ATTENTION MUST BE PAID FOR FIRE RISKS

22. THE FOURTH CONFERENCE OF THE PARTIES OF THE STOCKHOLM CONVENTION ON PERSISTENT ORGANIC POLLUTANTS (POPs) GENEVA, SWITZERLAND, 3-8 MAY 2009

23. COP4 Over 800 participants, representing more than 149 governments, as well as intergovernmental and non-governmental organizations, and UN agencies, attended the meeting. COP4 considered several reports on activities within the Convention’s mandate and adopted 33 decisions on, inter alia, nine new chemicals, financial resources, guidance to the financial mechanism, implementation plans, technical assistance, synergies and effectiveness evaluation.

24. STOCKHOLM CONVENTION ON PERSISTENT ORGANIC POLLUTANTS (POPs) Objective: Mindful of the precautionary approach as set forth in Principle 15 of the Rio Declaration on Environment and Development, the objective of the Stockholm Convention is to protect human health and the environment from the harmful impacts of persistent organic pollutants

25. Atmospheric pollutants Industrial Discharges Food Chain Particulates accumulation Sediment Sediment PERSISTENCE, BIO-ACCUMULATION AND LONG-RANGE TRANSPORT OF POPs

26. POPs =The "Dirty Dozen" • Aldrin • Dieldrin • Endrin • Toxaphene • Heptachlor • Mirex • Chlordane • PCBs • HCB • Dioxins & Furans • DDT PESTICIDES AND INDUSTRIAL CHEMICALS - ELIMINATION - (ANNEX A) UNINTENTIONAL PRODUCTION - (ANNEX C) PESTICIDE - RESTRICTION - (ANNEX B)

27. New POPs Chemicals recommended by PORC to be added to Annexes A, B and C of Stockholm Convention by COP-4 to be held in Geneva, Switzerland, 4-8 May 2009: • Alpha hexachlorocyclohexane (pesticide) –Annex A • Beta hexachlorocyclohexane (pesticide) –Annex A • Lindane (pesticide) – Annex A • Chlordecone (pesticide) – Annex A • Pentachlorobenzene – (pesticide) – Annex A • Hexabromobiphenyl (flame retardant) – Annex A • Commercial pentabromodiphenyl ether (flame retardant) – Annex A • Commercial octabromodiphenyl ether (flame retardant) – Annex A • Perfluorooctanesulfonate (surfactant) – Annex B

28. Perfluorooctanesulfonate COP decided to amend Part I of Annex B of the Convention to list PFOS, its salts and perfluorooctane sulfonyl fluoride (PFOSF) with acceptable purposes including, inter alia: photo-imaging, fire-fighting foam, and insect baits for leaf-cutting ants; and specific exemptions including, inter alia: metal plating, leather and apparel, textiles and upholstery, paper and packaging, and rubber and plastics

29. EXEMPTIONS • Notes the cancellation of all specific exemptions recorded in the register for the first twelve POPs and, with the exception of polychlorinated biphenyls (PCBs), all current exemptions listed in Annex A and Annex B will no longer be available to parties after 17 May 2009; • Agrees to extend the expiration date in paragraph 6 of the review process for entries in the Register of Specific Exemptions to 2015; and • Encourages parties that may seek a specific exemption for future POPs to make efforts to introduce alternative measures as soon as possible.

30. IMPLEMENTATION PLANS Updated NIPs would be due within three years of listing new chemicals

31. Regional and subregional centres • Endorses, for four years, eight nominated Stockholm Convention centres, namely centres located in China, Kuwait, the Czech Republic, Brazil, Mexico, Panama, Uruguay and Spain; • Invites four nominated centres, namely those in Algeria, Senegal, Iran and the Russian Federation, to continue their activities, seek support in complying with the decision SC-2/9 criteria, and be considered for endorsement at COP5; and • Decides to evaluate the performance and sustainability of the centres and to reconsider their status at COP6

32. Guidance to the financial mechanism A proposal put forward by China with Bangladesh, Brazil, Cambodia, India, Iran, Jamaica, Kuwait and Laos: • calling for the GEF to increase by five times financial support in the POPs focal area in light of the listing of new chemicals; • the Resource Allocation Framework (RAF) should not be applied to the POPs focal area; • the co-financing ratio for POPs projects is too high and should be lowered; • and initial financial support should be provided for project preparation

33. UPCOMING MEETINGS EXTRAORDINARY MEETING OF THE CONFERENCES OF THE PARTIES TO THE BASEL, ROTTERDAM AND STOCKHOLM CONVENTIONS: The ExCOP of the three chemicals conventions will take place in February 2010, at a venue to be decided, back-to-back with the eleventh special session of the UNEP Governing Council/Global Ministerial Environment Forum. These simultaneous meetings are aimed at giving high-level political support to the process of enhancing cooperation and coordination among the three conventions FIFTH MEETING OF THE CONFERENCE OF THE PARTIES TO THE STOCKHOLM CONVENTION (POPs COP5): This meeting is scheduled to take place in May 2011, in Argentina

34. Thanks for your attention!