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Health Care Waste Management (HCWM) Alternative Disposal Methods

Health Care Waste Management (HCWM) Alternative Disposal Methods. Ohrid, Ana Petrovska. Present practice. On-site HCW Treatment by hospitals: Internal treatment is done in small autoclaves and covers only HCW such as sharps, culture plates and small glass tubes with blood samples.

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Health Care Waste Management (HCWM) Alternative Disposal Methods

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  1. Health Care Waste Management (HCWM)Alternative Disposal Methods Ohrid, Ana Petrovska STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

  2. Present practice • On-site HCW Treatment by hospitals: • Internal treatment is done in small autoclaves and covers only HCW such as sharps, culture plates and small glass tubes with blood samples. • plastic sharps box is used, but it is emptied and reused due to the relatively high costs of the boxes • Following autoclaving the waste is without further treatment disposed into the municipal waste containers for disposal at the municipal landfill together with ordinary municipal waste. • Although the waste has been sterilised via the autoclave treatment the sharps will still be intact and thereby pose a risk for the staff of the municipal waste collection company and scavengers at the landfill. STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

  3. Present practice (II) • HCW Transport: • HCW is collected from HIs located in the urban area of Skopje using two dedicated trucks for this purpose, each equipped with 5 m3 open containers. • The containers are coloured yellow and are marked with text informing this is medical waste being transported. During transport the open containers are covered with a tarpaulin to avoid spillage. • For smaller HIs (typically private GPs and ambulatories) generating only small amounts of HCW a special yellow cardboard box is used for collection and transport in Skopje • HCW from the Kumanovo area is collected by the General Hospital in Kumanovo using the hospital’s own van the Health Centre’s van; the same vehicles are used for transport to "Drisla". STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

  4. Present practice (III) • HCW Disposal: • Currently the only external treatment and disposal of HCW, besides dumping at municipal landfills together with ordinary waste without pre-treatment except as stated above, is the incinerator at Drisla Landfill. • The incinerator cannot fulfil the requirements according to EU directive 2000/76/EC on waste incineration, nor will it within reasonable costs be possible to up-grade the incinerator to do so. • Faculty of Veterinary Medicine in Skopje has installed a small incinerator for animal carcasses and other animal by-products. STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

  5. Options for future HCW disposalIncineration Advantages • Non-recognizable remnants • Volume reduction by 90% • Safe elimination of pathogens Disadvantages • Intensive investment and operational costs for abatement of emissions in the air • High maintenance costs • Requires trained workers • Ashes as an incineration product are hazardous, thus require adequate disposal standards STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

  6. Incineration (II) • It is considered as an all round treatment option. Mercury containing waste (e.g. amalgam waste from dentists), as well as the radioactive waste and waste containing significant amounts of heavy metals may not be incinerated. • There isn't legislation in place regulating emission of hazardous substances originating from incineration in Macedonia • Flue gas cleaning unit requires application of chemicals • Ashes are considered hazardous waste, while in Macedonia there isn't any dedicated landfill accepting such waste • Setting an Incinerator would require obtaining a stringent IPPC permit and regular monitoring upon operation STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

  7. Options for future HCW disposalAutoclaving Advantages Comparably lower investment costs • Comparably lower maintenance costs • Volume and weight reduction by 50% (shredding and evaporation of moisture) • Comparably simple overseeing of operations • No requirements for cleaning of flue gases • Comparably low investment and operational costs Disadvantages Regular checking and replacement of safety modules is required • Each charge must not be shorter than 15 minutes; each charge treatment must strictly comply with the prescribed parameters regarding the duration and temperature • Requires trained staff for operation STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

  8. Autoclaving (II) • About 90 % of the yearly amount of HCW (infectuous) can be treated in appropriate autoclaves. • Chemicals, expired or unused pharmaceuticals including cytotoxic waste and mercury containing waste will remain problematic for disposal. • Also the biological (pathological) waste may not be treated, depending on the selected autoclave type; • The HCW will after treatment be sterile and can be disposed of at a landfill together with ordinary municipal waste in compliance with the EU Landfill Directive; waste volume is reduced due to the shredding. • Setting an autoclave would require less stringent IPPC permit, while monitoring is not as demanding as for incineration, due to lower emissions STRATEGY ON THE MANAGEMENT OF THE BIOMEDICAL WASTE

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