AUTOCLAVE TECHNOLOGY SELECTION FOR A REGIONAL HEALTHCARE WASTE PROCESSING PLANT IN KWAZULU NATAL

1. AUTOCLAVE TECHNOLOGY SELECTION FOR A REGIONAL HEALTHCARE WASTE PROCESSING PLANT IN KWAZULU NATAL Healthcare Waste Management in Africa Today Ray Lombard Lombard & Associates

2. A NEW HEALTH CARE RISK WASTE TREATMENT SYSTEM • Town & Regional Planning Commission Report • EIA & Public Participation • Legislative framework • General Technical Assessment • Bondtech Autoclave

3. Town & Regional Planning Commission Report • The Town & Regional Planning Commission Report on the Need for Hazardous Waste Disposal Facilities - completed in September 2000 • Need for Health Care Risk Waste treatment facilities in KwaZulu Natal formed part of that investigation

4. KWAZULU NATAL HEALTH REGION GOVT. FACILITIES STATE-AIDED & PRIVATE FACILITIES TOTAL DAILY GENERATION RATE Port Shepstone 712 24 736 Pietermaritzburg 2 571 320 2 891 Ladysmith 416 30 446 Ulundi 778 85 863 Jozini 347 347 Durban 3 691 1 144 4 835 Newcastle 741 18 759 Empangeni 1 056 61 1 117 Total 10 312 1 682 11 994 Town & Regional Planning Commission Report Findings – HCR Waste Generation

5. The data reported are conservative – no data for veterinary practices and little for private practices • Almost half of the waste is unaccounted for • The waste is either being burned in environmentally unacceptable ovens or illegally dumped Town & Regional Planning Commission Report Findings – HCR Waste Management

6. informs Interested & Affected Parties (I&APs) of proposed development provides opportunities for I&APs to raise issues, concerns and suggestions promotes transparency and understanding of the project and its consequences promotes liaison and communication with I&APs serves as a data gathering mechanism for the Scoping Study EIA process

7. Public Participation Process Facilitated by Icando with Compass Waste Services interacting with I&APs that included: • Depts of Water Affairs & Forestry and Environmental Affairs & Tourism at the national level • Depts of Agriculture & Environmental Affairs and Health in KwaZulu Natal Province • Local government including eThekwini Metro, Pietermaritzburg/ Msunduzi, uThukela, Ugu and Ilembe District Municipalities • Competitors (Sanumed (Pty) Ltd, Waste Services (Pty) Ltd, Clinx) • Client health care institutions (Afrox, Netcare & Provincial hospitals) • Organised labour in health care (Hospersa) • Pharmaceutical Society, NGOs (groundWork, EJNF and WESSA) and interested members of the public

8. Legislative Framework • Policy and guidelines • Relevant South African legislation and regulations • International guidelines and codes of practice • Informed by an extensive and comprehensive public participation process involving a wide spectrum of interested and affected parties – including all levels of government, environmental NGOs, user groups, potential competitors and concerned citizens

9. Policy & Regulatory Guidelines • Integrated Pollution and Waste Management • National Waste Management Strategy • Best Practical Environmental Option • Constitution (1996) • NEMA (1998) • ECA (1989) • Health Act (1977) • OHSA (1993) • A mass of old Statutes • Scheduled Trade Permit

10. Health Care Risk Waste Treatment • Historically, in the USA incineration was an effective way to deal with HCRW • EPA rulings have greatly increased the cost of incineration • Flue gas scrubbings generate other hazardous wastes apart from dioxins, dibenzofurans and organohalides • Hospitals have begun to close existing incinerators

11. General Technical Assessment • WHO • Basel Convention • SWANA • ISWA • CIWM in UK • Vogel International • Health Care without Harm • Shristi • Interested & Affected Parties roles • Public Participation Processes • Work Sessions • Decision making Tables designed by stakeholders in the process

12. Alternative Technology Selection • Incineration • E-beam • Microwave • Dry heat • Wet Heat • Chemical sterilisation • Autoclaving • Landfill or burial

13. TECHNOLOGY INFORMATION AVAILABLE PROVEN TECHNOLOGY HEALTH RISKS ENVIRONMENTAL & SOCIAL IMPACTS ECONOMIC IMPLICATIONS MICROWAVE AUTOCLAVE PLASMA ARC ELECTRON BEAM INCINERATION CHEMICAL STERILISATION LANDFILL Matrix used to eliminate Inappropriate Technology

14. Technology Machine Maintenance Occupational Risk Environmental & Social Impact Economic Implications Regulatory Compliance Overall MICROWAVE Sanitec HG-A250S -1 -1 0 -1 1 -2 AUTOCLAVE STI Chemclave S1000 1 -1 0 1 1 2 S2000 1 -1 0 0 1 1 Rotoclave 1500DI 1 0 0 2 1 4 2500DI 1 0 0 1 1 3 INCINERATOR 3T RD500 -1 -1 -1 -2 1 -4 RD700 -1 -1 -1 0 1 -2 Gencor -1 -1 -1 -2 1 -4 MACROburn -1 -1 -1 0 -1 -4 TOXIC 400 -1 -1 -1 1 1 -1 LANDFILL 1 1 -1 0 -1 0 Overall Assessment Matrix

15. Toxic 400 Dual Chambered Pyrolysis Incinerator • Capacity • Air emissions • Disposal of ash • Growing public pressure • Logistics • Maintenance

16. DETERMINAND GUIDELINE April 1998 May 1999 March 2000 Jan 2001 Stack Temp 0C 779 - 842 860 951 1 139 Stack Exit Velocity m/s 10 10.0 -14.0 3.7 4.8 Oxygen% 11 11 11.0 -11.5 9.9 9.5 CO vpm3 39 73 74 120 Cl- mg/m3 30 267 7.3 1.75 0.7 NOx mg/m3 118 8.6 145 93 SOx mg/m3 25 28 13.5 634 22 TSP mg/m3 120 163 52 106 182 Total Metals mg/m3 2.47 2.64 Emission Data

17. Autoclaves Objectives:- • To render health care risk waste sterile • To produce unrecognisable sterile waste material • Internationally acceptable specifications • Environmentally acceptable • Cost effective health care risk waste treatment in South Africa

18. Autoclaving

19. Features of Autoclave Option • Recorders for pressure & temperature • Packaged and modularised for easy installation • Removal of moisture for less weight at time of disposal • Built under ASME Boiler and Pressure Vessel Code, Section VIII, Div1 • Rugged design built for commercial use • Low maintenance • Hydraulic door closure • Liquid ring vacuum pump or steam ejector for high vacuum operation • Programmable Logic Control system

20. How does the autoclave work? • What is the process? • How long does it take for one cycle?

21. Cost effective medical waste treatment 75 units operating in USA Meets US Standards

22. The waste is brought to the machine and loaded into the stainless steel carts Bin Loading The carts are then rolled on to the lift table. The table lifts the cart up and it is then rolled into the machine

23. Bin Loading Once all of the carts are loaded the door is shut and the hydraulic lock is engaged

24. After the Autoclave door is closed the following steps are performed by the pre-programmed controller: Treatment • Pre-vacuum evacuates air from vessel and expedites steam penetration into infectious waste • Steam is injected and soaks the waste under pressure at temperatures from 141°C to 152°C for 40 minutes • A post vacuum process is used to dry the load and to reduce the associated treatment smell • Pre- and post vacuum air is filtered and all vapour is condensed and discharged to sewer • A green light indicates that the cycle is complete

25. Bins are unloaded by forklift which empties each cart into a shredder. The autoclave is ready for the next cycle Unloading

26. Shredder Specifications • Direct Drive • Hex Shaft Design • Automatic Reversing • Low Speed, High Torque • Anti-Jamming Device • Low Noise

27. Shredded Waste After sterilization

28. GTA factors favouring autoclave option • Lower health impacts on humans and environment than existing incineration methods • Unregulated liquid, solid or gaseous emissions are not produced • Unrecognisable final product a mixture of sterile solid and fibrous matter that is safe to landfill • Treated residue does not require hazardous waste disposal site specification • Kills all human pathogens in health care risk waste • Reduces volume of health care risk waste by 85% when shredded or compacted

29. Recommended mitigation measures • Health care risk waste collection, transportation and associated activities – standard industry controls • Off-loading and associated activities • Processing of streamed HCRW through the autoclave process – as specified controlled by PLC • Validation tests (Bacillus stearothermophilus & B subtilis) as in WHO & Basel Convention Guidelines • Disposal of sterile processed waste material at Class G Landfill (accepted by DWA&F in RSA) • Radioactive and chemically hazardous wastes are proscribed

30. Benefits of autoclave option • No combustion products or ash formed • No dioxins and furans from the combustion of chlorinated aromatics and other chlorine containing materials because operating temperatures do not exceed 160oC (problems at 277oC to 427oC) • No HCl (hydrogen chloride), SOx (sulphur oxides), NOx (nitrogen oxides), CO nor CO2 formed

31. Other impacts • Air pollution • Noise pollution • Light pollution • Water pollution

32. Conclusions • Negative social impacts were related to issues of public health and safety • Effective and transparent communication from the start ensured that representatives from the surrounding industries and residents were well informed • Fears based on misinformation or disinformation eliminated • Based on the information available to the consultants and the outcome of the public participation process, an authorization to implement the project was granted by the authorities