medical waste in Serbia

1. medical waste in Serbia Doc. Dr Goran Vujić

2. Medical waste and infectious medical waste (IMW)/1 • Medical waste is defined as any waste, generated in provision of health services: • diagnosis; • prevention; • treatment; • research in the field of human and veterinary medicine. • MW is created in medical institutions, medical centers or laboratories. • It is a heterogeneous mixture of waste, while 10-25% is hazardous waste. • In addition to health risk (result of direct contact) MW may have irreversible health effects through indirect contamination of water and land during the treatment and final disposal or air pollution due to insineration.

3. Medical waste and infectious medical waste (IMW)/2

4. Current situation in R.Serbia in terms of MW management • Medical waste in health care facilities in the RS is generated in uneven amounts, depending on: • the type of facilities, • numbers of beds, • type of diseases, • conditions of care and types of services provided. • In 2007 Ministry of Health of the Republic of Serbia started the specific activity in the introduction of uniform system of managing medical waste, a special category of infectious medical waste. • Only a limited number of health institutions in RS carries out sterilization of IMW, mostly in very old but regularly maintained autoclaves. • In individual health facilities used needles and syringes, cotton tufers and other IMW are mainly mixed with municipal waste without separation nor sterilization.

5. Current situation in R.Serbia in terms of MW management • The goal for treatment of IMW is that it can be turned into harmless household waste. • If the IMW is sterilized first, and then comminute in small pieces so it can not be recognized then it can be disposed to the MSW landfills. • There are 50,988 beds in hospitals across RS, the average use of beds is 72% on a year level. • There is an additional 2700 beds in military hospitals and private clinics. • Estimated average amount of MW waste generated in health care facilities in RS is 1.8kg of MW per hospital bed per day, this quantity is valid for the countries of Eastern Europe (WHO). • About 9.600t of the total amount of medical waste is considered hazardous waste.

6. The concept of "central places for the treatment of IMW" • Estimated quantities of IMW generated in health facilities do not including the private sector and the sector of veterinary medicine. • Research from 2008. showed that 100 registered visits to health centers produce 1kg IMW. • Central place for treatment of IMW system requires the existence of a central treatment institutions (CTI) according to model of administrative districts. • Under this system, autoclaves are set in places where is the higest production of IMW, which is inside the hospitals and clinical centers, which are by far the largest producers of waste.

7. Plan for distribution equipment for IMW treatment • Each of the mentioned districts was appointed and equipped with at least one health care institution, which is the largest manufacturer of IMW in a given district. Appointed CTI has the obligation to treat its own IMW and IMW generated from public sector health facilities in the county, and the network of health institutions. • "Regulation of the plan network of health institutions" (article 47 of the Health Care, Official Gazette of the RS, No. 107/05).

8. Plan for distribution equipment for IMW treatment • Medical waste management system is based on the assessment and analysis of the current situation in the Republic of Serbia, which takes into account the constraints imposed by equipment that was purchased for thermal processing of IMW.

9. Conceptual model relies on a generic topic with the following three variations: • Model for medical waste management for the city of Belgrade.

10. Conceptual model relies on a generic topic with the following three variations: • City/area health insti-tution with tertiary health care (Niš, Kragujevac and Novi Sad).

11. Conceptual model relies on a generic topic with the following three variations: • The health area with an institution of secondary level health care, general hospitals, as well as central place of treatment.

12. Handling infectious waste by steam sterilization • Device which is made of waste steam sterilization (autoclave) must not carry a risk for personnel or general population. • The basic requirement is that the process of steam sterilization leads to a sufficient degree of reduction of the biological agents content in waste. • The following categories of waste can be treated by steam sterilization • used sharp objects, syringes, tubes… • broken glass, objects from the smaller health facilities • blood and contaminated fluids… • nonrecognizable tissue from diagnostic procedures, nonsurgicla waste originated from hemodialysis and peritoneal dialysis • tufers, materials stained with blood and other bodily secretions and excretions, towels, diapers messy bodily fluids and/or excretions…

13. Health institutions equipped with system for treatment of IMW • "Technical assistance inmanagement of medical waste“ • Administrativ district of South Bačka: • Clinical center of Vojvodina, • Institute for Pulmonary Diseases of Vojvodina, • Institute for Public health of Vojvodina, • Health center of Novi Sad. • Clinical center of Vojvodina: • General Hospital in Novi Sad, • Maternity and nursery in Novi Sad, • Children‘s Hospital in Novi Sad. • Health center of Novi Sad – all health centers in administrativ district of Novi Sad.

14. Steps in the process of IMW treatment • Separation of waste in the place of generation; • Transportation of the waste to treatment facility; • Measurment of obtained waste; • Treatment of the IMW in autoclaves; • Sterilized IMW is fragmented; • After fragmentation, infectiv medical waste (IMW) is ready to be disposed; • Sterilized and fragmented IMW is desoposed in to conventional containers for comunal waste and then transported to a landfill; • Once closed bages and containers do not have to be open throughout the whole treatment proces.

15. Clinical center of Vojvodina • 3 autoclaves in clinical center of Novi Sad are donation from EU

16. Clinical center of Vojvodina • equippement for waste fragmentationis also donated from EU

17. Clinical center of Vojvodina • Containers and bags for IMW which are in use in Clinical center of Novi Sad (yellow colour is reserved for IMW)

18. Health Center of Novi Sad • There are 36 Health centers which are included in institution of Health center of Novi Sad and which use one facility equipped for treatment of IMW. • Employees who work in the plant for treatment of IMW are trained technical workers of Health Center of Novi Sad. • Some private clinics have sigened contract with Health center of Novi Sad for use of their facilitiy, as they do not own the equippementfor treatment of IMW. • Maintenance of equippement for IMW treatment is performened by privete thired party licenced for this operation.

19. Conclusions • DONATION EU to SERBIA • who pay now for operational, transport, maintenance and how much, why and where • Landfill?