Hospital and healthcare waste: why choose incineration?

HOSPITAL AND HEALTHCARE WASTE: DIFFERENTIATION AND CHARACTERISATION

The World Health Organisation classifies as health care waste all those wastes created by health care activities from hospitals to pharmacies, polyclinics, analysis laboratories and therapeutic centres, from mortuary laboratories and autopsy centres to banks and blood collection services, old people’s homes, including all sectors belonging to the “health care”.

The waste generated by the above-mentioned facilities can be broken down as follows:

1. Waste assimilated to municipal waste: this includes waste from kitchens for catering activities, residues of meals served in hospital wards (excluding infectious diseases), paper waste, waste from cleaning operations, disposable clothing and protective equipment and other waste whose disposal follows the normal procedure for municipal solid waste;
2. Non-hazardous medical waste: this category includes waste consisting of non-bulky metal material, empty drug containers, infusion solutions, expired drugs (except cytotoxic and cytostatic drugs, which are considered hazardous waste), unused sharps waste. From a legal point of view, these are considered as special waste and therefore follow a specific rule of registration, loading/unloading and disposal by thermal destruction or incineration;
3. Hazardous medical waste with an infectious risk: these are characterised by non-sharp and non-percolating materials that must be specially disinfected before being placed in a rigid cardboard container approved for the transport of dangerous goods; by sharp or pointed materials that must be disinfected and then placed in rigid plastic containers with a needle disconnection system and marked as high biological risk waste; infected or presumably infected materials, specifically laboratory materials that have come into contact with percolating materials such as blood, urine, faeces, secretions and other fluids, which must be placed in special rigid plastic containers, with disinfectant inside, labelled as biohazardous waste and closed inside a bag with a strangle tie closing. The waste will then be sent to the incinerator, which will operate at a temperature of 850°/1200°C, in order to avoid the formation of harmful substances;
4. Hazardous medical waste with a chemical risk: this classification includes all liquid waste from analysis, radiology and diagnostic laboratories in general, as well as waste containing mercury and similar materials.
5. Medical waste requiring special disposal methods: coded as hazardous waste with an infectious risk, this includes experimental animals, organs and anatomical parts that cannot be recognised. Disposal is by thermal destruction;
6. Waste from exhumation and other cemeterial activities: this includes anatomical parts that are deemed to be recognisable and are taken over by the mortuary police, who transport them and bury them or destroy them thermally.

HEALTH AND WASTE TREATMENT: RISK AND ENVIRONMENTAL DAMAGE

Because of their quantity and sorting, hospital waste can represent a serious danger not only to patients and medical staff but also to those who stumble upon it if it is abandoned in the open. People can become infected either through direct contact with contaminated waste or indirectly through contamination of soil, groundwater, surface water or air. Direct or indirect exposure through environmental contamination by pharmaceutical and laboratory waste can also cause disease in both human and animal populations.

According to a 2012 statistic, 23% of global deaths can be attributed to environmental factors, such as abandoned waste generated from treating patients with blood-borne diseases, such as HIV and viral hepatitis B, which can be acquired through mismanagement of hazardous hospital waste.

In developing countries there is unfortunately little attention paid to the problem of medical waste disposal. This is the case in Uganda, which does not have a specific legal system requiring health facilities to properly sort, store and dispose of this waste, nor is funding available to address these issues. It is therefore possible that staff working in health facilities and people living nearby are exposed to unnecessary risks, including possible environmental contamination.

Looking around the world again, about one-third of Pakistan’s population of 60 million people are at risk of serious health damage from arsenic in water that can cause skin diseases, lung and bladder cancer and cardiovascular complications if ingested over long periods. In addition to this type of poisoning, there is also an equally dramatic case of inappropriate management of dangerous hospital waste.

The same applies to the numerous open dumps in many parts of Africa, such as in Nairobi’s Korogocho slum and in Dandora, where there is one of the largest dumpsites in Africa. Here 10,000 workers sort waste by hand and 55% of the workers are children, who run away from school to increase their family income. A day’s work in the landfill is equivalent to less than € 2 in earnings. 50% of these children have severe respiratory problems and serious infections due to the dangerous and infectious material, much of which is hospital waste. Toxic exposure to pharmaceutical products, especially antibiotics and cytotoxics released into the environment, and to substances such as mercury cause very serious health damage.

Or in Nigeria, where 90% of waste, most of which is medical waste, is not collected and accumulates in cities as open dumps are depleted.

In Asia, in Manila, Payatas in Quezon City, a shanty town where over 25,000 people live, is infamous: it has sprung up on the slope of a hill of rubbish, the “smoking mountain” where adults and children, in vying for materials to be resold, risk contracting dangerous infectious diseases by rummaging through the infectious and sharp-edged medical waste that has not been properly disposed of.

An elaborate study has revealed that in India, of the 3 to 6 trillion injections administered every year, more than 30 % are done with recycled syringes and resold on the black market. As they are not disposed of safely, they cause a high risk of injury and infections such as HIV, hepatitis B and hepatitis C due to their reuse.

Unfortunately, the above case also concerns other developing countries that have suffered in recent decades from the spread of epidemics of viruses such as Ebola, Tuberculosis, AIDS, etc.

It has been estimated that in Africa, a patient hospitalised with Ebola produces up to 300 litres of liquid waste and excrement per day, potentially contaminated, which needs proper disposal to avoid the risk of transmission. This management becomes extremely difficult when one third of health facilities in affected countries do not have running water and 40% of these facilities do not have a waste management system.

The WHO points out that ‘high-income countries’ generate on average up to 0.5 kg of hazardous waste per hospital bed per day; while ‘low-income countries’ generate on average 0.2 kg. However, in low-income countries, medical waste is often not separated into hazardous and non-hazardous waste, making the actual amount of hazardous waste much higher.

The COVID-19 pandemic that the world has been facing for many months has forced several countries to adapt to the ever-increasing demand for single-use personal protective equipment and to manage disposal issues. For example, in the first half of 2020, the city of Whuan produced around 240 tonnes of medical waste per day, six times more than in the months before the outbreak of the virus, which created a knock-on effect as the risk that waste and recycling collection staff could contract the virus encouraged several municipalities to temporarily stop waste collection. The increase in the production of individual medical devices that are difficult to recycle, coupled with the massive increase in packaging due to the change in purchasing habits caused by the lockdown, has further highlighted the need for faster, more effective and environmentally friendly disposal systems such as incineration plants.

Proper disposal of this waste would also reduce the risk of illness and damage to health and intervention by the health system, which would also benefit from significant cost savings.

INCINERATION AS A SYSTEM OF CORRECT LOCAL MANAGEMENT FOR A GLOBAL SOLUTION

In order to improve the management of health care waste, it is necessary to plan and promote the correct segregation of the same starting from within the health care structure, where each specific department differentiates its type of waste, using appropriate containers and strict storage methods until they are completely destroyed and disposed of through an incinerator equipped with an adequate purification system, as they are or after sterilisation (which is certainly fundamental but only makes the waste less dangerous without eliminating it), by locating small plants around the various rural hospitals. It should be pointed out that the incineration of RSP-I (hazardous medical waste at risk of infection) is considered a guarantee of safety for the elimination of the bacterial load comparable to the highest levels obtainable with sterilisation. Moreover, the substantial reduction in weight and volume of waste that can be achieved by incineration (and comparable to that achieved with RU or similar) makes this practice the best at present, also considering the safety resulting from little or no handling of the waste by the operator, which does not expose him to infectious risks.

To date, incineration remains the safest and most effective treatment method for preventing damage to the environment and health in general. We have seen how other alternatives, including autoclaving or similar chemical treatments, cannot treat waste containing volatile and semi-volatile organic compounds, mercury, other hazardous radiological and chemical waste, bulky bedding and animal carcasses, specific pathologies, etc.

Not only does incineration not require any pre-treatment, but the incineration plant, if properly operated, is able to remove pathogens from the waste and reduce it to ash. Some medical wastes require higher temperatures for complete destruction, so high operating temperatures and flue gas cleaning limit the air pollution and odours produced by the incineration process.

The key technologies involved in proper thermal destruction are:

– incinerators with pyrolytic double chamber operation, which can be specially designed to burn infectious medical waste;

– high-temperature rotary kilns, which can decompose genotoxic substances and heat-resistant chemicals.

Incineration guarantees:

– correct and rapid management of the waste and its destruction by up to 99%;

– elimination of odours from storage or burial

– elimination of the risk of infection from handling and transport

– inertisation of the waste thanks to its treatment at 1000°C

– elimination of chemical and biological hazards associated with the waste

– absence of black fumes and unpleasant odours;

– zero environmental impact thanks to modern abatement systems on each plant;

– compliance with the strictest European and world parameters in terms of emissions;

– possibility of recovering heat

For.Tec. has been offering technologically advanced solutions to solve the problem of medical waste management for over 40 years with its EXCE OS – ROTOMAC and ECOTEC models with an incineration capacity ranging from 30 to 650 kg/hour. Depending on your needs, our experts will advise you on the most suitable model, tailoring it to your specific requirements.

Our incinerators are able to dispose of

– hospital waste

– hazardous medical waste

– waste from small communities

– shopping centre and airport waste

– agricultural, rubber, wood and paper industry waste

– waste sludge

– waste oils

Most of our models can be skid-mounted or containerised to allow easy access to remote areas, military bases and isolated communities, offering immediate and decisive intervention even in the event of epidemic outbreaks.

Depending on the place of installation and the regulations in force, it is possible to install different types of abatement systems on our plants, such as wet scrubbers or dry depuration systems with gas deacidification section and particulate removal by means of bag filters.

On each plant it is also possible to provide energy recovery systems for the production of hot water, hot air or steam that could be used for the needs of the hospital or buildings located near the plant.