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Environmentally Responsible Management of Health-Care Waste With a Focus on Immunization Waste. Comments and suggestions on the document are welcome. Send comments to: <firuzeh@essential.org>. Working Draft, October 2002. Health Care Without Harm 1755 S Street NW, Suite 6B

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environmentally responsible management of health care waste with a focus on immunization waste
Environmentally Responsible Management of Health-Care Waste With a Focus on Immunization Waste

Comments and suggestions on the document are welcome. Send comments to: <firuzeh@essential.org>

Working Draft, October 2002

Health Care Without Harm

1755 S Street NW, Suite 6B

Washington, DC 20009

USA

waste management strategies
Waste Management Strategies
  • First Things First
    • Eliminate unnecessary injections
    • Product selection and purchasing
    • Workers as the front-line of defense
      • Rigorous training
      • Immunization
    • Segregation is key
    • Proper containerization, secure transport & storage
    • Non-burn treatment technologies
    • Proper disposal
guidelines
Guidelines
  • Guidelines for Central Planners
  • Guidelines for Local Managers
  • Practical Procedures
  • Treatment and Disposal Options
  • Guidelines are adapted from valuable existing documents:
    • Management of wastes from immunization campaign activities (UNICEF)
    • Safe Management of Wastes from Health Care Activities (WHO)
    • First, do no harm (SIGN, draft 2002)
toxic pollutants from medical waste incinerators
Toxic Pollutants From Medical Waste Incinerators
  • Air Emissions
    • trace metals: As, Cd, Cr, Cu, Hg, Mg, Ni, Pb
    • acid gases: HCl, SO2, NOx
    • dioxins & furans, including 2,3,7,8-tetrachlorodibenzo-p-dioxin
    • other organic compounds: benzene, toluene, xylenes, chlorophenols, vinyl chloride, polycyclic aromatic hydrocarbons, etc.
    • carbon monoxide
    • particulate matter
    • pathogens(under conditions of poor combustion)
  • Ash Residues: metals, dioxins & furans, other organics

Medical waste incinerators are a major source of

dioxins & mercury in the environment.

health impacts of incinerator emissions
Health Impacts of Incinerator Emissions

Incinerator emissions have been linked to:

  • lung, laryngeal, stomach and other cancers
  • ischemic heart disease
  • urinary mutagens and promutagens
  • elevated blood levels of various toxic organic compounds and metals
stockholm convention on pops
Stockholm Convention on POPs
  • Stockholm Convention on Persistent Organic Pollutants (POPs Treaty)
  • Adopted in May 2001
  • Article 5: countries will take measures to further reduce releases of POPs with the goal of ultimate elimination
  • Annex C
    • First in the list of POPs from unintended production: Dioxins and Furans
    • Source with the potential for comparatively high formation and release of dioxins and furans: Medical Waste Incinerators
slide7

De Montfort Combustion Efficiencies*

  • Organic Emissions are 20 to 400 times above the South African limit

India

S. Africa

* Organic Emission Fraction

= 1 - Combustion Efficiency

Field Test: DM1, DM2, DM3, DM4 ; Lab Test: DM5, DM6

de montfort incinerator does not meet environmental standards
De Montfort Incinerator Does Not Meet Environmental Standards
  • Fails to meet combustion temperatures limits
  • Fails to meet residence time requirements
  • Exceeds opacity limits
  • Fails to meet combustion efficiency standards
  • Exceeds limits on particulate matter
  • Exceeds some limits on metals
  • Violates stack height requirements without modification
  • Has no pollution control, no controls on temperature and air input, no safe ash removal system
  • Could release significant quantities of dioxins, furans, mercury and other toxic pollutants
summary of field investigations
Summary of Field Investigations
  • Incinerators (1-2 yrs old) poorly maintained & operated
    • Broken ash doors and/or chamber doors, heavily corroded, clogged air vents, sharps waste around incinerator, etc.
  • Allwaste burned including …
    • PVC plastics (e.g., IV bags) and mercury thermometers
    • Non-infectious, recyclable and compostable waste (despite segregation practices or policies)
  • Large quantities of unburned material in the ash
  • Ash improperly disposed of in every case
  • Smoke visible from incinerators; in some cases, smoke coming out of chamber door and air inlets
  • Incinerators near populated areas
slide10

Heavy Smoke From Incinerator

Operator Using Motorcycle Helmet

Courtesy of P. Madhavan

problems of promoting incineration
Problems of Promoting Incineration
  • Results in Adverse Health Impacts on Health Workers and Communities
  • Pollutes the Environment
  • Weakens Enforcement of Environmental Laws
  • Threatens Worker Safety
  • Undermines Good Waste Management Practices
  • Promotes Dumping of Obsolete Technologies
  • Hampers Deployment of Cleaner Technologies
low cost options
Low-Cost Options

CE Cement Encasing

EI Encapsulation With Immobilizing Materials

BP Waste Burial Pit or Sharps Pit With Concrete Cover

PU Portable Autoclave or Microwave

ND Point-of-Use Needle Destruction Technologies

ND/m Mechanical Needle Destruction

CT Storage, Transport and Centralized Treatment

TG Traditional Grinders

S Shredders or Hammermills

Disposal in Sanitary Landfill

Burial in Restricted Sites

estimates for cement encasing

Number of children targeted for vaccination

100

1,000

5,000

10,000

Number of safety boxes

8

75

377

753

Volume of sharps waste (cubic meters)

0.04

0.042

2.12

4.25

Trench volume (cubic meters)

0.08

0.85

4.25

8.49

Amount of cement needed (kg)

10

96

478

955

Approximate cost of cement, lime, and sand (US $)

$5

$43

$215

$430

Estimates for Cement Encasing

Trench volume and cement needed for DTP-HepB-Hib vaccination waste

environmentally responsible management of health care waste with a focus on immunization waste1
Environmentally Responsible Management of Health-Care Waste With a Focus on Immunization Waste

Comments and suggestions on the document are welcome. Send comments to: <firuzeh@essential.org>

Working Draft, October 2002

Health Care Without Harm

1755 S Street NW, Suite 6B

Washington, DC 20009

USA