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Feliks Leybovich
  12/20/2012
Introduction
                    
 Medical care is vital for our life, health and well being.
 The waste generated from medical activities can be
  hazardous, toxic.
 Diseases like cholera, plague, skin infection, hepatitis
  , AIDS (HIV), pose grave public health risks.
 Environmental pollution.
 Institutional/Organizational set up, training and
  motivation.
 Great research & awareness have increased recently.
Definition
                       
 ‘Medical Waste’ means any solid and/or liquid waste including
  its container and any intermediate product, which is generated
  during the diagnosis, treatment or immunization of human
  beings or animals or in research or in the production or testing.
 Any waste which consists entirely or partly of human or animal
  tissue, blood or other body fluids, excretions, drugs or other
  pharmaceutical products, dressings or syringes, needles or other
  sharp instruments.
 Sources: Arising from medical, nursing, dental, pharmaceutical
  or similar practice, investigation, treatment, care, teaching or
  research or the collection of blood from transfusion.
Risk Involved
                
   Microorganisms           Infections
 Enterobacteria      Gastroentic infections
 Mycobacterium       Respiratory infection
  tuberculosis        Skin infection
 Streptococcus       Acquired
 Human                Immunodeficiency
  Immunodeficiency     Disorder
  Viruses
Generation
                   
 Public hospitals produce more healthcare waste than
  private hospitals.
 Mismanagement of Waste and lack of segregation of
  waste.
 North America produces 7–10 kg of healthcare waste per
  bed/day, South America produces 3kg . Western Europe
  produces 3–6 kg, Eastern Europe 1.4–2 kg, In Asia, richer
  countries produce 2.5 kg per bed/daily, and poorer
  countries 1.8–2 kg per bed/daily.
Worldwide Waste Generation
                 
 South Africa    0.60 kg/bed/day
 Algeria         0.70 kg/bed/day
 Brazil          2.63 kg/bed/day
 Jordan          6.10 kg/bed/day
 Greece          8.4 kg/bed/day
 Bangladesh      1.71 kg/bed/day
 China           1.22 kg/bed/day
Handling & Transportation
          
 Risks to healthcare staffs, the public and the environment.

 Codes of practices and guidelines for handling and disposal

 Problematic due to its enormous volume of generation, serious threat for the
  human health as well as disposal cost.

 Clinical waste cannot mix with non-clinical waste.

 workers are not educated enough and most of them have not had any special
  training on the management of clinical waste.

 Do not have appropriate colour coded bags or containers for sorting the different
  types of waste.
Storage of Waste
                 
 Recommended Labelling and Color
  Coding

 Segregate Storage in Separate
  Containers (at the Point of
  Generation).

 Certification.

 Common/Intermediate Storage Area.
Treatment Technologies
          
Incineration
Autoclaving
Microwave
Chemical disinfecting
Irradiation
Incineration
                   
 According to the EPA 90% of
  medical waste is incinerated
 Very effective and secondary
  benefit of powering boilers in
  the facility
 Strict regulations regarding air
  emissions
 Incinerator Ash is generally
  landfilled
Medical waste management updated
Autoclaving
                 
 Applied heat, pressure, and
  sometimes steam for
  sterilization.
 Often followed by
  compaction process, and
  eventually reaches landfills
 Many landfills are reluctant
  to accept the waste due to
  concerns that it still is
  infectious
Microwaving
                  
 On-site installation or mobile
  treatment vehicles in US
 First the waste is shredded and
  then it is mixed with water.
 Microwaving is applied
  internal heat (autoclaving is
  external heat)
 According to the EPA not          Industrial Microwaving Belt
  recommended for treatment of
  pathological waste
Chemical Disinfecting
            
 Primarily through the use of
  chlorine products
 Waste is first shredded and
  mixed with water
 According to the
  EPA, chemical disinfection is
  the most appropriate way to
  treat liquid medical waste
Irradiation
                    
 Exposure of Waste to Cobalt source
 Gamma Radiation inactivates all microbes
 Special treatment sites are required (No Mobile or in
  house process)
 High capital cost
 Operators’ safety risk in irradiation plant is an issue
 Does not sterilize pathological wastes
Comparison of Treatment Technologies

                
Case Studies
              
Metro Health Hospital, Wyoming, MI:
 Divert and Purchase Reprocessing
 Medical Devices
Spectrum Health: Medical Plastics
 Recycling
Germany Waste Act: 1991
Metro Health Hospital, Wyoming, MI: Divert
 and Purchase Reprocessing Medical Devices
                          
           What                      Benefits
 Reprocess many           Cost savings of $235,803
                            from purchasing
  previously single-use     reprocessed SUDs
  devices                   between 2008 and 2010
 Including: harmonic      „ 1.84 tons of waste
                            avoided due to
  scalpels, orthopedic      reprocessing in 2010.
  burrs, and orthopedic    „ Avoided $900 in
  cannulas/trocars          regulated medical waste
                            disposal fees in 2010.
Medical waste management updated
Spectrum Health: Medical
           Plastics Recycling
                             
            Plastics                          Benefits
 „ plastic casing                42,000 pounds of blue wrap
 hard plastic from devices        diverted to recycling in 2010
  paper lined with plastic       „ 100 bags per day diverted
  plastic from surgical gowns     from OR
 outer casings of syringes       „ Recycling cost half as
 soft plastics from glove         much as general waste
  wrappers                        „ Increases staff satisfaction
 rigid saline bottles             relative to reducing
 wash basins, and surgical        environmental impact of the
  preparation kits                 OR
Medical waste management updated
German Waste Act: 1991
                         
 Retailers and producers required to take back a
  certain percentage of packaging materials
 Duales System Deutschland (DSD) collects all the
  packaging with a Green Dot
 Licenses this symbol for the products they recycle
 Reimbursement will be given to companies only
  after recycling occurs and quotas are met
Targets for collection, sorting and recycling packaging
                    materials in 1996

                         
Thank You
                  
 Questions?

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Medical waste management updated

  • 1. Feliks Leybovich 12/20/2012
  • 2. Introduction   Medical care is vital for our life, health and well being.  The waste generated from medical activities can be hazardous, toxic.  Diseases like cholera, plague, skin infection, hepatitis , AIDS (HIV), pose grave public health risks.  Environmental pollution.  Institutional/Organizational set up, training and motivation.  Great research & awareness have increased recently.
  • 3. Definition   ‘Medical Waste’ means any solid and/or liquid waste including its container and any intermediate product, which is generated during the diagnosis, treatment or immunization of human beings or animals or in research or in the production or testing.  Any waste which consists entirely or partly of human or animal tissue, blood or other body fluids, excretions, drugs or other pharmaceutical products, dressings or syringes, needles or other sharp instruments.  Sources: Arising from medical, nursing, dental, pharmaceutical or similar practice, investigation, treatment, care, teaching or research or the collection of blood from transfusion.
  • 4. Risk Involved  Microorganisms Infections  Enterobacteria  Gastroentic infections  Mycobacterium  Respiratory infection tuberculosis  Skin infection  Streptococcus  Acquired  Human Immunodeficiency Immunodeficiency Disorder Viruses
  • 5. Generation   Public hospitals produce more healthcare waste than private hospitals.  Mismanagement of Waste and lack of segregation of waste.  North America produces 7–10 kg of healthcare waste per bed/day, South America produces 3kg . Western Europe produces 3–6 kg, Eastern Europe 1.4–2 kg, In Asia, richer countries produce 2.5 kg per bed/daily, and poorer countries 1.8–2 kg per bed/daily.
  • 6. Worldwide Waste Generation   South Africa  0.60 kg/bed/day  Algeria  0.70 kg/bed/day  Brazil  2.63 kg/bed/day  Jordan  6.10 kg/bed/day  Greece  8.4 kg/bed/day  Bangladesh  1.71 kg/bed/day  China  1.22 kg/bed/day
  • 7. Handling & Transportation   Risks to healthcare staffs, the public and the environment.  Codes of practices and guidelines for handling and disposal  Problematic due to its enormous volume of generation, serious threat for the human health as well as disposal cost.  Clinical waste cannot mix with non-clinical waste.  workers are not educated enough and most of them have not had any special training on the management of clinical waste.  Do not have appropriate colour coded bags or containers for sorting the different types of waste.
  • 8. Storage of Waste   Recommended Labelling and Color Coding  Segregate Storage in Separate Containers (at the Point of Generation).  Certification.  Common/Intermediate Storage Area.
  • 9. Treatment Technologies  Incineration Autoclaving Microwave Chemical disinfecting Irradiation
  • 10. Incineration   According to the EPA 90% of medical waste is incinerated  Very effective and secondary benefit of powering boilers in the facility  Strict regulations regarding air emissions  Incinerator Ash is generally landfilled
  • 12. Autoclaving   Applied heat, pressure, and sometimes steam for sterilization.  Often followed by compaction process, and eventually reaches landfills  Many landfills are reluctant to accept the waste due to concerns that it still is infectious
  • 13. Microwaving   On-site installation or mobile treatment vehicles in US  First the waste is shredded and then it is mixed with water.  Microwaving is applied internal heat (autoclaving is external heat)  According to the EPA not Industrial Microwaving Belt recommended for treatment of pathological waste
  • 14. Chemical Disinfecting   Primarily through the use of chlorine products  Waste is first shredded and mixed with water  According to the EPA, chemical disinfection is the most appropriate way to treat liquid medical waste
  • 15. Irradiation   Exposure of Waste to Cobalt source  Gamma Radiation inactivates all microbes  Special treatment sites are required (No Mobile or in house process)  High capital cost  Operators’ safety risk in irradiation plant is an issue  Does not sterilize pathological wastes
  • 16. Comparison of Treatment Technologies 
  • 17. Case Studies  Metro Health Hospital, Wyoming, MI: Divert and Purchase Reprocessing Medical Devices Spectrum Health: Medical Plastics Recycling Germany Waste Act: 1991
  • 18. Metro Health Hospital, Wyoming, MI: Divert and Purchase Reprocessing Medical Devices  What Benefits  Reprocess many  Cost savings of $235,803 from purchasing previously single-use reprocessed SUDs devices between 2008 and 2010  Including: harmonic  „ 1.84 tons of waste avoided due to scalpels, orthopedic reprocessing in 2010. burrs, and orthopedic  „ Avoided $900 in cannulas/trocars regulated medical waste disposal fees in 2010.
  • 20. Spectrum Health: Medical Plastics Recycling  Plastics Benefits  „ plastic casing  42,000 pounds of blue wrap  hard plastic from devices diverted to recycling in 2010  paper lined with plastic  „ 100 bags per day diverted  plastic from surgical gowns from OR  outer casings of syringes  „ Recycling cost half as  soft plastics from glove much as general waste wrappers  „ Increases staff satisfaction  rigid saline bottles relative to reducing  wash basins, and surgical environmental impact of the preparation kits OR
  • 22. German Waste Act: 1991   Retailers and producers required to take back a certain percentage of packaging materials  Duales System Deutschland (DSD) collects all the packaging with a Green Dot  Licenses this symbol for the products they recycle  Reimbursement will be given to companies only after recycling occurs and quotas are met
  • 23. Targets for collection, sorting and recycling packaging materials in 1996 
  • 24. Thank You   Questions?