material flow management for treating waste from medical activity

International Journal of Innovative Research in Information Security (IJIRIS) ISSN: 2349-7017(O) Issue 9, Volume 2 (November 2015) ISSN: 2349-7009(P) www.ijiris.com

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Material Flow Management for Treating Waste from Medical Activity

Daniela Bordeianu Simona G. Şaşcîm (Dumitrescu)* Cicerone L. Popa Costel E. COTEŢ MSP Department MSP Department MSP Department MSP Department

University POLITEHNICA University POLITEHNICA University POLITEHNICA University POLITEHNICA of Bucharest of Bucharest of Bucharest of Bucharest

Abstract— Developing methods for treating hazardous waste from medical activities is currently a priority. These medical activities aim to obtain a final product which is friendly for the environment and for people's health. This paper is going to present the existing methods for the disposal of medical waste, the necessity to introduce alternative treatment technologies in the material flow management of hazardous medical waste and a method for treating medical waste is developed; the method is based on existing technologies at this moment. The proposed method consists in chemical disinfection of infectious medical waste and turning them into household waste without any dangerous character and the recovery of disinfected plastic waste, in order to be used in the production of asphalt mixtures. For the proposed method was developed a project planner into Microsoft Project 2013 application.

Keywords— medical waste, incineration, material flow, treatment, plastic waste, project planner

I. INTRODUCTION Medical waste means all hazardous or non- hazardous waste which is occurring within the health unit. Medical waste

management means the activities of collecting, temporary storage, transport, treatment, recovery and disposal of waste, including the supervision of such operations and after-care maintenance of the used sites. [1] The way the hospitals need to manage waste resulting from the achieved activity is regulated nationally by the Order 1226/2012 approving the Technical regulations on the management of waste arising from medical activities and data collecting methodology for the national data base on waste resulting from medical activities.

Medical waste includes all the waste produced by health institutions, research institutions and laboratories. Collecting and sorting hazardous and non-hazardous waste from health locations.

Types of waste from medical activity: a. hazardous waste; b. non- hazardous waste.

Hazardous waste: infectious waste; sharp- stabbing waste; pathological waste; chemical waste.

Non-hazardous waste: waste which is similar to household waste. If they come in contact with any biological product or any infectious waste, they become infectious. Infectious waste: syringes, bandages, dressings, gloves, infusion tubing and materials that have come in contact with viruses, bacteria, parasites etc. Sharp- stabbing waste: needles, catheters, cannula, laboratory glassware that came in contact with infectious material etc. Chemical and pharmaceutical waste: disinfectants and surfactants (expired validity), serums, vaccines, reagents for laboratory use etc.

Waste collection within hospital units is a single package that is removed along with the contents, separately for each category of waste.

Hazardous waste resulting from medical activities are classified as:

pathological Waste and anatomical parts - waste comprising anatomical parts, biopsy material resulting from surgery and obstetric operating blocks, anatomical parts of the autopsy results from laboratories, corpses of animals resulting from research and experiencing activities. All these categories of waste are considered infectious;

infectious waste - solid or liquid waste that contains or has come in contact with blood or other body fluids, as well as viruses, bacteria, parasites and / or toxins of the microorganisms;

sharp-stabbing waste - waste that may cause mechanical damage by pinching or cutting. These include: needles, thread needles, catheters, syringes with needle, infusion disposable, bistoury blades, pipettes, laboratory glassware and other types of broken or unbroken glass, which have come in contact with infected material. These types of waste are considered infectious. Uncontaminated broken glassware falls in the category of sharp-stabbing waste because they are aggressive and present danger of pricking or cutting;




chemical and pharmaceutical waste - solid waste posed by solid chemicals, liquid or gas substances that can be toxic, corrosive or flammable;

radioactive waste is solid waste, liquid and gaseous waste resulting from nuclear medical activities , diagnosis and treatment activities, which contain radioactive materials.

Non-hazardous waste resulted from hospital units are waste similar to household waste, resulted from medical services, medical and technical services, administrative, accommodation, food blocks and offices for food distribution; these types of waste are collected and removed as household waste; waste similar to household waste ceases to be non-hazardous when they are mixed with some amount of hazardous waste.

Contact with medical waste can cause disease. The risks of illness and injuries caused by medical waste are due to the following characteristics: they contain infectious agents; they are genotoxic; they contain toxic or hazardous chemicals or pharmaceutical products; they are radioactive; they show sharp-stabbing characteristics. People whose health may be affected by the impact of this waste are those who come in contact with medical waste. There are exposed people working in health units that generate medical waste, but there may be affected others outside the hospital units, those who handle this waste, or those who come in contact with this waste as a result of mismanagement. Infectious waste may contain a wide variety of pathogenic microorganisms. People can become sick after contact with potentially infectious waste like that: through pinching, scratching or cutting; through the mucous membranes of the eyes, mouth and nose; by inhalation of infectious agents; by ingestion of infectious agents.

Incineration of medical waste, which contains plastic material having chlorine in its composition, causes the production PCBs. Dioxin is a carcinogenic substance. Once formed, dioxin binds to organic particles that are carried by the wind; they get deposited on soil and water. The half-life of dioxin is estimated at 25-100 years. Mercury can be found in thermometers, batteries, fluorescent lamps, etc. Incineration of medical waste containing heavy metals is prohibited.

II. STAGES RESULTED FROM MEDICAL WASTE MANAGEMENT. MEDICAL WASTE MANAGEMENT

IN ROMANIA. Knowing the types and quantities of produced waste and its management, transport and final disposal is the obligation

of each waste generator. Data recording is the way to control the production cycle - transport - final disposal by the generator (producer). Collection and separation of waste categories is the first step in the management of hazardous waste resulting from medical activity. The packaging in which collecting is made and which comes in direct contact with hazardous waste resulting from medical activity is disposable and is eliminated along with the content.

Temporary storage must be carried out according to the categories of waste collected on production site. In every medical unit there must be arranged a special space for temporary storage of waste. For the hazardous waste, this storage must not exceed 72 hours, out of which 48 hours inside the unit and 24 hours for transport and final disposal. The space for temporary storage of hazardous waste must be functionally separated from the rest of the building and secured by locking systems, because it is an area with septic potential. Waste, similar to household waste generated by hospital units, is stored and discarded according to Law 211/2011 on waste regime. Transport of hazardous waste to the final disposal site is in compliance with current legislation, with the rules of hygiene and security in order to protect staff and population.

The disposal of hazardous waste resulting from medical activity in accordance with present regulations on this type of waste, MS Order no. 1226/2012 approving the Technical regulations on the management of waste arising from medical activities and data collection methodology for a national database of medical waste resulting from medical activities was approved, issued and published in the Official Gazette at the end of 2012. Year 2013 is basically the first year of implementing the new national legislation in the field of medical waste management at the health units in the country. According to data provided by the Ministry of Environment and Climate Change and the National Agency for Environmental Protection in National report on the state of the environment in 2013, regarding the method of treatment and final disposal of hazardous waste resulting from medical activity, the following things resulted:

- 58% of health units under investigation have contracts with specialized companies for final disposal by incineration of generated hazardous waste;

- 14% of investigated medical units treat by low temperature thermal decontamination of hazardous medical waste (on contract with specialized companies and / or on the equipment belonging to hospitals), and incinerate hazardous waste in incinerators based on contract area;

- 11% of health facilities reporting only treats hazardous medical waste at low temperatures by thermal decontamination (including mechanical processing of such waste);

- 17% of health units did not fill in the questionnaire supplied by the authorities.

Elimination of non-hazardous waste similar to household waste is performed under contract with specialized sanitation companies, waste being transported in the municipal waste storages. [5]




III. METHODS FOR TREATMENT AND DISPOSAL OF HAZARDOUS MEDICAL WASTE Accepted methods for final disposal of hazardous waste resulting from medical activity are:

a.) Incineration. Hazardous waste from medical activity can be eliminated by incineration. According to data from the European Environment Agency, 90% of medical waste is incinerated. Incineration is the controlled burning of medical waste in a dedicated medical waste incinerator. Incineration process consists of the following steps: loading the waste incinerator with waste coming on a strip, the waste is not sorted in advance. Incineration has the advantage of reducing the volume of waste, sterilizing waste and eliminating the need for pre-processing of waste before treatment. What remains after incineration of the waste can be disposed in landfills. The disadvantage of the incineration process is given by the pollution potential due to the emissions generated during incineration. European Agency for Environmental Protection has set stringent requirements regarding emissions of medical incinerators. Incineration process can be applied to almost all types of medical waste including pathological waste, and the process reduces the waste volume by 90%. Modern incinerators come with a side benefit, to provide heat / electric power. The greatest concern regarding incineration is on air pollution emissions. The European Environment Agency says that at least 20% of medical waste is plastic. When plastics burn , dioxins and furans can be produced. The old and big medical waste incinerators were not equipped with pollution control equipment. The new regulations have imposed more stringent requirements. Over time, the amount of incinerated waste was reduced, other technologies being developed for waste treatment, technologies that are considered to be more environmentally friendly.

b.) The neutralization of waste in autoclaves. The autoclaves are rooms in which both heat and pressure, and sometimes steam are applied. Autoclaves have been used for nearly a century to sterilize medical instruments for reuse. Autoclaves are used to destroy microorganisms that may be present in medical waste before they are disposed in a municipal landfill. Medical waste treated in autoclaves is subject to a process of compaction, such as shredding, after treatment, so that they cannot be recognized and cannot be reused for other purposes. Autoclaves are not recommended for the treatment of pathological waste, because after treatment there is the possibility that pathological waste also contains low levels of radioactive material or cytotoxic compounds. A problem of waste treatment in autoclaves is due to the fact that the process can aerosolize chemicals present in waste according to the construction of the autoclave, these chemicals can be released into the air when opening the autoclave. [6]

c.) Chemical technologies use disinfecting agents in a process that integrates shredding and mixing to ensure the sufficient exposure to the chemical agent. The most commonly used technologies are those that use sodium hypochlorite and chlorine dioxide as an agent.

d.) Biological processes to neutralize medical waste use enzymes to break down organic waste.

e.) Irradiation is used to neutralize the medial waste. The irradiation technology consists in the bombardment of the medical waste with an electron beam, resulting ionizing radiation that destroy microorganisms. Hazardous waste may undergo medical treatment of neutralization before final disposal through storage in landfills. It is forbidden to store untreated hazardous medical waste. Waste which is similar to household waste does not require special treatment and it is included in the cycle of municipal waste disposal.

IV. THE PROPOSED METHOD FOR TREATING MEDICAL WASTE The proposed method for treating hazardous infectious medical waste started from the development of existing technologies for medical waste treatment. It is a method for chemical disinfection of infectious medical waste. By treating infectious medical waste through chemical disinfection they are converted to simple household waste. [2] As an innovative element, we propose to add a module for optoelectronic sorting of waste, so that recyclable waste to be removed from the mixture. Given that approximately 20% of total medical waste is the plastic waste, we intend to recover this waste and to use it in the production of asphalt mixtures. A study conducted in the framework of a project funded LIFE found that 71% of hospital plastic waste could be recycled if it has been sorted and collected efficiently. The study concluded with a classification of plastic waste from hospitals, depending on their degree of contamination, thus resulting four categories of plastic:

a.) clean plastic that does not require any special treatment; b.) plastic with dirt that needs a light rinse; c.) plastic contaminated with microbes at risk of infection that must be treated by methods of disinfection or in autoclaves

and d.) contaminated (infectious) plastic that require separate treatment and disinfection. [3]So far we have been developed a

series of studies that have shown that plastic waste can be successfully recycled in asphalt mixtures production process, reducing natural resource consumption, resulting in decreasing the amount of waste disposed in landfills and enhancing the quality of roads paved with such mixtures. [8]

The treatment method of medical waste through chemical disinfection process, as it can be seen in Figure 1, consists of the following steps:




a) waste feeding in the chemical disinfecting module; b) waste grinding and disinfection activities; c) discharge of disinfected liquid waste in the system of evacuation for municipal wastewater; d) discharge of disinfected waste from the disinfection module; e) optoelectronics sorting of the recyclable waste from that which is going to be disposed of; f) storing recyclable waste on categories.

Fig. 1. Material flow diagram for treating medical waste

The method described above and shown as a block diagram in Figure 1 is automatic. Its functioning takes place on the basis of the information obtained from the process, by the system of sensors located on each device. The installation is also fitted with presence sensors (not shown) for hazardous areas with audible alert and which order to stop power supply in order to avoid accidents. The installation is provided with a command unit. Through it, the installation devices and conveyors are ordered and controlled individually (ordering their speed and different positions of switches for directing the flow of materials in the installation in a different way).

V. THE PROJECT PLANNER FOR THE PROPOSED METHOD

The project planner for the proposed method for treating medical waste was processed into Microsoft Project 2013 application.

Fig. 2 setting options for project planning




TABLE I - INTRODUCTION FOR ACTIVITIES AND DURATION Activities Duration [minutes] Explanations A1-power 110m Waste feeding in the chemical disinfecting module - 110 minutes from 8

hours;

A2-shredding 360m

A2.a 120 m

Shredding 120 minutes of 8 hours, carried out with a gap of 3 minutes against A1

A2.b 240 m

Disinfecting of waste includes dosage of chemical substance and lasts about 240 minutes after feeding and shreddin

A3-evacuation 20 m Evacuation of disinfected liquid residues in the disposal system of municipal wastewater lasts approx. 20 minutes, it is carried out after completion of A2

A4 - desinfection 30 m Evacuation of disinfected waste from the disinfection module approx 30 min after completing A2

A5-sorting 20 m Optoelectronic sorting of recyclable waste from those which are to be removed It takes approximately 20 min

A6-storage 20 m Storage / baling of recyclable waste on categories 20 min A7-elimination 20 m Storage / baling of waste to be disposed 20 min

Initial duration =580m/ 9,666666666666667h

Fig. 3 Gant chart after establishing sequence of input operations of activities, duration and dependencies

In figure number 3 is presented Gant chart after establishing sequence of input operations of activities, duration and dependencies.

The project was divided into 7 activities, A2 activity having two subtasks. The manufacture process requires the activities to be carried out in a certain order and well-defined sequence. Tasks naming (activities) was taken suggestively from each activity of the flow.

Observation After entering duration of each activity, it is found the initial flow of 580 minutes, which means 9.666666666666667

hours, and after establishing dependencies and conditionings, there was a period of 480 minutes (8h). A3 and A4 activities occur in parallel, but A3 activity can last longer than A4. A6 and A7 activities occur in parallel, but A6 activity can last longer than A7, depending on the quality of supplied waste.

Fig. 4 Network Diagram after establishing the duration and dependencies




Introduction and resource allocation Microsoft Project uses: Working resources represented by the staff and equipment that perform work related to the

technological process and material resources represented by certain consumables used as the technological process is running.

To create a list of human resources, equipment and materials we can use resource-sheet Resource Sheet (figure number 5).

List of resources will be composed of labour resources and material resources. Human Resources:

o 1 Engineer 8 hours / week o 1 Operator 8 hours / day o A mechanic 8 hours / week o 1 Electrician 8 hours / week

Necessary material resources: plastic waste collected from the hospitals: o Fuel = Electricity,

Other materials and supplies: o Baling rope, o Foil; o disinfecting agent (sodium hypochlorite and chlorine dioxide);

Fig. 5 Sheet of resources for activities

In Microsoft Project, entering information about resources is necessary to set the time spent for implementation and cost of operation, so we have (figures numer 6 and 7) :

o 1 Operator 8 hours / day = 480 minutes, o 1 Engineer 8 hours / week; o a mechanic 8 hours / week; o 1 Electrician 8 hours / week = 96 minutes.

Fig. 6 Allocation of resources on activities




Fig. 7 Allocation of resources on activities

Duration and cost estimation Duration and cost estimation has been achieved following the framing in the estimated cost of approximately 0.4 - 0.7

Euro / kg for the treatment of a kilogram of waste and in accordance with installation capacity of 45 kg / day. 0,4*45=18.00 0,5*45=22,50 0,6*45=27.00 0,7*45=31,50)

Fig. 8 General Statistics of the Project

Statistics shown in figure 8, indicates the total length estimation of the process and technological process cost

calculation.

Fig. 9 View of flow duration estimation

The duration of an activity is estimated time to complete that activity. As a conclusion for estimating duration of the flow closure in our project the time was found 17.00.

As facilities offered by the Ms.Project application, it may include among others: planning activities in terms of constraints, duration and cost control, drawing flowcharts, import / export data and generating work reports.




Fig. 10 View of the final cost for activities

Fig.10 View of the final cost for resource

Fig.11 Gant chart after establishing the duration, dependencies and costs

Fig.12 Network Diagram after establishing the duration, dependencies and costs




VI. CONCLUSIONS The current trend in terms of overall waste and medical waste, in this case, assumes no growth and improvement of

disposal capacity, but the adoption of new technologies that produce waste in the minimum extent, in an easier way to be treated, a way that can be reused as raw materials in other production processes. Even if treatment cycle lasts longer, neutralization, followed by sorting, brings significant environmental benefits and contributes to achieving the targets for reducing waste storage and increases the amount of recycled waste. The presented work develops an innovative solution, in terms of magnitude and complexity of the proposed issue, by the fact that the recovery of a waste category is achieved, regarding plastic and it is proposed to be used in the production activity of asphalt mixtures, partially replacing natural resources.

ACKNOWLEDGMENT

The work of Daniela Bordeianu has been funded by the Sectoral Operational Programme Human Resources Development 2007-2013 of the Ministry of European Funds through the Financial Agreement POSDRU/187/1.5/S/155536.

REFERENCES [1] Order 1226/2012 approving the Technical regulations on the management of waste arising from medical and data

collection methodology for the national database on waste resulting from medical activities; [2] David Leak, Konstantinos Gialamas, Bill Townend, Chris Cheedeman, Alan Davis, Assement of microbial

inactivation achieved spore Using the Sterimed healthcare waste treatment system; [3] Reclamation of Plastic Waste generated in Hospitals LIFE98 ENV / FIN / 000577; [4] Management of waste from medical activity, a Programme financed by the Flemish Government,

http://eea.ngo.ro/materiale/germania/Publicatii%20diverse/Brosura_deseuri_medicale.pd [5] National Report on the State of the Environment for 2013, the Ministry of Environment and Climate Change,

National Environmental Protection Agency; http://www.anpm.ro/documents/12220/2209838/RSM-2013+fata+verso+final.pdf/76379d09-39c7-4ef9-9f04-d336406eda62;

[6] Basura Medical Waste Treatment of Medical Waste, avaible at: http://www.wastemed.com/treatment.htm [7] Non-Incineration Medical Waste Treatment Technologies, A Resource for Hospital Administrators, Facility

Managers, Health Care Professionals, Environmental Advocates, and Community Members August 2001; [8] Şaşcîm (Dumitrescu) S., Coteţ C., Popa L., Stoica G., 2014, Method and Instalation for Recycling Plastic Waste

and Toner Dust in the Production of Asphalt Mixtures, Proceedings in Manufacturing Systems, Volume 9. [9] Microsoft Project 2013

material flow management for treating waste from medical activity

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