Health Care Waste Incineration

Sunday Times

Waste Classification

Municipal Solid waste Health-Care Waste

Non-risk – health care waste Hazardous health – care waste Highly hazardous health – care waste

Other Hazardous Waste Industrial hazardous waste Domestic hazardous waste

Health Care Waste

Total waste generated by hospitals, healthcare establishments and research facilities in the diagnosis, treatment, immunization and associated research

Risky Waste

Inadequate health care waste Management… Mixing health care waste with general waste make the whole

waste stream hazardous

Cause environmental pollution by unpleasant smell

Growth & multiplication of vectors like insects, rodents and worms

Transmission of diseases like typhoid, cholera, hepatitis etc.

Increase BOD of draining water near to land fills and make surface and ground water pollution

Make additional cost & difficulty to the municipals

Difficulties at the collection & transportation of waste

Direct Health harm Community

Environment

Peoples working in hospitals

Patients attending to the hospitals

Hospitals & Their Bed strength Sri Lanka

Type of institution Total Number of Institutions

Average Number of

Patient Beds

Teaching Hospitals 18 1191

Provincial General Hospitals 2 1249

District General Hospitals 17 566

Base Hospitals Type A 22 353

Base Hospitals Type B 46 199

Divisional Hospital Type A 46 101

Divisional Hospital Type B 134 71

Divisional Hospital Type C 300 26

Primary Care Unit and Maternity Homes

9 17

Other 1 27 185Medical Static Unit: 2012 publication

Average Production of Health Care waste Sri Lanka

Health Care Waste Management Report, Ministry of Health

Health Care Waste Generation in Sri Lanka…

Type of institution

Average Number of

Patient Beds

Average Health Care Waste Generation

Kg/day

Total Number of Institutions

Teaching Hospitals 1191 429 18

Provincial General Hospitals

1249 450 2

District General Hospitals

566 204 17

Base Hospitals Type A

353 127 22

Base Hospitals Type B

199 72 46

Divisional Hospital Type A

101 36 46

Divisional Hospital Type B

71 26 134

Divisional Hospital Type C

26 9 300

Primary Care Unit and Maternity Homes

17 6 9

Other 1 185 67 27

Health Care Waste Management Sri Lanka

Management of health care waste is a responsibility of the institution that generates it.

Disinfection of waste by autoclaving is identified by the ministry of Health for the Colombo CMC area which is now in operation.

The National color code on health care waste has been established for waste separation

Methods for final disposal of clinical waste are being explored for implementation.

Budgetary allocation is provided for hospitals for health care waste management under the regular budget.

Medical Static Unit: 2012 publication

Health Care waste Management Sri Lanka

CMC defined a 25 year plan to treat MSW composting plan with private sector participation, it stipulated that no medical waste should be present

NEA No 47 of 1980 and its amendments are the basic legal documents that regulate hazardous waste and consequently HC WM in the country

Medical institutions weren’t included in the list of institutions for which an environmental protection license must be requested from CEA

Popular Hospitals & Their waste disposalName Bed

Strength

Quantity Infectious waste generated (kg/d)

Method of waste disposal

NHSL 3300 500 Auto clave, disposal by CMC

TH-CSHW 485 160 Steam.Ster. CMC

Lady Ridgeway hospital

901 125 Steam. Ster. shredding

TH-Colombo South 1093 200 Treatment outsourced

TH- Peradeniya 954 125 Out sourced

De Soyza Maternity hospital

343 100 Out sourced

National cancer institute

876 177 Out sourced

Popular Hospitals & Their waste disposal

Name Bed Strength

Quantity Infectious waste generated (kg/d)

Method of waste disposal

TH- Karapitiya 1606 175 Incinerator available- not adequate

TH – Chest Hospital 671 80 Incineration not adequate

TH- Jaffna 1228 1000 No

TH-Kurunegala 1650 2000 Incineration- Not adequate

National institute of mental health

1514 130 Out sourced

S.J.P 1046 100 Incineration

TH-Kandy 2286 470 Out sourced

Rapid Survey with MOH on 33 hospitals

2012, Rapid Survey with MOH

Rapid Survey with MOH on 33 hospitals

3 hospitals use steam sterilizers

13 hospitals use incinerators

5 hospitals outsource to a private sector

8 open burn

Treatment infrastructure & Funding for some hospitals…

Summery of HCWM strategies addressed in National Health Development Plan

Establish health care waste treatment facilities Island wide

Develop required guidelines and standards for heath care waste management

Obtain EPL and Hazardous Waste License for healthcare institution

Treatment Technologies available in Sri Lanka

Burial

Open Burning

Barrel Incinerators

Sharp pits

Needle Burners

Incinerators

Steam sterilization

Chemical disinfection

Placenta Pits

Treatment Technologies Comparison

Incineration

Advantages

Complete destruction & sterilization of waste/sharps

Available for high capacities

Significant reduction in waste volume & weight

Very disinfection efficiency

Destroys all types of liquid, pharmaceutical & other organic waste

Large quantities of waste can be treated

Disadvantages

Considerably high investment

Need extensive flue gas emission control system

Depending of the flue gases, discharge waste water

Expensive to operate

Generates Hazardous Ash residues

Autoclaving

Advantages Simple to operate

Low environmental impact

Disadvantages Relatively expensive to install

& operate

Large autoclaves may need boiler

Requiring regular maintenance

Efficiency of disinfection is very sensitive to the operational conditions

Generate waste water

Waste volume/ weight reduction is very low

Large quantities of disinfected waste needs final disposal to a landfill

Microwave Irradiation

Advantages

Good infection efficiency under optimal operating conditions

Environmentally sound

Good reduction in waste volume due to shredding & compacting involved

Disadvantages

High investment & operation cost

Sophisticated and complex technology

Cannot treat certain categories of waste such as cytotoxic waste, Pharmaceutical waste

Only solids can be treated and that too only once shredded

No reduction of weight of the waste

Frequent break down & poor functioning

Chemical Disinfection

Advantages Shredding, when

carried out, reduce the volume of waste

High disinfection efficiency

Effective for highly infectious liquid wastes

Disadvantages Use of hazardous

chemicals ha the potential to cause environmental contamination

Polluted waste water produced in the process

Require highly trained technicians

Inadequate for pharmaceutical, chemical and some types of infectious waste

Land Disposal

Advantages Simple & inexpensive

to operate

No specific construction cost is involved if operated within available landfill systems

Protected from scavengers gaining access to HCW

Disadvantages HCW is not treated and

remains hazardous

Strong co-ordination between waste collector and landfill operator required

Potentially high transportation cost that may be involved

Disposal in special HCW cells need conscientious operation according to specific guidelines

HAAT

DefinitionOld

The process of burning, setting fire to or destroying

New

An engineered process using controlled flame combustion to thermally degrade waste materials

Incinerator evolution Open burning

Single chamber incinerator

Multi – chamber incinerators

Addition of gas scrubbing equipment

Increase in temperature and residence time

Heat recovery

Continuous emission monitoring

Complete automation

Why incineration preferred

Waste volume reduction less than 5%

At sufficiently high temperature and residence time, any hydrocarbon vapor can be oxidized to carbon dioxide and water

Heat can be recovered

Avoid contamination by reducing infectiousness/ pollutant levels

Only solution for certain waste types

Incinerator Emission requirements on EPA-USAAir Pollutant Emission Limit Unit

Particulate Matter

46 mg/d.cu.m

CO 5.5 ppm

Dioxins/furans 0.85 ng/d.cu.m

HCl 7.7 ppm

SO2 4.2 ppm

NO 190 ppm

Lead 0.018 mg/d.cu.m

Cd 0.013 mg/d.cu.m

Hg 0.025 mg/d.cu.m

Incinerator system components

Waste pre- heating or shredding system (Op

Waste loading system

Burner management system

Combustion chambers

Heat recovery unit

Air pollution control device

Stack discharge

Ash disposal system

Emission monitoring system

Incineration process for a teaching hospital Average infectious waste generation per day = 200

kg/day

Req. incineration rate for 8 eight working hours = 25 kg/hr

LPG consumption required for incineration = 2.75 kg/hr

Daily LPG consumption= 22 kg

Monthly LPG consumption per hospital = 660 kg

= 17.6 Nos. of 37.5kg Cyl.

Monthly cost of LPG for institution= Rs.118,800.00

LPG cost per one kg of waste= Rs.19.8

No. of Teaching Hospitals in Sri Lanka = 18

LPG on Oil fired incinerators No requirement of oil supply system infrastructure

Rapid achievement of required operational temperature

Operational reliability on emission control

No operational cost for oil pressurizing pump

No maintenance cost for oil feeding system

Minimum air pollution compared to oil burning

No contaminated waste water generation

Can be made as mobile incinerators

Benefits to Institution Make environment pleasant and clean by reducing water, air, soil

pollution

Essential qualification for acquire environmental protection license

Uplift the institute image and quality of the service

Strong contribution for environmental protection

Ensure restriction of transmission of diseases

Reduce requirement of janitor staff

Save high cost incorporated with handling and transportation

No land requirements for landfilling

Benefits to LAUGFS Enhance company image and honor by removing a headache of

a community

CSR project for company

LPG Market Penetration through a new channel

Further developments Expand concept for non hazardous waste incineration in hospitals

Waste gas heat recovery and generation of steam, electricity for hospitals

Combined incineration & autoclave systems with incorporated incinerator waste heat recovery unit

THANK YOU…..