Dear Adamu Yunusa Ugya,

Health care facilities, including hospitals, clinics, doctors, dentists, morgues, or veterinary offices, generate a tremendous amount of waste in the course of treating patients. They generate “regulated medical waste” or infectious waste, hazardous chemical waste, recyclable, reusable and solid waste. In order to fulfill the medical ethic to “do no harm,” it is the responsibility of the health care industry to create and implement waste disposal polices for all of these waste streams that include worker safety, public health and environmental considerations, as well as regulatory compliance. Fulfilling this ethic also calls for a cultural shift to consider disposal technologies and services as part of a total waste management system. This system should include upstream waste management (elimination or minimization of some wastes, reuse and recycling of others) and the proper, accountable operation of all disposal equipment, post-treatment technology management and services (e.g., shredding, landfilled material, incineration ash, air and water emissions)

The primary methods of treatment and disposal of medical waste are:

·         Incineration

·         Autoclaves

·         Mechanical/Chemical Disinfection

·         Microwave

·         Irradiation

·         Thermal Treatments

·         Chemical treatments

 Incineration

According to the EPA, 90% of medical waste is incinerated. Incineration is the controlled burning of the medical waste in a dedicated medical waste incinerator.

Autoclaves

Autoclaves are closed chambers that apply both heat and pressure, and sometimes steam, over a period of time to sterilize medical equipment. Autoclaves have been used for nearly a century to sterilize medical instruments for re-use. Autoclaves are used to destroy microorganisms that may be present in medical waste before disposal in a traditional landfill.

Steam sterilization provides generators a way to treat waste in a cost-efficient manner. The destruction of the microorganisms is highly effective, but the problem comes when transportation is required. Many landfills and general incineration facilities are reluctant to accept the waste, fearing the waste is infectious.

Recent work in Japan has found a method of chemicaly stabilizing heavy metals in fly ash from medical waste incinerators. Much development goes on in Japan, including recent work on a dual torch plasme arc furnace.

Sharps waste: The potential for syringe needles and other sharps waste to spread HIV and hepatitis raise real concern.  In some countries, rag pickers search them out and they are illegally repackaged for sale.

Pharmaceutical waste: Hospitals should aim to negotiate take-back agreements with their suppliers for unused and/or expired pharmaceuticals.  Failing this there are a number of ways to neutralize or contain pharmaceutical waste.

Radioactive waste: Not all facilities produce radioactive waste, but it can result from treatment (eg radioactive tracers) or be present in diagnostic and analytical equipment.  

Pathological and anatomical waste:  Human tissues, blood, placenta- this waste can be hard to handle and sensitive, particularly for anything recognizably human.  However, a number of different options are available for different situations.

Biodegradable wastes: As much as 25 percent of the waste from a healthcare facility can be kitchen and food scraps.   These can be composted or biodigested to produce compost and biogas, a renewable fuel. 

Recyclable waste: Paper, plastic, metal and glass are the most widely recycled materials.  Segregating, reusing, and recycling these wastes can make a significant difference to the economics of the facility waste disposal operation. 

   Regards,

Prem Baboo

Dear Prof Baboo, what is your conclusion to which primary method is the best to employe

I think that the thermal treatment is a better choice using  microwave burners  

Dear Dr. Saifeldin, thank you very much with your contribution but could you pls help me with your reasons for suggesting microwave

I mean for suggesting thermal treatment by microwave burner

thermal treatment of the waste eliminates infection  reduces the  mass and volume of the waste  occurs. destruction of the waste (physical and chemical change), eg. mechanical treatment only reduce the volume, chemical treatment may not change either wight or volume.

 then you can think about environmental impact of the process and search a bout precautions of the process

 Good luck  

 Saif  

Thank you so much Prof Saifeldin, I really appreciate your contribution

Landfill in some cases too. Several scientific papers mention the lack of evidences about increased risks of some kinds of healthcare wastes when compared to household waste, and they may have final disposal based on the same criteria (landfill, if properly operated). 

BORG, M. A. Clinical waste disposal – getting the facts right. Journal of Hospital Infection. Dez. v. 65, p. 178-179, 2007.

COSTA E SILVA, C. A. M; CAMPOS, J. C.; FERREIRA, J. A.; MIGUEL, M. A. L.; QUINTAES, B. R. Caracterização microbiológica de lixiviados gerados por resíduos sólidos domiciliares e de serviços de saúde da cidade do Rio de Janeiro. Engenharia Sanitária e Ambiental. v. 16, n. 2, Abr/jun 2011, p. 127-132.

CUSSIOL, N. A. M. ; ROCHA, G. H. T.; LANGE, L. C. Quantificação dos resíduos potencialmente infectantes presentes nos resíduos sólidos urbanos da regional sul de Belo Horizonte, MG, Brasil. Cad. Saúde Pública, Rio de Janeiro, v. 22. n. 6, p. 1183-1191, 2006.

QUINTAES, B. R. Estudo bacteriológico em aterro experimental: avaliação da codisposição de resíduos sólidos domiciliares e de resíduos sólidos de serviço de saúde. Rio de Janeiro – RJ. 2013. 216 f. (Tese de Doutorado). Universidade Federal do Rio de Janeiro, 2013.

http://www.ncbi.nlm.nih.gov/pubmed/27207769

Ferreira JA, Tambellini AT, Silva CLP, Guimaraens MAAM. Hepatitis B morbidity in municipal and hospital waste collection workers in the City of Rio de Janeiro. Infect Control Hosp Epidemiol 1999; 20:591-2

http://www.scielo.br/pdf/csp/v31s1/0102-311X-csp-31-s1-0295.pdf

Dear Ugya AY

Greetings

During the selection of treatment alternatives for health-care waste (HCWs), decision makers usually consider different criteria and sub-criteria for optimal decisions.

There are many options for the treatment and disposal of medical waste. Some work best in large facilities appropriate to major hospitals or centralized facilities, and others are best for low to middle-income countries, small facilities and resource constrained settings. The first step in any waste management is to minimize waste and to ensure that it is properly segregated at source.

My latest paper was about the assessment and selection of the best infectious health-care waste treatment alternative. We used the sustainability assessment of technology (SAT) methodology which was developed by the

International Environmental Technology Center of the United Nations Environment Program (IETC-UNEP). The focus of this methodology is both on the process and outcome, with an interest towards informed and participatory decision-making.

Our paper is attached for your consideration.

Also you can find our paper from my homepage and from links below:

https://jehse.biomedcentral.com/articles/10.1186/s40201-016-0251-1

Hope these are helpful

Best Regards,

Ata