Site investigation on medical waste management practices in northern Jordan

This study investigated the medical waste management practices used by hospitals in northern Jordan. A comprehensive inspection survey was conducted for all 21 hospitals located in the study area. Field visits were conducted to provide information on the different medical waste management aspects. The results reported here focus on the level of medical waste segregation, treatment and disposal options practiced in the study area hospitals. The total number of beds in the hospitals was 2296, and the anticipated quantity of medical waste generated by these hospitals was about 1400 kg/day. The most frequently used treatment practice for solid medical waste was incineration. Of these hospitals, only 48% had incinerators, and none of these incinerators met the Ministry of Health (MoH) regulations. As for the liquid medical waste, the survey results indicated that 57% of surveyed hospitals were discharging it into the municipal sewer system, while the remaining hospitals were collecting their liquid waste in septic tanks. The results indicated that the medical waste generation rate ranges from approximately 0.5 to 2.2 kg/bed day, which is comprised of 90% of infectious waste and 10% sharps. The results also showed that segregation of various medical waste types in the hospitals has not been conducted properly. The study revealed the need for training and capacity building programs of all employees involved in the medical waste management.     

Selection of infectious medical waste disposal firms by using the analytic hierarchy process and sensitivity analysis

While Taiwanese hospitals dispose of large amounts of medical waste to ensure sanitation and personal hygiene, doing so inefficiently creates potential environmental hazards and increases operational expenses. However, hospitals lack objective criteria to select the most appropriate waste disposal firm and evaluate its performance, instead relying on their own subjective judgment and previous experiences. Therefore, this work presents an analytic hierarchy process (AHP) method to objectively select medical waste disposal firms based on the results of interviews with experts in the field, thus reducing overhead costs and enhancing medical waste management. An appropriate weight criterion based on AHP is derived to assess the effectiveness of medical waste disposal firms. The proposed AHP-based method offers a more efficient and precise means of selecting medical waste firms than subjective assessment methods do, thus reducing the potential risks for hospitals. Analysis results indicate that the medical sector selects the most appropriate infectious medical waste disposal firm based on the following rank: matching degree, contractor's qualifications, contractor's service capability, contractor's equipment and economic factors. By providing hospitals with an effective means of evaluating medical waste disposal firms, the proposed AHP method can reduce overhead costs and enable medical waste management to understand the market demand in the health sector. Moreover, performed through use of Expert Choice software, sensitivity analysis can survey the criterion weight of the degree of influence with an alternative hierarchy.     

Evaluation of the available air pollution control technologies for achievement of the MACT requirements in the newly implemented new source performance standards (NSPS) and emission guidelines (EG) for hospital and medical/infectious waste incinerators

After many years of research and debate, in August of 1997 the United States Environmental Protection Agency (EPA) issued New Source Performance Standards (NSPS) and Emission Guidelines (EG) for medical/infectious waste incinerators in the United States. These new emissions and operational standards establish considerably more restrictive limitations on air emissions for medical/infectious waste incinerators and will undoubtedly have a significant impact on the over 2300 hospitals presently operating an incinerator on-site. This paper will explore the options available to these facilities, and those facilities which may be considering installation of an incinerator, relative to achieving compliance with the NSPS and EG for medical/infectious waste incinerators.     

Medical waste management in China: A case study of Nanjing

Medical waste management is of great importance due to its infectious and hazardous nature that can cause undesirable effects on humans and the environment. The objective of this study was to analyze and evaluate the present status of medical waste management in the light of medical waste control regulations in Nanjing. A comprehensive inspection survey was conducted for 15 hospitals, 3 disposal companies and 200 patients. Field visits and a questionnaire survey method were implemented to collect information regarding different medical waste management aspects, including medical waste generation, segregation and collection, storage, training and education, transportation, disposal, and public awareness.The results indicated that the medical waste generation rate ranges from 0.5 to 0.8 kg/bed day with a weighted average of 0.68 kg/bed day. The segregated collection of various types of medical waste has been conducted in 73% of the hospitals, but 20% of the hospitals still use unqualified staff for medical waste collection, and 93.3% of the hospitals have temporary storage areas. Additionally, 93.3% of the hospitals have provided training for staff; however, only 20% of the hospitals have ongoing training and education. It was found that the centralized disposal system has been constructed based on incineration technology, and the disposal cost of medical waste is about 580 US$/ton. The results also suggested that there is not sufficient public understanding of medical waste management, and 77% of respondents think medical waste management is an important factor in selecting hospital services.The problematic areas of medical waste management in Nanjing are addressed by proposing some recommendations that will ensure that potential health and environmental risks of medical waste are minimized.     

Centralized incineration treatment of infectious waste for regional hospitals in Taiwan

Taiwan has a high population density. Recently, rapid advances of medical activities have caused an environmental problem in managing the wastes generated by hospitals or clinics. Government regulations, public concern and an increased commitment to a clean environment have also brought more attention to the handling problems of medical waste. A project to plan and manage the first centralized incineration plant for infectious hospital waste has been carried out in Taiwan. This paper summarizes the results of the execution of this project. It addresses the experience gained in siting a regional incinerator, its technical operation to meet local environmental regulations and the management of the regional plant. Public concern against incineration was considered to be the most important criterion to address during establishment of the incinerator, as well as good operational performance. The operational problems encountered most frequently in the regional plant with possible causes and solutions to the problems are summarized in this paper. It was also found that a delivery manifest was useful to manage the delivery of infectious waste.     

Metal leachability, heavy metals, polycyclic aromatic hydrocarbons and polychlorinated biphenyls in fly and bottom ashes of a medical waste incineration facility

Medical waste from hospitals and other healthcare institutions has become an imperative environmental and public safety problem. Medical waste in Greece has become one of the most urgent environmental problems, because there are 14,000 tons produced annually, of which only a small proportion is incinerated. In the prefecture of Attica there is only one modern municipal medical waste incinerator (started 2004) burning selected infectious hospital waste (5-6 tons day(-1)). Fly and bottom residues (ashes) are collected and stored temporarily in barrels. High values of metal leachability prohibit the landfilling of these ashes, as imposed by EU directives. In the present study we determined quantitatively the heavy metals and other elements in the fly and bottom ashes of the medical waste incinerator, by inductively coupled plasma emission spectrometry (ICP) and by energy dispersive X-ray analysis (EDAX). Heavy metals, which are very toxic, such as Pb, Cd, Ni, Cr, Cu and Zn were found in high concentrations in both fly and bottom ashes. Metal leachability of fly and bottom ashes by water and kerosene was measured by ICP and the results showed that toxic metals in both ashes, such as Pb, Cr, Cd, Cu and Zn, have high leaching values. These values indicate that metals can become soluble and mobile if ash is deposited in landfills, thus restricting their burial according to EU regulations. Analysis of polychlorinated biphenyls and polycyclic aromatic hydrocarbons in fly and bottom ashes showed that their concentrations were very low. This is the first known study in Greece and the results showed that incineration of medical waste can be very effective in minimizing the most hazardous and infectious health-care waste. The presence of toxic metals with high leachability values remains an important draw back of incineration of medical waste and various methods of treating these residues to diminish leaching are been considered at present to overcome this serious technical problem.     

Hazardous medical waste generation rates of different categories of health-care facilities

Goal of this work was to calculate the hazardous medical waste unit generation rates (HMWUGR), in kg bed(-1)d(-1), using data from 132 health-care facilities in Greece. The calculations were based on the weights of the hazardous medical wastes that were regularly transferred to the sole medical waste incinerator in Athens over a 22-month period during years 2009 and 2010. The 132 health-care facilities were grouped into public and private ones, and, also, into seven sub-categories, namely: birth, cancer treatment, general, military, pediatric, psychiatric and university hospitals. Results showed that there is a large variability in the HMWUGR, even among hospitals of the same category. Average total HMWUGR varied from 0.012 kg bed(-1)d(-1), for the public psychiatric hospitals, to up to 0.72 kg bed(-1)d(-1), for the public university hospitals. Within the private hospitals, average HMWUGR ranged from 0.0012 kg bed(-1)d(-1), for the psychiatric clinics, to up to 0.49 kg bed(-1)d(-1), for the birth clinics. Based on non-parametric statistics, HMWUGR were statistically similar for the birth and general hospitals, in both the public and private sector. The private birth and general hospitals generated statistically more wastes compared to the corresponding public hospitals. The infectious/toxic and toxic medical wastes appear to be 10% and 50% of the total hazardous medical wastes generated by the public cancer treatment and university hospitals, respectively.     

Assessment of medical wastes management practice: a case study of the northern part of Jordan

This study includes a survey of the procedures available, techniques, and methods of handling and disposing of medical waste at medium (between 100 and 200 beds) to large (over 200 beds) size healthcare facilities located in Irbid city (a major city in the northern part of Jordan). A total of 14 healthcare facilities, including four hospitals and 10 clinical laboratories, serving a total population of about 1.5 million, were surveyed during the course of this research. This study took into consideration both the quantity and quality of the generated wastes to determine generation rates and physical properties. Results of the survey showed that healthcare facilities in Irbid city have less appropriate practices when it comes to the handling, storage, and disposal of wastes generated in comparison to the developed world. There are no defined methods for handling and disposal of these wastes, starting from the personnel responsible for collection through those who transport the wastes to the disposal site. Moreover, there are no specific regulations or guidelines for segregation or classification of these wastes. This means that wastes are mixed, for example, wastes coming from the kitchen with those generated by different departments. Also, more importantly, none of the sites surveyed could provide estimated quantities of waste generated by each department, based upon the known variables within the departments. Average generation rates of total medical wastes in the hospitals were estimated to be 6.10 kg/patient/day (3.49 kg/bed/day), 5.62 kg/patient/day (3.14 kg/bed/day), and 4.02 kg/patient/day (1.88 kg/bed/day) for public, maternity, and private hospitals, respectively. For medical laboratories, rates were found to be in the range of 0.053-0.065 kg/test-day for governmental laboratories, and 0.034-0.102 kg/test-day for private laboratories. Although, based on the type of waste, domestic or general waste makes up a large proportion of the waste volume, so that if such waste is not mixed with patient derived waste, it can be easily handled. However, based on infections, it is important for healthcare staff to take precautions in handling sharps and pathological wastes, which comprises only about 26% of the total infectious wastes. Statistical analysis was conducted to develop mathematical models to aid in the prediction of waste quantities generated by the hospitals studied, or similar sites in the city that are not included in this study. In these models, the number of patients, number of beds, and hospital type were determined to be significant factors on waste generation. Such models provide decision makers with tools to better manage their medical waste, given the dynamic conditions of their healthcare facilities.     

Current status of waste management at home-visit nursing stations and during home visits in Japan

A questionnaire survey was conducted with the aim of examining the problems involved in the disposal of infectious waste at home-visit nursing stations and in its handling during home visits by nurses. From among the home-visit nursing stations registered with the National Association for Home-Visit Nursing Care, 1,965 offices were selected at random and questionnaires were sent to the selected offices. Nurses at 1,314 offices (66.9?%) responded to the survey and responses from 1,283 offices were identified as suitable for analysis after excluding 26 offices that closed and five offices whose main field of care was psychiatry. Offices were classified by management configuration. Offices attached to hospitals were classified as “attached office” and all others were classified as “independent office”. More attached office nurses recovered medical waste from patients’ homes than did independent office nurses. They were also more likely to transport waste with them during the course of a day’s visits. There was a significant difference between attached and independent offices in the burden of expense for waste disposal. Both offices have strong concern about waste treatment containers and handling in improvement in home medical care (HMC) waste disposal. Thus, in order to alleviate these concerns, it is necessary to provide nurses with containers for medical waste suited to home-visit nursing care and tools for preventing injuries. Japanese government should address HMC waste disposal more comprehensively through necessary legislation, subsidization and standardization.     

Characteristics and management of infectious industrial waste in Taiwan

Infectious industrial waste management in Taiwan is based on the specific waste production unit. In other countries, management is based simply on whether the producer may lead to infectious disease. Thus, Taiwan has a more detailed classification of infectious waste. The advantage of this classification is that it is easy to identify the sources, while the disadvantage lies in the fact that it is not flexible and hence increases cost. This study presents an overview of current management practices for handling infectious industrial waste in Taiwan, and addresses the current waste disposal methods. The number of small clinics in Taiwan increased from 18,183 to 18,877 between 2003 and 2005. Analysis of the data between 2003 and 2005 showed that the majority of medical waste was general industrial waste, which accounted for 76.9%-79.4% of total medical waste. Infectious industrial waste accounted for 19.3%-21.9% of total medical waste. After the SARS event in Taiwan, the amount of infectious waste reached 19,350 tons in 2004, an increase over the previous year of 4000 tons. Waste minimization was a common consideration for all types of waste treatment. In this study, we summarize the percentage of plastic waste in flammable infectious industrial waste generated by medical units, which, in Taiwan was about 30%. The EPA and Taiwan Department of Health have actively promoted different recycling and waste reduction measures. However, the wide adoption of disposable materials made recycling and waste reduction difficult for some hospitals. It has been suggested that enhancing the education of and promoting communication between medical units and recycling industries must be implemented to prevent recyclable waste from entering the incinerator.     

Medical waste production at hospitals and associated factors

This study was conducted to evaluate the quantities of medical waste generated and the factors associated with the generation rate at medical establishments in Taiwan. Data on medical waste generation at 150 health care establishments were collected for analysis in 2003. General medical waste and infectious waste production at these establishments were examined statistically with the potential associated factors. These factors included the types of hospital and clinic, reimbursement payment by National Health Insurance, total number of beds, bed occupancy, number of infectious disease beds and outpatients per day. The average waste generation rates ranged from 2.41 to 3.26kg/bed/day for general medical wastes, and 0.19-0.88kg/bed/day for infectious wastes. The total average quantity of infectious wastes generated was the highest from medical centers, or 3.8 times higher than that from regional hospitals (267.8 vs. 70.3Tons/yr). The multivariate regression analysis was able to explain 92% of infectious wastes and 64% of general medical wastes, with the amount of insurance reimbursement and number of beds as significant prediction factors. This study suggests that large hospitals are the major source of medical waste in Taiwan. The fractions of medical waste treated as infectious at all levels of healthcare establishments are much greater than that recommended by the USCDC guidelines.     

Estimating waste transfer station delays using GPS

This paper examines the use of on-board global positioning system (GPS) data recorders as a method to collect field data on the movements of solid waste collection vehicles at transfer stations. The movements of five waste collection vehicles using four different transfer facilities were compared over a period of 1 year. The spatial data were analyzed using geofences to determine the amount of time each truck spent on each of four activities: queuing for access to the weigh scale, sitting on the weigh scale, queuing for access to the tipping floor, and unloading waste. The study found that queuing delays can be identified and measured using GPS data. The average time at a facility for all trucks was 16.4min per visit, with a standard deviation of 14.3min. Time at the facility ranged between 2 and 111min per visit and the distribution of time at the facility was positively skewed. Multi-compartment vehicles (co-collection and recycling trucks) spent significantly more time at unloading facilities. There were also significant differences in the length and the location of the queues at different facilities. At one facility, the longest delays were encountered while waiting for the weigh scale, at two facilities trucks experienced delays in obtaining access to the tipping floor, while at the fourth facility no significant delays developed.     

Results of a hospital waste survey in private hospitals in Fars province, Iran

Hospital waste is considered dangerous because it may possess pathogenic agents and can cause undesirable effects on human health and the environment. In Iran, neither rules have been compiled nor does exact information exist regarding hospital waste management. The survey presented in this article was carried out in all 15 private hospitals of Fars province (Iran) from the total numbers of 50 governmental and private hospitals located in this province, in order to determine the amount of different kinds of waste produced and the present situation of waste management. The results indicated that the waste generation rate is 4.45 kg/bed/day, which includes 1830 kg (71.44%) of domestic waste, 712 kg (27.8%) of infectious waste, and 19.6 kg (0.76%) of sharps. Segregation of the different types of waste is not carried out perfectly. Two (13.3%) of the hospitals use containers without lids for on-site transport of wastes. Nine (60%) of the hospitals are equipped with an incinerator and six of them (40%) have operational problems with the incinerators. In all hospitals municipal workers transport waste outside the hospital premises daily or at the most on alternative days. In the hospitals under study, there aren't any training courses about hospital waste management and the hazards associated with them. The training courses that are provided are either ineffective or unsuitable. Performing extensive studies all over the country, compiling and enacting rules, establishing standards and providing effective personnel training are the main challenges for the concerned authorities and specialists in this field.     

Medical waste management in Turkey: A case study of Istanbul

The objective of this study was to analyze the present status of medical waste management in the light of the Medical Waste Control Regulation (MWCR) in Istanbul, the largest city in Turkey. About 17% of the hospitals, 20% of bed capacity, and 54% of private hospitals in Turkey are located in Istanbul. The first regulation about medical waste management in Turkey was published in 1993, and as a candidate state, it was changed in 2005 in accordance with EU Environmental Directives. In this work, a survey of 14 questions about the amount, collection, and temporary storage of medical wastes was applied to 192 hospitals in Istanbul through face-to-face interviews. It was found that the estimated quantity of medical waste from the hospitals is about 22tons/day and the average generation rate is 0.63kg/bed-day. Recyclable materials are collected separately at a rate of 83%. Separate collection of different types of wastes is consistently practiced, but 25% of the hospitals still use inappropriate containers for medical waste collection. Almost 77% of the hospitals use appropriate equipment for the medical waste collection personnel. The percentage of the hospitals that have temporary storage depots is 63%. Medical waste management in Istanbul is carried out by applying the MWCR.     

Hospital solid waste management practices in Limpopo Province, South Africa: a case study of two hospitals

The shortcomings in the management practices of hospital solid waste in Limpopo Province of South Africa were studied by looking at two hospitals as case studies. Apart from field surveys, the generated hospital waste was weighed to compute the generation rates and was followed through various management practices to the final disposal. The findings revealed a major policy implementation gap between the national government and the hospitals. While modern practices such as landfill and incineration are used, their daily operations were not carried according to minimum standards. Incinerator ash is openly dumped and wastes are burned on landfills instead of being covered with soil. The incinerators used are also not environmentally friendly as they use old technology. The findings further revealed that there is no proper separation of wastes according to their classification as demanded by the national government. The mean percentage composition of the waste was found in the following decreasing order: general waste (60.74%)>medical waste (30.32%)>sharps (8.94%). The mean generation rates were found to be 0.60kg per patient per day.     

Analyzing composition and generation rates of biomedical waste in selected hospitals of Uttarakhand,India

In India, a few studies have been conducted for analyzing the generation rates and composition of medical waste (MW). Inadequate information about the amount and composition of MW results in ineffective management practices. The present study seeks to evaluate healthcare waste (HCW) generation rates by healthcare facilities (HCFs) available in Uttarakhand, a northern state of India. Study also focuses on modeling the quantity of different types of MW generated at various HCFs and determining significant factors contributing towards MW generation. Seasonal variation in amount of MW generated from various HCFs has also been considered. To achieve these objectives, cross-sectional as well as longitudinal data have been collected from various HCFs in Uttarakhand, India. The survey revealed that around 36% of the total HCFs did not segregate their MW as per policy guidelines. Cross-sectional data for May 2015 were collected from 75 HCFs to analyze and model the composition and quantity of HCW generated. Multiple Linear Regression and Artificial Neural Network techniques were applied to model cross-sectional data. In the composition of the overall MW, ‘yellow waste’ carries the maximum share, followed by ‘red waste’ and then the ‘blue waste’. In addition, the ‘type of HCF’ and ‘bed occupancy’ have been modeled as the important factors, contributing towards the MW generations rates. Longitudinal data for 2 years (2013 and 2014) were collected to examine seasonal variation in HCW generation rates using polynomial regression analysis. Result shows that MW quantity also varies with the change in the season. Findings of the study will help hospitals and waste treatment facilities to predict amount of waste that may be generated, and plan resources towards efficient handling and disposal of MW.     

Generation and distribution of PAHs in the process of medical waste incineration

After the deadly earthquake on May 12, 2008 in Wenchuan county of China, several different incineration approaches were used for medical waste disposal. This paper investigates the generation properties of polycyclic aromatic hydrocarbons (PAHs) during the incineration. Samples were collected from the bottom ash in an open burning slash site, surface soil at the open burning site, bottom ash from a simple incinerator, bottom ash generated from the municipal solid waste (MSW) incinerator used for medical waste disposal, and bottom ash and fly ash from an incinerator exclusively used for medical waste. The species of PAHs were analyzed, and the toxicity equivalency quantities (TEQs) of samples calculated. Analysis results indicate that the content of total PAHs in fly ash was 1.8 × 10³ times higher than that in bottom ash, and that the strongly carcinogenic PAHs with four or more rings accumulated sensitively in fly ash. The test results of samples gathered from open burning site demonstrate that Acenaphthylene (ACY), Acenaphthene (ACE), Fluorene (FLU), Phenanthrene (PHE), Anthracene (ANT) and other PAHs were inclined to migrate into surrounding environment along air and surface watershed corridors, while 4- to 6-ring PAHs accumulated more likely in soil. Being consistent with other studies, it has also been confirmed that increases in both free oxygen molecules and combustion temperatures could promote the decomposition of polycyclic PAHs. In addition, without the influence of combustion conditions, there is a positive correlation between total PCDD/Fs and total PAHs, although no such relationship has been found for TEQ.     

Hazardous waste incinerators under waste uncertainty: Balancing and throughput maximization via heat recuperation

Hazardous waste incinerators (HWIs) differ substantially from thermal power facilities, since instead of maximizing energy production with the minimum amount of fuel, they aim at maximizing throughput. Variations in quantity or composition of received waste loads may significantly diminish HWI throughput (the decisive profit factor), from its nominal design value. A novel formulation of combustion balance is presented, based on linear operators, which isolates the wastefeed vector from the invariant combustion stoichiometry kernel. Explicit expressions for the throughput are obtained, in terms of incinerator temperature, fluegas heat recuperation ratio and design parameters, for an arbitrary number of wastes, based on fundamental principles (mass and enthalpy balances). The impact of waste variations, of recuperation ratio and of furnace temperature is explicitly determined. It is shown that in the presence of waste uncertainty, the throughput may be a decreasing or increasing function of incinerator temperature and recuperation ratio, depending on the sign of a dimensionless parameter related only to the uncertain wastes. The dimensionless parameter is proposed as a sharp a’ priori waste ‘fingerprint’, determining the necessary increase or decrease of manipulated variables (recuperation ratio, excess air, auxiliary fuel feed rate, auxiliary air flow) in order to balance the HWI and maximize throughput under uncertainty in received wastes. A 10-step procedure is proposed for direct application subject to process capacity constraints. The results may be useful for efficient HWI operation and for preparing hazardous waste blends.     

Techno-economic assessment of municipal solid waste management in Jordan

Mismanagement of solid waste leads to public health risks, adverse environmental impacts and other socio-economic problems. This is obvious in many developing countries around the world. Currently, several countries have realized that the way they manage their solid wastes does not satisfy the objectives of sustainable development. Therefore, these countries, including Jordan, which forms the case study presented here, have decided to move away from traditional solid waste management (SWM) options to more integrated solid waste management approaches. Unfortunately, in many developing countries like Jordan, the lack of adequate resources to implement the necessary changes is posing a serious obstacle. The present paper discusses the various practices and challenges of solid waste management in Jordan from both a technical and economic perspective. An overview of the current practices and their environmental implications in three major cities of the country, which generate more than 70% of the country's solid waste, is presented. Recent literature on solid waste management in Jordan has been reviewed; and data on the total amount of municipal solid waste generated, compositional variations over the last two decades, and future projections are presented. The necessity, importance and needs of solid waste recovery and reuse are identified. The review of the legal frameworks indicated that there is a need for detailed and clear regulations dealing specifically with solid waste. The service cost analysis revealed that none of the municipalities in Jordan sufficiently recover the cost of the services, with more than 50% being subsidized from the municipalities' budgets. The allocation of the available resources was analyzed and service performance indicators assessed. Factors that should be taken into consideration when making the decision to move from a traditional SWM approach to a more integrated approach are highlighted and suggestions for a more smooth transition are recommended.