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.     

Treatment and disposal alternatives for health-care waste in developing countries--a case study in Istanbul, Turkey.

Efficient health-care waste management is crucial for the prevention of the exposure of health-care workers, patients, and the community to infections, toxic wastes and injuries as well as the protection of the environment (Safe Management of Wastes from Health-care Activities. World Health Organization, Geneva). The amount of health-care waste produced in the Istanbul Metropolitan City in Turkey is 30 ton day(-1) in total. The method used for the final disposal of most of the health-care waste of Istanbul is incineration. However, a great portion of the infectious waste is disposed of with the domestic waste into the sanitary landfill because of improper segregation practices applied in the health-care institutions. Therefore the alternatives for the treatment and disposal of health-care waste were evaluated. The technical information related to the available treatment technologies including incineration, microwave irradiation, mobile or stationary sterilization, etc. were also investigated. The capital investment cost, transportation/operational costs for each alternative method and the different locations for installation were compared. When the data collected were evaluated, it was found that separate handling and disposal of health-care waste generated on the European and the Asian sides of the city was the most economic and practicable solution. As a result, it was concluded that the capacity of the Kemerburgaz-Odayeri incineration plant is enough to incinerate the health-care waste generated on the European side of Istanbul, the construction of a new incineration plant or a stationary sterilization unit for the disposal of health-care waste generated on the Asian side was the most effective alternative.     

Disposal of solid waste in Istanbul and along the Black Sea coast of Turkey

The increasing amount of solid waste arising from municipalities and other sources and its consequent disposal has been one of the major environmental problems in Turkey. Istanbul is a metropolitan city with a current population of around 14 million, and produces about 9000 ton of solid waste every day. The waste composition for Istanbul has changed markedly from 1981 to 1996 with large decreases in waste density, much of which is related to decreased amounts of ash collected in winter. In recent years, the Istanbul region has implemented a new solid waste management system with transfer stations, sanitary landfills, and methane recovery, which has led to major improvements. In the Black Sea region of Turkey, most of the municipal and industrial solid wastes, mixed with hospital and hazardous wastes, are dumped on the nearest lowlands and river valleys or into the sea. The impact of riverside and seashore dumping of solid wastes adds significantly to problems arising from sewage and industry on the Black Sea coast. Appropriate integrated solid waste management systems are needed here as well; however, they have been more difficult to implement than in Istanbul because of more difficult topography, weaker administrative structures, and the lower incomes of the inhabitants.     

Solid waste management practices in Turkey

As an economically developing country, Turkey has very well operated integrated solid waste management applications structured on modern facilities, besides over 2,000 scattered open dump areas in the country. Integrated waste management applications seem eligible for the metropolitan cities like Istanbul and Izmit (Kocaeli). Attempts have not been encouraging for the scattered regional settlements using central storage sites due to financial shortages and received rejections from nearby settlements. Small-scale compact solid waste management systems with materials recycling and composting can be more suitable alternatives in the small-scale regional settlements. The major constituents of municipal solid waste are organic in nature and approximately a quarter of municipal solid waste is recyclable. Although paper, including cardboard, is the main constituent, the composition of recyclable waste varies strongly by the source or the type of collection point. Solid wastes need primary treatment in order to be suitable for incineration and composting. Turkey needs to give more emphasis on the usage of modern solid waste removal technologies to overcome the overgrowing solid waste disposal problems.     

Improvement and modification of the routing system for the health-care waste collection and transportation in Istanbul

Handling of health-care wastes is among the most important environmental problems in Turkey as it is in the whole world. Approximately 25–30 tons of health-care wastes, in addition to the domestic and recyclable wastes, are generated from hospitals, clinics and other small health-care institutions daily on the European and the Asian sides of İstanbul [Kocasoy, G., Topkaya, B., Zeren, B.A., Kılıç, M., et al., 2004. Integrated Health-care Waste Management in İstanbul, Final Report of the LIFE00 TCY/TR/054 Project, Turkish National Committee on Solid Wastes, İstanbul, Turkey; Zeren, B.A., 2004. The Health-care Waste Management of the Hospitals in the European Side of İstanbul, M.S. Thesis, Boğaziçi University, İstanbul, Turkey; Kılıç, M., 2004. Determination of the Health-care Waste Handling and Final Disposal of the Infected Waste of Hospital-Medical Centers in the Anatolian Side of İstanbul. M.S. Thesis, Boğaziçi University, İstanbul, Turkey]. Unfortunately, these wastes are not handled, collected or temporarily stored at the institutions properly according to the published Turkish Medical Waste Control Regulation [Ministry of Environment and Forestry, 2005. Medical Waste Control Regulation. Official Gazette No. 25883, Ankara, Turkey]. Besides the inappropriate handling at the institutions, there is no systematic program for the transportation of the health-care wastes to the final disposal sites. The transportation of these wastes is realized by the vehicles of the municipalities in an uncontrolled, very primitive way. As a consequence, these improperly managed health-care wastes cause many risks to the public health and people who handle them.This study has been conducted to develop a health-care waste collection and transportation system for the city of İstanbul, Turkey. Within the scope of the study, the collection of health-care wastes from the temporary storage rooms of the health-care institutions, transportation of these wastes to the final disposal areas and the cost-benefit analyses of the existing and the proposed optimum transportation routes are investigated and the most feasible routes from the point of view of efficiency and economy have been determined.In order to solve the scheduling and route optimization problem, special software programs called MapInfo and Roadnet were used. For the program, the geocodes of hospital locations, data about the amount of the health-care wastes generated, the loading and unloading process times, and the capacity of the collecting vehicles were taken into account. The new systems developed aim at the daily collection of the health-care wastes from the institutions and their transportation directly to the final disposal area/facility by using the shortest and the most efficient routes to resolve the routing and scheduling problem and to reduce the cost arising from the transportation.     

Medical waste management in Trachea region of Turkey: suggested remedial action.

The main objective of this paper was to analyse the present status of medical waste management in the Trachea region of Turkey and subsequently to draw up a policy regarded with generation, collection, on-site handling, storage, processing, recycling, transportation and safe disposal of medical wastes. This paper also presents the results of study about awareness on how to handle expired drugs. Initially all health-care establishments in Tekirda?, Edirne and Kyrklareli provinces in Trachea region were identified and the amounts of hospital wastes generated by each of them were determined. Current medical waste-management practices, including storage, collection, transportation and disposal, in surveyed establishments were identified. Finally, according to results, remedial measurements for medical waste management in these establishments were suggested. Unfortunately, medical wastes are not given proper attention and these wastes are disposed of together with municipal and industrial solid wastes. The current disposal method is both a public health and environmental hazard. When landfill sites are visited, many scavengers can be seen sorting for recyclable materials, a practice which is dangerous for the scavengers. In addition, it was found that some staff in health-care establishments are unaware of the hazard of medical wastes. It is concluded that a new management system, which consists of segregation, material substitution, minimization, sanitary landfilling and alternative medical waste treatment methods should be carried out. For the best appropriate medical waste management system, health-care establishment employers, managers and especially the members of house- keeping divisions should be involved in medical waste management practice.     

Status and challenges of hospital solid waste management: case studies from Thailand, Pakistan, and Mongolia

Healthcare waste management is a serious public health concern. In developing countries, compared to developed nations, the management of infectious wastes has not received sufficient attention. Recently, worldwide awareness has grown of the need to impose stricter controls on the handling and disposal of wastes generated by healthcare facilities. This exploratory study attempted in seven selected hospitals to explain the situation of healthcare waste management, with a focus on handling practices, occupational safety, and the implementation status of waste management policy, together with other pertinent policy issues. It was noted that the current system of healthcare waste management was underdeveloped and was in dire need of immediate attention and improvement, especially in Mongolia and Pakistan; the medical waste management practices were better in the hospitals studied in Thailand. This study underscores the importance for improvement of medical waste management of a national regulatory framework, a sound internal management system, and programs to train and ensure the safety of related personnel, as well as programs to estimate quantities of waste generated and to evaluate appropriate techniques of disposal. Once a healthcare waste management plan has been prepared, a regular program of inspection and review can be undertaken within the healthcare institution. A good inspection program can also expose problems and new issues in managing healthcare wastes.     

Municipal solid-waste management in Istanbul

Istanbul, with a population of around 13 million people, is located between Europe and Asia and is the biggest city in Turkey. Metropolitan Istanbul produces about 14,000 tons of solid waste per day. The aim of this study was to assess the situation of municipal solid-waste (MSW) management in Istanbul. This was achieved by reviewing the quantity and composition of waste produced in Istanbul. Current requirements and challenges in relation to the optimization of Istanbul’s MSW collection and management system are also discussed, and several suggestions for solving the problems identified are presented. The recovery of solid waste from the landfills, as well as the amounts of landfill-generated biogas and electricity, were evaluated. In recent years, MSW management in Istanbul has improved because of strong governance and institutional involvement. However, efforts directed toward applied research are still required to enable better waste management. These efforts will greatly support decision making on the part of municipal authorities. There remains a great need to reduce the volume of MSW in Istanbul.     

How vital is the "lack of funding" in effective environmental management in Turkey?

The conflict experienced in Turkey between adequate legal and legislative arrangements with weak capabilities of policy implementation and enforcement is a typical scenario experienced in developing countries. The difficulties faced in environmental management is increased by funding issues. Although environmental management is directly influenced by problems associated with the distribution of public funds, lack of funding is not the sole reason responsible for the mismanagement of resources. The paper seeks to answer whether the lack of funding allocated to ameliorate environmental degradation and pollution is the main reason for an environmental crisis situation in Turkey. Turkey needs to ensure implementation of the basic obligations stated in its environmental policy with respect to national and international issues. Specific obstacles Turkey needs to overcome for more effective environmental management will be examined within this context.     

Storage,collection and disposal of Kariakoo market wastes in Dar es Salaam,Tanzania

In many developing countries, the market is still the most important source of commerce for traders and provisions for the general public. The transmission of disease in the market place involves factors relating to the host, the agent and the environment. This study examines the quality of solid waste management in Kariakoo market, Dar es Salaam. The main problems identified were poor market design and lack of a well organized waste storage, collection and disposal systems. Two-thirds of the waste consists of vegetable matter. Proposals for improved design of storage and collection facilities are described. Experiments revealed wastes from the market are readily decomposable by composting. A change in the design of covered markets and improvements in waste handling are essential to reduce the potential health hazards in developing countries.     

Municipal solid waste management in Rasht City, Iran

Pollution and health risks generated by improper solid waste management are important issues concerning environmental management in developing countries. In most cities, the use of open dumps is common for the disposal of wastes, resulting in soil and water resource contamination by leachate in addition to odors and fires. Solid waste management infrastructure and services in developing countries are far from achieving basic standards in terms of hygiene and efficient collection and disposal. This paper presents an overview of current municipal solid waste management in Rasht city, Gilan Province, Iran, and provides recommendations for system improvement. The collected data of different MSW functional elements were based on data from questionnaires, visual observations of the authors, available reports and several interviews and meetings with responsible persons. Due to an increase in population and changes in lifestyle, the quantity and quality of MSW in Rasht city has changed. Lack of resources, infrastructure, suitable planning, leadership, and public awareness are the main challenges of MSW management of Rasht city. However, the present situation of solid waste management in this city, which generates more than 400tons/d, has been improved since the establishment of an organization responsible only for solid waste management. Source separation of wastes and construction of a composting plant are the two main activities of the Rasht Municipality in recent years.     

Overview of waste disposal and landfills/dumps in Asian countries

Many cities in developing Asian countries face serious problems in managing solid wastes. The annual waste generation increases in proportion to the rises in population and urbanization. Asian countries with greater rural populations produce more organic waste, such as kitchen wastes, and fewer recyclable items, such as paper, metals, and plastics. Reliable data on solid waste compositions are difficult to obtain, and even if available, they are often not updated. We report the most recent waste composition data in some developing Asian countries. We suggest that a better classification system for landfills is needed to address inconsistencies in data for sanitary landfill sites versus waste dumps. We also discuss the information on waste disposal trends and problems associated with general solid waste management in developing Asian countries.     

A study of the dental solid waste produced in a school of dentistry in Turkey

Dental wastes are regulated under medical waste control regulations in most countries. Even though the quantity of hazardous wastes in dental solid wastes is a small proportion, there is still cross infection risk and potential danger for environment associated with mismanaged wastes. For this reason, knowledge of waste composition and development of proper management alternatives are necessary. In this study, the composition of solid wastes coming from eight clinics of the dental school of a University hospital in Turkey is examined. Although the waste has some variations between the two samplings, the general picture is such that the major components remain pretty much the same (in terms of %) for a fixed clinic. The composition of waste changes from one clinic to the other as expected. However, one can deduce from the data obtained that at about 35%, rubber gloves constitute close to the half of the total solid waste in almost all the clinics. Other major component is paper forming approximately 30% of the solid waste. In general, total waste coming from the clinics is related with the number of procedures conducted on patients at the clinics. Only a small fraction of the waste is hazardous indicating that at Hacettepe University School of Dentistry, hazardous waste collection rules are obeyed in most of the times.     

Healthcare waste management in the capital city of Mongolia

Inconsistencies are present in the management options for healthcare wastes in Mongolia. One of the first critical steps in the process of developing a reliable waste management plan requires the performance of a waste characterization analysis. The objectives of this study were an assessment of the current situation of healthcare waste management (HCWM) and characterization of healthcare wastes generated in Ulaanbaatar. A total about 2.65 tonnes of healthcare wastes are produced each day in Ulaanbaatar (0.78 tons of medical wastes and 1.87 tons of general wastes). The medical waste generation rate per kg/patient-day in the inpatient services of public healthcare facilities was 1.4-3.0 times higher than in the outpatient services (P<0.01). The waste generation rate in the healthcare facilities of Ulaanbaatar was lower than in some other countries; however, the percentage of medical wastes in the total waste stream was comparatively high, ranging from 12.5% to 69.3%, which indicated poor waste handling practices. Despite the efforts for the management of wastes, the current system of healthcare waste management in Ulaanbaatar city of Mongolia is under development and is in dire need of immediate attention and improvement. It is essential to develop a national policy and implement a comprehensive action plan for HCWM providing environmentally sound technological measures to improve HCWM in Mongolia.     

Medical wastes management in the south of Brazil

In developing countries, solid wastes have not received sufficient attention. In many countries, hazardous and medical wastes are still handled and disposed together with domestic wastes, thus creating a great health risk to municipal workers, the public and the environment. Medical waste management has been evaluated at the Vacacai river basin in the State of Rio Grande do Sul, Brazil. A total of 91 healthcare facilities, including hospitals (21), health centers (48) and clinical laboratories (22) were surveyed to provide information about the management, segregation, generation, storage and disposal of medical wastes. The results about management aspects indicate that practices in most healthcare facilities do not comply with the principles stated in Brazilian legislation. All facilities demonstrated a priority on segregation of infectious-biological wastes. Average generation rates of total and infectious-biological wastes in the hospitals were estimated to be 3.245 and 0.570 kg/bed-day, respectively.     

Perspectives for pilot scale study of RDF in Istanbul,Turkey

Municipal solid waste (MSW) is one of the most important environmental problems arising from rapid urbanization and industrialization. The use of alternative fuels in rotary kilns of cement plants is very important for reducing cost, saving fossil fuels and also eliminating waste materials, accumulated during production or after using these materials. Cement industries has an important potential for supplying preferable solutions to the waste management. Energy recovery from waste is also important for the reduction of CO₂ emissions.This paper presents an investigation of the development of refuse derived fuel (RDF) materials from non-recycling wastes and the determination of its potential use as an alternative fuel in cement production in Istanbul, Turkey. RDF produced from MSW was analyzed and its effects on cement production process were examined. For this purpose, the produced RDF was mixed with the main fuel (LPG) in ratios of 0%, 5%, 10%, 15% and 20%. Then chemical and mineralogical analyses of the produced clinker were carried out. It is believed that successful results of this study will be a good example for municipalities and cement industries in order to achieve both economic and environmental benefits.     

Energy implications of the thermal recovery of biodegradable municipal waste materials in the United Kingdom

Waste management policies and legislation in many developed countries call for a reduction in the quantity of biodegradable waste landfilled. Anaerobic digestion, combustion and gasification are options for managing biodegradable waste while generating renewable energy. However, very little research has been carried to establish the overall energy balance of the collection, preparation and energy recovery processes for different types of wastes. Without this information, it is impossible to determine the optimum method for managing a particular waste to recover renewable energy. In this study, energy balances were carried out for the thermal processing of food waste, garden waste, wood, waste paper and the non-recyclable fraction of municipal waste. For all of these wastes, combustion in dedicated facilities or incineration with the municipal waste stream was the most energy-advantageous option. However, we identified a lack of reliable information on the energy consumed in collecting individual wastes and preparing the wastes for thermal processing. There was also little reliable information on the performance and efficiency of anaerobic digestion and gasification facilities for waste.     

A system dynamics approach for hospital waste management

Healthcare services provided by hospitals may generate some infectious wastes. Although a large percentage of hospital waste is classified as general waste, which has similar nature as that of municipal solid waste and, therefore, could be disposed in municipal landfills, a small portion of infectious waste has to be managed in the proper manner in order to minimize risk to public health. Many factors involved in the hospital waste management system often link to one another, which require a comprehensive analysis to determine the role of each factor in the system. In this paper, we present a hospital waste management model based on system dynamics to determine the interaction among factors in the system using a software package, Stella. A case study of the City of Jakarta, Indonesia is selected. The hospital waste generation is affected by various factors including the number of beds in the hospitals and the NIMBY (not in my back yard) syndrome. To minimize the risk to public health, we found that waste segregation, as well as infectious waste treatment prior to disposal, has to be conducted properly by the hospital management, especially when scavenging takes place in landfill sites in developing countries.     

Characteristics of healthcare wastes

A comprehensive understanding of the quantities and characteristics of the material that needs to be managed is one of the most basic steps in the development of a plan for solid waste management. In this case, the material under consideration is the solid waste generated in healthcare facilities, also known as healthcare waste. Unfortunately, limited reliable information is available in the open literature on the quantities and characteristics of the various types of wastes that are generated in healthcare facilities. Thus, sound management of these wastes, particularly in developing countries, often is problematic. This article provides information on the quantities and properties of healthcare wastes in various types of facilities located in developing countries, as well as in some industrialized countries. Most of the information has been obtained from the open literature, although some information has been collected by the authors and from reports available to the authors. Only data collected within approximately the last 15 years and using prescribed methodologies are presented. The range of hospital waste generation (both infectious and mixed solid waste fractions) varies from 0.016 to 3.23kg/bed-day. The relatively wide variation is due to the fact that some of the facilities surveyed in Ulaanbaatar include out-patient services and district health clinics; these facilities essentially provide very basic services and thus the quantities of waste generated are relatively small. On the other hand, the reported amount of infectious (clinical, yellow bag) waste varied from 0.01 to 0.65kg/bed-day. The characteristics of the components of healthcare wastes, such as the bulk density and the calorific value, have substantial variability. This literature review and the associated attempt at a comparative analysis point to the need for worldwide consensus on the terms and characteristics that describe wastes from healthcare facilities. Such a consensus would greatly facilitate comparative analyses among different facilities, studies and countries.