Alternatives for treatment and disposal cost reduction of regulated medical wastes

Many hospitals or health care facilities have faced financial difficulties and thus they have attempted to find cost-effective treatment and disposal methods of their regulated medical wastes (RMWs). This study investigated generation volume and sources, composition, and treatment and disposal methods for RMWs obtained from three out of the five typical city hospitals in Massachusetts for which we could obtain relevant data on medical waste. Also, this study compared the generation patterns and amounts of RMWs between the hospital and the medical school. The yearly operational treatment and disposal costs of RMWs based on different treatment and disposal methods were analyzed for one hospital. The most cost-effective option of four different treatment and disposal options studied was to combine on-site incineration and microwave technologies. Finally, this study identified measures for the effective waste characterization methods for the reduction of treatment and disposal costs of RMWs. By careful exclusion of non-RMW from RMW waste streams, hospitals can reduce the RMW volume that requires special treatment and reduce disposal costs.     

A review of waste management practices and their impact on human health

This work reviews (i) the most recent information on waste arisings and waste disposal options in the world, in the European Union (EU), in Organisation for Economic Co-operation and Development (OEDC) countries, and in some developing countries (notably China) and (ii) the potential direct and indirect impact of waste management activities on health. Though the main focus is primarily on municipal solid waste (MSW), exposure to bioaerosols from composting facilities and to pathogens from sewage treatment plants are considered. The reported effects of radioactive waste are also briefly reviewed. Hundreds of epidemiological studies reported on the incidence of a wide range of possible illnesses on employees of waste facilities and on the resident population. The main conclusion of the overall assessment of the literature is that the evidence of adverse health outcomes for the general population living near landfill sites, incinerators, composting facilities and nuclear installations is usually insufficient and inconclusive. There is convincing evidence of a high risk of gastrointestinal problems associated with pathogens originating at sewage treatment plants. In order to improve the quality and usefulness of epidemiological studies applied to populations residing in areas where waste management facilities are located or planned, preference should be given to prospective cohort studies of sufficient statistical power, with access to direct human exposure measurements, and supported by data on health effect biomarkers and susceptibility biomarkers.     

Multi-objective reverse logistics model for integrated computer waste management.

This study aimed to address the issues involved in the planning and design of a computer waste management system in an integrated manner. A decision-support tool is presented for selecting an optimum configuration of computer waste management facilities (segregation, storage, treatment/processing, reuse/recycle and disposal) and allocation of waste to these facilities. The model is based on an integer linear programming method with the objectives of minimizing environmental risk as well as cost. The issue of uncertainty in the estimated waste quantities from multiple sources is addressed using the Monte Carlo simulation technique. An illustrated example of computer waste management in Delhi, India is presented to demonstrate the usefulness of the proposed model and to study tradeoffs between cost and risk. The results of the example problem show that it is possible to reduce the environmental risk significantly by a marginal increase in the available cost. The proposed model can serve as a powerful tool to address the environmental problems associated with exponentially growing quantities of computer waste which are presently being managed using rudimentary methods of reuse, recovery and disposal by various small-scale vendors.     

Safe management of hazardous waste

The size and the health significance of the hazardous waste problem are reviewed. Proper engineering and management practice are discussed, including the elimination, if possible, reduction, changing processes and product lines, treatment and reuuse, and disposal by landfill and incineration. Exports should be drasti cally reduced, also using complex administrative measures. International organizations concerned should encourage good national and international management practices. A siting for collection, treatment and disposal, remote from human habitation, and established under an international agreement, would release countries from managing a difficult problem within their own national borders.     

Management of immunization solid wastes in Kano State, Nigeria

Inadequate management of waste generated from injection activities can have a negative impact on the community and environment. In this paper, a report on immunization wastes management in Kano State (Nigeria) is presented. Eight local governments were selected randomly and surveyed by the author. Solid wastes generated during the Expanded Programme on Immunization were characterised using two different methods: one by weighing the waste and the other by estimating the volume. Empirical data was obtained on immunization waste generation, segregation, storage, collection, transportation, and disposal; and waste management practices were assessed. The study revealed that immunization offices were accommodated in either in local government buildings, primary health centres or community health care centres. All of the stations demonstrated a high priority for segregation of the infectious wastes. It can be deduced from the data obtained that infectious waste ranged from 67.6% to 76.7% with an average of 70.1% by weight, and 36.0% to 46.1% with an average of 40.1% by volume. Non-infectious waste generated ranged from 23.3% to 32.5% with an average of 29.9% by weight and 53.9% to 64.0% with an average of 59.9% by volume. Out of non-infectious waste (NIFW) and infectious waste (IFW), 66.3% and 62.4% by weight were combustible and 33.7% and 37.6% were non-combustible respectively. An assessment of the treatment revealed that open pit burning and burial and small scale incineration were the common methods of disposal for immunization waste, and some immunization centres employed the services of the state or local government owned solid waste disposal board for final collection and disposal of their immunization waste at government approved sites.     

The use of failure mode and effects analysis to construct an effective disposal and prevention mechanism for infectious hospital waste

In recent times, the quality of medical care has been continuously improving in medical institutions wherein patient-centred care has been emphasized. Failure mode and effects analysis (FMEA) has also been promoted as a method of basic risk management and as part of total quality management (TQM) for improving the quality of medical care and preventing mistakes. Therefore, a study was conducted using FMEA to evaluate the potential risk causes in the process of infectious medical waste disposal, devise standard procedures concerning the waste, and propose feasible plans for facilitating the detection of exceptional cases of infectious waste. The analysis revealed the following results regarding medical institutions: (a) FMEA can be used to identify the risk factors of infectious waste disposal. (b) During the infectious waste disposal process, six items were scored over 100 in the assessment of uncontrolled risks: erroneous discarding of infectious waste by patients and their families, erroneous discarding by nursing staff, erroneous discarding by medical staff, cleaning drivers pierced by sharp articles, cleaning staff pierced by sharp articles, and unmarked output units. Therefore, the study concluded that it was necessary to (1) provide education and training about waste classification to the medical staff, patients and their families, nursing staff, and cleaning staff; (2) clarify the signs of caution; and (3) evaluate the failure mode and strengthen the effects.     

Searching quality data for municipal solid waste planning

Effective waste reduction and recycling is predicated upon credible data on refuse generation and disposal. Despite improvements in the quality of data for municipal solid wastes (MSW) disposal, dependable generation and recycling statistics to support planning, regulation and administration are lacking. The available aggregates on national waste production from two sources do not conform to each other and fail to serve the requirements of local solid waste planning. As recycling estimates will be difficult to discern, the collection of generation data based on weighing waste samples at generator sites has been portrayed as the key for developing sustainable local databases. The coefficients developed from the databases for the various categories of residential, commercial, industrial and institutional wastes can be used as variables for waste generation models.     

Veterinary waste disposal: practice and policy in Durban, South Africa (2001-2003)

In South Africa, until recently, veterinary waste has not been included in definitions of health care waste, and so has been neglected as a contributor to the hazardous waste stream. Despite the application of, for example, the "Polluter Pays" principle in South African environmental legislation, to generators of waste, which would include veterinarians, there appears to be little awareness of and even less enforcement of the legislation in this regard. This paper reports on a 2001-2003 survey of management practices of the five waste contractors servicing just over half of the veterinarians in Durban, South Africa's second largest city. Some of their activities, when evaluated in terms of the legislation, guidelines and policies relating to waste handling and disposal, were found to be non-compliant. Since any discussion on waste management should take cognisance of waste from generation to final disposal, the responsibility of veterinarians as waste generators is also discussed in the light of the recent developments in health care waste management in South Africa. This study presents a review of past and current policies, legislation and guidelines that have application to veterinary waste. This is the first study to address veterinary waste disposal in any South African city.     

A performance-based system for the long-term management of municipal waste landfills

Landfills have been the dominant alternative for disposal of solid waste and there are tens of thousands of closed landfills throughout the world that require a long-term management strategy. In contrast to approaches based on time or target values, this paper describes a performance-based methodology for evaluation of post-closure care (PCC). Using the methodology, critical components of PCC at a landfill, including leachate and gas management, groundwater monitoring and cover integrity, are considered to determine whether a landfill meets defined conditions for functional stability and can transition from regulated PCC to a post-regulatory custodial care program representing de minimus care activities only. The methodology is predicated on understanding the biological, chemical, and physical behavior of a landfill and the presence of sufficient data to verify expected trends in landfill behavior. If an evaluation suggests that a change can be made to PCC, the landfill owner must perform confirmation monitoring and then surveillance monitoring at a decreasing frequency to verify that the change is protective of human health and the environment. A hypothetical case study showed that using the methodology to evaluate site-specific PCC requirements could result in increased environmental protection at comparable cost by spending available funds where they are most needed.     

Investigation of health care waste management in Binzhou District,China

In China, national regulations and standards for health care waste management were implemented in 2003. To investigate the current status of health care waste management at different levels of health care facilities (HCF) after the implementation of these regulations, one tertiary hospital, one secondary hospital, and four primary health care centers from Binzhou District were visited and 145 medical staff members and 24 cleaning personnel were interviewed.Generated medical waste totaled 1.22, 0.77, and 1.17 kg/bed/day in tertiary, secondary, and primary HCF, respectively. The amount of medical waste generated in primary health care centers was much higher than that in secondary hospitals, which may be attributed to general waste being mixed with medical waste. This study found that the level of the HCF, responsibility for medical waste management in departments and wards, educational background and training experience can be factors that determine medical staff members’ knowledge of health care waste management policy. Regular training programs and sufficient provision of protective measures are urgently needed to improve occupational safety for cleaning personnel. Financing and administrative monitoring by local authorities is needed to improve handling practices and the implementation of off-site centralized disposal in primary health care centers.     

Environmental audits of hazardous waste disposal and treatment facilities

Hazardous waste generators have a duty of care in ensuring that their wastes are disposed of in an environmentally acceptable manner. Increasingly, generators are being made liable for environmental damage at the site of a waste disposal contractor if their wastes have been accepted by that facility. An audit procedure is described, that permits generators to examine the performance of waste vendors and to assess their potential liability as a result of using the site. Post-audit decisions in estimating the degree of risk and selecting appropriate waste contractors are also discussed.The purpose of this paper is to guide the prospective auditor through the site assessment procedure, highlighting areas of particular concern in relation to present or future potential liabilities. The audit procedure that is described, applies to all types of waste disposal operations in all countries, since the principles of good waste management do not vary.     

Current situation of used household batteries in Iran and appropriate management policies

Used household batteries are considered as hazardous wastes in many countries due to the potential environmental and human health risks associated with the heavy metals present in batteries. This article presents the current situation of waste household batteries and policies in Iran. Iran with more than 70 million people is a developing country where latest technologies like cell phones and laptops are in widespread use and battery consumption increases accordingly. The household battery demand in Iran has rapidly grown since 2001 and it is expected to increase more quickly in next years, due to increasing technological development. Based on the available data, more than 9800 metric tons of household batteries were imported into Iran in recent decade, with the market value of about US$ 42.6 million. At present, there is no program available in Iran regarding to collection, separation, recycling or safe disposal of used batteries. Therefore, almost all of the spent household are discarded into municipal solid waste (MSW) and sent to sanitary landfills. Appropriate policies to meet safe disposal of household batteries in Iran is also discussed in this investigation.     

Medical waste management in Ibadan, Nigeria: obstacles and prospects

Quantification and characterization of medical waste generated in healthcare facilities (HCFs) in a developing African nation has been conducted to provide insights into existing waste collection and disposal approaches, so as to provide sustainable avenues for institutional policy improvement. The study, in Ibadan city, Nigeria, entailed a representative classification of nearly 400 healthcare facilities, from 11 local government areas (LGA) of Ibadan, into tertiary, secondary, primary, and diagnostic HCFs, of which, 52 HCFs were strategically selected. Primary data sources included field measurements, waste sampling and analysis and a questionnaire, while secondary information sources included public and private records from hospitals and government ministries. Results indicate secondary HCFs generate the greatest amounts of medical waste (mean of 10,238 kg/day per facility) followed by tertiary, primary and diagnostic HCFs, respectively. Characterised waste revealed that only approximately 3% was deemed infectious and highlights opportunities for composting, reuse and recycling. Furthermore, the management practices in most facilities expose patients, staff, waste handlers and the populace to unnecessary health risks. This study proffers recommendations to include (i) a need for sustained cooperation among all key actors (government, hospitals and waste managers) in implementing a safe and reliable medical waste management strategy, not only in legislation and policy formation but also particularly in its monitoring and enforcement and (ii) an obligation for each HCF to ensure a safe and hygienic system of medical waste handling, segregation, collection, storage, transportation, treatment and disposal, with minimal risk to handlers, public health and the environment.     

Analyses of the recycling potential of medical plastic wastes

This study analyzed the recycling potential of plastic wastes generated by health care facilities. For this study, we obtained waste streams and recycling data from five typical city hospitals and medical centers and three animal hospitals in Massachusetts. We analyzed the sources, disposal costs and plastic content of medical wastes, and also determined the components, sources, types and amounts of medical plastic wastes. We then evaluated the recycling potential of plastic wastes produced by general city hospital departments, such as cafeterias, operating rooms, laboratories, emergency rooms, ambulance service and facilities, and animal hospitals. Facilities, laboratories, operating rooms, and cafeterias were identified as major sources of plastic wastes generated by hospitals. It was determined that the recycling potential of plastics generated in hospital cafeterias was much greater than that in other departments. This was mainly due to a very slight chance of contamination or infection and simplification of purchasing plastic components. Finally, we discuss methods to increase the recycling of medical plastic wastes. This study suggests that a classification at waste generating sources, depending upon infection chance and/or plastic component, could be a method for the improved recycling of plastic wastes in hospitals.     

Benchmarking in municipal solid waste recycling

The paper presents an analysis of the factors influencing the recycling potential of municipalities in Israel, including population size and density, geographic location, current waste levels, and current waste management system. We employ a standard regression analysis in order to develop an econometric model to predict where potential for economically efficient recycling is highest. By applying this model to readily available data, it is possible to predict with close to 90% accuracy whether or not recycling will be economically efficient in any given municipality. Government agencies working to promote advanced waste management solutions have at their disposal only limited resources and budget, and so must concentrate their efforts where they will be most effective. The paper thus provides policy-makers with a powerful tool to help direct their efforts to promote recycling at those municipalities where it is indeed optimal.     

Risk management for outsourcing biomedical waste disposal – Using the failure mode and effects analysis

Using the failure mode and effects analysis, this study examined biomedical waste companies through risk assessment. Moreover, it evaluated the supervisors of biomedical waste units in hospitals, and factors relating to the outsourcing risk assessment of biomedical waste in hospitals by referring to waste disposal acts. An expert questionnaire survey was conducted on the personnel involved in waste disposal units in hospitals, in order to identify important factors relating to the outsourcing risk of biomedical waste in hospitals. This study calculated the risk priority number (RPN) and selected items with an RPN value higher than 80 for improvement. These items included “availability of freezing devices”, “availability of containers for sharp items”, “disposal frequency”, “disposal volume”, “disposal method”, “vehicles meeting the regulations”, and “declaration of three lists”. This study also aimed to identify important selection factors of biomedical waste disposal companies by hospitals in terms of risk. These findings can serve as references for hospitals in the selection of outsourcing companies for biomedical waste disposal.     

Long-term leaching scenarios for cement-based waste forms

Cement-based waste forms (solidified wastes) are used for the long-term land disposal of industrial hazardous wastes. A cement-based waste form can be prepared by mixing a hydraulic cement and, if needed, a bulking agent with an aqueous waste to cause it to solidify.This article presents eight long-term leaching scenarios based on various properties of waste forms and contaminants as well as different hydraulic regimes and characteristics of groundwater. Each scenario takes the form of a simplified mathematical model used to predict leaching rates for periods of up to 100 years.The analysis demonstrates the importance of chemically fixing the contaminants in the matrix and illustrates the advantages of avoiding situations where ground-water flows through the waste. In situations where advective transport is negligible, leaching rates are limited by pore diffusion and tend to decrease with time.     

Land disposal of mixed human and animal wastes: A review

Combining septic tank effluent and animal wastes (mixed wastes) for eventual application to land is being proposed as an alternative wastewater disposal system. Both types of waste are spread on land separately, and private practice may be to mix and spread them together, but in most of the United States mixing of these wastes for land disposal is illegal. No research has been done to assess the hazards associated with spreading mixed wastes on land. The concern is with the impact on public health of adding septic tank effluent to animal wastes for disposal as animal wastes. The effects of pathogens already present in animal waste are presumably allowed for in current U.S. regulations.Pathogens in mixed wastes include viruses, bacteria and parasites. Viruses are not always present in on-site waste disposal systems, but when present are in high numbers. Most viral particles will pass through the septic tank and will remain viable. Transmission will be prevented if these particles are retained in soil or other solids until any of several factors deprive them of infectivity. As animals are the chief reservoir of most enteric bacteria that are pathogenic to man, no additional hazards from bacteria are expected in a mixed waste system. Some parasite eggs and cysts will settle into the bottom of the septic tank, but significant numbers will pass through and will remain viable. Retention with solids will minimize transmission through food and water. In all instances it is important to match land use and waste disposal carefully.     

Report: biomedical waste management practices at Balrampur Hospital, Lucknow, India.

Biomedical waste has become a serious health hazard in many countries, including India. Careless and indiscriminate disposal of this waste by healthcare establishments and research institutions can contribute to the spread of serious diseases such as hepatitis and AIDS (HIV) among those who handle it and also among the general public. The present study pertains to the biomedical waste management practices at Balrampur Hospital, a premier healthcare establishment in Lucknow, in North India. The study shows that infectious and non-infectious wastes are dumped together within the hospital premises, resulting in a mixing of the two, which are then disposed of with municipal waste at the dumping sites in the city. All types of wastes are collected in common bins placed outside the patients wards. For disposal of this waste the hospital depends on the generosity of the Lucknow Municipal Corporation, whose employees generally collect it every 2 or 3 days. The hospital does not have any treatment facility for infectious waste. The laboratory waste materials, which are disposed of directly into the municipal sewer without proper disinfection of pathogens, ultimately reach the Gomti River. All disposable plastic items are segregated by the rag pickers from the hospital as well as municipal bins and dumps. The waste is deposited either inside the hospital grounds, or outside in the community bin for further transportation and disposal along with municipal solid waste. The open dumping of the waste makes it freely accessible to rag pickers who become exposed to serious health hazards due to injuries from sharps, needles and other types of material used when giving injections. The results of the study demonstrate the need for strict enforcement of legal provisions and a better environmental management system for the disposal of biomedical waste in the Balrampur Hospital, as well as other healthcare establishments in Lucknow.     

The potential for aeration of MSW landfills to accelerate completion

Landfilling is a popular waste disposal method, but, as it is practised currently, it is fundamentally unsustainable. The low short-term financial costs belie the potential long-term environmental costs, and traditional landfill sites require long-term management in order to mitigate any possible environmental damage. Old landfill sites might require aftercare for decades or even centuries, and in some cases remediation may be necessary. Biological stabilisation of a landfill is the key issue; completion criteria provide a yardstick by which the success of any new technology may be measured. In order for a site to achieve completion it must pose no risk to human health or the environment, meaning that attenuation of any emissions from the site must occur within the local environment without causing harm. Remediation of old landfill sites by aerating the waste has been undertaken in Germany, the United States, Italy and The Netherlands, with considerable success. At a pilot scale, aeration has also been used in newly emplaced waste to accelerate stabilisation. This paper reviews the use of aerobic landfill worldwide, and assesses the ways in which the use of aerobic landfill techniques can decrease the risks associated with current landfill practices, making landfill a more sustainable waste disposal option. It focuses on assessing ways to utilise aeration to enhance stabilisation. The results demonstrated that aeration of old landfill sites may be an efficient and cost-effective method of remediation and allow the date of completion to be brought forward by decades. Similarly, aeration of newly emplaced waste can be effective in enhancing degradation, assisting with completion and reducing environmental risks. However, further research is required to establish what procedure for adding air to a landfill would be most suitable for the UK and to investigate new risks that may arise, such as the possible emission of non-methane organic compounds.