Infectious waste management in Japan: a revised regulation and a management process in medical institutions

In Japan, the waste management practice is carried out in accordance with the Waste Disposal Law of 1970. The first rule of infectious waste management was regulated in 1992, and infectious wastes are defined as the waste materials generated in medical institutions as a result of medical care or research which contain pathogens that have the potential to transmit infectious diseases. Revised criteria for infectious waste management were promulgated by the Ministry of Environment in 2004. Infectious waste materials are divided into three categories: the form of waste; the place of waste generation; the kind of infectious diseases. A reduction of infectious waste is expected. We introduce a summary of the revised regulation of infectious waste management in this article.     

Thermal treatment and decontamination of mercury-contaminated waste: Recent developments and comparative evaluation

The land disposal restriction regulations have necessitated development of technologies for the treatment of wastes and soils containing mercury. Of all the treatment methods, thermal technologies are the most advanced and proven for a variety of mercury-contaminated waste materials. During the past few years, a number of thermal treatment processes have been developed both for listed and characteristic waste. A review of the technologies identified six that are in either commercial or pilot plant stages. The biggest volumes of waste currently occur in the gas processing and caustic-chlorine industries, so most of the technologies being used appear to have been developed around the characteristics of these two wastes. This article discusses the characteristics of each of the six available thermal treatment processes, and describes the types of mercury-contaminated wastes these technologies have been designed to handle.     

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.     

How changing regulations determine biotreatment options for petroleum wastes

Remediation of refinery wastes is regulated by three major federal environmental statutes: the Clean Air Act, the Clean Water Act, and the Resource Conservation and Recovery Act (RCRA); other statutes apply, but to a lesser degree. During the past two years, RCRA's rules have effectively outlawed the passive biological treatment of primary refinery waste sludges in waste ponds and lagoons, even though the law recommends active biological treatment as the second stage in the waste treatment train. RCRA's land disposal restrictions may also outlaw land farming treatment for the bottom sludges involved in crude oil storage. Since 1980, when the U.S. Environmental Protection Agency listed an initial group of five waste streams as hazardous, the agency has listed two more waste streams and twenty-five organic constituents, several found in petroleum wastes. Now it is about to list fourteen more petroleum refining wastes and is studying the addition of fifteen more waste streams. Treatment standards and restrictions have also been promulgated. This article explores the biotreatment techniques and technologies that are still available to petroleum and environmental engineers.     

A multi-criteria assessment of scenarios on thermal processing of infectious hospital wastes: A case study for Central Macedonia

In Greece more than 14,000 tonnes of infectious hospital waste are produced yearly; a significant part of it is still mismanaged. Only one off-site licensed incineration facility for hospital wastes is in operation, with the remaining of the market covered by various hydroclave and autoclave units, whereas numerous problems are still generally encountered regarding waste segregation, collection, transportation and management, as well as often excessive entailed costs. Everyday practices still include dumping the majority of solid hospital waste into household disposal sites and landfills after sterilization, still largely without any preceding recycling and separation steps. Discussed in the present paper are the implemented and future treatment practices of infectious hospital wastes in Central Macedonia; produced quantities are reviewed, actual treatment costs are addressed critically, whereas the overall situation in Greece is discussed. Moreover, thermal treatment processes that could be applied for the treatment of infectious hospital wastes in the region are assessed via the multi-criteria decision method Analytic Hierarchy Process. Furthermore, a sensitivity analysis was performed and the analysis demonstrated that a centralized autoclave or hydroclave plant near Thessaloniki is the best performing option, depending however on the selection and weighing of criteria of the multi-criteria process. Moreover the study found that a common treatment option for the treatment of all infectious hospital wastes produced in the Region of Central Macedonia, could offer cost and environmental benefits. In general the multi-criteria decision method, as well as the conclusions and remarks of this study can be used as a basis for future planning and anticipation of the needs for investments in the area of medical waste management.     

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.     

A mathematical model to predict the composition and generation of hospital wastes in Iran

The aim of this study is to investigate the quality and quantity of hospital wastes in Iran. The generated hospital wastes have been estimated by the number of hospitals and the number of active beds in each province of Iran in 2001. All data and information have been gathered from: (i) Iran Statistics Center, (ii) literature review, and (iii) hospital waste investigations for an average hospital. Physical analyses have been conducted in terms of various materials (plastic, textile, paper, metal, and others) and components (biological, infectious, medical, and regular wastes). Based on the above-mentioned investigation and information, a mathematical model has been developed to calculate the generation of (infectious) hospital wastes for any desired year. Utilizing the model, generated infectious hospital wastes has been estimated as 698,937 tones for 2008 (short-term) and 3,494,387 tones for 2028 (long-term period). If the real infectious wastes are collected separately, then the generated infectious wastes will be reduced by 15.1% of the above-mentioned amount (139,787 tones for 2008, and 698,877 tones for 2028). Results of physical analysis show the components of the hospital waste as: (a) infectious, 67.3%; (b) medical, 8.8%; (c) biological, 1.8%; and (d) common municipal wastes, 22.1%. An appropriate collection method requires training the staff at hospitals along with preparation of the required facilities. Of course, both of these requirements are cost intensive.     

Air pollution control residues from waste incineration: current UK situation and assessment of alternative technologies

Current disposal options for APC residues in the UK and alternative treatment technologies developed world-wide have been reviewed. APC residues are currently landfilled in the UK where they undergo in situ solidification, although the future acceptability of this option is uncertain because the EU waste acceptance criteria (WAC) introduce strict limits on leaching that are difficult to achieve. Other APC residue treatment processes have been developed which are reported to reduce leaching to below relevant regulatory limits. The Ferrox process, the VKI process, the WES-PHix process, stabilisation/solidification using cementitious binders and a range of thermal treatment processes are reviewed. Thermal treatment technologies convert APC residues combined with other wastes into inert glass or glass-ceramics that encapsulate heavy metals. The waste management industry will inevitably use the cheapest available option for treating APC residues and strict interpretation and enforcement of waste legislation is required if new, potentially more sustainable technologies are to become commercially viable.     

Hospital waste management and toxicity evaluation: a case study

Hospital waste management is an imperative environmental and public safety issue, due to the waste's infectious and hazardous character. This paper examines the existing waste strategy of a typical hospital in Greece with a bed capacity of 400-600. The segregation, collection, packaging, storage, transportation and disposal of waste were monitored and the observed problematic areas documented. The concentrations of BOD, COD and heavy metals were measured in the wastewater the hospital generated. The wastewater's toxicity was also investigated. During the study, omissions and negligence were observed at every stage of the waste management system, particularly with regard to the treatment of infectious waste. Inappropriate collection and transportation procedures for infectious waste, which jeopardized the safety of staff and patients, were recorded. However, inappropriate segregation practices were the dominant problem, which led to increased quantities of generated infectious waste and hence higher costs for their disposal. Infectious waste production was estimated using two different methods: one by weighing the incinerated waste (880 kg day(-1)) and the other by estimating the number of waste bags produced each day (650 kg day(-1)). Furthermore, measurements of the EC(50) parameter in wastewater samples revealed an increased toxicity in all samples. In addition, hazardous organic compounds were detected in wastewater samples using a gas chromatograph/mass spectrograph. Proposals recommending the application of a comprehensive hospital waste management system are presented that will ensure that any potential risks hospital wastes pose to public health and to the environment are minimized.     

Proximate composition of household waste and applicability of waste management technologies by source separation in Hanoi,Vietnam

The organic fraction of municipal solid wastes in Southeast Asia, which has a high moisture content, accounts for a large proportion of total waste. Local governments need to pay adequate attention to the composition of wastes to determine alternative waste management technologies. This study proposed the use of a triangle diagram to describe changes in proximate composition and rates of successful source separation of municipal solid waste and to identify technical challenges about alternative waste management technologies such as incineration, composting, and refuse-derived fuel production based on physical and proximate composition analysis of household waste sampled in Hanoi, Vietnam, as a case study. The analysis indicated the effectiveness of different types of source separation as well as different levels of successful achievement of source separation as an adjustment mechanism for the proximate composition of waste. Proper categorization of wastes for source separation is necessary for the appropriate use of alternative waste management technologies. The results showed that, at a source separation rate of just greater than 0.52 in a three-way separation scheme, the waste separated as combustible waste would be suitable for incineration with energy recovery. Based on well-designed schemes of source separation, alternative waste management technologies can be applied.     

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.     

Managing petroleum refining wastes by thermal desorption

The U.S. Environmental Protection Agency has developed regulations under the Hazardous and Solid Waste Amendments (HSWA) of 1984 to restrict the land disposal of hazardous wastes. As a result of the regulations, all hazardous wastes to be placed on the land must meet treatment standards based on the performance of the best demonstrated available technology (BDAT) identified for individual waste classifications. The Marathon Oil Company is currently evaluating innovative technologies for managing listed waste materials, with a focus on waste minimization and recycling. Remediation Technologies, Inc. (ReTeC) has conducted testing on wastewater treatment sludges from three Marathon refineries using a proprietary thermal desorption technology. The results from these tests have demonstrated that the technology has the ability to consistently meet BDAT treatment standards, while preferentially separating and condensing residual moisture and oils from the material.     

Municipal wastes and their solar transformities: an emergy synthesis for Macao

The debate over waste management practices has become increasingly important as human activities have begun to overload the biosphere's assimilative capacity. An effective waste management policy should be based on the principles of sustainable development, with wastes regarded as a potential resource rather than solely as something to eliminate. This approach requires an integrated waste management plan that makes full use of all available technologies. Macao is a highly populated consumer society that lacks natural resources and must therefore import almost all of its life-supporting goods and raw materials from regions outside the city. During the past 20 years, Macao has experienced an economic boom, accompanied by rapid socioeconomic development. Its discharged wastes have increased steadily during this period. This paper employs emergy analysis to investigate Macao's waste treatment in 1995, 1999, 2003 and 2004. The emergy of gaseous emissions was estimated to be 4.76 x 10(21) sej in 2004. Since 1992, Macao's municipal solid waste (MSW) has been incinerated to reduce its volume. The transformity of the fly ash and slag produced by this treatment in 2004, and the electricity generated by the incinerator, equaled 5.11 x 10(11) sej/g, 6.01 x 10(10) sej/g, and 7.61 x 10(6) sej/J, respectively. A large investment of natural resources and technology is required for the treatment of wastes; the feedback ratio of wastes, which represents the scale of the treatment of inputs, equaled 0.02 for MSW, 0.11 for sewage, and 0.06 for gaseous emissions.     

A method for livestock waste management planning in NE Spain

A method of decision-making on livestock wastes management in areas with nutrient surplus due to high livestock density is applied in Catalonia (NE Spain). Nutrient balance is made considering soil nitrogen application as the limiting factor. Special attention is paid to the centralized treatment option. The method presented consists of: 1. minimizing livestock waste generation (at farm scale) as a step previous to any other, both in amount and limiting components, 2. applying the nitrogen balance method at regional and municipal scale and providing enough storage capacity in order to apply wastes in an agronomically correct way, 3. spatially refining the results of the nitrogen balance by a proposed method that allows precisely pinpointing the hotspots of livestock waste generation, where centralized treatment might be an interesting option, and 4. deciding on the waste treatment objectives, provided that treatments be necessary. Knowledge about the wastes, meeting the interests and merging the efforts of the various actors, as well as an adequate budget are necessary ingredients for the success of any waste management plan.     

RECOMMENDATIONS FOR THE MANAGEMENT OF WASTES FROM HEALTHCARE FACILITIES IN HELSINKI

In Helsinki, Finland, new guidelines have been adopted for the management of wastes from healthcare facilities. The purpose has been to rationalize waste management, reducing the amount of waste needing special treatment and lowering costs, while at the same time maintaining occupational safety and preventing environmental hazards. The changes are mainly due to the new definition of infectious waste, based on practical assessment of the possibility of spread of infection via the wastes. As a result, it has been possible to omit one chain of waste handling which has led to simpler practices and economic benefits. Sanitary landfill has been accepted for disposal of clinical waste, except for the biological waste to be incinerated for ethical reasons and infectious waste contaminated by class 4 viruses,Yersinia pestisorBacillus anthracis. Diseases caused by these micro-organisms are not a practical problem in Finland.     

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.     

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.     

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.     

Hazardous chemical site remediation through capping: Problems with long-term protection

The capping of waste management units and contaminated soils is receiving increasing attention as a low-cost method for hazardous chemical site remediation. Capping is used to prevent further groundwater pollution by existing waste management units and contaminated soils through limiting the moisture that enters the wastes. In principle, for wastes located above the water table, the construction of an impermeable cap can prevent leaching of the wastes (leachate generation) and groundwater pollution. In practice, appropriately designed and constructed RCRA caps can provide for only short-term prevention of groundwater pollution. Alternative approaches are available for capping of wastes that can be effective in preventing moisture from entering the wastes and concomitant groundwater pollution. These approaches recognize the inability of the typical RCRA cap to keep wastes dry for as long as waste constituents will be a threat and, most importantly, provide the necessary funds to effectively address all plausible worst-case scenario failures that could occur at a capped waste management unit or contaminated soil area.     

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.