Table of Contents
1
Introduction......................................................................................................................................1
1.1 Objectives.................................................................................................................................1
1.2 Approach...................................................................................................................................1
2
Situation analysis regarding health-care waste.............................................................................2
2.1 Overview...................................................................................................................................2
2.1.1
Generation and disposal of health-care waste..............................................................2
2.1.2
Risks of infection.........................................................................................................3
3
Health-care waste treatment options..............................................................................................4
3.1 Evaluating technological options..............................................................................................4
3.2 Incineration of health-care waste..............................................................................................5
3.2.1
Risks from incineration emissions...............................................................................5
3.2.2
Incinerator performance...............................................................................................6
3.2.3
Control of incinerator emissions..................................................................................8
3.2.4
Incinerator costs...........................................................................................................9
3.3 Other options...........................................................................................................................10
4
Best practices for incineration.......................................................................................................12
4.1 Waste reduction......................................................................................................................12
4.2 Design.....................................................................................................................................12
4.3 Siting.......................................................................................................................................13
4.4 Construction............................................................................................................................15
4.5 Operation................................................................................................................................15
4.5.1
General operating (prior and following loading).......................................................15
4.5.2
Waste loading/charging.............................................................................................16
4.5.3
Burndown/cooldown..................................................................................................17
4.5.4
Monitoring.................................................................................................................17
4.5.5
Safety.........................................................................................................................18
4.6 Maintenance............................................................................................................................18
4.6.1
Facility inspection......................................................................................................19
4.6.2
Record keeping..........................................................................................................19
4.7 Training and management.......................................................................................................19
4.7.1
General duties............................................................................................................19
4.7.2
Operating and maintenance manual...........................................................................19
4.7.3
Operator certification.................................................................................................20
4.8 Regulations affecting incinerators..........................................................................................20
4.8.1
Emission limits..........................................................................................................20
4.8.2
Permitting...................................................................................................................23
4.8.3
Global conventions....................................................................................................23
4.9 Emission standards for small-scale incinerators.....................................................................23
5
Exposure and health risks from incineration...............................................................................24
5.1 Health risk assessment framework..........................................................................................24
5.1.1
Hazard assessment.....................................................................................................24
5.1.2
Dose-response assessment.........................................................................................24
5.1.3
Exposure assessment..................................................................................................25
5.1.4
Risk characterization..................................................................................................26
5.1.5
Uncertainties, variability and data gaps.....................................................................27
5.1.6
Comparative and screening risk assessments.............................................................27
5.2 Hazard identification \u2013 dioxins and furans.............................................................................28
5.2.1
Dose response and exposure evaluation.....................................................................29
5.3 Emissions of dioxins/furans from small-scale incinerators....................................................31
5.3.1
Emissions and dioxin formation................................................................................31
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