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14TOR_HEALTHCAREWASTES

14TOR_HEALTHCAREWASTES

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Published by Kierstine Joy Yamat

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Published by: Kierstine Joy Yamat on Jul 04, 2012
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11/23/2013

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TERMS OF REFENCEFEASIBILITY STUDY FOR HOSPITAL WASTE MANAGEMENT
[],[]
STUDY AREA
A feasibility study is planned for the study area of [], []. The study area is located [], covers an area of []square kilometers and a population of [] inhabitants. The income level of the study area, expressed asGross Domestic Product per capita per year, is [].
INTRODUCTION
Most wastes generated by hospitals and medical clinics are non-hazardous general wastes from hospitalorganization activities (i.e., including kitchen wastes, office materials, workshop residuals) and patient processing activities in wards which are not handling infectious diseases (i.e., first aid packaging, used butemptied disposable bed liners and diapers, disposable masks, pharmaceutical packaging, etc.). After source segregation of recyclables, disposal is typically by sanitary landfill.Potentially hazardous wastes from hospitals and clinics which have a pathogenic, chemical, explosive, or radioactive nature are called “medical wastes”. Medical wastes include the following:
 pathological wastes (i.e., body parts, aborted fetus, tissue and body fluids from surgery; anddead infected laboratory animals);
infectious waste (i.e., surgical dressings and bandages, infected laboratory beddings,infectious cultures and stocks from laboratories, and all waste from patients in isolation wardshandling infectious diseases);
sharps (i.e., needles, syringes, used instruments, broken glass);
 pharmaceutical wastes (i.e., soiled or out-of-date pharmaceutical products);
chemical wastes (i.e., spent solvents, disinfectants, pesticides and diagnostic chemicals);
aerosols (i.e., aerosol containers or gas canisters which may explode if incinerated or  punctured);
radioactive wastes (i.e., sealed sources in instruments, and open sources used in vitrodiagnosis or nuclear medical therapy); and
sludges from any on-site wastewater treatment facilities may be potentially hazardous.Pathological wastes should be destroyed by incineration under high heat (i.e., over 900
o
C with anafterburner temperature at over 800
o
C), although some countries require burial of human pathologicalwastes at official cemeteries for religious reasons. To reach these temperatures and have adequateafterburning and pollution control typically requires development of a regional medical waste facility.Smaller individual hospital or clinic incinerators may not be able to reach these temperatures andafterburning retention periods. Volatilized metals (such as arsenic, mercury, lead) and dioxins and furanscould result from inadequate burning temperatures and retention periods.Other procedures to consider may include chemical disinfection or sterilization (i.e., irradiation,microwave, autoclave, or hydroclave) followed by secure landfill disposal of residuals. In some cases,following complete disinfection, some wastes may be recycled. For example, recycling by specializedcontractors is sometimes arranged after disinfection of thick plastics, such as intravenous bags and tubs,and syringes.TERMS OF REFERENCE FOR HOSPITAL WASTE STUDY1
 
Pharmaceutical wastes require destruction, secure land disposal or return to the manufacturer for destruction through chemical or incineration methods.Chemical wastes need to be source segregated according to their recycling potential and compatibility;and those which are non-recyclable may require stabilization, neutralization, encapsulation, or incineration.Hospital wastewater treatment sludges require treatment (i.e., anaerobic digestion, composting,incineration, etc.) which raises temperatures to levels that destroy pathogenic microorganisms.Radioactive medical therapy and diagnosis in high-income countries are divided into two categories:“open sources” which derive from direct use of the radiochemical substance, and “sealed sources” whichinvolve indirect use of the substance within a sealed apparatus or equipment unit. Only open sources tendto result in radioactive wastes, as sealed sources are returned to the manufacture for recycling whenexhausted or no longer required. Radioactive wastes typically include isotopes such as technetium 99,gallium 67, iodine 125, iodine 131, cesium 137, iridium 192, thallium 201, and thallium 204. Thesewastes are seldom present in low-income and middle-income developing countries, because the hospitalsdo not have the equipment and technology to generate these wastes. If generated, these wastes should bestored safely until the radioactivity has declined to acceptable levels and then disposed with general refuseto sanitary landfill. The half-lives of commonly used medical radionuclides for therapy, diagnosis, or imaging range from 6 hours to several days. Storage on-site in a secured chamber is typicallyrecommended for a period of 10 half-lives, or for one to two months.The overall quantity of wastes generated in hospitals varies according to the income level of the country.For developing countries, the data base is limited, but it appears that the following range of quantities islikely:
general waste which is not contaminated, and can be handled with general municipal refuse:1.0 to 2.0 kg/bed/day; and
contaminated medical waste which needs special management, and is considered potentiallyhazardous: 0.2 to 0.8 kg/bed/day.Low-income countries would tend to generate medical wastes on the low end of this range, while middle-income countries would tend to generate medical wastes on the upper end of this range. The study area iswithin a [] income country, based on ranking criteria established by the World Bank and published in itsannual development report.Medical wastes, if not properly managed, pose a risk to the personnel who are handling these wastes,including custodial personnel and waste collectors, as well as to those providing disposal or pickingthrough the wastes for recyclables. There is the danger that syringes will be recovered from transfer depots and disposal sites by waste pickers for recycling (i.e., by drug users). Contaminated containers for collection of medical wastes are not usually dedicated to only one site, but are circulated throughout citiesas each skip truck brings an empty container to the hospital or clinic and removes the full one while itcovers its daily collection route for general refuse.Incineration is generally considered the preferred technology for some, if not all, medical wastes. At aminimum, infected tissue, body parts, and laboratory animal carcasses are generally recommended to beincinerated. On-site incinerators operating on a batch basis or regional incinerators operating on acontinuous basis are considered appropriate technology. Because of the cost of meeting stringent air  pollution control emission standards, many high-income countries are taking steps to steam sterilize,TERMS OF REFERENCE FOR HOSPITAL WASTE STUDY2
 
irradiate, chemically disinfect, or gas/vapor sterilize some of the medical wastes.One hospital incinerator with a capacity of 0.75 tonne/hour, operating on a continuous feed, could costfrom $US 0.5 to 1.0 million to implement. Air pollution control systems, if they are added to meet 1995USA standards, could cost another $ 0.5 to 1.0 million to implement. Incinerators which operate on a batch basis are typically dedicated to one hospital, as their capacity is limited to less than 1 tonne/day.Regional incinerators would typically be designed to operate on a continuous feed basis.These equipment costs do not include transportation, customs, and setup costs within the study area.Transportation and setup may add about 10% to these costs. If government imports the equipment,especially as it is for waste management purposes, customs may not need to be paid. However, if the private sector is building the facility and needs to import the equipment, customs could add about to thesecosts. Civil works and land costs which are local costs may add about 30% to these costs.While the costs/tonne of treatment/destruction are likely to be high (about $100 to $300/tonne dependingon the level of pollution control required), the low quantities of medical wastes in developing countrieswould result in a costs which generally would be less than 1% of the most hospital's operating budget,exclusive of salaries. Therefore, the proper treatment/destruction facilities are likely to be affordable.Hospitals interviewed in various developing countries have indicated a willingness to pay to cover thesecosts.Hospital waste treatment/destruction facilities could be implemented through one or more Design, Build,Own, and Operate (DBOO) or Design, Build, Operate and Transfer (DBOT) concession agreements of 10to 15 years duration. Or the government could implement the facilities and arrange for service contractsof 2 to 5 years for operation and maintenance. Each hospital would be required to pay tipping fees whichfully cover the costs of investment, debt service and operation. As part of the privatization agreement, thecompany providing the treatment/destruction services could also be awarded the task of also providingcollection of the wastes from each hospital and maintaining a manifest system to track the waste fromsource to ultimate disposal.Secured sanitary landfill is generally considered the preferred technology for medical wastes which do notrequire incineration or disinfection, such as packaging materials and general kitchen wastes. Nevertheless, special measures to fence and control access to the area of landfilling for medical wastes areessential. No waste picking should be allowed in the secured area. Also, the machinery for compactingrefuse should not come in direct contact with the waste. Instead, the waste should be dumped into a trenchand a adequate layer of soil dumped over the waste. Only thereafter is it recommendable that themachinery work over the soil covered waste to compact it and grade the surface so that infiltration of rainwater is minimized.
STUDY OBJECTIVES
The feasibility study will assess the technology options for medical waste treatment/destruction. Thestudy will result in recommendations which outline proposed numbers, sizes, and types of medical wastetreatment/destruction facilities. Technologies to be considered include incineration, irradiation, chemicaldisinfection and sterilization.For purposes of the proposed study on hospital waste management, the following objectives are to beaddressed:TERMS OF REFERENCE FOR HOSPITAL WASTE STUDY3

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