Hadrur Ph\% Cht~nl. Vol. 46. No. 4-h. pp.

1153-l 157, 1995

Elsevier Science Ltd. Printed in Greal Britain
Pergamon
0969-806X(95)00347-9

HOSPITAL WASTE STERILIZATION: A TECHNICAL AND ECONOMIC

COMPARISON BETWEEN RADIATION AND MICROWAVES TREATMENTS

A. Tata & F. Beone

ENEA-INNiTEC RadiationTechnologyDivision
P.O.Box 2400,00100Rome,Italy

ABSTRACT

Hospital waste(HW) disposalis becominga problemof increasingimportancein almost all industrially

advancedcountries.In Italy the yearly hospitalwasteproductionis about250,000tonsand only 60,000tonsare
treatedby incinerationat presenttime. As by a recentItalian law a meaningfidpercentageof HW (50 to 60%),
corresponding to food residuals,plastics,paper,variousorganicmaterials,etc., couldbe landfilledasmunicipal
refusesifpreliminarily submittedto a suitablesterilizationtreatment.
Underthis perspective,sterilization/sanitationtechniquesrepresentnow a technicallyand commerciallyviable
alternativeto HW thermaldestructionthat, besides,is moreandmoresociallyandpolitically lessaccepted.
Electron Beam (EB) and Microwave (MW) treatmentsare two of the most interestingand emergingHW
sterilizationtechniques,and, basedon engineeringreal data, a technicaland economiccomparisonis carried
out, focusingvantagesandlimits of eachprocess,

KEYWORDS

Radiation treatment, Electron beam, Microwaves. Hospital wastes,Sterilization, Sanitation, Disinfection,

Economics.

INTRODUCTION

As by a recentItalian law definitely issuedin 1992from Italian EnvironmentMinistry, the solid fraction of
hospitalwastescomingfrom administration,kitchens,diagnosticslaboratoryactivities (containers,glassworks,
etc.) and from refusesproducedfrom curative therapies,with exclusionof wastesfrom hospital infective
departments, canbe landfilledasmunicipalrefusesif submittedto a suitablesterilizationprocess.
The HW productionrate is estimatedas rangingfrom 0.5 to 3.0 kg/day/bedwith meanvalue around 2.0
kg/day/bed.The HW fraction assimilable to solidmunicipalrefuses(consideringalsothe expired medicines)is
consideredaround50-60%of total amount.Accordingto recentinvestigations,in Italy therewould be around
420,000hospitalbedssharingout among1,700public andprivate clinical hospital.Considering80%as very
conservativeoccupationfactor, the daily HW productionis about670 tons(250,000tons/y). The resultingHW
fraction assimilableto solid municipalrefusesif submittedat sterilizationtreatmentand excluding anatomic
parts, infected and hazardouswastes,etc., amountsto about 150,000tons/y, with the following standard
composition:papers20%. film plastics15%,rigid plastics20%,metals3%. cloths lo%, organicmaterials2%,
moisture30%andbulk densityof 100-200kg/m3.

HOSPITAL WASTES TREATMENT TECHNIQUES

The assimilabilityof HW to solid urban refises,asby Italian regulations,requiresa sterilization treatment

insteadof a disinfectionor sanitationtreatment.Sterilizationcanbeobtainedby a thermalor chemical-physical
processable to ‘&sure the destructionand/or the inhibition to the breedingof the microbial viable present
populationuntil to a residualconcentrationof 10e6CFU/g’. Otherwise,the “disinfection”or “sanitation”is the
I IT.7
process able to ‘eliminate all foreseen human pathogen agents that can be transferred to humans from hospital
and hazardous wastes”.
HW main viable sterilization processes could be distinguished as
- thermal processes (incineration, autoclave, steam/microwaves)
- chemical-physical process (chemical agents, irradiation by iomzmg radiation)

Conventional methods: Incineration

Incineration processes represent, at present time, the most largely diffused technology for HW treatment.
Incineration plants utilize liquid or solid fuels in addition to refuses (mean heat value of 3.000 kcal/kg) and the
final result are ashes and gases; ashes must managed as hazardous wastes. gases (acid gases mixed with
organo-chlorine pollutants) require special systems and equipment (post-combustion room. filters, scrubbers,
sprayers, etc.) before discharge into atmosphere.
In Italy , referring to the end of 1992, the number of incineration plants for solid rehlscs (contemporary
treatment of municipal refuses and HW) is 51 (25 operating, 19 under rc-structuring. 7 under construction)
with a total treatment capability of 5,400 t/d (about 1.600.000 t/y) The resulting HW mcincration capability
corresponds to 5 % of total capability, that is about 60.000 t/y. approximately less than half of present needs
with reference to HW assimilable to municipal refuses.
A meaningful limit of incineration process utilization msidc hospitals is the allowed liccnslng minimum plant
size corresponding at present in Italy to 100 t/d.
Treatment costs at present time in Italy, depending on many parameters (location. quantrtlcs. etc.) could be
considered in the range of 0.8-I .2 US$/kg.

EB-wocess
Sterilization/sanitation processes utilizing ionizing radiation (EB or gamma) are based mainly on the inhibiting
action on DNA and, in some cases, RNA molecules of the pathogenic microorganisms. The radiation reduction
mechanism of bacterial and viral populations is performed both directly and through media generated radicals.
In general terms the HW sterilization/sanitation process can be considered as analogous to well-known and
simple sterilization processes of medical commodities (180 commercial sterilization plants running at present
time in the world for treatment of medical commodities, surgical. etc.). With reference to italian irradiation
plant market, EB is going to substitute gammas mainly for safct! reasons connected to source management.
Electron beam energy , in order to allow adequate penetration. must bc as near as posslblc to 10 MeV (e.g.
LINAC type machines). With reference to HW. same doses (25 to 35 kG1) utilized for medical disposable
sterilization have been certified as adequate to reach a satisfactoc mimmlration of epidemiological risks and
infectious illness propagation. In case of sanitation doses of only IO kCiy could be considered as suitable for a
satisfactory treatment.

MW-treatment
Microwaves (MW) are electromagnetic waves with freauencv Included between the radio and Infrared waves.
The MW processes are based on tithecapability of polar (and polarIrablc) molecules to absorb energy (rotational
energy) from a suitable varying magnetic field. During the forced rotational movements. molecules produce
attrition and so the rotational energy is converted to heat. In MW processes water (or steam) is added to
materials to be treated being the water molecule of enhanced polarity and with high mobility and consequently
able to generate the process necessary heat. The thermal energy diffusion inside the material results adequately
uniform only if it is homogeneous and with thickness not higher than 30 mm. Metals content is a meanin&]
technology bottle neck: as a matter of fact it creates reflection surfaces inside the bulk gi\,mg rise to a non-
homogeneous treatment: maximum allowed metals mass content should bc 0.5-l% of bulk material and in
grinded form.
Therefore, in order to perform correctly a HW sterihzation process b> MW. the following steps are required:
HW loading, box opening, wastes grinding (volume reduction up to l/6-1/8), prc-heating and heating by steam
(up to 0.75 liter per kg of refuse, temperature up to 11O’C. pressure up to 1 5x10’ Pa), MW treatment (process
temperature at least 135°C for lo-15 min.). waste cstraction and disposal (landfilling). process waste (liquid
streams) collection and disposal.

EB VS. MW PROCESSES: TECHNICAL AND ECONOMIC COMPARISON

A technical-economic comparison between EB and MW processes for mdustrial applications must considered
at present time only as a prelimmary analysis. being not easily avallable. specific data rcgardmg experiences
about management of meaningful demonstrative/industrial plants utilizing the consldered technologies for HW
treatment.
In the foIlowIng. \antagcs and hmlts of Et3 process in comparison with microwaves-steam treatment are
enhanced. giving particular details on economic aspects

Vantages
1. In industrialized countries 40% IO 50% of medical products are sterilized by radiation processes. The
percentage is espected to reach approslmatcly 80% m next years. The processes utilizes either EB-machines or
Cobalt-60. Radiation processes has proved to be better than the conventional process (mainly EtO) with regards
to safety for workers and consumers. disinfection/sterilization reliability and processing capability as well as
managing. The gained Industrial cspcrience is directly transferable to HW irradiation plants.
2. With reference to EB lndustrlal applications there IS a large experience in material processing by electron
accelerators: at present over 801) commercial plants are running on a wide spectrum of material (cables, wires,
rubber, wood-plastic. etc ) and about 20 on sterilization processes (medical, surgical materials). On the contrary
microwaves treatments. 1111IWM. had yen: wide application but only with reference to small or medium
equipment for domcstlc utlli/.atlon (e g ovens).
3. Treatment homogeneit! in bulk IS very high. and independent from waste composition due to the intrinsic
mechanism of energy transfer. thermal processes. like MW. are not able to reach comparable results: in case of
MW, as a matter of fact. the prcscncc of metals not grinded produces, due to reflection phenomena, shadow
areas.
4. Treatment capablht! of HW 111the same orlginal containment system and without any additional process,
avoiding an! problem in boscs opcnmg and mfectlous waste handling; such operations are necessary utilizing
MW in order to perform the neccssa~ waste grindmg
5. No additional Hastes arc gcncratcd (like typical toxic gases and hazardous ashes in case of incineration, or
discharged extra \\ater or steam. ha\,mg a not negligible Infectious charge, due to humidification process in
case of MW)
6. Process running IS ai room tcmpcraturc and pressure. reducing risks of fire or explosion (MW require
temperature up to 140 “C and prcssurc up to 4.5s I O5 Pa); high voltage and radiation risks are common to both
EB and MW processes
7. The process control IS cas! and rchablc. with. also. the possibility of direct visual process monitoring; in case
of MW this kind of control IS 1101allowed wvlth present equipment. and. moreover, being the process of thermal
type. it is quite diff]cult to contiol process cfflcacy being this possible only through a temperature map inside
the waste mass

Limits
1. High in\,cstment cap1~11 cost\ EB-machmes costs oomcd with shielding costs) represent an heavy “entry
point”for technology industrial promotion. Only matching with consumption costs (power and personnel costs)
is possible to reach. comparmg \rith MW. a profitable occurrence (Italian scenario) in correspondence of HW
throughput over about 0 2 ton/h (XC Economics). with reference to countries where power costs are lower the
pitch point moves to higher throughput (e.g. 0 3 ton/h in correspondence of half electrical power cost).
2. Difficulties. in compartson \\ ith MW. to rea1ir.e a mobile plant (mainly due to shielding weight): such kind
of plant has been consldcrcd from some potential users as having good commercial chances for costs
minimizing in case of many small hospitals or analysis laboratories.
3. Irradiation plants licensing. almost c\er)where in advanced countries, requires long time and a large number
of technical documents to be approved from authorities: the presence of a specific control legislation for
radiation plants design. crcction and managcmcnt is valuable in general, but represents an extra-cost for
enterprises. and then an obstacle III comparison with less “controlled” technologies like at present MW.
4. Low public and social acccptancc as well as misconceptions (e.g. induced radioactivity) connected to a
general banning of an\ ‘rmclcar” or similar technology; also if analogous troubles are recently emerging with
reference to MW utih/.atlon. radlatlon technologies remain more heavily penalized than any other technology
from social uncertaintIcs and \\orrIcs arlsing from the lack of correct information.

Economics
The economic comparison bct\\ecn EB and MW processes has been carried out with reference to Italy as plants
siting in order to rcducc tla~a unccrtamt!. analysis results are however easily transferable to several
technologically ad\ anccd countries (maInI> European) haling similar social-economic conditions, as well as
environmental protcctlon la\+s and regulations.
The analysis is based 011 cnginccrlng real data for lrradlation plants (process not in-line), collected from main
equipment suppliers and carrlcd out by means of a computer code specifically elaborated for economic
evaluation of EB and MU’ processes applied not on line but in a separate planl.
As reference data. In Ital\. at prcxent. the HW mcmeration treatment cost (exluding transport, disposal, etc.) is
around 60 US cents/kg. hut consldermg plant throughput of 100 t/da>.
The following basic dat;l ha\ c been set up’
1 ISfJ A. Tata and F. Beone

HW: throughput : 0.05/0.1/0.2/0.3 and 0.5 ton/h; standard reference composition: see above.
Plant: depreciationfactor: 10%on a plant life of 10 years;Electricalpowercost: 0.113US$/kWh; Personnel
hourly cost:23.35US$/h.
EB: beamenergy: 10MeV; dose:25 kGy; non-homogeneity factor: 2; machineeff.: 0.5; plant eff.: 0.65; plant
utilization factor: 0.85; maintenancecost: 5% of plant cost per year; engineering,civil works, auxiliary
systems,etc.: min. about 1USM$.
MW: effective beampower (magnetrons):5.38 kW/lOO kg/h of HW; non-homogeneity factor: 2; plant eff.:
0.08; plant utilization factor: 0.75; maintenancecost: 7.5% of plant cost per year; engineering,civil works,
mechanicalequipment(e.g. grinding),auxiliary systems, etc.: min. about0.7 USM$.

Analysis resultsare shownin Tab.1 (EB) and Tab.2 (MW), while yearly
_ _ costs and unit costsare compared
respectivelyin Fig. 1 andFig.2.

Table 1 - EB-process
featuresandeconomics
Throughput (ton/y) 0.05 0.10 0.20 0.30 0.50
Plant features
Beam power (kW) 0.5 I.1 21 3.2 5.3
Plant power (kW) 1.1 2.1 4.3 6.4 10.7
Plant cost (US kS) 1785.87 1986.93 2214.47 2361.33 2562.41
Interests cost (US k%) 1120.60 1246.73 1389.47 1481.60 1607.80
Consumption
Power (MWWy) 8 15.9 31.8 47.7 79.6
Personnel (h/y) 3200 3200 4000 4800 4800
Yearly costs (us k$/y)
Power 0.93 1.80 3.60 5.40 9.00
PL%-SOM~l 74.67 74.67 93.33 112.00 112.00
Maintenance 89.27 99.33 110.73 118.07 128.13
Depreciation 290.67 323.33 360.40 384.27 417.00
Total 455.53 499.13 568.06 619.80 666.13
unitcost.9 (US cents/kg)
Power 0.24 0.24 0.24 0.24 0.24
P~!-SOtltld 20.05 10.65 6.66 5.01 3.01
Maintenance 23.99 13.34 7.43 5.29 3.44
Depreciation 78.07 43.43 24.20 17.21 11.20
Total 122.35 67.66 38.53 27.75 17.89

Table2 - MW-processfeaturesandeconomics
Throughput (ton/y) 0.05 0.10 0.20 0.30 0.50
Plant leatwe3
Beam power (kW) 2.69 5.38 10.75 16.13 26.88
Plant power (kW) 33.60 67.20 134.41 201.61 336.02
Plant cost (US k$) 744.29 942.74 1256.26 1551.12 2023.05
Interests cost (US k%) 468.90 593.93 79 1.44 977.21 1274.52
consumption
Power (MWh/y) 220.17 441.53 883.06 1324.60 2207.66
Personnel (h/y) 3200 4000 5600 6400 6400
Yearly costs (US k$/y)
Pow& . _’ 25.02 50.04 100.08 150.12 250.20
Pen0Nlel 74.67 93.33 130.67 149.33 149.33
Maintenance 55.82 70.71 94.22 116.33 151.73
Depreciation 121.32 153.67 204.77 252.83 329.76
Total 276.83 367.75 529.74 668.62 881.02
unitcosts (US wwkg)
Power 7.62 7.62 7.62 7.62 7.62
PUSolMel 22.73 14.21 9.94 7.58 4.55
Mamtenance 16.99 10.76 7.17 5.90 4.62
Depreciation 36.93 23.39 15.58 12.83 10.04
Total 84.27 55.97 40.3 1 33.92 26.82
 0th International Meeting on Radiation Processing 1157

40 -

30 -

20 i

0.00 0.10 0.20 0.30 0.40 0.60 0.00 0.10 0.20 o.ao 0.40 0.50
Throughput (ton/h) Throughpul (ton/h)

Fig 1 - EB- and MW- process Yearly costs Fig 2 - EB- and MW- process Unit costs

CONCLUSIONS

The technicalcomparisonenhancedsomemeaningfulvantagesof EB- versusMW-techniques.The combined

steam-MWprocess,beinga thermalprocess,is ableto sterilizeHW only if the wasteis completelygrindedand
without metallic materialsinside: this requiresthe handling of an infectious material through several
operationsnot necessary.on the contrary, in caseof EB-treatment.Radiationprocessing,moreover,is a more
industriallytestedsterilizationtechniquedueto the wideexperiencegainedin medicaldevicestreatment.The
economicanalysisshowedthat both technologiesare an interestingalternative, as emeringprocessesto
incenerationtreatment.Underplant management safetyandriskshazards,thereis a substantialparity between
technologies;nevertheless somevantages,at present,are to attributedto steam-MWprocessconsideringboth
the lessrestrictiveregulationsandlawsandthe misconceptions usuallyassociatedto ionizing radiation.
The economiccomparisoncarried out betweenEB- and MW-process,with referenceto Italian scenario,
pointedup that EB treatmentunit cost, dueto the high initial investmentcost(amplifiedby the depreciation
factor), but taking advantagefrom highly growingMW yearlycosts(mainlydueto requiredpersonnelfor waste
handlingand equipmentpower consumption), becomesprofitablein comparisonwith MW and, only starting
from a throughputof about0.2 ton/h that corresponds,consideringthefraction of HW assimilable to municipal
refuses,to a wastesproductionof hospitalsstructureshavingbetween2.000and3,000beds.

REFERENCES

Perelli,E. (1987). Sistemidi pastorizzazioneconmicroonde.Tecnologie Alimenturi, Panis,1, 22-25.

Bregman,J.I. (1989).Managementof MedicalWastes.5th Int. Co@ on Solid Wastes. Roma,26-29apr.1989
Marchioni, E.. et al. (1992). Sterilizationof HospitalWasteswith an ElectronBeamAccelerator.Applications
ofIsotopes and Radiation m Conservafion of the Envwonmenl, IAEA-SM-325, 183-189.
Italian Ministry of Environment(1992).RelazionesulloStat0dell’Ambiente.1st.Poligratico,Roma.
IAEA (1992).RadiationSafetyof GammaandElectronIrradiationFacilities.Sufiry Seriesno.107.
Waite, T.D, et al. (1992).Irradiation Treatmentof Water and Wastes.Applications of Isotopes and Radiation
in Conservation of Ihe Environment. IAEA-SM-325. 143-152.
Berejka,A.J. (1993).The economics of radiationprocessing. Rad.Phys.Chem., 42, I, 147-161.
Scheerer,W.R.(1993).Costofvarious industrialapplicationsof EB. Rad.Phys.Chem., 42, 1, 535-538.
Tata, A. (1994).La sterilizzazione dei rijiuti ospedalieri. ENEA TechnicalReportRT/INN/94/06.
Machi, S.andR. Iyer (1994).Nuclearand radiationapplicationsin industry:Toolsfor innovation.ZAE4 Bull.,
36,1,3-6.
Swinwood,J.F., et al. (1904) Radiationtechnologies for wastetreatment:A globalperspective.IAEA Bull., 36,
1, 11-15.