Bottom and fly ash treatment of medical

waste incinerator from community health

centres with solidification/stabilization
Cite as: AIP Conference Proceedings 2114, 050023 (2019); https://doi.org/10.1063/1.5112467
Published Online: 26 June 2019

I. Wayan Koko Suryawan, Gita Prajati and Anshah Silmi Afifah

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AIP Conference Proceedings 2114, 050023 (2019); https://doi.org/10.1063/1.5112467 2114, 050023

© 2019 Author(s).
 Bottom and Fly Ash Treatment of Medical Waste
Incinerator from Community Health Centres with
Solidification/Stabilization
I Wayan Koko Suryawan1,a), Gita Prajati1,b), and Anshah Silmi Afifah1,c),
1)
Department of Environmental Engineering, Universal University Batam, Riau Islands, Indonesia
a)
Corresponding author: iwayankokosuryawan@gmail.com
b)
prajatigita@yahoo.com
c)
silmi.kbub@gmail.com

Abstract. The amount of medical waste generation in Indonesia is increasing along with its poor processing method. One
of the producers of medical waste is community health centres. The usual treatment of medical solid waste is by incineration
and some have applied processing with solidification/stabilization (S/S). The objective of this study was to determine the
quality of compression test and total concentration of heavy metals (Cu, Cd, Cr, Zn, and Pb) using toxicity characteristic
leaching procedure (TCLP). The variations of bottom and fly ash: cement Portland composition were 25:75, 50:50, and
75:25. Maximum compression test results were at 25:75 with a result of 682 (7 days) and 772 tons/m2 (28 days). According
to the characters of TCLP test on bottom and fly ash, the results showed that Zn had the highest concentration followed by
Cu, Cd, Cr, and Pb. These results showed bottom and fly ash were classified as hazardous waste because of the metals
exceeded their thresholds. After solidification/stabilization (S/S) process, the lowest concentrations Cu, Cd, Cr, Zn, and Pb
of leachate was 0.521; 0.002; 0.118; 3.071; and 0.007 mg/L foe 28 days. Solidification (S/S) of bottom and fly ash could
reduce the amount of hazardous waste from medical waste incinerator facility.

INTRODUCTION
The rise of solid waste from health facilities in Indonesia is increasing, one of which is from the community health
centres. Medical waste is identified as one of the main problems that have a negative impact on both human health
and the environment [1]. Considering that the waste produced mostly consists of non-hazardous materials, similar to
municipal solid waste (MSW), waste management from the community health centres also includes waste
minimization [2]. This means avoiding wasteful use of disposable medical equipment and separating recyclable
materials. By minimizing the waste, it can reduce the amount of waste discharged into landfills and reduce
environmental impacts [3]. Scavengers at the landfill in Indonesia are apprehensive due to medical waste and other
sharp wastes [4]. To prevent the occurrence of health and environmental impacts by medical waste in landfills,
processing and packaging techniques are urgently needed.
The main technologies such as incineration used for treatment and final disposal of medical waste in community
health centres [5]. However, the benefit of the incineration process is the destruction of volume and weight of medical
waste. Incineration as a method of processing medical waste produces residues on such as the bottom ash, fly ash and
gas residues. After the incineration of medical waste, bottom and fly ash can be packed to secure landfill [6]. Extra
attention is needed for the disposal of medical waste since many untreated and ashes are in contact with municipal
solid waste. Ash from the incinerator processing usually contains some toxic heavy metals [7] [8]. None of the
facilities have special procedures for handling ash and are usually disposed it on the ground or disposed it in open
dumps landfill. Treatment of leachate in open dumps landfill for heavy metals and organic compound is usually
difficult because it contains low biodegradable organic, many technologies applied such as adsorption,
phytoremediation, advanced oxidation process, and so on [9-12].
The recommended handling of bottom and fly ash from healthcare facility is solidification /stabilization (S/S), in
which the process will stabilize bottom and fly ash and they can be used as products that are safe for health and the
environment. The determination of hazardous characteristics for bottom and fly ash and the results of
solidification/stabilization (S/S) can be performed by using TCLP (Toxicity Characteristic Leaching Procedure)

Exploring Resources, Process and Design for Sustainable Urban Development

AIP Conf. Proc. 2114, 050023-1–050023-6; https://doi.org/10.1063/1.5112467
Published by AIP Publishing. 978-0-7354-1850-9/$30.00

050023-1
quality standards for metal parameters. This paper studies the quality of the compression test results of
solidification/stabilization (S/S) and leachate concentration of heavy metals (Cu, Cd, Cr, Zn, and Pb) with TCLP test.

MATERIAL AND METHODS

Bottom and fly ash were taken from community health centres incinerator facility in Surabaya City. To determine
the quality of fly and bottom ash, the composition of the solid waste from incineration feed was measured. The process
of incineration occurring in the incinerator was to use a blower as an addition of oxygen. Incinerator was carried out
with a maximum temperature of around 680oC and for 150 minutes. The bottom ash used in processing was taken
after the normal temperature in the combustion chamber became more stable. Sifting was done to separate the bottom
ash and some non-combustible material such as sharp objects and bottles (Fig.1). Untreated bottom ash was tested for
its characteristics with TCLP tests on heavy metal parameters such as Cu, Cd, Cr, Zn, and Pb.

FIGURE 1. Sample from incinerator processes

Bottom and fly ash incinerators are processed by stabilization/solidification (S/S) method with Portland cement.
The mixture ratio of bottom and fly ash and Portland cement was 75:25; 50:50, and 25:75. The mold used was in the
form of a cube with a size of 5 x 5 x 5 cm. The moist curing process was performed for each variation for 28 days,
which referred to SNI 03-2834-2000. When testing the compressive strength, the specimen was weighed first and the
area of the press was measured. The stabilization/solidification (S/S) process results were sifted with a 1 mm sieve,
so as to produce powder less than 1 mm in diameter. The process of TCLP processing began with the process of adding
water and measuring pH. This value must be acidic and stirring with allegation rotation at 300rpm (18 ± 2 hours).
TCLP processing results was measured by Atomic absorption spectroscopy (AAS) method based on the parameters
Cu, Cd, Cr, Zn, and Pb.

RESULTS
Feed composition
The processed composition of medical waste was measured based on the separation that had been done by
operators. The composition of the feed inserted into the incinerator can be seen in Fig.2. Pathogenic infectious waste
is a waste that has a high weight composition of 45%. There is pathology in the community health centres because
there is a maternity unit. In the maternity unit, pathological waste comes from amniotic water. The infectious waste
mixed with other domestic waste that can cause contamination can be infectious. According to [13], infectious medical
waste of pathogens is accommodated in a strong and leak-proof yellow plastic bag. During the incineration process,
the plastic used for storage was also burned in the incineration process. Whereas, chemical/pharmaceutical waste has
low composition because there was no generation of chemical / pharmaceutical waste every day.

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 Chemicals /
pharmaceuticals
12%

Pathogen
Bottle 45%
27%

Sharp
16%

FIGURE 2. Composition of medical waste in incineration facility

The composition of the incineration process was based on the weight of the component. Figure 3 shows the
compared composition of bottles, sharp objects, and ash (bottom and fly ash) from incineration process. Bottles that
were processed with incinerators cannot burn properly. In the process of incineration, glass-ceramic materials were in
the form of gehlenite to augite, pigeonite, and diopside [14]. The process of medical waste incineration produced
bottom and fly ash by 35%.

Ash
35%

Bottle
49%

Sharp
16%
FIGURE 3. Composition of medical waste in incineration facility

Heavy metal characteristic of bottom and fly ash

The characteristic of bottom and fly ash must complete the quality standards to protect landfill at final disposal.
Based on the decree of the head of [14] concerning the procedure for the requirements for hoarding of processing
results, the requirements for ex-processing locations, and the location of the former landfill of hazardous and toxic
materials must meet the waste disposal to landfills. In the standard study, it was seen that the disposal of hazardous
waste to type A or B landfills. The results of characteristic bottom and ash incinerator are showed in Fig.4.

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 6000

5000
Concentration (mg/kg)
4000

3000

2000

1000

0
Cu Cd Cr Zn Pb
Metal parameters
Concentration of bottom and fly ash Landfill type B quality standard mg/kg
Landfill type A quality standard

FIGURE 4. Composition of medical waste in incineration facility

The results of characteristic bottom and ash incinerator showed that the Cd content had met the quality standard
for waste disposal into type B landfills. The Zn content has the highest concentration followed by Pb, Cr, and Cu.
Heavy metals such as Pb, Zn, Cd and Fe can be found in sharp objects, radioisotope shields, chemotherapy waste,
laboratory chemicals and pigments and additives found in plastic packaging [7].

Compression test
According to the [14] concerning the processing of hazardous and toxic waste, the minimum compressive strength
of solids is 10 tons/m2. The specifications of the stabilization/solidification (S/S) that the compressive strength of the
concrete should be not less than 10 tons/m2. Compressive strengths test results in experiments showed compliance
with the standards (Fig.5). The decrease in heavy metal mobility in the process of solidification/stabilization (S/S) of
incinerator ash was successfully found [15].

800
Compression test results (ton/m2)

750
y = -2.16x + 832.33
700 R² = 0.9604
650

600

550 y = -2.6x + 741.67

R² = 0.9802
500
28 d
450 7d
400
20 30 40 50 60 70 80
% bottom and fly ash
FIGURE 5. Composition of medical waste in incineration facility
The maximum compressive strength results were 772 tons/m2 in 28 days with ratio composition of 25:75 (bottom
and fly ash : cement). Anastasiadou, et al., showed that compressive strength was able to reach 810 tons/m 2 when

050023-4
adding 30% cement and 70% bottom ash [16]The compressive strength test from other matrices that had carried out,
Ritayani and Trihadiningrum showed a decrease in compressive strength as an effect of reducing the percentage of
cement composition [16]. To increase compressive strengths for > 5500 tons/m2, slags were used as additional
ingredients in the S/S process [18]. Linear regression results showed a strong relationship between the bottom and fly
ash composition with the compressive strength with R2 was 0.9604 and 0.9802. The things affecting compressive
strength in mixing bottom and fly ash were the exchange of strong materials into weak materials and the absence of
pozzolanic processes due to low concentrations of SiO2, Fe2O3 and Al2O[13].

Toxicity characteristic leaching procedure (TCLP)

The concentrations of parameters in leachate (extract/eluate) as listed in Table 1 TCLP quality standards
(extraction/leachate results) on decree of the head of [13]. Leachate produced by processing with
stabilization/solidification (S/S) were tested for each heavy metals concentration (Table 1). The results of the AAS
measurement showed that all variations met the quality standards of heavy metal leachate discharge to landfill or reuse
material. Similar measurement results were also shown in several prior studies [7],[15],[18]. The process of
immobilizing heavy metal ash was successfully carried out by cementing [19]. Heavy metal like Cu, Cd, Zn and Pd
in the hydration process of cement will bind dissolved forms of hydroxides and carbonate salts [20].

TABLE 1. Leachate concentration of stabilization/solidification (S/S)

No Metal Leachate concentration
parameters mg/L
Bottom Bottom and fly ash : cement Bottom and fly ash : cement Standard1
and fly ash ratio (7 day) ratio (28 day) mg/L
before S/S 25:75 50.50 75:25 25:75 50.50 75:25
1 Cu 7.107 0.374 0.613 0.786 0.415 0.497 0.521 10.00
2 Cd 0.687 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 <0.0001 0.05
3 Cr 2.478 0.104 0.114 0.108 0.099 0.101 0.118 0.50
4 Zn 71.190 2.821 2.204 2.943 2,118 2.189 3.371 50.00
5 Pb 2.618 <0.0001 <0.0001 0.007 <0.0001 <0.0001 <0.0001 5.00
1
Decree of the Head of BAPEDAL 03/BAPEDAL/09/1995

The stabilization/solidification (S/S) method changed bottom and fly ash into a massive, sturdy and stable form,
in which excessive leaching will not occur. The utilization of bottom and fly waste is for recycle activity and recovery
to convert into products that can be used and safe for the environment. However, with its effects on bottom and fly
ash waste, at the same time, it can reduce the amount of hazardous waste, save natural resources, and minimize the
potential negative impacts on environment and human health.

CONCLUSIONS
Based on its characteristics, bottom and fly ash cannot be disposed in landfills. According to the compressive
strength test results, the increase of cement ratio with bottom and fly ash grew. With the ratio of 75:25, the compressive
strength was 682 and 772 tons/m2. Toxicity characteristic leaching procedure (TCLP) of stabilization/solidification
(S/S) heavy metal leachate can meet the quality standards discharge to landfill.

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