Hcw

Veronica Di Bella

Potential and Challenges of Healthcare Disposal:

A case study of De Montfort incinerators

University of Bristol

Sustainable Water Supply & Sanitation in Developing Countries

Research carried out at CeTAmb – Research centre for appropriate technologies for environmental management

in Developing Countries, University of Brescia, Italy

Outline

HCWM in DCs

Treatment of HCW

De Montfort Incinerators

Case study - Hargeisa

Healthcare Waste (HCW)

Management in Developing

Countries

Treatment of HCW



Outline

Healthcare waste includes all the waste generated by healthcare

establishments, research facilities and laboratories (WHO,1999).

8 categories

General waste

Chemical waste

Pathological waste

Radioactive waste

Infectious waste

Sharps

Pharmaceutical waste

Pressurized containers

HCW Mangement in Developing

Countries

Outline

HCWM in DCs

Treatment of HCW



Category

General waste

Examples

Domestic waste, packing material, non-infectious animal

waste, bedding, wastewater from laundries, etc.

Pathological waste Tissues, organs, body parts, human foetuses, animal

carcasses, blood and body fluids.

Radioactive waste Waste containing radioactive substances: unused liquids

from radiotherapy or laboratory research, contaminated

glassware, packages, etc.

Chemical waste Discarded solid, liquid and gaseous chemicals, for example

generating from diagnostic and experimental work, cleaning,

housekeeping and disinfecting procedures.

HA

ZA

RD

OU

S

NO

T

MA

YB

E

YE

S


Countries

Infectious waste Waste suspected to contain pathogens: laboratory cultures,

tissues, excreta, etc.

Pharmaceutical

waste

Pharmaceutical products, drugs and chemicals that have

been returned from wards, have been spilled or outdated or

contaminated, or are to be discarded because they are no

longer required.

Pressurized

containers Gas cylinders, gas cartridges, aerosols cans; they may

explode if incinerated or accidentally punctured.

Sharps Needles, syringes, scalpels, blades, saws, glass, nails and

any other item that could cause a cut or puncture.

Y

ES


Countries

Category Examples

HA

ZA

RD

OU

S

75 - 90% of general waste (similar to domestic waste)

10 - 25% is hazardous (infectious, toxic etc.)


Countries

Outline

HCWM in DCs

Treatment of HCW




Countries

Hargeisa, Somaliland

Outline

HCWM in DCs

Treatment of HCW




Countries

Hargeisa, Somaliland

Outline

HCWM in DCs

Treatment of HCW




Countries

Juba, South Sudan

Outline

HCWM in DCs

Treatment of HCW




Countries

Juba, South Sudan

Outline

HCWM in DCs

Treatment of HCW




Countries

Juba, South Sudan

Outline

HCWM in DCs

Treatment of HCW




Countries

People at risk

Hazard Category of waste

Infectious waste, sharps,

pathological waste

Chemical and pharmaceutical waste

General public Patients

Health-care

personnel Waste workers

Infections

Intoxications and burns

Toxicity and damage to

genetic material Radioactive waste

Outline

HCWM in DCs

Treatment of HCW




Countries

Activity Hazard

Storage at health-care

establishments

Transportation

Dirt, proliferation of

rodents and insects

Waste blown on the streets

Release of hazardous gases Incineration

Disposal in water

bodies

Contamination of water

resources

Disposal in dumps Contamination of water

and soil

Outline

HCWM in DCs

Treatment of HCW




Countries

Outline

HCWM in DCs

Treatment of HCW



Treatment of HCW

3 categories of process for the treatment of hazardous waste

Thermal processes (dry and wet)

Chemical processes

Containment processes

Outline

HCWM in DCs

Treatment of HCW



Treatment of HCW - Incineration

Type of incinerator Adequate for

Pyrolytic incinerator -All infectious waste

- Most pharmaceutical

waste

- Most chemical waste

Single-chamber incinerator -General healthcare waste

- Infectious waste

BUT significant emissions

Drum or brick incinerator

-General healthcare waste

- Infectious waste

BUT it should be used only

in case of emergency

Outline

HCWM in DCs

Treatment of HCW




Main features

- Designed at De Montfort University, Leicester

- Cheap but effective

- Able to reach T > 800°C

- Primary and secondary combustion chambers

- Possibility to build it in developing country

- It should be used for sharps and infectious waste

Outline

HCWM in DCs

Treatment of HCW




Outline

HCWM in DCs

Treatment of HCW



Model Capacity Remarks

Mark 1 12 Kg/h Basic model; now superseded by M. 8a

Mark 2 12 Kg/h Larger combustion chamber compared to M.1; only used for

experimental purposes

Mark 3 50 Kg/h Designed for large hospitals (up to 1000 beds); now superseded by M.

9

Mark 5 50 Kg/h Higher chimney compared to M. 3; design under modification

Mark 7 12 Kg/h Specifically for emergencies

Mark 8

and 8a

12 Kg/h Similar to M.7, but with a brick built model. M. 8a recommended for

most applications

Mark 9 50 Kg/h Similar to M. 3, but simplified for manufacture and to eliminate

operational faults

Operation and Maintenace

-Trained, qualified and equipped operators

-Operators on-site while the incinerator is working

- Supervision essential

- Regular maintenance (e.g. ash removal) + annual inspections and rectifications

Case study – Hargeisa, Somaliland

Project SUDP SISDISC

Period 2005-2008 2008-2009

Aims Support the development of

urban areas through

strengthening urban institutions

Providing priority basic services

in the waste management

sector.

Funds European Commission, UNDP European Commission, Italian

cooperation agency, UN-

Habitat

Leader UN-Habitat Cesvi NGO

Partners UNA Consortium, UNICEF,

ILO, UNDP, NOVIB, CeTAmb

CeTAmb, Boroma University

The project

Outline

HCWM in DCs

Treatment of HCW



Study area

Somalia - East Africa

Capital City: Mogadiscio

18 regions and 3

“independent” states:

1991 Somaliland

1998 Puntland

2006 Galmudug

Outline

HCWM in DCs

Treatment of HCW



Study area: Hargeisa

Capital city and the biggest urban setting in Somaliland

Population: about 650,000 inhabitants

Concentration of public administration, private sector and

international community

Hosting 10 hospitals (1 private), 3 specialised centres, 20

health centres and 26 health posts

Outline

HCWM in DCs

Treatment of HCW




The three hospitals in Hargeisa: 1. General Group Hospital

- One of the biggest hospitals in

Hargeisa; public

- Capacity of 300-350 people

- Main departments: surgery and

mental health

- Total staff: 250 people

Outline

HCWM in DCs

Treatment of HCW





General waste Placentas

Needles and sharps Syringes

Outline

HCWM in DCs

Treatment of HCW





Single-chamber incinerator not in use

Used incinerator

Outline

HCWM in DCs

Treatment of HCW




The three hospitals in Hargeisa: 2. TB Hospital

- One of the biggest tubercolosis

hospitals in East Africa; public

- Capacity of 200 people

- Mainly for outpatients

- Departments: male and female

Outline

HCWM in DCs

Treatment of HCW




The three hospitals in Hargeisa: 2. TB Hospital

General waste

Hazardous waste

Outline

HCWM in DCs

Treatment of HCW




The three hospitals in Hargeisa: 3. Edna Adan Maternity Hospital

- Only private hospital in

Somaliland

- Capacity of 69 people

- Main departments: medical,

maternity and paediatric wards

- Close to international standards

Outline

HCWM in DCs

Treatment of HCW




The three hospitals in Hargeisa: 3. Edna Adan Maternity Hospital

Sharps

Hospital waste

General waste

Storage of safety boxes

Outline

HCWM in DCs

Treatment of HCW



De Montfort Incinerator

Model: Mark 8a

Capacity: 12 kg/h

General Group

Hospital

TB Hospital

Outline

HCWM in DCs

Treatment of HCW




De Montfort Incinerator at TB Hospital Outline

HCWM in DCs

Treatment of HCW




De Montfort Incinerator at TB Hospital Outline

HCWM in DCs

Treatment of HCW



Trainings and workshops

Trainings and workshops

Safe practices for

HCWM

Operation and

maintenance of

incinerators

Health-care personnel

Waste collectors

Waste workers

Outline

HCWM in DCs

Treatment of HCW




Issues during the construction: availability of materials

Fire bricks

Deber stones

Outline

HCWM in DCs

Treatment of HCW




Issues during operation and maintenance

- Lack of supervision

- Irregular de-ashing procedures

- Isssues of separation and collection

- Misuse of safety gears

What was the perception of local stakeholders?

Outline

HCWM in DCs

Treatment of HCW




Outline

HCWM in DCs

Treatment of HCW



LACK OF SUPERVISION

NON-OPTIMAL MANAGEMENT OF INCINERATORS

PROCEDURES MATERIALS

LACK OF SUPERVISION

LOW ENFORCEMENT

CHANGE IN ADMIN

BRICKS FLAKING OFF

BAD QUALITY OF

MATERIALS

LOW

AVAILABILITY SUNLIGHT

METHODS

IRREGULAR

DE-ASHING

INEFFICIENT

COLLECTION

INEFFICIENT

SEPARATION

LACK OF SUPERVISION

LACK OF KNOWLEDGE

TRAININGS NOT

REPEATED

PEOPLE

MISUSE OF SAFETY

GEARS

LACK OF KNOWLEDGE

TRAININGS NOT

REPEATED

LACK OF SUPERVISION

For further information: [email protected]

[email protected]

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