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Lecture 3 & 4

Major disposal technologies

• Incineration
• Autoclave disinfection
• Chemical disinfection

Health-care •

•
Microwave disinfection
Landfill burial
Waste Management
- Ajay K. Rajbhandari

19th Jan 2025

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Incinerator Waste types not to be incinerated

¨ Is basically a “controlled/regulated burning process”

¨ Highly reactive chemical waste
¨ Is designed to efficiently and safely burn waste
¨ Materials made up of PVC plastics
¨ Usually selected to treat those wastes that cannot be recycled, reused,
or disposed of in a landfill site. ¨ Photographic or radiographic wastes
¨ Suitable for pathological, infectious or sharp wastes ¨ Pressurized and sealed gas containers
¨ Wastes containing high heavy-metal content (such as broken thermometers, used
¨ For proper incineration, wastes batteries, and lead-lined wooden panels)
n should be at least 60% combustible
n moisture content should not exceed 30%

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Types of Incinerator Single chamber incinerator

¨ Varies greatly- from very basic combustion units to extremely

sophisticated
¨ For treating HCW, three types of incineration technologies are
of interest:
¤ Single-chamber incinerator
¤ Double-chamber pyrolytic incinerator
¤ Rotary kilns incinerator

Drum incinerator
Brick incinerator

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Single chamber incinerator Double chamber pyrolytic incinerator

¨ Simplest form of incineration- consist single chamber
¨ Also called “controlled air incinerator”
¨ Treats waste in batches ¨ Waste are burn in two chambers - pyrolytic chamber and post-combustion chamber
¨ Air inflow is usually based on natural ventilation n In pyrolytic chamber, the waste is thermally decomposed through an oxygen-deficient, medium temperature combustion
process (800-900oC), producing solid ashes and gases.
¨ Incineration temp: 300-400oC (Remember! HCW should be operated between 900- n In post-combustion chamber- gases produced in pyrolytic chamber are burnt at 900-1200oC using an excess of air to
minimize smoke and odors.
1200°C).
¨ Difficult to obtain complete combustion. Therefore, not adequate for pharmaceutical, ¨ Their ash contain <1% unburned material
chemical (genotoxic) waste. radioactive waste (may actually cause dispersal of ¨ Need to maintain a careful operation balance between two combustion chambers.
radioactivity) ¤ if high temperature à flow of gas from first chamber is highà low residence time in first chamberà may
¨ Could lead to air pollution not fully combustionà increase in particles/ pollutants à may clog the system and cause maintenance
problems.
¨ Commonly used in poor resource setting ¤ if the temperature is lowà flow of gas from first chamber is lowà flow speed of gas in the post-
¨ Appropriate only in emergency situation (acute outbreak of communicable diseases) combustion chamber will be reducedà may reduce air pollution but higher fuel consumption (lowering
incinerating capacity).

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Double chamber pyrolytic incinerator Rotary Kiln Incinerator

¨ Should be operated and monitored by a well trained technician who can maintain ¨ A rotary kiln is the most versatile incinerator available
the reqd. conditions (temp, fuel flow, airflow, etc). ¨ It consists of a slightly inclined rotating primary combustion chamber (cylindrical
in shape) and a post-combustion chamber
¨ Value added feature: Sophisticated incinerators include energy-recovery facilities ¨ Rotates @ 2-5 times/min
n The heat recovered can be used for preheating of waste to be burnt
¨ Due to its cylindrical form,
n Steam or hot water can be used for warming the room ¨ provide excellent mixing of waste
¨ the heat is equally refracted to the burning waste
¨ Capable of causing decomposition of heat-resistant chemical wastes and
genotoxic substances

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Pros and Cons - Incineration Autoclave

¨ Uses high pressure steam and high temperature

Advantages Disadvantages Not appropriate for
¨ Consists of
• Acceptability for almost all • High investment and • Pressurized containers,
¤ a reacting tank (that can withstand a pressure of 6 bar (600kPa) and temperature of 160oC)
waste type operating cost • reactive chemical waste,
• Require no pretreatment • Large space required • PVC containing plastics ¤ steam generator and also includes a vacuum pump
• Reduction of waste volume • If operated at low • Wastes with high heavy metal ¨ High pressure steam is introduced into a reacting tank
• Reduction of waste weight temperature cause air content ¨ Vacuum conditions are established in the tank; this increases the partial pressure of
• Heat recovery potential pollution (dioxin formation) • Radioactive waste the steam and hence the effectiveness of contact between steam and waste
• Public opposition
¨ Is often used to
¤ sterilize reusable medical equipment

¤ health-care waste prior to disposal in the municipal solid waste stream

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Disinfection efficiency Pros and Cons - Autoclave

¨ Efficiency depends upon Advantages Disadvantages Not appropriate for

¨ “extend of contact” between the steam and the surface of the waste, and • Require less space • Unable to change waste volume and • Anatomical,
¨ “Ease of penetration” of the steam • Encourage reuse and recycling waste appearance pharmaceutical and
• Ease of operation • Very sensitive to operational condition chemical waste
• Low investment and operating cost • Are usually batch systems
¨ Ideally, effective inactivation of all vegetative microorganism and most bacterial spores in a small • Creation of less hazardous residue • Time consuming with compared to
amount of waste (about 5-8kg) requires
than incineration incineration
¤ contact time = 60 min cycle at 121o C (minimum) and 1 bar (100kPa) • Low environmental impact
¤ contact time = 20 min above 121oC and 2 bar (200kPa)
¤ contact time = 5 min above 134oC and 3.1 bar

¨ Therefore, for optimum output, waste should be finely shredded and the tank should
not be overloaded (does not fill more than half the tank)

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Microwave disinfection Pros and Cons - Microwave

¨ Disinfection through microwave radiations Advantages Disadvantages Not appropriate for

¨ Most MOs are destroyed by the microwaves • Very efficient disinfection • High investment and operating cost • Not suitable for anatomical,
¤ f = 2450 MHz and λ = 12.24 cm (irradiation for 20mins) when operated well. • Potential operation and pharmaceutical or chemical
• Environmentally sound. maintenance problem wastes
¨ Waste to be disinfected are
¨ Shreddedà Humidified àTransferred to the irradiation chamber equipped with a series of microwave generators à
Irradiated for about 20 mins.

¨ The moisture contained within the wastes is rapidly heated by the microwaves and
the infectious components are destroyed by the heat generated

¨ After irradiation, the waste is compacted inside a container and enters the municipal
waste stream

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Chemical disinfection Frequently used chemical disinfectants

¨ Chemicals are used to kill or inactivate the pathogens present in the waste ¨ Formaldehyde (HCHO) and Ethylene oxide (CH2OCH2) - effects against all MOs,
including bacterial spores and viruses.
¨ Most suitable for treating highly infectious physiological fluids such as blood, urine,
stools and liquid waste or hospital sewage ¨ Sodium hypochloride (NaOCl) - active against most bacteria, viruses and spores.
Not effective for disinfection of liquids with high organic contents such as blood or
¨ Can also be used for microbiological cultures, sharps, etc. stools
¨ Speed and efficiency depends on ¨ Chlorine dioxide (ClO2) - active against most bacteria, and spore, is an ideal
¤ The “kind” and “amount” of chemical used choice for disinfection of equipment soiled with blood
¤ The “contact time” ¨ In many hospitals, before giving dirty linen (generated in places like labor room s, OTs or ICUs) to the
¤ Operating temperature, humidity, pH, etc. laundry department, they are disinfected at source by dipping in a 10% bleaching
¤ Organic load of the waste solution to minimize the risk of infection during transportation and sorting

¨ Usually results in ‘disinfection’ rather than ‘sterilization’

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Safety measures PPE

¨ Powerful disinfectants are often toxic in itself.
¨ Using sodium hypochloride and chlorine dioxide as well as its by products in
wastewater may possibly have long-term environmental effects
¨ Should only be done when there is no other treatment facility available
¨ Should be carried out by trained and adequately protected personnel
¨ All precautions should be taken while handling chemicals particularly chemicals like
formaldehyde (IARC G roup I).

handle and stored the chemicals safely wearing PPE.

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Pros and Cons – chemical disinfectant Landfill / burial

Advantages Disadvantages Not appropriate for

Open dumps Sanitary landfills
• Rapid processing • Disinfectants may themselves be hazardous • Inadequate for pharmaceutical,
• Easy waste deodorization to operators and pose risks chemical and some types of ¨ Is uncontrolled and scattered deposits of ¨ is a “controlled” deposits of waste at a site
• Possible toxic by-products in wastewater infectious waste. wastes at a site. ¨ Have at least 4 advantages over open
• Needs highly trained operators ¨ Open access to scavengers and animals dumps
¨ High risk of disease transmission ¨ Geological isolation of waste
¨ HCW should not be deposited on or around ¨ Appropriate engineering preparation before
open dumps. the site is ready to accept wastes (appropriate
sealing of the base and the sides of the sites)
¨ Staff present on site to control operations, and
¨ Organized deposit, compacted and daily
coverage of waste.

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Land burial Factors to consider while land burial

¨ In the poor resource setting, it may
be the only viable option available Certain basic rules should still be followed
at time
¨ The pit developed to receive HCW
should be 2-5m deep
¨ Infectious waste and small quantities
of pharmaceutical waste can be
deposited in sanitary landfills Follow 50 meter rule
¨ After each waste load, the waste
should be covered with a soil /lime
layer 10-15cm deep.

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Factors to consider while land burial Disposing Sharps

Certain basic rules should still be followed
Sharps waste can be disposed by
¨ The bottom of the pit should be at least 1.5 m higher than the groundwater level. ¨ Using needle destroyer (in case of needle)
¨ When the needle is insertedà the circuit gets completedà high temperature electric arc is
¨ The burial site should be lined with a material of low permeability, such as clay, if generated à burns the needle
available. ¨ Other sharps can be put directly into the disinfecting solution. The sharps, after
disinfection should be disposed in a pit.
¨ Each layer of waste should be covered with a layer of earth to prevent odors, as
well as to prevent rodents.

¨ The disposal site should be restricted to authorized personnel only

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Sharp Disposal Pit Encapsulation / Inertization

¨ All sharps, including needles, stored in large ¨ Is a safely way of disposing sharps and chemical / pharmaceutical residues.
puncture-resistant containers can be buried. ¨ Encapsulation involves the filling up of containers with waste, adding an immobilizing material (plastic
foam, sand and cement mortar or clay materials) and sealing the containers.
¨ Once the container is 2/3rd full, it can be autoclaved ¨ These sealed containers are then disposed of in landfill sites.
and dump into a simple pit (lined with brick or
¨ For inertization of pharmaceutical waste, the packaging should be removed and a mixture of water,
concrete rings)
lime and cement is added. [Typical proportion for the mixture; Pharmaceutical waste (65%), Lime (15%),
cement (15%)and water (5%)
¨ The pit should be covered with a heavy concrete
slab, with a galvanized steel pipe (internal diameter of ¨ Landfilling of large quantities of pharmaceuticals is not recommended unless the waste is
up to 20 mm) penetrating and projecting about 1.5 m encapsulated.
above the slab. ¨ Advantage –
¨ Relatively inexpensive and can be performed using relatively unsophisticated equipment
¨ Very effective in reducing the risk of scavengers gaining access to the hazardous waste
¨ When the pit is full it should be sealed completely
¨ Minimizes the changes of ground water contamination

Pit for disposing of sharps

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Pros and Cons – Land burial Others

Advantages Disadvantages Not appropriate for ¨ Biological processes-
¤ For treating and disposing of placenta waste as well as food waste and other organic waste.
• Simple, low cost and • If not operated properly • Generally suitable
¤ Includes, Com posting and Verm iculture
safe when operated scavengers may access the waste
properly ¨ Plasma pyrolysis-
¤ Waste are kept in the furnace or reactor and with the help of plasma arc torch uses gas or steam and powerful electrodes
to generate plasma (an ionized gas). These gas causes molecular dissociation and fully decomposition of organic
components
¤ Temperatures raised using plasma torches can be as high as 4500оF; at these temperatures molecular bonds break down .
¤ Plasma processing of waste is an ecologically clean process. The lack of oxygen and high temperature in a reactor prevent
the main elements of gas from forming toxic compounds, such as furans, dioxins, NOx, or sulfur dioxide.
n Environm entally-friendly-N o harm ful em issions or toxic waste
n Suitable for all types of waste
n Electric and therm al energy generation
n Production of clean alloyed slag w hic h could be used as construction m aterial

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Choosing an appropriate disposal option(s)

Several factors needs to be consider

¨ Know your waste first;
¨ Locally available treatment options and technologies;
¨ Capacity and efficiency of the system;
¨

¨
Operation and maintenance cost;
Infrastructure requirements;
HANDLING
¨ Occupational health and safety considerations; Health-care Waste
¨ Health and environmental considerations;
¨ Public acceptability;
¨ Regulatory requirements.

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HCW Management Benefits of segregation

HCW management starts with waste • If not segregated and everything is mixed,
minimization efforts. ¨ the hospital would have to treat the entire waste
¨ would have to spend up to 5-10x the cost of treating only infectious waste,
would also lose the revenue it would have earned by selling the general waste.
3R Principle contribute significantly in ¨

waste minimization. • If segregated,

– Only limited waste needs special handling
Hence, can be disposed of easily and relatively cheaply
Waste reduction can be best done by –

– Not only reduces the chances of spreading infection, but also prevents occupational hazards.
segregating the waste at its origin.

Hence, should always done at the point of its generation and as soon as it is generated.

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Recycling Waste Management Hierarchy

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Color coding Color coding

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Color coding Color coding

Examples of wastes
Non-risk HCW Non-risk waste Green Left over food stuffs/ fruit
Biodegradables peels, gardens, flower, etc.
Non-risk waste Dark Blue Plastic bottles, can, paper,
Recyclables etc.
Infectious and highly Brown
infectious wastes
Radioactive wastes Black waste contaminated with
radionuclides such as
Cobalt, Technetium, Iodine,
Iridium, generated from in-
vitro analysis of body
tissue, etc.
HCW requiring special Red
attention

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Some practices that encourage waste minimization Safe reuse and recycling
Reuse
¨ Avoid using disposable items if a reusable version is available. (Some items such as
• Certain types of medical and other equipment can be reused provided that they are carefully washed and
syringes and needles should not be reused if possible). disinfected.
¨ Use of physical rather than chemical cleaning methods (e.g. steam disinfection • Example of reusable items may include
instead of chemical disinfection) where ever possible – certain sharps, glass bottles and certain containers, gloves, etc.

Undamaged pressurized containers (can be reused for refilling).

¨ Careful stock management of goods. –
– Also, containers that once held detergent or other liquids may be reused as containers for sharps waste provided that they are
¨ Explore products/goods with unnecessary packaging and try to explore that puncture-proof.
could be recycled Recycling

¨ Do not over purchase medicines • Recycling is collecting waste and processing it into something new.
• Example: food discards, canteen waste, cardboard, plastics, paper, glass and metal.
¨ FIFO / FEFO • Can be source of revenue generation.
¨ Use all the contents of each container.
¨ Use pills instead of injections.
¨ Use non-plastic items when possible.

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Collection
In addition to 3R Principle and segregation ¨ Waste management does not stop at segregation – it only begins with it
at origin ¨ Should not be allowed to accumulate at the point of production
¨ For collection of HCW, container with lid should be used- it not only offers an
COLLECTION aesthetic advantage but is also much safer in cases of accidents (to minimize
spillage).
¨ Waste should be collected daily (or as frequently as required)
¨ The bags or containers should be replaced immediately with new ones
STORAGE ¨ Different waste streams should be collected at different times-reduces the
chances of mixing

TRANSPORT

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Collection-sharp Storage
¨ Sharps should all be collected together, regardless of whether or not they are ¨ Storage time is the time lag between the generation of waste and its treatment.
contaminated.
¨ It is wise to treat waste as soon as possible. Highly infectious waste should, whenever possible, be
sterilized immediately by autoclaving.
¨ Containers should be puncture-proof (usually made of metal or high-density plastic)
and fitted with covers.
¨ According to WHO, unless a refrigerated storage room is available, storage times for HCW should
not exceed the following:
¨ Should never attempt to correct errors of segregation by removing items from a bag ¤ Temperate climate: 72 hours in winter; 48 hours in summer
or container after disposal. ¤ Warm climate: 48 hours during the cool season; 24 hours during the hot season

¨ Animal remains that cannot be destroyed immediately after experimentation should be stored at a
temperature below -20oC

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Storage site Transportation

¨ Should be located inside the health-care establishment Onsite transport (within the health facility)
¨ Surface should be impermeable, with good water supply and drainage facility ¨ Onsite transport should be done by means of ‘dedicated’ wheeled trolleys,
containers or carts
¨ Have a smooth surface so that it can be washed easily in case of spills
¨ There should not be any sharp edges to avoid damage during un/loading;
¨ Have good lighting and ventilation but protection from the direct sunlight
¨ Be accessible to vehicles so that the collection vans can reach it- this reduces the ¨ Should be done through the quickest or shortest possible route;
number of personnel handling the waste. ¨ To prevent spilling during transportation waste should be packaged in sealed
bags or containers that are robust to resist against aggressive chemicals, changes
¨ Be inaccessible for animals, insects, birds, etc.
in temperature, humidity, or atmospheric pressure.

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Transportation Labeling HCW

Off-site transportation ¨ For health-care waste, the following additional information should be marked on the label:
¤ waste category
¨ Off-site transportation of hazardous waste should be avoided
¤ date of collection
¨ If not feasible, closed vehicles should be used to avoid spillage ¤ point of origin (e.g. ward)
¤ waste destination
¨ Safe packaging and adequate labeling (point of origin, content, along with
international hazard sign and emergency telephone number) should be displayed Importance of labeling
¨ In case of problems involving questions of liability, full and correct labeling allows the origin of the
on the vehicle or container
waste to be traced
¨ Labeling also warns operative staff and the general public of the hazardous nature of the waste.
¨ The hazards posed by container contents can be quickly identified in case of accident, enabling
emergency services to take appropriate action.

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Hand Hygiene Guiding Principles

¨ Duty of care principle: Any organization that generates waste has an
ultimate responsibility and duty to dispose the waste safely.

¨ Polluter pays principle: All waste producers are legally and

financially responsible for the safe handling and environmentally
sound disposal of the waste they produce. In case of an accidental
pollution, the organization is liable for the costs of cleaning it. The fact
that the polluters should pay for the costs they impose on the
environment is seen as an efficient incentive to produce less and
segregate well.

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Guiding Principles Take home messages

Emerging but usually avoided public health issues
¨ Precautionary principle: Following this principle one must always •

• The key to effective management and minimization of HCW is segregation (separation) and for this one need to -
assume that waste is hazardous until it is proved to be safe. This means KNOW YOUR WASTE
that where it is unknown what the hazard may be, it is important to • Remember- all HCW s are not infectious/hazardous

take all the necessary precautions. • There exist well established evidences of health risk due to inappropriate HCW managements and healthcare
professionals are at high risk
¨ Proximity principle: Recommends that treatment and disposal of • 3R principles should be encourage at most-Waste reduction is better than reusing or recycling.
hazardous waste should take place at the closest possible location to • Segregation at origin and color coding
Several disposable techniques available -wise decision need to be made
its source to minimize the risks involved in its transport. •

¨ Protective equipment should be provided to all personnel likely to be exposed.

¨ Personnel at risk should be trained in preventive measures and in emergency care in case of accident.

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Concluding Note References

MoHP, Nepal (2011), Health Care Waste Management Guideline
¨ Healthcare establishments are morally and legally responsible for the health protection and safety at ¨

NHRC (2002), Health care waste management, training manual for medical professionals
the workplace. ¨

¨ MoH, Nepal (2003), Healthcare Waste Management in Nepal, Assessment of present state and establishment of a
framework strategy and action plan for improvement
¨ Should therefore take all reasonable measures for safe disposal of waste. ¨ Pradhan, B and Paudel R, JNHRC, (2010), Health care waste management practice in a hosptial
¨ WHO, Geneva (1999), Safe management of wastes from health-care activities, edited by A. Prüss, E. Giroult and P. Rushbrook.
Available at: http://www.who.int/water_sanitation_health/Environmental_sanit/MHCWHanbook.htm.
¨ Department of Health, Manila. Healthcare waste management manual. Available at
http://portal1.doh.gov.ph/files/Health_Care_Waste_Management_Manual. pdf
¨ Hesperian foundation (2005), Safe handling of Health care Waste, community guide to environmental health.
¨ EPRI, Bio-medical waste management –self learning document for doctors, superintendents and administrator
¨ CAG (2001), Managing Bio-medical Waste
¨ The World Bank (2003), health care waste management in India; lesson from experiences
¨ Agrawal, R (1998), Medical Waste-Issues, Practices and Policy An Indian and International Perspective, Center for Science
and Environment

Thank You ! ¨ Management of Solid Health-Care Waste at Primary Health-Care Centres: A Decision-Making Guide

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