module 16: incineration of healthcare waste and the ... 16... · web viewwhat are some factors that...

UNDP GEF Project on Global Healthcare Waste

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MODULE 16: INCINERATION OF HEALTHCARE WASTE AND THE STOCKHOLM CONVENTION GUIDELINES

Estimated Time Lecture: 1 hour 30 minutesModule Overview Present the principles and basic approaches for healthcare waste treatment

Describe the basics of incineration and types of incinerators for healthcare waste Lay out factors for consideration when selecting waste treatment methods Describe the environmental and health impacts of incinerators Present the Stockholm Convention guidelines for incinerators Describe maintenance and troubleshooting of incinerators and air pollution control

devicesLearning Objectives Understand the factors to consider when deciding upon the proper treatment

method Understand the basics of incineration and its environmental and health impacts Be aware of the Stockholm Convention guidelines on incineration Learn basic maintenance and troubleshooting of incinerators and air pollution

control devicesTarget Audience HCWM coordinators

Administrators Healthcare professionals and other staff interested in participating in HCWM

planning On-site treatment managers and operators Central treatment plant managers and operators National staff and advisors in the Ministry of Health, Ministry of Environment and

other relevant government ministries, country level staff of international organizations or agencies, country level staff of national organizations and NGOs, and others involved in national or regional HCWM planning

Instructor Preparation Make notes pages of PowerPoint slides to hand out to class

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Read Chapter 8 in Blue Book, and other materials included in the References Global and country specific regulations and guideline for treatment and disposal of

healthcare waste. Make copies of any additional documents/readings that may be handed out to class,

such as those included in the References Prepare any additional notes to be discussed during the presentation Prepare any additional discussion points or review questions

Materials Needed Projector Student handouts: slides, exercise, homework Flip chart and marker pens and/or board and chalk

Student Preparation Blue Book Chapter 8 Global and country specific regulations and guideline for treatment and disposal of

healthcare waste. Think about incineration of healthcare wastes and the methods used in your own

facility. Review Questions What regulations or policies exist in your country or region regarding treatment

and disposal methods? What are viable options for disposal of healthcare waste available in your facility or

country? What are some factors that your facility considers when deciding on a waste

treatment method? What do think is important when evaluating which method would be most appropriate?

Does your facility use incineration, or have they used it as a treatment method in the past? What are some of the cost and benefits of incineration?

Discuss air emissions and dioxin formation in relation to incinerators. Does your incinerator meet the Stockholm Convention guidelines and national

regulations? What are the barriers to implementing non-incineration treatment and disposal

methods?

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PRESENTATION

Slide Number/Title

Teacher’s Notes

Slide 1: Title Slide This module should be modified to meet the needs of the participants. For example, the slides on the types of incinerators, maintenance procedures, and troubleshooting are more appropriate for technology operators and facility engineers. Administrators and the engineering department should be aware of the Stockholm Convention guidelines as well as national regulations related to incineration. All participants should be aware of the environmental and health impacts of incineration.

Slide 2: Module Overview

Introduce the outline and major points of the presentation

Slide 3: Learning Objectives

Describe what participants will learn at the end of this module.

Slide 4: Steps in Healthcare Waste Management

This module focuses on waste treatment and disposal using incineration.

Slide 5: Principles of Waste Treatment

Introduce some principles of waste treatment

Slide 6: Treatment Approaches

Different treatment approaches:-on-site-cluster treatment-central treatment

There is a fourth treatment approach: mobile treatment. In mobile treatment, the treatment technology is mounted on a vehicle which then goes from hospital to hospital to treat the waste. This is used in some countries mainly with autoclave-type treatment.

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Slide 7: Processes Used in the Treatment of Healthcare Waste

The Blue Book discusses five main processes for the treatment of hazardous components in HCW:-thermal-chemical-irradiation-biological-mechanical

Slide 8: Thermal Treatment Processes

Rely on heat to kill pathogenic organisms; divided into low-heat and high-heat designs.

Pyrolysis: thermal degradation of a substance through the application of heat in the absence of oxygen; most commonly used for organic materials.

Slide 9: Incineration Introduce the incineration process.

Disadvantage of these processes is the release of combustion by-products into the air and the generation of residual ash.

Combustion generally produces gas emissions in the form of steam, carbon dioxide, nitrogen oxides, a wide range of volatile substances, and particulate matter.

Gasification and pyrolysis operate at sub-stoichiometric air levels and can also take place in parts of an incinerator.

Larger healthcare facilities may have the means to reuse the heat generated form the combustion of waste, but most incinerators are too small for energy recovery to be very effective.

Slide 10: Incineration Identify some of the required waste characteristics of incinerators

Slide 11: Incineration Go through the bulleted list of points taken from the Blue Book, in which no pre-treatment will be needed as long as the wastes are not present or are kept to a minimum.

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Slide 12: Types of Incinerators for Healthcare Waste

Common types of incinerators: Dual-chamber incinerators Multiple-chamber incinerators Rotary kilns

Slide 13: Types of Incinerators for Healthcare WasteSlide 14: Types of Incinerators for Healthcare WasteSlide 15: Types of Incinerators for Healthcare WasteSlide 16: Construction and Installation of Incinerators

Go over the construction and installation of incinerators

Slide 17: Operation of Incinerators

General operational procedures include:- Waste charging- Combustion- Air pollution control- Ash removal

Slide 18: Why Preventive Maintenance is Essential

Describe why preventive maintenance of healthcare waste technologies is essential

Slide 19: Preventive MaintenanceSlide 20: Maintenance of Incinerators

This and subsequent slides on maintenance are intended primarily for incinerator plant manager and operator, and facility engineers. Go over the maintenance of incinerators – hourly, daily, weekly, bi-weekly, monthly, semi-annually

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Slide 21: Maintenance of Incinerators (cont’d)Slide 22: Factors in the Selection of Treatment Methods

Go through the listed points in this and the following slide to show that there are many factors to consider when deciding upon a treatment method.

Slide 23: Factors in the Selection of Treatment Methods, cont’d.Slide 24: Air Emissions From a Medical Waste Incinerator

Diagram showing some of the pollutants emitted from medical waste incinerators.

Slide 25: Pollutants Measured From Medical Waste Incinerators

Air pollutants measured from medical waste incinerator emissions include: trace metals, acid gases, dioxins and furans, other organic compounds, CO, particulate matter, and pathogens

Slide 26: Pollutants Measured From Medical Waste Incinerators

Bottom ash contains: dioxins and furans, other organics, and leachable metals

Slide 27: Epidemiological Studies Related to Health Effects of Incineration

In the next five slides inclusive, present the major findings of a number of epidemiological studies about the health effects of incineration.

Slide 28: Epidemiological Studies Related to Health Effects of Incineration

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Slide 29: Epidemiological Studies Related to Health Effects of IncinerationSlide 30: Epidemiological Studies Related to Health Effects of IncinerationSlide 31: Epidemiological Studies Related to Health Effects of IncinerationSlide 32: Medical Waste Incineration (MWI) is a Major Global Source of Dioxins

Go through some country statistics on the presence of dioxins related to MWI

Slide 33: Where are Dioxins Formed in a Medical Waste Incinerator?Slide 34: What are “Dioxins”?

Describe basic characteristics of dioxins

Slide 35: How Far Do Dioxins Travel?

Dioxins may travel long distances in the air (up to hundreds of kilometers)

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Slide 36: How Long do Dioxins Remain in the Environment?

Dioxins are very persistent in the environment.

Environmental half-life on surface soil: 9-15 yearsEnvironmental half-life in subsurface soil: 25-100 yearsVolatilization (process in which a substance is vaporized) half-life in body of water: > 50 years

Slide 37: Bioconcentration of Dioxins

Go over the listed bioconcentration factors for 2,3,7,8-TCDD.

Bioconcentration factor = the ratio of a contaminant’s concentration in biota to its concentration in the surrounding medium

Slide 38: Health Effects Associated with Dioxin

In the next four slides, go over the major health effects associated with dioxins.

Classification as a known human carcinogen by the IARC (1997).

A number of cancers are linked to dioxins.


Developmental effects: birth defects, alterations in reproductive system, impact on child’s learning ability and attention, changes in sex ratio

Immune system impacts


Male and female reproductive effects


Other health effects:-chloracne (acne-like spread of blackheads, cysts, pustules)-hirsutism (excessive hairiness)-hyperpigmentation (darkening of skin or area under nails)-altered fat metabolism-diabetes-nerve system damage-liver, spleen, thymus, and bone marrow damage

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Slide 42: Dioxin Toxicity at Extremely Low Concentrations

Give some of the values for toxicity at low concentrations: LOAELs, TDIs (WHO), cancer potency factor (US EPA)

LOAEL = lowest observed adverse effect level

Slide 43: Health Risk Assessment Study

Refer to the following article in the next few slides:

Batterman, Stuart, Environmental Health Services, University of Michigan. Assessment of Small-Scale Incinerators for Healthcare Waste. January, 2004.http://www.who.int/immunization_safety/publications/waste_management/en/assessment_SSIs.pdf

Recommended criteria for evaluating small-scale incinerator options for HCW:-effectiveness-cost-effectiveness-safety-simplicity-robustness


Three classes of small-scale incinerators: best practice, expected practice, worst case

Other elements of best practice:-effective waste reduction and waste segregation to ensure that the smallest amount of waste is incinerated-siting of incinerators away from populated areas or where food is grown in order to minimize risks and exposures-construction that follows detailed dimensional plans, thus avoiding flaws that could lead to incomplete destruction of waste, higher emissions, and premature failures of the incinerator


Go through three usage scenarios

Slide 46: Findings of the Risk Assessment Study

Use the table to provide a summary of the results

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http://www.who.int/immunization_safety/publications/waste_management/en/assessment_SSIs.pdf


Slide 47: Dioxins in Breast Milk

Chart showing dioxin concentrations in breast milk in selected countries, most of which exceed the permissible limit for dioxins in cow’s milk.

Slide 48: Incineration and the Stockholm Convention

Slide 49: Incineration and the Stockholm Convention

Incinerator emissions should comply with national standards and be in compliance with the Stockholm Convention’s best available technology (BAT) and best environmental practices (BEP) guidelines if the country has signed the agreement.

Slide 50: Best Available Techniques Guidelines under the Stockholm Convention

Incineration equipment should be chosen based upon local needs and available resources.

Single-chamber, drum-and-brick incinerators are not acceptable under the Stockholm Convention.

An incinerator should consist of:-furnace or kiln-afterburner chamber-flue gas cleaning system-wastewater treatment if wet flue gas cleaning is used


In the next batch of slides, go through specific BAT guidelines under the Stockholm Convention.

BAT air emissions performance levels and wastewater performance levels will be achieved by a combination of primary and secondary measures.

TEQ = Toxic Equivalent Quantity


General measures

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Primary measures


Primary measures


Secondary measures:Top drawing: fabric baghouse filterMiddle drawing: cycloneBottom: electrostatic precipitator


Secondary measuresTop drawing: dry absorption system (dry scrubber) using lineBottom: Wet absorption system (wet scrubber)


Disposal of residuesDrawing: example of a landfill design


Monitoring

Slide 59: Examples of

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Other Environmental RequirementsSlide 60: National Regulations Pertaining to Incineration

To be developed according to specific country’s regulations on incineration.

Slide 61: Maintenance of Air Pollution Control

Note: This and subsequent slides on maintenance and troubleshooting are intended for technology managers, operators and facility engineers.

Go through an example of a wet scrubber maintenance schedule – daily, weekly, monthly, semi-annually

Slide 62: Maintenance of Air Pollution Control

Go through an example of a baghouse filter maintenance schedule – daily, weekly, monthly, quarterly, semi-annually, annually

Slide 63: Troubleshooting Incinerators

Discuss troubleshooting of incinerators and air pollution control devices in the next series of slides.

Symptom: Black smoke from the stack


Symptom: Steady white or blue-white smoke from stack


Symptom: White smoke or white haze appears a short distance from the stack


Symptom: Smoke coming out of the primary chamber


Symptom: Incinerator uses too much fuel

Slide 68: Symptom: A lot of combustible materials remaining in the ash (poor ash quality)

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Troubleshooting IncineratorsSlide 69: Troubleshooting Air Pollution Control Devices

Symptom: Corrosion of wet scrubber parts

Slide 70: Troubleshooting Air Pollution Control Devices

Symptoms: Fan vibration, stuck dampers, or poor nozzle spray patter in the wet scrubberErosion of fans, dampers and duct work (dry components of the wet scrubber)Erosion of scrubber and spray nozzle (wet components of wet scrubbers with recirculating systems)

Slide 71: Troubleshooting Air Pollution Control Devices

Symptoms:Unusually high pressure readings of the baghouse filterUnusually low pressure readings of the baghouse filter or high opacity

Slide 72: Resources

Slide 73: Some Trends in Medical Waste Incineration (MWI)

The graphs show some trends in MWI in different countries

Slide 74: Treatment TechnologiesThat Do Not Generate Dioxins/Furans(covered in Module 15)Slide 75: Discussion Generate a discussion with the class using these points and the review questions as a basis.

References (in order Blue Book, Chapter 8

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as they appear in slides; refer to individual slides about epidemiological studies for their respective sources)

USGS: Toxic Substances Hydrology Program – Bioconcentration. http://toxics.usgs.gov/definitions/bioconcentration.html

Batterman, Stuart, Environmental Health Services, University of Michigan. Assessment of Small-Scale Incinerators for Healthcare Waste. January, 2004.http://www.who.int/immunization_safety/publications/waste_management/en/assessment_SSIs.pdf

United Nations, UNEP: Stockholm Convention. http://www.pops.int/

European Commission, Integrated Pollution Prevention Control (IPPC). Reference Document for the Best Available Techniques for Waste Incineration, August 2006.http://eippcb.jrc.es/reference/BREF/wi_bref_0806.pdf

Emmanuel, Jorge and Stringer, Ruth (2007). FOR PROPER DISPOSAL: A Global Inventory of Alternative Medical Waste Treatment Technologies.http://www.gefmedwaste.org/downloads/For%20Proper%20Disposal.pdf

GEF Medical Waste Project: www.gefmedwaste.org

US EPA: Hospital Incinerator Operator Training Course, 1989.

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http://www.gefmedwaste.org/

http://www.gefmedwaste.org/downloads/For%20Proper%20Disposal.pdf

http://eippcb.jrc.es/reference/BREF/wi_bref_0806.pdf

http://www.pops.int/

http://www.who.int/immunization_safety/publications/waste_management/en/assessment_SSIs.pdf

http://toxics.usgs.gov/definitions/bioconcentration.html

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