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  • Non-Incineration

    Medical Waste

    Treatment Technologies

    in Europe

    A Recource for Hospital Administrators,

    Facility Managers, Health Care Professionals,

    Environmental Advocates, and

    Community Members

    June 2004

    Health Care Without Harm Europe

    Chlumova 17

    130 00 Prague, Czech Republic


    +420 222 782 808, 222 781 471,

  • Non-Incineration

    Medical Waste

    Treatment Technologies

    in Europe

    June 2004

    This resource book is based on the report Non-Incineration Medical Waste TreatmentTechnologies: A Resource for Hospital Administrators, Facility Managers, Health CareProfessionals, Environmental Advocates, and Community Members issued by Health CareWithout Harm in August 2001. While the general chapters on waste minimisation and wastecategories are shortened, more space is given to the description of technologies that operate inEurope.

    The final document was written by Dr. Jorge Emmanuel, HCWH, USA; Dr. estmr Hrdinka,HCWH, Czech Republic and Pawe Guszyski, Waste Prevention Association, Poland withcontributions from Ralph Ryder, Communities Against Toxics, UK; Michael McKeon, IrishDoctors for the Environment, Ireland; Rui Berkemaier, Quercus, Portugal and Aurlie Gauthier,CNIID, France.

    Health Care Without Harm EuropeChlumova 17

    130 00 Prague 3, Czech RepublicTel.: +420 222 782 808Fax: +420 222 781 471

  • 2 Health Care Without Harm


    Until recently, incineration was the almostexclusive method of treating hazardous medicalwaste. In 1994, the U.S. Environmental ProtectionAgencys (EPA) Reassessment of 2,3,7,8-Tetrachlorodibenzo-p-Dioxin (TCDD) andRelated Compounds identified medical wasteincineration as the single largest source of dioxinair pollution in the United States of America.In 1997, the EPA promulgated regulations forexisting and new incinerators, setting newemission limits. Existing incinerators had to beequipped with additional air pollution controldevices to comply with the new legislationrequirements. For the vast majority of hospitalsand other medical waste incinerator operatorshowever, investing in efficient filters was tooexpensive and resulted in the closure of morethan five thousands medical waste incinerators.

    In 2000, stricter emission limits for medical wasteincinerators were introduced in the EuropeanUnion. This resulted in the closure of manyincinerators and an increase in the number of non-incineration facilities for treating infectious medicalwaste. However, the speed of the introduction ofalternative treatments is much slower than inthe USA and incineration remains the prevailingmethod of treating medical waste in Europe.

    Although incineration is still widely used, non-incineration technologies are winning increasingsupport in Europe. In Slovenia, all infectiouswaste has been treated by using a steam-basedsystem since 90s. Portugal has closed almost allits medical waste incinerators and is treatingmedical waste in autoclaves. More than 50operators in France have introducedshredding/steam/drying systems for medicalwaste treatment in last 10 years. The Joint WasteManagement Board of Ireland decided in 2003 todecontaminate the vast majority of its medicalwaste by autoclaves using hot steam.

    Recently, 10 new countries entered the EuropeanUnion. Incineration facilities in these countriesare mostly old and not complying with EUemission limits for incinerators. In the CzechRepublic and Poland, (taking these countries as

    examples), the overwhelming majority ofmedical waste incinerators exceed the dioxinemission limit of 0.1 ng/m3 TEQ.

    There are two ways these new member countriescan meet the statutory limits in the future theycan either equip incineration plants with veryexpensive filters, or close them and set up thealternative - non-incineration - technologies. Thelatter are more environmentally friendly andusually cheaper than incinerators. Non-incineration technologies (unlike incinerators) donot produce toxic dioxins and their introductionis therefore in accordance with the StockholmConvention on POPs (Persistent OrganicPollutants) that entered into force in May 2004.

    It is widely accepted within the scientificcommunity that the incineration of waste resultsin the formation of Persistent Organic Pollutants,including dioxins, thus contributing to globalPOPs emissions. Although installation of new airemission control devices could reduce dioxinemissions in stack gas, this is usually accompaniedwith an increase of dioxin in fly ash. As theStockholm Convention recognises releases to air,water and land, future support for incinerationwould go against the primary goal of thisconvention, which is the reduction of POPs.

    The problem of pollution caused by theincineration of medical waste has beenrecognised by the World Health Organisation(WHO). In its policy paper entitled Health-careWaste Management (March 2004) WHO statesthat a long-term goal shall be: Effective, scaled-up promotion of non-incineration technologiesfor the final disposal of health-care wastes toprevent the disease burden from (a) unsafehealth-care waste management and (b) exposureto dioxins and furans.

    Health Care Without Harm hopes that allcountries in Europe will support the developmentof non-incineration medical waste treatmenttechnologies instead of choosing to reconstructand equip existing outdated incineration plants orsupporting the construction of new ones.

  • Non-Incineration Medical Waste Treatment Technologies in Europe 3

    Executive summary

    The international Convention on the Eliminationof Persistent Organic Pollutants (POPs) listsmedical waste incinerators among the maindioxin sources in the environment. However,medical waste incinerators emit a wide range ofpollutants besides dioxins and furans. Theseinclude heavy metals (lead, mercury andcadmium), fine dust particles, hydrogen chloride,sulphur dioxide, carbon monoxide, nitrogenoxides and other pollutants like Products ofIncomplete Combustion (PICs) into theatmosphere. They also generate highlycontaminated ash that is potentially hazardous tohuman health. It is scientifically acknowledgedthat these pollutants can have serious negativeimpacts on the health of incineration plantpersonnel, the public and the environment.

    In order to maximise the benefits of non-incineration technologies, a basic concept ispresented of which the underlying elements arewaste minimisation and segregation.By implementing a program that includes sourcereduction, segregation, recycling and otherpollution prevention techniques, health-careservices can reduce the amount of infectiouswaste that needs to be decontaminated.

    A waste analysis is an important step in selectingany non-incineration technology. Contrary topopular belief infectious medical waste isestimated to be approximately 15% or less of

    the overall waste stream. By the introduction ofefficient waste segregation and classificationsystems based on a real threat from infectiouswaste, this amount can be reduced in many casesto 3-5%.

    Medical waste can be defined as waste generatedas a result of diagnosis, treatment andimmunisation of humans or animals. It is usefulto categorise the overall waste stream into thefollowing four categories: Municipal solidwaste, infectious waste, hazardous waste andlow-level radioactive waste. Waste categoriesare specified in the European Waste Catalogueand might be further defined by nationallegislation. Although infectious waste is only

    a small part of the total waste generated bymedical facilities, it accounts for a considerableportion of the costs incurred by a health carefacility for the disposal of medical waste.

    Four basic processes are used in alternativemedical waste treatment: thermal, chemical,irradiative and biological. Thermal processes relyon heat to destroy pathogens (disease-causingmicro-organisms). The low-heat processes utilisemoist heat (usually steam) or dry heat. Chemicalprocesses employ disinfectants to destroypathogens or chemicals to react with the waste.Irradiation involves ionising radiation to destroymicro-organisms while biological processes useenzymes to decompose organic matter.Mechanical processes, such as shredders, mixingarms, or compactors, are added as supplementaryprocesses to render the waste unrecognisable,improve heat or mass transfer, or reduce thevolume of treated waste.

    For each of these processes, an overview andprinciples of operation are presented along withinformation on the types of waste treated,emissions, waste residues, microbial inactivationefficacy, advantages, disadvantages and otherissues. Specific examples of technologies inoperation in Europe are provided. Technologydescriptions are based on vendor data,independent evaluations and other non-proprietary sources where available. Sincetechnologies change quickly in a dynamicmarket, it is advisable for facilities interested inusing a non-incineration method to contact thevendors to get the latest and most accurate datawhen conducting the evaluation of anytechnology.

    Health Care Without Harm does not endorse

    any technology, company, or brand name, and

    does not claim to present a comprehensive list

    of technologies.

  • 4 Health Care Without Harm

    Steam disinfection, a standard process inhospitals, is done in autoclaves and retorts.Tuttnauer is an example of an autoclave. Morerecent designs have incorporated vacuuming,continuous feeding, shredding, mixing,fragmenting, drying, chemical treatment and/orcompaction, to modify the basic autoclavesystem. Examples of these so-called advancedautoclaves are: Ecodas, Hydroclave, Sterival, STI-CHEM Clav, STS, System Drauschke.

    Microwave technology is essentially a steam-b


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