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 tel./fax: +420 222 782 808, 222 781 471 [email protected], www.noharm.org Non-Incineration Medical Waste Treatment Technologies in Europe June 2004 This resource book is based on the report ”Non-Incineration Medical Waste Treatment Technologies: A Resource for Hospital Administrators, Facility Managers, Health Care Professionals, Environmental Advocates, and Community Members” issued by Health Care Without Harm in August 2001. While the general chapters on waste minimisation and waste categories are shortened, more space is given to the description of technologies that operate in Europe. The final document was written by Dr. Jorge Emmanuel, HCWH, USA; Dr. Čestmír Hrdinka, HCWH, Czech Republic and Paweł Głuszyński, Waste Prevention Association, Poland with contributions from Ralph Ryder, Communities Against Toxics, UK; Michael McKeon, Irish Doctors for the Environment, Ireland; Rui Berkemaier, Quercus, Portugal and Aurélie Gauthier, CNIID, France. Health Care Without Harm Europe Chlumova 17 130 00 Prague 3, Czech Republic Tel.: +420 222 782 808 Fax: +420 222 781 471 [email protected] www.noharm.org Preface Until recently, incineration was the almost examples), the overwhelming majority of exclusive method of treating hazardous medical medical waste incinerators exceed the dioxin waste. In 1994, the U.S. Environmental Protection emission limit of 0.1 ng/m3 TEQ. Agency’s (EPA) Reassessment of 2,3,7,8- Tetrachlorodibenzo-p-Dioxin (TCDD) and There are two ways these new member countries Related Compounds identified medical waste can meet the statutory limits in the future – they incineration as the single largest source of dioxin can either equip incineration plants with very air pollution in the United States of America. expensive filters, or close them and set up the In 1997, the EPA promulgated regulations for alternative - non-incineration - technologies. The existing and new incinerators, setting new latter are more environmentally friendly and emission limits. Existing incinerators had to be usually cheaper than incinerators. Non- equipped with additional air pollution control incineration technologies (unlike incinerators) do devices to comply with the new legislation not produce toxic dioxins and their introduction requirements. For the vast majority of hospitals is therefore in accordance with the Stockholm and other medical waste incinerator operators Convention on POPs (Persistent Organic however, investing in efficient filters was too Pollutants) that entered into force in May 2004. expensive and resulted in the closure of more than five thousands medical waste incinerators. It is widely accepted within the scientific community that the incineration of waste results In 2000, stricter emission limits for medical waste in the formation of Persistent Organic Pollutants, incinerators were introduced in the European including dioxins, thus contributing to global Union. This resulted in the closure of many POPs emissions. Although installation of new air incinerators and an increase in the number of non- emission control devices could reduce dioxin incineration facilities for treating infectious medical emissions in stack gas, this is usually accompanied waste. However, the speed of the introduction of with an increase of dioxin in fly ash. As the alternative treatments is much slower than in Stockholm Convention recognises releases to air, the USA and incineration remains the prevailing water and land, future support for incineration method of treating medical waste in Europe. would go against the primary goal of this convention, which is the reduction of POPs. Although incineration is still widely used, non- incineration technologies are winning increasing The problem of pollution caused by the support in Europe. In Slovenia, all infectious incineration of medical waste has been waste has been treated by using a steam-based recognised by the World Health Organisation system since 90’s. Portugal has closed almost all (WHO). In its policy paper entitled “Health-care its medical waste incinerators and is treating Waste Management” (March 2004) WHO states medical waste in autoclaves. More than 50 that a long-term goal shall be: “Effective, scaled- operators in France have introduced up promotion of non-incineration technologies shredding/steam/drying systems for medical for the final disposal of health-care wastes to waste treatment in last 10 years. The Joint Waste prevent the disease burden from (a) unsafe Management Board of Ireland decided in 2003 to health-care waste management and (b) exposure decontaminate the vast majority of its medical to dioxins and furans.” waste by autoclaves using hot steam. Health Care Without Harm hopes that all Recently, 10 new countries entered the European countries in Europe will support the development Union. Incineration facilities in these countries of non-incineration medical waste treatment are mostly old and not complying with EU technologies instead of choosing to reconstruct emission limits for incinerators. In the Czech and equip existing outdated incineration plants or Republic and Poland, (taking these countries as supporting the construction of new ones. 2 Health Care Without Harm Executive summary The international Convention on the Elimination a small part of the total waste generated by of Persistent Organic Pollutants (POPs) lists medical facilities, it accounts for a considerable medical waste incinerators among the main portion of the costs incurred by a health care dioxin sources in the environment. However, facility for the disposal of medical waste. medical waste incinerators emit a wide range of pollutants besides dioxins and furans. These Four basic processes are used in alternative include heavy metals (lead, mercury and medical waste treatment: thermal, chemical, cadmium), fine dust particles, hydrogen chloride, irradiative and biological. Thermal processes rely sulphur dioxide, carbon monoxide, nitrogen on heat to destroy pathogens (disease-causing oxides and other pollutants like Products of micro-organisms). The low-heat processes utilise Incomplete Combustion (PICs) into the moist heat (usually steam) or dry heat. Chemical atmosphere. They also generate highly processes employ disinfectants to destroy contaminated ash that is potentially hazardous to pathogens or chemicals to react with the waste. human health. It is scientifically acknowledged Irradiation involves ionising radiation to destroy that these pollutants can have serious negative micro-organisms while biological processes use impacts on the health of incineration plant enzymes to decompose organic matter. personnel, the public and the environment. Mechanical processes, such as shredders, mixing arms, or compactors, are added as supplementary In order to maximise the benefits of non- processes to render the waste unrecognisable, incineration technologies, a basic concept is improve heat or mass transfer, or reduce the presented of which the underlying elements are volume of treated waste. waste minimisation and segregation. By implementing a program that includes source For each of these processes, an overview and reduction, segregation, recycling and other principles of operation are presented along with pollution prevention techniques, health-care information on the types of waste treated, services can reduce the amount of infectious emissions, waste residues, microbial inactivation waste that needs to be decontaminated. efficacy, advantages, disadvantages and other issues. Specific examples of technologies in A waste analysis is an important step in selecting operation in Europe are provided. Technology any non-incineration technology. Contrary to descriptions are based on vendor data, popular belief infectious medical waste is independent evaluations and other non- estimated to be approximately 15% or less of proprietary sources where available. Since the overall waste stream. By the introduction of technologies change quickly in a dynamic efficient waste segregation and classification market, it is advisable for facilities interested in systems based on a real threat from infectious using a non-incineration method to contact the waste, this amount can be reduced in many cases vendors to get the latest and most accurate data to 3-5%. when conducting the evaluation of any technology. Medical waste can be defined as waste generated as a result of diagnosis, treatment and immunisation of humans or animals. It is useful to categorise the overall waste stream into the following four categories: Municipal solid Health Care Without Harm does not endorse waste, infectious waste, hazardous waste and any technology, company, or brand name, and low-level radioactive waste. Waste categories does not claim to present a comprehensive list are specified in the European Waste Catalogue of technologies. and might be further defined by national legislation. Although infectious waste is only Non-Incineration Medical Waste Treatment Technologies in Europe 3 Steam disinfection, a standard process in necessary to prevent worker exposure to the hospitals, is done in autoclaves and retorts. ionising radiation. Biological processes, such as Tuttnauer is an example of an autoclave. More the Bio-Converter, use enzymes to decompose recent designs