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Some Factors to Consider in Evaluating Treatment Technologies Non-Incineration Healthcare • Throughput capacity or size Treatment Technologies • Microbial inactivation efficacy • Types of waste treated • Overall environmental impact: air emissions, Jorge Emmanuel wastewater and solid residues UNDP GEF Project • Mass and/or volume reduction JSI Conference Room October 11, 2010 • Occupational safety and health • Noise, odor

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Some Trends: Medical Waste Incineration (MWI) Some Factors to Consider in Evaluating United States 8000 Canada 6200 250 219 Treatment Technologies 6000 200 150 • Automation, ease of use, documentation 4000 2400

MWIs 100 56 2000 MWIs 72 50 • Reliability, maintenance requirements, 0 0 equipment life span 1995 2003 1988 1997 2006 • Space requirements 554 600 Germany Portugal 50 40 • Community and staff acceptance 400 40 30 • Acceptance by regulatory authority 200 20 MWIs 0 10 1 • Level of commercialization On-Site MWIs On-Site 0 0 • 1984 2002 1995 2004 Background of the technology vendor, availability Ireland 200 of parts and technical support 150 150 • Utility and other installation requirements 100 MWIs 50 0 • Capital and operating costs 0 2 5 1990s 2005

Alternative Technologies Recommended Alternatives • Low-Heat Thermal Technologies – or Retorts • Thermal – Integrated or Hybrid Steam Systems • Chemical – Microwave Units – Dry Heat Systems • Irradiative • Chemical • Biological – Non-Chlorine Technologies

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The STI Process Types of Standard Autoclaves (BioSafe Engineering)

 Gravity displacement  Pre-vacuum  Pre- and post-vacuum  Multiple vacuum

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Autoclave Indoor installation Pressure Gauge Air Vacuum STI 300PPH

Release Safety Filter Valve Valve

Jacket

Autoclave Chamber

Charging Door

Thermocouple Steam Steam Steam Trap Trap Outdoor installation Drain STI 1000PPH 8 11

STI Commercial Shredding Processing up to 84 TPD Autoclave Temperature From “Principles of Steam Sterilization” by John L. Perkins

300

250

200 100% Air Dis 50% Air Dis T oF 150 33% Air Dis 100 0% Air Dis

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0 5 10 15 20 25 30 35 40 45 50 55 60 Time (minutes)

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The Path-Clav basket offers abundant space for animals STI Medical Waste Treatment System or excised body parts • Waste Reduced in Volume by over 85% • Odor Control Injection System prior to treatment eliminates harsh odors Bone and teeth remnants may be easily crushed by hand

After processing, the basket is placed in the emptying bracket, and is then emptied from a

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Now BioSafe Engineering

Path-ClavTM Results of digestion for pathologic waste, animal of a human cadaver at carcass, and human tissue and Mayo Clinic body parts elimination (placentas, amputated limbs, excised organs, etc.) using alkaline hydrolysis.

Available in 3 standard sizes and any custom size ranging up to 3,200 kilograms per cycle.

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NIH study (University of Florida – Gainesville photos)

Hoist

Basket Emptying Vessel Bracket Platform -Temperature from 110° to150° C for 4 to 8 hrs. Control -Sizes: 15 to 4.500 Kg. -Also destroys many chemotherapeutic (cytotoxic) Panel , formaldehyde and glutaraldehyde

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San-i-Pak

MODEL 1050 - H1 Smallest model Processing vessel size – approximately 3’ x 4’ (.9m x 1.2m) Internal Drum Volume (100%) 24 Cubic Feet (0.65 Cubic Meter) Cycle time (including loading and unloading) – approximately 45 minutes

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MODEL 2500 - DS2 Dual vessel Rotoclave® system for regional medical waste processing plants. Each vessel has its own set of conveyors and grinder, as well as autoloader. Processing vessel size – approximately 5’ x 15’ (1.5m x 4.6m) each 20 Internal Drum Volume (100%, 2 vessels) — 518 Cubic Feet (14.7 Cubic Meters)23

MedClean (formerly Aduromed) Tempico Rotoclave

21 24 Source: Tempico, Madisonville, Louisiana

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Mark Costello

25 Vecoplan

Bondtech Sanitec Microwave

Source: Sanitec 26 29

Redbag AMB Ecosteryl (Belgium)

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ECODAS (France)

Rango de capacidad: 45 hasta 180 Kg./HR Proceso: - Los residuos se cargan en la parte superior y se sellan -Trituración interna - Vapor a 138° C, 3,8 bar -Se baja la temperatura a 80° C -Se drena y se sella al vacío

31 34 Fuente: Ecodas T.1000

How the Hydroclave Works

T150 with treatment capacity of T2000 with capacity of 2000 L per 60 150 liters per 35 minutes average minutes cycle time

cycle time 32 35 Source: Hydroclave

Hydroclave (Canada) LogMed (Germany)

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Meteka Medister Peerless Waste Solutions Steam exposure plus shredding, autoclaving, heated auger, exit

MEDISTER 360

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Peerless Waste Solutions Sharpsblaster & Microwave D-Series is designed for converting protein- based matter into sterile waste safe for a sewer or temporary holding tank

D-1 (Up to 15 lbs. per cycle

D-2 (Up to 200 lbs. per cycle)

D-3 (custom-designed)

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SHARPS Examples of Point-of-Use Needle Destroyers • NEEDLES •SYRINGES • SCALPEL BLADES • VACUTAINER NEEDLES • BROKEN GLASS AMPOULES • SUTURE NEEDLES

DRY HEAT CYCLE IN SHARPS BLASTER

POTENTIALLY DECONTAMINATED & SAFE 39 42 HAZARDOUS /METAL SCRAP Sources: Disintegrator, Balcan, MedPro, St. Stephen’s Hospital (Delhi)

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Demolizer Sintion Microwave (Austria)

• Small-scale table-top system for small clinics or hospital departments • Waste heated by dry air to 177 C for 90 minutes • 1 hour to cool to room temperature • HEPA filter to control odors

• Capacity: 3.8 liters/cycle

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Moss medical waste autoclave system The MATACHANA series 6200 (Spain) (manufacturers of AMSCO Eagleguard retort) DESCRIPTION:

•Chamber volume 6.200 liters

•2-door version

• Steam supply by external steam generator

•Sterilization programs at 121°C or 134°C Special customer programs SPECIAL FEATURES:

Vacuum TECHNIQUE •Sterilization capacity: 324 to 504 kg / cycle.

•Treatment of AIR & CONDENSATES • Volume depends on pretreatment & configuration •CLEAN, NON POLLUTANT of waste.

•MOST EFFICIENT & RELIABLE OTHER DIMENSIONS FROM 250 TO 6.200 LITRES AVAILABLE 44 •LOW OPERATION COST 47

Ecolotec (Canada) STERILIZATION PROCESS

Pre-vacuum Drying

Sterilizing

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Area of control & reception OnSite Sterilization VariClave Passage control connected to a PC

Treatment area

MATACHANA sterilizers :

Trolley washing area : Industrial steam generator High pressure disinfecting equipment with hot water spray-gun (minimum 80°C). Air compressor Water treatment equipment

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Storage Area Medical Waste Processing Utilizing Chambers at a tempeature of + 4° C to keep bacteria inactive before treatment the PIWS-3000 System

Grinding & compacting area Reduce the volume of waste

Cold-Ster™ and water

Grinding set Compacting set 50 53

STERIFANT PROCESS (Germany)

BINS ON AUTOMATIC RETRACTABLE PLATFORM OF MICROWAVE UNIT

"The OZONATOR" SHREDDING AND COMPACTION 51 54

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Bagamoyo District Hospital Demonstration Project Funded by UNDP GEF & HCWH with help from Toxics Link

• Autoclave and shredder imported from India – 6/08 • Hospital renovated a building for the technologies – 9/08 • Colored bins, bags, PPE – 9/08 • Training by JSI – 9/08 • Waste assessment by JSI and HCWH – 9/08 to 10/08 • Installation & testing of technologies by UNDP GEF and AGENDA; SIGNPost – 10/08 Temperature (C) Pressure (psig) 140 • Technologies operating for one 120 100 80 year, hand-over to hospital Dioxins 60 40 planned for 11/09 eliminated: 20 3.8 g TEQ/yr 0 :05 1 :15 1 :25 1 :35 1 :45 1 :55 1 :05 2 :15 2 :25 2 :35 2 2:25 12 :35 12 :45 12 :55 12 55

SRC Kyrgyzstan Project: Sharps

Treat in an Bury in a pit Collect on-site BMDI needles autoclave $25

54 liter autoclave Sharps Needle $1000 30-40% waste cutter volume Collect Treat in an reduction plastic on-site Shred syringe autoclave

Recycle at plant

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Non-Burn Thermal Technologies • Autoclaves & advanced autoclaves Resistance to Disinfection Microorganism Examples • Other steam-based technologies Bacterial spores Geobacillus • Microwave technologies stearothermophilus Mycobacteria M. tuberculosis • Dry heat technologies Non-lipid or small Polio virus, Hepatitis viruses A virus Typical disinfection criteria for medical waste: 4 Log Fungi Aspergillus reduction or higher of Geobacillus stearothermophilus or Bacillus atropheus Vegetative bacteria Staphylococcus, Pseudomonas Temp Press Spore Lipid or medium-size HIV, HBV °C (kPa) Kill time viruses (min) 116 174 30 118 186 18 Typical standard: 121 ºC for 30 min 121 205 12 Monitoring methods: microbial 125 232 8 inactivation tests, self-contained 132 287 2 biological indicators, color indicators 138 341 1 57

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