Recommended
Recommended
More Related Content
Similar to TW_Powerpoint_Healthcare-Waste-Management_Final.pptx
Similar to TW_Powerpoint_Healthcare-Waste-Management_Final.pptx (20)
More from ssuser54b5c5
More from ssuser54b5c5 (12)
Recently uploaded
Recently uploaded (20)
TW_Powerpoint_Healthcare-Waste-Management_Final.pptx
- 1. Nadia Ibrahim Head of Consultancy EmiratesGBC Technical Workshop Sustainable Management of Health Care Waste FARNEK 25 Feb 2020
- 2. Agenda Health Care Waste : Global & Middle East Statistics Treatment Systems Review Sustainable Management of Healthcare Waste – Challenges & Opportunities Best Approach Recycling of HCW – A Case Study
- 3. STATISTICS
- 4. Health Care Waste (HCW) ….. A growing problem Global • 2-4 kg of waste per bed per day (WHO) • In US HC facilities generate 14,000 tons of waste/day • 16 billion injections are administered worldwide every year without proper disposal • A study in Canada has found that a single operation may produce more waste that a family produces in 4 weeks • 0-20% of a facility’s budget every year is spent on waste disposal. Middle East • More than 150 tonnes of medical waste per day in GCC • KSA 80 tons/day UAE 21.5 tons/day Kuwait 12 tons/day • Bahrain 7 tons World Future Energy Summit, Ecomena .org, WHO, US National Library of Medicine Resources, Healthcare Plastic Recycling Councils
- 5. Health Care Sector – Growing market in Middle East Urbanization Medical Tourism Lifestyle Demands World Future Energy Summit 2016 2021 60% GROWTH USD 28 Billion UAE
- 7. HCW Treatment Systems Incineration Autoclaving Plasma Gasification Landfilling
- 8. Are these technologies sustainable? Disposal Systems Advantages Disadvantages Landfilling - Easy process - Severe pollution impacts - Risks of communicable disease - Landfill space Incineration - Significant volume reduction - Eliminate biohazard risks – high temp - Air pollution (dioxin & furans) - Fly ash disposal : Heavy metals - High cost Autoclaving (Steam Sterilization) - Eliminate biohazard risks - Less costly than incinerators - Less space required - Operating requirements (temp control, time consuming) - Waste volume remain same requiring landfilling Futuristic Technologies : Plasma Gasification - Ecologically clean - Eliminate biohazard risks - Large costs - High operating requirements
- 10. Challenges Social Stigma : Everything coming out a healthcare facility is hazardous or risky? Will it create environmental & health risks if recycled? Health care cleaning staff is concerned about internal segregation. Waste contractor support: Reluctance by recycling companies to accept wastes from healthcare facilities : Are they actually segregated? Will our staff be at risk? Is the waste that is treated after autoclaving is safe to handle and recycled? Recycling Infrastructure: No separate infrastructure in many Material Recovery Facilities for handling medical waste separately Cross Contamination: Recycling bins from medical waste are not fully trustable as there might be infectious contamination so it ends may be as medical waste. Lack of awareness from healthcare staff on various waste types & their segregation methodology Material Quality Treatment technology that keep the recyclable quality intact is not much available in UAE & other parts of middle east Convenience: Segregation is costly & time consuming, its easy to dispose as general waste Legal Barriers: Disposal requirements, health & safety requirements
- 11. 85 % of the waste generated from a healthcare facility can be categorized as municipal waste. Only 15% belongs to the regulated or hazardous healthcare. (WHO) However, health-care waste is often not separated into hazardous or non-hazardous wastes making the real quantity of hazardous waste much higher. Most of the regulated wastes are handled almost adequately through government regulations & various treatment systems. However; Healthcare facilities often spend more than is necessary to treat medical waste that is not defined as regulated. This increases the cost of healthcare and creates burden into the existing treatment systems Is HCW too risky to handle?
- 12. Composition & Types of HCW WHO 85% 15% General waste Regulated & Hazardous Waste Office Paper, Cartons, PET bottles constitute the largest recyclable stream that has high value in the recycling market.
- 13. What constitutes the 85%? PAPER Office paper, newspapers, magazines, cardboard, tissue boxes, tissue rolls, posters, leaflets METALS Aluminium beverage cans, aluminium containers, food tin cans, metal containers PLASTICS PET bottles- water, soft drinks, juices. HDPE milk containers, PP plastic bottles for plastic packaging GLASS Glass bottles COMPOSTABLE Food, flowers, yard waste BULKY WASTE Furniture, beds, electrical items, gas cylinders E-WASTE Lamps, Bulbs CONSTRUCTION WASTE Source: WHO
- 14. Non-segregated vs Segregated Without Segregation – 2 to 4 kg/bed/day With Segregation – 0.2 to 0.4 kg/bed/day Source: WHO
- 15. BEST APPROACH
- 16. 5 R’s Strategy – Cradle to Grave Approach Reduce Reuse Recycle Research Rethink 5 R’s Strategy
- 17. Waste Minimization – The Key Sustainable Purchasing : Packaging minimization policy, bulk packaging, eco friendly or compostable packaging, supplier take back policy Minimizing plastic packaging : (E.g.: Blue sterile wraps (Polypropylene) for surgical instruments which is one of the most biggest contributor; as per Practice Green Health estimates that 255 million pounds is disposed each year. This can be replaced by metal cases or a separate recycling process for blue wrap is set up as they are made of high quality recyclable polypropylene. Proper Segregation: Placing color coding bins to segregate different waste types – help reduce the % of infectious waste & increase non-hazardous waste that can be recycled. Single use containers replaced with durable containers
- 18. Is Reuse possible? What is required is more effective sterilization procedures rather than disposable equipment. Reuse saves money & also reduce packaging & clinical waste Wherever considered safe to use, single use items should be replaced by reusable items. Reuse: Developing vs Developed Countries In developing countries reuse is a more a cost savings measure; however safety is compromised In developed countries, it is systematically regulated e.g. in US it is regulated by US Food & Drug Administration
- 19. What can be Recycled? As with waste from other business, for the non hazardous wastes from healthcare facilities the same waste hierarchy principles can be applied Healthcare Waste HAZARDOUS – 15% Incineration Autoclaving Non-Hazardous 85% Organic Waste Composting Paper docs & cartons Reduce, Reuse, Recycle Bottles & Cans Reduce, Reuse, Recycle Plastic packaging Reduce, Reuse, Recycle
- 20. 1. Conduct a Waste Audit: Understand what is generated & from where, what type of bins & other facilities are required. 2. Seek support from your Waste Contractor : Can the segregated waste be recycled & not taken to landfill. 3. Sustainable Supply Chain: Control of what is coming to reduce, reuse & divert from landfill. 4. Facilities & Equipment: Color coded bins, compactors, composting. 5. Train, Train & Aware: Engage staff & Visitors REDUCE, REUSE & RECYCLE Setting Up an Integrated HCW Management Systems
- 21. Monitoring & Benchmarking “You can’t manage What you can’t measure” Monitoring & Benchmarking of healthcare waste is very important as it can be used as a point of reference from which an evaluation can be made. Benchmarking can be used to identify where they stand and what can be achieved. Benchmark create a competitive environment promoting improvement and growth. Benchmarking involves looking at standards, best practices and evidence-based practices and then identifying potential areas of improvement. It is very important to monitor, measure & review trends in HCW statistics by utilizing efficient data management systems that can compare year to year performance, performance with other hospitals & identify improvement options
- 22. Stakeholder Support Ministry of Climate Change Government Municipality MOH, DHA, HAAD Associations Emirates Medical Associations Healthcare Facilities Private Healthcare Products suppliers Medical waste contractors Recycling contractors Waste Management
- 23. Benefits of Sustainable HCW management systems Employee & Visitor Safety Less Waste: Landfill impact Less burning: Less pollution Cost savings Less resource consumption Promoting Circular Economy
- 24. CASE STUDY
- 25. Plastic Waste Recycling: A case study by RISE Research Institutes of Sweden 3 types of plastic products were chosen for the study: Polyethylene (PE) used in aprons, Polypropylene(PP) used in medicine cups and syringes & PVC used in gloves The materials were subject to hydrothermal method & an ionization method After pre treatment the items were evaluated for color change, stability & alteration of chemical structure The various plastics were intact except with a minor plasticizer loss in the PVC samples Repurposing of this plastics were checked in recycling trials – PP material was used for production of 100% recycled floor tiles while PVC was used for flooring with 20% recycled content. The results show that pretreatment and recycling is beneficial from a climate perspective, even with assumed material losses and assumed quality reduction of the recycled materials.
- 26. SUPPLY Plastic Products DEMANDS Recycled plastics of adequate quality Segregation Recycling Pretreatment / Sterilization Recovery of plastic materials Usable recyclable quality Less demand on virgin plastics: CO foot print – less landfill Plastic Waste Recycling: Process Flow
- 27. Although the main mission of the hospital is to promote human health, it cannot be assumed as an island apart from its urban environment. This philosophy has a significant impact on the future hospital ideas and priorities: Promoting and advancing the health and well-being of all individuals and people wherever against the environment in a responsible manner.
- 28. Let’s Discuss Is incineration the ultimate solution for healthcare waste management? Social stigma against 3 R’s in Medical Waste Management Is government intervention required for guiding hospitals in adopting waste reduction & segregation strategies? Are our existing waste recycling contractors & facilities ready to accept and segregate non- hazardous waste from healthcare sectors?
- 29. Thank You
Editor's Notes
- 1: The progress of modern medicine in the recent years has been astounding. Technologies that can treat life threatening diseases to extending life span of human has been developed. Modern medicine has so expanded that every home is a miniature healthcare facility. The business of Medical Tourism is accelerating & in fact becoming an important part of a country’s economy. 2: But as global healthcare charges forward, it leaves behind a waste crisis waiting to explode, especially in the GCC region. 3: In the recent World Future Energy Summit in Abu Dhabi the upcoming boom in the GCC healthcare industry was a topic of discussion. The summit also discussed about the various disposal technologies for HCW. 4: : However; the summit focused more on final disposal options with no attention on the sustainable management of HCW. 5: THIS WORKSHOP IS A SMALL EFFORT FROM OUR SIDE TO INITIATE & OPEN THE DOORS FOR MORE RESEARCH & DISCUSSIONS ON THE CHALLENGES & OPPORTUNITIES FOR SUSTAINABLE MANAGEMENT OF HEALTHCARE WASTE.
- 1: During my research on the subject what I noticed was that Not much comprehensive global statistics are available on the medical waste generation trends 2: Stats are available for different countries in terms of kg/day or kg/bed etc, it’s a bit difficult to generalize 3: For instance developed countries generate 2-4 kgs of waste per day 3: In GCC as per an article in ecomena.org around 150 tonnes of medical waste are produced per day, with KSA leading the statistics 4: These figures are indicative of the magnitude of the problem faced by municipal authorities in dealing with medical waste disposal problem across GCC. The growing amount of medical wastes is posing significant public health and environmental challenges in major cities of the region. The situation is worsened by improper disposal methods, insufficient physical resources, and lack of research on medical waste management.
- 1: The Middle East region especially UAE is going to witness an unprecedented growth in the health care sector thanks to Rising Urbanization, medical tourism & life style changes. 2: It is estimated that from 2016 to 2021 the UAE healthcare sector will grow by 60%; correspondingly the 21.5 tonnes that was estimated will grow, that can impact the existing waste disposal systems & process
- 1: Traditional approaches to medical waste disposal in the Middle East heavily rely on landfill and small-scale incineration. 2: Both of these approaches pose severe long-term public health risks in the form of water, air and soil contamination 3: Much of the Middle East is already trying to cut back on relying on landfill for waste disposal, while incineration facilities are still being developed. However incineration is becoming a less preferred disposal system due to pollution issues as well as higher costs. In EU Waste Incineration Directive 2000/76/EC focus to minimise the negative environmental effect of incineration emission and exploring sustainable options. 4: However, in the long term, investment is likely to flow towards more advanced and sustainable disposal methods, such as steam sterilization (or autoclaving) which has the lowest capital costs of current options and can be used to safely process up to 90% of all medical waste types. 5: Alongside a rise in interest and investment in autoclaving and other leading sustainable methods, even more advanced medical waste disposal technologies may be making their way to the Middle East in the near future. Plasma gasification is an emerging solution with excellent prospects for use in medical waste disposal. Last year saw a number of MoUs signed for the development of plasma gasification pilot projects in the Middle East
- 1: Are these technologies the only solution? Can they help in managing healthcare waste sustainably? 2: We will just do a quick analysis of the pros and cons associated with each disposal method 3: From this analysis it is clear that each of these disposal methods is not 100% efficient and we need to look for methodologies or processes that can help to manage healthcare waste in the most sustainable way.
- 1: So the raises a question: can we sustainably manage the healthcare waste? Can we actually apply the Reduce, Reuse & recycle hierarchy to healthcare waste? 2: Thinking outside landfilling or incineration has a number of challenges: Lets look into some of these 3: Up to now, there has been no single resource that provided a good frame of reference, objectively portrayed, of sustainably managing healthcare waste 4: For those health care facilities and communities looking for a tool to really evaluate their options for going beyond incineration for the effective treatment of health care wastes, the search for information has been problematic. 5; Although recycling has potential environmental and financial benefits, it is hampered by convenience, technology, lack of knowledge, concerns about environmental safety, and strict regulation.
- 1: When you think of healthcare waste, the immediate picture that comes to your mind is red or yellow bags with biohazard warning . 2: However the most noticeable fact is that only 15% of the total waste that is generated is actually categorized as medical waste 3: These include sharps, infectious waste, radioactive, pathological, pharmaceutical, chemical & genotoxic (cancer medicines) 4: The rest is paper, plastics, organics, the usual trash that is generated from our offices 5: The hazardous medical waste is handled well ; However; Healthcare facilities often spend more than is necessary to treat medical waste that is not defined as regulated. This increases the cost of healthcare and creates burden into the existing treatment systems
- 1: So how much can we reduce if we segregate the waste? 2: A research done by World Health Organization in developed countries has found that without segregation a bed generates average 2 to 4 kgs of waste per day 3: If segregated it reduces to 0.2 to 0.4 per bed. 4: This does not require any explanation as it gives more clarity into the necessity of proper segregation
- 1: So what's the best strategy? The 3 R’s is not enough’ we need research & rethinking strategy when it comes to healthcare waste. 2: I will be discussing Reduce, Reuse & Recycle in more detail; however the 2 new R’s deserves special attention. 3: Healthcare facilities need to do serious rethinking on their current systems to favor sustainable process that can reduce waste 4: We need more research into finding out sustainable process and materials in HC process
- 1: The most important waste minimization practice is reducing packaging concepts; For example, single wrapping of sterilized instruments has been found to be as effective as double wrapping in preventing bacterial contamination, but still double wrapping is preferred. 2: A major contributor to this waste is plastic including plastic items & packaging, From sterilization wrap to gowns, irrigation bottles, IV bags, basins, pitchers and trays, many materials are for the most part used once and then thrown away with many surgical products packaged in large containers . All these items have a potential to be made of reusable quality
- 1: Concerns about cross infection have resulted in the phasing out of reusable items in favor of single use; eg reusable anesthetic devices in favor of single use, disposable items. 2: Medical and other equipment used in a health-care establishment may be reused provided that it is designed for the purpose and will withstand the sterilization process 3: Reusable items may include certain sharps, such as scalpels and hypodermic needles, syringes, glass bottles and containers, etc. 4: Reprocessing now involves the cleaning of visible debris, the complete sterilization of the device, repackaging and labelling and, finally, the reprocessor being liable for any adverse events caused by the device. 5: Medical items reprocessing is expected to grow in the coming years. 6: Ideally the market should develop in such a way: A third-party reprocessor must acquire a steady supply of undamaged used devices, and then must be able to reprocess them at a cost that allows it to sell the devices much more cheaply than a new device. 7: On average, reprocessed medical devices are 50% cheaper than new devices. A survey of nearly 3,000 hospitals in the US showed over $150m in savings were generated for each year through reprocessing. 8: Use reusables in patient rooms versus disposables (bed pans, water pitchers etc.)
- 1: This self-explanatory figure clearly shows the recycling potential of waste from HC facilities.
- 1: So How can a healthcare facility establish an Integrated waste management system? 5 key steps 2: Hospitals have an important role in reducing hospital waste and should not be discouraged by either lack of knowledge or the threat of legal liability. 3: Concerns about safety, which have restricted recycling initiatives, might be countered by management acting as guarantors for the contents of disposed waste, by signing labelled bags of recycling waste before disposal.
- 1: Quantification of healthcare waste from different HC facilities is very important to understand trends as well benchmarking to find who is performing best and who needs improvement & what improvement is needed. 2: Online data management systems to track & analyze the waste generation trends from different healthcare facilities is a requisite to establish sustainable management of healthcare waste.
- 1: Responsible & Sustainable management of Healthcare waste requires effort & action from different stakeholders 2: including support from government in terms of appropriate regulations, providing healthcare waste collection & recycling infrastructure, providing awareness etc. 3: Associations and Bodies that is in charge of healthcare facility in each emirate or states has to play a key role in regulating & monitoring the entities that is registered with them 4: Suppliers needs to research & provide sustainable products 5: An finally the key role rests with waste management companies in provide smooth collection, segregation support & final processing support.
- Hospitals like any other organization should be embracing recycling as standard practice. The benefits of an effective hospital recycling program are wide ranging but from a financial point of view, it means cost savings and a potential to earn back money. Successful recycling can reduce operational costs, increase worker safety, enhance community relations, and even begin generating revenue for the hospital. 1: The first step is to discuss with the waste contractor. Will they be able to accommodate all the different medical waste streams the hospital is producing? Will they be ready to consider the segregated waste for recycling.
- 1: Before I wind up I would like to present a case study on a Plastic Recycling from HC facilities that was undertaken in Sweden. 2: Hospitals use large amounts of plastics which continue to rise. Most of the plastics are used as disposable items such as plastic syringes, single-use gowns, sterile packaging, etc. due to patient safety, lower cost and convenience. Medical wastes historically have been disposed of in landfills or incinerated. 3: However, world wide environmentalists are beginning to call for a new approach at hospitals that minimizes waste from manufacturing to the disposal. 4: In this context, significantly increased recycling is highlighted as important part of a broader effect to improve hospital sustainability and reduce waste. 5 : Products for the healthcare sector are often of high quality and made from high grade plastics, which makes them even more valuable for recycling. 6: However, despite the fact that there is considerable demand for such high quality plastic waste, the perception that waste generated in hospitals is “dirty” and constitutes a health risk makes people reluctant to use it.
- In nut shell what the benefit?