Zeerust Health Care Waste Autoclave Project

Transcription

1 Zeerust Health Care Waste Autoclave Project presented by Ms. Beauty Mazibuko BAZISA

2 Topics Introduction Overview of the project Purpose Autoclave system Status of the project Infrastructure needs Costs

3 INTRODUCTION Description: Located in the NorthWest Province, close to the border with Botswana Major HCW generators: Zeerust Hospital, 84 beds, 75% occupation rate Lehurutshe Hospital, 105 beds, 75% occupation rate Minor HCW generators: 21 clinics Lehurutshe, Dinokana, Gopane, Motswedi, Barokalalo, Lobatla, Driefontein, Rietpan, Moshana, Supingstad, Mmasebudule, Braklaagte, Ikageleng, Tawiesa, Derdepoort, Welbedacht, Lobatleg, Groot Marico, Lekubu, Paagsdrai HCRW Generation: ~ 220 kg/day About 6 m³ ( tonnes) of waste per week will be generated, Or every two weeks (12 m³/ tonnes)

4 Project area

5 Area of coverage North West RMoiloa District Improved

6 PROJECT PROPONENTS The project is a partnership between BAZISA (South Africa) WEBECO GmbH & Co. Kg (Germany), ETLog EnviroTech & Logistics GmbH (Germany) The Basel Convention Regional Centre (Intergovernmental organization headquartered in South Africa)

7 PROJECT PROPONENTS The company WEBECO has obtained a Grant from the DEG (German bank for development) to implement a pilot project in Healthcare Waste Management in South Africa to demonstrate the economical and ecological advantages of the implementation of integrated waste management and the usage of advanced autoclaving technology for the treatment of infectious waste.

8 PURPOSE Demonstration of the VDV-Autoclave Technology as alternative for problematic burning and incineration Provision of an alternative technology to incineration On site treatment of waste instead of long distance of transporting of waste Vocational training and capacity building on different levels (Training of staff ) Instill proper HCRW handling procedures Implementation of integrated HCW management systems in 2 Hospitals and 21 Clinics Demonstration phase and workshop

9 PROJECT HISTORY Project started in 2004 Stage 1 Identification of suitable area in NW to carry it out Stage 2 Discussions with stakeholders Workshops and meetings Design of facilities Stage 3 EIA and permit application Phase 4 Implementation

10 Introduction Lack of incineration capacity and inadequacy of existing incineration facilities lead to disposal of healthcare waste at general landfill sites, burning or burying at source or incomplete incineration. Lack of resources and attempts to save on disposal costs lead to illegal disposal in open fields or spaces or at general waste disposal sites.

11 Zeerust Prevalent Practices The waste separation system is not widely understood by the waste generators The skill level for managing the waste properly is poor Different kinds of colour coding systems are used in the hospitals and clinics Shortage in the supply of colour coded bags leads to the usage of wrong bags for the collection of the different kind of waste. In some clinics, infectious waste and general waste are collected together. The quality of the plastic bags and sharp containers does not meet the Gauteng standards The lids of the sharp containers do not seal and are easy to open.

12 INFECTIOUS WASTE VOLUMES 75% 25% 19% 1% 1% 3% 1% Household W. Infectious Waste "Sharps" Waste Body parts Chem./Pharmac.W Cyto./Radioact.W. Infectious waste makes up about 85 % of HCRW A bulk of the HCRW will be treated at the facility Environmental benefits and costs saving

13 Healthcare Waste disposal cycle The four main handling steps: Segregation of the waste Collection of the infectious waste Safe treatment by saturated steam Collection for disposal Shredding Landfill

14 PROJECT IMPLEMENTATION COMPONENTS Training Installation Construction Operation Final workshop

15 Characterization of main risk waste Infectious Waste: Biological active, living waste which may contain pathogens Normally will include so called sharp items Storage times are limited (1-7 days, depending on Temp.) Low density waste ( kg/m³), high total volume Task of treatment Target: Complete destruction of all form of microbial life. Accepted: 99,9999% reduction (one millionth survival probability) of the pathogens Recommended treatment methods: Steam treatment (Autoclaving) Oxidation (Hospital waste incineration, T = >800 C

16 AUTOCLAVING Why is steam treatment getting today so popular? Lower cost Relatively straightforward operation Reduced pollutant emissions to the air and to the sewer, the environments is not burdened with toxic products of incineration. Excellent treatment efficacy with proper operation Residuals that are safer than ash but that still look like medical waste Somewhat reduced worker safety hazards Lower (but not zero) operating noise

17 Disinfection versus Sterilization Minimum requirement level for microbial inactivation of infectious waste according to STAATT - Level III: Inactivation of vegetative bacteria, fungi, lipophilic/hydrophilic viruses, parasites and mycobacteria at a 6 Log 10 reduction or greater; and inactivation of B. stearothermophilus spores and B. subtilis spores at a 4 Log 10 reduction or greater (Level IV = 6 Log 10 reduction) Sterilization: Complete destruction of all form of microbial life. Accepted: 99,9999% reduction (one millionth survival probability) = 6 Log 10 reduction of B. stearothermophilus Disinfection: Reduction of microbiological contamination. Accepted: 99,99% reduction (one-ten thousandth survival probability) = 4 Log 10 reduction of B. stearothermophilus

18 AUTOCLAVE FACILITY Delivered at Lehurutshe in September 2004

19 The Treatment plant Steam sterilization autoclave Designed for the treatment of infectious healthcare waste Treatment: Advanced VDV-Cycle, full automatically operation Including air and waste water treatment Chamber size: 439 Liters ( 6 STE) About 40 kg/h capacity (320 kg/d)

20 All WEBECO Sterilizers: Fractionated VSV-Cycle: STERILIZATION PROCESS Treatment efficiency: Sterilization! (10log6) Total removing of the air by several pre-vacuum steps Safe sterilization Drying and cooling down Adjustable treatment cycles Shortest batch times for high utilization of the investment Prevacuum Sterilizing Drying

21 Air Treatment: For the treatment of 1 ton of hazardous waste, 0,24 m³ compressed air is needed This results in about 50 m³ of potentially contaminated exhaust air Usage of first class HEPA Filter PALL filter type EMFLON II 0,02µ Automatic cleaning and sterilization of the filter during the sterilization time for highest lifetime Continues quality check of the filter by pressure with automatic alarm system

22 Waste Water Treatment : Treatment in a completely hermitic special chamber Higher treatment efficiency Protection of the treatment chamber and reduction of maintenance work Safety device Until the sterilization phase is properly concluded, the condensates remain at the bottom of the chamber The door opening is not allowed unless the cycle is ended correctly

23 Monitoring & Control Periodical control: By Bio-indicators Bacillus Subtilis Var.Niger Bacillus Stearothermophilus Bowie-Dick Test Batch control Chemical indicators Indicator strips On-line monitoring Temperature Pressure Time

24 Packaging Infectious waste is collected at the place of generation. The steam sterilizer are able to treat waste in a wide range of packaging: Plastic bags (e.g. PP) Plastic containers (e.g. PS) Plastic bags will be used for this project

25 UTILITIES The plant needs 0.05m³ water per treating hour. Water will be supplied from the outside tap extended to the inside Depending on the kind of waste, up to 120 litre of wastewater will be generated per ton of treated waste 26.4 litre of wastewater will be produced per day The water will not contain any hazardous pathogens and will be discharged to the sewer via a drain The Hospital generator has sufficient capacity for the needs of the hospital and the autoclave.

26 CONTROL MEASURES Waste control at collection and disposal Waste storage guidelines Risk minimization Spillage procedure Infectious waste spillage procedure Safety measures on the vehicles Training for employees and Protective clothing

27 Disposal The autoclaved waste will be shredded & transported to a landfill for disposal There are two suitable landfills Holfontein - hazardous waste site To be used before delisting Rosslyn Closer but only after delisting A waste service provider will transport the waste to the landfill

28 Shredding Autoclaving does greatly alter the physical make-up of the waste. But, the wastes remain recognizable. DWAF has stipulated that the sterilized waste has to be shredded to make it unrecognizable. A biomatic B250 E shredder wil be imported from Germany The shredder has capabilities to shred plastic, glass, metal and bones.

29 PROJECT SPLIT Phase 1 collection system from all the 20 clinics to one central point treatment of the waste by incineration as at present Phase 2 installation of autoclave use of the autoclave facility to treat infectious waste: bandages, sheets etc Incineration for pharmaceutical, pathological, sharps

30 Processes required Completion of an EIA Permit for storage of untreated waste Permit to dispose of shredded waste in a landfill site Permission for discharge of effluent in the sewer system After operation begins: Delisting of the waste for disposal in GSB site Validation of the Technology - CSIR

31 Processes Approval of EIA, Permits from DEAT Installation Testing Phase of the technology Delisting of waste and Validation of technology

32 RESPONSIBLE AUTHORITIES Process Responsible authority EIA North West DACET Application -GTA Permit for storage Permit for disposal Delisting Validation of technology DEAT DEAT/ DWAF DEAT/ DWAF DWAF CSIR for approval by DEAT and DACE

33 INSTALLATION Construction of a small building with three rooms for housing the treatment machine and for storage and cleaning Installation of a steam sterilisation machine Training of relevant hospital staff to operate the treatment machine Adoption of a maintenance plan

34 2.54 m 2.94 m 2 m 3 m 2 m 3 m 5. Clean Container Storage Toilette 4. Container Cleaning Passage 2.5 m 2. Plant Trolley 1.2 m 1. Infectious Waste Storage Sliding Door Garage Door Drain N O S W 3. Skip Input Infectious Waste Rough plant area sketch

35 Storage Storage time in clinics will be 7 days if collection will be performed once a week Storage time of untreated waste delivered to the waste processing facility will be 1-4 hours after delivering The autoclave machine can process 0.4 m3 of waste per cycle. The processing cycle lasts one hour. Capacity of autoclave (at least 6 cycle per working day) A storage area has been specially designed with ventilation to put the waste Tiled Floors sloping at slope

36 IMPLEMENTATION/CONSTRUCTION Local companies will construct the project treatment facility. For erecting the plant the engineer of WEBECO and one local technical assistant will be available. One Worker will operate the treatment facility and the storage. About 5 workers will be involved.

37 INFRASTRUCTURE NEEDS Incoming waste must first be temporarily stored (1) before entering the autoclave machine (2). After waste is treated, the treated waste will be shredded and removed to a 2.5 m³ skip (3) the containers in which the infectious waste was transported and stored will be washed thoroughly (4) and then stored (5) for the next collection process.

38 COSTS Construction of the building Budget for collection and Budget for disposal of treated waste Transportation Disposal fees Budget for operation minimal Salaries, utilities Maintenance (a local company will be trained to carry out the maintainace)

39 Anticipated Benefits The Zeerust district HCRW management system will be a model for other districts in South Africa Each Clinic in the Zeerust District will have a trained person who can implement a basic waste management system People from the relevant authorities will be trained to be to monitor and supervise the hospitals and clinics in the NorthWest Province in regards to integrated HCRW management All infectious waste in the Zeerust district is safely collected, transported and environmentally friendly treated by the advanced autoclave system Occupational accidents (e.g. with blood borne pathogens) are minimized and hospital acquired infections are reduced

40