Академический Документы
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Культура Документы
MARCH, 2005
ACKNOWLEDGEMENT
First and foremost, I would like to express my sincere gratitude and appreciation
to my supervisor, En Mohd Nor Othman for his endless support, invaluable guidance
and critics throughout the project.
Finally, my gratitude goes to my parents and family members who have been
most supportive all the times.
ABSTRAK
TITLE PAGE
DECLARATION ii
DEDICATION iii
ACKNOWLEDGEMENT iv
ABSTRAK v
ABSTRACT vi
TABLE OF CONTENT vii
LIST OF TABLE xi
LIST OF CHART xii
LIST OF FIGURE xiii
LIST OF APPENDIX xv
I INTRODUCTION
1.1 Introduction 1
1.2 Objectives 4
1.3 Scope of Study 5
1.3.1 Organization Structure System 5
1.3.2 Segregation System 5
1.3.3 Documentation System 6
1.3.4 Temporary Storage System 6
1.3.5 Internal and External Transportation System 6
1.3.6 Waste Treatment and Disposal System 7
1.4 Problem Fact 8
II LITERATURE REVIEW
III METHODOLOGY
REFERENCES 85
APPENDIX 87
LIST OF TABLES
2.1 Incinerator 30
4.1 Clinical waste generated in HUKM, Cheras 46
4.2 Biohazard Symbol 47
4.3 Yellow clinical waste plastic bag 52
4.4 Blue clinical waste plastic bags 53
4.5 Sharp container 54
4.6 50 L bag holder 56
4.7 660 L wheeled bin 56
4.8 Small opening for internal transportation of clinical waste 58
4.9 The other side of clinical waste small opening 59
4.10 Front view of temporary storage 61
4.11 The porter taking collected clinical waste to temporary 61
storage
4.12 Vehicle loading with clinical waste in 15 kg 63
wheeled bin
4.13 Side view of vehicle used in external transportations 63
4.14 Loading waste in the wheeled bin into Cart Elevator 68
4.15 Waste loaded into Hopper 68
4.16 Waste collected in Hopper 69
4.17 Waste flow in Charge End Process 69
4.18 Rotary Kiln 71
4.19 SCC Tower 71
4.20 SCC Flow 73
4.21 Waste Heat Boiler 74
4.22 Pollution Control activities 76
xiv
4.23 Pollution Control Area 76
4.23 Lime and Activated Carbon Injection area 77
4.24 Bottom Ash (Slag) 77
LIST OF APPENDIX
INTRODUCTION
1.1 Introduction
Malaysia has experienced phenomenal economic growth in the last two decades.
It has undergone a major structural transformation, moving from agriculture to
manufacturing-based economy, with significant social changes. This rapid development
has brought about significant impacts to the natural environment.
The government has since as early as 1974 taken concrete steps by introducing
an enabling legislation called the Environmental Act 1974. The main objective of this
act is to prevent, abate and control pollution, and further enhancing the quality of the
environment in this country. The Department of Environment has been entrusted to
administer this legislation to ensure that Malaysia will continue to enjoy both industrial
grow and a healthy living environment.
Presently, waste management is one of the most important responsibilities
of local authorities in Malaysia where much money is spent in the disposal of
waste. Growing affluence and increasing population concentration in urban areas
have increased the generation and types of solid waste. A comparison of the increase
in waste generation or several urban areas in Malaysia over the last 30 years is
shown in Table 1.1.
This study is done basically to explain the importance of managing the clinical
waste in a proper way. As stated above, the act and legislation is to guide the people
involved in clinical waste management on doing their work effectively and concerning
about the risk to be faced.
1.2 Objectives
ii) To study the act and legislation with regards to the procedures of
management and disposal of clinical waste.
Segregation starts at the place where the clinical waste is generated until at the
place it will be disposed, internally or externally. Segregation is also done during the
transportation of the waste. In the hospital, every worker who is responsible on waste
segregation has to make sure all the clinical wastes were put into yellow bin. For the
sharps, it is placed in drum container. The bin and drum container must be tightly
covered and when it is three quarter full, it should ready to be disposed.
1.3.3 Documentation System
The source of every bin and container must be recognized to trace if there is any
spills or over limit of waste. Labeling and documentation is done in certain way. For
example, by writing down to the bag or container, using adhesive tag etc.
Every single bin and container containing clinical waste will be moved out from
where it is generates. Usually, trolley and minivan is used in internal and external waste
evacuation. This vehicle shall be reserved only for transportation of clinical waste. It
should thoroughly clean and disinfected immediately following any spillage or
accidental discharged. Plus, the internal transport routes shall be designed to minimize
the passage of waste through patient care areas and other clean areas.
1.3.6 Waste Treatment and Disposal System
An evaluation on choosing the right place for disposal and right method for
treatment is needed to optimize effectiveness and safety. The evaluation covers some
aspect such as technology, environment, economy and geography.
The most common problem related to the management and disposal of hospital
or clinical waste is money. Just because of budget constraint, the importance of
management and disposal of hospital or clinical waste was ignored. Sometimes, lack of
awareness also contributes to the problem.
The main objectives in this study are to make sure the management and disposal
of clinical waste is in good condition plus to fulfill the act that relates to it. Besides that,
observation on important elements of management and disposal of hospital or clinical
waste is observed.
CHAPTER II
LITERATURE REVIEW
For many years, health workers, hospital administrators, and other health related
professionals have understood the necessity to protect themselves, their
employees/members, and the public from exposure to wastes that might be reservoirs of
diseases-transmitting organism.
In 1982, the recommendation from Health and Safety Commission London, The
Safe Disposal of Clinical Waste, clinical waste is defined as: Waste arising from
medical, nursing, dental, veterinary, pharmaceutical or similar practice, investigation,
treatment, care, teaching or research which by nature of its toxic, infectious or
dangerous content may prove a hazard or give offence unless previously rendered safe
and inoffensive. Such waste includes human or animal tissue or excretions, drug and
medical products, swabs and dressings, instruments or similar substance or materials.
(Collins,1991)
Pathological waste consists of tissues, organs, body parts, human fetuses and
animal carcasses, blood and body fluids. Within this category, recognizable human or
animal body parts are also called anatomical waste. This category should be considered
as a subcategory of infectious waste, even though it may also include healthy body
parts.
2.2.3 Sharps
Sharps are items that could cause cuts or puncture wounds, including needles,
hypodermic needles, scalpel and other blades, knives, infusion sets, saw, broken glass,
and nails. Whether or not they are infected, such items are usually considered as highly
hazardous health-care waste.
Table 2.1: Most common genotoxic products used in health care premises
Classified as carcinogenic
Chemicals:
Benzene
Radioative substances
Chemical waste consists of discarded solid, liquid and gaseous chemicals, for
example from diagnostic and experimental work and from cleaning, housekeeping, and
disinfecting procedures. Chemical waste may be hazardous or nonhazardous; in the
context of protecting health, it is considered to be hazardous if it has at least one of the
following properties:
i) Toxic;
ii) Corrosive (e.g. acids of pH < 2 and bases of pH >12
iii) Flammable;
iv) Reactive (explosive, water reactive, shock-sensitive)
v) Genotoxic (e.g. cycostic drugs)
Photographic fixing and developing solutions are used in X-ray department. The
fixer usually contains 5-10% hydroquinone, 1-5% potassium hydroxide, and less than
1% silver. The developer contains approximately 45% glutaraldehyde. Acetic acids
used in both stop baths and fixer solution.
2.2.9 Solvent
Waste inorganic chemicals consist mainly of acids and alkalis (e.g. sulfuric,
hydrochloric, nitric, and chromic acids, sodium hydroxide and ammonia solution).
They also include oxidants, such as potassium permanganate (KMnO4) and potassium
dichromate (Kr2Cr2O7) and reducting agents, such as sodium bisulphate (NaHSO3) and
sodium sulfite (Na2SO3).
Many types of gas are used and are often stored in pressurized cylinders,
cartridges, and aerosol cans. Many of these, once empty of no further use (although
they may contain residues), are reusable, but certain types.
Anaesthetic gases:
Ethylene oxide:
Oxygen:
Compressed air:
Ionizing radiation cannot be detected by any of the senses and usually cause no
immediate effects unless an individual receives a very high dose. The ionizing of
radiations of interest in medicine includes the X-rays, - and - particles, and - rays
emitted by radioactive substances. An important practical different between these types
of radiation is that X-rays from X-rays tubes are emitted only when generating
equipment is switch on whereas radiation from radionuclides can never be switched off
and can be avoided only by shielding the material.
The sources of clinical waste can be classed as major or minor according to the
quantities produced. The major sources are listed in Table 2.1
While minor sources may produce some clinical waste in categories similar to
clinical waste and their compositions will be different. For example:
Hospitals
University hospitals
General hospitals
District hospitals
Clinical waste
Hazardous Non-Hazardous
Hazardous
Plastic Non-Plastic
Blood, body,
Disposables Cotton, gauze fluids, secretions
Syringes dressings and excretions
IV sets, contaminated with
catheters blood, purulent
ET tube exudates
2.4 Important elements of managing clinical waste
i) Identification of waste
ii) Segregation
iii) Labeling and documentation,
iv) Internal and external transportation
v) Temporary storage
vi) Treatment technique
vii) Disposal of treated clinical waste
Every generated waste in hospital must be identified depends on its sources and
level of hazards. Basically, two most generated wastes in hospital are clinical waste and
kitchen waste. The health-care workers must identify each waste and separate it. This is
because each waste needs to be disposed in different ways.
Clinical waste should be in package in order to protect waste handlers and the
public possible injury and disease that may result from exposure to the waste. In daily
practice, the selection of packaging materials is important and appropriate. For
example, plastic bags for many types of solid or semisolid waste and puncture-resistant
containers for sharps. For liquid-base waste, bottles, flasks, or tanks is used.
Labelling can be done in a number of ways such as writing the information on
the bag or container, using pre-printed self-adhesive address labels supplied on a peel-
off roll, tie-on tag label and self-locking plastics tags. In terms of labeling, all bags and
drum containers must be identified at the point of production and should be indelibly
and clearly marked with biohazard symbol. An inventory provides an accurate and up-
to-date record of quantities and categories of clinical waste being generated, treated and
disposed off.
Most modern clinical waste incinerators operate on controlled air using two
chambers. The primary chamber, into which the waste is fed, operates with restricted
air flow at 1600 to 1800F. The waste is pyrolized, and the volatiles move to a
secondary chamber where they are combusted at 1800F or higher temperature. Excess
air is provided, in the secondary chamber, to ensure complete combustion. Ash is
moved through and exist the primary chamber by the use of hydraulic rams or other
feed devices.
Advantages Disadvantages
Maximum volume weight Noncombustibles not reduced in
reduction volume (ash, metal, etc)
Disposal refers to the final placement of treated waste on the land, using a
sanitary landfill or any other environmentally acceptable method of final storage
appropriate to the local conditions. Waste disposal are important for sharps, waste-
requiring incineration, waste that not be incinerated and radioactive waste. Incineration
of clinical waste will form the formation of CO2, H2O, SOx, POx, HF, HCl, HBr, I2.
Also present are metal oxides and traces of unburnt waste.
Much attention is directed toward concentrations of oxides of nitrogen (NOx)
and sulphur (SOx), hydrogen chloride, particulates, dioxin and furan in the gaseous
emissions from clinical waste incinerators (Blenkarn, 1995).
The ash and other residue from the incinerator are to render harmless before
final disposal. These wastes are also classified as schedule wastes and have to be
managed as stipulated in the Environmental Quality (Scheduled Waste) Regulation
1989.
In Malaysia, there are some acts related to clinical waste. The Department of
environment of Environment (DOE) is empowered under the Environmental Quality
Act 1974 to control and prevent pollution and to protect and enhance the quality of the
environment.
i) Waste generators
ii) Waste contractors
iii) Waste disposal site operators
METHODOLOGY
To achieve the objectives of this study, a variety of method are used. Besides
that, to get the best information, one has to experience every step from where the waste
is generate to where it will be disposed.
Main data is defined as data from the study done. In order to get the information
related to clinical waste, two basic methods are used.
Department of Engineering HUKM and Radicare (M) Sdn Bhd is the main
source of information about management and disposal of clinical waste. Every section
of the department has it own specialties. By visiting, data on background of clinical
waste management system, number of disposal sites, transportation method, health
worker involved can easily found and understood.
A visit to Radicare (M) Sdn Bhd incinerator located at Teluk Panglima Garang
and waste disposal site at Kualiti Alam Sdn. Bhd. located at Bukit Nenas, Port Dickson,
Negeri Sembilan is done. This dispoal sites is the final place for disposal clinical waste
in order to practice the safe disposal method.
3.2.1.2 Interview
Interviewing method is used because it is the best method of getting the correct
data. Other method such as questionnaire is not appropriate for this study because it is
not very effective since number of health-worker in Radicare (M) Sdn Bhd is small.
Beside that, by using questionnaire, problem of getting responses can occur.
All the data is arranged, processed and analyzed for making some good
recommendations on management and disposal of clinical waste. Further more, data
analyzing is important to achieve the objectives that were set earlier.
From the observation and study that will be done later, it is expected that the
management and disposal of clinical waste at Hospital Universiti Kebangsaan Malaysia
(HUKM) be in good condition. This is because; this newly established hospital is
expected to have latest and absolutely efficient technology.
a) Supply of consumables
b) Wheeled bin for central storage and transportation
c) Collection and transportation of clinical waste on daily basis or as
required
d) Provide dedicated vehicle
e) Incineration plant
f) Consignment note
HUKM is one of the teaching hospitals in Malaysia that provides secondary and
tertiary treatment service. Same as PPUM and HUSM, HUKM also provides the best
medical services. Besides, HUKM is one of the first hospitals in Malaysia using
information technology approach entirely in its operation. This hospital is complete
with the capacity of 1054 bed, 700 medical students and 600 postgraduate students.
Located at Jalan Tenteram, Cheras; HUKM is built on 55 acres land is the new
campus for Faculty of Medical UKM that replace the old campus at Hospital Kuala
Lumpur (HKL)
Their responsibility in each ward and clinic is to remind the medical personnel,
technical personnel and nurses the awareness on managing clinical waste.
Radicare (M) Sdn Bhd Supervisor is the officer send by their company and
responsible directly on daily clinical waste management. He must take care on every
porters activity on collection, loading to temporary storage. Plus, he is responsible on
safety steps taken for any emergencies and ordering consumables from his company main
office.
Chart 4.1 : Clinical Waste Management Service for Radicare (M) Sdn Bhd
Organisation Chart
Organization
Clinical Waste Management Services
Wards Clinics
Pediatric Ward 1, 2 and 3 Ear, Nose and Throat Clinic
(ENT Clinic)
A & E Ward Oftalmology Clinic
Orthopedic Ward Endoscopy Clinic
Trauma Ward
PICU Ward
Basically, every ward and clinic in HUKM will generate the same type of waste.
The two most generated waste are ordinary clinical waste and household waste. Clinical
waste are generated by the health worker such as doctors and nurses. Household waste
comes from other sources, for example food waste from patients and visitors who come
for the purpose of visiting the patients and food wrappers.
23000 22590.96
22074.86 21985.02
22000 21652.51
21360.91
20953.48
Waste Generated ( kg )
21000
20263.84
20000 19670.2
19195.25
19000
18000
17000
JANUARY MARCH MEI JULY SEPTEMBER
Months in 2004
From the interview, it is known that segregation is the most important element
in managing clinical waste. By adding the clinical waste and household waste together,
the waste status will change to clinical waste and have to be treated exactly as clinical
waste. This is stated under Environment Quality Act (Scheduled Waste) 1989.
Furthermore, this practice will only increase the fee for the waste treatment.
Segregation process started when used clinical equipment are thrown away. The
basic clinical wastes generated in every ward and clinic at HUKM are used syringe,
cotton, gauze, dressings contaminated with blood, purulent exudates and IV sets.
Equipment used for clinical waste in wards and clinics is yellow in colour with
biohazard logo printed on it. They are pedal bin, wheeled bin, sanitary bin, plastic bag
and sharp container. The location of the equipment is different depending on demand
and suitability.
They are also responsible to make sure that the clinical waste capacity of each
plastic is three quarter full. After that, it is the porters responsibilities to seal it in a
proper way. In manual clinical waste operation, the opening of each the equipment
must be in the condition where it is easy to enter the waste. Besides, in any situation,
the operation with the equipment must only be done by the handle or neck. Less manual
operation on plastic bags of clinical waste is preferred.
Every full plastic bags containing clinical waste should be sealed using ordinary
plastic band or by usual tie-up. It is forbidden to use stapler for sealing the plastic bags
because of the piercing action onto the plastic bags. Plus, it will contribute to odor
problem.
The main duty of the porters is to carry and collect each of the full plastic bag.
After collecting, it is their duty to provide new plastic bags at the bin. Size of the
plastics provided varies according to the source of waste generated. The best location
for temporary storing is the place nearest to where it is generated. It is a good practice
to place clinical waste far from public passages.
At HUKM, Radicare (M) Sdn Bhd has provided eight porters consisting of six
men and two ladies for this duty at the location according to their daily duty. Collection
is done three times a day. They begin carrying and collecting at 8.30 a.m. Then they
continue at 2.30 pm and 6.00 pm. Collection frequency depends on the need and
demand.
The use of plastic bags is considered the most convenience and cheap in clinical
waste management. As mention earlier, plastic bags is only for non-sharp waste. The
plastic bags used by RMSB fulfill the required standard in BS 6642 : 1985;
Specification for Disposable Plastic Bags From Polyethylene Material.
a) The plastic bag thickness is at least G 225 (55micron) for less density
waste and at least G 100 (25 micron) for higher density waste.
b) The plastic bag from high density polyethylene and not easily punctured.
c) The plastic bags must hold to autoclaving process
d) The plastic bags must yellow in colour
e) For clinical waste that will be disposed using incineration technique,
every plastic bag is printed clearly with SISA KLINIKAL UNTUK
DILUPUSKAN MELALUI PENUNUAN/ INCINERATOR together
with BAHAYA.
f) KEMENTERIAN KESIHATAN MALAYSIA sign must also be
printed clearly.
g) Standard infectious/clinical waste sign must also be printed where the
symbol of three crescents arranged overlapping a black circle with white
background. The size of every biohazard symbol must not be less than
50mm x 50mm.
The examples of waste that use autoclaving bags are human tissue from surgery
ward, placenta from labour room and waste infectious disease treatment. Standard
infectious/clinical waste sign must also be printed where the symbol of three crescents
arranged overlapping a black circle with white background. The size of every biohazard
symbol must not be less than 50mm x 50mm. KEMENTERIAN KESIHATAN
MALAYSIA sign must also be printed clearly.
This bag must in light blue colour and transparent. The thickness of each plastic
is 55 micron and can hold out the temperature of 132 degree Celsius and not easily
punctured. It will go through autoclaving process.
4.2.2.3 Method of using clinical waste plastic bags
in suitable sharp containers, which should be sealed when full and enclosed in a yellow
clinical waste bag before collection and disposal. Plastics or other fiber material makes
sharp container together with plastic lining outside it. It comes with different sizes of
2.5 L, 5 L, 10 L and 20 L.
a) The container must have handle and the location of handle must not
interfere when using it.
b) The container must have high durability, puncture-proof, and leakage- proof
whether in upside down condition.
c) Can be taken away without feeling anxious the waste may spill or come out.
d) The opening must close tightly and safely when the waste has reached three
quarter full of the container as marked outside the container.
e) The opening must close tightly during transportation
f) The container material can be burned in the incinerator with biohazard logo
printed outside it.
4.2.2.5 Pedal bins, 15 kg wheeled bins and 660 liter wheeled bins
A pedal bin is a kind of bin where it has foot pedal to open the bin cover. The
porter provides the bin with yellow plastics. The (3) three basic pedal bins situated in
every HUKM wards and clinics are 20 L bag holder, 50 L bag holder and 20 L sanitary
bin.
The 15 kg wheeled bins and 660 liter wheeled bins are always used together
for transportation purposes. When on duty, every porter will bring 660 liter wheeled
bins to the ward and clinics. After it is full, the porter should bring down the bins to
Radicare (M) Sdn Bhd situated at HUKM to transfer the collected clinical waste into
the 15 kg wheeled bins for weighing process.(APPENDIX A)
Figure 4.6 : 50 L bag holder
The next step of managing clinical waste is transportation. It can be divided into
two types, internal transportation and external transportation. External transportation
will be discussed later on the next sub-section.
Radicare (M) Sdn Bhd has enough equipment for this purpose. The equipment
use for internal transportation is 660 liter wheeled bin. This wheeled bin is covered to
protect the porters and public from waste spills and smelly odour. The porters are
responsible to collect clinical waste from every ward and clinics in HUKM. For
example, the collection at pedal bin that is located in every corner of the ward and the
clinical equipment store next to the ward.
The porter starts their duty by entering every ward or clinic according to their
weekly duty rosters. With complete facemask, apron, gloves and shoes, the porter will
collect clinical waste in pedal bin and sharp containers. After that, they will gather all
yellow plastic bags and sharp containers in one storeroom at the same level of the
building.
The storage is placed far from canteen, other stores, and public passage. It also
must also have good air circulation. This area must always remain locked when no
clinical waste storage activity happen. For transportation purposes, the storage must
easily entered by the vehicle that will specially transport it to the incinerator located at
Teluk Panglima Garang, Selangor.
Before deciding the dimension of temporary storage, there are some factors to
be considered. The collection frequency is the most important. In HUKM, Radicare (M)
Sdn. Bhd have decided that clinical waste collecting activity starts at 8.30 a.m., 2.30 pm
and 6.00 pm daily. Other considerations made on clinical waste temporary storage are
number of public holiday weekly and probability of having difficulties in collection.
Radicare (M) Sdn. Bhd had provided a large storeroom for this purpose. Storage
capacity is for 3 days of collection and minimum of 2 days for storage. The container is
locked to make sure that the wheeled bin is safe while waiting for transportation to
incinerator. It can store up to 40-wheeled bin with capacity of 15 kg of each bin. In
order to prevent bacteria from breeding and odor problem, the container is installed
with air conditioned system. The temperature is maintained at 4 to 6 degree Celsius.
Outside of the container is marked by biohazard symbol and N-261 as waste category.
It is the porters duty to clean the container weekly. Radicare (M) Sdn Bhd has
provided all equipment for cleaning and personal protective equipment (PPE) such as
gloves, safety boots, apron and mask if any leakage happened during the storage.
Figure 4.10 : Front view of temporary storage
Figure 4.11 : The porter taking collected clinical waste to temporary storage
4.2.5 External Transportation
In HUKM, Radicare (M) Sdn Bhd will send a vehicle from the incinerator plant
located at Teluk Panglima Garang, Selangor to collect clinical waste daily. The vehicle
will come to Radicare (M) Sdn Bhd branch in HUKM at 11.00 am. The driver will
bring along empty 15 kg wheeled-bin. After arriving to HUKM, the driver will unload
the empty wheeled-bin. After he had finished, the porter unloads the wheeled bin from
the temporary storage.
The time taken to deliver clinical waste from HUKM to Radicare (M) Sdn Bhd
incinerator at Teluk Panglima Garang, Selangor is 45 minutes. There are several
guidelines for the driver when delivering the clinical waste.
Consignment note records the details of the waste generator (HUKM), the
transport contractor and the final receiver (Radicare (M) Sdn Bhd) together with the
information on the clinical waste being transported. An inventory provides an accurate
and up-to-date record of the quantities and categories of clinical wastes being
generated, treated and disposed of. The respective parties should retain the record for a
period of three years.
The consignment note or form is design to record the name of the hospital,
name and signature of the officer who responsible in the hospital, quantity of waste
generated, name of driver and signature. The steps on consignment note procedure in
hospital level are:
a) In every collection done by the driver, the clinical waste weight must be
calculated and recorded in consignment note. It must be filled in 7
(seven) copies where a copy is kept by HUKM, a copy to Ministry of
Health, a copy to Department of Environment and balance of 4 (four)
copies are taken by the driver to the incinerator (Radicare (M) Sdn Bhd)
b) After arriving at the incinerator, every information on the consignment
written down on the consignment note will be signed by the incinerator
operator. The operator should return back a copy to the driver.
c) After all the waste is disposed at Kualiti Alam Sdn Bhd, the operator
will send a copy to Department of Engineering at HUKM, Department
of Environment and a copy for record at the incinerator
The information of consignment will be used by Radicare (M) Sdn Bhd to get
monthly statistics for annual report or for any future planning. Example of consignment
note is in Appendix C.
4.3 CLINICAL WASTE TREATMENT AND DISPOSAL
Next, the ash and other residues comprising mainly deformed metallic such
blades, scalpel and needles from the incinerator are to render harmless before final
disposal. These wastes are also classified as schedule wastes and have to be managed as
stipulated in the Environmental Quality (Schedule Waste) Regulation 1989.(Lee, 2001)
The incineration system used in Radicare (M) Sdn Bhd in Teluk Panglima
Garang is Rotary Kiln with Waste Heat Boiler Incinerator. It started operation in
1998 with a cost of RM 17.2 million. It is controlled automatically with combustion
capacity of 500 kg/hr or 12 ton/day. This total up to 7000-8000 kg of waste treated
daily. In daily operation, this incinerator plant is operates 24 hours a day with 3 shift of
group worker.(RMSB,2004)
If it is practiced correctly, it can destroy all pathogenic microorganisms and
harmful gaseous. It was admitted from the clinical waste disposal practitioner that
incineration is the best-disposed method if the plant is well built and operate at very
high temperature as suggested.
Basically, the incinerator in Teluk Panglima Garang has four different stages
(APPENDIX B). Each of the stages is designed to convert solid waste into gaseous,
liquid and solid while reducing environmental impact of the incinerator. The stages are:
The first step is where the workers load the 15 kg wheeled bins that contain
clinical waste into skip loader. Only two bins can enter in one time. Then, the waste is
discharged into hopper. The feed conveyor is then used to move the waste into ram
feeder. After that the ram head will push the waste into rotary kiln for incineration.
Figure 4.14 : Loading waste in the wheeled bin into Cart Elevator
Figure 4.15 : Waste loaded into Hopper
Figure 4.16 : Waste loaded in Hopper
Skip Elevator
Hopper
Rotary Kiln
Guillotine door
Burner
Ram feeder
PCC is using Rotary Kiln for the first incineration stage. The retention time of
gas waste is 1 second and solid waste is an hour. Rotary Kiln is insulated with castable
or fire brick that can hold the temperature of 760C to 900C. To complete the
combustion, 130% to 150% of excess air is required. This combustion chamber uses
diesel as fuel. Final product of PCC is Bottom Ash. It will be send to Kualiti Alam Sdn
Bhd (KASB) for final disposal. Waste gas from PCC will be treated through SCC to
disperse dioxin and furan at 1000C.
SCC
Gas Phase
Gas phase
Burner Incineration
Waste Solid Phase (Slag)
Bottom Ash
Rotary Kiln
SCC
Bottom Ash
In this stage, hot air from SCC-Down Leg will enter Waste Heat Boiler. Waste
Heat Boiler is a cooling media to reduce the temperature of hot air. Radicare (M) Sdn
Bhd incinerator uses excess steam from this stage to wash wheeled bins as a waste
reuse approach.
Figure 4.21 : Waste Heat Boiler
Air containing toxic and acid gas from Heat Recovery Stage is treated using
powdered lime and carbon. Hydrated powder lime, Ca(OH)2 will neutralized acid gas in
recommended reacting temperature of 160C to 180C. Activated carbon is used to treat
heavy metal content. The chemical reaction is stated below
Fly ash is the side product of this stage and the final product is clean gas. The
air emission standards imposed by the Department of Environment are shown in Table
4.5
Table 4.5 : Air Emission Standards for Clinical Waste Incinerator.
Parameter Standard
Smoke emission Ringleman Chart No. 1
Particulate 0.2 g/Nm3
Dioxin and Furan 0.1 ngTEQ/Nm3
Sulphiric Acid 0.1 gSO3/Nm3
Chlorine 0.2 g HCl/Nm3
Hydrochloric Acid 0.1 g/Nm3
NOx 2.0 gNo2/Nm3
Arsenic 0.025 g/Nm3
Cadmium 0.015 g/Nm3
Mercury 0.01 g/Nm3
Source : DOE
All ashes are collected through Bag House Filter before releasing the gas to the
atmosphere. The ash produced is considered as schedule wastes and need to be
disposed at a licensed facility. Then, the collected ashes are send to Kualiti Alam Sdn
Bhd.
Bag House
Filter bags
Ash
Radicare (M) Sdn Bhd (RMSB) has signed an agreement with Kualiti Alam Sdn
Bhd (KASB) for disposal of bottom ash (slag) from incinerator. KASB was
incorporated on 9 December 1991 and becomes Malaysias first integrated waste
management system centre. The integrated project with the capital cost of RM 300
million will manage variety of hazardous waste including clinical waste in Malaysia.
The company is having special rightful authority for 15 years of operation.
(APPENDIX D). Some of the facilities in KASB located at Bukit Nenas, Negeri
Sembilan are incinerator, physical-chemical treatment plant, leachate treatment plant,
stabilize pond, secured landfill, disposal and movement of schedule waste especially in
Malaysia using licensed mechanism and information system of consignment.
However, when the system has been fully implemented, it might be feasible
both economically and in terms of safety to establish secure landfills in other states. For
the collection of wastes from areas futher away from the integrated facility, collection
(transfer) stations will be established. The collection stations are located at Johor, Pulau
Pinang and Terengganu. By sitting the collection stations in the major toxic waste
producing areas, the transport distance from the waste generators to the collection
stations will be reduced. (APPENDIX E)
4.3.2.2 Secure Landfill of KASB
The slag or bottom ash arrived from RMSB incinerator at KASB will be
disposed at secure landfill. Secure landfill is the final destination for every schedule
waste such as metal hydroxide sludge, used catalyst, asbestos waste, mineral sludge,
other less dangerous schedule waste, fly ash or residue and slag form incineration.
Two types of landfill in KASB are secure landfill and asbestos landfill. Every
waste buried here is in solid or semi-solid according to Department of Environment
Malaysia. It is well designed to prevent any pollution to water table by using 1 meter
thick of compacted clay layer. The compacted clay is layered with Geomembrane High
Density Polyethylene (HDPE) and Geonet. The drainpipe system is used to collect
leachate to retention pond. Leachate from the retention pond must comply Standard B,
Third schedule, Environmental Quality (Sewage and Industrial Effluents) Regulation
1979.
Types of ash packaging from RMSB incinerator are plastic bags. Below are the
method practiced in KASB for disposal.
i) Stabilized waste is covered with clay after the waste layer reached 2
meter high.
ii) After each cells became full, it must be covered with geomembrane liner
that can prevent infiltrate water. At the top of geomembrane is layered
with soil for the purpose of growing herbaceous plant to prevent erosion.
iii) Separate drainage system for collecting rain is built around secure
landfill.
iv) Slope landfill area is needed for runoff flowing to retention pond.
v) Leachate at any liner must not exceed 30cm from the liner level.
CHAPTER V
5.1 Conclusions
From the observation made by site visiting, explanation and interview whether
from the hospital or incinerator, a conclusion can be made. The management and
disposal of clinical waste is good condition.
Every personnel that is responsible for clinical waste management know their
responsibility and scope of work. They have attended several courses by Radicare (M)
Sdn Bhd (RMSB) on handling clinical waste and they must wear apron, gloves, mask
and safety shoes while at work. For safety purposes, they are given immunization
vaccination on tetanus, hepatitis A, hepatitis B, cholera and polio.
Collected clinical waste from wards and clinics is stored in temporary storage
located near RMSB branch office at HUKM. The storage is air conditioned and
complete with weighing equipment for clinical waste. It is also complete with cleaning
material for any spillage in or outside the temporary storage. It complies with the
Ministry of Health regulations.
RMSB is applying Manifest System in documentation system of clinical
waste by using consignment note. The main reason of using the system is to make sure
all the amount of waste arrived at RMSB incinerator is the same amount of waste
generated in HUKM. Information on each consignment note is important for future
references.
5.2 Recommendations
Hence a case study is suggested on Tongkah Medivest Sdn Bhd, a company that
manages clinical waste in southern region of Peninsular Malaysia consisting on Negeri
Sembilan, Melaka and Johor. A consideration between privatized, half privatized or
government hospital in this region is preferred..
REFERENCES
Frank L. C Jr, Howard E.H and Rykowski P.K (1990), Infectious Waste
Management. Technomic Publishing Co Inc, 18-19
J.I Blenkharn, (1995), The Disposal of Clinical Wastes, Journal of Hospital Infection
1995, Department of Infectious Diseases and Bacteriology, Royal Postgraduate
Medical School: 514-520.
Types of
Purposes Location Capacity
Equipment
Sharp container - Special container for sharps - Special store - 4 different sizes
i.e syringe next to the i) 2.5 L
- Is a disposable container that ward ii) 5.0 L
will burn straight away after it iii) 10.0 L
is full iv) 20.0 L
Wheeled Bin During waste picking-up - Store - 15 kg load
process, waste
in from every ward and
department were
put in it. Then it goes to
weighting
process.
Sanitary bin - Bin for used sanitary napkins -In toilets - Medium size to
corner large
Ordinary bin - Yellow in colour - in corners at - Multiple sizes
with lid - For disposal of other than every ward and
sharps i.e. cotton, rubber surgery room
gloves
Bag holder/ -Yellow plastic with - in bins - 3 different sizes
yellow bag biohazard symbol i) 5L
- A layer to the bins for ii) 30 L
making it easier to handle iii) 100 L
Autoclave Bag - light blue - 30 L
- sterilized in autoclave
machine for 24 hours
before disposed to
incinerator
APPENDIX B Stages of Rotary Kiln incinerator