A SEMINAR REPORT ON

TREATMENT OF INFECTIOUS BIOMEDICAL WASTE

Submitted In partial fulfillment of the award of degree of Masters of technology In Environmental engineering (Civil engineering)

SUPERVISED BY:
Dr. A.B. GUPTA Professor Civil Engg. Dept.

SUBMITTED BY:
ISHITA KHAZANCHI M.Tech (Env. Engg. ) 2009 PCE120

Department Of Civil Engineering MALVIYA NATIONAL INSTITUTE OF TECHNOLOGY JAIPUR-302017

CERTIFICATE

This is to certify that the seminar entitled TREATMENT OF INFECTIOUS BIOMEDICAL WASTE, which is submitted by Ishita khazanchi, in partial fulfillment for the award of the degree of masters of technology in environmental engineering (civil engg.), MNIT, Jaipur is a bonafide work done by her under my guidance and supervision.

Dated:

Dr. A.B.Gupta Professor Dept. of civil engg. MNIT, Jaipur

ACKNOWLEDGEMENT

I wish to acknowledge immense pleasure to express my deep sense of gratitude to Dr. A.B.Gupta, professor and Dr. Sanjay Mathur, associate professor in Civil Engg, Dept., Malviya National Institute of technology, Jaipur for their valuable guidance, inspiration and support in preparing this seminar report. I am very thankful to my colleagues for their kind support and help. Final thank goes to my parents and friends for their continuous support and encouragement.

Date:

Ishita Khazanchi

CONTENTS

1. INTRODUCTION 2. LITERATURE REVIEW Biomedical waste- An overview Rules for BMW Infectious waste 3. TREATMENT OPTION FOR INFECTIOUS BIOMEDICAL WASTE 3.1 Incineration 3.2 Autoclaving 4. CONCLUSION 5. REFERENCES 6. ANNEXURE

6-7 8-12 12-13 13

14-27 27-29 30 31-32 33

LIST OF TABLES
TABLE 1: Categories of Biomedical Waste and their Treatment and Disposal TABLE 2: Colour coding of biomedical waste TABLE 3: Typical pollutants from BMW Incinerators TABLE 4: Fuel consumption (l of LPG/kg of waste) TABLE 5: Medical equipment made of plastic TABLE 6: List of autoclavable items 9-11 12 18 26 26 28

LIST OF FIGURES
Fig. 1 Continuous feed mass fired incinerators for BMW treatment Fig. 2.Time history record of temperature evolution over a charging cycle in the PCC Fig. 3.Correlation between T1 and T2 for 5 kg feed at 500 C charging temperature 24 24 17

INTRODUCTION
Medical care is vital for our life, health and well being. But the waste generated from medical activities can be hazardous, toxic and even lethal because of their high potential for diseases transmission. The hazardous and toxic part of waste from health care establishments comprising infectious, bio-medical and radio-active material as well as sharps (hypodermic needles, knives, scalpels etc.) constitute a grave risk, if these are not properly treated/disposed or is allowed to get mixed with other municipal waste. Its propensity to encourage growth of various pathogen and vectors and its ability to contaminate other nonhazardous/ non-toxic municipal waste jeopardizes the efforts undertaken for overall municipal waste management. The rag pickers and waste workers are often worst affected, because unknowingly or unwittingly, they rummage through all kinds of poisonous material while trying to salvage items which they can sell for reuse. At the same time, this kind of illegal and unethical reuse can be extremely dangerous and even fatal. Diseases like cholera, plague, tuberculosis, hepatitis (especially HBV), AIDS (HIV), diphtheria etc. in either epidemic or even endemic form, pose grave public health risks. Unfortunately, in the absence of reliable and extensive data, it is difficult to quantify the dimension of the problem or even the extent and variety of the risk involved. With a judicious planning and management, however, the risk can be considerably reduced. Studies have shown that about three fourth of the total waste generated in health care establishments is non-hazardous and non-toxic. Some estimates put the infectious waste at 15% and other hazardous waste at 5%. Therefore with a rigorous regime of segregation at source, the problem can be reduced proportionately. Similarly, with better planning and management, not only the waste generation is reduced, but overall expenditure on waste management can be controlled. Institutional/Organizational set up; training and motivation are given great importance these days. Proper training of health care establishment personnel at all levels coupled with sustained motivation can improve the situation considerably. The rules framed by the Ministry of Environment and Forests (MoEF), Govt. of India, known as Bio-medical Waste (Management and Handling) Rules, 1998, notified on 20th July 1998, provide uniform guidelines and code of practice for the whole nation. It is clearly mentioned in this rule that the occupier (a person who has control over the concerned institution / premises) of an institution generating bio6

medical waste (e.g., hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood bank etc.) shall be responsible for taking necessary steps to ensure that such waste is handled without any adverse effect to human health and the environment. An average of 1-2 kg of waste is generated per bed per day in a hospital in India while the hospital in the western countries produces 3-5 kg respectively. It is estimated that annually about 0.33 million tones of bio- medical waste is generated in the country. The improper management of bio- medical waste causes serious environment problems in terms of air, water and land pollution. Environment problems can arise due to the mere generation of bio-medical waste and from the process of handling, treatment and disposal. A study conducted by the WHO in 1996, reveals that more than 50,000 people die everyday from infectious disease. One of the causes for the increase in infectious disease is improper waste management. Environmental Concern The following are the main environmental concerns with respect to improper disposal of bio-medical waste management: Spread of infection and disease through vectors (fly, mosquito, insects etc.) which affect the in -house as well as surrounding population. Spread of infection through contact/injury among medical/non-medical personnel and sweepers/rag pickers, especially from the sharps (needles, blades etc.) Spread of infection through unauthorized recycling of disposable item such as hypodermic needles, tubes, blades, bottles etc. Reaction due to use of discarded medicines. Toxic emissions from defective/inefficient incinerators. Indiscriminate disposal of incinerator ash / residues.

LITERATURE REVIEW
Bio-Medical Waste - An Overview
Bio-Medical Waste is any waste generated during the diagnosis, treatment or immunization of human beings or in research activity [1]. The waste produced in the course of health care activities carries a higher potential for infection and injury than any other type of waste [2]. Bio-Medical waste generated in the hospital falls under two major Categories Non Hazardous and Bio Hazardous. Constituents of Non Hazardous waste are Non-infected plastic, cardboard, packaging material, paper etc. Bio hazardous waste again falls into two types (a) Infectious waste- sharps, non sharps, plastics disposables, liquid waste, etc. (b) Non infectious waste-radioactive waste, discarded glass, chemical waste, cytotoxic waste, incinerated waste etc. Infectious waste includes pathological waste, cotton, dressing, used needles, syringes, Scalpels, blades, glass, etc. and non-infectious waste includes general waste from the kitchen / canteen, packaging material. Approximately 85% to 90% of the waste generated in hospitals is non-infectious (free from microbes and has not been in contact with any body fluids, which is similar to domestic waste). It is the remaining 10% to 20% of waste that is of concern because it is hazardous and infectious (CPCB 2000) to humans or animals and deleterious to environment. It is important to realise that if both these types are mixed together then the whole waste becomes harmful.[3] Major hospitals contribute substantially to the quantum of Bio-Medical waste generated.Smaller hospitals, nursing homes, clinics, pathological laboratories, blood banks, etc also contribute a major chunk.

Sources of Generation of BMW

The primary sources of Bio-Medical Waste are - Hospitals, Diagnostic Centers, Laboratories, Blood Banks, Nursing Homes and Clinics and Veterinary Hospitals and Clinics. Non - infectious waste forms nearly 90% of the waste generated by a hospital. The remaining 10% comprises of infectious waste and is generated in all the Wards, Operation Theatres, Intensive Care Units, Laboratories and Blood Banks.

The waste generated in each of these areas can be categorized as follows: General ward (Out Patient Department - OPD), Department wards, Intensive Care Unit and Emergency Care - Cotton, dressing, bandages, syringes, needles, IV sets and tubing, blood sets, urine bags - all contaminated with blood, pus or other body fluids and other waste like packaging, paper waste and food waste. Operation Theatres - Pathological waste, Cotton, dressing, instruments, contaminated plastic waste like syringes, tubing, IV sets, Blood sets, contaminated linen, contaminated gloves, caps, masks, hospital gowns used by the patients as well as the staff and doctors. Laboratories - Contaminated samples, cultures, pipettes, petridishes, tips, test tubes (both plastic and glass), and slides. Blood Banks - Contaminated samples, cultures, pipettes, petridishes, tips, test tubes (both plastic and glass), slides, blood bags, unused blood bags (past the expiry date) and infected blood bags. Nursing Homes and Clinics - These generate the same kind of waste that hospitals generate but on a smaller scale depending on the facilities provided and the number of beds.

Definition of Bio-Medical Waste:

The following materials are defined as infectious/biomedical waste according to schedule-I [4]: Table1: Categories of Biomedical Waste and their Treatment and Disposal Option Category No. 1 Category No. 2 Waste category Human Anatomical Waste Treatment & Disposal incineration deep burial incineration deep burial

(human tissues, organs, body parts) Animal waste (animal tissues, organs, body parts carcasses, bleeding parts, fluid, blood and experimental animals used in research, waste generated by

veterinary houses) Microbiology Waste

hospitals,

colleges,

discharge from hospitals, animal Category No. 3 & Biotechnology local autoclaving microwaving incineration

(Wastes from laboratory cultures, stocks or micro-organisms live or vaccines, human and animal cell culture used in research and infectious agents from research and industrial laboratories, wastes from production of biologicals, toxins, dishes and devices used for transfer Category No. 4 of cultures) Waste Sharps

disinfection

(chemical

(needles, syringes, scalpels, blade, glass, etc. that may cause puncture and cuts. This includes both used and unused sharps) Discarded Medicines and Cytotoxic

treatment) autoclaving/microwaving mutilation/shredding incineration/destruction drugs disposal in secured

Category drugs No. 5 (Waste comprising and of outdated, discarded Waste including other cotton, material contaminated Category No. 6 medicines) Soiled body fluids

landfills

Incineration,

(items contaminated with blood, and dressings, soiled plaster casts, lines, bedding, contaminated with blood) Solid Waste (Waste generated from disposal items other than the sharps such as catheters, intravenous set etc.) Liquid Waste

autoclaving/microwaving

Category No. 7

disinfection by chemical

treatment autoclaving/microwaving mutilation/shredding disinfection by chemical

Category

10

No. 8

(Waste generated from laboratory and washing, and cleaning, disinfecting Ash housekeeping

treatment and discharge into drains

Category No. 9 Category No. 10

activities) Incineration medical waste) Chemical biological, chemicals

disposal

in

municipal

Ash from incineration of any bioWaste used in

landfill chemical treatment and into drains for

(Chemicals used in production of production of biological, chemicals used in disinfection, as insecticides, etc.)

discharge solids

liquids and secured landfill for

Source: www.cpcb.nic.in

Note[4]: There will be no chemical pretreatment before incineration. Chlorinated plastics shall not be incinerated. Deep burial shall be an option available only in towns with population less than five lakhs and in rural areas. Chemicals treatment using at least 1% hypochlorite solution or any other equivalent chemical reagent. It musts be ensured that chemical treatment ensures disinfection. Mutilation/shredding must be such so as to prevent unauthorized reuse.

Table2: Color coding-biomedical waste (Management and Handling) rules, 1998(schedule II):[4]of container Waste categories

11

Colour Coding Yellow Red

Type of Container Plastic bags Disinfected container Plastic bags

Waste Categories Category 1, 2, 3, 6 Category 3, 6, 7

Blue/white

Plastic bags/puncture proof container

Category 4, 7

black

Plastic bag

Category 5, 9, 10

Rules framed for BMW

Realizing the seriousness of the problem associated with the poor management of the bio-medical wastes, the Ministry of Environment and Forests (MoEF), Govt. of India, notified the Bio-Medical Waste (Management and Handling) Rules in July 1998 under the Environment (Protection) Act, 1986, through a Gazette notification. Thereafter, the Bio-Medical Waste (Management and Handling) Rules were amended twice in the year 2000 and the last amendment was made in the year 2003. The first amendment was published on 6th March 2000, the second amendment was published on 2 June 2000 and third Amendment was published on 17th September 2003. The main objectives of the rules are to ensure proper segregation, collection; transportation and disposal of the infectious BMW in order to safe guard the public health of the society. Some of the salient features of these rules are as follows: 1) These rules are applicable to the Hospitals, Nursing Homes, Veterinary Institutions, Pathological Laboratories and Clinics, Blood Banks, etc. generating bio-medical wastes.
2) The State Pollution Control Board/Pollution Control Committee is the prescribed

authority for the implementation of the Rules in the States/Union Territories. 3) Every occupier (bedded/ non-bedded) generating, collecting, receiving, storing, transporting, treating, disposing and/or handling BMW in any manner, except such occupier of clinics, dispensaries, pathological laboratories, blood banks 12

providing treatment/service to less than 1000 (one thousand) patients per month, shall apply to the prescribed authority for grant of authorization. 4) The treatment of the BMW lies squarely with the occupier of the health care unit. Treatment is to be done on their own or by joining the Common Bio-medical Waste Treatment Facility available in the area. 5) The Municipal body of the area cannot pick up and transport untreated biomedical wastes generated in the hospital and nursing homes. They can only collect and dispose duly treated BMW for disposal at municipal dump site. 6) The BMW shall not be stored beyond 48 hours without permission of the appropriate authority.

INFECTIOUS WASTE:
Infectious wastes are those biomedical wastes which contain sufficient population of infectious agents that are capable of causing and spreading infections among people, livestock and vectors. Infectious wastes include human tissues, anatomical waste, organs, body parts, placenta, animal waste (tissue / cell cultures), any pathological / surgical waste, microbiology and biotechnology waste (cultures, stocks, specimens of micro-organism, live or attenuated vaccines, etc.), cytological, pathological wastes, solid waste (swabs, bandages, mops, any item contaminated with blood or body fluids), infected syringes, needles, other sharps, glass, rubber, metal, plastic disposables and other such wastes. Hazards from infectious waste and sharps Pathogens in infectious waste may enter the human body through a puncture, abrasion or cut in the skin, through mucous membranes by inhalation or by ingestion. There is particular concern about infection with HIV and hepatitis virus B and C, for which there is a strong evidence of transmission via health-care waste. Bacterias resistant to antibiotics and chemical disinfectants may also contribute to the hazards created by poorly managed waste.

13

TREATMENT

OPTION

FOR

BIOLOGICAL

/INFECTIOUS WASTE
As bio-medical is a specialized class of waste, that is highly infectious and hazardous, there are specific technologies are required to treat and dispose the waste. The standard technologies being utilized in the country for treatment and disposal of biomedical waste are Incineration Autoclave

The two major options for reducing the hazards from pathogenic waste are sterilization, usually by steam autoclave, or incineration.

3.1

INCINERATION:

A process that works on the simple principle of burning or combustion is technically called incineration. The incinerator, as the machine is referred to, uses either oil or electricity to power itself. Waste material is fed into the incinerator and is burnt in it. Incineration of waste materials converts the waste into incinerator bottom ash, flue gases, particulates and heat which can in turn be used to generate electric power. The flue gases are cleaned of pollutants before they are dispersed in the atmosphere. Normally incinerators are operated at temperatures between 300oC to 1100oC based on the volume of waste, the type of incinerator and the type of fuel used. Incinerators used in India are either single chambered or double chambered. Incineration not only attempts to both kill the pathogens but also destroy the materials in which these reside - most of which are plastic disposables or cellulose rich materials etc. The burning of plastics, especially in unregulated incinerators is extremely hazardous as it creates a new set of chemical toxins, some of which according to current research are highly toxic even in trace quantities. Some of the chemical toxins produced by waste incinerators are: (a) Heavy metals, such as lead, cadmium, arsenic, chromium, nickel and so on, which are compounds that are present in plastics. (b) Acid gases such as sulphur gases, hydrogen chloride and nitrogenous gases, particulate matter

14

(c) Dioxins and furans. (d) Poly-Chlorinated Bi phenyls (PCBs) which, if not trapped in pollution control devices, have grave health effects on humans like endocrinal problems thus causing disruptions in the human nervous system. If trapped, they become a part of the fly ash which is also very toxic and has to be disposed off carefully. Of these, dioxins and furans are extremely toxic. These belong to a family of polycyclic aromatic hydrocarbons compounds which are formed when PVC plastic present in the waste is burned. Incineration provides the additional advantage of volume reduction. Properly designed and operated, the incinerator will destroy all biologically and chemically hazardous materials and will reduce the volume of waste requiring final disposal to approximately 10% of its original value. Incinerators reduce the mass of the original waste by 8085 % and the volume (already compressed somewhat in garbage trucks) by 95-96 %, depending upon composition and degree of recovery of materials such as metals from the ash for recycling. This means that while incineration does not completely replace landfilling, it reduces the necessary volume for disposal significantly. The technique has the important additional advantage of rendering hypodermic syringes ("Sharps") unusable by melting and/or deforming them and then oxidizing them into the ash. Based on the requirements for final disposition of the products of any waste treatment process and the types of waste which may be classified as infectious, it appears that incineration is an environmentally responsible option for volume reduction, cost and convenience of handling the final product, and assurance of permanent disposal of materials that are potentially biologically hazardous. Certain states and local regulatory bodies, however, have expressed concerns regarding a number of constituents in the ash residues and flue gases associated with incinerators. The concerns include the following areas:[5] Formation of organic compounds of public health concern, such as dioxins and furans; Release of toxic metals; Formation and release of acid gases (HCl, SO, and NO.); Release of respirable particulates, in fly ash; and Release of radionuclides from analytic processes.

15

Most of the hazardous constituents are either destroyed by the combustion process or are removed by air pollution control equipment operating at very high efficiencies (up to 99 .7%). Metals and certain organic pollutants will concentrate in the residues and will be incorporated into the solids to be disposed of as fly ash. In order to be deposited in a U.S. landfill following the incineration process, the ash residues must pass EPA's leachability requirements (EP Toxicity Test). In addition to the specific emission limitations associated with the technology applied, Operators and owners are required to describe an operating procedure for the facility which includes protocols for anticipated "upset" conditions as well as for normal operating procedures which will be followed during all stages of operation, from initial sorting and loading of the waste through handling of the ash. These procedures are intended to demonstrate that the operator will meet all requisite specifications of the appropriate regulatory agencies to provide safe operation of the facility. These requirements apply to all similar facilities.

BIOMEDICAL WASTE INCINERATORS

BIOMEDICAL HEALTHCARE WASTE incinerators generally have a primary combustion chamber operating at 800-1000C and a secondary chamber operating at 850-1100C with gas retention times of two seconds [6]. The incinerator plant includes gas-cleaning equipment to reduce emissions to air and comply with the EU Waste Incineration Directive Incinerators can be oil fired or electrically powered or a combination thereof. Broadly, three types of incinerators are used for hospital waste: multiple hearth type, rotary kiln and controlled air types. All the types can have primary and secondary combustion chambers to ensure optimal combustion. These are refractory lined. In the multiple hearth incinerators, solid phase combustion takes place in the primary chamber whereas the secondary chamber is for gas phase combustion. These are referred to as excess air incinerators because excess air is present in both the chambers. The rotary kiln is a cylindrical refractory lined shell that is mounted at a slight tilt to facilitate mixing and movement of the waste inside. It has provision of air circulation. The kiln acts as the primary solid phase chamber, which is followed by the secondary chamber for the gaseous combustion. In the third type, the first chamber is operated at low air levels followed by an excess air chamber. Due to low oxygen levels in the primary chamber, there is better control of particulate matter in the flue gas. In a nutshell, the 16

primary chamber has pyrolytic conditions with a temperature range of about 800 (+/-) 50 deg. C. The secondary chamber operates under excess air conditions at about 1050 (+/-) 50 deg. C (Schedule V of the Rules). The volatiles are liberated in the first chamber whereas they are destroyed in the second one. Some models are fitted with Eductor mechanism, which maintains the system under negative pressure and helps control the flue gases more effectively. The chimney height should be minimum 30 meters above ground level. A. Operating Standards: [4] Combustion efficiency at least 99.98% Primary Chamber temperature 800 50C Secondary Chamber: Gas residence time at least ONE second; temperature of 1050C; minimum 3% oxygen in the stack gas. B. Emission Standards (at 12% CO2 Correction) [4]. Particulate matter 100mg/Nm 3 Nitrogen oxides 400 mg/Nm 3 HCL 50 mg/nm 3 Minimum stack height 30 meters Volatile organic compounds in ash shall be not more than 0.01%

Fig. 1: Continuous feed mass fired Incinerator for BMW treatment

Source: http://www.oneia.ca/files/EFW%20-%20Knox.pdf

17

Source: Environmentally Responsible Management of Health Care Waste With a Focus on Immunization Waste by: Jorge Emmanuel, PhD, CHMM Glenn McRae, PhD Firuzeh Mahmoudi, MSES, MPA. o c t o b e r 2 0 0 2

GUIDELINES FOR DESIGN AND CONSTRUCTION OF BMW INCINERATOR [7]

1. General i. These guidelines should be applicable only to the new installation of incinerators. However, the existing incinerator shall be retrofitted with Air Pollution Control Device as mentioned in these guidelines. ii. Incinerator shall be allowed only at Common Bio-medical Waste Treatment Facility (CBWTF). iii. Installation of individual incineration facility by a healthcare unit shall be discouraged as far as possible but approval may be granted only in certain inevitable situations where no other option is available.

18

2. Incinerator Following design criteria may be adopted for better performance: i. The incinerator should be designed for capacity more than 50 kg/hr. For 50 kg/hr capacity, the minimum hearth area shall be 0.75 sq. m (8 sq. feet) and the minimum flow of the flue gas in the secondary chamber shall be 0.6m3/sec at 1050C. Each incinerator must be installed with an air pollution control system (as specified in the section 3). ii. The size of the opening through which the waste is charged shall be larger than the size of the waste bag to be fed. The volume of the primary chamber shall be atleast five times the volume of one batch. iii. The double chamber incinerator shall preferably be designed on "controlledair" incineration principle, as particulate matter emission is low in such incinerator. Minimum 100% excess air shall be used for over all design. Air supply in the primary and secondary chamber shall be regulated between 30%80% and 170%-120% of stoichiometric amount respectively. Primary air shall be admitted near / at the hearth for better contact. Flow meter / suitable flow measurement device shall be provided on the primary & secondary air ducting. The combustion air shall be supplied through a separate forced draft fan after accounting for the air supplied through burners. Optional: For higher capacity incinerators, typically above 250 kg/hr, other design e.g. Rotary Kiln shall be preferred. iv. A minimum negative draft of 1.27 to 2.54 mm of WC (Water Column) shall be maintained in the primary chamber to avoid leakage of gaseous emissions from the chamber and for safety reasons. Provision shall be made in the primary chamber to measure the Water Column pressure. v. The waste shall be fed into the incinerator in small batches after the fixed interval of time in case of fixed hearth incinerator and continuous charging using appropriate feeding mechanism incase of rotary kiln incinerator or as recommended by the manufacturer. The size of the hearth i.e. primary chamber shall be designed properly. vi. The sides and the top portion of the primary and secondary chambers shall preferably have rounded corner from inside to avoid possibility of formation of black pockets/dead zones.

19

vii.

The size of the secondary chamber shall be properly designed so as to facilitate a minimum of one second of residence time to gas flow. For the estimation of residence time in the secondary chamber its volume shall be calculated starting from the secondary burner tip to the thermocouple.

viii.

The refractory lining of the chamber shall be strong enough to sustain minimum temperature of 1000 C in the primary chamber and 1200 C in the secondary chamber. The refractory & insulation bricks shall have minimum 115 mm thickness each & conform to [7 i.]

ix.

The Incinerator shell shall be made of mild steel plate of adequate thickness (minimum 5 mm thick) & painted externally with heat resistant aluminum paint suitable to withstand temperature of 250C with proper surface preparation. Refractory lining of the hot duct shall be done with refractory castable (minimum 45 mm thick) & insulating castable (minimum 80 mm thick). Ceramic wool shall be used at hot duct flanges & expansion joints.

x.

The In

thermocouple Primary chamber-

location Before

shall admission

be of

as

follows: air

secondary

In Secondary chamber - At the end of secondary chamber or before admission of dilution medium to cool the gas xi. There shall be a separate burner each for the Primary & Secondary chamber. The heat input capacity of each burner shall be sufficient to raise the temperature in the primary and secondary chambers as 80050C and 105050C respectively within maximum of 60 minutes prior to waste charging. The burners shall have automatic switching "off/on" control to avoid the fluctuations of temperatures beyond the required temperature range. a. b. c. d. Each burner shall be equipped with spark igniter and main burner. Proper flame safeguard of the burner shall be installed. Provide view ports to observe flame of the burner. Flame of the primary burner i. ii. e. shall be pointing towards the centre of the hearth. shall be having a length such that it touches the waste but does not impinge directly on the refractory floor or wall. The secondary burner shall be positioned in such a way that the flue gas passes through the flame.

20

xii.

There shall not be any manual handling during charging of waste in to the primary chamber of the incinerator. The waste shall be charged in bags through automatic feeding device at the manufacturer's recommended intervals ensuring no direct exposure of furnace atmosphere to the operator. The device shall prevent leak age of the hot flue gas & any backfire. The waste shall be introduced on the hearth in such a way so as to prevent the heap formation. Suitable raking arrangement shall be provided for uniform spreading of waste on the hearth.

xiii.

A tamper-proof PLC(Programmable Logic Control) based control system shall be installed to prevent: o o o Waste charging until the required temperature in the chambers is attained during beginning of the operation of the incinerator. Waste charging unless primary & secondary chambers are maintained at the specified temperature range. Waste charging in case of any unsafe conditions such as - very high temperature in the primary & secondary chambers; failure of the combustion air fan, ID fan, recirculation pump; low water pressure& high temperature of the flue gas at the outlet of air pollution control device. The incineration system must have an emergency vent. The emergency vent shall remain closed i.e. it shall not emit flue gases during normal operation of the incinerator. Each incineration system shall have graphic or computer recording devices which shall automatically and continuously monitor and record dates, time of day, batch sequential number and operating parameters such as temperatures in both the chambers. CO, CO2, and O2 in gaseous emission shall also be measured daily (atleast hour at one minute interval). The possibility of providing heat recovery system/heat exchanger with the incinerator shall also be considered wherever possible. Structural design of the chimney / stack shall be as per. [7 ii.] The chimney/stack shall be lined from inside with minimum of 3 mm thick natural hard rubber suitable for the duty conditions and shall also conform to [7 iii.] to avoid corrosion due to oxygen and acids in the flue gas. 21

ii.

iii.

iv.

v.

vi.

The location and specification of porthole, platform ladder etc. shall be as per the Emission Regulations, Part-3 [7 iv] published by CPCB

3. Air Pollution Control Device It is not possible to comply with the emission limit of 150 mg/Nm3 (corrected to 12% CO2) for Particulate Matter, without Air Pollution Control Device (APCD). Therefore, a bio-medical waste incinerator shall always be equipped with APCD. i. ii. No incinerator shall be allowed to operate unless equipped with APCD. The incinerator shall be equipped with High Pressure Venturi Scrubber System as ordinary APCD such as wet scrubber or cyclonic separator cannot achieve the prescribed emission limit. For the facilities operating for 24 hrs a day, APCD in terms of dry lime injection followed by bag filter can be considered. The details of High Pressure Venturi Scrubber System are given in ANNEXURE-I. 4. Incinerator room and waste storage room i. The incinerator structure shall be built in a room with proper roofing and cross ventilation. There shall be minimum of 1.5 m clear distance in all the directions from the incinerator structure to the wall of the incinerator room. ii. Adjacent to the incinerator room, there shall be a waste storage area. It shall be properly ventilated and so designed that waste can be stored in racks and washing can be done very easily. The waste storage room shall be washed and chemically disinfected daily. iii. The floor and inner wall of the incinerator and storage rooms shall have outer covering of impervious and glazed material so as to avoid retention of moisture and for easy cleaning. iv. The incineration ash shall be stored in a closed sturdy container in a masonry room to avoid any pilferage. Finally, the ash shall be disposed in a secured landfill.

22

5. Operator of the incinerator i. A skilled person shall be designated to operate and maintain the incinerator. The operator shall have adequate qualification in relevant subject and shall be trained and certified by the incinerator supplier in operation & maintenance of the incinerator. ii. There shall be at least one assistant designated at the incinerator plant to keep track of the wastes, records of incinerator operation, cleanliness of the surrounding area and incinerator & waste storage room. They shall also take care of waste charging and incineration ash disposal. iii. iv. All the staff at the incinerator plant shall put on protective gears such as gumboots, gloves, eye glasses, etc. for safety reasons. Any accident occurred shall immediately be reported to the facility operator. The facility operator shall have well defined strategies to deal with such accident/emergency.

3.1.1 Effect on primary combustion chamber temperature [8]

The graphically recorded variation in temperature of the primary combustion chamber (T1) for each waste charge is a real time indication of the heat released during combustion. A typical temperature evolution during a single charging cycle is shown in Fig. 2. In the first interval, T1 decreases somewhat from the PCC preheating temperature (T01): as radiation delivers heat to the waste, moisture is evaporated and the waste is heated to the volatilization temperature. In the second interval, the waste is devolatilizing. As the volatile gases are oxidized, heat is generated and T1 continuously increases until a maximum temperature is reached. In the third interval, T1 declines gradually as the volatile gases are depleted and the heat release is reduced. The partially oxidized combustion gases pass to the SCC. When the temperature has fallen to the set temperature, the next charging cycle begins. As higher starting temperatures are used, the time it takes to fall to the charging temperature decreases, that is, a new charge would come sooner and there is less time available for devolatization. For the same preheating temperature, the larger batch sizes take more time to reach the preheat temperature. At higher T01, a shorter time is required for the waste to reach its thermal cracking (devolatilization) temperature which is associated with the higher rate of

23

devolatilization. Subsequent partial oxidation of the gas released results in higher combustion chamber temperature. Similarly, larger batch size leads to a greater amount of combustible gas, so that for the same preheating temperature, the combustion chamber temperature increases with the batch size.

Fig. 2. Time history record of temperature evolution over a charging cycle in the PCC [8].

3.1.2 Effect on secondary chamber temperature [8]

Fig..3 shows the time history record of temperatures for the PCC (T1) and for the SCC (T2) during the feeding of 5 kg charges at a charging temperature of 500C. It is seen that T2 follows T1 closely, with higher peaks in T1 giving rise to higher peaks in T2 but the latter being lagged behind. Since T1mean is directly related to the PCC preheating temperature (T01), it could be expected that T2mean would also be a direct function of T01 for each batch size. As the charge weight is increased, longer time is required before the temperature falls to the charging temperature. The SCC temperature is higher than that of the PCC because additional air has been supplied to complete the combustion, resulting in conversion of CO to CO2. As the charge is increased, relatively more secondary air would have to be added in order to hold the SCC temperature at 900C. However, since the secondary air has been limited, the SCC temperature has climbed higher in response to the larger charges.

Fig. 3. Correlation between T1 and T2 for 5 kg feed at 500 C charging temperature [8].

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Since higher PCC preheating temperature contributes a higher rate of combustible gas flow and enthalpy to the SCC. It is also noted that T2mean at the larger batch size (10 kg) is less sensitive to T01 than at the smaller batch sizes (5 and 7.5 kg).This is likely to be the so-called bottleneck effect, where complete combustion of the incoming gas from the PCC at high volume flow rates is constrained by the size of the SCC volume and, hence, the residence time available. Higher PCC preheating temperatures are seen to reduce the time available for devolatization before the temperature reaches the charging temperature and another charge is added. At this point, the secondary air in the SCC is added to control the temperature, which tends to quench the combustion, impairing the conversion of CO to CO2 even though there is ample oxygen available due to the excess air, leaving a residue of CO leaving the SCC.

3.1.3. Effect on CO concentration [8]

The CO emission is highly dependent on batch size. For a 5 kg batch, almost all the CO generated in the PCC is completely oxidized to CO2 in the SCC by the addition of secondary air, so the measured CO concentrations are negligible. At larger batch sizes (7.5 and 10 kg), the high rate of volatile gas generated in the PCC encounters the bottleneck effect due to the fixed SCC volume, and thus, the conversion of CO to CO2 is constrained, giving rise to high CO concentration at the SCC exit. Similarly, the CO concentration increases with increasing PCC preheating temperature.

3.1.4. Effect on O2 level [8]

The oxygen level of the combustion gas exiting the SCC is an indicator of the completeness of combustion in the chamber. The O2 concentration varies with the PCC preheating temperature in opposite directions for the case of the 5 kg batch on the one hand and for the case of the 7.5 and 10 kg batches on the other hand. At the 5 kg batch, the O2 concentration is in the range of 79% and increases with increasing T01, implying that the added secondary air is sufficient for combustion, which is consistent with the low level of CO detected At the 7.5 and 10 kg batches, the measured oxygen level varies in the range of 49% and 37%, respectively, and decreases with increasing T01. This implies that there is insufficient oxygen for the conversion of the large volume of CO emitted from the PCC.

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3.1.5. Effect on fuel consumption [8]

The fuel consumption of the afterburner is closely related to the temperature of the combustion chamber since it must be maintained at a set point by the burner. The result of fuel consumption is shown in Table 4, which indicates that the fuel consumption per unit mass of waste treated decreases with T01 and increases with the batch size except at T01 = 800 C, where it is low for all batch sizes. The low fuel consumption at high T01 is associated with the high T2 as explained earlier and is achieved at higher CO emission. Therefore, it appears that fuel economy is obtained for the case of the 5 kg batch and 700 C PCC preheating temperature.
Table: 4 [8]

WHY PLASTIC SHOULD NOT BE INCINERATED?

Plastics constitute a major chunk of medical waste. The use of disposable plastics symbolizes the healthcare establishments attempt to reduce infection and transmission of disease during patient care. Plastics decrease infections within hospitals as they are meant for single use. Thus, inter-patient transfer of pathogens via equipment is reduced. Plastics comprise 15 percent of the total waste generated in the hospital [9]. Various equipments containing different types of plastics are listed in Table 5.

TABLE 5:[9]

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Disposal of PVC via incineration leads to the formation of dioxin and furans. Dioxin and furans are unwanted by-products of incineration with carcinogenic and endocrinedisrupting properties. They are toxic at levels as low as 0.006 picograms per Kg of body weight. India does not have safe landfilling sites. Disposing PVC in the dumps that are being currently used can contaminate the surrounding soil and water bodies through leaching [9]. Even in high temperature incinerators (>800 C), temperatures are not uniform and dioxins and furans can form in cooler pockets or during start-up or shutdown periods. Optimization of the incineration process can reduce the formation of these substances by, for example, ensuring that incineration takes place only at temperatures above 800C, and that flue gas temperatures in the range of 250C to 450C are avoided [10]. Plastics should be treated by non-burn technologies. The World Health Organization recommends that medical waste be disinfected and not sterilized. Therefore, there is no need to destroy the material, it is sufficient to ensure that the material is disinfected and mutilated. Mutilation ensures that the waste is not reused and also enhances the disinfection process by increasing the surface area of the waste. Use of alternative technologies like microwaves, autoclaves, hydroclaves, needle cutters/destroyers and chemical disinfection are the most suitable methods for the treatment of plastics [9].

3.2

AUTOCLAVE TREATMENT [11]

The autoclave operates on the principle of the standard pressure cooker. The process involves using steam at high temperatures. The steam generated at high temperature penetrates waste material and kills all the micro organisms. An autoclave is an excellent method for the treatment of biomedical waste as it utilizes a three-prong approach to sterilize material, including: heat, pressure, and stream. An autoclave is a pressurized chamber that is designed to heat aqueous solutions above their boiling point by exposure to saturated stem under pressure. The high pressure and heat has penetrative power to enter living bacterial cell walls and their dormant, heat-resistant forms (endospores). The use of a pre-vacuum autoclave allows for the removal of air in several stages to allow for complete steam penetration of

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solid objects making it the preferred and most reliable method of sterilizing biological waste. The types of wastes that can be treated in autoclaves are listed in Table 6. This is the most effective and reliable method of sterilizing laboratory materials. The primary purpose of autoclave is to sterilize/ disinfect the wastes. Microorganism, which contribute to infection do not survive beyond 80oC. However, MOEF has stipulated a temperature of 135oC and 35 psi pressure. To ensure disinfection, 30-35 minutes sterilization time is required. At this temperature and pressure, microorganisms are completely destroyed and thus render the wastes infection free. TABLE 6:[11]

Autoclavable bags should be closed but not sealed airtight to allow steam penetration before they are placed into the autoclave chamber. A Treated Biological Materials Non-Hazardous sticker must be applied over the biohazardous warning symbol prior to disposing of a treated autoclave bag in the normal non-hazardous waste stream. The following aspects should be taken into account when loading the autoclave: Avoid crowding or stacking materials Place packages on their edge to allow for penetration of steam Place empty and non-porous containers on their side providing a horizontal pathway for stream and reducing possibility of air pockets Ensure containers do not touch each other Process liquids and dry goods separately. Sterilize materials separately from items which require decontamination.

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Types of Autoclaves: There are three different types of autoclaves available: (1) Gravity; (2) Pre-vacuum; and (3) Isothermal. o Gravity autoclaves are used in the sterilization of empty and/or nonporous containers which are stable to both heat and moisture. Common examples of these items include: liquids, media, and solids (i.e. biomedical waste). o Pre-vacuum autoclaves draw out a significant portion of the air within the autoclave chamber improving the speed and efficiency of the sterilization process. The removal of air from the chamber allows for the penetration of porous materials which are both heat and moisture stable. Common examples of these items include bench-coat and animal bedding. o An isothermal autoclave uses a lower temperature in the sterilization of materials which are either heat sensitive or congealable. This sterilization process is commonly used in the pasteurization of items such as media. To effectively sterilize biological waste the internal chamber must reach a temperature between 121 123C for at least 30 minutes under 15 psi. STANDARDS FOR AUTOCLAVING BIOMEDICAL WASTE: [4] (I) When operating a gravity flow autoclave, medical waste shall be subjected to: a temperature of not less than 121 C' and pressure of 15 pounds per square inch (psi) for an autoclave residence time of not less than 60 minutes; or a temperature of not less than 135 C and a pressure of 31 psi for an autoclave residence time of not less than 45 minutes; or a temperature of not less than 149 C and a pressure of 52 psi for an autoclave residence time of not less than 30 minutes (II) When operating a vacuum autoclave, medical waste shall be subjected to a minimum of one pre-vacuum pulse to purge the autoclave of all air. The waste shall be subjected to the following: (i) a temperature of not less than 121 C and pressure of 15 psi per an autoclave residence time of not less than 45 minutes; or

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(ii) a temperature of not less than 135 C and a pressure of 31 psi for an autoclave residence time of not less than 30 minutes;

CONCLUSION:
To investigate the influence of the operating parameters on the combustion of medical waste in a two chamber controlled air incinerator having a nominal capacity of 50 kg/h. The results obtained from the burning of simulated waste in the pilot incinerator show that the primary chamber preheating temperature and the batch size strongly affect the production of CO and its conversion to CO2. At higher preheat temperatures (T01), less time is available for the waste to be devolatilized. Larger batch weights require more time to devolatilize. When sufficient time is not available, the combustion process is quenched in the SCC, resulting in a residue of CO and higher concentrations of CO emissions in the exit gases. Bottleneck effects, as indicated by the high level of CO emission from the secondary chamber, occurred in the case of high primary chamber preheating temperature and large batch size. On the basis of waste destruction effectiveness, CO emission and secondary chamber temperature and, hence, afterburner fuel consumption, the optimum operating condition for the range of experiments tested appears to be: a batch size of 5 kg and a primary chamber preheating temperature in the vicinity of 700C. The results from this study will serve as the starting point to examine the effect of the secondary air supply rate on the operation of the secondary combustion chamber. CO measurements provide the means for determining and maintaining optimum conditions. During normal operation, recording of PCC and SCC temperatures, as well as CO, assures continuously efficient combustion and minimum impact on the environment. Plastic should not be incinerated in biomedical waste incinerators. To effectively sterilize biological waste the internal chamber must reach a temperature between 121 123C for at least 30 minutes under 15 psi.

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References:
[1] Govt of India, Ministry of Environment and Forests Gazette notification No 460 dated July 27, New Delhi:1998:10-20 [2] Park K. Hospital Waste Management. Parks Textbook of Preventive and Social Medicine. M/s Banarasidas Bhanot Publications, New Delhi. 18th Edn, 2005: 595598. [3] Biomedical Waste Management - An Emerging Concern in Indian Hospitals. Author(s): Virendar Pal Singh, Gautam Biswas, Jag Jiv Sharma Vol. 1, No. 1 (2007-07 - 2007-12). http://www.indmedica.com/journals.php?journalid=11&issueid=98&articleid=1324 &action=article. [4] http://envfor.nic.in/legis/hsm/biomed.html - Website of the MINISTRY OF ENVIRONMENT & FORESTS. Bio-Medical Waste (Management and Handling) Rules, 1998. Last accessed on 6th February 2009. [5] INCINERATION TECHNOLOGY FOR MANAGING BIOMEDICAL WASTES by Charles O. Velzy, J. Feldman and M. Trichont Waste Management & Research (1990) 8, 2 93-298. [6] Guidelines for bmw management by CPCB [7] Design and construction of biomedical waste incinerators guidelines by CPCB i. IS: 8-1983 & IS: 2042-1972 ii. IS: 6533-1989 iii. IS: 4682 Part I-1968 iv. COINDS/20/1984-85 [8] Energy Conversion and Management 46 (2005) 31373149 Effects of operating parameters on the combustion of medical waste in a controlled air incinerator by W. Jangsawang, B. Fungtammasan, S. Kerdsuwan www.elsevier.com/locate/enconman [9] A BOOK ON HOSPITAL WASTE T I M E T O ACT Srishtis factsheets on 14 priority areas. A FACTSHEET ON PLASTICS IN HEALTHCARE by Sameer Nazareth, JUNE 2002 [10] Health Care Waste Management To Reduce the Burden of Disease, HealthCare Waste Needs Sound Management, Including Alternatives to Incineration Fact Sheet No. 281- August 2004 31

[11]SAFE OPERATIONS OF AUTOCLAVES IN THE TREATMENT OF BIOMEDICAL WASTE by: Chemical Control Centre, University of Windsor Laboratory Safety Division uwindsor.ca/labsafety

ANNEXURE-I Details of High Pressure Venturi Scrubber System

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i. The venturi scrubber shall have minimum pressure drop of 350 mm WC to achieve the prescribed emission limit. The temperature of the flue gas at the outlet of the venturi scrubber shall be approx 70-80 C to ensure the saturation of the flue gas. ii. The venturi scrubber shall preferably be made of stainless steel - 316L grade or better material or mild steel lined with acid resistant bricks to avoid corrosion. iii. The water to be used in venturi scrubber shall be added with caustic soda solution to maintain the pH of the scrubbing liquid above 6.5. iv. The scrubbing medium shall be circulated @ 2-2.5 ltrs/m3 of saturated flue gas at venturi outlet. This shall be done using a pump & piping made of stainless steel - 316 grades or better material. The scrubbing medium shall be recirculated as far as possible. v. Venturi scrubber shall be followed by centrifugal type droplet separator to remove water droplets from flue gas. vi. The material of construction of the droplet separator and interconnecting ducting from venturi scrubber to droplet separator, droplet separator to ID fan & ID fan to stack, shall be mild steel lined from inside with minimum 3 mm thick natural hard rubber suitable for the duty conditions and shall also conform to IS: 4682 Part I-1968 to avoid corrosion due to oxygen and acids in the wet flue gas. vii. The wastewater generated from the air pollution control device shall be properly handled so as to avoid any non-compliance of the regulatory requirements. viii. Stack emission monitoring and ash analysis as per the requirement of the Bio-medical Waste (Management & Handling) Rules, 1998, shall be done quarterly i.e. once in every three months and record shall be maintained by the facility operator.

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