Module 16 Incineration of Healthcare Waste and the Stockholm Convention Guidelines_English.ppt

MODULE 16:
Incineration of Healthcare Waste and
the Stockholm Convention
Guidelines

Module Overview
• Present the principles and basic approaches for
healthcare waste treatment
• Describe the basics of incineration and types of
incinerators for healthcare waste
• Lay out factors for consideration when selecting waste
treatment methods
• Describe the environmental and health impacts of
incinerators
• Present the Stockholm Convention guidelines for
incinerators
• Describe maintenance and troubleshooting of
incinerators and air pollution control devices

Learning Objectives
• Understand the factors to consider when
deciding upon the proper treatment method
• Understand the basics of incineration and its
environmental and health impacts
• Be aware of the Stockholm Convention
guidelines on incineration
• Learn basic maintenance and troubleshooting
of incinerators and air pollution control
devices

Steps in Healthcare Waste
Management
• Waste classification
• Waste segregation
• Waste minimization
• Handling and collection
• On-site transport and storage
• Treatment and disposal

Principles of Waste Treatment
• The main purpose is to reduce the potential hazard posed by
healthcare waste in order to protect public health and the
environment
• Treatment should be viewed in the context of the waste
management hierarchy
• Measures should first be taken to minimize
wastes, segregate and reuse non-infectious
waste items wherever possible
• After minimization, the remaining waste
materials should be treated to reduce the
health and environmental hazards, and the
residues should be properly disposed of

Treatment Approaches
• On-site – healthcare facility treats its own waste
• Cluster treatment – hospital treats its waste plus
waste from other health facilities in a small area
• Central treatment – dedicated treatment plant
collects and treats wastes from many health facilities
in an urban center or region
On-Site Treatment
T
Hospital as Cluster Hub
T
T
Central Plant

Processes Used in the Treatment of
Healthcare Waste
• Five basic processes are used for the treatment of
hazardous healthcare wastes, particularly sharps,
infectious and pathological waste:
– Thermal
– Chemical
– Irradiation
– Biological
– Mechanical (used to supplement the other
processes)

Thermal Treatment Processes
• Rely on heat to destroy pathogens
• Divided into two types:
– High-heat thermal systems
which involve combustion and/or pyrolysis of
healthcare waste (covered in this Module)
– Low-heat thermal systems
also called non-burn or non-incineration
treatment technologies (covered in Module 15)

Incineration
• High temperature (200ºC to 1000ºC), dry
oxidation process that reduces organic and
combustible waste to inorganic, incombustible
matter, resulting in a significant decrease in
overall waste volume
• Organic matter is chemically and physically
broken down mainly through the process of
combustion

Incineration
• The basic requirements for incineration to be
feasible and affordable are:
– The heating (calorific) value of the waste is at least 2000
kcal/kg
– Calorific values are within the regulatory and design
standards
– Content of combustible matter is above 60%
– Content of non-combustible solids is below 5%
– Content of non-combustible fine particulates is below 20%
– Moisture content is below 30%

Incineration
• No pre-treatment will be needed when the following
wastes are not present or are kept to an absolute
minimum:
– Pressurized gas containers
– Large amounts of reactive chemical wastes
– Silver salts and photographic or radiographic wastes
– Halogenated materials (such as PVC plastics)
– Waste containing mercury, cadmium, and other heavy metals
– Sealed ampoules or vials that might implode during combustion
– Radioactive materials
– Pharmaceuticals that are thermally stable in conditions below
1200ºC

Types of Incinerators for Healthcare
Waste
• Incineration
– Range of capacities:
10 kg/hr to over 20 tonnes per day
– Historically common types of incinerators:
Dual-chamber incinerators
Multiple-chamber incinerators
Rotary kilns

Waste
– Dual-chamber incinerator

Waste
– Multi-chamber excess air incinerator

Waste
– Rotary kiln

Construction and Installation of Incinerators
• Construction of the foundation, enclosure and ventilation
• Construction or assembly of the refractory layers, steel casing,
grates, and insulation of the combustion and post-combustion
chambers, as well as the refractory-lined channels
• Assembly of the burners, fuel supply systems, air dampers and
induced draft fans
• Connection of the electrical controls and air compression
system for pneumatic controls
• Addition of the waste charging system, heat recovery boiler if
used, and ash sump
• Installation of the flue gas cleaning system and its accessories,
including wastewater treatment system, if needed, monitoring
sensors and electrical controls
• Construction and connection of the stack or chimney.

Operation of Incinerators
• General operational procedures
– Waste charging
– Combustion
– Air pollution control
– Ash removal

Why Preventive Maintenance is
Essential
• Enhances safety by avoiding serious accidents
• Increases the efficiency of the technology
• Ensures that the treatment technology continues
to reduce the hazards of healthcare waste
• Extends the life of the technology
• Avoids downtime due to equipment breakdowns
• Saves on the cost of repairs, spare parts, and
unscheduled maintenance
• Reduces energy consumption

Preventive Maintenance
• Healthcare facilities should work with equipment
vendors and manufacturers to develop a
detailed preventive maintenance schedule
• Technology operators should be trained in
simple preventive maintenance
• Maintenance logs should be maintained
• Facility engineers and managers should monitor
maintenance procedures

Maintenance of Incinerators
• Example of a maintenance schedule
– Hourly: inspect ash removal conveyor and
water levels in quench pit
– Daily: check opacity, oxygen and temperature
monitors; clean underfire air ports, ash pit and
sump; inspect limit switches and door seals
– Weekly: clean heat recovery boiler tubes,
blower intakes, burner flame rods and
sensors, heat recovery induced draft fan;
lubricate latches, hinges, hopper door pins,
etc.

Maintenance of Incinerators
(cont’d)
• Maintenance schedule (continued)
– Bi-weekly: check hydraulic fluid, lubricate ash
conveyor bearings; clean fuel trains, burners
and control panels
– Monthly: inspect surfaces and refractories,
internal ram face, pilot lights; clean secondary
chamber floor; lubricate blowers and fans
– Semi-annual: inspect hot surfaces; clean and
lubricate chains

Factors in the Selection of Treatment
Methods
• Types and quantities of waste for treatment and disposal
• Capability of the healthcare facility to handle the waste quantity
• Technological capabilities and requirements
• Availability of treatment options and technologies
• Capacity of system
• Treatment efficiency (microbial inactivation efficacy)
• Occupational health and safety factors
• Environmental releases
• Volume and/or mass reduction
• Installation requirements
• Space available for equipment

Factors in the Selection of
Treatment Methods, cont’d.
• Operation and maintenance requirements
• Infrastructure requirements
• Skills needed for operating the technology
• Location and surroundings of the treatment and disposal sites
• Options available for final disposal
• Public acceptability
• Regulatory requirements
• Capital cost of the equipment
• Operating and maintenance costs of the equipment
• Other costs including costs of shipping, customs duties,
installation and commissioning, transport and disposal of
residues, and decommissioning

Air Emissions
From a
Medical
Waste
Incinerator
Particulate
Matter
Carbon
Monoxide
Other Organic
Compounds
Acid Gases
Dioxins &
Furans
Trace Metals
including
Lead,
Cadmium,
Mercury
Toxic
Incinerator
Ash

Pollutants Measured From Medical
Waste Incinerators
• Air Emissions
– trace metals: As, Cd, Cr, Cu, Hg, Mg, Ni, Pb
– acid gases: HCl, SO2, NOx
– dioxins and furans, including
2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)
– other organic compounds: benzene, carbon tetrachloride,
chlorophenols, trichloroethylene, toluene, xylenes,
trichlorotrifluoroethane, polycyclic aromatic hydrocarbons,
vinyl chloride, etc.
– carbon monoxide
– particulate matter
– pathogens (from incinerators with poor combustion)

• Bottom Ash generally contains:
– dioxins/furans
– other organics
– leachable metals
Bottom ash from medical waste incinerators often
fails tests for hazardous constituents (e.g.,
Toxicity Characteristic Leachate Procedure) and
has to be treated as hazardous waste.
Pollutants Measured From Medical
Waste Incinerators

Epidemiological Studies Related to
Health Effects of Incineration
STUDY SUBJECTS CONCLUSIONS REGARDING
ADVERSE HEALTH EFFECTS
REFERENCE
Residents living
within 10 km of an
incinerator, refinery,
and waste disposal site
Significant increase in laryngeal
cancer in men living with closer
proximity to the incinerator and
other pollution sources
P. Michelozzi et al.,
Occup. Environ. Med., 55,
611-615 (1998)
532 males working at
two incinerators from
1962-1992
Significantly higher gastric cancer
mortality
E. Rapiti et al., Am. J.
Ind. Medicine, 31, 659-661
(1997)
Residents living
around an incinerator
and other pollution
sources
Significant increase in lung cancer
related specifically to the
incinerator
A. Biggeri et al. Environ.
Health Perspect., 104, 750-
754 (1996)
People living within
7.5 km of 72
incinerators
Risks of all cancers and specifically
of stomach, colorectal, liver, and
lung cancer increased with closer
proximity to incinerators
P. Elliott et al., Br. J.
Cancer, 73, 702-710 (1996)

REFERENCE
10 workers at an old
incinerator, 11 workers
at a new incinerator
Significantly higher blood levels of
dioxins and furans among workers at
the old incinerator
A. Schecter et al., Occup.
Environ. Medicine, 52,
385-387 (1995)
53 incinerator workers Significantly higher blood and urine
levels of hexachlorobenzene, 2,4/2,5-
dichlorophenols, 2,4,5-
trichlorophenols, and hydroxypyrene
J. Angerer et al., Int. Arch.
Occup. Environ. Health,
64, 266-273 (1992)
37 workers at four
incinerator facilities
Significantly higher prevalence of
urinary mutagen/promutagen levels
X.F. Ma et al., J. Toxicol.
Environ. Health, 37, 483-
494 (1992)
104 workers at seven
incinerator facilities
Significantly higher prevalence of
urinary mutagen and promutagen
levels
J.M. Scarlett et al., J.
Toxicol. Environ. Health,
31, 11-27 (1990)

REFERENCE
86 incinerator workers High prevalence of hypertension and
related proteinuria
E.A. Bresnitz et al., Am. J.
Ind. Medicine, 22, 363-378
(1992)
176 incinerator workers
employed for more than
a year from 1920-1985
Excessive deaths from ischemic heart
disease and lung cancer among workers
employed for at least 1 year; significant
increase in deaths from ischemic heart
disease among workers employed for
more than 30 years or followed up for
more than 40 years
P. Gustavsson, Am. J. Ind.
Medicine, 15, 129-137
(1989)
Residents exposed to an
incinerator
Reproductive effect: frequency of
twinning increased in areas at most risk
from incinerator emissions
O.L. Lloyd et al., Br. J. Ind.
Medicine, 45, 556-560
(1988)

REFERENCE
Residents from 7 to 64
years old living within
5 km of an incinerator
and the incinerator
workers
Levels of mercury in hair increased
with closer proximity to the
incinerator during a 10 year period
P. Kurttio et al., Arch.
Environ. Health, 48, 243-
245 (1998)
122 workers at an
industrial incinerator
Higher levels of lead, cadmium, and
toluene in the blood, and higher
levels of tetrachlorophenols and
arsenic in urine among incinerator
workers
R. Wrbitzky et al., Int.
Arch. Occup. Environ.
Health, 68, 13-21 (1995)
56 workers at three
incinerators
Significantly higher levels of lead in
the blood
R. Malkin et al., Environ.
Res., 59, 265-270 (1992)

REFERENCE
Mothers living close
to incinerators and
crematoriums in
Cumbria, north
west England, from
1956 to 1993
Increased risk of lethal
congenital anomaly, in
particular, spina bifida and
heart defects around
incinerators, and increased risk
of stillbirths and anacephalus
around crematoriums
T. Drummer, H.
Dickinson and L.
Parker, Journal of
Epidemiological and
Community Health, 57,
456-461 (2003)

Medical Waste Incineration (MWI)
is a Major Global Source of Dioxins
– Europe: 62% of dioxin emissions due to 4 processes, including MWI
– Belgium: MWI accounts for 14% of dioxin emissions
– Denmark: MWI is 3rd or 4th largest dioxin source of 16 process groups
– Thailand:
• MWI - highest dioxin source by far of 7 sources tested
• Extremely high dioxin levels in MWI ash and wastewater
• Thailand’s 1,500 incinerators exceed combined total dioxin releases of
several European countries
– United States:
• MWIs – third largest source of dioxins: 17% of total dioxins in 1995
• Drop in dioxin emissions from MWI in part due to shift to non-incineration
methods: 2470 g TEQ/yr in 1987 to 477 g TEQ/yr in 1995
– Canada:
• MWI - largest dioxin source in Ontario province
• Drop in dioxin emissions from MWI due to closure of MWIs: 130 g TEQ/yr
in 1990 to 25 g TEQ/yr in 1999

Where are Dioxins Formed in a Medical
Waste Incinerator?
• Dioxins are created in cooler sections of the primary
chamber and as the gases cool down after the secondary
chamber
• Dioxins are found in:
– Bottom ash or slag
– Boiler ash
– Filter cake
– Wastewater from the wet scrubber
– Fly ash in the gas exhaust from the stack

What are “Dioxins”?
• Short term for polychlorinated dibenzo-p-dioxins
and dibenzofurans
• Family of 210 compounds
• Among the most toxic compounds known to
humans
> The most toxic is
2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD)

How Far Do Dioxins Travel?
• Dioxins travels long distances in the air (up to
hundreds of kilometers)

How Long do Dioxins Remain in the
Environment?
Dioxins are very persistent:
– Environmental half-life t1/2 on surface soil:
9 to 15 years
– Environmental half-life t1/2 in subsurface soil:
25 to 100 years
– Volatilization half-life t1/2 in a body of water:
more than 50 years

Bioconcentration of Dioxins
• Bioconcentration factors for 2,3,7,8-TCDD
–Aquatic plants: 200 to 2,100 in 1-50 days
–Invertebrates: 700 to 7,100 in 1-32 days
–Fish (carp): 66,000 in 71 days
–Fish (fathead minnow): 128,000 in 71
days

Health Effects Associated with Dioxin
• Classified as a known human carcinogen by
IARC in 1997
• Cancers linked to dioxins:
– Chronic lymphocytic leukemia (CLL)
– Soft-tissue sarcoma
– Non-Hodgkin’s lymphoma
– Respiratory cancer (of lung and bronchus,
larynx, and trachea)
– Prostate cancer

• Developmental Effects
– Birth defects
– Alteration in reproductive systems
– Impact on child’s learning ability and attention
– Changes in sex ratio (fewer male births)
• Immune System Impacts
– Suppression of the immune system
– Increased susceptibility to disease

• Male Reproductive Effects
– Reduced sperm count
– Abnormal testis
– Reduced size of genital organs
– Lower testosterone levels
• Female Reproductive Effects
– Decreased fertility
– Ovarian dysfunction
– Endometriosis
– Hormonal changes

• Other Health Effects
– Chloracne
– Hirsutism
– Hyperpigmentation
– Altered fat metabolism
– Diabetes
– Nerve system damage
– Liver, spleen, thymus, and bone marrow
damage

Dioxin Toxicity at Extremely Low
Concentrations
• Toxicity:
– LOAELs (animal studies):
• Increased abortions, severe endometriosis,
decreased off-spring survival, etc. (Rhesus
monkeys, 3.5-4 years): 0.00064 μg/kg/day
• Cancer (Rat, 104 weeks): 0.0071 μg/kg/da
– WHO tolerable daily intake
= 0.001 ng TEQ/kg/day
– US EPA cancer potency factor (2002)
= (0.000001 ng TEQ/kg/day)-1
Note: 1 ng = 0.000000001 grams

Health Risk Assessment Study
“Assessment of Small-Scale Incinerators for Health
Care Waste,” January 2004
• Study conducted for WHO
• Screening level health risk assessment
• Exposure to dioxin and dioxin-like compounds
through inhalation and ingestion
http://uqconnect.net/signfiles/Files/WHOIncinerationReportFeb2004.pdf

• Three classes of small-scale incinerators
– Best practice
Engineered design
Properly operated and maintained
Sufficient temperatures and residence time
Has an afterburner and other pollution control
– Expected practice
Improperly designed
Improperly operated or maintained
– Worst-case
No afterburner

• Three usage scenarios
– Low use
1 hour per month (12 kg waste per week)
– Medium use
2 hours per week (24 kg waste per week)
– High use
2 hours per day (24 kg waste per day)

Compared to
WHO ADI
Compared to EPA
Cancer Risk
Worst Case: High Use unacceptable unacceptable
Worst Case: Medium unacceptable unacceptable
Worst Case: Low Use unacceptable unacceptable
Expected: High Use unacceptable unacceptable
Expected: Medium Use unacceptable unacceptable
Expected: Low Use Acceptable unacceptable
Best Practice: High Use Acceptable unacceptable
Best Practice: Medium Acceptable Acceptable
Best Practice: Low Use Acceptable Acceptable
Findings of the Risk Assessment Study

Permissible limit in cow’s milk (Netherlands): 0.006 picograms/kg milk

• Most countries have ratified the Stockholm Convention
on Persistent Organic Pollutants
• Under Article 5 of the Convention:
Countries have to take measures to further reduce
releases of dioxins and furans “with the goal of their
continuing minimization and, where feasible, ultimate
elimination.”
• Annex C of the Convention:
– Medical Waste Incinerators are a major source with
“the potential for comparatively high formation and
release” of dioxins & furans
Incineration and the Stockholm
Convention

Incineration and the Stockholm
Convention
• Incinerator emissions should comply with
national standards and be in accordance with
the Convention’s BAT (best available
techniques) and BEP (best environmental
practices) if the country has signed the
convention

Best Available Techniques Guidelines under
• On Incinerator Design
– Single-chamber, drum and brick incinerators are not
acceptable
– An incinerator should consist of:
• Furnace or kiln (primary combustion chamber)
• Afterburner chamber (secondary chamber)
• Flue gas cleaning system
• Wastewater treatment if wet flue gas cleaning is
used

• BAT air emissions performance level:
– 0.1 nanograms I-TEQ/Normal cubic meter at
11% oxygen
• BAT wastewater performance level for effluents
from treatment of gas treatment scrubbers:
– 0.1 nanograms I-TEQ/liter
To be achieved by a suitable combination of
primary and secondary measures

• General measures
– Operation by trained, qualified personnel
– Use of personal protection equipment
– Periodic maintenance including cleaning of
the combustion chamber and declogging of
air flows and fuel burners
– Auditing and reporting systems
– Routine inspections of the furnace and air
pollution control systems by the regulatory
authorities

• Primary measures
– Introduction of waste at 850ºC or higher;
automation to avoid introducing waste below
850ºC
– Avoidance of temperatures below 850ºC and
no cold regions
– Auxiliary burners
– Avoidance of starts and stops
– Control of oxygen input

• Primary measures
– Minimum residence time of 2 seconds at
1100ºC in the secondary chamber after last
addition of air and 6% O2 by volume (for
waste with >1% halogenated substances)
– High turbulence of exhaust gases and
reduction of excess air
– On-line monitoring for combustion control (T,
oxygen, carbon monoxide, dust), and
regulation from a central console.

• Secondary measures
– Dedusting
• Fabric filter operating below 260ºC
• Ceramic filter used between 800 to 1000ºC
• Cyclones for pre-cleaning
• Electrostatic precipitators around 450ºC
• High performance adsorption units with
activated carbon

• Secondary measures
– Techniques for further emission
reduction
• Catalytic oxidation
• Gas quenching
• Catalyst-coated fabric filters
• Different types of wet or dry
adsorption systems using mixtures
of activated charcoal, coke, lime
and limestone solutions
Best Available Techniques Guidelines
under the Stockholm Convention

• Disposal of Residues (bottom and fly ash)
– Ash should be handled, transported (using covered
hauling) and disposed of in an environmentally friendly
manner
– Catalytic treatment or vitrification of fabric filter dusts
– Disposal in safe dedicated landfills (e.g., landfilling in
double-walled containers, solidification, or thermal
post-treatment)

• Monitoring
– Routine monitoring of CO, oxygen,
particulate matter, HCl, SO2, NO2, HF, air
flows, temperatures, pressure drops, and pH
– Periodic or semi-continuous measurement of:
polychlorinated dioxins and furans

Examples of Other Environmental Requirements
Pollutant Units US EPA emission limits EU emission limits
Small Medium Large Daily
average
0.5-hour
average
0.5-8 hour
average
Particulates mg/m3 50 17 14 10 10, 30
CO mg/m3 18 1.6 9.8 50 100, 100
Dioxins/furans ng TEQ /m3 0.0099 0.011 0.027 0.1
HCl mg/m3 17 8.9 5.9 10 10, 60
SO2 mg/m3 2.8 2.8 16 50 50, 200
Mercury mg/m3 0.011 0.0027 0.00099 0.05
Lead mg/m3 0.24 0.014 0.00053
All reference conditions: 273°K, 101.3kPa, 11% O2, dry; Small ≤ 200 lbs/hr, medium > 200 to 500 lbs/hr, and large > 500 lbs/hr.
For half hour averages, at least 97% of concentrations must meet the first value and 100% must meet the second value.

National Regulations Pertaining to
Incineration

Maintenance of Air Pollution Control
• Example of a wet scrubber maintenance schedule
– Daily: check scrubber pump, liquid lines, fans
– Weekly: check oil levels and damper air purge
– Monthly: inspect duct work, fan and motors; clean fan
blades and internal housing, pipes and manifolds;
check drain chain drive, dampers, spray bars,
pressure gauges and main body
– Semi-annual: check fan, pump, motor, bearings, flow
meters, damper drive, seals

Maintenance of Air Pollution Control
• Example of a baghouse filter maintenance schedule
– Daily: check stack, pressures, compressed air, damper valves,
dust removal system, subsystem operations
– Weekly: check filter bags, hoppers, and cleaning system
– Monthly: check shaker mechanism, monitors
– Quarterly: inspect inlet plenum, gaskets, shaker mechanism
– Semi-annually: lubricate all motors and fans
– Annually: check bolts and welds, inspect whole system

Troubleshooting Incinerators
• Symptom: Black smoke from the stack
• Possible Causes:
– Incomplete burning of waste, not enough air,
overcharging of waste or volatile material, poor mixing
in the secondary chamber, burner failure, primary
chamber temperature too high
• Possible Solutions:
– Increase secondary chamber air, decrease underfire
or overfire air, ensure secondary chamber
temperature is above the minimum, decrease charge
rate, check burners, install or check air pollution
control system

• Symptom: Steady white or blue-white smoke from stack
– Aerosols in the stack gas, too much air entering the
incinerator, secondary chamber temperature is too low
– Check secondary chamber burner, ensure that
secondary chamber temperature is above 1000ºC,
decrease underfire air, decrease secondary chamber
air, check if waste contains pigments or metallic
oxides, install or check air pollution control system

• Symptom: White smoke or white haze appears a short
distance from the stack
– Condensation of hydrochloric acid
– Reduce amounts of chlorinated materials in the waste,
eliminate chlorinated plastics in the hospital, install a
scrubber or check the efficiency of the gas scrubber

• Symptom: Smoke coming out of the primary chamber
– Positive pressure in the primary chamber, too much
underfire air, too many highly volatile substances in the
waste, problem with the draft damper or induced draft
fan, primary chamber temperature too high
– Check damper or fan operation, decrease undefire air,
decrease feed rate, check charging door seals

• Symptom: Incinerator uses too much fuel
– Not enough heat input from the waste, inconsistent
charging, insufficient or poorly distributed underfire air for
controlled-air incinerators, too much secondary chamber air,
too much air infiltration, fuel leaks, high moisture content in
the waste, excessive draft, burning setting too high
– Charge waste at regular intervals, avoid charging wet waste
all at one time, increase underfire air or check air ports for
controlled-air incinerators, reduce secondary chamber air,
reduce draft, check door seals, check burner settings, check
fuel lines and burners

• Symptom: A lot of combustible materials remaining in the
ash (poor ash quality)
– Not enough undefire air; improper waste charging;
insufficient burndown time
– Check underfire air setting and clean underfire ports;
charge waste at regular intervals not to exceed the
rated capacity of the incinerator, avoid charging all wet
waste at one time; allow longer burnout period,
maintain primary chamber temperature during
burndown

• Symptom: Corrosion of wet scrubber parts
– Acid build-up in the scrubbing liquid
– Maintain the pH of the scrubbing liquid, check the
system for adding alkali, check pH monitor, perform
preventive maintenance on the scrubber
Troubleshooting Air Pollution Control Devices

• Symptoms:
– Fan vibration, stuck dampers, or poor nozzle spray patter in the
wet scrubber
– Erosion of fans, dampers and duct work (dry components of the
wet scrubber)
– Erosion of scrubber and spray nozzle (wet components of wet
scrubbers with recirculating systems)
– Scaling and plugging
– Droplet carryover due to poor mist eliminator performance
– Suspended solids in the scrubber liquid
– Conduct preventive maintenance to clean the wet scrubber,
repair the mist eliminator, or purge the system

• Symptoms:
– Unusually high pressure readings of the baghouse filter
– Unusually low pressure readings of the baghouse filter or
high opacity
– High resistance to airflow, filter bags not cleaned properly,
high condensation at the filter bags
– Low resistance to airflow, holes in the filter bags, improper
bag installation
– Conduct preventive maintenance, adjust temperatures of the
inlet gas and baghouse, check installation of filter bags,
check the cleaning system

Resources
• Guidelines on best available techniques and provisional guidance
on best environmental practices, to be posted on the Stockholm
Convention website
http://www.pops.int/
• Reference document on the best available techniques for waste
incineration: BAT reference document (BREF), European
Commission, 2008; available in the European IPCC Bureau
website
eippcb.jrc.es/pages/FActivities.htm
o “Standards of Performance for New Stationary Sources and
Emissions Guidelines for Existing Sources:
Hospital/Medical/Infectious Waste Incinerators – Final rule
amendments,” 40 CFR Part 60, US Environmental Protection
Agency, 2011

United States
6200
2400
72
0
2000
4000
6000
8000
1988 1997 2006
MWIs
Canada
219
56
0
50
100
150
200
250
1995 2003
MWIs
Germany
554
0
0
200
400
600
1984 2002
On-Site
MWIs
Ireland
150
0
0
50
100
150
200
1990s 2005
MWIs
Portugal
40
1
0
10
20
30
40
50
1995 2004
MWIs
Some Trends in Medical Waste Incineration (MWI)
United States Canada
Germany Portugal
Ireland

Treatment Technologies
That Do Not Generate Dioxins/Furans
(covered in Module 15)
• Non-Burn Thermal Technologies
– Autoclaves
– Hybrid Steam Systems
– Microwave Units
– Frictional Heat Treatment
– Dry Heat Systems
• Chemical Technologies
– Alkaline Hydrolysis

Discussion
• What regulations or policies exist in your country or region regarding treatment
and disposal methods?
• What are viable options for disposal of healthcare waste available in your
facility or country?
• What are some factors that your facility considers when deciding on a waste
treatment method? What do think is important when evaluating which method
would be most appropriate?
• Does your facility use incineration, or have they used it as a treatment method
in the past? What are some of the cost and benefits of incineration?
• Discuss air emissions and dioxin formation in relation to incinerators.
• Does your incinerator meet the Stockholm Convention guidelines and national
regulations?
• What are the barriers to implementing non-incineration treatment and disposal
methods?

Module 16 Incineration of Healthcare Waste and the Stockholm Convention Guidelines_English.ppt

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