1. Segregation of waste emanating from Healthcare Institutions in South Africa Presented by: Neil Brink Operations Manager: Dispose-tech, a Division of Enviroserv Waste Management (Pty) Ltd

2. Overview Why the need for segregation? New treatment technologies introduced. Technology limitations e.g Compatibility, legal restrictions, social and ethical reasons, environmental impact. Financial considerations. Occupational Health & Safety reasons. Environmental.

3. What are the benefits of Segregation? Critical aspect of responsible waste management. Ensures cost effective, environmentally friendly, efficient & safe way of containerization, transportation, treatment & disposal.

4. Understanding the Waste Streams Healthcare waste divided into two categories determined by: –Characteristic of waste –Best environmental option for disposal HealthcareGeneralWasteHealthcareRiskWaste

5. Health Care General Waste (HCGW) Packaging materials: e.g. cardboard boxes, plastic bags, clean packaging from needles, syringes and IV lines etc. Kitchen waste: e.g. organic waste and packaging materials Office wastes: Mostly paper etc. Other solid wastes generated from patient wards and other patient care unrelated to medical care: Similar to household waste Non-infectious animal bedding: e.g. from veterinary institutions Garden and park waste: Organic waste from gardening activities Building and demolition waste: From construction and renovation activities Boiler ash: From coal fired boilers found at large hospital used for heating and auxiliary electricity generation

6. Health Care Risk Waste (HCRW) Infectious waste: All kinds of waste that is likely to contain pathogenic micro- organisms Pathological waste: Includes parts that are sectioned from a body Sharps: Includes sharp and pricking objects that may cause injury as well as infection Chemical waste: Includes all kinds of discarded chemicals, including pharmaceuticals, that pose a special risk to human health and environment Radioactive Waste: This includes solid, liquid and gaseous waste contaminated with radio nuclides

8. Why Segregation Is Necessary? Not all technologies are capable of effectively treating all the components of the healthcare risk waste stream Segregation meeting incineration requirements (avoidance of heavy metals and PVC);Segregation meeting incineration requirements (avoidance of heavy metals and PVC); Segregation meeting non-burn treatment technology requirements (avoidance of heavy metals, large pathological waste and prion disease contaminated waste )Segregation meeting non-burn treatment technology requirements (avoidance of heavy metals, large pathological waste and prion disease contaminated waste ) Being selective in terms of the type of container being used for disposal of specific waste types.Being selective in terms of the type of container being used for disposal of specific waste types. Segregating needles from syringes and placing the latter in the infectious waste containers,Segregating needles from syringes and placing the latter in the infectious waste containers, The characteristics of HCGW lends itself to recycling particularly if segregation takes place at source.The characteristics of HCGW lends itself to recycling particularly if segregation takes place at source. Incinerator ash should not be disposed of together with boiler ash which could, depending on its characteristics, go to a general landfill site.Incinerator ash should not be disposed of together with boiler ash which could, depending on its characteristics, go to a general landfill site.

9. Implications of Poor Segregation: Healthcare risk waste often lands up in the general waste stream resulting in the waste being disposed of on general landfill sites reclaimers are exposedreclaimers are exposed contamination of groundwater.contamination of groundwater. Impact on the medical staff, cleaning staff, waste handlers, transport-and disposal facility staff Introduction of a variety of waste processing technologies, each with its own specific operating capabilities and limitations

10. Financial Implications Healthcare General Waste is safe for disposal at a general landfill site. The associated cost is between R45.00 and R70.00. per tonne. The cost of safely disposing of Healthcare Risk waste could, depending on the technology used, range between R1200 and R4100 per tonne. This indicates the significant difference in disposal costs between the two waste categories and should serve as an incentive for management to implement proper segregation measures.  Although there could be a significant cost involved in remediation where segregation has not taken place, this has not been quantified.

11. Precautionary Principle The precautionary principle dictates that where the risk is unknown, we have to assume that the risk is significant and act accordingly. As a general rule segregation should take place at source as separation of misplaced waste after the fact could have serious health and safety implications.

12. Practicalities When Implementing a System Compatibility of waste with treatment technologies,Compatibility of waste with treatment technologies, Occupational health and safetyOccupational health and safety Environmental concernsEnvironmental concerns Financial reasonsFinancial reasons Ethical concernsEthical concerns

13. Minimum Requirements  All HCW must be sorted at source  Suitable receptacles shall be available for segregation and containerisation at source;  HCGW does not require special treatment and shall be disposed of via the conventional domestic waste disposal system, thus minimising the need for costly treatment and implications thereof  No after-sorting of HCRW at any point of the waste stream It shall all be treated and disposed of as HCRW;  A maximum allowable mass of 15 kg is to be adhered to for all containers that are to be lifted manually;  Manual handling and lifting as well as the number of transfers must be minimised by use of trolleys, wheeled bins, or similar mechanisms.

14. Making It Work Capacity building needs to take place.Capacity building needs to take place. A dedicated person per institutionA dedicated person per institution Incentives could be a way of motivating staff to practice good segregation principles.Incentives could be a way of motivating staff to practice good segregation principles. A Code of practice could serve as a guidelineA Code of practice could serve as a guideline A national colour coding policy should be adhered toA national colour coding policy should be adhered to Effort should be made to ensure that the correct container for a situation is available where and when it is needed.Effort should be made to ensure that the correct container for a situation is available where and when it is needed. Training and Awareness is the responsibility of both the healthcare facility management an the healthcare waste contractor.Training and Awareness is the responsibility of both the healthcare facility management an the healthcare waste contractor. Lastly, segregation requires the buy-in and support of management.Lastly, segregation requires the buy-in and support of management.

15. The Roll of Industry Legal obligation in terms of which disposal facility operators have to comply with their permit conditions There is both a legal and a moral obligation to act environmentally responsible.Legal obligation in terms of which disposal facility operators have to comply with their permit conditions There is both a legal and a moral obligation to act environmentally responsible. Industry has the capacity to implement containerisation systems, which facilitate proper segregation. In addition, industry has the technical expertise.Industry has the capacity to implement containerisation systems, which facilitate proper segregation. In addition, industry has the technical expertise. Training and the implementation of a segregation policy should forms an integral roll in the service provided by industry.Training and the implementation of a segregation policy should forms an integral roll in the service provided by industry. It is no longer acceptable that healthcare waste management companies merely act as waste collectors.It is no longer acceptable that healthcare waste management companies merely act as waste collectors. Industry needs to realise that segregation has to be practised in the interest of a safe and healthy environment for all. This is a right that has been entrenched in the Constitution of this country for the benefit of all. Industry needs to realise that segregation has to be practised in the interest of a safe and healthy environment for all. This is a right that has been entrenched in the Constitution of this country for the benefit of all.

16. Thank You !