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The Journal of the Egyptian Public Health Association (JEPHAss.

),

Vol.80, No 3&4, 2005

Evaluation of Medical Waste Incinerators


in Alexandria.
Ossama A. Labib*, Ahmed H. Hussein**, Waffaa I. El-shall**,
Adel Zakaria***, Mona G. Mohamed**
*
Petrojet Co.,Alexandria,
** Environmental Health Department, HIPH.
*** occupational health Department

ABSTRACT
Medical establishments play important roles in different activities by
using of modern technology to serve the humans and the environment
through different departments in the establishment and its firms.
Medical wastes are considered as a hazardous waste because they contain
toxic materials, infectious, or non-infectious wastes and they are considered
as a hazard to millions of patients, health care workers, and visitors.
Treatment processes for medical wastes comprise autoclaving, microwaving,
chemical disinfection, irradiation, plasma system, and incineration.
Incineration is a thermal process, which destroys most of the waste
including microorganisms. Combustion process must be under controlled
conditions to convert wastes containing hazardous materials into mineral
residues and gases.
Hospital waste incinerators may emit a number of pollutants depending on
the waste being incinerated. These pollutants include particulate matter,
acid gases, toxic metals, and toxic organic compounds products of
incomplete combustion, e.g., dioxins, furans, and carbon monoxide, as well
as sulfur oxides and nitrogen oxides. So, there should be a reduction of
emissions of most of these pollutants by air pollution control devices.
This study was conducted in 51 medical establishments (ME) in Alexandria.
To evaluate its incinerators. It was found that only 31.4% of total ME have
their own incinerators to treat their medical waste. Also, the incinerators
conditions were poor with incomplete combustion.
Correspondence to:
Dr. Mona G. Mohamed,
Assistant Professor of Environmental Chemistry and Biology,
Environmental Health Department,
High Institute of Public Health, Alexandria University.

The Journal of the Egyptian Public Health Association (JEPHAss.),

Vol.80 No.3& 4, 2005

So, the study recommend handling of all medical wastes of ME in


Alexandria by the company which is responsible now for management of
domestic solid wastes of the city.
Keywords: Hospital waste, medical wastes, medical wastes management,
medical wastes treatment, incineration.

INTRODUCTION
Health care waste management is strongly influenced by cultural,
social,

and

economic

circumstances.

well-designed

waste

management policy, a legislative frame work, and plans are essential for
handling of medical waste. Medical and research facilities are moving
toward the achievement of a healthy and safe environment for
employees and communities.(1-4)
Medical establishments play important roles in different activities
by using of modern technology to serve the humans and the
environment through different departments in the establishment and its
firms.(5)
Medical establishments include hospitals, clinics, medical centers,
private practices, home health care, blood banks, veterinary offices,
clinical

facilities,

research

laboratories,

clinical

laboratories,

all

unlicensed and licensed medical facilities; (6-8)


Medical waste is including but not limited to:
- Soiled or blood-soaked bandages.
- Culture dishes and other glassware.
- Discarded surgical instruments as scalpels.
- Discarded surgical gloves.
- Needles used to give shots or draw blood.
- Cultures, stocks, and swabs used to inoculate cultures.
- Removed body organs.

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The Journal of the Egyptian Public Health Association (JEPHAss.),

Vol.80 No.3& 4, 2005

- Lancets, the little blades the doctor pricks finger with to get a
drop of blood.(9)
- Radioactive materials such as radioisotopes.(6, 7)
These wastes are considered as a hazardous waste because they
contain toxic materials, infectious, or non-infectious wastes and they are
considered as a hazard to millions of patients, health care workers, and
visitors.(6, 7)
In a truly integrated medical waste management system, there are
six functional elements:
1. Waste generation from the sources,
2. Waste handling , separation and storage,
3. Transfer and transport, which involve the transfer of wastes from
the smaller collection vehicles into the large transport equipment,
4. Separation; processing; and transportation of solid waste into
treatment stations such as incinerators, and
5. Disposal which deals with the disposal of waste directly from
sources to landfill site, and the disposal of residual waste from
incineration to final disposal.(2)
Treatment processes for biomedical wastes comprise autoclaving,
microwaving, chemical disinfection, irradiation, plasma system, and
incineration.(10)
Incineration is a thermal process, which destroys most of the waste
including microorganisms.(6) Combustion processes must be under
controlled conditions to convert wastes containing hazardous materials
into mineral residues and gases. The common objectives of waste
incineration are volume reduction, removal of volatile; combustible; and
destruction of toxic and pathogenic materials under the combustion
conditions. These conditions are: adequate free oxygen to be available in
the combustion zone, turbulence, proper combustion temperature (900-

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The Journal of the Egyptian Public Health Association (JEPHAss.),

Vol.80 No.3& 4, 2005

1200 C), a long residence time of the waste gases in a hot oxidizing
environment (>2 or 3 seconds), rapid stack gas cooling (to avoid the
formation of toxic dioxins and furans), and flue gas cleaning.(11)

suitable site for a hazardous waste incinerator would be a site where the
resulting air emissions would not diminish the air quality for the
residents of a city or town.(12)
Hospital waste incinerators may emit a number of pollutants
depending on the waste being incinerated. These pollutants include
particulate matter, acid gases, toxic metals, and toxic organic
compounds products of incomplete combustion, e.g., dioxins, furans,
and carbon monoxide, as well as sulfur oxides and nitrogen oxides. So,
there should be a reduction of emissions of most of these pollutants by
air pollution control devices.(13) These emissions such as dioxins and
furans cause hazards for human beings. (14)

MATERIAL AND METHODS


This study was conducted from February 2000 till September 2002
in 51 medical establishments (ME) in Alexandria. The field work was
divided into the following steps:
Two simple representative random samples were taken, one
sample from raw waste and the other from ash after incineration, where
the ash sample was divided into 2 sub-samples one for physical and
chemical analysis and the other for biological analysis.
The following parameters were determined for each sample
according to standard methods :(15)

A) Before incineration:

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The Journal of the Egyptian Public Health Association (JEPHAss.),

Vol.80 No.3& 4, 2005

1- Moisture.
2- pH.
B) After incineration:
1- Total bacterial count.
2- Volatile solids.
3- Heavy metals.

RESULTS AND DISCUSSION


Table (1) shows different handling methods of medical wastes
(MW) in the study. It was found that 16 ME (31.4%) had incinerators
such as El-Ma'moura Chest Hospital and Gamal Abd El-Nasser
Hospital. On the other hand, the medical establishments which had no
incinerators were 35(68.6%) such as El-'Agamy General Hospital and ElQabbary General Hospital. There is a significant difference (P < 0.05)
between medical establishments according to the presence of
incinerators.
According to the Priminister Executive Decree No. 338/1995,
Article No. (38), infectious wastes generated from the hospitals, medical
centers,,etc may be treated by incineration within residential areas.(16)
So, about 69% of ME do not comply with Environmental low No.
4/1994.
Also, it was found that 12 ME incinerators (23.5%) are functioning
such as Gamal Abd El-Nnasser Hospital, Medical Research Institute,
and Central Blood Bank. On the other hand, the non-functioning
incinerators in the medical establishments were 4ME (7.8%). VIZ, ElShatby both Obstetrics and Pediatrics Hospitals and El-Gomhouria
General Hospital.

393

The Journal of the Egyptian Public Health Association (JEPHAss.),

Vol.80 No.3& 4, 2005

Table (1) shows also that 29ME (56.9%) transport their wastes to the
nearest incinerators such as Ras El-Tin General Hospital, El Qabbary
Chest Dispensary, and Sidi Gaber Polyclinic. On the other hand, the
disposal of medical wastes in communal containers (1 ME, 2%) was the
minority.
Table (2) and figure (1) present the moisture percentage of medical
raw samples before incineration, which ranged between 2.33% to
31.89%. Moisture content below 30% is needed for self incineration.(17,18).
All samples comply with this value except one sample.
If the moisture is more than 50%, wastes would require additional
fuel to be combusted. In addition, this high moisture % can cause
damage to the burners and may cause corrosion to the insulation of the
incinerator.(13)
Table (2) and figure (2) show that pH of raw wastes ranged
between 5.02 to 8.62. The pH should range between 6-8.(19, 20) Almost
all the medical raw waste samples comply with this value. However,
there are two values, which were beyond this range (5.02 and 8.62).
In this respect, acidity causes corrosion of incinerators` insulation
and causes destruction of the refractory. (21)
Table (2) presents the bacterial colony count of the ash which
ranged as the following:
At 20C, the colonies ranged between 0 570000 Col/Kg.
At 37,C the colonies ranged between 0 940000 Col/Kg.
The presence of these colonies is an indication of poor conditions of
medical

waste

incineration.

These

conditions

are

temperature,

turbulence rate, and residence time. Temperature should range between


700-900C. Turbulence rate or the degree of mixing between the waste

394

The Journal of the Egyptian Public Health Association (JEPHAss.),

Vol.80 No.3& 4, 2005

Table (1): Treatment Methods of Medical Waste According to Medical Establishments.

No.
1

Medical waste treatment

Medical establishments
Polyclinics
Dispensaries
Blood Banks

Hospitals

Medical Centers

Treatment:
Yes
No

Total

Percentages

15
15

0
6

0
12

0
2

1
0

16
35

31.4
68.6

Type of treatment
Incineration
Others

15
0

0
0

0
0

0
0

1
0

16
0

31.4

According to operation of
incinerator:
Yes

11

12

33.5

No

If no, waste is transported into:


Nearest incinerator
Waste collection areas

7.8

12
2

3
2

12
0

2
0

0
0

29
4

56.9
7.8

Communal containers

Landfill

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The Journal of the Egyptian Public Health Association (JEPHAss.),

Vol.80 No.3& 4, 2005

Maximum
35

Minimum

30

Moisture %

25

20

15

10

0
1

ME

Figure (1): Maximum and Minimum Values of Moisture Percentages of Raw Medical Wastes.

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The Journal of the Egyptian Public Health Association (JEPHAss.),

Vol.80 No.3& 4, 2005

and oxygen in the combustion air was not adequate due to infrequent
stirring and/or poor design. In the present study, it was found that the
temperature did not reach to the right range needed for complete
combustion, and there was no air fan-induced draft in some of the
medical incinerators, which led to incomplete combustion. Polycyclic
aromatic hydrocarbons (PAHs) and their derivatives are harmful
compounds generated by incomplete combustion of organic materials.
They cause health problems for animals and humans as they are
genotoxic, carcinogenic, and known as they are mutagenic compounds.
Table (2) and figure (3) show that the volatile solids of ash ranged
between 0.22 - 3.9 %. The medical wastes ash should not contain more
than 1.2 %,(20) and some of the ash samples had more than this
percentage, which is related to incomplete combustion.
Table (2) and figures (4 and 5) show that Pb ranged between 0.01
474.47 mg/Kg and Cd ranged between 0.0111.66 mg/Kg. The
maximum allowable values of lead and cadmium are 33.97 mg/kg and
4.59 mg/kg, respectively.(22)

The effect of heavy metals in the heavily

polluted areas cause damage to respiratory system, allergic morbidity,


and serious toxicity. (23, 24)
The inhalation of metals has been found to have greater effect on
the human body than receiving the same metals by ingestion.(24,25)
Exposure to cadmium emission leads to bioaccumulation of cadmium in
the human body, and may cause acute disease in humans. This acute
effect is very serious and causes hypertension, kidney damage,
destruction of testicular tissue, destruction of red blood cells,
hypertension, and damage of bones and joints. (25,26)
Lead causes dysfunction in the hematological system and central
nervous system, which decreases intelligence and behavior.(2)

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The Journal of the Egyptian Public Health Association (JEPHAss.),

Vol.80 No.3& 4, 2005

Table (2): Some Chemical and Bacteriological Parameters of Raw Medical Waste and Ash.
Raw
M.E No.

Measurements
Minimum
Maximum
Mean
Standard deviation
Minimum
Maximum
Mean
Standard deviation
Minimum
Maximum
Mean
Standard deviation
Minimum
Maximum
Mean
Standard deviation
Minimum
Maximum
Mean
Standard deviation
Minimum
Maximum
Mean
Standard deviation

Moisture

Ash
pH

8.06
31.89
20.67
9.12
5.5
22.1
13.8
11.74

6.64
8.62

5.54
25
15.56
8.48
10.1
24.46
15.89
6.99
8.04
22.2
13.63
6.05

5.02
6.53

6
7.5

6.88
8.44

7.2
7.9

Total bacterial count, col/kg


20C
0
80000
1666.6
32041.64
0
0
0
0
0
20000
5000
8366.6
0
40000
12000
17888.5
0
570000
108571.43
206674.35
0
10000
2500
5000

37C
0
30000
13333.33
12110.6
0
20000
10000
14142.13
0
50000
30000
14142.13
10000
290000
13000
137840.48
10
940000
178571.42
336869.34
0
50000
12500
5000

Volatile solids
%
1.53
3.92
2.31
0.85
0.93
2.69
1.81
1.24
0.22
2.25
1.26
0.68
0.6
3.21
2.19
0.6
2.02
4.04
3.13
0.71
2
3.58
2.73
0.7

Heavy metals, mg/kg


Pb
0.01
474.47
118.7
183.4
0.89
19
9.94
12.8
15
68.96
39.24
19.63
60.68
157.24
93.64
38.25
12
55.17
39.99
15.78
0.3
18.63
5.05
9.05

Cd
0.013
2.39
0.69
1.08
0.073
0.13
0.1
0.04
1.52
11.66
4.56
4.83
1.09
3.34
1.79
0.92
1.08
3.05
2.44
0.71
0.01
1.28
0.87
1.28

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The Journal of the Egyptian Public Health Association (JEPHAss.),

Vol.80 No.3& 4, 2005

10
Maximum
9

Minimum

8
7

pH values

6
5
4
3
2
1
0
1

ME

Figure (2): M aximum and M inimum of pH Values of Raw M edical Wastes.

4.5
Maximum
4

Minimum

3.5

V o la tile s o lid s %

3
2.5
2
1.5
1
0.5
0
1

ME

Figure (3): Maximum and Minimum of Volatile Solids Percentages of Medical Wastes ash

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The Journal of the Egyptian Public Health Association (JEPHAss.),

Vol.80 No.3& 4, 2005

500
Maximum

450

Minimum
400

L ead (m g/kg)

350
300
250
200
150
100
50
0
1

ME

Figure (4): Maximum and Minimum of Lead Concentrartion (gm/kg) of Medical Wastes Ash.

14
Maximum

12

Minimum

C adm ium (m g/kg)

10

0
1

ME

Figure (5): Maximum and Minimum of Cadmium Concentrations (mg/kg) of Medical Wastes Ash.

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The Journal of the Egyptian Public Health Association (JEPHAss.),

Vol.80 No.3& 4, 2005

This metal is inhaled or ingested and accumulates in the body causing


headache, anemia, birth defects, central nervous system damage,
damage to kidney, reproductive system, and death. (25, 26) Elevation of
blood lead in children (40-60 Ug/dl) causes deficiency of red blood cells
(RBC) and anaemia. This anaemia occures when blood levels of lead
increase to 60-120 Ug/100 g of whole blood. Greater than 120 Ug/100g
of blood causes acute brain damage. (2,27)

CONCLUSIONS AND RECOMMENDATIONS

From the previous results, it is concluded that their medical waste


incinerators conditions in the studied medical establishments there
are poor and is incomplete combustion of medical waste in all
studied incinerators.

Only 31.4% of total ME have their own incinerators to treat their


medical waste.

Most of the operating incinerators have optimum combustion


conditions. The incomplete combustion results in health hazards
impacts.

So, the following is recommended :-

1)

Handling of the collection, treatment, and disposal of all medical


wastes of ME in Alexandria by the company that is responsible
now for management of domestic solid wastes of the city.

2)

Rehabilitation of medical waste incinerators.

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Vol.80 No.3& 4, 2005

REFERENCES
1.

Prus A, Giroult E, Rushhbrook P. Safe management of waste from healthcare activities. Geneva: WHO; 1999.p.2-144.

2.

Williams PT. Waste treatment and disposal. UK: John Willy; 1998.
chapter6.

3.

pMoller DW. Environmental health. London: John Wiley; 1997.p.262-275.

4.

Bassic IN, Moltin AJ. Encyclopedia of environmental control technology:


controlled air multistage solid waste incinerator with energy recovery.
Volume 1 Illinois: Paul N Cheremisinoff Guff Publication Company;
1998.p.268-273.

5.

Cassedy IH. Medicine in America. amalgamation: the new medical


establishment as colossus. London: Johns Hopkins University Press;
1991,p.chapter 4.

6.

Hill MK. Understanding environmental pollution. London: Press


Syndication of the University of Cambridge; 1998,p.10, 171-194.

7.

El-Shall W, El-Sharkawy FM. Safety of handling of radioactive isotopes


in some Alexandria Medical Centers. Bulletin of High Institute of Public
Health 1995; 25 (3) 643-52.

8.

Wager GR. Screening and surveillance of works exposed to mineral dust.


Geneva: WHO; 1996.p.2, 130-155.

9.

Avent J, Frases I, Wang H. Medical care research review. Formerly


medical care review. New York: Sage Publication Inc; 1999,p. 85, 113.

10.

Wolper LE. MBA Health-care administration. Principles, practices,


structure, and delivery. New York: Aspen Publication Inc; 1995. Chapters
(15),(23).

402

The Journal of the Egyptian Public Health Association (JEPHAss.),

11.

Vol.80 No.3& 4, 2005

Embaby MH, Bassiouny MK. Investigation of monosized large particle


Newtonian or drag reducing liquid beds. Alexandria Engineering
Journal 1998; 37(4): 207-8.

12.

Christina B, Andres B, Hutzler N. Characterization and use of fluidizedbed combustion coal ash. Journal of Environmental Engineering 1994;
120(6): 1460-89.

13.

The US Egypt partnership for economic growth and development.


Persistent organic pollutants. Mansoura University 2000; p.90-96, 125150,287.

14.

Chen KS, Tong CH. Modeling of turbulent burning flow and


performance evaluation of municipal solid waste incinerator. Journal of
Environmental Engineering 1997; 123(11): 1100-1, 1150.

15.

EPA. Standard methods for the examination of water and wastewater.


Washington: American Public Health Association, American Works
Association, and Water Environment Federation; 1995. p.2-57, 103-105.

16.

Priminister

Executive

Decree

No.

380/1995

Concerning

The

Environmental Law, Cairo.


17.

United Nations Conference on Environment and Development. Agenda


21-Environmentally sound management of hazardous wastes including
prevention of illegal international traffic in hazardous wastes. 1992;
chapter 20.

18.

Sankaran S, Pandey S, Sumathy K. Experimebtal investigation waste heat


recovery by refinery oil sludge incineration using fluidized bed
technique. Journal of Environmental Engineering 1998; 33(5): 830-45.

19.

Greenberg MR. Public health and the environment. New York: The
Guilford Press; 1987. Chapters 6 and 7.

20.

Batstone R, Smith E, Wilson D. The safe disposal of hazardous wastes.


London: WHOp; 1989. p.654-696, 710-738.

403

The Journal of the Egyptian Public Health Association (JEPHAss.),

21.

Vol.80 No.3& 4, 2005

Office of Air Quality Planning and Standards and Air and Energy
Research Laboratory. Handbook operation and maintenance of hospital
waste incinerators. Cincinnati: Center of Environmental Research
Information Office of Research and Development US EPA; 1990. p.1-98.

22.

Elden RA, Eldden WR. The encyclopedia of the environment. Boston:


Houghton Mifflin Company; 1994. p.314-315, 439, 581-582.

23.

Yenwey M, Yu LJ, Iou SI, Chiang BC, Ver MC. Adsorption on carbon and
zeolite of pollutants from flue gas during incineration.

Journal of

Environmental Engineering 1999; 125(10): 925-6.


24.

Holmes G, Sinngh BR, Theodore L. Handbook of environmental


management and technology. Toronto: John Wiley and Son, Inc;
1993.p.33.

25.

Basic IN, Matin AJ, Krull PJ, Williamson P, Bhata SP. Encyclopedia of
environmental control technology: Thermal treatment of hazardous
waste-controlled air multistage solid waste incinerator recoveryApplication of dry flue gas scrubbing to hazardous waste incinerators.
Texa: John Willy; 1983. p.1-62, 343.

26.

Manahan SE. Fundamentals of environmental chemistry. Michigan:


Lewis Publishers; 1993. Chapters 12, 17, and 20.

27.

Ladou j. Occupational medicine. London: Apple Tan & Lange, A


publishing Division of Prentice Hall; 1990. p.67-75.

404

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