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Concentration of Atmospheric Pollutants in the

Gaseous Emissions of Medical Waste Incinerators
a a a
M.C.M. Alvim Ferraz , J.I. Barcelos Cardoso & S.L. Ribeiro Pontes
a
Chemical Engineering Department , Faculty of Engineering of Oporto University , R.
dos Bragas, Portugal
Published online: 27 Dec 2011.

To cite this article: M.C.M. Alvim Ferraz , J.I. Barcelos Cardoso & S.L. Ribeiro Pontes (2000) Concentration of
Atmospheric Pollutants in the Gaseous Emissions of Medical Waste Incinerators, Journal of the Air & Waste Management
Association, 50:1, 131-136, DOI: 10.1080/10473289.2000.10463989

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 TECHNICAL PAPER
Concentration of Atmospheric Pollutants in the Gaseous
Emissions of Medical Waste Incinerators
M.C.M. Alvim Ferraz, J.I. Barcelos Cardoso, and S.L. Ribeiro Pontes
Chemical Engineering Department, Faculty of Engineering of Oporto University, R. dos Bragas, Portugal
ABSTRACT
The purpose of this paper is to quantify the production of
medical waste from a general hospital and to evaluate the
atmospheric pollutant concentrations in gaseous emissions
associated with its incineration. A 3.8 kg (bed.day)1 pro-
duction of medical waste was estimated for 1998; its incin-
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eration is related with an ash production of 0.30.4 kg
(bed.day)1. The concentrations of atmospheric pollutants
were estimated using emission factors, comparing the ef-
fluents with and without control of atmospheric pollut-
ants. The calculated concentrations were compared with
the emission limits established by Portuguese legislation.
The results indicate that, if there is no control of atmo-
spheric pollutants, their concentrations exceed the estab-
lished limits. This is observed even if correct operation and
maintenance procedures are used. The emission concen-
trations of dioxins are higher than the Portuguese emis-
sion limit, which is particularly worrying due to the high
toxicity of some of these compounds. Generally, it is possible
to reduce pollutant concentrations if appropriate control equip-
ment is used. The conclusions obtained clearly justify the great
concern regarding air pollution associated with medical waste
incinerators currently operating in Portugal.
INTRODUCTION
Medical waste is defined as any solid waste that is gen-
erated in the diagnosis, treatment, or immunization
IMPLICATIONS
Without control of atmospheric pollutants, the emissions
of medical waste incineration do not comply with Portu-
guese legislation. Therefore, in association with the incin-
eration system, appropriate control equipment should be
used to reduce atmospheric emissions to safe levels for
public health. Emission stacks must be specifically de-
signed to provide a good dispersion of pollutants. Cor-
rect operation and maintenance procedures should be
obeyed. Programs to measure emission concentrations
should be developed to evaluate the amount of pollut-
ants emitted. Air quality networks should be installed to
measure the pollutant concentrations in the air breathed.
Volume 50 January 2000
Ferraz,
ISSN 1047-3289 J. Air &Cardoso,
Waste Manage.and
Assoc.Pontes
50:131-136
Copyright 2000 Air & Waste Management Association
of human beings or animals, in related research, and in
the production or testing of biologicals. This waste is con-
sidered either hazardous or municipal, depending on
whether it is contaminated. Medical waste represents
0.3% of the total solid wastes generated in Europe. The
hazards to human health and to the environment posed
by this type of waste justify a high level of concern with
its management.
Incineration is the most widely used treatment pro-
cess for medical waste. The incineration process must be
properly controlled (temperature, residence time, and
turbulence). Classic incineration technologies are being
replaced by controlled-air incineration systems. These
systems have the advantages of smaller pollution risks and
smaller operation costs combined with easier maintenance
of high temperatures. Controlled-air incinerators are
equipped with two chambers. The first operates at tem-
peratures of about 800 C, while the operation tempera-
ture of the second chamber should never be lower than
1000 C (Portuguese legislation establishes 1100 C as the
minimum temperature for cytotoxic incineration and two
seconds as the minimum residence time).1,2
The main disadvantage of medical waste incinera-
tion is the emission of atmospheric pollutants, some
of them extremely toxic. The theoretical production
of only carbon dioxide and water arising from the com-
plete combustion of organic wastes occurs only in ideal
conditions. Nevertheless, incineration should not be
a way of transference of pollutants from the waste to
the air. The selection of an emission control strategy
should be designed to meet and, where possible, to
exceed regulatory limits. 3-7 Thus incinerators should
be provided with equipment for the control of atmo-
spheric emissions that enables the reduction of pol-
lutant concentrations to legal levels, concerning the
protection of public health. The selection of the most
appropriate control system depends on the type and
concentration of pollutants. The control systems used
on hospital incinerators are usually fabric filters, wet
scrubbers (venturi, spray towers, packed bed scrubbers)
and dry scrubbers (absorption and adsorption systems).
Journal of the Air & Waste Management Association 131
 Ferraz, Cardoso, and Pontes

The gaseous products of combustion are vented to
the atmosphere through the incineration system stack.
The provision of proper stack height and emission veloc-
ity promotes atmospheric dilution of pollutants and, as a
result, lower concentrations at ground level.
A properly operated incinerator reduces the waste
mass by about 90%, decreasing final residues to a rela-
tively small amount. If correct temperatures are main-
tained during the incineration process, the ashes can be
innocuous, and it is thus possible to landfill them.8,9 Moni-
toring of gaseous effluents is essential to evaluate the con-
centration of atmospheric pollutants; a periodic evaluation
of ash toxicity is also required.
Pollutants usually emitted from the stack of hospital
incinerators include particulate matter, sulfur oxides, ni-
trogen oxides, carbon monoxide, hydrogen chloride,
heavy metals (mainly as small particles), volatile organic
compounds, and dioxins. Especially toxic are particulate
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animals, in related research, and in the production or test-
ing of biologicals. Pathological waste includes human and
animal remains, tissues, body fluids, and cultures. The
components of general hospital waste are similar to those
of municipal waste (food waste, administrative waste, yard
trash).13 Most Portuguese hospitals incinerate red bag
waste, pathological waste, and a proportion of the gen-
eral waste. The quantity of general waste incinerated de-
pends upon the hospital concerned.
In order to calculate the pollutant concentrations in
gaseous effluents, the emission factors must be divided
by the volume of combustion gas produced (Vg ).
Considering ideal gas behavior, the theoretical vol-
ume of combustion gas (Vgth) was determined using the
medical waste composition shown in Table 1 and the fol-
lowing theoretical combustion equation:13
CzHyOxClwSvNu + [z + + v -0.5x ] O2 + 79

21
matter, heavy metals, and dioxins. [z + + v -0.5x ] N2 z CO2 + 2 H2O +
Dioxins is the general term used to describe a group w HCl + v SO2 + [ 0.5u + 79 (z + + v -0.5x)] N2 (1)
21
of chemically similar compounds consisting of some 75
chlorinated dibenzo-dioxins and 135 chlorinated dibenzo- In order to provide proper combustion, the incinera-
furans. Seventeen of these compounds are tetra-chlorinated tion must be performed with excess oxygen. The excess
in the 2, 3, 7, and 8 positions and have a suspected or air volume (Vexcair ) must therefore be considered in order to
known toxic effect. The group of 2, 3, 7, and 8 tetra- determine the volume of combustion gas actually produced
chlorinated dibenzo-p-dioxins (commonly known as 2378
TCDD) has been classified as a known human carcino- Vg = Vgth + Vexcair = Vgth (2)
gen. In early estimates, incineration of medical wastes was
considered to be responsible for a significant amount of The volumetric percentage of oxygen present in the gas-
the total dioxin burden emitted to the atmosphere. A later eous effluent (V0 ) was calculated according to the equa-
2
and more comprehensive review showed that the origi- tion
nal estimation was incorrect and that dioxin emissions
1
from medical waste incinerators were less than 2% of the VO2 (%) = 0.21 100 (3)
total dioxins generated. Recent research has shown that,
in a well-regulated incinerator with emission controls, The emission limits established by Portuguese legislation
dioxin emissions are roughly proportional to the time the (general and specific) consider the presence of 8 and 11%
off-gases are held in the temperature range of 400 to 200 of oxygen, respectively, in effluent gases.3-7 These values,
C.10 The incineration of plastics (widely used as dispos- and eqs 2 and 3, allow the calculation of the parameter
able material) and chlorinated materials (paper and inks) and thence the volume of combustion gas produced (Vg).
are the main sources of dioxin emissions. The mechanisms
of formation are inadequate destruction of dioxins present Table 1. Average medical waste composition.
in the waste stream, incomplete destruction of long chain
organic compounds, and processing catalytic reactions at Weight (g kgres-1) Variable
low temperatures.11,12
Incinerator efficiency depends greatly on operation Carbon 511.0 z
Hydrogen 62.3 y
and maintenance procedures. Incorrect practices lead to
Oxygen 213.0 x
equipment deterioration and to a consequent decrease in
Nitrogen 4.5 u
process efficiency. These practices should be corrected by
Sulfur 1.7 v
following appropriate procedures.1 Chlorine 41.2 w
Three types of hospital waste were considered: red Moisture 90.0
bag waste, pathological waste, and general hospital waste. Ash 76.2
Red bag waste includes any waste generated in the diag-
nosis, treatment, or immunization of human beings or Notes: = 0,25 (y-w) when y > w; = 0 when y w.

132 Journal of the Air & Waste Management Association Volume 50 January 2000

METHODOLOGY OF ANALYSIS
In order to assess the production of solid wastes in a Por-
tuguese general hospital, a survey was conducted in which
the daily production was estimated based on the weight
of waste bags produced. The waste production associated
with each hospital service was calculated based on the
number of bags produced in each service.14 To obtain re-
sults applicable to 1998 based on the previous survey, a
mathematical estimation was applied.
As the actual emission results are not known for hos-
pital waste incineration in Portugal, emission factors for
each pollutant were used to evaluate the amount of pol-
lutants emitted and their concentrations in incineration
effluents.13 The concentrations were calculated before and
after eventual atmospheric pollution control and then
compared with the Portuguese emission limits.
The efficiency of atmospheric pollution control equip-
ment was analyzed according to the level of reduction to
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be reached. Current Portuguese practices were assessed,
and appropriate corrective measures were proposed.
RESULTS AND DISCUSSION
Based on a previous survey conducted at Hospital Geral
de Sto Antonio, a mathematical procedure was applied to
estimate the amount of medical waste produced by a gen-
eral hospital in 1998.14 This estimation considered the
difference in the number of hospital beds. A global in-
crease on a per-bed basis does not necessarily imply a
gradual increase. The general acceptance of disposables
in the late 1970s and early 1980s increased the amount of
waste generated. Conversely, European Union (EU) direc-
tives in the early 1990s required a considerable effort to
reduce waste generation rates.
The annual increase in waste production was calcu-
lated using eq 4, according to the measured daily waste
production in 1978 and 1996 at the Hospital Geral de Sto
Antonio.14
P = P0 (1 + x )
(4)
P0 is the waste production in the reference year, x is the
annual increase in waste production, and P is the waste
production for the same number of hospital beds ( years
after the reference year). An increase of 1.7% per annum
was calculated.
For each hospital service, the daily waste production in
1998 (Ps) was estimated using eq 5, considering the data of
daily waste production at each hospital service in 1978 (Pso).14
N
PS = PS0 (1 + 0.017)
20
(5)
N0
N0 and N are the number of hospital beds in 1978 and
1998, respectively. The daily production was then
Volume 50 January 2000
Ferraz, Cardoso, and Pontes
normalized to the number of beds; the results obtained
are shown in Table 2 (PS ).
N
In the literature, it was possible to find, for different
countries, the following ranges of medical waste genera-
tion (rate per bed):
Portugal: 2.54.5 kg (bed.day)1;15
Italy: 35 kg (bed.day)1 ;16 and
United States: 57 kg (bed.day)-1.16
Comparison of published data with those estimated
in this study allows one to conclude that the waste pro-
duction of 3.8 kg (bed.day)1 agrees well with the biblio-
graphic information available.
Incineration, the most widely used treatment process
for medical waste in Portugal, provides volume and mass
reductions of 90 to 95%.17-19 The mass reduction associ-
ated with the incineration of medical waste in Portugal is
about 82%.1 Incinerated wastes represent 4060% of the
total waste produced, leading to an estimate of 0.30.4 kg
(bed.day)1 of final solid waste production after the incin-
eration process in a hospital similar to that considered in
this study.
Based on the estimated waste production, the amount
of pollutants emitted yearly was calculated. As most Por-
tuguese hospitals incinerate wastes without control of
atmospheric pollution, this fact was considered in order
to estimate the amount of pollutants emitted in a hospi-
tal with 1000 beds. The emission factors used were calcu-
lated according to experimental data from 40 medical
waste incinerators in the United States and Canada;13 these
incinerators operate according to correct practices of op-
eration and maintenance. The results obtained are shown
in Table 3, assuming the incineration of 40 and 60% of
the total waste produced. Pollutant concentrations in the
gaseous effluent of the medical waste incinerators were
estimated using the emission factors already stated.
Using the conditions specified in the Portuguese leg-
islation (dry gas at 0 C and 101,3 kPa), the volume of
combustion gas produced per mass of waste was calcu-
lated using eq 2. The parameter was determined using
Table 2. Normalized production of solid wastes in a general hospital (1978 and
1998).
PSN / 1978 PSN / 1998
(kg (bed.day)1) (kg (bed.day)1)
Hospital services 1.15 1.59
Kitchen 1.47 2.04
Clean paper 0.062 0.086
Fabric rag 0.030 0.042
Scraps 0.046 0.064
RX films 0.0008 0.0011
Total 2.8 3.8
Journal of the Air & Waste Management Association 133
 Ferraz, Cardoso, and Pontes

Table 3. Amount of pollutants emitted yearly (incineration without control of atmo- Table 4. Theoretical volume of combustion gas, volumetric percentage of oxygen,
spheric pollution in a hospital with 1000 beds). parameter, and volume of combustion gas produced in the incineration process (dry
gas0 C and 101.3 kPa).
Pollutant Amount of Pollutants Emitted (kg year1)
40% Incinerated 60% Incinerated Vgth VO2 Vg
3 -1 3 -1
(m kgres ) (%) (m kgres )
Dioxins 1.8E-2 2.6E-2
Cd 1.1 1.7 5.3 8 1.6 8.6
Hg 1.4E+1 2.1E+1 11 2.1 11
Pb 1.6E+1 2.4E+1
Cr (total) 2.3E-1 3.5E-1
Cr (VI) 1.8E-2 2.6E-2 limit with the values estimated for emitted concentra-
Fe 2.7 4.0 tions, corrections should be made, because these are ex-
Mn 1.4E-1 2.0E-1 pressed in units of absolute mass. As I-TEQ units are 10
Ni 6.9E-2 1.0E-1 to 100 times smaller, the value of 0.1 ng m-3 of the Portu-
As 6.5E-2 9.8E-2
guese legislation was considered equivalent to 1E-6 to
CO 1.4E+3 2.1E+3
1E-5 mg m-3. The estimated emitted concentrations are
NO2 1.1E+3 1.7E+3
5.6E-3, 6.4E-4, and 2.8E-3 mg m-3, respectively, for in-
SO2 3.1E+2 4.7E+2
cineration of red bag, pathological, and general wastes.
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Particles 1.7E+3 2.6E+3

HCl (as Cl-) 6.0E+3 9.1E+3 These results show that, if incineration of these three
Benzene 7.3E-1 1.1 types of medical wastes is conducted without control of
atmospheric pollutants, the limit value for dioxins is
clearly exceeded. This means that these kinds of incin-
erators are not able to reduce the emission of dioxins to
eq 3 for a volumetric percentage of oxygen equal to 11%. levels compatible with Portuguese and European stan-
The theoretical volume of combustion gas was deter- dards. This is particularly worrying due to the high tox-
mined using eq 1 and assuming the medical waste com- icity of some of these compounds. It should be noted
position shown in Table 1. The results obtained are shown that a well-controlled incinerator, operating at designed
in Table 4.
This analysis considered three types of medical wastes:
red bag, pathological, and general. In Figure 1, estimated
emitted concentrations for incinerators without control
of atmospheric pollutants are compared with the Portu-
guese emission limits for hazardous waste incineration.4,20
These limits correspond to the incorporation of the EU Di-
rective in the Portuguese legislation, since all member states
were required to modify their national legislation to in-
corporate European guidelines.6
The incineration of the three types of medical waste
considered is associated with emission of gaseous efflu-
ents with concentrations of particulate matter and heavy
metals (cadmium and mercury) higher than the legal lim-
its. When general and red bag wastes are incinerated, these
limits are also exceeded for the emissions of carbon mon-
oxide and heavy metals (lead, total chromium, iron, man-
ganese, nickel, and arsenic).4
The presence in the feed stream of thermometers,
mercury batteries, amalgam from dental fillings, and other
residues related with mercury manipulation is related to
high mercury emissions.
According to NATO criteria, the limit value for diox-
ins settled by Portuguese legislation is expressed in units Figure 1. Estimated emitted concentration and Portuguese emission
of international toxicity equivalent to 2378 TCDD/F In- limits for hazardous waste (incinerators without control of atmospheric
ternational Toxicity Equivalent (I-TEQ).20 To compare the pollution; dry gas, 11% oxygen, 0 C, 101.3 kPa).

134 Journal of the Air & Waste Management Association Volume 50 January 2000
 Ferraz, Cardoso, and Pontes

temperature, residence time, and excess oxygen levels,
will have a dioxin emission that can be compatible with
the limit value.
It can be concluded that the incineration of medical
waste without control of atmospheric pollutants does not
obey the legal emission limits even when correct prac-
tices of operation and maintenance are used (controlled
feeding rate, controlled combustion air, high temperatures,
proper turbulence, and residence time). Therefore, the
presence of equipment to control atmospheric emissions
was analyzed according to its reduction effects. The ranges
of pollutant removal efficiencies for different types of
controls are expressed in Table 5.13 Under proper operat-
ing conditions, the lowest efficiency should be zero. Nega-
tive efficiencies mean that dioxin formation or corrosion
of equipment can occur during control.
The pollution removal efficiencies reported in
Table 5 allow one to conclude that the fabric filter/dry
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A wet scrubber is often more effective in controlling gas-
eous vapors because it generally operates at lower tem-
peratures than the fabric filter, and hence there is a greater
level of condensation. The operating pH of the scrubber
can also chemically change the pollutant, allowing more
effective control. Wet scrubber systems reduce, but do
not efficiently control, the emission of fine particle and
volatile metals; dioxins present in the fine particles are
not controlled either. These systems can add heavy met-
als to the gas stream due to the corrosion of the wet scrub-
ber vessels by acid mists or metals added through the
caustic agents used to remove acid gases. As nickel, chro-
mium, and iron are the major constituents of stainless
steel, an increase of these heavy metals in effluents is
generally related to the corrosion of stainless steel. There-
fore, the corrosion aspect depends greatly on the con-
struction material of the equipment.
High-efficiency emission controls tend to have a fab-

scrubber systems are efficient in controlling fine par- ric filter followed by a wet scrubber in series. Such con-
ticulate matter and fine condensation aerosols pro- figurations are currently considered to represent the
duced by volatile metals. They are not efficient for the maximum achievable control technology. Therefore, ap-
control of dioxins, because these systems may even be propriate control equipment should be used in associa-
an additional source of these compounds. This hap- tion with the incineration system to effect a convenient
pens when the presence of adequate organic precur- reduction of atmospheric pollutant concentrations. How-
sors and chlorine sources causes the formation of ever, this fact must not diminish the importance of imple-
dioxins in post-combustion zones or when the elevated menting a correct waste management and treatment
temperatures observed in some cases at fabric filter policy in order to minimize the quantity of medical waste
inlets result in volatilization of dioxins adsorbed onto to be incinerated.
particles.13 The fabric filter system is also not efficient In Portugal there are about 60 medical waste incin-
in controlling gaseous pollutants such as mercurial erators in operation; only one of them is equipped with
vapors, sulfur oxides, and nitrogen oxides, unless they an atmospheric pollution control system. It is absolutely
have absorbent or adsorbent additives. necessary to obey correct practices of operation and main-
Wet scrubber systems can be efficient in controlling tenance and to reduce atmospheric emissions to safe lev-
emissions of hydrogen chloride, sulfur oxides, and dioxins. els for public health. In order to install appropriate
control equipment, it is essential to implement programs
Table 5. Ranges of pollutant removal efficiencies. to measure the emitted pollutant concentrations.
A well-designed stack is sized to (1) avoid the
Pollutant Removal Efficiencies (%) downflow effects of adjacent buildings, (2) have a mini-
Fabric Filter / Dry Scrubber Wet Scrubber mum efflux velocity, and (3) ensure that, under adverse
climatic conditions, the computer-modeled dispersed
Dioxins 24 to 40 40 to 95 ground-level concentrations of the constituent pollut-
Cd 99.2 to 99.9 (-378) to 69 ants are lower than the public healthbased guidelines.
Pb 99.4 to 99.8 (-3) to 55 In Portugal, almost all the emission stacks for medical
Hg (-14) to 48 23 to 51
waste incinerators have heights similar to those of the
Cr (total) 83 to 99 (-5) to 58
adjacent buildings, thereby down-flowing atmospheric
Ni 76 (-62) to (-18)
emissions. It is clearly important to measure ground-level
Fe 99.6 (-370) to 15
Mn 99.4 (-16) to 29
pollutant concentration in order to know if limits and
As 58 to 99.9 (-78) to 73 guidelines are being obeyed. It is extremely difficult to
HCl 96 to 97 83 to 99.9 measure ground-level concentrations for some pollutants
SOx (as SO2) (-114) to 32 30 to 83 when concentrations are low. Nevertheless, the installa-
NOx (as NO2) (-10) to 17 5 to 15 tion of air quality networks should help to evaluate the
Particles 87 to 98 24 to 61 pollutant concentrations in the breathed air affected by
emissions from medical waste incinerators. These

Volume 50 January 2000 Journal of the Air & Waste Management Association 135
 Ferraz, Cardoso, and Pontes
conclusions clearly justify the great concern regarding
air pollution associated with medical waste incinerators
currently operating in Portugal.
CONCLUSIONS
A 3.8 kg (bed.day)1 production of medical waste was esti-
mated for 1998; its incineration is related with an ash pro-
duction of 0.30.4 kg (bed.day)1. As was expected, the results
indicate that, if there is no control of atmospheric pollut-
ants, the legislation of emission concentration limits is not
obeyed. It is generally possible to reduce pollutant concen-
trations if appropriate control equipment is used. It is abso-
lutely necessary to obey correct practices of operation and
maintenance and to reduce atmospheric emissions to safe
levels for public health. In order to install appropriate con-
trol equipment, it is essential to implement programs to
measure emitted pollutant concentrations. Air quality net-
works should also be installed to measure the pollutant
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concentrations in the air breathed.
ACKNOWLEDGMENTS
The authors acknowledge the Chemical Engineering De-
partment of the Faculty of Engineering of Oporto Univer-
sity, the Hospital Geral de Sto Antonio, the Hospital Geral
de S. Joo, and the Direco do Norte do Servio de 18.
Utilizao Comum Hospitalar for their support of this work.
NOMENCLATURE
I-TEQ = International Toxicity Equivalent
N = number of hospital beds
N0 = number of hospital beds in the reference year
P = waste production
P0 = waste production in the reference year
PS = waste production at each hospital service
PSN = normalized waste production at each hospi-
tal service
PSO = waste production at each hospital service in
the reference year
Vg = volume of combustion gas
Vgth = theoretical volume of combustion gas
Vairexc = air volume excess
V0 = volumetric percentage of oxygen
2
VOC = volatile organic compounds
X = annual increasing of waste production
= parameter related to the excess of air
D = number of years after the reference year
136 Journal of the Air & Waste Management Association
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About the Authors
Maria da Conceio Machado Alvim Ferraz is an auxiliary
professor in the Chemical Engineering Department of Oporto
University in R. dos Bragas, Portugal. Joana Isabel Barcelos
Cardoso is a masters degree student in the Chemical Engi-
neering Department at Oporto University. Sara Isabel
Lagorsse de Ribeiro Pontes graduated in chemical engi-
neering, GERAR, R. Eugnio de Castro, no. 248, 4100 Porto
Portugal.
Volume 50 January 2000