CLINICAL SAFETY

2.0 BIOLOGICAL SAFETY

2.1 INTRODUCTION
Clinical waste arises from a number of sources, including hospitals and clinics, medical
and dental surgeries, veterinary practices, medical teaching establishments, medical
research and laboratories, and nursing homes. Clinical waste is potentially dangerous
because it may contain infectious materials and sharps such as needles. In addition,
clinical waste containing human organs and body parts may be offensive in nature. It is
therefore important to exercise special caution in the handling and management of clinical
waste in order to minimize its potential danger to public health or pollution to the
environment.

2.2 THE DUTY OF CARE OF CLINICAL WASTE PRODUCERS

Waste producers have a duty of care to take the following measures in managing the
clinical waste generated from their premises:

 Segregate clinical waste from other waste streams and prevent clinical waste from
entering the disposal chain of municipal solid waste;
 Package and label clinical waste properly to enable easy identification, including
information on the source of generation;
 Provide safe and secure temporary storage area for clinical waste;
 Ensure their staff take all necessary safety measures in handling clinical waste, and
provide sufficient training for them; and
 Compile a Clinical Waste Management Plan for reference by their staff.

Specifically, the Regulation requires all waste producers to arrange for their clinical waste
to be properly disposed of. Waste producers are deemed to have discharged the duty if
they consign the waste to a licensed clinical waste collector (“licensed collector”), or
arrange the waste to be delivered to a collection point or licensed clinical waste disposal
facility (“licensed disposal facility”) according to the requirements specified in the
Regulation. The Regulation also requires waste producers to keep records of the clinical
waste consigned to licensed collectors or delivered to a collection point or licensed
disposal facility, and to produce such records for inspection upon request by the Director
of Environmental Protection (“the Director”).

2.3 DEFINITION OF CLINICAL WASTE

2.3.1 Types of Clinical Waste
Under the Waste Disposal Ordinance, clinical waste means waste consisting of any
substance, matter or thing generated in connection with :-
 a dental, medical, nursing or veterinary practice;
 any other practice, or establishment (whatsoever described), that provides medical
care and services for the sick, injured or those who require medical treatment;
 dental, medical, nursing, veterinary, pathological or pharmaceutical research; or
 a dental, medical, veterinary or pathological laboratory practice,

and which consists wholly or partly of any of the materials specified in one or more of
the groups listed below :

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Group 1 - Used or Contaminated Sharps

Syringes, needles (include acupuncture needles,) cartridges, ampoules and other sharp
instruments which have been used or which have become contaminated with any other
group of clinical waste.

Group 2 - Laboratory Waste

Unsterilized laboratory stock cultures, or cultures, of infectious agents and potentially
infectious waste with significant health risk from dental, medical, veterinary or
pathological laboratories. Note: “potentially infectious waste with significant health risk
from dental, medical, veterinary or pathological laboratories” refers to those unsterilized
materials or devices used to culture, transfer, inoculate or mix the laboratory stock
cultures, or cultures, of infectious agents. Examples include culture dish, bottle, flask,
tube, pipette, pipette tip, inoculation loop and inoculation wire.

Group 3 - Human and Animal Tissues

All human and animal tissues, organs and body parts as well as dead animals, but
excluding –
1) dead animals and animal tissues, organs and body parts arising from a veterinary
practice; and
2) teeth arising from a dental practice.

Note: Group 3 clinical waste is not intended to cover small quantities of human and
animal tissues which cannot be completely separated from items such as dressings.

Group 4 - Infectious Materials

Infectious materials from patients with the following pathogens - Crimean / Congo
haemorrhagic fever, Ebola, Variola viruses; Herpes virus simiae (B virus); and Severe
Acute Respiratory Syndrome Corona virus. Any materials contaminated by the above
infectious materials are also classified as Group 4 waste.

Group 5 - Dressings
Surgical dressings, swabs and all other waste dribbling with blood, caked with blood
or containing free-flowing blood.

Group 6 - Other Wastes

Such other wastes as specified by the Director by notice published in the Gazette if in
his opinion such wastes -
1) are likely to be contaminated with infectious materials from patients falling
within such case definition as specified in the notice; and
2) may pose a significant health risk.

2.3.2 What Are Not Clinical Waste

For the avoidance of doubt, the following wastes are not classified as clinical waste and
waste producers should observe relevant legal requirements applicable to the handling of
these wastes :
 Radioactive waste, whether arising from medical sources or not, as defined under the
Radiation (Control of Radioactive Substances) Regulations (Cap. 303A);

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 Chemical waste as defined under the Waste Disposal (Chemical Waste) (General)
Regulation (Cap. 354C) including cytotoxic drugs;

Note: "Cytotoxic drug" means a drug which has the capability of selectively killing cells
while they are dividing. Cytotoxic drugs in bulk or of significant residual volume in
containers (e.g. unused or partially used drugs in ampoules or syringes) are regarded as
chemical waste and should be disposed of according to the Waste Disposal (Chemical
Waste) (General) Regulation. Significant residual volume means more than 3% volume of
the container filled with the drugs. Ampoules or syringes with less than 3% volume filled
with cytotoxic drugs can be placed in sharps boxes and disposed of as Group 1 clinical
waste. Such sharps boxes (i.e. with sharps contaminated with residual amount of cytotoxic
drugs) should be disposed of by incineration and not by any other methods.

 Dead animals and animal tissues, organs and body parts arising from veterinary
practices, abattoirs, pet shops, farms, wholesale and retail markets, or domestic
sources; and
 Human corpses.

2.4 SEGREGATION, PACKAGING AND LABELLING OF CLINICAL WASTE

2.4.1 Segregation
Clinical waste should be segregated from municipal solid waste or other waste streams at the
point of arising. Different groups of clinical waste should be handled differently according to
their packaging requirements as specified in section 3.4.2 of this Code. A sufficient number of
appropriate and dedicated containers for holding clinical waste should be placed adjacent to
the locations where clinical waste is generated so as to facilitate the segregation. Clinical
waste should be put into appropriate containers as quickly as possible so as to avoid
contaminating other materials and to minimize potential human exposure. Containers for
holding clinical waste should be covered by secure lids.

2.4.2 Packaging
2.4.1.1 General Requirements
Clinical waste must be placed in containers that are leak-proof, impervious to moisture and
strong enough to prevent tearing or bursting under normal handling. Such containers should
be of one-trip type and should not be reused. They should be capable of being sealed in a
manner that can prevent spillage of the contents during transportation.

The containers should be in good condition and free from contamination, damage or any other
defects which may impair their safe and secure use. A waste producer should carry out visual
inspection of such containers to determine their condition before they are used.

2.4.1.2 Types of Containers

Different groups of clinical waste should be placed in the appropriate types of containers in
accordance with Table 1. All containers should be securely closed and sealed in accordance
with section 3.4.2.5 of this Code before collection. Group 1 clinical waste should be put into
sharps boxes. Group 2, 3, 4, 5 and 6 clinical wastes should be put into either heavy duty
plastic bags or plastic drums that are strong enough to hold the waste without any leakage or
breakage. Plastic drums should be used for clinical waste containing liquids.

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Group 2, 4, 5 and 6 clinical wastes may be placed together in the same bag/drum. Group 3
clinical waste should be placed in separate bags/drums and should not be mixed with any
other groups of clinical waste.

2.4.2.3 Specifications for Different Types of Containers

The design, materials and construction of different types of containers for clinical waste
should follow the specifications set out.

2.4.2.4 Colour-Coding of Packaging

To enable easy and unique identification of clinical waste which is essential for subsequent
handling by licensed collectors and operators of licensed disposal facilities, the packaging of
clinical waste should follow the colour-coding specified in Table 1.

2.4.2.5 Sealing of Containers

Containers of clinical waste should not be filled above the warning line indicating between
70% and 80% of their maximum volume before sealing. The packaging and sealing should be
conducted with care to ensure that no clinical waste adheres to the external surface of the
containers. Sharps boxes should be properly sealed by the proprietary closure whereas plastic
drums by the proprietary closure or tape as appropriate. Plastic bags should be sealed by tying
the neck securely to prevent spillage. The swan-neck sealing method as shown in Figure 1 is
recommended.

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Figure 1: Sealing Method for Clinical Waste Bags.

No staple or unprotected metallic wire tie should be used for sealing or tagging of plastic bags
with clinical waste, so as to prevent injury to waste handlers and damage to other bags.
Metallic wire tie fully wrapped with plastic is acceptable for use in sealing plastic bags.
Plastic drums containing clinical waste with liquids should be securely sealed to prevent
spillage. Absorbent materials may be added into the containers to prevent seepage of liquids
as appropriate.

2.4.3 Labelling
Every container of clinical waste must bear a label. The label must be securely affixed or pre-
printed on a prominent position of the container which allows the information on the label to
be read easily. It is recommended to affix or pre-print a label on each of the opposite sides of
the container wherever practicable.

In addition, each container should be marked using BLACK indelible ink, or a tag should be
securely attached, to show the origin of the waste (i.e. the name and address of waste
producer) and the date of sealing.

If a bag holder (e.g. an ordinary type rubbish bin) is used for holding the plastic bag which is
in use, it should be in good condition and should follow the same labelling requirements as for
the plastic bag itself. The colour of the bag holder should preferably be the same as that of the
bag for easy identification.

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2.4.4 Special Considerations for Handling Chemical Waste Arising from Medical
and Dental Sources

Certain clinical waste may contain chemical residues which are classified as chemical waste.
In such cases, the chemical residues should be segregated from the clinical waste at source
wherever it is practicable. For example, broken thermometer containing mercury should be
segregated from other clinical waste. Chemical waste arising from medical and dental sources
does not fall within the definition of clinical waste (see section 3.3.2 of this Code). Disposal
of such waste is subject to the Waste Disposal Ordinance and the Waste Disposal (Chemical
Waste) (General) Regulation. If the chemical waste contains or is contaminated with any
clinical waste, pre-treatment measures should be taken as far as practicable to render the
waste non-infectious before it is collected by a licensed chemical waste collector.

2.5 HANDLING AND ON-SITE STORAGE OF CLINICAL WASTE

2.5.1 Transfer to On-Site Storage Area
2.5.1.1 General Requirements
Clinical waste containers after being properly sealed and labelled should be transferred from
the place of waste generation to an on-site storage area for temporary storage before
collection. The containers should be handled with care and should not be left unattended
during the transfer of the waste.

2.5.1.2 Trolleys or Carts Used for the Transfer of Clinical Waste

Dedicated trolleys and carts should be used for the transfer of clinical waste on the premises.
They should be designed and constructed according to the following specifications :
 The surfaces should be smooth, with no rough or sharp edges (which may damage the
packaging of clinical waste);
 Impermeable materials should be used and the design should provide containment of
any spillage of waste which may occur in transit;
 The trolleys or carts should be easily cleaned and drained; and
 The overall design should allow the bags and containers to be properly retained in the
trolleys or carts, and to be safely loaded/unloaded and handled without difficulty.

The trolleys and carts should be cleaned at the end of each working day and thoroughly
disinfected at regular intervals.

2.5.2 Storage of Clinical Waste

2.5.2.2 Provision of On-site Storage Area
Waste producers should provide suitable and adequate area for temporary on-site storage of
clinical waste. The storage area should be located close to the sources of waste generation so
as to minimize waste handling and to facilitate management control.

The storage area should be enclosed on at least three sides by wall, partition or fence. The
enclosures should be rigidly erected and fixed to the area. An illustration of a storage area
layout is shown in Figure 2. Depending on the waste generation quantity, a small lockable
cupboard as shown in Figure 3 can also be used. Where possible, all clinical waste should be
contained in transit skips inside the storage area.

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Figure 2: Schematic Drawing of a Storage Area f or Clinical Waste.

Figure 3 Schematic Drawing of a Clinical Waste Storage Cupboard.

Back

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2.5.2.3 Specifications of Storage Area

The design of storage area will depend on the quantity and types of clinical waste involved. In
all cases, the storage area should be designed to meet the following requirements and
specifications :
 Used for storage of clinical waste only;
 With an adequate capacity to cater for the quantity of waste produced and the
frequency of waste collection;
 Exhibiting a warning sign on the external surface of the vertical structure of the area at
or near its entrance. A warning sign is shown in Figure 4;
 Protecting the integrity of the waste packaging;
 Protecting the waste containers therein from the weather (wind, rain, flooding, etc);
 With cover and lockable door to prevent access by unauthorized persons, animals,
birds, and free from rodent and insect infestations;
 With adequate ventilation and lighting;
 Sited on a well-drained, impervious hard-standing area provided with wash down
facilities, or
 as a lockable room or cupboard which can be cleaned and disinfected;
 Installed away from any air-intake of building ventilation;
 Not adjacent to any food stores or food preparation areas; and
 Accessible to waste collection vehicles where possible.

Figure 4. Warning Sign f or Storage Area.

2.5.2.4 Refrigeration of Clinical Waste

Clinical waste that may rapidly decompose (e.g. waste containing human or animal
tissues) should be stored under refrigeration to prevent nuisance such as obnoxious odour.

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2.5.2.5 Other Requirements

Where any clinical waste with liquids is stored, the storage area should be designed to be
capable of containing any spillage of liquids. The area should be cleaned and disinfected
promptly and thoroughly in case any waste spillage occurs.

Clinical waste containers should not be compacted to avoid damaging their packaging
when placed in the storage area. Stacking of bagged clinical waste should also be avoided
as far as possible to avoid damage to the bags.

2.5.3 Collection Point

Subject to the authorization granted by the Director, a waste producer may use his
premises where he produces clinical waste (e.g. hospital, clinic, medical laboratory) to
provide temporary storage area as an “on-site collection point”, for receiving clinical
waste generated by him in other premises or delivered by other small waste producers.

Waste producers who intend to set up on-site collection points must obtain authorization
from the Director and follow such terms and conditions specified in the authorization, and
more details can be obtained from the Environmental Protection Department. The
objective is to minimize the risks of pollution to the environment and the danger to public
health that might be caused by the operation of these collection points.

Licensed collectors may also set up collection points for clinical waste if they are
authorized to do so under their waste collection licences. The operation of such collection
points must meet the requirements specified in the licence.

The delivery of clinical waste from the premises of other small waste producers to the
collection point must be conducted by healthcare professionals in accordance with the
requirements set out in section 3.6.4 of this Code. A waste producer who operates an on-
site collection point must check and confirm the professional identity of the person who
delivers the waste. The operator of an on-site collection point must prepare and issue a
copy of the record of waste delivery to the person who delivers the waste. The operator of
an on-site collection point must also keep the record and produce it to the Director for
inspection upon request. The record must include the following information and as
required in the authorization :
 The name, address and telephone number of the person who produced or caused to
produce the clinical waste;
 The name, address and telephone number of the person who delivers the clinical
waste to the collection point;
 The date and time of delivery of the clinical waste;
 The origin, nature and quantity of the clinical waste; and
 Other particulars relating to the clinical waste as may be specified by the Director
in granting the authorization.

2.6 COLLECTION AND TRANSPORTATION OF CLINICAL WASTE

2.6.1 Collection Service

Collection of clinical waste to a licensed disposal facility must be conducted by licensed
collectors in accordance with the requirements specified in waste collection licences and
in full compliance with the Regulation.

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Transit skips as specified in section 3.6.3.1 of this Code should be used to collect clinical
waste from waste producers. Licensed collectors should check and ensure proper
packaging, sealing and labelling of the waste containers with reference to the relevant
requirements set out in this Code before placing them into transit skips. Group 3 clinical
waste (Human and Animal Tissues) should be put into dedicated transit skips without
mixing with other groups of clinical waste. If the clinical waste has already been placed
into transit skips during storage by waste producers as in the case of some hospitals,
licensed collectors should ensure the transit skips are securely closed and fastened and
properly labelled according to section 3.6.3.1 of this Code before collecting the skips.

No clinical waste should be transferred from one transit skip to another during waste
collection under normal circumstances. Where the premises of certain waste producers are
not accessible to the transit skips, it would be acceptable to use smaller skips to collect
clinical waste from these waste producers and transfer the waste to the transit skips. Such
transfer operation is governed by the terms and conditions of waste collection licence.

2.6.2 Frequency of Collection

The frequency of collection should be agreed between waste producer and licensed
collector with due account of the nature and quantity of clinical waste generated. In order
to minimize potential health hazards, prolonged storage of clinical waste should be
avoided. Guidelines on the collection frequency for different groups of clinical waste are
set out in Table 2.

Table 2: Collection Frequencies f or Dif f erent Groups of Clinical Waste.

Where clinical waste is generated at very small quantity, a longer time interval between
the collection trips of the waste is acceptable, upto a maximum of 1 month for Group 1
waste and a maximum of 1 week for Group 2 and 5 wastes.

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2.6.3 Transportation of Clinical Waste

2.6.3.2 Transit Skips
The specification of transit skips used for the collection of clinical waste should meet the
requirements of mechanical handling equipment of the collection vehicles and the licensed
disposal facility. Each skip should bear words and characters of a minimum height of
40mm in BLACK stating, for clinical waste other than those requiring refrigeration,
"CLINICAL WASTE" in English and, for clinical waste requiring refrigeration,
“CLINICAL WASTE FOR REFRIGERATION”
and the international bio-hazard sign as given in Annex C with a minimum height of
240mm in BLACK. Transit skips for Group 3 clinical waste should be in YELLOW
colour or with a prominent label in YELLOW to facilitate identification of the waste.
Each skip should bear a unique serial number which should be displayed in prominent
BLACK figures and/or letters for easy identification and recording purpose.
The transit skips should meet the following requirements :

 Dedicated for the purpose of storing packaged clinical waste only;

 Provided with lids and capable of being fastened;
 Proof against spillage of the contents and infiltration of rainwater through the lid
or cover;
 Proof against harbourage for insects and vermin, and accumulation of clinical
waste on edges or in crevices, etc.;
 Multiple-trip type and reusable; and
 Capable of being readily disinfected or decontaminated by steam.
 The transit skips should be maintained in good condition and in a clean and
sanitary state. The covers of transit skips should be closed and fastened at all times
except during loading or unloading of clinical waste.

2.6.3.3 Loading of Transit Skips

Loading and unloading of transit skips onto and from the collection vehicle should be
performed with care. Staff involved should be competent, suitably trained, supervised,
and authorized to perform such a duty; and wear appropriate protective clothing such
as gloves, industrial safety shoes, aprons and masks.

A licensed collector should ensure that the covers of all transit skips are securely
closed and fastened before loading the skips onto a collection vehicle. The door of the
cargo compartment of the vehicle should be securely locked at all times except during
loading or unloading.

2.6.3.4 Collection Vehicle/Vessel

Transportation of transit skips should be undertaken only when the covers of skips are
securely closed and fastened. All transit skips whether loaded or not should be secured
against movement inside the collection vehicle to avoid skidding or falling during
transportation.

Transportation by road should be undertaken by dedicated vehicles only in accordance

with the conditions specified in the waste collection licence. Vehicles employed for
the transportation of clinical waste should have the following features :

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 Equipped with mechanical handling equipment to enable the transit skips to be

loaded and unloaded with minimal manual effort and human contact with the
skips;
 Capable of providing secure retention of transit skips when travelling, and
maintaining skips in a good and sanitary condition;
 Comprise either a fully enclosed lorry having a separated cab, or a unitary
vehicle in which the driver’s cab is permanently separated from the cargo
compartment by a sealed fixed bulkhead;
 The cargo compartment should be provided with adequate lighting and
ventilation, lockable doors, spillage-proof and capable of being hygienically
cleaned and disinfected;
 Equipped with a tool kit for minor repairs;
 Equipped with sufficient safety gear, decontamination and cleaning equipment
and materials for dealing with spillage (e.g. personal protective clothing, spare
plastic bags and sharps boxes, disinfectant, absorbent granules, brushes, mops,
shovels and buckets);
and
 Equipped with suitable equipment such as mobile telephone to facilitate
communication with disposal facility operator and the Environmental
Protection Department.

A proper warning panel should be displayed at both the front and rear ends of the vehicle to
indicate the carriage of clinical waste.

At least one portable fire extinguisher with a minimum capacity of 2 kg of dry powder, or
other suitable extinguisher with an equivalent test fire rating of at least 5A and 34B as defined
in British Standard BS EN 3-7:2004, should be provided in the vehicle at an accessible
location.
 Vehicles employed to collect, remove or transport clinical waste should be -
maintained in sound condition and roadworthy and cleaned at least once per week;
 thoroughly cleaned and disinfected immediately following any spillage inside the
vehicle or when contaminated with any clinical waste;
 prohibited from carrying food or pharmaceutical products or any materials which
require good sanitary conditions;
 prohibited from carrying any material other than clinical waste unless thoroughly
cleaned and disinfected beforehand; and
 prohibited from transportation of any other waste, material or substance during the
course of the transportation of clinical waste.

Any vehicle being used for the carriage of clinical waste should not be left unattended unless
it is properly locked up and safely parked in an isolated location such as an open space
separated from public roads and dwellings.

Any marine vessel used for the transportation of transit skips should be equipped with the
necessary facilities to store the skips securely and enable the embarkation and disembarkation
of the skips in a safe and secure manner. The marine vessel should have similar safety
precaution features as for transportation vehicles subject to necessary modifications.

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The transportation of clinical waste should be supervised by trained operational personnel to

ensure the waste is handled safely and properly.

2.6.4 Delivery of Clinical Waste by Healthcare Professionals

Waste producers who are healthcare professionals# may deliver their clinical waste to a
collection point or licensed disposal facility. They may ask their employees who are also
healthcare professionals to deliver the waste on their behalf. A waste collection licence is not
required for such delivery of clinical waste. However, the waste delivery is subject to the
requirements specified in the Regulation, which include the following :
 They must not carry more than 5 kg of clinical waste at any one time;
 No Group 4 waste must be delivered;
 Group 1 waste must be packaged in containers that are puncture- resistant, shatter-
proof and leak-proof (e.g. sharps boxes);
 Other groups of clinical waste must be packaged in containers that are made of rigid
material, impervious to moisture and leak-proof, and that will not rip, tear or burst
under normal conditions of handling;
 The clinical waste must be properly packaged to prevent spillage, and the containers
must be labelled in accordance with the specifications set out in Annex C;
 Only private car## within the meaning of the Road Traffic Ordinance (Cap. 374) must
be used as a means of transport in delivering the clinical waste; and
 The clinical waste must be delivered directly to a collection point or licensed disposal
facility within 24 hours and must not be left unattended during the delivery.

In addition, the healthcare professionals must carry adequate and appropriate first-aid
equipment for use in case of injury to any person caused by the clinical waste during the
delivery. They must also carry appropriate equipment for cleaning up spilled clinical waste
(e.g. spare red bags and sharps boxes) in case of spillage. The healthcare professionals should
exercise professional judgment in carrying adequate quantity of such equipment by reference
to the amount of clinical waste they deliver.
 Healthcare professionals include registered medical practitioners, dentists and
veterinary surgeons, registered medicine practitioners, and registered or enrolled
nurses as defined in the Waste Disposal (Clinical Waste) (General) Regulation.
 Private car means a motor vehicle constructed or adapted for use solely for the
carriage of a driver and not more than 7 passengers and their personal effects but does
not include an invalid carriage, motor cycle, motor tricycle or tax

2.7 HOSPITAL INCINERATION SYSTEMS

2.7.1 INTRODUCTION
Incineration is the process by which combustible materials are burned, producing combustion
gases and noncombustible residue and ash. The product combustion gases are vented directly
to the atmosphere or to the atmosphere after treatment in an air pollution control device.
noncombustible ash residue is removed from the incinerator system and is disposed of in a
landfill. Incineration provides the advantage of greatly reducing the mass and volume of the
waste. This reduction substantially reduces transportation and disposal costs. For infectious
hospital wastes, another major objective of the incineration process is the destruction of
infectious organisms (pathogens) that may exist in the waste. The destruction of the pathogens
is caused by their exposure to the high temperatures which exist within the incinerator.

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Incineration of hospital wastes also is attractive aesthetically because it destroys organic

components of the waste that the community often finds objectionable when wastes are
disposed of in landfills.

Two additional objectives achievable through proper operation of hospital waste incinerators
are minimizing organic content in the solid residue and controlling atmospheric emissions to
acceptable levels. Generally, tight control on organics in the ash, i.e., good burnout,
promotes waste reduction and pathogen destruction. Reduction of atmospheric emissions of
constituents that are potentially harmful to human health and the environment is a prerequisite
to acceptance of hospital incineration as a feasible disposal alternative by the community.

The overall purpose of this technical document is to present information on the operation of
hospital waste incineration systems that can contribute to achieving these objectives. This
section provides background information on the incineration process that will enhance the
usefulness of the remainder of the document. It presents information on basic incineration
principles and processes and integrates this information to promote an understanding o f
hospital waste incineration as an overall system.

The hospital waste incineration process can be separated into the following steps:

i. Waste preparation:
ii. Waste charging:
iii. Waste combustion:
iv. Treatment of the combustion gases, (i.e., add-on air pollution control ) : and
v. Residue ash handling.

Waste heat recovery also may be included as a part o f the incinerator system. The
incineration process and the major subsystems of an incineration system are depicted in
Figure 3-1. An incinerator operates as a system in which all of the process steps mentioned
above are interrelated. For example, the charging procedures implemented by the operator
will affect how well the wastes burn in the combustion chamber and, consequently, the ash
quality. Proper operation of a system requires an understanding of the principles of operation
o f each of the components and of the interrelationship of those components for a particular
system configuration

2.7.2 FUNDAMENTAL CONCEPTS RELATED TO HOSPITAL WASTE

INCINERATION
An understanding of how an incinerator operates as a system requires familiarity with some
basic scientific and engineering principles. This section provides a brief discussion o f the key
principles related to two basic areas--pathogen destruction and combustion chemistry/physics.
The discussions are quite abbreviated and are designed to provide the reader with the basic
information needed to understand the remainder o f this document; they do not provide
complete coverage o f the subject areas.

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Fgure 5. Major components of an incineration system.

2.7.2.1 Pathogen Destruction

The primary objective of hospital waste incineration is the destruction of pathogens in
infectious wastes. The U. S. Environmental Protection Agency (EPA) has defined infectious
waste as "waste capable of producing an infectious disease . . . . For a waste to be infectious,
it must contain pathogens with sufficient virulence and quantity so that exposure to the waste
by a susceptible host could result in an infectious disease."' Some examples of hospital wastes
has been considered.

2.7.2.2 Princip1es of Combustion

In principle, combustion of hospital waste is a chemical process that is equivalent to
combustion of fossil fuels for energy recovery. It is a chemical reaction that involves rapid
oxidation of the organic substances in the waste and auxiliary fuels. This violent reaction
releases energy in the form of heat and light and converts the organic materials to an
oxidized form.

TECHNICAL UNIVERITY OF MOMBASA, MEDICAL ENGINEERING DEPARTMENT Page 15