TERMS OF REFENCE
FEASIBILITY STUDY FOR HOSPITAL WASTE MANAGEMENT
A feasibility study is planned for the study area of , . The study area is located , covers an area of  square kilometers and a population of  inhabitants. The income level of the study area, expressed as Gross Domestic Product per capita per year, is .
Most wastes generated by hospitals and medical clinics are non-hazardous general wastes from hospital organization activities (i.e., including kitchen wastes, office materials, workshop residuals) and patient processing activities in wards which are not handling infectious diseases (i.e., first aid packaging, used but emptied disposable bed liners and diapers, disposable masks, pharmaceutical packaging, etc.). After source segregation of recyclables, disposal is typically by sanitary landfill.
Potentially hazardous wastes from hospitals and clinics which have a pathogenic, chemical, explosive, or radioactive nature are called “medical wastes”. Medical wastes include the following:
pathological wastes (i.e., body parts, aborted fetus, tissue and body fluids from surgery; and dead infected laboratory animals); infectious waste (i.e., surgical dressings and bandages, infected laboratory beddings, infectious cultures and stocks from laboratories, and all waste from patients in isolation wards handling infectious diseases); sharps (i.e., needles, syringes, used instruments, broken glass); pharmaceutical wastes (i.e., soiled or out-of-date pharmaceutical products); chemical wastes (i.e., spent solvents, disinfectants, pesticides and diagnostic chemicals); aerosols (i.e., aerosol containers or gas canisters which may explode if incinerated or punctured); radioactive wastes (i.e., sealed sources in instruments, and open sources used in vitro diagnosis or nuclear medical therapy); and sludges from any on-site wastewater treatment facilities may be potentially hazardous.
Pathological wastes should be destroyed by incineration under high heat (i.e., over 900o C with an afterburner temperature at over 800o C), although some countries require burial of human pathological wastes at official cemeteries for religious reasons. To reach these temperatures and have adequate afterburning and pollution control typically requires development of a regional medical waste facility. Smaller individual hospital or clinic incinerators may not be able to reach these temperatures and afterburning retention periods. Volatilized metals (such as arsenic, mercury, lead) and dioxins and furans could result from inadequate burning temperatures and retention periods.
Other procedures to consider may include chemical disinfection or sterilization (i.e., irradiation, microwave, autoclave, or hydroclave) followed by secure landfill disposal of residuals. In some cases, following complete disinfection, some wastes may be recycled. For example, recycling by specialized contractors is sometimes arranged after disinfection of thick plastics, such as intravenous bags and tubs, and syringes.
Pharmaceutical wastes require destruction, secure land disposal or return to the manufacturer for destruction through chemical or incineration methods.
Chemical wastes need to be source segregated according to their recycling potential and compatibility; and those which are non-recyclable may require stabilization, neutralization, encapsulation, or incineration.
Hospital wastewater treatment sludges require treatment (i.e., anaerobic digestion, composting, incineration, etc.) which raises temperatures to levels that destroy pathogenic microorganisms.
Radioactive medical therapy and diagnosis in high-income countries are divided into two categories: “open sources” which derive from direct use of the radiochemical substance, and “sealed sources” which involve indirect use of the substance within a sealed apparatus or equipment unit. Only open sources tend to result in...
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