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  3. Tuesday, 06 June 2000
Post00256 WASTE MANAGEMENT 6 June 2000 CONTENTS 1. MEDICAL WASTE MANAGEMENT RESOURCES 2. UWEP E-MAIL BULLETIN 22 3. THE MEDCIN 400 - A LOW COST RURAL MED WASTE INCINERATOR NOW AVAILABLE Greetings from Rome! ____________________________________*______________________________________ 1. MEDICAL WASTE MANAGEMENT RESOURCES Recently the Moderator visited with Nancy Muller and Lisa Christianson, at PATH, Program for Appropriate Technology in Health, in Seattle Washington. We exchanged examples of various practices seen and resources available in this nascent field of small health facility medical waste management. Nancy has kindly sent the Forum a list of useful resources for posting. In addition, Nancy forwarded a recent copy of UWEP e-mail bulletin 22, a listserve dedicated to the Urban Waste Expertise Programme. The full text of Bulletin 22 follows. Technet members may wish to subscribe to the UWEP Bulletin. See the subscription details below. ___________________________________________________________________________ ** In Seattle we discussed collecting TECHNET members and SIGN Associates observations of "Best Practices", "Good Practices" and "Poor Practices" in medical and injection waste management. ** A collection of observed practices may be useful in the process of devising management and technological approaches to improving the currently dangerous situation. ** A contest was proposed to encourage submissions! Prizes? Criteria? Help? Send your observations to: [][/email] or use your reply button ___________________________________________________________________________ From: "Muller, Nancy" To: "''" Subject: Medical Waste Management Resources Date: Tue, 23 May 2000 14:48:29 -0700 Hello Allan, It was a pleasure to meet the face behind the Technet listserve when you visited PATH Seattle on Friday. As promised, here are the email addresses for several medical waste groups I thought might be interested in SIGN and Technet. - Urban Waste Expertise Programme (see below) out of the Netherlands - - Mumbai Medwaste Action Group in Mumbai, India. 5th Floor, CVOD Jain School, 84 Samuel Street, Dongri, Mumbai 400009 Tel: +91 22 3702592, email: The names I have for MMAG are Deepika d"Souza, Conan Pereira, Hehzabeen Hoosein, and Kajal Mehta. - Srishti in New Delhi Mr. Ravi Agarwal Chief Co-ordinator SRISHTI 1001, Antariksha Bhawan, 22 K.G. Marg New Delhi 110001 Ph. : 91-11-3328006 Fax : 91-11-4632727 e-mail : [][/email] Megha Kela (enclosed email from Electronic Toxics Link) is also with Srishti. - Health Care Waste Management Cell at the Dept of Community Medicine, M.S. Ramaiah Medical College in Bangalore. Their email is [][/email]. There is also a group called Healthcare Without Harm based in Washington, D.C. that has a spin-off called Healthcare Without Harm South that I have been told works on issues such as medical waste in the developing world. However, I have yet been able to get in contact with them. Best wishes, Nancy Nancy Muller Program Officer PATH (Program for Appropriate Technology in Health) 4 Nickerson Street, Seattle, WA USA 98109-1699 Tel: (206) 285-3500 Fax (206) 285-6619 __________________________________________________________________________ 2. UWEP E-MAIL BULLETIN 22 Crossposted with thanks! ___________________________________________________________________________ From: [][/email] [] Sent: Wednesday, December 22, 1999 7:05 AM To: [][/email] Subject: [UWEP-BULLETIN] UWEP e-mail bulletin 22 URBAN WASTE EXPERTISE PROGRAMME E-MAIL BULLETIN 22 edited by WASTE, Gouda, the Netherlands December 1999 This is the twenty-second e-mail bulletin of the Urban Waste Expertise Programme, a six-year research and pilot project programme on urban waste in the South. The UWEP programme is coordinated by WASTE and funded by the Netherlands Development Assistance (NEDA), Ministry of Foreign Affairs. Please, feel free to forward this bulletin. Your comments, enquiries, orders for back issues and suggestions for other organisations to send this e-mail bulletin to, are very welcome at the following address: WASTE, attn. Anne-Lies Risseeuw Nieuwehaven 201 2801 CW Gouda the Netherlands e-mail: [][/email] fax + 31 (0)182 550313 website: *************************************************************************** Both the UWEP and the WASTE team wish you a very happy New Year! Hit *************************************************************************** CONTENTS 1. Environmental impact of micro-enterprises in El Salvador 2. Wastewater treatment and water use: the other options 3. West-African workshop for micro-entrepreneurs in the water and sanitation sector 4. News in short 5. Publications 1. ENVIRONMENTAL IMPACT OF MICRO-ENTERPRISES IN EL SALVADOR The PROMICRO - OIT project completed a study on the environmental impact of micro-enterprise activities in El Salvador. A report of which has now become available in Spanish. In the study a total number of 47 micro- enterprises were looked into, of which 60% are working informally - i.e. do not have a registered status. The study looked into the technologies applied, the level of education among the employees, and the turn-over of the enterprises. As major environmental impact aspects, erosion, the use of natural resources, emissions, the generation of waste, energy use, water and soil contamination and excessive noise levels were identified. The study has also looked into the occupational health and health risks of the workers active in these enterprises. The study has come up with the general conclusion that, although the micro-enterprises cause contamination, the levels of contamination are low. And the contamination in itself is very easily to locate in these micro-enterprises and in most cases very easy to correct. Most of the contamination causes local nuisance, so, it is mainly the neighbours and other persons living nearby who suffer. Most of the contamination is caused by a lack of financial means and a lack of technical assistance. Health risks are mainly run by not using appropriate protective clothing, either as it is simply not provided for or because it is not worn as it hinders the employee during the work. The full text of the study is available in Spanish from WASTE. For the address, see the beginning of this bulletin. 2. WASTEWATER TREATMENT AND WATER USE: THE OTHER OPTIONS While water resources are becoming more and more scarce due to a rapidly increasing population, more and more attention is being given to alternative approaches, such as the so-called 'ecological integrity approach'. This approach calls to reconsider our consumption patterns and to be conscious not only of the benefits of using water but also of the drawbacks. As with the use of many resources occurs: one tends to concentrate the benefits and deconcentrates the drawbacks. This means that people are very little involved with the impact of their behaviour on the environment and society, claiming the benefits for oneself and transferring the drawbacks to the community. The ecological approach calls for the implementation of sustainable water treatment and reuse technologies, with the following major points: 1. One should not use a higher quality or larger quantity of water than is actually needed. 2. One should consider wastewater as potentially a valuable product. For example, wastewater from laundry and showers can be reused for landscape irrigation or agricultural purposes. One should also: a. Differentiate, so, analyse which water quality and how much is needed for which purpose. b. Cascade, so, the water used for a certain purpose, can be re- used for another purpose which requires water from a lower quality. c. Close, so, aim at a total re-use of all components of the wastewater. This approach has been implemented in a town in the Netherlands where a grey water and reuse system has been installed, where water from bathing is treated in a reed bed before being used for toilet flushing. The paper that was written on this topic, was presented by Herbert Aalbers at a conference on urban management in Alexandria, Egypt. "Present technological options for water use and treatment in the context of the ecological integrity approach" is also available from WASTE as an Occasional Paper in the UWEP series. 3. WEST-AFRICAN WORKSHOP FOR MICRO-ENTREPRENEURS IN THE WATER AND SANITATION SECTOR From the 25th till the 29th of September a workshop was held in Bamako, Mali, where 20 micro-entrepreneurs from 10 West- African countries gathered. During the workshop attention was paid to the fact that in the urban part of the world, the private sector now serves the major part of the clientele, and has become an important employer. It could even generate more employment if the bigger companies would cooperate more with the smaller companies, such as the micro-enterprises. This calls for: 1. Official recognition of the micro-enterprises, i.e. a formal status, which involves alterations in national laws. 2. Policies in tariffing 3. Consciousness of the relationship between environment and public health 4. Attention and support should be given to the financial set-up of the micro-enterprises and better access to credit 5. Better capacity-building for the entrepreneurs This workshop was attended by the UWEP Regional Coordinator for West- Africa, Mr. Modibo Keita. 4. NEWS IN SHORT WELL's TECHNICAL ASSISTANCE WELL is a resource centre in the UK promoting environmental health and well-being in developing and transitional countries. WELL is managed by the London School of Hygiene & Tropical Medicine (LSHTM) and the Water, Engineering and Development Centre (WEDC), Loughborough University. It is also supported by a network of collaborating institutions. The Centre is funded by the United Kingdom's Department for International Development (DFID). One of the services which WELL offers is immediate technical assistance to Southern NGOs working in the water and sanitation sector in developing countries, and to DFID field staff. Up to one day of technical advice can be provided per query free of charge (paid for by DFID). Frequently asked questions and other useful information is listed in the WELL technical briefs page . If you have a technical query, you are invited to complete the 'Immediate Technical Assistance request form' or contact: Sue Sherry (at LSHTM) Keppel Street, London, WC1E 7HT, UK tel: +44 (0) 171 927 2214; fax: +44 (0) 171 636 7843 e-mail: [][/email] UPCOMING: 2ND UWEP PROGRAMME POLICY MEETING IN BANGALORE In the first quarter of 2000 the UWEP team including its committee and the financier will meet in Bangalore for a week to plan the remaining period for the UWEP programme. During the course of the programme, which started in 1995, the focus has become more and more on the Integrated Sustainable Waste Management concept. This concept will now also be used to describe the various pilot projects in the four urban areas where UWEP is active: Bangalore, Bamako, La Ceiba in Honduras and Batangas Bay in the Philippines. Apart from paying some field visits to the Bangalore pilot projects, the workshop will also pay attention to a follow-up to the programme, and what themes this possible follow- up will concentrate on. 5. PUBLICATIONS UWEP/WASTE publishes on various waste related topics. More and more of these publications are being made accessible through the WASTE website: - organic waste and compost - plastic waste - rubber waste - hazardous waste - micro and small enterprises in waste management - excreta collection - urban agriculture - occupational health aspects in waste collection and recycling - community participation in sanitation - sustainable wastewater treatment - hospital waste management - separation at source - ship and port waste - battery recycling For any orders and/or a copy of the UWEP publication list, please contact WASTE (direct e-mail: [][/email]). For full address, see the beginning of this bulletin. URBAN WASTE EXPERTISE PROGRAMME E-MAIL BULLETIN 22 edited by Anne-Lies Risseeuw, UWEP information officer WASTE, Gouda, the Netherlands December 1999 --- To cancel your subscription you must send an e-mail message to with the following text in the body of the message: unsubscribe UWEP-BULLETIN To subscribe: send an e-mail message to [][/email] with the following text in the body of the message: subscribe UWEP-BULLETIN BEWARE: Don't use your signature when sending messages to majordomo! ____________________________________*______________________________________ 3. THE MEDCIN 400 - A LOW COST RURAL MED WASTE INCINERATOR NOW AVAILABLE At Technet'99 in Harare, the Technet reviewed the results of field trials of some 65 small medical waste incinerators for use at rural health facilities. Stephen Caine, MSC Envirohealth Products, provides information on the Medcin 400, a rural medical waste incinerator available for under US$ 3,000 FOB South Africa. Stephen follows up with a message pointing out web resources on the Medcin 400. Moderators Note: Stephen has sent the Technet Forum the Medcin-400 user manual as a rather large MS Word file - now converted to a smaller PDF file at 583 kb. Due to very slow internet connections at my present location it will be uploaded to the Technet Forum FTP/Email sites soon. I will post an announcement of availability in the Technet Forum after I successfully upload it. In the meantime for a copy of the user manual and field test results please email Stephen at: "Stephen Caine" ___________________________________________________________________________ Date: Wed, 24 May 2000 17:46:43 +0200 From: Stephen Caine Subject: Infectious Medical Waste To: [][/email] This e-mail serves as an initial contact with yourself, an attendee of the WHO Technet 99 meeting in Harare in December 1999. Session 3/WP 21 refers. Since December 1999 the Northern Province in South Africa has successfully commissioned in excess of 65 small scale waste incinerators as described in the Technet report. Other provinces are following.The product has proven to be a great success insofar usage by operators and performance is concerned. All relevant approvals have been granted. Environmental concerns are addressed as per the Technet report. The urgency for a solution in the management of waste in rural situations is well documented. The scope of usage broadens to refugee situations, the military and beyond. Our patented product, the Medcin 400, also described as 'the Molope Gas Incinerator' is available to the market. The cost per unit is less than $3000.00 (FOB SA). Please contact the writer for a report on the product. Specifications and performance ratings are included (text or low graphics). We can also send graphic rich documents - please indicate if you wish to receive such. With kind regards Stephen Caine MSC Envirohealth Products, Johannesburg, SA (Our own web site will be launced in July 2000) --- From: "Stephen Caine" To: [][/email] Subject: Health Care Waste Date: Mon, 5 Jun 2000 17:30:11 +0200 Dear Allan, Thank you for your recent interest shown in our Medcin 400 - a solution in the treatment of health care waste in rural areas. Here are some helpful web sites for more information on our product. When you see the name 'Molope gas fired " or similar, read Medcin 400. For the full Technet report : (look at the Power Point Presentation option) /Vaccine_Cold_Chain/Technet/19 99Technet.htm We have received responses from around the world - Cameroun, New York, Copenhagen, Harare, and etc. These documents underwrite the extensive testing undergone over the past 18 months. We are now in a position to supply units to interested parties. Email the sender for further information. With kind regards Stephen Caine MSC Envirohealth Products Johannesburg, South Africa Fax : +2711 314 7535 Phone: + 2711 314 7540 email: [][/email] ___________________________________________________________________________ [Selected and edited extracts of the MSC Medcin 400 User Manual] Contents 1. Introduction 2. Findings of Laboratory Trials 2.1 Emission Testing 2.2 Conclusion 3. Field Trials 3.1 Mechanics of the Field Trials 3.1.1 Clinic Selection 3.1.2 Co-ordination of the Trials 3.2 The Outcome of the Field Trials 4. Technical and Performance Specifications 5. Operating Procedure 5.1 Operation Safety 5.2 Operating Instructions 5.3 Health Care Waste Disposal 5.3.1 Burn Times 5.3.2 Loading the Waste Basket 5.3.3 Destroyed Health Care Waste 5.4 Safety with the Medcin 400 5.4.1 Health Care Waste Storage 5.4.2 Smoke Emissions 5.4.3 Ensuring Your Safety 5.5 What About 5.5.1 Gas Levels 5.5.2 Burning Temperatures 5.5.3 Needles & Sharps 5.5.4 Glass 5.5.5 Placentas 5.5.6 Under-Performance 6. MSC Envirohealth Products contact details --- 1. Introduction Health Care Waste Management at primary health care institutions, particularly those in developing countries, has come under international attention. Pressure to develop and apply sustainable techniques in the responsible management of infectious waste is mounting. The incorrect management of health care waste, or total lack thereof, places patients, health workers and communities at great risk. The Medcin 400, a small-scale gas incinerator, has been developed and tested for use in the rural primary health care environment. This device forms an integral part of a waste management strategy by rendering infectious waste harmless. It is an on-site solution that accommodates the disposal of sharps, placentas and general infectious waste. The following international and South African institutions were involved in the approval process of the Medcin 400: South African National Department of Health (National & Provincial Levels) South African Department of Occupational Health & Safety (National & Provincial Levels) South African Department of Environmental Affairs & Tourism South African Department of Water Affairs & Forestry South African Department of Labour National Waste Management Strategy Group SA Local Government Association SA National Civics Organisation National Education, Health and Allied Workers Union Democratic Nurses Organisation of SA SA Association of Community Pharmacists Mamelodi Community Health Committee Pharmaceutical Society of SA SA Federation of Hospital Engineers Council for Scientific and Industrial Research (CSIR) South African Collaborative Centre for Cold Chain Management The World Health Organisation (WHO) United Nations Child Education Fund (UNICEF) Medecins Sans Frontieres --- 2.2 Conclusion The laboratory trials have shown: * This unit can be used to render medical waste non-infectious, and to destroy syringes or render needles unsuitable for reuse. * Suitable training can reduce the potential health hazard arising from smoke emissions and soot. * The emissions from small-scale incinerators are expected to be lower than those from a wood fire, but higher than a conventional fire- brick-lined multi-chambered incinerator. --- 3.1 The Mechanics of the Field Trials 3.1.1 Clinic Selection Clinics selected had to be in rural locations or under-serviced with: * No medical waste removal * No existing incineration * No transport * Located in a high-density population area * Acceptable environmental conditions must prevail * Community acceptance must be obtained * Operator skill level to be used must be a level of illiteracy 3.1.2 Co-ordination of Trials The performance in the field was evaluated according to these performance criteria: * Safety (occupational and public health) * Destruction capability * Usability * Community acceptability This information was gathered through questionnaires supplied to the clinics at bi-weekly intervals. The questions covered with regard to the criteria were the following: Safety * Smoke Emission * Volume and thickness * Colour * Odour * Ash Content * Are the filled sharps boxes and soiled dressings stored in a locked location while waiting to be incinerated? Destruction Capability * Destruction Rate * Complete * Partial * Minimal * Residue content Usability (for available staff) * Can the incinerator be used easily? * Is the process of incineration safe? * Has training been successful? * Is protective clothing such as gloves, goggles, dust masks and safety boots available? Community Acceptability * What is the opinion of the following persons on the use of the incinerator? * Operator * Nurse * Head of the clinic * Local Authority representative * Community Leader ____________________________________*______________________________________ Selected items reprinted under the fair use doctrine of international copyright law: ____________________________________*______________________________________

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