12 Evaluation of Medical Wastes DISPOSAL METHODS AND THEIR APPLICATIONS IN JORDAN

EVALUATION OF MEDICAL WASTES
DISPOSAL METHODS AND THEIR

APPLICATIONS IN JORDAN
AT
JORDAN UNIVERSITY OF SCIENCE &
TECHNOLOGY
January 2000

BY
Omar Mohammad Ali Al-Qudah
A thesis submitted in partial fulfillment of the requirements for the degree

ofM .Sc in Chemical Engineering
AT
FACULTY OF GRADUATE STUDIES
JORDAN UNIVERSITY OF SCIENCE & TECHNOLOGY
January 2000
Signature of Author:... . _
~0.0 ,.
Committee Members:
Dr. Mamdouh Allawzi (Chairman)
.... . ...
.January 5, 2000
Signature and Date:
~ . ... . .
Dr. Nabil Abdel-Jabbar

Dr. Hussein Allaboun
Dr. Mousa Hawari (Cognate, Spectrum Scientific)
-~-rMA
DEDICATION
0.\0.l\t %l'le mm t\\e c\\an.ce t() \\'le an.O. ~ee till~ ffi()men.t t() t\\e ~()\l\ ()l
ffi':J \:n:()t\\e\: ~a\~a\.
t\..no. to ffi':J cou.n.t1:':J w\t\\ a\\ ffi':J \()'le.
ACKNOWLEDGMENT
At the beginning I wish to thank Allah (God) the most

merciful the compassionate the lord of the world.
My thanks and appreciation are to Dr. Mamdouh Allawzi and
Dr. Mousa Howari, my thesis advisors for years of encouragement,
confidence ,guidance, and excellent interaction.
Also, I wish to express my deep gratitude to Dr. N abil Abdel
J abbar and Dr. Hussein Allaboun for their encouragement and
participation as committee members.
Special thanks to all staffs in the hospitals, medical
laboratories, and pharmaceutical factories , whose I worked with
them, for their helpful and supports.
Finally my appreciation and gratitude are to my parents, my
brothers and sisters, Dr. Ali, Abdel-Hammed, Ahmad, Faries,
Khloud, my wife Fatima, and to all my friends for their
encouragement, help, and strong support.
II
Table of Contents
DEDICATION ......................................................................... ...... ............. I
ACKN"OWLEDG:MENT .................................. ......................................... . II
TABLE OF CONTNETS ........................................................................... III
LIST OF FIGURES ........ ... ........ ... ......................... ... ................................. IX
LIST OF TABLES .......................................... .. ............... ........... ..... ..... ..... . X
ABSTRACT .. .. ... ........ .. .............. .................. ...... ........... .... .... ...... ............ XV
CHAPTER ONE .... .. ............... ..... .. ... .. ....................................................... 1
Introduction ................... ......... .......... .. ................ ........................... ..... ....... 1
1.1 General Background .... .................... .................................................. .... 1

1.2 Objectives of the Study ............................................... ... ... .. .. ........... ...... 3
1.3 Summary of the Study Plan ......... ... ... ..................................................... 4
-CHAPTER TW0 ....................................................................................... 5
Literature Review ........................................ ...... .................................. ... ... 5
2.1 Introduction ............................ ........... .... ... .................... .... ..................... 5

2.2 Definitions ........................................ ..................................................... 6
2.3 Healthcare Wastes Classification and their Sources ................ ............ 11
2. 3 .1 Hospital and HealthCare Establishments Waste ...................... ...... 14
2.3.1.1 Non-Clinical Waste (General Waste) ................................. .. ..... 14
2.3.1.2 Clinical Waste (Medical Waste) ................................................. 14
2.3.1.3 Medical Waste Composite ......... .. ... .. .... ...................................... 23
2.4 Health and Safety Aspects ............... ... .... ........... ...... ..... .............. ......... 23
2 .4 .1 Health Hazards ......................... ............... ..... ................................. 23
2.4.2 Risks to Persmmel ................. ....... ........ ....... ... ............................... 25
2.4.3 External Health Hazards ............................. .... .............................. 27
2.4 .4 Hazards from Different Waste Categories ..................................... 28
2.4.4.1 Hazards from Infectious Waste ................ .... .............................. 28
III
2.4.4.2 Hazards from Sharps .... .. ... ................................... .. ... ................. 28

2.4.4.3 Hazards from chemical and Pharmaceutical Waste .. .................. 30
2.4.4.4 Hazards of Radioactive Waste ............................. ......... ....... ... .... 30
2. 4. 4. 5 Hazards of General Waste ......................................................... . 31
2. 5 Generation Rates of Medical Wastes .................................... ........ ..... .. 31
2.5.1 Weight Basis ..... .... .... ..................... .. .......................................... ... 32
2.5.2 Population Basis ........................................................................... 32
2.5.3 Volume Basis ....... .. ................................................................. ...... 34
2.5.4 Amounts of Waste Generated in Different Parts of the World ....... 36
2.5.5 Ratio ofDepartmental Waste Weight to the Total Waste Weight .. 40
2.6 Factors Affecting the Amount ofHealthCare Waste that Generated .... 42
2.7 Handling, Collection, Storage, and Transportation ofWaste ................ 45
2.7.1 Waste Handling ......... ......... .......... ................................................. 45
2.7.2 Waste Collection .... ... .......... ...................................... .... ................ 47
2.7.3 Segregation and Storage .................................... ... ..................... .... 48
2.7 .3.1 Bags and Containers ................ .............. ......... ..... .. ..................... 50
2.7.3.2 Labeling ......................................................................... ... ... ...... 52
2.7.3.3 On-site Storage (Initial Storage) ................................. ........... ..... 56
2.7.3.4 Off-site Storage Area (Secondary Storage) ............ .. .................. 56
2.7 .4 Transport........ ... ......................................... ...... .. ... ... ..................... 58
2.8 Waste Treatment Methods .................................................... ....... ........ 59
2. 8 .1 Disinfection ................ ..... ............... ....... ...................................... . 60
2.8.1.1 Chemical Disinfection ... .. ........... .... .. ........... .... ... ..... ................... 60
2. 8.1.2 Wet Thermal Disinfection (Autoclaving, or Steam Sterilization)61
2.8.1.3 Irradiation ........................ ... ...................................................... : 63
2. 8.1. 4 Disinfection by Microwaves ... ..... ... ...................... ..................... 64
2.8.2 Thermal Inactivation/sterilization... ............................................... 64
2.8.3 Gas/Vapor Sterilization .... ................................. ... ......................... 66
2.8.4 Inertization .. ....... ..................... .... ......... ....... ........................... ....... 66
2.8.5 Encapsulation ........................... .... ............................... ......... ..... ... .67
2.8.6 Mechanical Treatment. ..... .... ......... ... ...... ....................................... 67
IV
2.8.7 Steam Reforming ............ ....................................................... ..... .. 67

2.8.8 Electyro-Pyrolysis Oxidation ................................................... ..... 68
~
2.8.9 Plasma Based Pyrolysis Vitrification (PBP.Y) ......................... ..... 68

2.8.10 Infrared Sterilization ................................................................... 69
-2.8.11 Incineration ................................. .. ..... ........................................ 69
2. 8 .11.1 Principles of Combustion and chemical Reaction ......... .... .. ..... 71
2.8.1 1.2 Optimum Conditions for Incineration ...................................... 72
2.8.11.3 Principles of Incinerator Design ........ ...................................... 73
2.8.11.4 Types oflncinerators ................................. .............................. 74
2.8.11.5 Incinerators Air P?llution Control Equipment ......................... 79
2.8.11.6 HealthCare Waste that should be incinerated ... ......... ....... ...... .. 80
2.8.11.7 HealthCare Waste not be incinerated ............... ......... ............... 81
2.8.11.8 Health and Environmental Impact of Incineration ..... .............. 81
2.8.12 Comparison between the Infectious Waste Treatments ....... ........ 82
2.9 Disposals ofTreated Waste ............. ..... ...... ....... ...................... ............ 86
2.9.1 Landfilling ........... ................................................... .. ..... ........ .. ..... 86
2.9.2 Types ofLandfilling Accepted for HealthCare Waste .................. 87
2.9.2.1 Landfills Operating on Face Principle ................. ..... ................. 87
2.9.2.2 Sanitary Landfilling ............................. ...................................... 87
2.9.3 Discharge to the Sanitary Sewer System............. .. ......... ............... 88
2.9.4 Health and Environmental Impact ofLandfilling, Open Damping 89
2.10 Cost. .................................................................................................. 91
2.11 Waste Minimization Methods .............. .......... .................... ......... ...... 92
- 2.12 Medical Wastes in Jordan ................ ....... ... ........................................ 95
2.12 .1 Introduction .................................................... .. ... .... ... .. .. ... ......... 95
2.12.2 Waste Generation Rates .................. .......................................... 96
2.12.3 Hospitals Waste Generation ......................................... .............. 96
2.12.4 Medical Laboratories Waste Generation ............... ...................... 98
2.12.5 Pharmaceutical Plants Waste Generation ............... ..................... 99
2.12 .6 Legislation ........ ........ ....... ........... .................................... ........... 102
CHAPTER THREE ... ... ............... ... .......... .......... ................................... 104
Data Collection Study ....... ... ... ... ................................. ........ .............. ..... 104
3 .1 Introdt1ction .................. ... .................................................................. 104
3.2 Segregation and Analysis ......... ........... ... .... ....... ..... ............................ 105
3.2.1 Hospitals ..... ....... .. .............. ......................................................... 105
3.2.2 Laboratories and Pharmaceutical Plants ...................................... 106
3. 3 Studying Area and Period ............ ... ..................... ........... ................... 106
3.4 University of Jordan Hospital (UJH) ...................................... .... ... ... .. 107
3.4.1 Normal Solid Wastes Collection System ..................................... 108
3.4.2 Collection and Disposal System for the Medical Waste .............. 108
3.5 Al-Hussein Hospital.. ......................................................................... 110
3.5.1 Normal Solid Wastes Collection System ...... .. .. ........ ................... l1 1
3.5 .2 Collection and Disposal System for the Medical Waste .............. 111
3. 6 The Islamic Hospital .. .......... .. ........... ..... ... .... .... ....... ......... ................. 113
3 .6.1 Normal Solid Wastes Collection System ..................................... 113
3.6.2 Collection and Disposal System for the Medical Waste ...... .... .... 114
3. 7 Jordan Hospital ................... ......... ........... ... ........................................ 115
3.7.1 Normal Solid Wastes Collection System ......................... .. ......... . l16
3.8 Al-Basher Hospital .......................... .. ............ .................................... 117
3.8.1 Normal Solid Wastes Collection System ..................................... l18
3.9 Medical Wastes Collection System at the Medical Laboratories .... .. .. 119
3.10 Medical Wastes Collection System at the Pharmaceutical Plants ..... 119
CHAPTER FOUR .............. ....... .......................................................... .. 120
Data Analysis and Discussion .......................................... .. ........... ..... .... 120
4.1 Introduction ............................ ... ........... ................. ................ ............ 120
4. 2 Estimation of the Generation Rates .............. ... ....... ..... ....................... 12 0
4.2.1 University of Jordan Hospital. ..................................................... 121
4.2.2 Al-Hussein Hospital .................... ........ ...... ................................ .. 126
4.2.3 The Islamic Hospital ...................................................... .. .......... . 129
4.2.4 Jordan Hospital ................. ... .................... .. ................................. 134
VI
4.2.5 Al-Basher Hospital. ... ...... .. ................... ................. .. .................... 138

4.2.6 Comparison between the Hospitals in this Study .... .... ................. 143
4.3 Physical Properties of the Generated Wastes ............................ .... ..... 150
4.3. 1 Solid Wastes Components in UHJ ............................................... 150
4.4 Medical Laboratories .. ........... ... ................................. .. ........... .... ... ... . 15 5
4.5 Pharmaceutical Study .. ............ .. ........... .. ......... ... ....................... .... .... 159
4.5.1 Pharmaceutical Factories .. .......... ................................................ 159
4.5 .2 Future Trends ......... ... .... ........... .......... ...... ................................... 164
4.5.3 Prices Structure .. .. ....... ......... .. .. ............................ .. .................. ... 164
4.5.3.1 Liquid Wastes Treatment Services .................................... .... ... 164
4.5.3 .2 Solid Wastes Treatment (Incineration) ...... .................. ............. 164
4.6 Evaluation of Handling, Storage, Transport, and Disposal Methods .. 165
4.7 An Overview of Medical Waste Management Situation........ ............. 168
4.8 Suggested Guidelines for Proper Handling, and Management of Hospital
wastes ...................................................................................................... 170
4.8.1 Handling; Collection and Initial Storage ............................ ......... 170
4.8 .2 Transport of Solid Waste within the Hospital. ............ ........ .. .... ... 170
4.8 .3 On-site Storage ........................................................................... 171
4.8 .4 On-site Processing .. ....................... ................ ............. ................ 171
4. 8. 5 Off-site Hauling ............. ....... ...... .... ........ ........ ................ ............ 171
4.8.6 Ultimate Disposal of Hospital Solid Waste ................................. 172
4.8.7 Regulations .... ...... ...... ................................. ... ... .. .... ..... ............... 172
4.9 Experimental Work ....... ....... .. ................................................. ........... 173
4.9 .1 Introduction ... ........... .................................................................. 173
4.9 .2 Instrutnents ........ ..... ......... ............................. ........ ...................... 173
4.9 .2.1 Incinerator ..... ............. ..... .......... ..... ..... ..... .................. .... ........ .. 173
4.9.2.2 Flue Gas Analyzer ............................................................. .. .. .. . 173
4. 9. 3 Type of Medical Waste that Incinerated .. ......... ................. ....... ... 17 6
4. 9. 4 Properties of Bacterial Culture that Used ... ............ ... .................. 17 6
4.9. 5 Experimental Procedure .... ..... .......... ........................................... 177
4.9. 6 Experimental Results .. ............... ................. ......................... ....... 177
4. 9. 6.1 Results of Gases Analysis ........... ........... .. ................................ 177
VII
4.9.6.2 Results of Ashes Analysis ............................................... .... ..... 183

4.9.7 Discussion of the Results .... ........... ... ........... ......... ...................... 183
4 .9.7.1 Discussion of the Gases Analysis Results .... ..... ... ... ....... .......... 183
4.9.7.2 Discussion ofthe Ashes Analysis Results .............. .................. 185
CHAPTER FIVE ......................... ......................................................... 186

Conclusions and Recommendations .......... ........................................... 186
5.1 Conclusions ..... .. ............ .................................................................... 186
5.2 Recommendations ...... ................. .. .... ......................... .......... .............. 189
REFERENCES ................... .............. ..... .................................... ...... .. ... ... 191
APPENDICES ......... ........ .............................................................. .... ...... 193
APPENDIX A ........ ........................................................................ ....... .. 194
Generation Quantities ............ ...... ..... .. .................................... .... ............. 195
APPENDIX B ..... ... ...... ........ ...... ... ........... .... .... .... .................................... 209
Contribution the Generated Waste to the Various Departments ............... 210
APPENDIX C ..................................... ..... .......................................... ..... . 216
Physical Properties of the Generated Wastes at UJH ............................... 217
APPENDIX D ........................................ ............................. .................... 220
Type of the Medical Wastes that Produced and the Applied Methods for
Disposal of these Wastes at Al-Basher Hospital ...................................... 221
APPENDIX E ......... ....... ............................ ...... ....... ... .............................. 223
Disposal Methods for Different Types of Medical Wastes (Complied from
American Hospitals Association Handbook, p .p. 130-11) ...... .. ........... ..... 224
APPENDIX F ................. ...................................... ..... ...................... ....... . 228
Vehicle Design for Off-site Transportation of Hazardous HCW .............. 229
APPENDIX G .. ........... ..... ............................. ........ ...... ..... ............ ... ... ..... 230
Abbreviations ............................................................................ .. ............ 230
VIII
List of Figures
Figure
Description
Page
4.1
Comparison between the medical waste compositions that obtained in

this study at UJH, and the WHO typical values ............ ...... .... .. ........... 125
4.2

this study at the Islamic hospital, and the WHO typical values .. ...... .. .. 133
4.3

this study at Jordan hospital, and the WHO typical values .................. . l37
4.4
Instruments that used in the experimental work .. .......... ......... .............. 174
IX
List of Tables
Table
Description
Page
2. 1
Sources and quantities of medical waste generated in USA by

different healthcare establishments ............ ... ... .. ......... ... ... .. .. .......... ..... .. 13
2.2
Categories of clinical waste produced by various types ofhealthcare

services ......... ........... ... ... .. ... ..... ..... ... ... .. ... ...... ... ... ..... ... ... ... .. ...... .... ... .. .. 16
2.3
Principle radio nuclides used in healthcare establishments ..... ... .... ......... 17
2.4
Types of medical waste designated as infectious by the CDC and the

EPA ................................... ......... .... .. .... ................ ..................... .. .. ...... . 19
2.5
CDC recommended categories ofinfectious waste ... ... ... ..... ..... .... .. ... .. .. 19
2.6
EPA categories of infectious waste ... ... ... ..... .. .... ..... ................ .. ... .. ... .... 20
2. 7
Physical parameters ............... ..... .. .......... ... ........ ... .............. .. ... ..... ... ..... 20
2.8
Typical composition of healthcare waste .................... ............ .. .. ........... 21
2.9
Typical categories of hospital's solid waste .............. ...... .... .. ...... ... ... .. ... 22
2.10
Occupational HBV infectious through injuries from sharps USA ... .. .... .29
2. 11
Breakdown of daily waste production by types of waste in (kg) at Los

Angeles hospitals ... .... ... ... .. ......... ... ..... ..... .. .... ...... .... .... ..... .. ... ... .... ... ..... 33
2.12
Summary of solid waste generation at New York University Medical

Center ........... .............. ... ........ .. ..... ...... ......... ... ....... ...... ......... .. .............. 34
2.1 3
Summary of generation rate by type of hospital in France ... ... ........ ...... .3 5
2.14
Average daily of hospital waste of29 hospitals in USA with Average

of 224 patients .... ..... ... ... ...... .. .... ... .. ... ... .. ... ... .... .......... ... ... ........ ... ... ... ... 35
2.1 5
Healthcare waste generated according to the income levels .... ..... .......... 36
2. 16
Hospital waste generated according to regions ................. ........... .......... 36
2. 17
Hospital waste generated according to waste type in Western Europe ... 36
2.18
Hazards healthcare waste quantities produced in healthcare facilities

in selected countries of Latin America! and Carbibbean ......... .......... ... .. 37
2. 19
European generation rate of hospital waste source type ... .... .. ... ... ... ....... 37
2.20
Generation rate of solid waste in some industrialized countries .... ......... 38
2.21
Generation rate of solid waste in Latin America! hospitals ..... ..... ... ... .... 38
2.22
Generat ion rate of healthcare waste in Europe .... ....... .... ... .. ................... 38
2.23
E stimated amount of healthcare waste in different countries ......... ......... 39

X
2.24
Summary of solid waste generation by units at St. Anthony hospital,

St. Petersburg, Fla .. .. ... ... ... ... ... ...... .. .... .. ... ... ...... .. ... ... ..... .... ..... ........... ... 40
2.25
Summary of solid waste generation by units at Fair hospital, USA ........ 41
2.26
Sources of solid wastes within the hospitals ....................... .................. .41
2.27
Healthcare waste according to source size ........................ .. .............. .... .43
2.28
Summary of generation rates, by the type of hospital in the

Netherlands ...... ............................................................... .. .................... 44
2.29
Summary of generation rates, by size of hospital in the United States

of America ... ....... ......... .. ...... .......................... .. .. .... ............ .. .. ... ..... ....... 44
2.30
Generation rates at Washington area hospitals ...................... ................ .44
2.3 1
Recommend segregation and color coding for healthcare waste ............ 54
2.32
Segregation and color coding for HCW in minimal programs .. .. ........... 54
2.33
Recommended UK color coding for containers for clinical waste .... ..... 55
2.34
Labeling............ ....................... .............................................. .... ........... 55
2.35
Waste storage periods ........................................................................... 51
2.36
Time and temperature requirements for steam sterilization .................... 63
2.37
Autoclave sterilization requirements ................................. .. .. .............. ..63
2.38
Dry heat sterilization ............................................. ....... ..... ... ............. .... 65
2.39
Summary of emission test result PBPV furnace after burner outlet.. ...... 68
2.40
Components of an infectious waste incinerator ..................................... 70
2.41
Concentration of gases that flue from the incinerator chimney that is

not allowed to exceed .... ......... ........ ............. .......... .... .. ...... ......... ...... ..... 74
2.42
Standard reference combustion temperatures for infectious waste

incinerator ................................ ... .......................... ........... .......... .......... 74
2.43
Characterization of different types of incinerators .. ... ........... ... ......... .. .. . 76
2.44
Incinerator Institute of America Waste, classification ofwaste .............. 77
2.45
The emission of the gas from the chimney of the incinerator of the
hospital Felkirch in Vorarlberg, Austria in 1975 ............. .... .................. .78
2.46
Air pollution control devices (scrubbers) used for incineration .............. 80
2.47
Comparison between the infectious waste treatments .............. ............ .. 82
2.48
Summary of main advantages and drawbacks of treatment and

disposal option ........................................... .. .................... .. ... ............. ... 83
2.49
Overview of disposal and treatment methods for healthcare waste

categories ...... ............. ........ ... .. ............... ............................... ................ 85
2. 50
Estimated infectious waste treatment cost ....... .. ......... .. .... ... ... ... .... ...... ..91
2.51
Methods for waste minimization for general medical and surgical

hospitals ................................. ... .. ............... .................... ........... ........ .... 93
2.52
Healthcare services in Jordan .... .. ...... .... .............. ........ ........... .... ... ........ 95
XI
2.53
Total number ofbeds in public and private hospitals in Jordan .. .. ... .... ... 95
2. 54
Wastes generation rates in selected hospital in Amman ... ...................... 96
2.55
Solid wastes components in the UJH ........................................ ......... .... 97
2.56
Summary of solid waste generation rates for local hospitals at Irbid

City .. .................................................. ............... ... ........... ................. .... .97
2.57
Physical properties of solid wastes generated at the specialized

medical laboratories in Amman ............ ............................................. .... 98
2.58
Summary of generation rates at governmental and private

laboratories in Irbid ............. .... ................................... .. ......... ... ......... ... . 99
2.59
Estimated production size ofpharmaceutical factories ................. ......... 99
2. 60
Estimated annual quantities of solid hazardous wastes by waste type .. 100
2. 61
Current collection and disposal systems of solid wastes followed by

the existing pharmaceutical factories in Jordan ...................... .... ....... .. . 100
2.62
Types of liquid hazardous wastes generated by Jordanian

pharmaceutical factories and their estimated annual volume ........ ........ 101
2.63
Current collection and disposal systems ofliquid waste followed the

existing pharmaceutical factories in Jordan ...... ........... ....................... . 101
3. 1
Hospitals that studied ........ ........ ............. .............. ......................... ...... 106
3.2
Medical laboratories that studied .. ....................... .. ............ .................. 106
3.3
Pharmaceutical plants that studied .................. ............. ... ....... .... ...... ... . l06
4. 1
Summary of the solid waste generation rates at UJH ............. ... .. ... ...... 123
4.2
Summary of the solid waste generation rates at various departments

at UJH ....... ..... .............. ....................... ................. ................. ... ... ... .... 123
4.3
Summary of the solid medical waste generation rates at UJH .............. 124
4.4
Summary of the solid waste generation rates at Al-Hussein hospital... . 127
4.5

at Al-Hussein hospital .. ... .. ..... ..... .................. ... ..... ... .............. ............. 127
4.6
Summary of the solid medical waste generation rates Al-Hussein

hospital .. ............................. ....... .... ....... ......... ..... .. ..................... ......... 128
4.7
Summary ofthe solid waste generation rates at the Islamic hospital .... 130
4.8

at the Islamic hospital .. .......................... .... .................. ....... ................ 131
4.9
Summary of the medical waste generation rates at various

departments at the Islamic hospital. ... .... ... ....... ...... ............ ... .. ......... .. .. 131
4.10
Summary of the solid medical waste generation rates at the Islamic

hospital .......... ... ... .................... .................... ... ........... .... .......... ... ... ..... 132
4.11
Summary ofthe solid waste generation rates at Jordan hospital. .......... 135
4.12

at Jordan hospital ................................................................................ 135
XII
4.13
Summary of the solid medical waste generation rates at Jordan

hospital .................................... ... ..... .. ..... ...... ...... ............. .... ......... .. .. .. 136
4.1 4
Summary ofthe solid waste generation rates at Al-Basher hospital .... . l39
4.15

at Al-Basher hospital... ......................... .... ....... ......... .................. .. ....... 139
4.16
Summary of the solid hazardous waste that produced at Al-Basher

hospital ... ............ ... ............. .... ....... ...... ......................... .. ... .......... .... ... 140
4.17
Summary of the solid medical generation rates at Al-Basher hospital..141
4 .18
Summary of the disposal methods for different types of medical

wastes at Al-Basher hospital ........ .... ................................................... 142
4.19
Summary of the solid waste generation rates for local hospitals at

Amman City ................ ............ ......... ... .................. .... .. ..... .... ....... ....... 144
4.20
Percentage of weights and generation rates of solid wastes generated

at the various departments at the five hospitals in this study ...... ...... .. .. 148
4.21
percentage of weights and generation rates for different medical

wastes generated at the five local hospitals in this study ...................... 149
4.22
Summary of physical properties of the solid wastes generated at

various departments at Ulli .. .. .. .. ... ........ ... .. ... ... ... ... .......... .. ... ... ... ...... . 153
4.23
Summary of physical properties of medical wastes generated at

various departments at Ulli ...... .. ...... ..... .. .... ..................................... .. 154
4.24
Summary of the solid waste generation rates in certain laboratories at

Amman City ....................................................................................... 155
4.25
Summary of physical properties of the solid wastes generated at Jabal

AI-Hussein consulting medical laboratory ....... ....... ....... .. ...... .............. 157
4.26
Summary of physical properties of medical wastes generated at Jbal

Al-Hussein consulting medical laboratory .......................... ... ........... ... 158
4.27
Summary of physical properties of medical wastes generated at

Jordan hospital laboratory .... ... .. .. ..... .............. ...... ...... ......... ........... ... .. 158
4.28
Summary of the wastes generation rates at Hikma for sterilizes ... ..... ... 163
4.29
Summary of the solid waste generation rates at Hikma for medicine ... 163
4.30
Summary of the liquid waste generation rates at Hikma for medicine .. 163
4.3 1
The emissions of the flue gas from the chimney ofUlli incinerator as
a wood basis, Jordanl999 ... ............... ............................ .. ................... 179
4.32
N ormalization for the flue gases emissions that presented in Table

(4 .3 1) at 10% 0 2 percentage ........... ... ........... ... ... ........... ... ....... ... ... .... 180
4.33
The emissions of the flue gas from the chimney ofUlli incinerator as
a light fuel oil basis, Jordan 1999 ......................................................... 181
4.34
Normalization for the flue gases emissions that presented in Table

(4.33) at 10 % 0 2 percentage ... ... .............. .. ............ .. .......................... 182
4.35
Typ ical maximum concentration of gases that flue out from the
incinerator chimney (WHO) ............................................... ....... ... .. .. ... 184
XIII
4.36
Comparison between the concentration of gases that emission from

the incinerator chimney which obtained in this study and the WHO
typical values Table (4.35) ............................... ................. .................. 185
XIV

By:
Omar Mohammad AI-Qudah
Supervised by:
Dr. Mamdouh Allawzi
Dr. Mousa AI-Howari
ABSTRACT
Medical wastes (or infectious wastes) is an essential part of the municipal waste
management, and is categorized as hazardous waste. Unfortunately, in practice in Jordan
this waste is taken as general waste and thus treated as any other waste and this create
many dangers to the persons whose deal these wastes and to the environment as the same
time.
This study comes to understand and to issue solutions for the previous big problem
through collect actual data and facts regarding wastes (specially medical wastes) generated
at the Healthcare Establishments (HCE) located in Amman City (in Jordan). Also, to
approve the effectiveness of the incineration treatment method for the solid waste
(especially medical waste) based on experimental analysis for the emission gases and the
reminder ashes from an incinerator located at University of Jordan hospital. And then make
a comparison between the results that obtained and the reported results in the literatures.
Field investigations of hospitals, medical laboratories, and pharmaceutical factories
solid wastes in Amman were carried out in 1998 and 1999. Towards this end, five hospitals
have been considered in this study, namely University of Jordan hospital (general
governmental and teaching), Al-Hussein hospital (military), the Islamic hospital (general
and private), Jordan hospital (general and private), and AI-Basher hospital (general and
governmental). As well as two private medical laboratories, namely Jabal Al-Hussein
consulting medical laboratory and laboratory of Jordan hospital and one pharmaceutical
plant (AI-Hikma pharmaceutical plants).
The generation rate of solid wastes for hospitals was found in a range 3.503
kg/pat./day for Jordan hospital and 5.102 kg/pat./day for Al-Basher hospital. Also, the
average generation rate of solid wastes for medical laboratories was determined to be 0. 066
kg/test/day, and the generation rate of solid waste for pharmaceutical plants was found to
be 1.44 exp.-4 kg/drug/day. The average percentage of medical waste generated at HCE in
Amman is
17.75 % by the total weight, finally the average efficiency of the UJH
incinerator was found to be 46.2%.

Solid wastes generated from all above HCE were considered hazardous, since
segregation of these generated wastes, was not practiced. This study took into
consideration both quantity and quality of the generated wastes as to determine their
generation rates and physical properties. Also, it presents a comprehensive survey of the
current situation regarding handling, transportation, storage, and disposal practices of the
medical wastes. Results of this survey showed the need for a second look of the current
situation and to develop programs and plans of action to ensure proper and safe handling
transportation, storage, and disposal schemes.
A comprehensive management scheme was also proposed for handling the medical
wastes while taking care of financial constraints of the HCE, but providing safety to both
human health and environment, at the same time.
XVI
CHAPTER ONE
INTRODUCTION
(1.1) General Background
There is a growing awareness, on a worldwide scale, of the need to impose stricter
controls over the disposal of wastes generated by hospitals and other healthcare services
and the pharmaceutical plants. This is an extension of the common concern for hospital
hygiene and should be an integral part of hospital management. In general, throughout
Europe and North America clinical waste is not classed as hazardous or special waste.
Even though many countries have devised codes of practice and made recommendations
for the handling and disposal of hospital and clinical wastes, they tend not to be enforced,
resulting in many categories of clinical wastes being disposed of in landfi ll sites without
any special precautions or safety measures being taken.
For many years the World Health Organization (WHO) has advocated that hospital
wastes should be regarded as special wastes. It is now commonly acknowledged that
certain categories of clinical wastes are among the most hazardous and potentially
dangerous of all wastes arising in the community. As the volume and complexity of
healthcare waste increase, the risk of transmitting disease through unsatisfactory handling
and disposal practices also increases. The recent rise in the incidence of diseases such as
Acquired Immune Deficiency Syndrome (AIDS) and Hepatitis B & C opens up the
possibility of infection of personnel handling these wastes, and the wide spread illicit use
of drugs makes the need for proper disposal of used hypodermics and syringes imperative.
Even less hazardous categories of clinical wastes need t0 be handled and disposed
of in a controlled manner so as to ensure that environmental pollution does not result. This
can only be achieved by the use of enforceable codes of practice and guidelines for all
aspects of the handling, storage, transport and disposal of these wastes.
In developed countries, there are enforced rules that define medical wastes and
state the various possible ways for collection, transport, storage and disposal of such
wastes. Also, the best available technologies are used for the development of alternatives
for proper disposal process of medical wastes without risks or pollution to human health
and environmental.
In Jordan, healthcare establishments are less fortunate when it comes to the ways
and methods for the handling and disposal of wastes generated by them. First, there are no
defined methods for handling and disposal of these wastes, starting from the personnel
responsible for collection through those who transport them and until the disposal site.
Second, there are no specific regulation or guidelines for segregation or classification of
these wastes. This would mean the mixing of wastes coming from the kitchen as an
example with those generated by different departments and so on. Finally, and most
important, no body could furnish a scientific and accurate guess about the rates or
quantities generated from each department based upon the known variables within this
department. In fact one of the objectives of this study is just that taken some hospitals,
medical laboratories, and pharmaceutical factories as a model.
Solid wastes generated from hospitals, medical laboratories and pharmaceutical

plants in Amman City are collected and transported without taken into consideration any
segregation
or classification practices. Environmental Protection Agency
(EPA) has
established a guidance to prevention states by current law, any wastes mixture of non2
hazardous or infectious and hazardous waste must be handled as hazardous wastes, this
would mean that all mixed solid wastes generated from health care establishments are
hazardous waste.
(1.2) Objectives of the Study

The specific objectives ofthis study are directed towards:
1.
Conducting a survey of the available procedures, techniques, and methods of

handling and disposal of medical waste at mid-size to large health care institutions
(including hospitals, medical laboratories, and pharmaceutical plants) in the city of
Amman. Important factors, which characterize each one of these institutions and their
possible influence on the type and quantity of the generated waste, are considered.
2. Re-evaluate the generation rates, components, and physical properties of solid wastes
(specially medical waste) from such institutions in Amman, through fact-finding and
interviews.
3. Review and compare the available alternatives for the treatment and disposal of hiehazardous medical and pharmaceutical waste, including but not limited to, incineration,
\
Plasma Based Pyrolysis Vitrification (PBPV), microwaves, autoclaving, and radio

frequency radiation ...
4.
Identify a recommended pnmary and secondary methodology of treatment and

disposal of bio-hazardous medical and pharmaceutical wastes.
5.
Recommend guidelines on proper handling and management of such wastes. Such

guidelines will assist planners in developing proper and comprehensive waste
management schemes.
6.
To measure the effectiveness ofthe incineration treatment method.
(1.3) Summary of the Study Plan

To do the previous objectives:
1. Literature review of the quantities and kinds of the wastes was made for the world
and for Jordan as a private case.
2.
Direct weighting and many interviews were made in different five hospitals, two
medical laboratories,
and one pharmaceutical plant in Amman city. To find the
generation rates and evaluation of the treatment methods that applied in these Health
Care Establishments (HCE).
3. Mass balance was made around some departments where the direct finding of
generation rates was very difficult.
4.
Experimental work was done in the University of Jordan Hospital (UJH) incinerator
to find the amount of gases that emission to the air and composition of the remainder
ashes, and then evaluate the incinerator efficiency.
CHAPTER TWO
LITERATURE REVIEW
(2.1) Introduction
Institution generation infectious and medical waste has found its management to be
an intractable problem. Various regulatory bodies are continually issuing new rules and
guidelines. Employees complain of threats to their health and inadequate training.
Commercial services for infectious and medical waste disposal are either poor on
nonexistent in most areas of the country. Few inspectors under stand the nature of its
generation or the labyrinth of its control. Thus, institutional administrators fail to find
waste management system that is both workable and cost-effective. And loose hypodermic
needles still end up at the local landfill.
The need for infectious and medical waste management now reaches beyond
hospitals and medical waste centers to smaller waste generators, such as clinics, colleges
and universities, diagnostic laboratories, pharmaceutical and biotechnology companies,
funeral homes; vocational/technical schools, doctor's office, and other health service
facilities. An administrator looking for a solution faces a perplexity of jargon, management
options, and environmental nuance, including such controversial issues as employee safety
and Acquired Immune Deficiency Syndrome (AIDS) (Reinhardt and Gordon, 1991).
(2.2) Definitions
A quick review of the jargon used in waste management is a good place to begin.
Solid waste is a catchall term used by the U.S . Environmental Protection Agency
1.
(EPA) to define all solid, liquid, and gaseous waste. Chemical, hazardous, infectious,
and medical wastes are subcategories of solid waste that can threaten human health or
the environment because they are potentially harmful. The term "solid waste" is
frequently used generically for the non-hazardous component of solid waste, such as
normal refuse and trash. Unless other wise noted, the authors use the term "solid waste"
in none legal sense, to denote normal trash that doesn't have any inherently harmful
characteristics that merit additional regulation (Reinhardt and Gordon, 1991).
2. Normal waste or municipal waste is used to define all non-hazardous waste, nonchemical waste, non-infectious waste, and non-medical wastes.
3.
Healthcare Waste (HCW) is total waste stream from HCW generators (major and
scattered sources) (WHO, 1998).
4.
Generation is the term used for the process of making waste. For example, the care
of patients often generates infectious waste. Waste generation also refers to the
decision to disposal of a material, such as the discarding of laboratory chemicals
prompted by an annual review of storage shelves (Reinhardt and Gordon, 1991).
5. Waste stream is used to distinguish a segregated waste type; sharps and flammable
solvents are examples of two such as waste streams. It is from this point on ward that
containment is important to prevent contamination or exposure to workers handling the
waste, wastes are often temporarily accumulated at the point of generation (Reinhardt
and Gordon, 1991).
6
6.
Storage usually refers to the use of a dedicated facility or centralized area where the
generated waste is held prior to transport, treatment, or disposal (Reinhardt and
Gordon, 1991).
7. Treatment refers to the process that reduces or eliminates the hazardous

characteristics or reduces the amount of a waste (Reinhardt and Gordon, 1991 ).
8. Disposal usually refers to the permanent containment of a waste in a landfill. (The
waste may or may not retain some harmful characteristics). Disposal sometimes
denotes dilution and dispersal, such
as emission into air of small amounts of
contaminants from incineration or discharge into sewer (Reinhardt and Gordon, 1991 ).
9. Special wastes are those waste materials that present an unusual problem or required
a special handling, according to the American Public Works Association (APWA)
(Bdour, 1997) USA Environmental Protection Agency, EPA defines such wastes as:
a. Hazardous wastes by reason of their pathological, explosive, radioactive, or toxic
nature;
b. Security wastes, confidential documents, negotiable papers, etc ...
10. Hazardous wastes are defined by EPA in the Resources Conservation and Recovery
Act of 1976, (RCRA), subtitle C, as "solid waste or combination solid wastes, which
because
of its
quantity, concentration, or physical, chemical, or infectious
characteristics may:
a. Cause or significantly contribute to an increase in mortality or an mcrease m
serious, irreversible, or incapacitating reversible, illness or:
b. Pose a substantial, present or potential, hazardous to human health or the
environment when improperly
treated, stored, transported, or disposed of, or
otherwise managed. This is a subset of hazardous wastes.

7
Also, hazardous waste is legally defined by EPA in title 40 of the Code ofFederal
Regulations (40 CFR), part 261. EPA's use ofthe term "hazardous waste" is very
confusing because it only pertains to hazardous chemical waste. Although infectious
waste is indeed hazardous, it doesn't currently fit EPA's legal definition of
hazardous waste. Also confusing is the term "hazardous material", which is defined
by the U.S. Department OfTransportation (DOT) to include chemical, radioactive,
and etiological agents. EPA also uses the term "hazardous substance" in some
environmental laws. Consequently, the word "hazardous" must be used carefully
(Reinhardt and Gordon, 1991).
Also WHO defined hazardous health-care waste as
75-90% of general waste (similar to domestic waste), 10-25% is hazardous

(infectious, toxic etc ... ) (WHO, 1998).
11. Infectious agent means a pathogen that is sufficiently virulent so that if a susceptible
host is exposed to the pathogen in an adequate concentration and through a portal of
entry, the result could be transmission of disease to a human (Wagener, 1998).
12. Infectious waste includes all kind of wastes, which may transmit viral, bacterial or
parasitic diseases to human beings. In addition to infectious, medical wastes it includes
infectious animal wastes from laboratories, slaughterhouses, veterinary practices and so
on (WHO, 1994). In 1976, congress used the word "Infectious" to characterize a
potential type of hazardous waste. Until 1988, EPA continued to use the word in its
guidance for "waste capable of producing an infectious disease". EPA now uses the
term "medical waste" which includes many of the wastes formally listed as infectious
(Reinhardt and Gordon, 1991).
13. Medical wastes means any waste which is generated in the diagnosis treatment or
immunization of human beings or animals, in research pertaining thereto, or in the
production or testing of biological (this is the wording and definition used in the USA)
(WHO, 1994). Also medical waste means any of the following that are not generated
from a household, a farm operation or other agricultural business, a home for the aged,
or a home health care agency (Wagener, 1998):
a. Cultures and stocks of infectious agents and associated biological, including
laboratory waste, biological production waste, discarded live and attenuated
vaccines, culture dishes, and related devices.
b. Liquid human and animal waste, including blood and blood products and body
fluids, but not including urine or materials stained with blood or body fluid.
c. Pathological waste.
d. Sharps.
e. Contaminated waste from animals that have been exposed to agents infectious to
humans, these being primarily research animals.
AP\VA also has divided medical wastes into a non-contaminated and contaminated
wastes based on the point of origin as follows (Bdour, 1997):
a. Non-contaminated wastes:
Are those materials resulting from non-medical activities not directly or physically
related to patient's care, such as materials generated through warehousing,
processing, and preparation of new sterile materials and supplies?
b. Contaminated wastes~
Are those materials resulting from the use of clean materials generated and used in
connection with a patient care through clinical services, medical support services
and certain non-medical services solid linen, etc ...
Biological and infectious waste generated from patients treatment, operation and a
result procedures, laboratory, research activities, radioactive, explosive, and toxic
materials.
14. Hospital wastes means all waste coming out of hospitals out of which around 85%
are actually non-hazardous wastes, around 10% are infectious wastes, and 5% are noninfectious but hazardous wastes (WHO, 1994).
15. Clinical wastes means any waste coming out of medical care provided in hospitals
or other medical care establishments. (This is the wording and definition used in the
Basel convention regulating transboundary movement of hazardous wastes). Actually
this definition neglects medical wastes resulting from medical care in the home (WHO,
1994).
16. Pathological wastes include human tissues, organs, and body parts and body fluids
that are removed during surgery or autopsy or other medical containers. (They are part
of infectious wastes as well as ofthe three kinds ofwastes listed above) (WHO, 1994).
Also, EPA defined pathological waste as human organs, body parts other than teeth,
products of conception and fluids removed by trauma or during surgery or autopsy or
other medical procedures, and not foxed in formaldehyde (Wagener, 1998).
17. Pathogen means a microorganism that produces disease (Wagener, 1998).
18. Point of generation means the point at which medical waste leaves the producing
facility site (Wagener, 1998).
19. Producing facility means a facility that generates, stores, decontaminates, or
incinerates medical waste (Wagener, 1998).
20. Release means any spilling leaking, pumpmg,
pouring, emitting, emptying,
discharging, injecting, escaping, leaching, dumping, or disposing of medical waste into

the environment in violation of this part (Wagener, 1998).
21 . Response activity means an activity necessary to protect the public health, safety,
welfare, and includes, but is not limited to, evaluation, cleanup, removal, containment,
10
isolation, treatment, monitoring, maintenance, replacement of water supplies, and

temporary relocation of people (Wagener, 1998).
22. Decontamination means rendering medical waste safe for routine handling as solid
waste (Wagener, 1998).
23 .
Sharps means needles, synnges, scalpels, and intravenous tubing with needles
attached (Wagener, 1998).

24. Autoclave means to sterilize using super heated steam under pressure (Wagener,
1998).
25. Household means a single detached dwelling unit or a single unit of multiple
dwelling (Wagener, 1998).
26. Transport means the movement of medical waste from the point of generation to any
intermediate point and finally to the point of treatment or disposal. Transport does not
include the movement of medical waste from a health facility or agency to another
heath facility or agency for the purpose of testing and research (Wagener, 1998).
(2.3) Healthcare Wastes Classification and Their Sources

Waste components can be classified according to the point of origin into: domestic,
agricultural, commercial, industrial, constructional waste, as well as health care waste.
Health care waste is the waste arising from medical activities such as diagnosis,
treatment, and prevention of disease or alleviation of handicap in humans or animals
including clinically related research under the supervision of a medical or veterinary
practitioner or approved health care system (WHO, 1994).
Health care establishments can be divided in terms ofthe amount ofwaste generated by
each (WHO, 1998) into:
11
Major sources of health-care waste
l.
1. Hospitals.
2. Emergency Medical Care services.
3. Health Care centers and dispensaries.
4. Obstetrical and maternity clinics.
5. Outpatient clinics.
6. Dialysis centers.
7. First aid posts and sick bays.
8. Long-term healthcare establishments and hospices.
9. Transfusion centers.
10. Military medical services.
11. Medical and biomedical laboratories.

12. Biotechnology institutions.
13. Medical research centers.
14. Veterinary services, animal research and testing.
15. Blood banks and blood collection services.
16. Old-age nursing homes.
17. Mortuaries.
18. Autopsy centers.
II.
Minor sources of healthcare waste include
1. Physician's office.
2. Dental clinics.
3. Acupuncturists.
4. Post-care nursing homes.
5. Psychiatric clinics.
6. Disabled person institutions.

7. Cosmetic ear-piercing or Tottoo parlors.
8. Elicit drug users.
9. Funeral services.
10 .Home healthcare.
11. Paramedic services.
While hospitals are considered to be the primary generator of health care waste by
volume, the figures capture only a fraction of health care facilities that generate medical
waste. Approximately 50,000 tons of medical waste are produced in USA annually (U.S.
EPA 1990) and by about 375,000 waste generators. Most medical waste (about 77%) is
produced by hospitals which comprise about 2% of the total number of generators. The
remainder
of healthcare waste is processed by a large, diverse group of generators,
including physicians, clinics, dentists, and pharmacies, most of which generates less than
50 pounds/month. Table (2.1) shows the sources and quantities ofwaste generate in USA
by different healthcare establishment's (El-Far, 1998).
Table (2.1) Sources and quantities of medical waste generated m U.S.A, by different
healthcare establishments
Generation type
Number of
generators
Hospitals
7100
Laboratories
4300
Clinics
15500
180000
Physician's offices
98400
Dentist's offices
Veterinarians
38000
Long-term
12700
healthcare facility
900
Free standing blood
banks
Funeral homes
20400
Total
377300
Source: (El-Far, 1998), (Schmidt, 1996)
Total medical
waste generated
(Tons/Yr.)
359000
15400
16700
26400
7600
4600
29600
Medical waste per

facility (lb./mo.)
2400
3900
465600
13
8400
600
180
24
13
320
440
32
(2.3.1) Hospital and Healthcare Establishments Waste

Hospitals and healthcare establishments produce two distinct types of waste, nonclinical or general waste and clinical waste or medical waste or hazardous healthcare
waste.
(2.3.1.1) Non-Clinical Waste (General Waste)

The non-clinical wastes (General wastes) identified below are produced by a wide
range of services, (WHO, 1984):
I)
Kitchen and canteen waste. These wastes are produced in the preparation and
serving of food, including food packaging, waste and surplus food, cleaning
materials etc ...
II)
Commercial and clerical waste. Included are office materials and equipment
including timber, metal, paper and cardboard waste water and laundry waste.
III)
Used disposal bedpan liners, urine containers, feces, incontinence pads and stoma
bags.
IV)
Non-infectious animal bedding.
V)
Other substances that do not pose a special, handling problem or hazard to human
health or the environment.
(2.3.1.2) Clinical Waste (Medical waste or Hazardous Healthcare Waste)

Clinical wastes
(medical waste or hazardous healthcare wastes) are typically
classified into seven categories, as indicated in Table (2.2). And these are as follows:
I)
Pathological wastes. Consists of tissues, organs, body parts, human tootsies and
animal carcasses, and most blood and body fluids (WHO, 1984), (WHO, 1994).
II)
Radioactive waste includes solid, liquid and gaseous waste contaminated with radio
nuclide generated from "in-vitro" analysis of body tissues and fluid or "in-vivo"
14
body organ imaging and tumor location and therapeutic procedures (WHO, 1984),
(WHO, 1994), (Qusous, 1988).
There are three sources of radioactive waste. First, research activities that which
commonly use significant quantities of 14C and 3 H and generate large volumes of
waste with low radioactivity. Second, clinical laboratories, which are involved in
radioimmunossays procedures that like wise generate relatively large amount of
waste with low radioactivity. Finally, nuclear medicine laboratories, which generate
relatively small amounts of waste but with higher radioactivity than the previous
two sources, (Bdour, 1997). In other hand, radioactive waste can be divided into
two sources:
a) "Sealed" source are those in which the radioactive isotopes are sealed into the
source for use as a component or an instrument isotope can not be separated
from the component and is usually much higher level of activity than "open"
sources. Sealed sources are used, for example, in brachytherapy but do not
routinely give rise to radioactive waste. They are normally disposed ofby
returning them to the supplier for special procedures.
b) "Open" sources are those in which the isotope it self is used, for example, in
vitro
analysis of body tissues and fluid. Waste generated by this type of
treatment or use can be gaseous, liquid or solid, and are generally of low
activity (Anderson, 1996), (El-Far, 1998). A list ofthe principal radionuclides
with their format and application emission as well as their half-life used in
healthcare establishments is shown in Table (2.3).
15
Table (2.2) Categories of clinical waste produced by various types of healthcare services
Source
Pathological
Patient services
Medical
Surgical
Operating-theatre
Recovery and intensive care
Isolation word
Dialysis unit
Oncology unit
Emergency
Out patient clinic
Autopsy room
Radiology
Laboratories
Biochemistry
Microbiology
Hematology
Research
Pathology
Nuclear medicine
Support services
Blood bank
Phannacy
Central sterile supply
Laundry
Kitchen
Engineering
Administration
Public areas
Long-term health care establishments
-
. blood and body fluids,
0
:
Chemical
Infectious
Sharps
Phannaceutical
Pressurized
containers
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Radioactive
x
X
X
a,b
a,b
x
x
x
x
X
a,b
x
X a,b
x
x
x
x
X
X
a,b
a,b
x
x
X
X
X
X
Tissues and bone. Source: (WHO, 1984)
16
Table (2.3) Principle radionuclides used in healthcare establishments

Radio
nuclides
jH
Principle emission
Half-life
Application
emiSSIOn
Research
Research
Therapy
In vitro diagnosis
In vitro diagnosis
In vitro diagnosis
Diagnostic imaging
Diagnostic imaging
Diagnostic imaging
Diagnostic uptake
Therapy
Diagnostic imaging
Diagnostic therapy
Diagnostic therapy
12.3 y
Beta particle
Beta particle
5730 y
J:.:p
Beta particle
14.3 d
5lCr
Gamma ray
27.8 d
'7Co
Beta particle
270 d
5
~Fe
Betaparticle
45 .6 d
61
72 h
Gamma
ray
Ga
6 .,Se
Gamma ray
120 d
Y'JmTc
Gamma ray
6h
uJI
Gamma ray
13h
n:>I
Gamma ray
60 d
lJ li
Beta particle
8d
133
Xe
Beta particle
5.3 d
6UCo
Beta particle
5.3 y
jj'Cs
Beta particle
30y
Source: (Environmental Technology Consultants Ltd.1994),(WHO, 1985)
l"c
III)
Chemical
Format
Unsealed
Unsealed
Unsealed
Unsealed
Unsealed
Unsealed
Unsealed
Unsealed
Unsealed
Unsealed
Unsealed
Unsealed
Unsealed
Sealed
Sealed
waste compn ses discarded solid, liquid and gaseous chemicals, for
example rrom diagnostic and experimental work, cleaning, housekeeping and

disinfecting procedures. Chemical waste may be:
1. Hazardous wastes because can be sub-divided according to their properties, such as:
Toxic,
Corrosive (Acids below pH 2.0 and Alkali s above pH 12.0),
Highly fl ammable (flash point below 21C but below 50C),
Reactive (explosive, shock sensitive, water reactive, air reactive), and
Genotoxic (carcinogenic, Mutagenic, teratogenic or other wise capable of

altering genetic material) for example, cytotoxic drugs.
2.
Non-hazardous chemical wastes consist of chemicals other than those described

above, such as sugars, amino acid s and other organic and inorganic salts.
TV)
Infectious waste is defin ed as that portion of healthcare waste that could transmit
infectious diseases (TCOE, 1993), like viral and bacterial infectious (WHO, 1994),
17
and also infectious animal wastes from laboratories (Rutala et al. 1989). There are
four possible routes of disease transmission, i.e., ways in which infectious agents
can enter the body to cause infectious disease, and these are :
Through the skin via broken skin, cuts, scrapes, or puncture wounds.
Through mucous membranes via splashing onto the mucous membranes of the
eyes, nose, or mouth.
By inhalation.
By ingestion.
Exposure to infectious agents present in infectious waste could result in disease
transmission by any of these routes, depending on the type of exposure.
(Anderson, 1996) and (Reinhardt and Gordan, 1991) recommend that the following
types of waste be classified and managed as infectious waste:
Human blood and blood products.
Cultures and stocks of infectious agents.
Pathological waste.
Contaminated sharps.
Contaminated laboratory wastes.
Discarded biological.
Contaminated animal carcasses, body parts, and bedding.
Contaminated equipment.
Miscellaneous infectious wastes.
18
The Center of Disease Control (CDC) and Environmental Protection Agency

(EPA) recommendation and definition of infectious waste is shown in Table (2.4).
Table (2.4) Types of medical waste designated as infectious by the CDC, and the EPA
Source I Type of medical waste
Microbiological
Blood and blood source
Pathology
Sharps
Communicable disease isolation
Contaminated animal carcasses, body parts, and bedding
Contaminated laboratory
Surgery
Autopsy
Dialysis
Contaminated equipment
Item contacting secretions or excretions
Intensive care
Emergency department
Surgery patients
Obstetric patients
Pediatrics patients
Treatment/examination room
All patient related
Source: (Rutala et al. 1989), (El-Far, 1998)
CDC
Yes
Yes
Yes
Yes
No
Yes
No
No
No
No
No
No
No
No
No
No
No
No
No
EPA
Yes
Yes
Yes
Yes
Yes
Yes
Optional
Optional
Optional
Optional
Optional
No
No
No
No
No
No
No
No
In addition to the previous table, the categories of infective waste designated by the
CDC are listed in Table (2. 5). The infectious waste categories listed by EPA in guidance
and in regulations are in Table (2.6).
Table (2.5) CDC Recommended categories of infective waste
CDC4
Yes
Yes
Yes
No
No
Category
Microbiological laboratory_ waste
Pathology waste
Blood specimens and blood products
Sharps
Isolation waste
Source: (Reinhardt and Gordon, 1991).
19
CD Co;/
Yes
Yes
Yes
Yes
Yes
Table (2.6) EPA categories of infectious waste

Category
Isolation wastes
Culture and stokes and associated
biological
Human blood and blood products
Pathological wastes
Contaminated sharps
Contaminated animal carcasses, body
parts, and bedding
Wastes from surgery and autopsy
Contaminated laboratory wastes
Dialysis unit wastes
Contaminated equipment
Unused sharps
Source: (Reinhardt and Gordon, 1991).
Recommended
category
Yes
Yes
Yes
Yes
Yes
Yes
Optional
O_Qtional
Optional
Optional
No
Class of regulated medical

waste
Yes
Yes a
Yes 0
Yes c
Yes ct
Yes
May be e
Maybe 1
May beg
No
Yes
includes cultures and devices used to transfer, inoculate, and mix cultures.
b includes items that are or were saturated and/or dripping with blood, blood containers,
and intravenous bags.
c includes specimens ofbody fluids and their containers.
d includes culture dishes with or without infection agents, and slides and cover slips that
were in contact with infectious agents.
e wastes in this category may be included in other classes of regulated medical waste. (See
footnotes band c to this table).
r waste in this category may be including in other classes of regulated medical waste. (See
footnotes a-d to this table) .
g wastes in this category may be included in another class of regulated medical waste. (See
foot note b to this table).
a
In view of waste management planning pertaining to certain treatment techniques,

such as incineration, selected physico-chemical parameters of infectious waste should be
assessed before hand estimated. These parameters as shown in Table (2. 7) should be
considered, as well as those in Table (2.8).
Table (2.7) Physical parameters
Parameter
Percentage of combustible items
Wet heating value
Humidity rate
Minimum
83%
3000 kcaVkg
0% for plastic
waste
Source: (WHO, 1997), (EI-Far, 1998).
20
Maximum
99%
6000 kcaVkg_
90% in some
anatomic
waste
Average
35%
Table (2.8) Typical* composition ofhealthcare waste

Material
High-Income countries
Middle-Income countries
percentage
percentage
Plastic
40
50
Glass
9
1
30
16
Paper
Metals
1
1
3
3
Tissues
Textiles
16
10
1
Rubber
1
Source: (WHO, 1997), (El-Far, 1998).
Note*: Typical composition means the composition that not is allowed to exceed.
The chemical composition is usually approximately as follows:
50% carbon
20% oxygen
6% hydrogen
Numerous other elements.

In this connection, it is preferable to assess the type of plastic used, and if possible
the percentage of halogenated plastic (such as PVC) in order to provide indications on the
exhaust gas cleaning requirements in case of incineration (WHO, 1997), (El-Far, 1998).
V)
Sharps includes needles, syringes, scalpels, saws, blades, broken glass, nail and any
other item that could cause a cut or puncture. They may be infected or not
discarded sharps used in animal or human patient care, medical research, or
industrial laboratories are also considered hazardous waste (WHO, 1984), (El-Far,
1998).
VI)
Pharmaceutical waste includes pharmaceutical products drugs and chemicals that

have been returned from wards, have been spilled, out dated or contaminated, or are
to be discarded because they are no longer required (WHO, 1984), (El-far, 1998),
(Anderson, 1992). They also
comprise discarded items used in handling of

21
pharmaceuticals such as bottles or boxes with residues, gloves, masks, connecting

tubes or drug vitals (WHO, 1997), (El-far, 1998).
VII)
Pressurized containers are often used in healthcare, for demonstration on

instructional purpose, containing innocuous or to store gases such as compressed
gas cylinders and disposable aerosol cans. When these are empty or still contain
residues but are not of use any move, they generate reusable or disposable
containers (WHO, 1997), (Bdour, 1997). These may explode if incinerated or
accidentally punctured (WHO, 1997), (El-Far, 1998).
Most common gases used in healthcare are anaesthetic gases, Ethylene oxide used
for sterilization, Oxygen and compressed air.
The waste categories at hospitals are related to source of origin within the hospital.
The typical categories of waste generated from various departments are shown in Table
(2.9).
Table (2.9) Typical categories of hospital's solid waste
Typical waste category
General waste; paper goods, ETCL.
Medical wastes; general waste; sharps.
General waste; pathological waste; sharps; chemical
waste; infectious waste; pharmaceutical waste; tissues
and blood.
General waste; pathological waste; sharps; infectious
Laboratory; Autopsy room
waste; chemical waste; blood
Sharps; general waste; paper goods
Nursing station
General waste
Services and Maintenance
Kitchen and cafeterias
General waste
General waste; pathological waste; blood and body
Dialysis unit
fluids; chemical waste; sharps; infectious waste;
pharmaceutical waste.
Source: (Qusous, 1988), (El-Far, 1998)
Area of generation
Administration
Maternity
Operating room; emergency;
surgery; out patient clinics.
22
(2.3.1.3) Medical Waste Composite

A typical medical waste composite (Composite that not be allowed to exceeded)
was formulated (by Sandiego medical center, 1993) which included approximately 48%
cellulose, 33% plastic (includes equal volumes of polypropylene, polyethylene and
polyvinyl chloride), 2% metal, 7% borosilicate glass and 10% putersible materials.
Approximately one-half of the moisture was added to the waste via the culture inoculum.
The resultant average moisture content of the waste composite was 32.8% by weight.
(2.4) Health and Safety Aspects

(2.4.1) Health Hazards
There is strong evidence, from Canada, Japan and USA that the main concern of
infectious hospital waste is the transmission of AIDSIIDV viruses and, more often, of
hepatitis B or C viruses through injuries caused by syringes contaminated by human blood.
The groups mostly at risk are medical care workers, especially nurses, followed by the
other hospital workers as housekeepers or those in the food-preparation. The deaths of six
nursing staff following two separate outbreaks of hepatitis in Renal Failure Units in
hospitals in the United Kingdom during 1965/66 and 1969/71 (Department ofHealth and
Social Security, 1972) dramatically illustrate the health and safety hazards associated with
the handling of infectious materials. In the USA, the Agency of Toxic Substances and
Disease Registry states that: the overall injury rate of all workers who my contact medical
waste within the healthcare establishments was 180 per 1,000 workers per year (Anderson,
1996). However, such risks are not limited to staff within the confines of hospitals and
other healthcare centers, since waste materials from such establishments are frequency
disposed of at sites remote from their source. It is imperative, therefore, that consideration
is given to the storage, packaging, handling, transport and disposal of waste material s
arising from healthcare. Even where there is no risk to health, it is important that attention
23
'
should be paid to the aesthetic impact of hospital waste in order not to give the impression
that a risk is present (Bdour, 1997).
Apart from the patients and personnel employed in health care establishments,
including those involved in home care or primary care (for example, home dialysis), a wide
range of other persons may be at risk from poor waste management. These will include
workers providing support services on the premises or in transit on a contrast basis, such as
laundries, waste disposal facilities, food services etc. and will also include workers such as
delivery and maintenance personnel.
The recent increases in the number of patients infected with AIDS and hepatitis B,
together with the concern of the general public for the real or imagined dangers of cross
infection from such patients. Have highlighted the need for an increased awareness on the
part of hospital administrators to make proper arrangements for the management of waste
materials generated in their establishments (Anderson, 1996).
Although there is some variation according to the type and location of hospital, it is
estimated that about 50% of waste generated at hospital are of a non-clinical nature
(Department of the environment, 1971). Such material includes clean kitchen waste,
uncontaminated tins and bottles, clean paper, cardboard and plastics. This waste will,
however, in all probability also contain waste generated in the preparation of food and
other putrescible materials. Such waste is in itself a possible source of bacterial infection,
especially if not thoroughly disinfected. It is essential therefore that infectious materials are
not allowed to be stored adjacent to normal domestic-type waste in healthcare
establishments, especially if different disposal routes are chosen for clinical and nonclinical wastes (Anderson, 1996).
The greatest risks, however, are associated with the handling and disposal of
clinical wastes, which may remain potent for considerable periods of time after being
24
removed from their source. The dangers from healthcare wastes (HCW) may be
significantly increased in situations where the wastes are disposed of in conjunction with
other municipal solid waste and not either sterilized or incinerated at source. The health
hazard potential is raised still further if secondary handling ofthe waste is carried out, for
example when a recycling process such as composting, refuse derived fuel or sorting for
the reclamation of glass, plastics, metal, paper, fabrics etc. is. Used where these practices
are employed within the community, there will always to be a risk of infection if clinical
wastes are not disposed of separately.
After this introduction we can defined the risk as the probability that the hazard of a
substance will cause harm and the severity of that harm, (WHO, 1998). Also we can
determined who is at the risk as follows (WHO, 1998):
Doctors and nurses.
Patients.
Hospital support staff
Waste collection and disposal staff.
General public.
(2.4.2) Risks to Personnel

The major risks for particular groups of personnel are as follows (Anderson, 1996) and
(WHO, 1984):
1. Personnel handling waste that contains blood-soaked objects from patients in dialysis
units must be protected against the transmission of hepatitis B . special arrangements
are necessary for the isolation, separation, collection and disposal of this waste. In the
case of patients whose diagnostic status is unclear, it would be appropriate to deal with
waste in the same manner.
25
2. Custodial personnel, maintenance staff and porters could be at risk from sharps in
waste that contains syringes and needles, if these have not been kept separate and
safety packaged for disposal.
3. Personnel involved in the final disposal or incineration ofwaste may be exposed to risk
from pathological waste that has not been kept sufficiently cool, especially ifthe
wrapping or storage sacks are punctured or torn.
4. Pharmacy personnel may be at risk from respiratory or dermal exposure to aerosols
contaminated with pharmaceuticals or solvents.
5. Custodial personnel could be exposed to risk on any premises where leaks or
obstructions in drains result in the escape of gases or hazardous solvents that may be
inhaled. Exposure to HzS escaping from blocked sewers is a well-known hazard.
6. Personnel working in or visiting laboratories and rooms in clinical laboratories where
pathogenic microorganisms, infectious agents or pathological materials are examined,
handled or stored could be at great risk from wastes which may be generated there.
To ascertain the above, a study was conducted with a view to surveying the
prevalence of hospital-acquired infections in 14 countries between 1983-1985. Almost 47
hospitals of different sizes ranging from 227-1502 beds were surveyed to detect the
nosocomial infection among patients, hospital personnel, as well as visitors. The results
showed a large range of prevalence from 3%-21% in individual hospitals. This clearly
indicates the importance of hospital hygiene (which depends largely on proper waste
management) for public health (WHO, 1997), (El-Far, 1998).
26
(2.4.3) External Health Hazards
In addition to health risks to patients and personnel, consideration must be given to

the impact of health care waste on Humana health and the government outside healthcare
establishments. In particular, attention should be paid to possible effects on the public,
including aesthetic factors, and to the risk of the pollution of air, water and soil. To
mm1m1ze these external health and environmental risk, action should be segregated and
concentrated within healthcare establishments to simplify its management and, wherever
feasible, waste should be recycled to that it does not enter the waste stream-requiring
disposal (WHO, 1984).
To safeguard against waster pollution, measures should be taken at source to reduce
the quantity and strength of incompatible pollutants in the waste waster flow. Ifhealthcare
establishments are not connected to a municipal wastewater treatment system, on-site
treatment should be carried out where feasible. Sludge from an on-site plant should be
managed with the same precautions as for municipal on feed crops.
The use of disinfectants should be minimized when there are alternatives, which
would reduce the quantity of waste disinfectants produced. Where a large amount of
dilution water is available, however, disinfectants may safely be disposed of in the sewer.
The grinding of solid waste for disposal in the sewer system is not designed to cope
with them. Excessive solids can cause problems at sewage treatment plants. Food waste
from health garbage grinders to the sewer system.
Faces and urine from patients in isolation wards should be disinfected before
disposal to the sewer provision should be made in the case of an epidemic for the
emergency disinfecting of waste a large number of infectious patients, before disposal to
the sewer system (WHO, 1984).
27
Climatic conditions are detectable factor in the gap between normal infectious
disease rates and epidemics. This gap is smaller in hot climates than in moderate ones.
Healthcare establishments in hot climates may, therefore, need to be more alert to detecting
changes in normal conditions. The difference between seasons may also call for attention
(Anderson, 1996), (El-Far, 1998).
(2.4.4) Hazards From Different Waste Categories

(2.4.4.1) Hazards From Infectious Waste
Infectious waste may be cause hazard to human body through a crack or cut caused
by sharp injuries. Two infections of particular concern, for which there is a strong evidence
of transmission via healthcare waste, are HIV virus, and more frequently Hepatitis B and
C. these are in general transmitted through injuries from syringes needles contaminated by
human blood.
Another way of infection by infectious waste is through absorption of mucus
membranes, by inhalation of aerosols during uncontrolled dumping or storage which
allows
possible dispersion of particulate and pathogenic organisms by wind causing
respiratory and subsequent systemic infection as well as ingestion of contaminated food or

water (TCOE, 1993), (El-Far, 1998).
(2.4.4.2) Hazards From Sharps
Sharps may cause cuts and punctures and infection by introducing infectious agents
to the blood, if previously contaminated. Due to this double risk of injury and disease
transmission, sharps are considered an extremely hazardous waste category, since it
provides a direct route into the blood stream. Syringe needles are of particular concern
since they are contaminated with patients blood (WHO, 1997), (El-Far, 1998).
28
The hazard of infection by sharps is due to the survival ofiDV, HBV viruses in the
syringes in an infective dose for eight days after having been used on an infected patient
(WHO, 1994).
The annual number of HBV infections in USA resulting from exposure to
healthcare waste lies between 162-321, against a yearly total of 300,000 cases, Table
(2.10) shows the occupational HBV infections through injuries from sharps (WHO, 1997)
and (El-Far, 1998).
Table (2.10) Occupational HBV infectious through injuries from sharps (USA)
Professional
category
Annual number of
injuries from
sharps
(persons/year)
Annual number of
HBV infections
(persons/year)
Percentage ofHBV
infected after injury
(persons/year)
56 to 96
26 to 45
2 to 15
0.25-0.54
0.05-0.16
0.03-1. 9
13 to 91
0.05-0.8
24
0.20
<1
<1
1 to 3
0.06-0.6
<1
< 0. 3
5 to 8
0.13-0.3
24
0.20
1 to 15
0. 01-0.03
Nurses
In hospital
17700 to 22200
28000 to 48000
Out side hospital
Laboratory workers
800 to 7500
in hospital
11700 to 45300
Hospital
housekeepers
12200
Hospital
technicians
100 to 400
Physicians and
dentists in hospital
Physicians out side
500 to 1700
hospital
100 to 300
Dentists out side
hospital
2600 to 3900
Dental assistants
out side hospital
12000
Emergency medical
personnel (out side
hospital)
500 to 7300
Refuse workers
(out side hospital)
Source: (Who, 1997) and (El-Far, 1998)
29
(2.4.4.3) Hazards From Chemical and Pharmaceutical Waste
These wastes may be found, as fractions after use or if no longer needed. They may
cause intoxication, which can result
from adsorption through the skin, the mucus
membranes, inhalations of dust aerosols, ingestion of food accidentally in contact with

drugs or through the bad practice of mouth piping with drugs during preparation or
handling of the drug. Contact of flammable, corrosive, or reactive chemicals with skin,
eyes, or the mucus of the lung airway can provoke injuries. It should be noted that the
severity of health hazard associated with handling genotoxic waste is the combined effect
of the substance toxicity and the magnitude of exposure.
Many antineoplastic drugs have cell cycle specific cytotoxicity, targeted on specific
cell processes such as DNA synthesis and mitosis or at resting cells. Experimental studies
have shown that many antineoplastic drugs are carcinogenic and mutagenic.
Many cytotoxic drugs are extremely irritant, producing harmful local effects after
direct contact with skin or eyes, they may also cause dizziness, nausea, headache or
dermatitis (Who, 1994) and (El-Far, 1998).
(2.4.4.4) Hazards of Radioactive Waste

The amount and
type of exposure determine the type of disease caused by
radioactive waste. It can range from headache and dizziness to vomiting, and may also
affect the genetic material, i.e. , it may be genetoxic. Handling of highly radioactive source,
like certain sealed sources from diagnostic instruments, may cause much more sever
injuries (such as amputation of body parts) and should be handled very carefully.
Hazards of low activity waste may occur from the contamination of external
surfaces of containers or improper storage mode or time of the waste. Any health care
worker or waste handling personnel who is exposed to the radioactivity is at risk (WHO,
1997), (El-Far, 1998).
30
(2.4.4.5) Hazards of General Waste
General waste, as formally defined does not pose any risk. However, when the
bacterial concentration of different hospital waste emanating from operating room,
intensive care units and nursing station was compared with household waste, it was found
that hospital waste 10 to 10,000 times less microbial contaminated (Rutala et.al. 1989). But
its hazard is limited, since disease causation is multi factorial, that is, transmission will
occur only when all factors i.e. (virulent pathogens, dose, portal of entry, and susceptible
host) are present simultaneously (El-Far, 1998).
(2.5) Generation Rates of Medical Wastes
Generation rates of medical waste from health care establishments may expressed in
several ways (Bdour, 1997):
(a) Quantity of waste generated on weight or volume basis per patients per day.
(b) Quantity of waste generated (weight or volume) per bed per day.
(c) Quantity of waste generated (weight or volume) per gross population (total patients,
outpatients and employee) kg (m3)/person (Gr.pop.)/day.
(d) Quantity of waste generated (weight or volume) per equivalent population (avg. gross
population present each 8 hrs shift over 24 hrs per day and 7 days per week) kg
(m3 )/capita equiv.pop./day.
(e) Quantity of waste generated (weight or volume) per laboratory test, (used only in
laboratories) kg (m3)/test/day.
(f) Quantity of waste generated (weight or volume) per drug manufacturing of solid
medicine or per liter manufacturing of liquid medicine (used only in pharmaceutical
plants) kg (m3 )/drug/day or kg (m3)/liter/day.
31
Also there are other expressions which are rarely used in the literature to expressed the
generation rates as the total quantity of waste generated (weight or volume) per total area
of the hospital buildings.
(2.5.1) Weight Basis

The weight expression basis is the most common expression in the literature, many
studies were carried out by different associations on this basis. The US Environmental
Protection Agency (EPA) carried out a study on seven Los Angeles hospitals in 1968 for
the determination of waste generation rates from these hospitals, Table (2.11) show a
summary of this study. The generation rate range between 7.71 to 21 kg/pat./day. These
results may be misleading for estimating purposes in the design of solid waste systems
(Bdour, 1997)
(2.5.2) Population Basis

This basis was often used m the literature, and by it the generation rates showed
less variation. In a study carried out by the USEPA it found range varies between 5.13 to
6.94 kg/cap.eq./day.
Generation rates expressed by the gross population factor are also used. According
to the previous US EPA study on this basis the analysis showed a range to vary between
1.68 to 2.45 kg/Gross.pop ./day. Table (2.11) presents a summary ofthis study. In another
study by New York University Center as illustrated in Table (2.12) a generation rate of
1.04 kg/Gross.pop./day was found (Bdour, 1997).
32
Table (2.11) Breakdown of daily waste production by types of waste in (kg) at Los Angeles hospital
Type of waste
LAC-USC*
medical center
34.0
Sharps & Needles
Pathological & Surgical
453.0
Solid Linen
20638.80
7348.80
Rubbish
Non combustible
680.40
Garbage, nongrindable
816.50
4082.40
Food service items
Ash & residue
Traces
11.34
Animal carcasses
1179.40
Food waste, grindable
35244.74
Total
Generation rates (kg/bed/day)
17.60
Generation rates
5.67
kg/cop.equi./day
1.68
Generation rates
kg/pop.gross/day
Note*: LAC; Los Angeles center.
USC; University Southern California
Long Beach
general
hospital
1.36
Traces
1696.50
244.90
34.00
68.00
635.00
Rencho LosAngeles
hospital
18.10
1.81
7402.80
1251.90
328.90
396.90
1905.10
9.07
9.07
499.00
11822.65
12.75
5.90
John Wesly
hospital
Olive View
hospital
Mira Lomo
hospital
3.63
52.16
1315.40
325.20
36.30
72.60
362.90
22.70
4.50
95.30
2290.69
13.40
5.83
9.10
2.72
2553.80
781.10
113.40
215.50
1134.00
9.07
10.40
843.70
5672.79
10.10
5.62
2.30
Traces
508.00
164.20
36.30
49.90
472.20
11.30
149.70
2829.46
9.30
5.36
Harbor
general
hospital
9.98
70.80
6169.00
2979.70
210.90
299.40
1088.60
9.07
99.80
430.90
11368.15
21.00
6.94
68.00
1112.20
7.71
5.13
2.27
2.04
2.17
2.04
2.31
2.45
Source: (El-Far, 1998), (WHO, 1998), (Bdour, 1997)
33
Table (2.12) Summary of solid waste generation at New York University Medical Center
H OSPI.tIN
a arne
University hospital
No. ofbeds
General waste (kg)
Food waste (kg)
Total waste (kg)
Generation rate
Kg/bed/day
Generation rate
Kg/pop./day
Source: (El-Far, 1998).
630
4494
2729
7223
11.46
Institute ofRehabilitative
medicine
140
-
10392
7.42
1.04
(2.5.3) Volume Basis

The volume of solid wastes generated per patient per day is often determined to
evaluate various storage areas required at departments and for on-site storage. It is also
important to determine the size of containers such as transfer carts and waste baskets in
patient's rooms. In addition the volume generated is required in designing on-site
processing and treatment equipment such as incinerators and compactors.
Generation rates expressed by m3/pat./day depend greatly on the method of
collection and packaging practiced by the housekeeping staffs. As the frequency of
collection is increased the waste is less compacted and the volume generated per patient
per day is increased also .
In France (13), the generation rates range between 0.005 to 0.017 m3/bed/day,
Table (2.13) shows a summary of results for a study carried out on different types of
hospitals with various bed numbers. The study showed a high generation rate for teaching
hospitals and low values of central hospitals. The relationship between number of beds and
generation rate was directly proportional.
The American Public works Association (1) introduced a study for 29 hospitals in
USA with average 224 patients. This study presented the different types of medical wastes
34
generated at hospital and their percentage to the total weight. A generation rate of0.02
m3/pat./day was reported on average for the 29 hospitals as shown in Table (2.14).
Table (2.13) Summary of generation rate by type of hospital in France

Type of hospital
No. ofbeds
Teaching
> 1000
< 1000
> 500
< 500
> 500
< 500
> 100
< 100
Central
Private
Generation rate
lt./bed/day
16.5
14.8
10.7
8.1
5.2
14.4
11.6
12.8
10.0
Table (2.14) Average daily of hospital waste for 29 hospitals in USA with average of224
patients
Type of waste
Kg/pat./day
1.49
Garbage
Non
0.5
combustible
Combustible
1.18
0.05
Surgical
Autopsy
.014
Total
3.23
M 3 /pat./day
Kg/pop./day M3 /pop./day
0.00182
0.00315
0.84
0.38
0.000993
0.0255
0.015
0.76
0.0976
-
0.02
1.98
35
0.0133
%of total
weight
46.13
15.48
36.53
1.55
0.43
100 %
(2.5.4) Amounts of Waste Generated in Different Parts of the World

According to (WHO, 1997) the amount ofhealthcare waste generated depends on
the income level, region, waste type, and source type in different countries as illustrated in
the following Tables (El-Far, 1998):
Table (2.15) Healthcare waste generation according to the income levels

Income level
High income countries
All healthcare waste
Hazardous healthcare waste
Middle income countries
Hazardous healthcare waste
Low income countries
Source: (WHO, 1997), (El-Far, 1998)
waste generation (kg/bed/day)

1.1-12.0
0.4 -5.5
0.8-6.0
0.3-0.4
0.5-3.0
Table (2.16) Hospital waste generated according to regions

Region
Waste generation (kg/bed/day)

7-10
3
3-6
1.4-2
1.3-3
2.5-4
1.8-2.2
North America
Latin America
Western Europe
Eastern Europe
Middle East
East Asia high income
East Asia middle income
Source: (WHO, 1998)
Table (2.17) Hospital waste generation per waste type in (Western Europe)
Type of waste
Chemical and pharmaceutical waste
Sharps
Combustible packaging
Source: (WHO, 1997), (El-Far, 1998).
Waste generation (kg/bed/day)

0.5
0.04
0.5
36
Table (2.18) Hazardous healthcare waste quantities produced in healthcare facilities in

selected countries ofLatin America and Caribbean
Country
Number ofbeds
150000
Argentina
501660
Brazil
50293
Cuba
5745
Jamaica
Mexico
60100
47200
Venezuela
Source: (WHO, 1997), (El-Far, 1998)
Hazardous waste (tons/year)

32850
109960
11010
1260
13160
10340
These estimations of waste quantities are based on a factor of0.22 (tons/year) generated
for each bed of healthcare establishment.
Table (2.19) European generation rate of hospital waste/source type

Source type
General practitioners
Waste generation (kg/year)

4
20
100
a. Sharps.
b. Infectious waste.
c. Total waste.
Phlebologists
Infectious waste
Gynecologists
Infectious waste
Nurses
a. Sharps.
Dentist
a. Sharps.
c. Heavy metals (including mercury).
d. Total waste.
e. Biomedical laboratories
(60 analysis/day) infectious waste
f. kidney dialysis (3 per week) infectious
waste
Source: (WHO, 1997), (El-Far, 1998).
175
350
20
100
11
50
2.5
260
at least 300
400
37
Table (2.20) Generation rate of solid waste in some industrialized countries*

Type of hospital
Norway
Spain
University hospital
3.9
4.4
General hospital
Maternity
3.4
Mental hospital
1.6
1.2
Geriatric
Source: (WHO, 1994)
Note* : Quantity of waste (kg/bed/day)
UK
3.3
3.0
0.5
9.25
France
3.35
2.5
USA
5.24
4.5
-
Netherlands
4.2 to 6.5
2.7
1.3
1.7
Table (2.21) Generation rate of solid waste in Latin America hospitals

Year of
study
1973
Chile
1976
Venezuela
Brazil
1978
Argentina
1982
Peru
1987
Argentina
1988
Paraguay
1989
Source: (WHO, 1994)
Country
Minimum
0.97
2.56
1.20
0.82
1.60
1.85
3.0
Generation rate (kg/bed/day)

Medium
Maximum
1.21
3.10
3.71
2.63
3.80
4.2
2.93
6.00
3.65
2.80
4.50
Table (2.22) Generation rate of healthcare waste in Europe

Special (OOOs oft/pa.)
Normal (OOOs oft/pa.)
Denmark
32000
5400
France
400000
300000
Germany
963000
96000
Italy
150000
50-60000
Spain
190000
23000
Sweden
65000
5000
Netherlands
142000
8000
UK
200000
250000
Source: (environmental Technology Consultant ltd. , 1994), (El-Far, 1998).
Country
38
It is worth mentioning that study results give many different numbers of the
estimated amount of waste depending on the year of performance, number of beds, and
hospitals included in the study of concern.
Table (2.23) Estimated amount ofhealthcare waste in different countries

Country
Ireland
Year of study
1992
Italy
USA
USA
Oman
1995
1985
1987
1988
Saudi Arabia
1994
Egypt
1993
Amount & kind of waste

21000 tons hospital waste.
9.000 tons clinical waste.
250000-tons hospital waste.
491 million ponds of infectious waste.
6063-tons/day hospital waste.
1485.2 kg/day average total waste.
2000 kg/day pathological waste.
I kg/bed/day medical.
10 kg/bed/day total waste.
0.014 m3.pat./day average total waste.
4.5-7 kg.bed/day range for amount ofwaste.
Source: (El-Far, 1998)
In 1997, WHO suggested that developing countries not yet performing their own
healthcare waste survey as yet, may use the following estimated figures for an average
distribution of healthcare waste in their preliminary planning of healthcare waste
management (El-Far, 1998):
80% of non-risk healthcare waste, which may join the stream of domestic garbage
and urban refuse management.
15% pathological and infectious.
1% sharps waste.
3% chemical or pharmaceutical waste.
Less than 1% of special waste, such as radioactive, or cytotoxic, or pressurized

containers, broken thermometers and used batteries.
39
(2.5.5) Ratio of Departmental Waste Weight to the Total Waste Weight

Different studies were made to classify solid wastes generated from healthcare
establishments and to show the ratio (%) of department's wastes to the total generated
wastes.
There is a study carried out at St. Anthony hospital in St. Peters burg, Fla., (Bdour,
1997), showed that direct unit has the highest percentage of the total generated waste
(47%), see Tables (2.24 and 2.25) summarizes a study made at Fairview hospital in USA
Kitchen wastes formed (27.4%) ofthe total wastes. Iglar (Bdour, 1997), prepared a study
on hospital waste management and he found that the dietary facilities waste comprised the
major amount of solid waste about (49%) see Table (2.26).
Table (2.24) Summary of solid waste generation by units at St. Anthony hospital, St.
Petersburg, Fla.
Area of generation
Total weight
(kg)
680
90
20
47
10
259
20
15
32
8
45
128
Dietary unit
Labs.
Emergency
Coffee shop
X-rays unit
General patient, care room
Coronary care unit
Medical ICU
Dialysis
Physchiatric ward
Obstetrics
Operating room & ICU
Housekeeping
Morgue, Autopsy, Blood bank
Respiratory therapy
Laundry
Central receiving & computer RM,convent
Total
Source: (Bdour, 1997)
No. ofbeds = 335.
Total weight generated= 1443 kg/day
Generation rate= 1.68 kglpop./day.
13
12
19
23
22
1443
40
Approximate
percentage
47
6
1
3
1
18
1
1
2
1
3
9
1
1
1
2
2
100%
Table (2.25) Summary of solid waste generation by units at Fair View hospital, USA
Total waste (kg)
Department
63 .9
Data center
261.9
Kitchen and shop
27.5
Labs.
Surgery
60.8
6.5
Pharmacy
Isolation
26.6
Brace shop
33.7
Out patients clinics
13.7
460.4
Mixed, other
955
Total
No. of beds= 430 beds.
Total weight generated= 955 kg/day
Generation rate = 2.22 kg/bed/day
Percentage
6.7
27.4
2.9
6.4
0.7
2.8
3.5
1.2
48.2
100%
Table (2.26) Sources of solid wastes within the hospitals

Source of solid waste
Administration
Dietary
Emergency
Maternity
Nursing stations, general
Outpatient clinics
Pediatric
Surgery
X-rays unit
Pharmacy
Labs.
Isolation, ICU, Extended care
Physical therapy, physiatric care
Laundry, maintenance, housekeeping, public areas, store room,
ground, hospitality shop, central supply.
Others
41
Mean % of total solid

weight
1.6
49
0.82
3.8
20
0.24
0.85
4.5
1.1
0.74
2.1
1.26
0.29
4.56
9.14
(2.6) Factors Affecting the Amount of Healthcare Waste that Generated
Literature introduce the following factors which affect the amount of medical generated
from healthcare establishments (Bdour, 1997) and (Qusous, 1988):
1.
Classification of hospitals (range and care type)

Hospitals can be specialized or general, whether they are private, military,
educational or governmental. The type and amount ofwaste produced reflects the kind of
services offered by the hospital. Many studies were conducted to show this effect on the
generation rate. In 1988 Qusous determined the generation rate of specialized medical
center (rehabilitation center) to be 6.41 kg/pat./day which is almost twice as that of a
general hospital (Islamic hospital) 3. 73 kglpat./day, University of Jordan hospital generates
0.024 m3/pat./day. Table (2.27) confirms this idea.
Also, Table (2.28) shows a summary for a study conducted in the Netherlands. It
shows a high variation in the generation rates of hospital. From this table hospitals with
research and teaching facilities have higher generation rates than other hospitals.
Department classification has also a significant effect on the generation rate due to
the operations and practices within the departments. For example, heavy care units (e.g.
intensive care, operating theaters, burn units) produce 1. 6 times more waste than light care
units such as pediatrics, and two times more than support services such as administration.
2.
Capacity of hospitals
The amount of medical wastes generated at healthcare establishments depends
greatly on the number of beds and patients it can accommodate. As the capacity of
hospitals increase, the number of staff members who provide services increases too, the
number of outpatient and visitors increase. So, large hospitals that provide services to a
wider community, through sophisticated and high level of service generate a high amount
of medical waste and therefore high generation rates.
42
This can be seen in Tables (2.27, 2.29, and 2.30). Table (2.29) presents the results
of a study conducted in United States. The highest generation rate of 5.24 kg/bed/day was
found for hospitals with beds number greater than 500, while the lowest value of 4.1
kg/bed/day was found for hospitals with beds number less than 100. In Washington area,
generation rates of solid waste was determined for several hospitals with varying number
of beds, as shown in Table (2.30) as the number of beds increases the generation rate also
mcreases.
However, some studies have shown variations in the trends of generation rates with
the number of beds. Which means that not only the number of beds is the major factor
affecting the amount of solids wastes generated at healthcare establishments, but also there
are other factors that affect the generation rates and should be taken into considerations.
3. Management policy
The management policy within HCE has a great affect on the amount of generated
solid wastes. Hospitals produce different types of solid wastes, some of these could be
reused for different purposes such as some food wastes used in kitchen food, the use of
certain medical instruments several times before disposal or the use of cardboard box
containers.
Table (2.27) Healthcare waste according to source size

Source size
University hospital
General hospital
District hospital
Primary healthcare centers
Source: (WHO, 1997), and (El-Far, 1998)
Waste generation _{k_g/bed/day)

4.1-8.7
2.1-4.2
0.5-1.8
0.05-0.2
43
Table (2.28) Summary of generation rates, by the type of hospital in the Netherlands
Type of hospital
University hoSQ_ital
Research
General
Specialized medical center
Mental
Generation rate (kg/bed/day)

4.2
6.5
2.7
2.3
5.0
6.0
1.3
1.2
No. ofbeds
900-1000
800-900
600-700
300-400
<100
100-200
800-900
400-500
Table (2.29) Summary of generation rates, by size of hospital in the United States of
America
Generation rates (kg/bed/day)
No. ofbeds
<100
4.41
4.42
100-299
300-499
4.88
>500
5.24
Mean
4.51
Generation rates (kg/pat./day)

5.38
5.8
6.4
6.87
5.92
Table (2.30) Generation rates at Washington area hospitals

Hospital
No. ofbeds
A
B
80
85
152
236
250
335
367
400
447
523
1100
D
E
F
G
H
I
J
K
L
No. of
patients
50
69
117
156
250
300
312
322
330
375
450
1045
Generation rate
kg/bed/day
7.1
4.64
5.91
1.76
3.74
2.92
1.79
4.60
3.25
4.14
4.00
5.1
44
Generation rate
kg/pat./day
11.34
5.72
7.67
2.65
3.74
3.27
2.11
5.66
4.00
4.93
4.73
5.38
(2. 7) Handling, Collection, Storage, and Transport of Waste

(2. 7.1) Waste Handling
The management ofhealthcare waste is basically a system problem. In involves the
removal and disposal of waste hygienically and economically as possible, by methods that
at all stages minimize the risk to the health and the environment (Bdour, 1997).
The removal of hospital's solid wastes from the point of generation to the point of
final disposal is achieved in several steps. Those steps, in sequence, are collection at point
of generation, packaging,
initial storage, internal transport, on-site storage, external
transport, and final disposal. The link between those steps is defined as "handling" .
The process starts at the departments where the housekeeping staff normally does
collection and packaging; plastic bags are used for packaging. Wastes are placed in transfer
carts (or horizontal pneumatic conveyors), for transport to chutes or to an elevator for
subsequent transport to the outside storage containers. The waste is transferred into a
collection vehicle and finally hauled to the final disposal site.
Certain categories of wastes require special handling techniques because oftheir
hazardous or infectious nature, so that general waste should be segregated and separated
from medical waste (e.g. labs and properly monitored to ensure that each type ofwaste
goes to the proper stream).
The success of any waste handling and segregation system revolves around its
simplicity; the simpler the procedure, the smaller will be the risk of human error. These
procedures are based on the provision of an adequate supply of appropriately marked or
coded containers of suitable
strength in safe, but convenient location close to the
generation areas. It is important to have a standard marking system for different kinds of
waste within the hospital. This segregation system should be applied all over the country
and continue from generation point to disposal point. It is even recommended to adopt in
45
international color-coded, signaled system, which is clearly distinguished by all staff (local
or foreign or even illiterate) and also all waste handlers off-site. This step is the key issue,
and it involves the largest number of personnel, unfortunately, most are concerned with
patient care often in urgent conditions and under pressure (WHO, 1984).
The greatest hazard of waste handling is from direct contact with specialized waste,
like sharps) items such as hypodermic and IV needles, razors and other blades, scalpels,
and broken glass). Sharps can cause puncture wounds, scratches, and scrapes. When the
skin is not intact either because of an existing injury or other medical condition or as the
result of sharps induced injury-infectious agents can penetrate the skin (Reinhardt and
Gordon, 1991).
During waste handling, there is also potential for exposure through inhalation of
pathogen-containing aerosols or dusts. Pathogens can also be ingested when a person eats
or smokes with hands dirtied during handling of infectious wastes. Exposure can also occur
through splashes of infectious liquids onto mucous membranes (such as those in the mouth,
nose, and eyes) (Reinhardt and Gordon, 1991 ).
When one understands the possible routes of exposure, it is apparent that the best
way to minimize the risk of exposure is to ensure that the infectious waste is properly
contained at all times. Some basic principles and procedures can help to achieve the goal of
minimizing exposures, these are (Reinhardt and Gordon, 1991):
Packaging the waste properly.
Maintaining the packaging and containment of the waste and avoiding practices that
may tear or break waste containers.
Avoiding physical contact with the waste.
Using personnel protective equipment (gloves, aprons, masks, goggles, etc.) as

needed for particular tasks.
46
Handling the waste as little as possible.
Limiting the number of persons with potential for exposure.
Avoiding spills and accidents.
(2.7.2) Waste Collection

A routine program (time, frequency, and staff responsibilities) for collection of
waste should be setup. Nurses and clinical staff should ensure that waste bags are sealed,
when (3/4) full, with adhesive tape or sealing tags not by stapling (WHO, 1997), (El-Far,
1998).
Accumulation of waste is refused. Workers should pickup waste and transport it to
an initial or central storage area, and immediately replace the bags or containers with
another of the same type. These should be readily available at the location ofwaste
production.
Certain precautions are necessary when specialized wastes (like infectious wastes
are collected that do not even have to be considered during the collection of general solid
waste. The concerns about packaging and containerization are also relevant in waste
collection. In order to minimize the risk of exposure, it is essential to maintain the integrity
of the packaging throughout the waste collection process. In other words, the objective is
to avoid those situations and incidents that can result in actual or potential exposure to
infectious agents-things such as tom bags, broken boxes, wet containers, leaks, and spills.
Carts are generally used to move infectious wastes to the treatment or storage area.
It is best to use different types of carts to move the different kinds of waste containers.
Bins are suitable for bagged waste, whereas a cart with level shelves is usually better for
rigid waste containers (for example, sharps containers and boxes) (Reinhardt and Gordon,
1991).
47
Whatever type of carts is used, it should be easy to move, cleanable, and easily
disinfected. In order to avoid the risk of exposures and contamination, it is best to dedicate
carts to infectious waste transport-that is. They should be used only for this purpose and
never for other activities such as transporting food or supplies, with a color coding or
labeling system, carts for infectious waste are readily identifiable (Reinhardt and Gordon,
1991).
Therefore, procedures for waste collection should be developed with the ultimate
goal of minimizing the possibility of exposure to the waste during its movement.
(2.7.3) Segregation and Storage

The storage of waste at source and intermediate stages prior to disposal is closely
linked to the strategy for waste handling, since the provision of proper storage facilities,
including containers, receptacles, bins, skips, etc. enables for easier handling of the waste.
General waste does not require any special handling and type of storage facility to
be provided and can safely be handled and stored in the same type of receptacles as general
municipal waste. Recycling should be practiced where feasible. Paper, glass, metal and
plastic may be salable, depending on local conditions. Kitchen waste should be stored in
large containers protected against scavengers, such as rodents, dogs and people and it
should leak-proof(WHO, 1984)
Whilst awaiting removal for any treatment methods or collection by the authorized
collector should be:
Stored in containers to a specification suitable for the intended task,
Situated in a separate area adequate size related to the frequency of collection, with
bags of each coded color kept separate,
Sited on a well-drained, impervious hard standing which is provided with wash

down facilities, and
48
Accessible to collection vehicle (where appropriate).

Sharps, needles, and syringes should be packed in puncture-proof containers for
disposal. According to the USA EPA, it is not recommended to recap needles before
disposal to avoid accidental needle stick and injury (WHO, 1984).
Pathological and infectious wastes, these wastes must be segregated. High-risk
infectious wastes may be initially autoclaved before packaging for treatment and disposal.
Wastes to be segregated should be put into single-use, moisture-proof bags hung in special
holders. The bags should be strong enough to resist internal or external mechanical damage
and should be filled only to a level that allows the bags to be easily and tightly closed.
Color-coded bags or containers should be used to identify pathological and infectious
wastes
and labeled with appropriate symbols. The containers must be sealed before
transport (Bdour, 1997), (WHO, 1984).

Radioactive wastes, these wastes should be properly labeled. The waste is then
compacted and retained at a permanent storage or burial site. Most solid radioactive wastes
can be stored in an appropriate container and under secure conditions pending decay. A
plastic bag in a large can or drum is an appropriate container. Since the half-life of nearly
all nuclear medicine wastes is in the range of hours or days, storage for period of one or
two months is satisfactory before disposal in the ordinary waste stream (WHO, 1984).
Pressurized containers such as aerosol cans must not be placed in waste disposal
bags destined for incineration, but should be stored separately in containers which are
marked with the words "DO NOT INCINERATE, DO NOT PUNCURE, KEEP OUT OF
DIRECT SUNLIGHT" (WHO, 1984).
Chemical waste should be segregated into hazardous and non-hazardous waste
chemicals. This waste should be put in leak-proof containers, which should be labeled to
identify their contents. Non-hazardous waste can be disposed of along with general waste
49
or be recycled. Non-recyclable, non-hazardous waste chemicals should be collected in

disposal containers or plastic bags. Hazardous chemical wastes that can not be recycled
should be further segregated according to the type of hazard and the appropriate treatment
and disposal method. Secured storage areas must be provided or the accumulation of
chemical wastes (WHO, 1984).
Pharmaceutical waste should be stored in waterproof preferably red containers, or it
may be
collected with infectious waste except for cytotoxic drugs. While chemical
pharmaceutical waste should be stored in containers that resist their chemical activities and
are properly labeled. Chemicals should not be mixed (WHO, 1984).
(2.7.3.1) Bags and Containers

For storing the waste may be suspended inside a frame that has a lid to cover the
opening of the bag at the top, or bags may be placed inside a rigid bin with the top folded
over the rim of the bin, and the bin lid placed on top. Plastic bags may not be the preferred
storage option in all circumstances. However, all plastic bags used are supported to have
different colors and signs adopted by the country (or international colors) see Table (2.31,
and 2.32). So that, we can classified the plastic bags as follows (WHO, 1984):
a. Plastic bags used for the storage of clinical waste in areas other than those specified
in b. below, should:
Be moisture-proof bags of maximum capacity 0.1 m3 ,
Be of a minimum gauge 50 microns if of low density or minimum gauge 25 microns

if of high density,
Match the chosen receptacle or fitting in use,
When destined for autoclaving, be suitable for this treatment, and
Conform to the recommended color coding system see Table (2.31 , and 2.32).
50
b. Plastic bags, when used in high-risk areas, infectious disease and isolation nursing
units, hameodialysis units, and for the disposal of human tissue should:
Be of minimum gauge 200 microns if of low density or mm1mum gauge 100

microns if of high density, and
Conform in all other respects with the recommendations in a. above.
c. Paper bags used for the storage of clinical waste should:
Be capable of holding a weight of specified contents of at least 30 kg with safety

and have a wet strength of30%, and
Conform in all other aspects with the recommendations in a. above.

All kind of plastic bags should be of a single use, shouldn't be filled more than (3/4)
to be tightly and easily closed before moving, and contents ofthe plastic bags shouldn't be
transferred loss from container to container.
Various factors must be considered m the selection of containers for infectious
wastes. These factors include:
The type of waste .
Waste collection procedures .
Waste handling practices .
Waste storage.
Waste treatment .
Transport of waste offsite.

The first consideration in selection of waste containers is the type of infectious
waste. From the perspective of containment, infectious wastes are of three general types:
sharps, solid wastes, and liquids. These types of waste differ greatly in their physical
nature; consequently, there are different requirements for the kinds of containers and
packaging that will adequately and safely contain each type ofwaste. In practice, therefore,
51
at least three different types of containers should be used for infectious wastes (WHO,
1984).
(2.7.3.2) Labeling
The reason for labeling is that it may be necessary to be able to trace the waste back
to its source. This may be necessary if there is an incident involving the waste. For
example, if a syringe or blade that has injures a porter been put into a bag rather than into
the correct sharp container. It is possible to determine the origin of that waste and identify
the member of staff, who was responsible for that ward, so that disciplinary action may be
taken. As a result of such an accident, it may also be important to know the types of
infectious that may have been transmitted, and this may be determined ifthe source is
known. It may also be useful to know the source of a bag of waste if the waste has been
wrongly
segregated-for example, general waste is found in a yellow bag. Staff will
probably be reluctant to label the waste in this waste for fear of being accused of bad
practice, so supervisors must be vigilant to ensure that all bags are labeled. Porters may be
instructed that they may not pickup a bag that is not labeled; if they are illiterate it will be
necessary to develop a set of symbols for each ward. Such labeling will have a preventive
effect, because each staff member will feed more responsible for what they put into each
bag.
Each receptacle should be clearly labeled to show the ward or room where it is
kept. In the case of reusable bins, the location ofthat bin should be written clearly on the
side, and it should always be kept in the same room. In the case of bags, the bags should
either be marked with the room number before use, or, when full, an adhesive label should
be fixed to the bag in a conspicuous place see Table (2.31 ).
Proper marking is needed to clearly identify containers that hold infectious sharps.
This is useful and important not only for the users (that is, those who discard sharps into
52
the containers), but also for the waste handlers. Three types of marking are in common use:
the red (or red-orange or orange) color that is commonly used to denote biohazards, the
universal biohazard symbol, and warding such as "CONTAMINATED SHARPS" see
Tables (2.31 , 2.32, 2.33, and 2.34).
As a result, the term "Red bags" refers to plastic bags that contain infectious waste.
One problem with the use of red bags for infectious wastes is the steam sterilization does
not usually affect the red color, and most red bags remained after they have been steams
sterilized. This could create difficulties in distinguishing between treated and untreated
waste that is contained in red bags.
The waste labeling should be contain the following items:
Date of production.
Place of production (e.g. ward/establishment).
Waste quantity.
Waste category.
Waste destination.
UN symbol, number and shipping name.

The United Nations has developed a standard label, represented on Table (2.32).
This label bears the "International Infectious Substance Symbol" , with which all bags and
containers containing infectious waste, sharps and pathological waste should be marked.
53
Table (2.31) Recommend segregation and color coding for healthcare waste
Type of waste
Highly infectious waste
Color of container
Yell ow marked
"IITGHLY INFECTIOUS"
Other infectious waste,

pathological and anatomic
waste
Sharps
Chemical and
pharmaceutical waste
Radioactive waste
General healthcare waste
Source: (WHO, 1998)
Yellow
Yellow marked
"SHARPS"
Brown
Type of container
Leak-proof and strong plastic
bag, or container supporting
autoclave
Leak-proof plastic bag or
container.
Puncture-proof container
Plastic bag or container
Lead box, labeled with the
radioactive symbol
Plastic bag
Black
Table (2.32) Segregation and color coding for HCW in minimal programs
Designation
Type of
receptacle
Color
Characteristics
Waste
categories
Hazardous waste
container
Container or plastic
bags in a holder
Highly hazardous
waste container
Container or plastic
bags in a holder
Yellow
Yellow marked
"HIGHLY
INFECTIOUS"
Leak-proof suitable
for autoclaving
Leak-proof
Non-sharp
infectious waste,
some
pharmaceutical and
chemical residues
Highly infectious
non-sharp waste
Source: (WHO, 1998)
54
Sharps
container
Sellable box
or drum, or
cardboard
box
Yellow
marked
" SHARPS"
Punctureproof and
leak-proof
sharps
General waste bag

Plastic bag or
container
Black
No special
requirements
Waste similar to
municipal waste,
not contaminated
by hazardous
substances
The bags and containers color-coded that are suggested in the United Kingdom and
may also be adopted internationally are shown in Tables (2.33 and 2.34).
Table (2.33) Recommended U.K. color coding for containers for clinical waste
Kind of waste
The highly infectious waste/foul or
infected linen
Other infectious waste, pathological and
anatomic waste
Sharps
Chemical and pharmaceutical waste
Radioactive waste
Color-code of bag
Red or white with red band
Yellow (incineration)
Yellow-incineration
Red-encapsulation
Brown
Not bags but lead boxes that are properly
labeled
Light blue/transparent
Yellow with black band
Waste of autoclaving
Waste, which is preferably disposed by
incineration or it, may be disposed by
land filling.
Soiled linen
White/clear plastic
Black
Non-risk healthcare waste (general or
domestic)
Source: (ETCL, 1994), (WHO, 1997), and (El-Far, 1998)
Table (2.34) Labeling

Color code
Red
Yellow
Clear bags
Black
Special boxes
Special bags
(cellos)
Red
Black
Type of waste
Medical waste without
isolation waste
Isolation wastes
Radioactive waste
General waste
Sharps
"INFECTIOUS WASTES"
"RADIOACTIVE WASTES"
"DEANGEROUS WASTES"
Addresses
"INFECTIOUS WASTES"
Chemical and
"DANGEROUS CHEMICALS"
Label
"DANGEROUS WASTES"
"DO NOT INCINERATE"

"DO NOT PUNCTURE"
"KEEP OUU OF DIRECT
SUNLIGHTS"
Pressurized can
Source: (WHO, 1998) and (Anderson, 1996)
55
(2.7.3.3) On -Site Storage (or Initial Storage)

On-site storage containers used at hospitals prior to pickup by a collection vehicle can be
of the following types (Qusous, 1988):
a. Non-portable, box-type container
This container is suitable for small hospitals, or for large hospitals where several
collection points are available. Plastic bags are placed manually in these containers several
times a day and then pickup by the collection vehicle manually. Problems of spilling
during unloading are frequently encountered and the janitors should be very careful to
avoid injury.
b. Mechanically portable containers
This type is similar to the previous container except that, it is equipped with a
mechanical system for loading the plastic bags into the collection vehicle.
c. Mechanical compactors
These compactors reduce the volume of solid wastes four to five times, thus reducing
the storage area required . It is not recommended that hospital wastes be compacted for two
reasons:
1. There is a potential for aerosolization of microorganisms from infectious wastes.
2. Compaction may interfere with the effectiveness of certain treatment methods like
incineration, which is mostly practiced at hospitals.
(2.7.3.4) Off-Site Storage Area (or Secondary Storage)

Secondary storage areas should be placed close to the on-site incinerator, secured
with self-closing door that can be opened from the inside. They should be totally closed,
sited on a well drained, impervious hard standing spot. Provided with wash-down facilities,
equipped with water supply and a good daring system, easy to clean and disinfect, well lit
and ventilated. It location should be easily accessible to authorized staff, away from food
56
supplies, storage, and preparation, close to cleaning equipment and protective clothes. It
should be
supplied with needed material in case of spillage. It should also have a
appropriate access to collection vehicles if transportation of waste is needed. It should not

allow in sects or rodents in. Its capacity depends on the generation rate of the waste and the
frequency of collection or incineration. The maximum storage time must not exceed 24 and
48 hours in summer and winter respectively see Table (2.35). The storage room should be
labeled with clear warning signs.
Recyclable waste should have a separate storage area as well as pharmaceutical
waste, sharps, and cytotoxic waste. Radioactive waste should be stored in containers,
prevented from dispersion, behind lead shielding. Proper labeling is required including the
name of the radioactive, date, and required storage details.
All storage areas are supposed to be fire resistant and accessed only authorized personnel.
Table (2.35) Waste storage periods
Maximum Storage Times
Temperature climate
72 hours in winter
48 hours in summer
Warm climate
48 hours in cool season
24 hours in hot season
Source: (WHO, 1998).
57
(2. 7.4) Transport

Wastes transport from the point of origin to storage or to their place offinal
disposal is a key factor, which may affect the health and safety of staff, patients, and
visitors, waste disposal operators and community as a whole (WHO, 1984).
There are two types of transportation:
1. On-site transport, wherever possible, containers and vehicles used for the transport of
clinical wastes, especially infectious and pathological materials, should be dedicated
vehicles and used solely for that purpose. Where this is impractical, a strict code of
practice for cleaning and disinfecting used containers should be enforced. Trolleys
and carets used for transferring clinical wastes within healthcare establishments
should be designed and constructed so that:
Surfaces of the conveyance are smooth and impermeable,
They do not offer harborage to insects,
Can easily be cleaned and drained,
Particles of waste do cot become lodged in the of the conveyance, and
The waste may be easily loaded, secured and unloaded.
2. Off-site transport, the transport of clinical wastes through the community should be
carried out in such away as to present no danger to the public. The transport of
infectious, pathological and other categories of hazardous clinical waste on the high
way should be controlled in the same manner as hazardous chemical wastes. They
should be accompanied by a written document in the form of a manifest, to be carried
by the driver of the vehicle, indicating:
The classification of the waste,
Its principal hazardous component,
Its most significant hazardous properly,
58
Any special precautions to be taken whilst handling,
Emergency procedures in the event of spillage,
The name of the person or authority to contact in the event of an emergency arising
transport and/or disposal,
The destination of the waste, and
The proposed disposal method.
Vehicles used to transport waste to off-site disposal facilities should be of a high standard.
Any vehicle used in such a role should conform special criteria see appendix (F).
(2.8) Waste Treatment Methods

The term treatment refers to the process that modifies the waste in some way before
it is being taken to its final resting-place. Treatment is required for the following reasons
(WHO, 1994):
1.
To disinfect or sterilize the waste, so that it is not longer the source of pathogenic
organisms. The methods used may include, chemical disinfection
sterilization,
or thermal
irradiation, autoclaving, gas/vapor, or microwave sterilization, or
incineration. After such treatment the residues can be handled more safely with fewer
precautions.
2.
To reduce the bulk volume of waste in order to reduce the size of requirements for
storage and transportation, examples are baling and size reduction.
3.
To make surgical waste (body parts) unrecognizable, and therefore less aesthetically
unacceptable-an example is shredding.
4.
To make recyclable items unusable-for example, syringes may be cut up or needles

cut or damaged so that they can not be reused.
Due to the wide range of waste categories produced no one method is totally
satisfactory for all wastes, which arise from healthcare services. From small facilities like
59
clinics to large regional hospitals many technologies or methods have been developed
recently and new technologies will still be developed. These are the main technologies
applied at the time of production ofthis study.
(2.8.1) Disinfection
Disinfection is a method of waste treatment that may be achieved by a chemical
process, thermally, or by irradiation. Thermal disinfection may be dray or wet, dry
disinfection takes place through incineration, which is discussed later. Disinfection is not
reliable in some cases especially in isolation wards and it does not involve sterilization
(WHO, 1994).
(2.8.1.1) Chemical Disinfection

Chemical disinfection is
used routinely in medical care for cleaning certain
instruments and supplies, for surgical scrubs, and for general cleaning of floors, walls, and
furniture. As applied to clinical waste treatment, chemical disinfection is treatment of the
waste by addition of chemicals that kill or inactivate the infectious agents (Reinhardt and
Gordon, 1991).
Chemical disinfection is most suitable for use in treatment of liquid wastes like
blood, urine, but can also be used to treat solid infectious waste that is shredded before or
during treatment in; for example, a hammer mill. With intact solid infectious wastes,
chemical treatment provides only surface disinfection. Shredding is important to increase
surface area, prevent reuse of discarded syringes, and make waste unrecognizable and to
decrease its volume. Chemical disinfection efficiency depends on the kind, amount
concentration of the chemical used, in
addition contact time, and conditions like
temperature, humidity and pH ofthe waste (Reinhardt and Gordon, 1991).

It is more efficient on viruses and bacteria than on parasite eggs, except that some
kinds of bacteria may develop resistance against the selected chemical.
60
Thus selection of the chemical depends on the target microorganism and its media
smce some chemicals are not effective on pathogens in organic compounds. It is not
suitable to disinfect needles and syringes since diffusion of disinfectants up the needle
takes along time (Reinhardt and Gordon, 1991 ).
The disadvantage of using chemical disinfection is that disinfected waste may be
treated as "safe" while it may not be. Another problem is the disinfectant disposal, which
may affect the wastewater treatment plants if used in large quantities. But it is the cheapest
disinfection method especially if the chemicals are available in the local market; more
advantages and drawbacks ofthis method are shown in Table (2.48) (El-Far, 1998).
(2.8.1.2) Wet Thermal Disinfection (Autoclaving, or Steam Sterilization)

Steam sterilization is the oldest method of sterilization available to healthcare
facilities. Treatment is applied by utilization of saturated steam within a pressure vessel at
a temperature sufficient to kill infectious agents present in the waste. Three factors are
critical to assure effective sterilization by steam (Reinhardt and Gordon, 1991):
1. Time.
2. Temperature.
3. Moisture.
If saturated steam at the proper temperature is not present, no microorgani sms are killed
regardless of the time
at that temperature see Table (2.36). Simply increasing the
sterilization temperature when biological indicator failures occur will not solve the
problem because it will not assure the presence of saturated steam.
Unlike time and temperature, which can be easily measured moisture conditions
surrounding a microorganism can not be directly determined.
All surfaces requiring sterilization must be exposed to adequate moisture to allow
denaturing of proteins.
61
Steam sterilization decontaminates the waste by steam penetration. Air should be

completely displaced by steam from the treatment chamber to ensure effectiveness of the
process (Reinhardt and Gordon, 1991 ).
The autoclave has been used effectively for many years as a sterilization venue for
medical devices. The results have been documented as regards both autoclave efficacy and
the problems or restrictions on the use of autoclaves (Biosterile Technology, 1997).
A review of autoclave capabilities emphasizes that the autoclave is designed for
sterilization of medical devices and is not particularly well suited for treatment of
infectious medical waste see Table (2.37) (Biosterile Technology, 1997).
Waste type, which can be autoclaved, is low densities waste (petri dishes and
infected materials). It should be placed in plastic bag made of heat-labile plastic and they
should be placed in heat stable containers (metallic and not perforated). Containers should
left open with the bags rims turned back to facilitate steam penetration, volume and
configuration of efficient sterilization (Biosterile Technology, 1997).
Autoclaving
temperature
and pressure should be monitored usmg record
thermometer, biological indicator, thermocouples that must be placed in the middle and
bottom of the waste autoclave test tape placed on the container's mouth is also a color
indicator of the process. But Browne's tube placed (2/3) the depth of the container in an
easy seen spot in more accurate (Biosterile Technology, 1997).
Temperature of 121C for not less those 15 minutes is found adequate as shown in
Table (2. 36). Penetration and cooling time should be added to the 15 minutes. Advantages
and drawbacks of this method are shown in Table (2.48). It is worth mentioning that if
waste has multiple hazards it should not be steam sterilized because of the potential
exposure to toxic chemicals or radioactive hazards or volatilized chemicals (Reinhardt and
Gordon, 1991).
62
Disinfection is the inactivation of 99.99% of microorganisms while sterilization is

the inactivation of99.999% ofmicroorganisms (Lauer et al. , 1982), (WHO, 1997), (El-Far,
1998).
Table (2.36) Time and temperature requirements for steam sterilization
Spore kill time a
(minutes)
Temperature
(oF)
240
245
250
257
270
280
c)
116
118
121
125
132
138
0
30
18
12
8
2
0.8
Source: (Reinhardt and Gordon, 1991)

a: In steam sterilization, exposure time for treatment is usually at least double the kill time.
Table (2.37) Autoclave sterilization requirements
Clean
Disinfect
Carefully pack
Control temperature, pressure,
and time
Inspect for wet sack
Inspect for verification
Source: (B10stenle Technology, 1997).
Medical devices
Yes
Yes
Ys
Yes
Infectious waste
Not possible
Not possible
Not possible
Yes
Yes
Yes
Not possible
Not possible
(2.8.1.3) Irradiation
Radiation is used for sterilizing certain products and supplies. Application of thi s
technology to treatment of infectious waste is limited because of high costs, the need for
extensive protective equipment, the requirement for highly trained operating personnel,
and problems with disposal of the radioactive source (Reinhardt and Gordon, 1991).
Ultraviolet light can not penetrate material to any depth; therefore, its use is limited
to the sterilization of surfaces. One good use for ultraviolet light in waste treatment is the
sterilization of sheets of paper. This is a very specialized application that is certainly not
efficient in routine treatment of infectious waste (Reinhardt and Gordon, 1991 ).
63
Several processes of disinfection usmg X-rays, or gamma rays from the

radioisotope cobalt-60, have been developed. They can be very effective. Preliminary
milling or shredding is done for aesthetic reasons but also to improve disinfection. They
are clean processes, producing minimal pollution and nuisance, but irradiation is more
expensive than chemical or thermal disinfection. Irradiation is a new, high technology
process which is difficult to operate and maintain, therefore is it not recommended in
situations where technicians with a satisfactory background are not readily available, or
where spares and sources are not easy to obtain (WHO, 1994).
(2.8.1.4) Disinfection by Microwaves

Microwave disinfection
achieves sterilization by subjecting medical waste to
shredding high temperature steam injection and microwaves. The total treated end products
are suitable for landfill or waste to energy plants (For Business Customers, internet 1998).
The process produces no harmful air emission or liquid discharges and reduces
volume by up to 80%. Models are available which can process from 200 to 900 pounds per
hour. The equipment is unable to process radioactive chemically hazardous or gross
anatomical waste.
Because of its size and capacities, the market for microwave disinfection includes larger
hospitals and healthcare facilities. The process is not suitable for large metal objects.
(2.8.2) Thermal Inactivation/Sterilization

Thermal inactivation/sterilization refers to the treatment of waste with dry heat, i.e.,
without the addition of water, steam, or fire . For dry heat to sterilize waste, the waste must
be maintained at a certain temperature so that the target microorganisms are exposed so
that temperature for a minimum period oftime (Reinhardt and Gordon, 199 1).
Thermal inactivation can be used for treating larger volumes of infectious waste,
solid
or liquid. Thermal inactivation of liquid waste is of two types: batch type or
64
continuous type. The difference between them is whether the waste will be collected in a
vessel or waste is pumped a cross the piping system, the waste is heated by a heat
exchanger, the time-temperature requirements are selected on basis of resistance, and kind
of pathogens present in the waste. When the liquid waste is cooled it is dumped into the
sewer, while solid thermal disinfection is applied in an electric oven. A temperature-time
requirement is about 160C-170C for two hours, Table (2.3 8). Shows the range of items
and temperature required for dry heat sterilization under ideal conditions. Because ideal
conditions are almost impossible to achieve when infectious waste is being treated,
sterilization cycles used in actual treatment operations are usually longer than those
indicated in the table. A safety factor of two is generally used-that is, the waste is kept at
treatment temperature for at least twice the length of time needed to kill spores of the
indicator microorganisms (El-Far, 1998).
Table (2.38) Dry heat sterilization

Spore kill time a
(Hours)
Temperature
(oC)
121
140
150
COF)
250
285
300
160
170
180
320
340
356
6
3
2.5
2
1
0.5
Source: (Reinhardt and Gordon, 1991)

a: In heat sterilization, exposure time for treatment is usually at least double the kill time.
Dry heat is less efficient than moist heat as a sterilizing agent, and longer treatment times
are necessary. Because it is less efficient, this technique is also more expensive than steam
sterilization, and cost can bean important factor when dry heat sterilization is being
considered for the treatment of infectious waste, also thermal inactivation consumes lots of
expensive energy (Reinhardt and Gordon, 199 1).
65
(2.8.3) GasNapor Sterilization

Gas sterilization was also used originally to sterilize medical equipment and
various medical and industrial products before use. This practice of using gas for
sterilization of supplies was extended more recently to its application for treatment of
infectious wastes (Reinhardt and Gordon, 1991).
Gas sterilization is the treatment of infectious waste by exposing it to a sufficiently
high concentration of a sterilizing gas under the required conditions for the designated
treatment period. Ethylene oxide and formaldehyde are the sterilizing agents usually used
in gas sterilization. These two chemicals are proved to be carcinogenic and caution must be
exercised when they are used. Therefore, when gas sterilization is considered, the relative
hazard of the treatment should be weighed against the benefits resulting from the
treatment.
Ethylene
oxide gas is often used to sterilize thermolabile supplies.
Formaldehyde is used to sterilize certain disposable items that may be contaminated. Welltrained personnel should do this method. The potential hazard is that both chemicals will
frequently form residues and gases from the treated waste for a substantial period of time
after treatment (Reinhardt and Gordon, 1991 ).
(2.8.4) Inertization
This method consists m mixing the waste with cement and eventually other
substances in order to dispose them without major risk of mobilization of the toxic
substances into the ground or water. It is especially suited for pharmaceuticals and
chemical waste and or ashes with heavy metals. For inertization of pharmaceuticals wastes,
packaging should be removed, then pharmaceuticals should be ground, and a mix of water.
Lime and cement added. A homogenous mass should be formed, pellets or cubes are then
produced on sit, after wards transported to a storage site. It is an inexpensive process and
66
done in unsophisticated manner (WHO, 1997). Advantages and drawback ofthis method
are shown in Table (2.48) (El-Far, 1998).
(2.8.5) Encapsulation
This method is cheap and mostly applied by filling the waste (without pretreatment)
into a container and adding immobilizing material such as plastic foam or bituminous sand
or cement, then sealing the container and sending it to landfill. The most important
advantage of this process that it prevents scavengers from reusing disposed materials. It is
suitable for the disposal of sharps and pharmaceutical waste only. Advantages ofthis
method are shown in Table (2.48) (El-Far, 1998).
(2.8.6) Mechanical Treatment
To ensure that sharps- such as syringes and drip needles-are efficiently disinfected,
it may be necessary to crush, break, cut or otherwise damage those sharps prior to
treatment. The processing will also prevent unsafe reuse of discarded syringes. Many
methods for destroying sharps have been tried, and none have proved fully reliable or costeffective, and some may actually give rise to the risks they are supposed to prevent (WHO,
1994).
(2.8. 7) Steam Reforming
Steam reforming shreds and sterilizes infectious waste in an enclosed unit that
operates in a similar manner to an autoclave but without fuel/air combustion-solid byproducts are disposed of a recycled. The process achieves approximately 70% volume
reduction. The market for steam reforming technology includes medium to large hospitals
and healthcare facilities (For Business Customers, Internet 1998).
67
(2.8.8) Electro-Pyrolysis Oxidation

Electro-pyrolyiss oxidation (Bio-oxidizer) uses pryrolysis and oxidation to treat
bio-hazardous waste. The resulting end product is a sterilize and unrecognizable product.
Red plastic bags, pathological and general hospital waste can be processed,
achieving reductions ofup 95% in mass and volume. The process eliminates air emissions
and produces ash, which is non-hazardous, can be disposed of in local landfills.
The market for Electro-pyrolysis oxidation technology includes medium to large
hospitals and healthcare facilities (For Business Customers, Internet 1998).
(2.8.9) Plasma Based Pyrolysis Vitrification (PBPV)
PBPV system is a plasma heating/melting system that completely destroys the

waste it processes, breaking down waste streams into basic elements. PBPV system
eliminates the need for landfills, terminating all long-term liability for waste generators. It
saves time, money and valuable resources by avoiding the potential dangers of transporting
hazardous and non-hazardous waste streams over distances (For Business Customers,
internet 1998).
PBPV medical waste disposal system combines plasma with pyrolysis. The
extreme temperatures (upwards of 3,000 to 3,500 degrees Fahrenheit in the chamber)
convert organic material to mid-grade fuel gas, which is primarily hydrogen and carbon
monoxide. Acidic materials is removed by ascribing process and in organic materials can
be recovered or vitrified with glass (For Business Customers, internet 1998).
The process can handle all types ofwaste and results in reduction ofup to 90% in
volume and 80% in weight. The market for PBPV technology includes very large hospitals
and regional treatment facilities. Table (2.39) showed the amount and percentages of some
materials that flue out from PBPV furnace (San diego medical center, 1993).
68
Table (2.39) Summary of emission test result PBPV furnace, after burner outlet.
Test parameters
Particulate (lb./hr)
HCL (lb.!hr)
02 (%)
C02 (%)
N2(%)
H2(%)
Mean test value

0.8
0.004
12.7
6.0
81. 1
< 0. 1
< 0.1
C~(%)
Source: (Sand1ego medical center, 1993).
(2.8.10) Infrared sterilization

Infrared sterilization uses infrared rays with resistance or convection heating to
sterilize medical waste. This technology can be used for variety oftypes of medical waste
including microbiology waste and human blood products. In achieves a waste reduction of
90% and sterilized waste can be disposed of in landfills (For Business Customers, Internet
1998).
The market for infrared sterilization technology includes smaller healthcare
facilities such as clinics, laboratories, nursing homes, blood tanks and small hospitals.
(2.8.11) Incineration
Incineration is the process by which combustible materials are burned at high
temperature, producing combustion gasses, non-combustible residue and ash in the
presence of oxygen. The product of gasses is vented directly to the atmosphere. After
treatment by an air pollution control device. The non-combustible ash residue is removed
from the incinerator system and is disposed off in a landfill. The great advantage of
incineration system is the reducing of waste volume by 90% and, m some case, may
provide economic benefits through recovery of heat produced by the burned waste (Chang,
1993). Up till
now, most infectious and pathogenic waste from hospitals has been
incinerated on-sit, the reminder dumped in a landfill. Incineration process of hospital

wastes can be separated into the following steps:
69
Waste preparation.
Waste charging.
Treatment of combustion gasses.
Residue ash handling.
The incineration process and its major components are depicted in Table (2.40).
A properly managed incineration can serve several purposes, destruction ofthe
waste accompanied by a significant reduction in its weight and volume, and the production
of a sterile solid residue. On the other hand, the risk of causing nuisance and environmental
pollution from emission of particulate, acidic gasses, unburned waste and trace quantities
of hazardous organic, by products, should be appreciated in the selection of equipment and
by out ofthe incineration facilities (Bdour, 1997).
Table (2.40) Components of an infectious waste incinerator

Component
Primary combustion
chamber.
Purpose
Dry, heat and convert
waste to gases; some
oxidation and pyrolysis
may occur.
Secondary combustion
chamber.
Oxidize gaseous waste

into carbon dioxide and
water.
Boiler
Recover heat from exhaust

gases.
Air pollution control

devices.
Remove hydrogen
chloride, other acid gases,
and particulate.
Disperse exhaust gases.
Stack
Source: (Who, 1998).
70
How it works
Auxiliary fuel (e.g., natural
gas) is used to raise the
chamber temperature to
1600-1800F to initiate and
maintain combustion.
With sufficient oxygen
present (supplied as air),
1800F and above efficiently
converts organic
components of the waste
into carbon dioxide and
water.
A heat exchanger converts
water to steam; steam can be
used for heating and cooling.
Release exhaust gases from
the secondary combustion
chamber of a height and
location that allows dilution
to safe concentrations.
(2.8.11.1) Principles of Combustion and Chemical Reaction
The combustion process in hospitals is a chemical reaction that involves rapid

oxidation of the organic substances in the waste and the auxiliary fuels. This violent
reaction releases energy in the form of heat and light and converts the organic materials to
an oxidized form, organic portion ofthe hospital wastes consist of Carbon (C), Hydrogen
(H), and Oxygen (0). These elements are involved in the reactions that generate most of
the energy and the bulk
of the combustion gas products that are released during
incineration. Metals, Sulfur, Nitrogen, and Chlorine are other elements, which found in the
medical wastes, but to lesser degree (Bdour, 1997).
Chemical reaction can be simply described as a combination of carbon and
hydrogen in the orgamc materials. These simplified reactions can be represented
chemically as:
C + 1/2 02 _. CO + Heat
CO + 1/2 02-. C02 +Heat
Available bench scale tests indicates the organic chlori~ whi~lre
____-:.-
combustion chamber reacts almost completely~w]l)lydrogen chloride (HCL) and (Ch),
-----
unless the system has very low (H) to (CL) ratio in the feed, almost no (Ch) will be
formed.
The existence of sulfur in organic materials will be oxidized during the combustion
process to form sulfur dioxide S02. Some of S02 may react with alkaline reagents present
in the waste or the ash. However, the amount of S02 is expected to be negligible due to
high HCL content of the fluent gas and since HCl is available alkaline compounds than
71
Nitrogen enters the combustion chamber as apart of a waste and in the combustion
a1r. It can react in the combustion chamber to produce Nitrogen oxide Nox, but its
formation rate is sensitive to the flame temperature. The detailed mechanisms of fuel Nox
formation are not well understood.
In addition of the above emittants, the incineration facility produces thousands of
different emittants, ofwhich up to 50% have not yet been identified, of the substances that
have been identified. The most prevalent emittants are dioxins, lead, cadmium, mercury,
and particulate matter, all ofwhich have very sever consequences for human health. It is
the inability of experts to successfully identify many of these substances which is of great
concern too many health experts see Tables (2.41 and 2.45) (Bdour, 1997).
(2.8.11.2) Optimum Conditions for Incineration

Efficient operation of a hospital incineration can be attained under the following
conditions:
1.
High temperature.
2.
Sufficient (gas) residence time.
3.
Good turbulence (mixing).
4.
An excess of oxygen.
The temperature of incinerator is affected by many factors such residence time,
turbulence (mixing) and the availability of oxygen see Table (2.42). By experience gained
in the laboratory and in industrial units, the following operation conditions were
recommended (Reinhardt and Gordon, 1991):
1.
Temperature
of 900-1100C for hydrogen waste, and 1100-1200C for certain
tractable waste such as PCBs, that contains halogen.

2.
Minimum gas phase residence time of2 second. Residence time for health solids is
measured in hours rather than seconds.
72
3.
100% combustion atr m excess of stoichiometric requirements. Turbulence is

achieved through good incineration design, by providing the incinerator with tangential
fans and liquids injectors who produce cycling burns paths. Mixing process operated in
most of the hospital incinerators by mechanical means. Efficiency of incineration
process for combustion
Destruction
and
of a particular organic compound, often defined as the
Removal Efficiency (DRE) is calculated by measuring the
concentration of the particular organic compound in both the waste and the air
emissions by applying the following formula (Bdour, 1997):
I
"
DRE = ((Cin- Cout)l Cin)
-=-
* 100%
Where;
DRE: Destruction and Removal Efficiency.
Cn: Concentration of that compound in the waste feed .
Cou( Concentration of that compound in the stack gas.
(2.8.11.3) Principles of Incinerator Design

The pnmary objectives associated with the proper operating of incinerators system
m a manner so that the solid wastes are rendered harmless are: waste volume is reduced,
good ash quality (from an aesthetic stand point) is ensured; air pollution, emissions of
particulate matter, organic compounds, carbon monoxide, and acid gas are minimized; and
the requirements of clean air are met. To achieve the previous mentioned objectives, the
following principles should be taken into consideration in the design of incinerator (Bdour,
1997):
1.
The volume of the combustion chamber should be sufficient to receive the physical
bulk of the waste, and provide adequate gas phase residence time.
2. High temperature should be maintained.
73
3. Combustion atr requirements should be met, and in excess of the stoichoimetric

quantity.
Maximum turbulence and mixing should be achieved in the combustion chamber
by proper sitting of fans and burners. Advantages and disadvantages of incineration system
are shown in Table (2.48).
Table (2.41) Concentration of gases that flue from the incinerator chimney that is not
exceeded
Materials
Maximum concentration mg/m3
100 as (HCL)
Chlorine component
100 (as a ratio per hour)
Carbon mono oxide (CO)
300
Sulfur dioxide (S02)
20 (represent by carbon)
Organic material
Heavy metals (cadmium, mercury, lead)
5 (from the total concentration)
Other material
100
Source: (WHO, western pacific reg10n, and reg10nal gmdelmes for healthcare waste
management).
Table (2.42) Standard reference combustion temperatures for ~!ious waste incinerators
Combustion chamber
Primary
Secondary
Secondary chamber
retention time
Source: (WHO, 1997)
Previous
1400-1600 oF
144-1600 oF
0.25 to 0.5
seconds
Newer
1600-1800 oF
1800 + F
1 to 2
seconds
(2.8.11.4) Types of Incinerators

There are many types of incinerators that may be used to incinerate medical waste, which
includes (El-Far, 1998):
1. Multiple-chamber incinerator
This type of incinerator is considered improper to incinerate medical waste due to
the emission problems, i.e., allowing non-combusted waste into the ash pit, which exposes
operators to infectious waste (U.S.EP A, 1991).
2.
Rotary-kiln incinerator
This type is recommended for medical waste since it promotes excellent turbulence,
produce good quality ash and allows continuous feed operation. But it is not generally used
74
due to its high operation cost and maintenance, and its small size, which affects the
efficiency. It may be supplied with air pollution control system (U.S.EPA, 1991), and the
ranges of its temperature from 1200-1600C.
3.
Single chamber furnaces with static great, it is used in range oftemperature from
300-400C.
4.
Simple field incinerators, it is used for the temperature< 300C.
5.
Double-chamber incinerator (pyrolytic incinerator).

The first chamber operates under saturated air conditions to volatile the moisture in
the waste, vaporize the volatile fraction of waste, and combust the fixed carbon in the
waste. The lower temperature achieved in this chamber helps avoid the melting fusion
temperature of most metals, glass and other non-combustibles, thus minimizing slogging
and clinker formation. The combustion gases are then passed from the first chamber to the
secondary chamber, in which combustion air is regulated to provide excess air condition,
and complete the combustion as volatile and other hydrocarbons emitted from the primary
chamber.
Good turbulence is provided to promote mixing of combustion gases and air. The
gas/air mixture then is burned
at high temperature. Both chambers are controlled
automatically to maintain optimum burning conditions with varying waste loading rate,
composition and characteristics of the waste.
Its advantage over multiple chamber incinerators is that it allows slow, quiet
combustion to occur, which minimizes entertainment of particulate in the combustion
gases and this reduces particulate emission to the atmosphere (U. S.EP A, 1991 ).
This type is extremely popular in healthcare facilities due to its low cost and
relatively clean combustion. In case of strict air quality standards, air pollution control
equipment will be needed. Single-chamber, drum or Brick incinerators advantages and
75
drawbacks are cleared in Table (2.48). Also Table (2.43) shows the characteristics of
different types of incinerators.
Whatever type the incinerator is, its capacity should be determined with regard to
the volume
of waste loaded/unit time as well as characteristics of the waste to be
incinerated, as classified according to the incinerator Institute of America waste

classification, as shown in Table (2.44).
Table (2.43) characterization of different types of incinerators

Single chamber
incinerator
Capacity
Temperature
Exhaust gas
Cleaning
Personnel
Costs
100-200 kg/day
300-400 c
Difficult to install
Training of
operatives needed
Reasonably low for
investment and
operation
Source: (WHO, 1998)
76
Pyrolytic double
chamber
incinerator
200-1000 kg/day
800-900 c
Usually installed
larger plants
Well trained
personnel requires
Relatively high for
investment and
maintenance
Rotary kiln
500-3000 kg/day
1200-1600 c
Required
Highly trained
personnel required
High
Table (2.44) Incinerator Institute of America Waste, classification of waste as:

Type
description
Trash
Rubbish
Refuse
Garbage
Animals
solids and
organic
wastes
P rincipal components
Highly combustible
waste, paper, wood,
cardboard cartons,
including up to 10%
treated papers, and
plastic or rubber
scraps; commercial and
industrial sources.
Combustible waste
paper, cartons, rags,
wood scraps,
combustible floor
sweepings, domestic,
commercial and
industrial sources.
Rubbish and garbage;
residential sources
Animal and vegetable
wastes, restaurants,
hotels, and markets,
institutional,
commercial and club
sources.
Carcasses, organs, solid
organs waste, hospital,
laboratory, abattoirs,
animal pounds and
similar sources.
Approximate
composition
%by total
weight
Moisture
content
%
Incombustible
solids%
Btu value/lb.
of refuse as
fired
Trash 100%
10%
5%
8,500
Rubbish 80%
Garbage 20%
25%
10%
6,500
Rubbish 50%
Garbage 50%
Garbage 65%
Rubbish 35%
50%
7%
4,300
70%
5%
2,500
100% animal
and human
tissue.
85%
5%
1,000
Source: (U.S.EPA, 199 1), (El-Far, 1998).
77
Table (2.45) The emission of the flue gas from the chimney of the incinerator at the hospital Felkirch in Vorarlberg, Austria
in 1975
Number oftest
Time of test
Time
Combustion out put
Kg/h
By-Pass
1
8.4 18.51
102
2
8.559.05
102
3
9.089.18
102
4
9.209.30
102
5
9.5610.06
204
6
10.1010.20
204
7
10.2310.33
204
8
11.0411.14
185
9
11.1611 .26
185
10
11.3311.43
185
closed
closed
closed
closed
open
open
open
open
open
open
1070
300
258
990
280
253
Temperature of flue gases

After post combustion
After suction fan
Before chimney outlet
oc
oc
oc
650
170
820
230
750
230
630
230
910
190
860
200
940
210
980
270
239
Content of C02 measured after suction fan
2.9
4.0
4.7
3.3
3.3
2.8
3.3
3.4
3.5
2.8
Content of 02 measured after suction fan
16.1
14.5
15.0
16.2
16.0
16.5
15.8
15.2
13.5
15.0
Content of CO measured after suction fan

Content of ash measured after suction fan
Chimney outlet
Related to a content of 02 of 17%
Measured after suction fan
Chimney outlet
%
mg/m3
mg/m3
mg/mj
0
30
< 0.02
29
0
38
0
25
0
14
0
15
0
14
59
67
47
Visibility of gases according to

Ringelmann graduation.
25
18
26
21
11
14
11
mg/mj
--
41
35
32
<1
<1
<1
<1
<1
<1
<1
<1
78
Incinerators system does not include only incinerators, but waste and ash handling
equipment, burner, stack chimney, combustion air blower system, flue gas handling
system, and air pollution control system.
Incinerator's stack must be lined with high temperature refractory. Its height is
determined by the heights of surrounding buildings or topography. It should be built
according to handling and fire codes, draft requirements, entrapment avoidance and/or
ambient air quality and dispersion modeling. Meteorological conditions (wind direction
and velocity) must also be considered. Minimum heights expected to be no less than 40 m
and at least 3 m above the height of neighboring buildings and structures (Anderson, 1996)
(El-Far, 1998).
It was found that to calculate the increase in Ground Level Concentration (GLC) of
components in the stack gases, the maximum increase of (GLC) would occur at distance
between 15-30 times the stack's height. Hence the higher the chimney, the greater the
distance from the stack and the greater the dispersion. Typically, under most occurring
atmospheric conditions, a plume emitted at 150 C above ambient temperature at an exit
velocity of 15 rn/s, will achieve adulation of approximately 1:200,000. It follows that the
maximum impact on the community can be determined by specifying the height of the
stack, the temperature and exit velocity of the plume and the maximum permitted
concentration of pollutants in the emissions (El-Far, 1998).
(2.8.11.5) Incinerators Air Pollution Control Equipment

Air pollution control equipment used to day is of two types: wet scrubber and dry
scrubber. Wet scrubbers are used because of their low cost and ease of operation. They can
remove acid gases by absorption of gaseous pollutants in liquid. It removes particulate by
large liquid droplets capturing particulate by impact or diffusion. The collected fly ash and
liquid effiuent are discharged directly to sewer system (U.S.EPA, 1991). Dry scrubber
79
consist generally of acid-gas removed system, in which dry alkaline, such as lime is
inj ected upstream from particulate removal device usually a fabric filter. Dry scrubber is of
two major types: spray-dryer/fabric filter and
dry-injection/fabric filter. The main
difference between them is the method of introducing the alkaline absorbent. These
systems are efficient and inexpensive. Size of the facility is a factor that helps choosing the
air pollution control system. Venture (wet scrubber) is recommended for small facilities
since it is able to accept hot flue gases directly and require no start up considerations and
requires less space (U.S.EPA, 1991). Table (2.46) shows the air pollution control devices
(scrubbers) used for incinerator (El-Far, 1998).
Table (2.46) Air pollution control devices (scrubbers) used for incineration
Device
Venture
Packed tower
Lime injector
Bag house
Electrostatic
precipitator
Purpose
Mixing to facility
neutralization of acidic
gases.
Remove and neutralize
acid gases.
Remove and neutralize
acid gases.
Remove particulate.
Remove particulate.
How it woks
Neutralizing chemicals mix with stack gases.
A column filled with small beads that provide

a large surface area for gases and neutralizing
agent to mix.
Atomized lime slurry is mixed with stack
gases.
Stack gases pass through filters.
Charged particles are attracted to plates and
removed from the stack gas.
(2.8.11.6) Healthcare Wastes that should be Incinerated

Incineration should be employed for the disposal of:
1. Human tissue, limbs placenta, infected carcasses and dialysis wastes.
2.
Sharps.
3.
All pathological wastes.
4.
Small amounts of drugs, medicines and injectables,
5.
Soiled surgical dressings, swabs and other contaminated wastes.
80
(2.8.11.7) Healthcare Wastes not to be Incinerated
Incineration should not be employed for the disposal of:

1.
Pressurized gas containers.
2 . Large amounts of reactive chemical waste.

3. Radioactive waste.
4.
Silver salts or radiographic waste.
5.
Halogenated plastics (e.g. PVC)
6.
Mercury or Cadmium.
7.
Ampoules of heavy metals.
(2.8.11.8) Health and Environmental Impact of Incineration
The process of incineration generates hundreds of thousands of new compounds

during
the operation of the facilities. Many of these compounds are released as air
emissions through the giant smoke stacks. Additional substances are released as both solids
an liquids, many of which are leaked into landfill sites. The air emissions are the area of
greatest concern, as they are freely dispersed into the surrounding environment, often with
severe consequences.
It is the emission into air of highly toxic chemicals such as dioxins, mercury, lead,
cadmium, carbon
monoxide, NOx gases, SOx gases, hydrochloride acid (HCl), and
particulate matter, that have become the primary focus of those opposed in incineration.
The operators are in the risk of incineration, because the operators may be injured
and get contaminated during the loading of waste and unloading of ash which may still
have some sharps in addition to the info dust from non-combustible material.
81
(2.8.12) Comparison between the Infectious Waste Treatment

The following Tables represent comparison between the main infectious waste
treatment methods and summary of advantages and disadvantages of these treatment
methods.
Table (2.47) Comparison between the infectious waste treatment

Issues
Adds weight (cost) to
waste stream
Requires additives
Requires pretreatment
processing
Treatment volume per hr.
& time load
Treats total % of
infectious waste
Volume reduction option
Requires venting
Generates recyclable
options
Drain lines/ waste water
Verify treatment per load
Set standards for
treatment
Cost of equipt. For 250bed hospital
Ease of fit with collection
process
Process produces byproducts
Operation safety
Cost/lb. Comparison
Microwave
Yes
Autoclave
Yes
Chemical
Yes
Incinerate
No
Yes
Yes
Yes
Yes
Yes
Yes
No
No
220-550 lb. per
300-1000 lb.
per hr.
95-98% no
liquids
Yes
Yes
(off site)
95-98% no
liquids
Yes
Yes
300-1000 lb.
per hr.
95-98% no
liquids
Yes
Yes
95-98%
no liquids
Yes
Yes
No
Yes
No
No
No
Yes
No
Yes
No
Yes
No
No
No
No
No
Yes
$ 325,000550,000
Good
$ 199,000525,000
Good
$ 285,000460,000
Poor
(off site)
Yes
Yes
Yes
No
Good
$0.11-0.16 per
lb.
210 sq.ft.
Good
$0.11-0.16
per lb.
130 sq.ft.
Good
$ 0.24-0.52
per lb.
396 sq.ft.
Good
$ 0.3 2-1.02
per lb.
(off site)
hr.
Size of equipment space

required
Source: (Electron Beam Infectious Waste Treatment, Internet 1998).
82
Good
Table (2.48) Summary of main advantages and drawbacks oftreatment and disposal option
Treatment method
Double-chamber
incinerator (pyrolytic
incineration)
Single-chamber
incineration
Drum or brick
incinerator
Chemical disinfection
advantages
Very high disinfection
efficiency; adequate for all
infectious waste, and most of
pharmaceutical and chemical
waste.
Good disinfection efficiency;
drastic reduction of weight
and volume ofwaste; the
residues may be landfilled:
No need for highly qualified
operators: relatively low
investment and operation
costs.
Drastic reduction of weight
and volume of the waste; very
low investment and operating
cost.
Highly efficient disinfection

good operating conditions;
costly if the chemical
disinfection is expensive.
/ Wet-thermal
treatment
Environmentally friendly;
relatively low investment and
operation costs.
Microwave irradiation
/
Good disinfection efficiency

under appropriates
operational conditions;
environmentally friendly .
83
drawbacks
Incineration temperature of
800C. Destruction of
cytotoxics; relatively high
costs of investment and
operation.
Generation of significant
emission of atmospheric
pollutants. Need for periodic
slag and soot removal;
inefficiency in destruction of
thermally resistant chemicals
and drugs such as cytotoxics.
Only 99% destruction of
microorganisms; no
destruction of many
chemicals and
pharmaceuticals; massive
emission of black smoke,
flying ashes and toxic flue
gas.
Requirements of highly
qualified technicians for
operation of the process; use
of hazardous substances
which require
comprehensive safety
measures; inadequate for
pharmaceutical, chemical
and some types of infectious
waste.
Shredding are subjected to
many breakdown and bad
functionng; operation
requires qualified
technicians' inadequate for
anatomic waste,
pharmaceutical and chemical
waste or waste which not
easily penetrable by steam.
High investment and
operation costs; potential
operation and maintenance
problems.
Continue to Table (2.48)

Encapsulation
Safe burying
Inertization
Rotary kiln
/
v
Incineration
Simple and safe; low

costs; may also be applied
to pharmaceuticals;
Low costs; relatively safe
if access restricted and
where natural infiltration is
limited.
Relatively inexpensive
Adequate for all infectious
waste, chemical and
pharmaceutical waste.
Good disinfection
efficiency; drastic
reduction of weight and
volume.
Source: (El-Far, 1998), (WHO, 1998).
84
Not recommended for nonsharp infectious waste.

Only safe if access of site
is limited;
Not applicable to
infectious waste.
High investment and
operating costs.
Efficiency of chemical and
treatment good for rotary
kiln,-95% for pyrolytic
incinerator, very limited
for lower temperature;
toxic emission to air if no
control devices.
Maintaining temperature
levels and (efficiency) in
field incinerators is
difficulties, usually high
costs for high temperature
incineration.
Table (2.49) Overview of disposal and treatment methods suitable for healthcare waste categories
Waste types
Encapsulate on
(only minimal
programs)
Safe burying
inside hospital
premises
Discharge
to the
Yes
No?
Yes
No
No
Yes
Yes
Yes
No
Yes
No
No
Yes
No
No
Yes
Yes
Yes
Yes
Small quantities
No
No
Small
quantities
No
No?
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
Small
quantities
No
No
No
Small quantities
No
No
Yes?
Yes
No
No
No
No
No
No
Small quantities
Small quantities
No
No
Yes
No
No
Low - level
infectious waste
No
No
No
No
no
Low-level
liquid
No?
Low
level
infectio
No
No
Wet-thermal
treaunent
Pyrolytic
incineration
(double
chamber)
Yes
Single chamber
incineration or
municipal
incineration
Yes
Chemical
disinfection
Yes
Yes
Anatomic
Sharps
Pharmaceuti
cal wastes
Yes
Yes
Small quantities
or at high tern.
Yes
Yes
No
No
Yes
No
Cytotoxic
Waste
At high temp.
No
Chemical
Small quantities
Low - level
infectious waste
Infectious
Microwave
irradiation
Inertization
Other method
Rotary
kiln
sewer
Drum or
brick
Sanitary
landfill
incinerator
wastes
waste
Radioactive
waste
waste
Return
expired drugs
to supplie r
Return
expired drugs
to supplier
Return
unused
chemicals to
supplier
Decay by
storage
us waste
85
(2.9) Disposal of Treated Waste

When infectious waste has been properly and effectively treated, the waste is no
longer infectious. The treated waste then poses essentially no risk, and it can be handled in
the same way as ordinary solid waste. There are, however, two exceptions to this
generalization:
1.
For certain types of waste, such as sharps and pathological wastes, additional
processing before disposal may be warranted or even necessary, depending on the type
oftreatment used.
2.
If other hazards m addition to infectious ness were present in the waste (e.g.,
chemical toxicity or radioactivity), there must be additional treatment before disposal
and/or special handling and disposal.
There are two disposal options for treated infectious waste: the sanitary landfill and
the sanitary sewer. Regardless of the disposal method used-a quality control program is
necessary to ensure that only treated waste is designated for disposal.
(2.9.1) landfiJ.ling
Landfilling is an accepted disposal method for hospital waste since it was found
that the highest portion of waste is non-hazardous and will be diluted when co-disposal
with urban waste. But actually waste dilution does not occur due to the fact that hospital
waste is delivered separately and it is not recommended to be spread by personnel. Not all
forms of medical waste can be disposal of land filling because it is an ideal medium for
microbial growth; furthermore, the presence of antibiotics among the waste may affect the
microbial population in the landfill.
Landfills used for
disposal of clinical waste should be licensed by disposal
authority; a record should be kept to those sites, type of waste, and any operating
procedures required also should be identified, as well as using color-coded bags for the
86
accepted waste. It should be operated according to the lightest standards, located away
from sensitive aquifers or water abstraction unless considered contaminated, as well as
away from residential areas. It also should be securely fenced to prevent scavengers access
to the waste. Landfilling is found to be the least cost option (El-Far, 1998)..
(2.9.2) Types of Landfilling Accepted for Healthcare Waste

(2.9.2.1) Landfills Operating on Face Principle
Medical waste disposed of by this method should be disposed so that it is within 1
meter of the working surface and no less than 2 meters from the face of the flanks and it
should be covered immediately with a thick layer of a suitable cover material. Direct
compaction of clinical waste is not recommended since some waste may be trapped on the
compactor. If this is the case, then a trench should be dug in an area where there is
sufficient material to bury and cover the waste. That area should not be re-excavated for
trenches to take liquid waste or covering material before a reasonable time elapse for waste
degradation to take place (El-Far, 1998).
(2.9.2.2) Sanitary landfilling

WHO, 1997 recommended the following design and operation for a sanitary
landfilling site:
1. It should have access to site and working areas by waste delivery and site vehicles.
2.
Site office is needed to depot vehicles and tools.
3. Division of the site area manageable phases and there processing before starting to
landfill.
The cells should be adequately sealed from sides and bases to protect ground water
contamination with a designed leachate collection and treatment system. The disposed
waste should be covered immediately with at least 0.5 m of a suitable covering material.
The purpose of covering the waste is fore aesthetic consideration, protection of medical
87
waste from action of machinery operating on the landfill, prevent animals and birds from
disturbing it. Thus cover availability is an important factor of site choosing. Compaction of
materials
should be done after waste covering. A final covering material should be
provided. Surface water collection trenches around side boundaries, and the final landscape
should be designed after restoration (El-Far, 1998) ..
Any kind of waste that is recognizable after disinfection should either be shredded
or burned before landfilling or it may be filled in containers before disposal.
(2.9.3) Discharge to the Sanitary Sewer System

Liquid wastes are unsuitable for disposal in landfill, and incineration of aqueous
wastes is fuel-intensive and inefficient. Therefore, treated waste that is liquid or semi
liquid is best disposed of by discharge to the sanitary sewer system, provided that such
discharge meets the requirements of the local sewer authorities for wastewater constituents
and characteristics. These requirements may include limits on various parameters including
chemicals, organic material (BOD), pH, total suspended solids, and temperature.
Liquid wastes suitable for sewer disposal are infectious wastes that were treated
prior to their discharge into the sewer system. This includes wastes that were steam
sterilized, those that were treated chemically, and those that received heat treatment. Semi
liquids are usually formed when wastes are ground up during or after treatment, with the
semi liquid product being discharged directly to the sewer system. Sharps and pathological
wastes are sometimes treated this way. In addition, certain infectious waste treatment
system pass the waste through a hammer mill or grinder while it is being treated
chemically although the resultant slurry is drained on a conveyor belt, some semi liquid
waste enters the sewer system (Reinhardt and Gordon, 1991 ).
88
(2.9.4) Health and Environmental Impact of Landfilling, Open Dumping

Disposal site whether it is landfill or open dump should be thoughtfully considered
due to the problems that may be encountered with soil and ground water contamination
resulting from run off and seepage from waste in landfills. Leachate (a liquid from landfill
containing dissolved chemical substances) from landfills and dumpsites may seep into
fresh and sea waster together in case ofunchecked dumping. This could lead to possible
uptake and bio-accumulation of such waste in the aquatic food chain which man and
animal consume. Certain chemicals and even pathogens and radioactive waste can
contaminate other food supplies of human beings and animal.
Municipal landfills in many developing countries do not meet the acceptable
standards, where waste is not covered daily and it is not controlled. Little attempt is made
to restrict access by unauthorized scavengers. The difficulty of control and supervision of
the municipal disposal sites is another problem, were drivers and cash or threat to allow
scavengers access to waste may tempt laborers. A 24 hour guard would be necessary if real
supervision is required (WHO, 1994).
A significant increase in health hazard is associated with healthcare waste, when it
IS
disposed of in conjunction with other municipal waste particularly if not either sterilized
or incinerated at source. Further health hazard potential is enhanced if secondary handling

of waste is carried out. For example when recycling processes such as composting refuse
derived fuel or sorting for reclamation of glass, plastic, metal, paper, fabrics are used.
When these practices take place among the community, there will always be a potential
risk of infection.
The role of vectors and their control on the dumpsite is very important, where flies
and rats can spread disease and contaminate food since they find shelters and possibly
food, in piles of solid waste. It was also pointed out, those vectors, as rodents and insects
89
should be considered in the concomitant evaluation of survival or spread of pathogenic

microorganisms in the environment (this may concern healthcare waste management inside
as well as outside the establishment). These vectors are known to be passive carriers of
microbial pathogens and their population increases tremendously in case of waste
mismanagement (WHO, 1997). Garbage collectors may act as carriers of certain diseases
as they undertake their daily activities among residential communities, which might cause
indirect, risk to the public at large, see Table (2.49).
90
(2.10) Cost
As with all activities, the economic aspect must be considered. It is clear that good
hospital waste management is not free of charge but when all is included it represents only
very minor part of the total hospital cost probably around 0.1-0.2% of the total hospital
running cost or 1-2%. Therefore, saving on this item is of little significance in proportion
to the total expenditures. Table (2.50) presents the estimated infectious waste treatment
cost at some HCE in USA
Table (2.50) Estimated infectious waste treatment costs
N/A= not applicable
Summary costs $/lb.*

Thermal
off-site
Thermal
on-site
Chemical
on-site
Collection
Off-site transfer
On-site treatment
0.02
0.05-0.10
0.02
0.02
N/A
N/A
N/A
0.21-0.48
Disposal
Subtotal post
collection
Recycle option
0.25-0.90
0.3-1.0
0.070.12
0.015
0.090.14
N/A
Subtotal post
collection with
recycle
Total cost
Radiation
on-site
Microwave
&
autoclave
Hazardous
waste
landfill
0.02
0.02
N/A
N/A
0.02
0.05-1.0
0.03
0.07-0.12
N/A
0.015
0.22-0.50
0.015
0.05
0.015
0.11-0.16
0.25-0.90
0.30-1.00
N/A
N/A
N/A
N/A
0.3-1.0
0.090.14
0.22-0.50
(-) 0.010.005
0.04
N/A
0.3-1.0
0.32-1.02
0.110.16
0.24-0.52
0.06
0.11-0.16
0.32-1.02
Source: (Browser, 1997).

Note: * Prices per lb. Are ranges only indicative of cost ratios per method. Rates can and
will vary greatly from one geographic location to another.
91
(2.11) Waste Minimization Methods

Many terms are used to describe waste minimization efforts, reduction, abatement,
prevention, avoidance, elimination, and source reduction.
The impetus for waste minimization usually stems from the need to control or
reduce the cost of waste management, the need to preserve total landfill capacity, or a
desire by regulators to reduce environmental impacts (David Rhodes, 1998).
An often-over looked benefit of waste minimization is its reduction in occupational
and environmental risk. Less waste results in less handling, smaller chance of exposure,
lower incinerator emissions, and reduced possibility of a release. Also, when source
separation is ignored and normal trash is haphazardly discarded with infectious waste,
trash
handlers and there staff start handling red bags as if they were normal trash;
employees because complacent about the occupational hazards of infectious waste. Waste
minimization lowers poetical risks too; at a minimum, such efforts demonstrate to the
community that the institution is serious about reducing its environmental impact Table
(2.51) shows that (David Rhodes, 1998).
92
Table (2. 51) Methods for waste minimization for general medical and surgical hospitals
Waste
Chemotherapy &
Antineoplastics
Formaldehyde
Photographic chemicals
Radioisotopes
Solvents
Waste minimization methods

Reduce volumes used.
Optimize drug container sizes in purchasing.
Return outdated drugs to manufacturer.
Centralize chemotherapy compounding location.
Minimize waste from compounding hood cleaning.
Provide spill cleanup kits.
Segregate wastes.
Minimize strength of formaldehyde solutions.
Minimize wastes from cleaning of dialysis machines and RO
units.
Use reverse osmosis water cleaning to reduce dialysiscleaning demands.
Capture waste formaldehyde.
Investigate reuse in pathology, autopsy labs.
Return off-spec developer to manufacturer.
Cover developer and fixer tanks to reduce evaporation,
oxidation.
Recover silver efficiently.
Recycle waste film and paper.
Use squeegees to reduce bath losses.
Use concurrent washing.
Use less hazardous isotopes where ever possible.
Segregate and properly label radioactive wastes, and store
short lived radioactive wastes in isolation on site until decay
permits disposal in trash.
Substitute less hazardous cleaning agents, methods for
solvent cleaners.
Reduce analyte volume requirements.
Use pre-mixed kits for tests involving solvent fixation.
Use calibrated solvent dispensers for routine tests.
Segregate solvent wastes.
Recover/reuse solvents through distillation.
93
Continue of Table (2. 51)
Mercury
Waste anaesthetic gases
Toxins, Corrosives, and

Miscellaneous Chemicals
Substitute electronic sensing devices for mercury

containing devices.
Provide mercury spill cleanup kits and train personnel.
Recycle uncontaminated mercury wastes using proper
safety controls.
Employ low leakage work practices.
Purchase low-leakage equipment.
Maintain equipment properly to avoid leaks.
Inspection and proper equipment maintenance for
ethylene oxide sterilizes.
Substitute less toxic-cleaning agents.
Return volumes used in experiments.
Return containers for reuse use recyclable drums.
Neutralize acid waste with basic waste.
Use mechanical handling aids for drums to reduce spills.
Use automated systems for laundry chemicals.
Use physical instead of chemical cleaning methods.
Source: (David Rhodes, 1998).
94
(2.12) Medical Wastes in Jordan

(2.12.1) Introduction
The total area of Jordan is 92,000 km2 . Based on 1995 statistics the total population
was 4,591, 193 capita, with a growth rate 3.6%. The average age ofthe Jordanian citizen
was around 68 years. Table (2.52) gives a general idea about the healthcare services in
Jordan based on statistics done in 1995 (Rasras, 1997).
Table (2.52) Healthcare services in Jordan.

Healthcare service
A doctor
A nurse
A pharmacist
Abed
..
Source: (Mimstry of health files).
Number of citizens per item in the 1st column.

627
351
1376
577
*-
Jordan has witnessed a rapid development in private and public medical care
establishments, Table (2.53). This results in a significant increase in the generation of

clinical wastes. This situation urges administrators to work to achieve the highest standards
in handling and disposing medical wastes (Rasras, 1997).
Table (2.53) Total number ofbeds in public and private hospitals

Type of hospital
Ministry of health
Royal health care services
University of Jordan hospital
Private sector
Total
Source: (Ministry of health files) .
No. ofbeds in 1997

3207
1787
506
2629
8129
95
(2.12.2) Waste Generation Rates in Jordan

Three studies were made to evaluate the generation rates of solid wastes in HCE in
Jordan. Qusous made the first study in 1988 at University of Jordan, he studied the
generation rates of solid wastes in different hospitals and medical laboratories in Amman
City.
Bdour made the second study in 1997 at Jordan University of Science and
Technology, he studied the generation rates of solid wastes in different hospitals and
medical laboratories in Irbid City.
The final study was made by El-Far in 1998 at University of Jordan, she studied the
management of solid wastes in some hospitals in Amman City. The following items
summaries these studies.
(2.12.3) Hospital Waste Generation in Jordan

(2.12.3.1) Amman City
A survey on the generation of wastes in the major hospitals of Amman, was done
by Qusous (1988), in which the generation rates in each hospital was determined as shown
in Table (2.54). The University of Jordan hospital was selected to determine the waste
composition as shown in Table (2.55). The study reported a maximum generation rate of
6.41 kg/pat./day for the Royal Farah rehabilitation center and a minimum of 3. 73
kg/pat./day for the Islamic hospital.
Table (2.54) Wastes generation rates in selected hospital in Amman

Hospital
University of Jordan
hospital
Al-Hussein hospital
Islamic hospital
Royal Farah Rehabilitation
center
Source: (Qusous, 1988).
Generation rate kg/pat./day

4.84
% from kitchen
5.53
3.73
6.41
39.4
44
46.2
96
38.8
Table (2.55) Solid waste components in the University of Jordan hospital

Component
Garbage
Paper
Plastics
Textiles
Glass
Metals
Needles
Others
Percentage by weight (%)

42.53
23.46
14.43
7.37
5.86
2.65
1.12
2.4
(2.12.3.2) Irbid City

A survey on the generation of wastes in the major hospitals oflrbid city was done
by Bdour (1997). Table (2.56) shows the generation rates in each hospital. The study report
a maximum generation rate of 6.10 kg/pat./day for the princess Basma hospital, and a
minimum of 4.018 kg/pat/day for Ibn Al-Nafis hospital.
Table (2.56) Summary of solid waste generation rates for local hospitals at Irbid City.
Hospital name
Princess Basma hospital
Princess Bade'a and
Rahma hospitals.
Ibn Al-Nafis hospital
Source: (Bdour, 1997).
Avg. no. ofpatients

116
114
Generation rate kg/pat./day

6.10
5.62
43
4.018
97
(2.12.4) Medical Laboratories Waste Generation in Jordan

(2.12.4.1) Amman City
A survey on the generation of waste in the specialized medical laboratories of
Amman, was done by Qusous (1988), in which the generation rate and the physical
properties of solid wastes generated at this laboratory was determined, Table (2.57) shows
that.
Table (2.57) Physical properties of solid wastes generated at the specialized medical
laboratories.
Component
Percentage by weight
37.8
24.6
6.3
2.5
1
27.1
0.7
100
Paper
Plastics
Garbage
Needles
Metals
Glass
Others
Total
Avg. generation rate= 0.084 kg/test/day
Moisture content percentage

44.2
3.2
32.1
-
79.5
(2.12.4.2) Irbid City

A survey on the generation of wastes in the major governmental and private
laboratories in Irbid city was done by Bdour (1997) in which the generation rate was
determined as it can be seen in Table (2.58). The study reported a maximum generation
rate of 0.102 kg/test/day for Ibn Al-Haytham lab. and a minimum of0.034 for Al-Nabelsy
lab.
98
Table (2.58) Summary of generation rates at governmental and private laboratories in lrbid
City.
Avg. no. of
tests
259
115
467
38
12
8
20
43
14
16
Lab. name
Central Irbid labs. (Gov.)
Princess Basma hospital lab. (Gov.)
Princess Rahma hospital lab. (Gov.)
Abdel Hameed Al-Qudah lab. (Private)
Central lab. (Private)
Ibn Sina lab. (Private)
Sa'doon lab. (P_rivatti
Ibn Al-Haytham lab. (Private)
Al-Zahrawy lab. (Private)
Al-Nabelsy lab. (Private)
Source: (Bdour, 1997).
Generation rate
kg/pat./day
0.055
0.065
0.053
0.082
0.0423
0.048
0.046
0.102
0.056
0.034
(2.12.5) Pharmaceutical Plants Waste Generation in Jordan

There is only one study was made to evaluate the generation rates of medical waste
at the pharmaceutical plants in Jordan by Industrial Development Bank (IDB) in 1998. The
following tables summarize the results of this study.
Table (2.59) Estimated production size of pharmaceutical factories.
Product type
Production
capacity
Annual
production size
Capacity
utilization
Solid products (kg)

Tablets
Powders
Capsules
Suppositories
Others
Sub-total
Liquid products (liter)
Solutions
Suspensions
Others
Sub-total
Ointments and creams (k~)
Medical supplies (k~)*
Others (kg)
Source: (IDB, 1998)
*There is one company only.
------ --------- ----- -- --- ------------- ------- -- -- ---- -------- ------- --
858,446
409,750
457,733
141 ,928
187,928
2,054,875
349,702
395,974
266,288
121,715
114,000
1,247,681
41%
97%
58%
86%
61%
61%
-- --- ---- --- ------- -- ----- --- ---- ----- --- --- --- -- ---- ------- ---- --- --
17,100,992
1,548,995
0
18,649,987
203,717
1,050,000
180,000
99
10,255,394
1, 126,420
0
11 ,381,81 4
172,745
1050,000
156,000
60%
73%
61%
85%
100%
87%
The following estimated percentages have been reached:
About ( 66.7%) of the surveyed pharmaceutical factories produce tablets.
About (26.7%) of the surveyed pharmaceutical factories produce powders.
(60%) ofthe surveyed pharmaceutical factories produce capsules.
(40%) of the surveyed pharmaceutical factories produce suppositories.
(73 .3%) of the surveyed pharmaceutical factories produce solutions.
(26.7%) ofthe surveyed pharmaceutical produced suspensions.
(46.7%)) of the surveyed pharmaceutical factories produced ointments and creams,

and
(6.7%) of the surveyed pharmaceutical factories produce medical supplies.
Table (2.60) Estimated annual quantities of solid hazardous wastes by waste type.
Solid hazardous waste
Invalid medicaments
Laboratory wastes
Paper and cardboard
Plastic packaging
Metal packaging
Glass packaging
Others*
Total
Source: (IDB, 1998)
* Empty gelatin capsules.
Estimated annual quantity (kg)

12,155
2,910
335,929
22,463
4,615
323,878
200
702,150
Table (2.61) Current collection and disposal systems of solid wastes followed by the
existing pharmaceutical factories in Jordan
Disposal system
Burned in an incinerator
Sterilization
Transferred to the domestic garbage dump
Marketed to be reused
Transferred via a contractor
Source: (IDB, 1998)
% of pharmaceutical factories
46.7
6.7
40
20
53 .3
100
Table (2.62) types of liquid hazardous wastes generated by Jordanian pharmaceutical

factories and their estimated annual volume.
Liquid hazardous waste
Invalid medicaments
Spent solvents
Spent laboratory chemicals
Industrial waste water
Total
Source: (IDB, 1998).
Estimated annual volume (liter)

29,410
100,740
81,938
73,260,360
73,472,448
Table (2.63) current collection and disposal systems of liquid wastes followed by the
existing pharmaceutical factories in Jordan
Disposal system
Domestic waste water
Connection with the domestic waste
water network.
Collection in access pool
On-site waste water treatment unit
Industrial waste water
Diluted and mixed with the domestic
wastewater.
On-site waste water treatment unit
Transferred via mobile tanks.
Chemicals
On-site storage
Off-site storage
Incineration
Mixing with industrial waste water
Marketed for reuse.
Source: (IDB, 1998).
% of pharmaceutical factories
---- ----- --------------- ----------- ---- ------- ------ --
66.7
6.7
26.7
------------ --------- ----------- ----- -- --- -- ---- --- ---
33.3
33.3
20
53 .3
20
33.3
6.7
101
(2.12.6) Legislation
Prior to 1995, there were no national laws for the regulation of hazardous wastes in
Jordan. Laws and regulations pertaining to the environment, as well as their amendments
and modifications, have been over lapping and creating confusion. Duplication among
official agencies responsible for environmental matters led to operational and managerial
problems and a lack of focus in the national environmental protection program (IDB,
1998), (Rasras, 1997).
An environmental protection acts Jordan Environmental Protection Agency (JEPA)

proposal was declared in Jordan in August 1995 . The articles related to the waste
management are (IDB, 1998), (Rasras, 1997):
1.
Article 3: establishing "the general corporation of environmental protection", which

is related to the ministry of municipalities, rural affairs and the environmental. It has
already been established.
Article 4 : the aim of the corporation is to put a general comprehensive policy to
2.
protect and upgrade the environment.

Article 5: one of the corporation targets is establishing a strategy of handling the
3.
hazardous materials.
4.
Article 16: putting standards for water in all its uses.
5.
Article 17: deals with air protection, and the control of emission of pollutants, and
the impacts ofwastes handling on air.
6.
Article 189: categorizing wastes, according to their degree of hazard, and the
methods of treating each category.
Guidelines for clinical waste management in Jordan have been prepared in the
environmental health directorate at the ministry of health. The existence of these guidelines
102
IS
considered to be a major step towards establishing a comprehensive strategy for hospital
waste management in Jordan (IDB, 1998), (Rasras, 1997).
103
CHAPTER THREE
DATA COLLECTION STUDY
(3.1) Introduction
The second purpose of this study is to evaluate generation rates of medical wastes,
which are produced from mid to large size HCE in Amman from all (hospitals, medical
laboratories and pharmaceutical plants). Also the results of such study will help planners
and decision-makers in developing defined methods for handling and treatment of such
waste. Also proposed a comprehensive strategy for the management scheme in health care
institutions based on areas an apply accurate data about the quantity of medical wastes and
its components that are produced to help assessing the present situation and developing of
solutions for handling and disposal of medical wastes. To achieve the previous objectives
the following parameters were investigated:
1.
Methods of collection, handling storage and transport systems at all hospitals,

medical laboratories and pharmaceutical plants were observed.
2.
Generation rates; all solid wastes including (medical waste) at one hospital were
weighed for a certain period.
Another technique was obtained to evaluate the
generation rates of medical wastes in the other departments was calculated the amount
of materials needed for each department for one year then see how each department
deal with this quantity of materials (make material balance around each department).
3.
Composition of solid wastes;
a study of the components of medical wastes
generated at each departments was determined.

104
This procedure was applied on the following health care establishments:

1.
Hospitals surveyed
University of Jordan Hospital.
Al-Hussein hospital.
The Islamic hospital.
Jordan Hospital.
Al-Basher Hospital.
1.
Laboratories surveyed
Consulting Medical Laboratories .
Jordan Hospital Laboratory .
2.
Pharmaceutical plants surveyed
Al-Hikma pharmaceutical plants .

The generation rates for each hospital as a total were determined and expresses as
Kg/bed/day. The number of beds was taken from the information center in each hospital.
For laboratories the generation rates were expressed in Kg/test/day. So the number
oftests conducted were obtained at the end of a working day.
For pharmaceutical plants the generation rates were expressed in Kg/drug/day or
liter of waste/liter of producing medicine/day. So the number of drugs and the quantity of
liquid medicine produced were obtained from the sales manager.
(3.2) Segregation Analysis

(3.2.1) Hospitals
One of the aims of this study is to determine the components of the medical wastes.
For this purpose an extensive analysis for the general wastes at each hospital was made.
The analysis was done based on the following categories; plastic, sharps, needles, metal,
105
glass, pathological components to the total weight was determined and average values
were calculated.
(3.2.2) Laboratories and Pharmaceutical Plants

The same previous procedures and the same components were determined.
(3.3) Studying Area and Period

This study was conducted for a period of time starting from September, 98 to
September, 99. Five hospitals, two private laboratories and one pharmaceutical plant, in
Amman was investigated in this study. Tables (3 .1, 3.2, and 3.3) show the names and types
for these health care establishments under study.
Table (3 .1) Hospitals that studied

Hospital name
Type
University of Jordan Hospital
General, Governmental and

teaching
Military
General private
General private
General, Governmental
-
Al-Hussein Hospital
The Islamic Hospital
Jordan Hospital
Al-Basher Hospital
Total
No. of
beds
506
Avg. no. of
patients
400
583
340
177
874
2480
530
220
120
735
2005
Table (3 .2) Medical laboratories that studied

Type
Private
Private
Laboratory name
Consulting medical lab
Jordan hospital lab.
No. oftest per day

45
832
Table (3 .3) Pharmaceutical plants that studied

Pharmaceutical plants
Type
Amount of drugs
Manufacturing
(drug/day)
Al-Hikma
pharmaceutical plants
Private
1121189
106
Amount of liquid
medicine
manufacturing
(Liter/day)
1339
(3.4) University of Jordan Hospital
University of Jordan Hospital was established in 1973. It is a general, governmental,

teaching hospital accommodating 506 beds with an average number of patients 400. It
consists of the fo llowing departments:
( 1)Patient's Departments
a. Pediatric.
b. Internal department
c. Internal department & medical ICU.
d. Nose, Ear, Throat and orthopedic departments.
e. Surgery departments.
f. Maternity.
g. Burns unit.
(2) Support Services

a. Operating Theatres.
b. X-rays unit.
c. Emergency and Accidents.
d. Outpatients clinics.
e. Administration.
f. Laboratories and blood bank.
g. Laundry.
h. Disinfecting room.
1.
Kitchen and cafeterias.
J. Maintenance and stores.

107
(3)Residences
a. Doctor's residences.
b. Nurses residence.
Total number of staff in the hospital is 1887 employees.
(3.4.1) Normal Solid Wastes Collection System

Present collection system of solid waste generated at the hospital is a manually
operated system based on three shifts, the collection system is controlled by the hospital
administration. There is no definite time for the collection process, but in general the major
amount is collected at 7:00am, 12:00 p.m. and 21:00 p.m.
All refuse is collected by janitors at each department then packaged in plastic bags
and stored in a small storage room for subsequent transport to the on-site tow compactortype containers of 8 m3 each placed outside the hospital building. Transport is achieved
using small, open, manually driven carts, driven by janitors of each department and using
the general, multi use elevators available at the hospital for vertical transfer. Solid wastes
are collected every day by municipality of Amman and taken along with the domestic
waste from the city and hauled to an open dumping site area Al-Russeifa outside of
Amman.
(3.4.2) Collection and Disposal Systems for the Medical Solid Waste
There are tow types of medical waste collection systems. The first one is the
collection of sharps and needles, in wood boxes. The box capacity ranges from (2 to 3) kg
and collected tow to there times in a week. The other collection system is the pathological
and cultures waste from research laboratories and the waste from isolated rooms, which
collected in red bags and it was collected daily. They also collected by the same procedures
mentioned above.
108
The disposal systems depend upon the kind of medical waste. For instance the body
parts return to the patient's families, and some of maternity wastes is sealed to some
companies. But the common method for the disposal of this waste is by incineration.
There is an on-site incinerator placed near the storage containers outside the
hospital building. Waste which are incinerated are cultures from research laboratories,
some pathological waste such as human tissues, blood and urine, and sharps and needles
and plastic injectors and plates ... etc.
The incineration is equipped with a furnace have double combustion chamber one
of them for the solid waste and the other for the gases. The capacity of this incinerator is
25 kg/hr. The incinerator temperature ranges between 800 and 900 C. The average
number of operating hours should not exceed twenty hours per week, the ashes produced
after burning were collected in black bags and put with the other solid waste.
No special handling techniques were practiced at the hospital except for some
wastes from the nuclear medicine department, these wastes were placed on the roof for two
to three months to allow for decay of the radioactive materials before final disposal with
other wastes.
109
(3.5) Al-Hussein Hospital

Al-Hussein hospital was established in 1967. It is a general and military hospital
accommodating 583 beds with an average number of patient 530 patients. It consist ofthe
following department:
( 1) patient's departments
a. Pediatrics.
b. Neurology.
c. Surgery, men and women.
d. Psychiatry.
e. Internal, men and women.
f. Kidney.
g. Maternity.
h. Nose, ear, throat and orthopedic.
I.
Burns unit.
(2)Support services.
a. Operating theatre.
b. ICU, disinfecting room.
c. Emergency and accidents.
d. Out patient clinics.
e. X-rays unit.
f. Laboratory and blood banlc
g. Kitchen and cafeterias.

h. Administration.
I.
Maintenance and stores.
J. Laundry.
110
(3)Residences
a. Doctor's residences.
b. Nurse's residences.

The present collection system of normal solid wastes at Al-Hussein hospital is
operated by a private company based on three shifts. The system at Al-Hussein is different
from that used in the University of Jordan hospital. All solid waste are collected and
packaged in black bags by janitors and kept in a special service room at each department.
A single, large, manually driven closed container driven by janitor who collects the plastic
bags from all departments at least three times per day collects the solid waste. The janitor
transfers the materials using the multi-use general elevators to a central open storage area
where the carts are emptied. The plastic bags are loaded manually into a private
compactor-type truck once per day and then hauled to Al-Russeifa open dumpsite.
(3.5.2) Collection and Disposed Systems for the Medical Solid Wastes
The medical wastes in Al-Hussein hospital divided into the following categories:
a. Pathological wastes that consist of the surgery room's wastes, which contain human
tissues, blood organs and body parts.
b. Chemical wastes.
c. Radioactive wastes.
d. Infectious wastes that consist of cultures from the laboratories and the tests that
taken from patients have infectious despise, and the kidney room wastes.
e. Medicine wastes; like invalid medicine.
f. Sharps and needles.
g. Cotton and sponges.

111
The sharps and needles were collected in hard plastic containers, and the other
medical wastes were collected in red plastic bags.
The procedure used for medical wastes collection is the same procedure that is used
for normal solid wastes mentioned earlier.
The disposed systems also depend upon the kind of medical wastes~ the body parts
as an example returned to the patients families to landfills in graves or landfills by a private
contractor. Also some of maternity wastes is sealed to a private contractor.
The other medical wastes and all paper work and documents are considered
confidential are incinerated at on-site incinerator basically designed for pathological
wastes. It was previously used to incinerate some of the hospitals solid wastes and is no
longer used for that purpose. The incinerator is very old incinerator and doesn't meet the
environmental purposes. It doesn't have a temperature indicator and it consists of one
combustion chamber. The average number of operating time is twice a day.
Remain ashes after combustion collected in black bags and putted with the other
solid wastes. There is a special handling technique practiced for radioactive wastes~ these
wastes were placed in a leaded room for some time to return it to a private contractor.
112
(3.6) The Islamic Hospital

The Islamic hospital was established in 1982. It is a general private hospital
accommodating 340 beds with an average number of patient 220 patients. The total
number of staff is 700 employee of which 110 are in the housekeeping sector. It consists of
the following departments:
(1) patient's departments
a. Surgery & Internal departments, men and women.
b. Pediatric.
c. Maternity.
(2) support services
a. Operating theatre & ICU.
b. X-rays unit.
c. Laboratories.
d. Administration.
e. Emergency & accidents.
f
Maintenance.
g. Kitchen &cafeteria.
h. Stores, housekeeping offices.

The present collection system is a manually operated system for three shifts. The
system is similar to the one adopted at the university of Jordan hospital, except that the out
side storage containers is a non-portable, box-type large container.
All wastes are collected
at each department by the housekeeping staff and
transported to the outside on-site storage container using small open manually driven carts.
113
The great Amman municipality collects the black plastic bags and loads them
manually into the collection vehicle once per day.
The collection and disposed systems for the medical wastes at the Islamic hospital
depend upon the categories of medical wastes as follows:
a. Laboratories
(Bacteria and tissues) waste such as: blood, human tissues, the
pathological wastes and cultures.

The liquid wastes, blood and urine are collected in good closed containers then
placed in red plastic bags to be taken to the incinerator.
The human tissues are collected after removing the phormalien in red plastic bags
then taken to the incinerator.
The Bacteria wastes and cultures are sterilized by the autoclave in the laboratory
then collected in red plastic bags to be taken to the incinerator.
b. Sharps and needles; the needles are sterilized by needle terminator in the
departments and then collected in red plastic bags to be taken to the incinerator.
For the previous wastes there are stickers written on it (be careful hazardous
wastes) putted on the red plastics bags.
c. Infectious wastes; wastes from isolated rooms are collected in yellow plastic bags
to be taken to the incinerator labeled (be careful infectious wastes).
d. Chemicals wastes; collected in special containers labeled (be careful chemical
materials) and some of them taken to the incinerator.
There are two autoclaves in the Islamic hospital with an average capacity 25 litter. And
there is one on-site incinerator with an average capacity for the first step 1 m3 and after the
second step 0.5 m3 .
114
(3. 7) Jordan Hospital

Jordan
hospital
was
established in 1996. It is a general private hospitaL
Accommodating 177 beds with an average number of patient 120 patients. The total
number of staff is 500 employee of which 108 are in the housekeeping section. It consist of
the following department:
(1) patient's department
a. Pediatric.
b. Surgery, men and women.
c. Internal, men and women.
d. Maternity.
e. Nuclear department
f Kidney unit.
(2) support services
a. Laboratories.
b. X-rays unit
C.
Operating theatre & ICU.
d. Emergency and accident

e. Kitchen and cafeteria.
f Out patient clinics.

g. Administration.
h. Maintenance.
I.
Stores, housekeeping office.
11 5

The present collection system of normal solid wastes at Jordan hospital is operated
by a private company based on three shifts. All wastes are collected and packaged in black
plastic bags by jointers and transported to a crasher in order to cut the wastes into small
paces using small open manually driven carts and then transported to the outside on-site
storage container. The
municipality of Amman collects the wastes and loads them
manually into the collection vehicle once per day.
(3.7.2) Collection and Disposed System for Solid Medical Wastes

The employees of the laboratory and surgery rooms supervise and operate the
present collection system for medical wastes at Jordan hospital. They collect the sharps and
needles in hard plastic containers and then putted in red plastic bags. Also they sterilized
the laboratory plates and the blood by using the autoclave at temperature 121
C, and
pressure 15 bar, then it putted in red plastic bags. Also the other kinds of medical wastes
collected in red plastic bags.
Then, the housekeeping staff using small open manually driven carts and storage in
a storage room transports all the medical wastes. Every Saturday morning the medical
wastes transported by a private vehicle to incinerated in university of Jordan hospital
incinerator. The body parts returned back to the patient's families to landfills.
116
(3.8) AI- Basher Hospital

Al-Basher hospital was established in 1954. It is a general and governmental
hospital accommodating 874 beds with an average number of patient 735 patients. The
total number of staff is 1989 employee for which 474 are in the housekeeping section. It
consist ofthe following departments:
( 1) Patient's departments
a. Pediatric.
b. Internal department.
c. General surgery and special surgery.
d. Maternity.
e. No, ear, throat and orthopedic departments.
f. Nuclear medicine department.
g. Psychiatry.
h. Medium care, CCU & ICU.
(2) Support services
a. X-rays unit.
b. Operating theatres.
c. Emergency and accidents.
d. Out patient clinics.
e. Administration.
f. Laboratories and blood bank.
g . Laundry.
h. Disinfecting room.
1.
Kitchen and cafeterias.
J. Maintenance and stores.

117
(3.8.1) Normal Solid Wastes Collection System at Al-Basher Hospital

The present collection system of normal solid wastes at Al-Basher hospital is
operated by a private company based on three shifts. It applies the same methods for
collection, transportation and stores as those used at the AI-Hussein hospital.
The present
collection system for medical wastes at Al-Basher hospital also
operated by the same private company as above, and it takes the same technique for
collection and transportation. The disposal methods for the medical wastes are different as
the types of medical wastes different, see appendix (D).
There is an incinerator out side Al-Basher hospital buildings, it is very old
incinerator and contains only one chamber and have short chimney. Also there are a lot of
disadvantages of this incinerator, as it is not safety and not sufficient for using.
118
(3.9) Medical wastes collection system at the medicalla boratories

One of the medical laboratories that was studied is located within a hospital (Jordan
hospital), so the collection and handling procedures for their solid wastes are the same as in
the hospital.
In the other laboratory the wastes collection system is operated manually. The solid
medical wastes are collected at the end of working day and packed in red bags, then it
taken by a private contractor to incinerated, not in a special incinerator, but in a tank. No
special handling techniques were practiced at these laboratories.
(3.10) Medical wastes collection system at the pharmaceutical plants

In Al-Hikma pharmaceutical plants there is wastewater station for the industrial
water. But the solid waste collection system is operated manually, the solid waste are
collected as the end of working day and packed in black bags for normal wastes and in red
bags for medical wastes. All the quantity of waste are collected and placed out side the
buildings then incinerated, in a non specialized incinerator. Large quantity of nitric acid
was collected in iron tanks and no special handling technique methods were practiced at
these plants.
119
CHAPTER FOUR
DATA ANALYSIS AND DISCUSSION
(4.1) Introduction
In any management system, the handling and disposal practices of medical wastes
are the major constituent. To deal with wastes generated from health care establishments in
a manner that ensures a safe disposal and avoid risk to public health, an investigation of the
handling, storage, transport and disposal practices at the Amman hospitals, medical
laboratories and pharmaceutical plants was conducted.
(4.2) Estimation of the Generation Rates
All solid wastes generated from a hospital in Amman city (University of Jordan
Hospital) are weighed on a daily basis and the average quantity of solid wastes generated
are determined.
For the other hospitals, laboratories, and pharmaceutical plants we used another
technique to evaluate the generation rates of medical wastes. This technique depends upon
the quantity of raw materials needed for one year at each health care establishment and the
average quantity of solid wastes generated is determined (by doing a material balance
around each health care establishment). Data from these items are shown in appendices (A
to D). A summary for the generation rates from different department at the five hospitals is
shown in Tables (4.1 to 4.18).
120
(4.2.1) University of Jordan Hospital

Table ( 4.1) presents the generation rates of general wastes and medical wastes from
the University of Jordan hospital as a whole. The total generation rates for solid wastes in
the whole hospital is found to be 4.646 kg/pat./day or 3.672 kg/bed/day, and the generation
rate for the general waste is found to be 3.89 kg/pat./day or 3.077 kg/bed/day which
present 83.779% by the total weight, and the generation rate for medical waste is found to
be 0. 7536 kg/pat./day or 0.5957 kg/bed/day which present 16.22% by the total weight
which lies in the international range of medical waste.
Comparing these generation rates with that obtained by Qusous in 1988 (presented
in Table (2.54) in chapter two), one can see that there is a decrease in the generation rates
on patient basis from 4.84 kg/pat./day in 1988 to 4.646 kg/pat./day in 1998. And this is
because the increasing of number of patients from 360 patients per day in 1988 to 400
patients per day in 1998. Also the total amount of waste is increase from 1740.7 kg/day in
1988 to 1858.48 kg/day in 1998, so it is shown that the increase of amount of waste is not
largely.
Table (4.2) shows the generation rates of solid wastes for various departments of
the University of Jordan hospital. Burns unit has the highest generation rate of9.85
kg/pat./day, while the lowest value was 1.683 kg/pat./day for nose, ear, throat and
orthopedic department. Data shows that kitchen has the highest percentage which is
25.51% of the total generated wastes. The lowest percentage value of 2.705% is obtained
for the maintenance unit.
Table (4.3) present the generation rates for different types of medical wastes within
the University of Jordan hospital. Plastic materials have the highest generation rate of
120.52 kg/pat./day which present 39.98% by the total weight. While the lowest value of
8.0195 kg/pat./day was found for metals which present 3.323% by the total weight.
121
Comparing these data with those that found in Table (2.8) in the literature survey
section, it could be seen that the percent of plastic is within the typical percent value,
which is 50% by the total weight and it, considered good phenomena. But in the opposite
direction the percent of metals is higher than the typical percent which is 1% by the total
weight and it considered bad phenomena. Figure (4.1) shows the deviation ofthe obtained
composition from the typical composition.
Also, comparing generation rates for the University of Jordan hospital with those
found in the literature presented in chapter two, it is found that there is an agreement
between the obtained and the reported values. For example, for general teaching hospitals,
Table (2.16) showed a generation rate of (1.3-3) kg/bed/day in the Middle East region.
Table (2.20) showed generation rates in some industrialized countries as an example, in
Spain the generation rate of 4.4 kg/bed/day for university hospital, also in France the
generation rate of 3.35 kg/bed/day in university hospital and 2.5 kg/bed/day in general
hospital. Also Table (2.29)
showed a generation rates of 5.24 kg/bed/day or 6.87
kg/pat./day for hospitals that contain number of beds greater than 500 beds in American
hospital.
From the above reported values, it is apparent that the obtained value for
generation rate at University of Jordan hospital is in the same range, which is 3.672
kg/bed/day.
The techniques that applied in the University of Jordan hospital for solid medical
waste treatment and disposal is the incineration and the residue is taking to landfill.
122
Table (4.1) Summary of the solid waste generation rates at University of Jordan Hospital
Type of wastes
Generation
rate*
(kg/pat./day)
Generation
rate*
(kg/bed/day)
%by total
weight
Normal wastes
Avg. total
weight
generated
(kg/day)
1557.03
3.89
3.077
83.779
Medical wastes
301.45
0.7536
0.5957
Total
1858.48
4.646
3.672
16.22
100%
Note:*
1. Average number of patients = 400 patients
2. Total number of beds= 506 bed
Table (4.2) Summary of the solid waste generation rates at various departments at
university of Jordan hospital
Department
Pediatrics
Internal & kidney room
Nose, Ear, Throat and
Orthopedic
Surgery
Maternity
Burns unit
Emergency & Traumas, Xrays unit, out patients clinics
and administration
Laboratories, blood bank,
laundry and disinfection
Maintenance
Kitchen
Total
Avg. total
weight
generated
(kg/day)
98.3
250.49
75.76
Avg. no. of
patients
Generation
rate
Kg/pat.!day
%by total
weight
40
96
45
2.457
2.609
1.683
5.289
13.478
4.076
200.05
185.00
68.97
135.02
104
76
7
32
1.923
2.434
9.85
4.219
10.764
9.95
3.711
7.265
200.195
10.77
120.35
50.27
474.075
1858.48
400
400
1.185
4.6462
6.475
2.705
25.51
100 %
123
Table (4.3) Summary of the solid medical waste generation rates at University of Jordan
Hospital
Type of wastes
Pathological waste
Waste contents
Human tissues,
organs and body
parts, blood and
unne
Needles
Pasteur pipettes
Scalpel blades
Quantity (kg/day)
% by total weight
91.0655
30.21
21.350
3.894
6.35
7.08
1.3
2.1
Sub-Total
Glasses
Glass tubes
Glass wares, Plates
& Slides and
broken glasses
31.594
11.506
10.48
3.8
27.1366
9.0
38.6426
12.8189
Sharps
Sub-Total
Metals
Plastic
Red plastic bags

Plastic tubes
Syringes
Gloves, blood
containers, urine
containers
8.0195
1.3698
5.479
99.378
3.323
0.45
1.8
32.96
14.2932
4.7
Sub-Total
120.52
39.98
Infectious papers
Masks, coats, shoes

covers and
different papers
11.61
3.1879
301.45
Total
124
100%
50
45
40
35
30
Percentages (%) 25
C Compositions that obtained in this study

Typical values that not allowed to exceed
20
15
10
5
Paper
Glass
Metal
Compositions
Figure (4.1) Comparison between the medical compositions that obtained in this study at UJH , and the WHO
typical values
Plastic
125
(4.2.2) AI- Hussein Hospital

Table (4.4) present the generation rates for general wastes and medical wastes at
Al-Hussein hospital as a whole. The total generation rates for solid waste is found to be
4.906 kg/pat./day or 4.4598 kg/bed/day, and the generation rate for the general waste is
found to be 3.978 kg/pat./day or 3.617 kg/bed/day which present about 81.10% by the total
weight. And the generation rate for medical waste is found to be 0.9271 kg/pat./day or
0.8428 kg/bed/day which present about 18.9% by the total weight which lies in the
international range for medical waste.
Comparing these generation rates with that obtained by Qusous in 1988, it is found
that there is a decrease of generation rates on patient basis from 5. 53 kg/pat./day in 1988 to
4.906 kg/pat./day in 1998, and this is due to the increasing of the number of patients from
447 patients per day in 1988 to 530 patients per day in 1998. And the total amount ofwaste
is increased from 2473.88 kg/day in 1988 to 2600 kg/day in 1998. So it is shown that the
increasing of the amount of waste is not too high.
Table (4.5) presents the generation rates for solid wastes for various departments
within Al-Hussein hospital. ICU and disinfection have the highest generation rate of 8.38
kg/pat./day, while the lowest value was 0.279 kg/pat./day for the outpatients clinics. The
kitchen has the highest percentage, which is 3 9.41% of the total generated waste. The
lowest value of 1.9% is obtained at psychiatry department.
Table (4.6) presents the generation rates for different kinds of medical waste within
Al-Hussein hospital. Plastic and glass materials have the highest generation rate of 183.762
kg/day, which present 37.39% by the total weight. While the lowest value of34.5517
kg/day for sharps which present 7.03% by the total weight.
Comparing these data with those found in Table (2.8), it is found that the percent of
plastic is lower than the typical percent, which is 50% of the total weight.
126
The techniques that applied
in Al-Hussein hospital for solid medical waste
treatment and disposal is the incineration and the residue is taking to the landfill.
Table (4.4) Summary of the solid waste generation rates at Al-Hussein Hospital
Type of waste
Normal waste
Medical waste
Total
Avg. total
weight
generated
kg/day
2108.65
491.35
2600
Generation
rate
kg/bed/day
3.617
0.8428
4.4598
Generation
rate
kg/pat./day
3.978
0.9271
4.906
%by total
weight
81.10
18.9
100%
Note:
Average number of patients= 530 patients.
Total number of beds = 583 beds.
Table (4.5) Summary of the solid waste generation rates at various departments at AlHussein hospital
Department
Pediatrics
Neurology
Surgery, men
Surgery, women
Psychiatry
Internal, men
Internal, women
Internal, surgery
Kidney
Maternity
Operating theatre
ICU, disinfection
Emergency & traumas
Outpatient clinics
X-rays unit
Laboratories
Kitchen
Total
Avg. total
weight
generated
kg/day
117.184
80.904
128.377
77.436
49.533
99.664
56.679
109.33
111.048
132.09
156.22
123.47
80.247
82.22
99.93
71.183
1024.706
2600.2
Avg. no. of
patients
Generation
rate
kg/pat./day
47
30
59
53
30
56
40
59
38
58
25
15
135
294
2.49
2.697
2.197
1.46
1.651
1.779
1.41 7
1.853
2.92
2.27
6.2488
8.38
0.59
0.279
452
530
2.267
4.906
127
%by total
weight
4.5
3.11
4.94
2.97
1.9
3.83
2.179
4.20
4.27
5.08
6.01
4.748
3.08
3.162
3.843
2.737
39.41
100%
Table ( 4.6) Summary of the solid medical waste generation rates at Al-Hussein hospital
Type of wastes
Pathological wastes
Human tissues.
Blood & urine.
Organs & body parts
Sharps
Needles.
Cannula
Butterfly.
Needle-spinal.
Given set.
Quantity (kg/day)
117.788
% by total weight
23 .969
24. 83
2.13
0.769
0.0887
6.734
5.05
0 .433
0.156
0.018
1.37
Sub-Total
Plastic & glasses
Urine bags.
Nutrition tubes.
Stomach & nose tubes
Gloves
Syringes
34.5517
7.03
19.56
5.216
6.52
38.94
113 .526
3.98
1.06
1.326
7.92
23 .10
Sub-Total
Infectious wastes
Cotton &sponges.
Tolerated mild.
Adsorbent sponges.
Treated sponges.
Towels.
Bandage.
Face mask.
Paper coat.
Shoes cover or labor shoes.
Sponges soap.
183.762
37.39
8.15
10.712
31.76
16.30
25 .15
11.18
3.26
4 .075
2.79
41 .92
1.658
2.179
6.46
3.317
5.118
2.275
0.66
0.829
0.567
8.53
Sub-Total
Total
155.357
491.4
31.615
100 %
128
( 4.2.3) The Islamic Hospital
Table (4 .7) presents the generation rates of general waste and medical waste at the
Islamic hospital as a whole. The total generation rate for solid waste is 3. 95 kg/pat./day,
and the generation rate for the general waste is found to be 3.2727 kg/pat./day, which
present about 82.76% of the total weight. And the generation rate for the medical waste is
found to be 0.68 kg/pat./day, which present about 17.24% of the total weight and its lies in
the international range of medical waste which is from 10% to 25% of the total waste.
Comparing these generation rates with that obtained by Qusous in 1988, it is found
that there is an increase of generation rates on patient basis from 3. 73 kg/pat,/day in 1988
to 3. 95 kg/pat./day in 1998, and this is because the number of patient is increasing from
166 patients per day in 1988 to 220 patients per day in 1998. Also the total amount of
waste is increase from 618.63 kg/day in 1988 to 870 kg/day in 1998.
Table ( 4.8) presents the generation rates for solid wastes for various departments
within the Islamic hospital. Maternity has the highest generation rate of3.4786 kg/pat./day,
while the lowest value is 0.8376 kg/pat./day for surgery and internal men department.
Also, kitchen has the highest percentage, which is 42.32% of the total generated wastes.
And the lowest value of 1.028% is obtained in pediatrics department.
Table (4.9) presents the generation rates for medical waste for various departments
within the Islamic hospital. Maternity department has the highest generation rate of 1.398
kg/pat./day, while the lowest value is 0.0837 kg/pat./day for pediatrics department.
Table (4.10) shows the generation rates for different types of medical wastes at the
Islamic hospital, which shows the highest generation rates for plastic materials of85.61
kg/day, which present 57.07% of the total weight. While the lowest value is 2.20 kg/day
for metals which present 1.46% of the total weight. Comparing these results with those
found in Table (2.8), it is found that the percent of plastic materials is higher than the
129
typical percent, which is 50% of the total weight. Also the percent of metals is higher than
the typical value which is 1% ofthe total weight as shown in Figure (4.2).
Comparing generation rates for the Islamic hospital with those found in literature
presented in chapter two, it is found that there is an agreement between the obtained and
the reported vales. Table (2.56) found a generation rate of 4.018 kg/pat./day for Ibn AINafis hospital (private) at Irbid city, a close value to that reported for the Islamic hospital.
The technique that applied in the Islamic hospital for medical waste treatment and
disposal is the incineration and the residue is taking to landfill.
Table (4.7) Summary ofthe solid waste generation rates at the Islamic Hospital
Type of waste
Normal wastes
Medical wastes
Total
Avg. total
weight
generated
kg/day
720
150
870
Generation
rate
kg/pat./day
Generation
rate
kg/bed/day
o/o by total
3.2727
0.68
3.95
2.117
0.44117
2 .558
82.76
17.24
100 %
Note:
l . Average number of patients = 220 patients.
2. Total number of beds = 340 beds.
130
weight
Table (4.8) Summary of the solid waste generation rates at various departments at the
Islamic hospital
Department
Surgery & internal, men

Surgery & internal, women
Pediatric
Maternity
Operating room, ICU,
emergency and traumas, and
X-rays unit
Laboratory
Office & maintenance
Kitchen
Total
Avg. total
weight
generated
kg/day
78.736
86.067
89.485
125 .23
Avg. no. of
patients
Generation
rate
kg/pat./day
%by total
weight
94
54
36
36
0.8376
1.594
2.4857
3.4786
9.05
9.89
1.028
14.394
62.44
33
1.892
7.177
38.584
21.33
368.22
870
440a
0.08769b
4.43
2.45
220
220
1.742
3.95
42.32
100%
Note:
a: number oftests.
kg/test/day.
b:
Table (4. 9) Summary of medical waste generation rates at various departments at the
Islamic hospital
Department

Surgery & internal, women
Pediatric
Maternity
Laboratory
Emergency and Traumas
X-rays unit
Total
Avg. total
weight
generated
kg/day
20.28
18.75
3.015
50.347
15.09
27
Avg. no. of
patients
Generation
rate
kg/pat./day
%by total
weight
94
54
36
36
33
440a
0.215
0.347
0.0837
1.398
0.457
0.06136b
13.518
2.00
150
13.52
12.5
2.01
33.56
10.06
18.00
9.0 1
1.33
100 %
220
Note:
a: number oftests.
b: kg/test/day.
13 1
0.682
Table (4.1 0) Summary of the solid medical waste generation rates at the Islamic hospital
Type of wastes
Contents
Quantity
(Kg/day)
Pathological wastes
Human tissues
Blood and urine
Organs and body parts
4.6
7.4
12.25
%by total
weight
3.00
4.93
8.16
Sub-Total
24.25
16.16
Sharps
Glasses
Needles
Glass tubes
Slides and plates
Broken glasses
14.9
9.33
3.50
2.33
Metals
2.20
1.46
Plastic
Syringes
Gloves
Blood containers
Urine containers
Stool containers
Plates
Red plastic bags
58.96
9.69
3.31
8.69
0.3
3.84
0.82
39.31
6.46
2.206
5.79
0.2
2.56
0.546
Sub-Total
85.61
57.07
Infectious wastes
Masks
Shoes cover
Coats
Isolated room waste
1.2
1.2
2.7
15.34
0.8
0.8
1.8
10.22
Sub-Total
20.44
13.626
Total
150
100%
132
60
50
40
Percentages (%) 30
C Compositions that obtained in this study

Typical compositions that not allowed to exceed
20
10
Plastic
Glass
Metal
Paper
Compositions
Figure (4.2) Comparison between the medical waste compositions that obtained in this study at the Islamic
hospital, and the WHO typical values
133
(4.2.4) Jordan Hospital

Table ( 4.11) presents the generation rates of general waste and medical waste at
Jordan hospital as a whole. The total generation rate for the solid wastes is 3.503
kg/pat./day, and the generation rates for the general waste is found to be 2.898 kg/pat./day,
which present 82.74% of the total weight. And the generation rate of medical wastes is
found to be 0.605 kg/pat./day which present about 17.26% of the total weight, and it is lies
within the international range of medical wastes.
Table ( 4.12) shows the generation rates for solid wastes of various departments
within the Jordan hospital. Maternity department has the highest generation rate of0.863
kg/pat./day. While the lowest value was 0.09 kg/pat./day for X-rays unit. Also, kitchen has
the highest percentage, which is 42.94% of the total generated wastes. And the lowest
value of0.358% is obtained for administration and maintenance unit.
Table (4.13) presents the generation rates for different kinds of medical wastes.
Plastic materials have the highest generation rate of38.839 kg/day, which present 53 .51%
of the total weight, while the lowest value of 1.09 kg/day for chemical wastes which
present 1.5% ofthe total weight.
Comparing these data with those found in Table (2.8), it is found that the percent of
plastic materials is higher than the typical percent, which is 50% of the total weight. Figure
(4. 3) shows the deviation of the obtained composition from the typical composition.
Comparing generation rates for Jordan hospital with the other private hospital
(Islamic hospital) that studded in this research, it is found that there is a good agreement
between these values and it is close to be the same, where the difference between them
does not exceed 14%.
The techniques that applied in the Jordan hospital for medical waste treatment and
disposal is incineration and the residue is taking to landfill.
134
Table (4.11) Summary of the solid waste generation rates at Jordan hospital
Type ofwaste
Normal wastes
Medical wastes
Total
Avg. total
weight
generated
kg/day
347.7955
72.5745
420.37
Generation
rate
kg/pat./day
Generation
rate
kg/bed/day
%by total
weight
2.898
0.605
3.503
1.965
0.41
2 .375
82.74
17.26
100%
Note:
1. Average number of patients= 120 patients.
2. Total number ofbeds = 177 beds.
Table (4.12) Summary of the solid waste generation rates at various departments at Jordan
hospital
Department
Surgery (m & w)
Internal ( m & w)
Pediatric
Maternity
Emergency & traumas
Laboratory
Disinfiction & pharmacy
X-rays unit
Outpatient clinics
Kidney unit
Operating theatre & ICU
Administration &
maintenance
Kitchen
Total
Avg. total
weight
generated
kg/day
31.35
37.27
13.25
17.26
15.86
39.399
23.4
6.34
37.45
8.75
8.01
1.508
Avg. no. of
patients
Generation
rate
kg/pat./day
%by total
weight
47
49
21
20
116
832a
0.66
0.76
0.63
0.863
0.1367
0.0473b
85
67
120
34
45
0.27
0.09
0.3
0.227
0.178
7.46
8.86
3.15
4.10
3.77
9.37
5.56
1.51
8.9
2.1
1.9
0.358
180.523
420.37
120
120
1.5
3.503
42.94
100%
Note:
a: number oftests.
b: kg/test/day.
135
Table (4.13) Summary of the solid medical waste generation rates at Jordan hospital
Type of wastes
Pathological wastes
Sub-Total
Sharps
Glasses
Contents
Human tissues
Blood and urine
-
Needles
Tubes
Slides and plates
Broken glasses
Quantity
(Kg/day)
4.25
5.45
1.5
11.2
% by total
weight
5.8
7.51
2.1
15.43
9.75
13.43
0.379
4.9
2.4
Sub-Total
0.275
3.56
1.75
5.585
Metals
2.31
3.18
1.658
2.75
2.584
0 .345
0.246
1.11
6.75
0.14
2.28
3.78
35.6
0.475
0.338
0.0153
9.3
0.193
38.839
53.51
1.39
0.6
0.95
0.45
1.9
0.826
1.3
0.62
0.41
0.565
3.8
5.23
0.82
0.27
1.12
0.372
Plastic
Sub-Total
Infectious wastes
Sub-Total
Chemical wastes
Red plastic bags

Gloves
Syringes
Plastic tubes
Plastic plates
Urine containers
Blood containers
Autoclave bags
-
Paper and carton

Masks
Paper coats
Shoes cover
Head cover and
Isolated room wastes
-
Corrosive materials
Noncorrosive materials
7.69
Sub-Total
1.09
1.5
Total
72.545
100%
136
50
40
Percentages (%) 30
I::J Compositions that obtained in this study

Typical compositions that not allowed to exceed
20
10
Paper
Metals
Glass
Compositions
Figure (4.3) Comparison between the medical compositions that obtained in this study at Jordan hospital, and
the WHO typical values.
Plastic
137
(4.2.5) Al-Basher Hospital
Table (4.14) presents the generation rates of general waste and medical waste at AlBasher hospital as a whole. The total generation rates for solid wastes is 5.102 kg/pat./day,
and the generation rate for the general waste is found to be 4.176 kg/pat./day, which
present 81.85% of the total weight. And the generation rate for medical waste is found to
be 0.926 kg/pat./day, which present 18.146% of the total weight, and it is lies within the
international range of medical wastes.
Table (4.15) shows the generation rates of solid wastes for various departments
within Al-Basher hospital, the highest generation rate was 3.004 kg/pat./day for operating
theatre unit which present 6.01% of the total weight. While the lowest value is 0.64
kg/pat. /day for outpatient clinics which present 6.95% of the total weight.
Tables (4.16 and 4.17) shows the generation rates for different kind ofmedical
wastes. Pathological wastes have the highest generation rate of356.917 kg/day, which
present 52.45% of the total weight, while the lowest value is 12.006 kg/day for radioactive
waste, which present 1.76% ofthe total weight.
Comparing generation rates for Al-Basher hospital with those found in other
general hospital in this study shows there is an agreement between them. Also, comparing
generation rates for At-Basher hospital with those found in the literature presented in
chapter two, it is found that there is an agreement between the obtained and reported
values. For example, for general hospital, Tables (2.27 and 2.28) showed a generation rate
of (2.1 to 4.2) kg/bed/day. Also Table (2.29) showed a generation rates of 5.24 kg/bed/day
or 6.87 kg/pat./day for the hospital contains number of beds greater than 500 beds in
America. From the above reported values, it is apparent that the obtained value for the
generation rate at Al-Basher hospital is in the same range which is 5.102 kg/pat./day or
4.518 kg/bed/day .
138
Finally,
Table (4.18) present the kind of treatment and disposal methods for
different kinds of waste in Al-Basher hospital. It is found that the common method is the
incineration and it takes place in the hospital incinerator.
Table (4.14) Summary ofthe solid waste generation rates at Al-Basher hospital
Type of waste
Normal wastes
Medical wastes
Total
Avg. total
weight
generated
kg/day
3069.53
680.47
3750
Generation
rate
kg/pat./ day
Generation
rate
kg/bed/day
o/o by total
weight
4.176
0926
3.698
0.8198
4.518
81.85
18.146
100%
5.102
Note:
Average number of patients= 735 patients.
Total number ofbeds = 830 beds.
Table (4.15) Summary ofthe solid waste generation rates at various departments at AtBasher hospital
Department
Pediatrics
Internal
Surgery
Maternity
Nose, Ear, Throat
and orthopedic
Emergency &
traumas
Psychiatry
X-rays unit
Operating theatre
ICU, CCU
Labs and blood
bank
Outpatient clinics
Kitchen
Total
Avg. total
weight
generated
kg/day
Avg. no.
of
patients
Avg.
no. of
beds
169.002
225.47
454.498
190.499
65
133
230
125
91.585
115.73
71.436
144.12
225.3
178.1
145. 66
260.77
1477.83
3750
Generation rates
o/o by
total
weight
124
168
226
144
Kg/pat./d
ay
2.6
1.695
1.976
1.524
Kg/bed/d
ay
1.37
1.34
2.01
1.323
55
135
32
36
1.665
0.857
2.86
3.21
2.44
3.1
52
1.37
1.9
3.84
6.01
4.75
3.88
75
69
40
3.004
2.58--
407
626
735
60
0.64
2.36
5.102
1.35
830
139
4.45
4.518
4.51
6.01
12.13
5.1
6.95
39.41
100 %
Table (4.16) Summary ofthe solid hazardous waste that produced at Al-Basher Hospital
Types
Sharps
SQecial medical wastes

a. Human waste
b. Animals wastes
Contents
Needles, injectors, Scalpel
blades, and broken glasses
Sources
Clinics, labs., surgery
departments, all the
patient's departments
Tissues, organs, body

parts, blood, urine, others
parts, blood, infectious
body liquids and carcasses
Different surgery
departments.
c. Laboratory wastes
(Microbiology lab).
Microbiology lab.
Artificial kidney units.
d. Waste from artificial kidney

units.
e. Waste from isolated rooms.
Toxic wastes
Radioactive wastes
a. Sealed sources
b. Open sources
c. Materials that used
in radioactive materials
Pressurized vials
Invalid medicine, medicine

containers, chemical
wastes, materials that
caused cancer, and
corrosive materials.
As a liquid
Needles, gloves and
addresses
Medicine containers
140
All the hospital

departments.
Nuclear department and Xrays unit.
Table (4.17) Summary ofthe solid medical waste generation rates at Al-Basher hospital
Type of waste
Pathological wastes
Contents
Sub-Total
Plastic
Sub-Total
Toxic wastes
Radioactive wastes
Pressurized vial
Total
%by total
weight
19.12
68.047
10
90.729
34.023
34.0235
13.33
5
5
356.917
52.45
30.303
4.201
3.5
7.35
4.45
0.617
0.514
1.08
45 .36
98.89
20.616
6.6
13.35
8.67
0.65
6.6
14.53
3.03
0.969
1.96
1.27
0.09
158.776
23.33
90.729
13 .33
12.006
1.76
16.682
2.45
680.47
100 %
a. Human wastes
tissues, organs, body parts and urine
b. animals wastes
Tissues, organs, body parts, blood and
infectious body liquids, and carcasses.
c. Laboratories wastes
d. wastes from artificial kidney room
e. Wastes from isolated rooms.
Sub-Total
Sharps
Quantity
kg/day
130.094
Needles
Pasteur pipettes
Scalpel blades
Broken glasses
Syringes
Gloves
Red plastic bags
Urine containers
Blood containers
Stool containers
Invalid medicine, medicine containers,

chemical waste, materials that caused
cancer, and corrosive materials.
a. Sealed sources (liquids)
b. Open sources.
C. Materials that used in radioactive
substances like gloves, needles,
and addresses
Medicine containers and different cans
that closed under pressure
141
Table (4.18) Summary ofthe disposal methods for different types ofmedical wastes at AtBasher hospital
Methods of disposal
Types of wastes
Normal wastes
Sharps
Human wastes
Animals wastes
Laboratories wastes
Wastes from isolated rooms and from artificial
kidney rooms
Toxic wastes
Radioactive wastes
a. sealed sources
b. open sources
c. materials that used for radioactive
materials
Landfills
Incineration and then to the landfills
Some time autoclaving, incineration and
then to the landfills
Incineration, landfills
For the chemical wastes the kind of
disposal of them depend upon the
information from the product company,
and the waste that remain incinerated.
Returned back to the contractor
Dilution and then to the sewers
Only landfills, without incineration or

broken.
Pressurized vials
142
(4.2.6) Comparison between the Hospitals in this study
Generation rates at the five hospitals that studied was found to be 4.4646
kg/pat./day (3.672 kg/bed/day) at University of Jordan hospital, 4.906 kg/pat./day (4.4598
kg/bed/day) at Al-Hussein hospital, 3.95 kg/pat./day (2.558 kg/bed/day) at the Islamic
hospital, 3.503 kg/pat./day (2.375 kg/bed/day) at Jordan hospital, and 5.102 kg/pat./day
(4.518 kg/bed/day) at Al-Basher hospital as shown in Table (4.19).
The higher generation rates at Al-B asher hospital is due to the fact that the hospital
IS
a general and governmental and it is consider the biggest hospital in Jordan from the
total number ofbeds and the average number of patients per day.
Al-Hussein hospital has a generation rate quite close to that found at AI-Basher
hospital, and this is due to the fact that the hospital is military and serving regular meals to
a large number of employees. In addition, the hospital is part of a medical center, which
receives large number of outpatients and visitors. Also Al-Hussein hospital accommodates
large number of patients per day.
University of Jordan hospital has a generation rates quite close to that found at AIHussein hospital, and this is due to the hospital being governmental and teaching hospital.
And serves a large number of university students at its outpatient's clinics, more research
activities are taking place, and it accommodates quite large number of patients.
On the other hand, the Islamic hospital is a private hospital with a few numbers of
specialties. It does not contain a separate dialysis unit (kidney room) which generates large
quantities of wastes, or a burns unit, which generates the highest quantity of wastes per
patient. In addition, it accommodates low number of patients per day.
Finally, Jordan hospital is a private hospital and it has a generation rate quite close
to that found at the Islamic hospital and this is due to the hospital have few number of
143
specialties, also there is no a bums unit. In addition it accommodates the lowest number of
patients among the hospitals in the study which explains the low generation rates found.
From the generation rates that found for general hospitals, the effect of capacity of
the hospital and the number and kind of specialties is apparent. Large hospitals with more
kinds of specialties, like Al-Basher hospital, Al-Hussein hospital, and University of Jordan
hospital, produce more waste per patient than small hospitals with few specialties, like the
Islamic hospital and Jordan hospital. Large hospitals require large complex plants, more
staff and support personnel and more sophisticated equipment and facilities. Unfortunately
it was not possible to know the number of staff and support personnel at Al-Hussein
hospital which would have supported this point.
Table (4.19) Summary of the solid waste generation rates for local hospitals at Amman
City.
Hospital name
University of Jordan
Al-Hussein
Islamic
Jordan
Al-Basher
Average
Avg. quantity of
generated
wastes kg/day
1858.48
2600
870
420.37
3750
9498.85
Avg. no. of
patients
Number
of beds
Generation rate
kg/pat./day
400
530
220
120
735
2005
506
583
340
177
830
2436
4.646
4.906
3.95
3.503
5.102
4.787
In order to give a clear idea of the distribution of solid and medical wastes
generation at the hospitals, it was necessary to determine the quantities generated from the
various departments and the percentage of those weights to the total weight generated from
the hospitals.
Table (4.20) shows the percentages of weights and generation rates at each
department in the five hospitals that studied. The results and all data are also presented in
appendices (A, B, and C).
144
From Table (4.20) it is apparent that the kitchen contribution to the total solid
wastes generated at the hospitals is the highest. The percentages range between 25.51% at
University of Jordan hospital and 42.94% at the Jordan hospital. This range is within that
found in the literature, being 37% to 50%. Generation rate of kitchen wastes ranged
between 1.185 kg/pat./day at University of Jordan hospital to 2.36 kg/pat./day at Al-Basher
hospital.
The total percentage of solid wastes generated from the internal and surgery
departments at the five general hospitals that studied was found to be close to each other.
At University of Jordan hospital the percentage was found to be 24.24%; at Al-Hussein
hospital 18.119%; at the Islamic hospital18.94%; at Al-Basher hospital18.13%, and at the
Jordan hospital the percentage of internal and surgery departments wastes was found to be
16.32% of the total weight generated.
The percentage of wastes of departments depends on the number of departments

and facilities available at the hospital. For example, at the Islamic hospital, which contains
fewer specialties than the other three hospitals, the pediatrics wastes formed 10.28% of the
total weight generated.
The quantity of solid wastes generated at a certain department is related to the

extent and kind of medical treatment at that department. For example, surgery wastes
formed about 10.764% of the total wastes generated at University of Jordan hospital, while
the nose, ear, throat and orthopedic wastes formed only 4.076%. The generation rate factor
is a better measure ofkind oftreatment received by patients. For surgery department, the
generation rate was found to be 1.923 kg/pat./day, while that of the other department 1.683
kg/pat./ day.
145
Generation rate of solid wastes from the operating room was found to be 6.25
kg/pat./day at Al-Hussein hospital. On the other hand, generation rates of all other
departments ranged between 1.651 to 9.24 kg/pat./day.
The highest generation rate of solid wastes from departments was noted at the
burns unit. A generation rate of9.85 kg/pat./day was determined at University of Jordan
hospital.
A relatively low generation rate
IS
noted at the psychiatric department at Jordan
hospital of0.178 kg/pat./day.
Table (4.21) also shows the percentage of weights and generation rates for different
medical wastes generated at the five local hospitals in Amman City.
From Table (4.21) it is apparent the plastic materials contribution to the total
medical wastes generated at hospitals is the highest in four hospitals. The percentage
ranges between 37.39% at Al-Hussein hospital and 57.07% at the Islamic hospital. This
range is exceed the typical range in the literature, Table (2.8); being until 50%. Generation
rate of plastic materials ranged between 38.8 kg/day at Jordan hospital to 183.76 kg/day at
Al-Hussein hospital.
In Al-Basher hospital it is found the highest percentage of 52.45% of the total

weight for pathological waste which generation rate is 356.9 kg/day. Also, the lowest
generation rate is found to be 1.09 kg/day for chemical waste at Jordan hospital which
present 1.5% of the total weight.
Table (4.21) also shows, all the hospitals that studies produced pathological waste,
sharps, plastic, glass, metals, and infectious waste. One of them produced toxic wastes,
chemical wastes, pressurized vial, and radioactive wastes.
146
Al-Basher hospital as shown in Table (4.21) produced the highest generation rates
for medical waste than other hospitals, which is 680.47 kg/day, and this due to the same
reasons that mentioned in the comparison.
147
Table (4.20) Percentage of weights and generation rates of solid wastes generated at the various departments at the five hospitals in the study
Departments
Kitchen
Pediatrics
Internal (m + w)
Internal & surgery ( m + w)
Internal & kidney
Kidney room
Generation rates (Kg/pat./day)

A*
1.185
2.457
-
2.609
-
B*
2.267
2.49
3.196
1.853
2.92
C*
1.742
2.4857
2.432
-
D*
1.5
0.63
0.76
-
A
25.51
5.29
-
E*
2.36
2.6
1.695
-
0.227
3.478
-
B
39.41
4.5
6.009
4.2
13.48
0.863
-
1. 524
-
2.86
1.892
0.66
0.178
1.37
1.976
3.004
0.7967
*0.0876 3
3.95
*0.0473 3
3.503
Maternity
Maintenance
2.434
2.27
-
Burns unit
Nose, ear, throat and
orthopedic
Neurology
Psychiatric
Surgery (m + w)
Operating theatre
9.85
1.683
2.697
1.651
3.557
6.25
4.219
9.249
4.646
Emergency & traumas, Xrays unit and outpatient

clinics
Laboratory and blood bank
Total
1.923
4.906
Percentage of weights (%)
c
42.32
10.28
18.9
D
42.9
3.15
8.86
-
E
39.41
4.51
6.01
4.3
2. 1
9.95
2.7
5.1
-
14.4
2.5
4. 10
0.35
3.7
4.076
3.11
1.9
7.91
6.01
18.03
14.9
7.46
1.9
19.74
1.9
12.12
6.01
4.077
7.2
5.102
6.47
100%
2.74
100%
4.43
100%
9.37
100%
3.88
100%
10.764
'
___ [ ___
5.1
2.44
18.64
Note* :
3
;
kg/test/day, .A; University of Jordan hospital, B; AI-Hussein hospital, C; the Islamic hospital, D ; Jordan hospital, and E; Al-Basher
hospital.
148
Table (4.21) Percentage of weights and generation rates for different medical wastes generated at the five local hospitals in the study
Type of wastes
Pathological wastes
Sharps
Plastic & glasses
Plastic
Glass
Metals
Infectious wastes
Toxic wastes
Chemical wastes
Pressurized vial
Radioactive wastes
Total
Generation rates (Kg/day)

A*
91.1
31.6
12.52
38.64
8.02
B*
117.78
34.55
183.76
-
11.61
20.44
155.36
-
491.4
150
72.54
301.45
C*
24.25
14.9
85.61
3.5
2.20
Percentage of weights (%)
D*
11.2
9.75
38.8
5.58
2.31
E*
356.9
45.36
A
30.21
10.5
158.7
39.98
12.82
3.23
3.8
-
90.73
1.09
-
12.01
680.47
57.07
2.33
1.46
D
15.43
13.43
53.5 1
7.69
3.18
E
52.45
6.6
23.33
-
3.18
-
31.615
13.626
5.23
13 .33
100%
100%
1.5
100%
100%
2.45
1.76
100%
B
23.969
7.03
37.39
-
16.16
9.33
Note*:
A; University of Jordan hospital, B; Al-Hussein hospital, C; the Islamic hospital, D; Jordan hospital, and E; Al-Basher hospital.
149
(4.3) Physical Properties of the Generated Wastes

(4.3.1) Solid Wastes Components
One of the most important elements in the design of solid waste disposal system is
the composition of wastes to be dealt with. Determining the components of the solid
wastes, their percentages to the total quantity generated is very essential in order to select
the best
method of collection, on-site storage, on-sit processing, transport and final
disposal. For on-site processing, it is important to know the percentage of paper goods.
Hospital wastes included different types ofwastes. Plastic materials, (plastic group)
primarily consists of glucose bottles, blood bags, urine bags, syringes, catheters, packing
materials and bags used for food, etc. cotton, gauze, linen, etc., are the materials that are
soiled with patient's secretions, excretions and different chemicals as antiseptics. Or used
in pathological labs (garbage and textile groups). Needles and sharps items are produced
from different departments, which considered as infectious and harmful wastes (needles
group). Another large amount ofwastes generated includes discarded food, fiuit, fruit skin,
vegetables, etc., either brought by the visitors of patients or supplied by the food units
within the hospital. Paper item composes a large amount of the generated wastes. It
consists of paper, paper boxes, fiuit or juice packs, etc.
A study of hospital solid wastes physical properties was carried out for the
University of Jordan hospital, solid wastes as a general case, and medical wastes as a
private case. The complete set of data is given in Appendix (D), and the results are
presented in Tables ( 4.22 and 4.23).
Table (4.22) shows the average percentages at the components ofthe generated
wastes at University of Jordan hospital (at the department level). Kitchen wastes were not
analyzed for physical properties because of difficulty in taking a representative sampl e and
150
transporting it to the laboratory due to the large quantity generated and it's high moisture
content.
Analysis indicates that paper has the highest contribution of 55.02% at the
maintenance department, while the lowest value was 24.45% at the laboratory and blood
bank departments.
Plastic item was the second highest percentage. Values ranged between 8.996% for
burns unit to 36.28% for laboratories and blood bank with an average of21.82% for the
whole hospital. The high percentage is expected due to the extensive use of plastic
materials for different purposes.
Textile item was the third
highest percentage with a range of 0% for the
maintenance and laboratories departments to 44.26% for burns unit. This high percentage
in burns unit because of the extensive use ofbandages. Garbage item percentage ranged
between 0% for operating room to 18.66% for nose, ear, throat, and orthopedic department.
Metals percentage ranged from 0.83% for operating room to 4.68% for maternity
department, while glass item percentage ranged between 1.92% for burns unit to 20% for
laboratories and blood bank.
Human wastes which include human's and animal's tissues, organs and body parts,
and blood and urine have percentages ranged between 0% for maintenance department to
11 .921% for maternity department.
Needles and sharps are one the most harmful items in hospitals, they formed the
lowest percentage in weight. A range between 0% for maintenance department to 4.28%
for pediatrics department was found at University of Jordan hospital.
Table (4.23) shows the physical properties of medical wastes generated at various
departments at the University of Jordan hospital.
151
Analysis indicates that plastic has the highest generation rates, which is 12.5
kg/day, and the value ranged between 4.97 kg/day for the burns unit to 20.01 kg/day for
laboratory and blood bank. In the other hand, metals have the lowest generation rate, which
are 8.03 kg/day and the value ranged between 0.227 kg/day for operating theatre to 1.52
kg/day for maternity department.
152
Table (4.22) Summary of physical properties of the solid wastes generated at various departments at the University of Jordan Hospital
Department
Pediatrics
Internal & kidney
room
Nose, ear, throat
and orthopedic
Surgery
Maternity
Burns unit
Operating room
Emergency &
traumas, X-rays
unit, out patients
clinics and
administration
Laboratories,
blood bank
Maintenance
Average
Paper
51 .65
36.56
Plastic
23 .517
24.99
Textiles
0.88
6.75
Garbage
4.99
12.85
Metals
1.137
3.539
Glass
10.25
7.10
Needles
4.286
2.56
Human wastes
3.29
5.651
39.108
15.35
8.84
18.66
3.78
9. 19
1.286
3.786
50.55
50.53
35.50
25.63
52.78
25.63
20.67
8.996
22.13
25.9
8.17
5.07
44.26
40.30
7.46
8.86
4.76
4.16
3.52
2.44
4 .68
2.35
0.83
2.375
6.67
3.217
1.92
7.53
5.485
1.671
1.708
0.534
2.59
1.268
11.009
11.921
2.28
0.99
1.211
24.45
36.28
2.29
3.309
20
1.75
9.365
55.02
42.178
14.73
21.82
11.136
7.12
0.886
2.53
3.235
7.46
1.7
4.9
12.173
153
Table (4.23) Summary of physical properties of medical wastes generated at various departments at the University ofJordan hospital
Labs&
blood
bank
2.1885
Emergency &
tramnas, X-rays
unit, outpatient
clinics
2.25
17.1
0.992
4.81
2.355
3.25
1.66
0.99
3.899
2.84
10.35
1.675
0.96
14.169
1.52
11.427
0.744
4.97
0.227
12.234
0.537
14.318
1.05
20.01
0.3497
7.91
1.07
24.798
1.51
43.292
1.39
41.27
0.976
12.822
0.705
24.06
1.01
23.31
1.39
53.125
0.67
10.6
8.23
14.36
13.69
4.25
7.98
7.73
17.62
3.51
Waste items
Pediatrics
Internal &
kidney
room
Nose, Ear,
Throat and
orthopedic
surgery
maternity
Bums
unit
Operating
theatre
Pathological
wastes
5.992
10.29
6.895
20.1
22.1
4.15
Sharps
6.807
4.75
2.389
3.10
3.173
Glasses
5.307
3.676
4.758
3.453
Metals
Plastic
0.348
13.00
1.10
13.81
1.2
8.486
Infectious papers
Total
1.42
32.874
1.452
35.078
% by total weight
10.91
11.64
maintenance Total
91.0
655
31.5
6
38.6
4
8.03
120.
5
11.6
301.
4
100
%
Note: *Generation rates in (kg/day)
154
(4.4) Medical Laboratories

Consulting medical laboratories (Jabal Al-Hussein branch) and the laboratory of
Jordan hospital are the only medical laboratories, which was included in this study.
Laboratory wastes include pathological wastes, sharps, infectious wastes, chemical
wastes, blood and general wastes. All these wastes are contaminated wastes and may
spread diseases if not handled and disposed of properly.
Jabal al-Hussein consulting medical laboratories as
well as all other local
laboratories, dispose of their solid wastes with the general waste stream. In other words,
the municipality of Amman collects these wastes daily with other residential and
commercial wastes and dumps them at Al-Russeifa open dump. Some wastes which
contain cultures and other infectious materials are autoclaved at the laboratory before
disposal, but the rest such as needles and sharp objects is placed in plastic bags without
labeling or any pre cautionary procedures and set for collection.
Table (4.24) shows the average generation rate for solid wastes generated at the
certain private laboratories at Amman area. The generation rates are determined based on
the average number of worked tests per day, thus the generation rates are expressed as
kg/test/day. Generation rates for Jabal AI-Hussein consulting laboratories were found to be
0.0833 kg/test/day. And for laboratory of Jordan hospital is found to be 0.05kg/test/day.
Table (4 .24) Summary of the solid waste generation rates m certain laboratories At
Amman City.
Lab. name
Jabal Al-Hussein consulting
medical laboratories
Laboratory of Jordan hospital
Total
Avg. generated
weight (kg/day)
3.75
Avg. no.
of tests
45
Generated weight
kg/test/day
0.0833
41.625
45.375
832
877
0.05
0.1203
The quantity of generated wastes at medical laboratories depends mainly on two

factories; number of tests per day and the nature of these tests. The study reveals that the
155
relationship between the number of tests per day and the quantity of generated wastes is
directly proportional. The nature and type be important, since some tests require many
treatments and need certain kits, to produce more wastes.
Comparing generation rates for Jabal Al-Hussein consulting laboratories and
laboratory of Jordan hospital with those found in the literature presented in chapter two at
Amman and lrbid cities it is found that thee is consistency between these values. Table
(2.57) shows the generation rates for solid wastes generated at specialized medical
laboratories in Amman City was found to be 0.084 kg/test/day. Also Table (2.58) shows
the generation rates for solid wastes generated at some medical laboratories in Irbid city
like, central Irbid lab which generation rate is 0.055 kg/test/day, and Abdel Hameed AIQudah lab which generation rate is 0.082 kg/test/day.
Table (4.25) shows the generation rate and the physical properties of solid wastes
generated at Jabal Al-Hussein consulting medical laboratories, the main components were
found to be, urine containers (12.81 %), injectors (12.66%), blood containers (7.2%), black
bags (6.66%), plates (5.76%), and human wastes (4.77%). Sharps and needles formed
2.13% of the total weight generated.
Table (4.26) shows the reported percentages for physical properties of medical
wastes at Jabal Al-Hussein consulting medical laboratories. Plastic has the highest
percentage which is 84.98% ofthe total weight, then human wastes which is 10.375% of
the total weight, finally sharps and needles which has the lowest percentage which was
4.637% of the total weight.
Table (4.27) shows the reported generation rates and the percentage of physical
properties of medical wastes at laboratory of Jordan hospital. Syringes has the highest
percentage which is 50.45% of the total weight, while the lowest percentage was 0.06% of
156
the total weight for the corrosive materials. All other components contribute average small
percentages compared with the previously mentioned items.
Table (4.25) Summary of physical properties of the solid wastes generated at Jabal AlHussein consulting medical laboratories
Components
Sharps and needles
Plates
Black bags
Injectors
Urine containers
Blood containers
Stool containers
Human wastes
1. Blood.
Quantity (Kg/day)
% by total weight
0 .08
0.216
0.25
0.475
0.481
0.27
0.024
2.13
5.76
6.66
12.66
12.81
7.2
0.64
3. Stool.
0.090
0.065
0.024
2.40
1.73
0.64
Sub-Total
0.179
4.77
Paper, carton, metal, glasses, garbage, textile
1.775
4.733
Total
3.75
100%
2. Urine.
Average number oftests = 45 tests.

Average solid wastes generation rates= 0.0833 kg/test/day
157
Table ( 4.26) Summary of physical properties of medical wastes generated at Jabal AlHussem
. consu ltmg
. med'1call ab oratones
Avg. total generation rate
Components
o/o by total weight
(kg/day)
Sharps & needles
0.08
4.637
Plastic
1. Plates
0.216
12.52
2. Injectors
0.475
27.53
3. Urine containers
0.481
27.88
4. Blood containers
0.27
15.65
5. Stool containers
0.024
1.39
Sub-Total
1.466
84.98
0.09
0.065
0.024
5.217
3.768
1.390
0.179
10.375
100%
Human wastes
1. Blood.
2. Urine.
3. Stool.
Sub-Total
Total
1.725
Average medical solid wastes generation rates= 0.0383 kg/test/day.
Table (4.27) Summary of physical properties of medical wastes generated at the laboratory
't al
0 f Jordan hosp1
Avg. total weight
Type of wastes
% by total weight
generated kg/day
Sharps
7.687
3.2
21
Syringes
50.45
Blades
0.04
0.096
1
Slides
2.4
Plates
2.52
6.054
Papers
0.16
0.067
Carton
1.715
0.714
Plastic bags
0.78
0.328
Autoclave bags
0.336
0.14
Blood containers
6
14.41
Urine containers
2.66
1.11
Blood
4.73
1.97
Urine
0.35
0.147
Not corrosive materials
0.1969
0.082
Corrosive materials
0.027
0.06
Human tissues
7.879
3.28
100%
Total
41.625
Average number oftests = 832 tests.
Average solid wastes generation rates = 0.05 kg/test/day
158
(4.5) Pharmaceutical Study

(4.5.1) Pharmaceutical Factories
Pharmaceutical industry in general is divided into the following sub-categories:
1. Fermentation products.
2.
Biological and natural extraction products.
3.
Chemical synthesis products.
4. Mixing/compounding and formation.

5.
Microbiological, biological and chemical research.
Processes are characterized largely by batch operations, which have significant variations
in pollution characteristics during any typical operating period.
In general, the chemical processing area of a pharmaceutical manufacturing plant is
made up of a number of batch reactors followed by intermediate product storage and
purification steps. Since some equipment may be common to several product needs, careful
equipment cleaning is necessary to avoid cross contamination. Most of pharmaceutical
plants in Jordan fall under the sub-category (D). There is one plant under sub-category (A),
which produces antibiotics by fermentation, and another plant under the sub-category (B),
which produces serums and plasma. The primary objective of plant under the sub-category
(D) is to convert the desired prescription into tablets, pills, syrups, parenterals,
suspensions, tinctures, ointments, lozenges, powders,
capsules, extracts, emulsions,
solutions, aerosols, suppositories, and other miscellaneous consumable forms. The

manufacturing operations for formulation plants may be either dry or wet. Dry production
involves dry mixing, tabulating, or capsuling and packaging. Process equipment is
generally vacuum cleaned to remove dry solids and then washed down using water and
solvents. Wet production includes mixing, filtering and bottling. Process equipment is
washed down between production batches. The major sources ofwastewater are, floor and
159
equipment wash waters, wet scrubbers. Air pollution control devices such as bag filters
will generate solid waste laboratories are the main source for contaminated organic
solvents.
Al-Hikma pharmaceutical plant is the only pharmaceutical plant, which was
included in the study. Pharmaceutical wastes divided into two main categories, solid
pharmaceutical wastes that include tablets, powders, capsules, suppositories, and general
wastes. The second category is liquid pharmaceutical wastes, which include solutions,
suspensions, and spent solvents. All these wastes are contaminated wastes and may spread
diseases if not handled and disposed of properly.
Al-Hikma pharmaceutical plant,
as well as the most pharmaceutical factors,
disposes of their solid wastes by two ways. For normal solid wastes, the municipality of
Amman collects these wastes daily with other residential and commercial wastes and
dumps them at the final open dump. Specialized solid wastes are collected out-side the
plant buildings and incinerated not in a special incinerator.
There is a treatment station for the industrial water at Al-Hikma pharmaceutical
plant. But this station is not suitable for all kind ofliquid wastes, like acids nitrate, because
it is kill the Bacteria that used for the treatment, Tables (2.61 and 2.63) present collection
and disposal systems of solid and liquid wastes at the pharmaceutical factories in Jordan.
Al-Hikma pharmaceutical plant contains two individual sections. Hikma for
sterilizes and
Hikma for medicine. Tables (4.28, 4.29, and 4.30) show the average
generation rates for solid and liquid wastes at Al-Hikma factories. All data are given in
Appendix (A).
Table (4 .28) presents the contents and generation rates for solid and liquid wastes at
Hikma for sterilize manufacturing. The generation rates for solid wastes are found to be
0.0493 kg/day, which present about 0.0359% of the total weight, while for liquids wastes
160
the generation rate is 136.98 kg/day which present about 99.96% of the total weight. The
high amount of liquid wastes is due to these plant produce liquid products. And all the
solid waste contains packaging plastic and paper.
Table (4.29) presents the generation rates and percentages ofthe solid wastes at AlHikma for medicine manufacturing. The total generation rate for the solid wastes is found
to be 162.46 kg/day or 1.448 exp.-4 kg/drug/day based on the number of drugs that
manufacturing. Plastic, metal, and glass packaging have the highest generation rate of
136.986 kg/day which present
about 84.32% of the total weight while the lowest
generation rate is found to be 2.19 kg/day for the laboratory wastes which presents about
1.348% of the total weight.
Comparing
generation
rates for solid wastes at Al-Hikma for medicine
manufacturing, with those found in the literature presented in chapter two, it is found that
there is an agreement between the obtained and the reported values. For example, Table
(2.60) presents the annual quantities of solid hazardous wastes that found at all the
pharmaceutical factories in Jordan by the Industrial Development Bank (IDB). The total
generation rate is found to be 702,150 kg/year which equal to 1923.7 kg/day. Also the
average generation rate at each plant is found to be 113.2 kg/day. From the previous
reported value, it is apparent that the obtained value for generation rates of solid wastes at
Al-Hikma medicine plant is in the same range.
Table (4.30) shows the generation rates and percentages of the liquid wastes at AlHikma medicine plant. The total generation rate for the liquid wastes is found to be
70,032.876 liter/day or 52.3061 liter of liquid waste/liter of medicine that produced/day
based on the total amount of liquid medicine that manufacturing.
161
Industrial wastewater has the highest generation rat of 70,000 liter/day, which
present 99.93% of the total weight. While the lowest generation rate is very small quantity
for spent laboratory chemicals.
Comparing generation rates for liquid wastes at Al-Hikma medicine plant, with
those found in Table (2.2) in the literature presented in chapter two, it is found that there is
bad agreement between the obtained data and reported one.
Table (2.62) shows the annual quantities of liquid hazardous wastes is found to be
73,472,448 liter for the all pharmaceutical factories in Jordan. So, the average generation
rate for liquid hazardous wastes at each pharmaceutical plant is found to be 11,840.8
liter/day. From the previous reported value, it is apparent that the obtained value for
generation rate of liquid wastes at Al-Hikma medicine plant is out the range, because the
generation rates for solid or liquid wastes is depend upon the biggest of pharmaceutical
plant and the capacity of manufacturing. So, when the total amount of the wastes divided
on the different pharmaceutical plants to get the average generation rate for each plant it is
found that there are some errors in the generation rates of liquids and solid wastes at these
plants.
162
Table (4.28) Summary ofthe wastes generation rates at Hikma for sterilizes
Type
Contents
Quantity
(Kg/day)
Solid wastes
Liquid wastes
Total
Laboratory wastes
Spent solvents
-
%by total
weight
0.0359
99.96
100%
0.0493
136.98
137.03
Table (4.29) Summary of the solid waste generation rates at Hikma for medicine
Type
Quantity (Kg/day)
% by total
Invalid medicaments
23.287
Laboratory wastes
2.19
Plastic packaging
Metal packaging
136.986
Glass packaging
Total
162.46
Total amount of drugs that manufacturing= 1121189.24 drugs/day
Average generation rates for solid wastes= 1.448 exp.-4 kg/drug/day
weight
14.33
1.348
84.32
100%
Table (4.30) Summary ofthe liquid waste generation rates at Hikma for medicine
Types
Quantity ( Lit./day)
Invalid medicaments and spent solvent

Industrial wastes water
Total
32.876
% by total
weight
0.0469
Very small quantity
70000
99.95
70032.876
100%
Total amount of liquid medicine that manufacturing = 1338.9 1/day

Average generation rates for liquid wastes = 52.306 1. liquid waste/1. liquid medicine/day
163
(4.5.2) Future Trends

The results of the field survey showed that, in general, the pharmaceutical and
agricultural industries sectors in Jordan had gained a growth rate of(10 %) annually (IDB,
1998).
In addition, the results of the field survey showed that live pharmaceutical factories
started production in 1997, 1998, which means that these factories are expected to grow at
a more rapid rate, in addition to two companies under construction. Therefore the growth
rate will assume as (15%) (IDB, 1998).
It is expected that the solid hazardous wastes will grow at the same growth rate of
production. However, the liquid wastes are expected to grow at nearly third (1/3) the
growth rate of production. This is due to the fact that the wastes from equipment washing
is nearly constant and doesn't depend on the quantity produced (IDB, 1998).
(4.5.3) Prices Structure

(4.5.3.1) Liquid Wastes Treatment Services
As stated before, most of the pharmaceutical factories send their wastes either to
industrial states wastewater treatment plants, or to the domestic waste water network at a
cost of JD 0.5/m3 . The rest do have private waste treatment plants, the investment cost of
each individual plant was given in most cases, which depends on the volume and capacity
of the plant. However, the operating costs of the plant or the estimated unit cost (JD/m3)
was not estimated by these factories.
(4.5.3.2) Solid Wastes Treatment (Incineration)

The price provided by the two factories that have incinerators was JD 20/ton, while
their estimation
of the cost of incineration was JD 15/ton. This indicates that they
incinerate the waste of other factories as a service provided to a colleague (IDB, 1998).
164
(4.6) Evaluation of Handling, Storage, Transport and Disposal Methods
Evaluation of solid waste systems is based on four basic environmental factors or

conditions affecting the health of hospital occupants and the general public health. These
factories are sanitation, safety, security and aesthetics and may be defined as follows
(Qusous, 1988):
( 1) Sanitation
Control of all conditions, which contribute to contamination and may permit the spread
of disease or infection, the irritation or discomfort through inhalation, ingestion or
contact.
(2) Safety
Control of all conditions relating to prevention of accidents or catastrophe which could
cause personnel injury or property damage.
(3) Security
Prevention of unauthorized access to waste handling and disposal areas to eliminate
salvaging of hazardous wastes and accidental contact with contaminated materials.
(4) Aesthetics
Public and users acceptability in terms of appearance, n01se, odors, psychological
factors, convenience, workability of the system, etc.
Other factors to consider in the evaluation
process include environmental
contamination within the community. The community environment may be exposed to

hospital waste contaminants throughout the course of travel or at the disposal site where
direct contact by refuse workers and scavengers may occur or where water pollution via
run-off or leaching may ultimately affect the population. In addition, air pollution from
incineration may affect the community in general.
165
Based on the above factors and the presentation of solid waste systems at the local
hospitals, medical laboratories, and pharmaceutical factories in chapter three, the following
comments may be drawn:
( 1) Transport of waste in the uncovered transfer cart at University of Jordan hospital and
Al-Basher hospital exposes visitors and patients to possible contamination. At the
Islamic hospital and the Jordan hospital the transfer carts are covered with a piece of
cloth which makes it acceptable from aesthetic point of view. At Al-Hussein hospital
the use of closed transfer carts eliminates the possible exposure to contamination and is
very acceptable aesthetically.
(2) The plastic bags used for kitchen waste are not strong enough and easily develop leaks.
Also
the same bags which are used for other departmental wastes provide little
protection against injury from sharp items placed in with other general wastes. This
practice was noticed at all hospitals except at few occasions at Al-Hussein hospital
where it used stronger bags for kitchen wastes.
(3) No segregation of contaminated wastes is practiced at any of the hospitals. Therefore
all solid wastes generated from the hospital are to be considered contaminated. These
contaminated wastes are not disposed of separately which is not acceptable from
sanitation and security factors.
( 4) The use of main elevators for vertical transport of wastes is one of the major factors
preventing efficient operation of the system. In addition, this practice exposes visitors,
patients and food to contaminated wastes. Also from aesthetic point ofview, this
practice.
(5) The use of compactors for on-site storage at University of Jordan hospital and AlBasher hospital is not a recommended practice because there is a potential for
aerosolization of microorganisms from infectious wastes. Th compactors, which are
166
placed at the entrance of the parking lot, are not secured enough against rodents and
scavengers. Also the capacity of the compactors are not enough in cases of emergency
when the collection vehicle is out of order or late, as it was noted. Several times, that
plastic bags were placed on the ground near the compactors which is extremely
unacceptable from aesthetic, sanitation, and security and safety factors.
The situation is even worse at Al-Hussein hospital. There is no storage container
available for on-site storage and all plastic bags are placed at an un-secured area and
causing odor problems at all times. The plastic bags, which have to be loaded manually
into
the collection vehicle, expose the janitors to various hazards from leakage,
spillage, sharps, needle sticks and others. The problem of manual loading of plastic
bags is the same at the other two hospitals. Also at the Islamic hospital and the Jordan
hospital, the use of the closed, box-type storage container reduces the problem
aesthetically.
(6) Off-site hauling of hospital wastes poses a potential hazard to sanitation serv1ce
employees and the public at large. All wastes from residential, commercial and other
areas are collected together with hospital wastes. Therefore, no special handling of
hospital wastes at landfill sit (open dump) is practiced and landfill workers and
scavengers would generally be unaware of the type of waste with which they are
dealing.
(7) Considering safety, no precautionary procedures are practiced. Housekeeping staff did
not wear protective gloves. Some needles and syringes were misplaced in the plastic
bags thus exposing janitors to injury and needle sticks.
(8) Disinfection of infectious and some other hazardous wastes is an essential technique
before the disposal of such wastes by incineration. At the Islamic and Jordan hospitals
there is a autoclave thermal disinfection for this purpose, but there are no guidelines or
167
well defined categories of the wastes types that should be sent to disinfection, so this
process is run in a random manner.
(9) At all hospitals, medical laboratories, and pharmaceutical plants in this study, there is
no well-defined procedures or guidelines for any management system of their wastes
or proposed techniques for minimization and recycling.
(4. 7) An Overview of Medical Waste Management Situation

Review of available data for all hospitals, medical laboratories, and pharmaceutical
factories in this study shows that;
(a) None of the hospitals, medical laboratories, and pharmaceutical factories has adequate
information about the quantities and composition of their wastes.
(b) Very few of the hospitals, medical laboratories, and pharmaceutical factories have
provided
the
fo llowing essential requirements for the safety of employees,
housekeeping workers, indoor patients and outdoor patients.
Protective clothing for personnel who handle the wastes.
Color coded bags or their usage.
Interim waste storage facilities before transporting to disposal facilities.
Disinfection or autoclaving facilities for their disposable.
Special handling faci lities for radiological or radioactive waste.
Special hazardous waste storage cans.
Trained personnel or training programs for the handling and management of medical
wastes, infection control and protection, hospital personnel and protection against
medical waste hazards, e.g. Hepatitis B & C, AIDS, and Typhoid.
(c) In terms of transportation and disposal facilities;
Only one hospital has adequate incineration facilities that with no proper
regulations, standards or guidelines. The incineration process was also rarely practiced.
168
All hospitals practice open-dumping or follow in adequate landfilling procedures.
None of the hospitals and medical laboratories is seriously considering developing

programs and plans of action dealing with proper storage, transportation and disposal
schemes. Most ofthe hospital workers and managers do not know the serious impact of
such wastes on the human health and the environment.
(c) Environment surrounding the medical facility;

In addition to health risk to patients and personnel, there is substantial impact of
medical waste on human health and the environment (risks of pollution of air, water and
soil) outside the medical health care establishments. None ofthe hospitals and medical
laboratories in this study has taken any steps against the following environmental
impacts:
To safeguard against water pollution due to;
On site wastewater treatment.
Sludge generation and management.
Smell, odor and H2S.

To safeguard against chemicals used for water and wastewater minimization of
emissions from incinerators.
169
( 4.8) Suggested Guidelines for Proper Handling, and Management of

Hospital Wastes
Based on the previous discussions and the literature review given in chapter two,
the following guidelines for proper handling, collection, storage, transport and disposal of
hospital solid wastes are suggested. These guidelines may be considered by hospital
managers to aid them in improving their hospital wastes system.
(4.8.1) Handling; Collection and Initial Storage

(1) General wastes need no special handling techniques. Recycling should be practiced
where feasible.
(2) Sharps and needles should be packed in puncture-proof containers. It is not
recommended to recap needles before disposal.
(3) Segregation of infectious, pathological, and chemical wastes is recommended.
Segregated wastes should be put into single-use, moisture-proof, strong, and colorcoded bags.
( 4) Radioactive wastes can be stored, pending decay, for one or two months in a large
drum before disposal.
(4.8.2) Transport of Solid Wastes within the Hospital

(1) The feasibility of installing a mechanized transport system should be considered.
(2) For manual transport, transfer carts should be closed or covered ones.
(3) Use single-use, special elevators for vertical transport.
( 4) If vertical chutes are to be used, in air-purifying system should be installed to avoid
aerosol contamination. In addition, large storage areas should be provided at the
bottom of the chute to avoid accumulation of solid wastes. This storage should be
cooled and properly ventilated.
170
(4.8.3) On-site Storage
(1) None-portable storage containers should be avoided to eliminate hazards of injury and
spillage. Mechanized portable containers are recommended.
(2) Compactors are not recommended for on-site storage because there is a potential for
aerosolization of microorganisms and it interferes with on-site processing methods like
incineration.
(3) Storage areas must be secured against scavengers and vectors of disease.
(4) Enough storage containers should be provided to allow for emergency cases.
(5) Kitchen wastes preferably be stored in a refrigerator-type, fly-proof container to
prevent odor problems and transmission of diseases.
(4.8.4) On-Site Processing
(1)Food grinding followed by discharge to sewers is recommended for on-site processing

and disposal of kitchen wastes.
(2) On-site incineration, with control of air pollution, is the best method of disposal of all
hospital wastes. The residue may be transferred to a sanitary landfill and covered
immediately.
(3) If sanitary landfill is to be used for ultimate disposal, baling and shredding followed by
sterilization of pathological and infectious wastes should be carried out.
(4.8.5) Off-Site Hauling
( 1) Hospital solid wastes should be tightly containerized and sealed properly before offsite transport.
(2) Hospital wastes should be collected and transported separately.
171
(4.8.6) Ultimate Disposal of Hospital Solid Wastes

( 1) Incineration, on-site or central, is the recommended method of disposal of hospital
solid wastes.
(2) Sanitary landfill would be an acceptable method of disposal if wastes were granddad,
shredded or pulped and denatured to reduce the wastes to a homogenous,
unidentifiable material. Wastes should also be sterilized before transport to produce an
innocuous end product.
In addition, special handling procedures should be practiced at the landfill site. These
procedures are:
(a) Tight security and proper selection of site.
(b) Wastes should be placed at the base of the sanitary landfill and immediately compacted
and covered.
( 4.8. 7) Regulations
The above mentioned guidelines are to be considered by policy makers to formulate
rules and regulations to control the disposal of hospital solid wastes. And to provide
guidance to all workers at the hospital and at the disposal sites to be aware of the wastes
they are dealing with and to practice proper handling and management of such wastes.
172
( 4.9) Experimental Work

(4.9.1) Introduction
In this part a complete description and analysis ofthe instruments and methods
employed to achieve specific goals of this study (that discussed in chapter one) are
presented. The experimental approach and procedure are also explained. The instrumental
system is represented by the INCINCO incinerator, flue gas analyzer. Methods include;
Bacterial spore's preparation, kind of wastes used, and different assays either used or
modified to study the effect of gases and ashes. Finally, data collection and reliability with
respect to statistics are discussed.
(4.9.2) Instruments
(4.9.2.1) Incinerator
A model INCINCO
F25 1/2 SEC.PETENTION incinerator was used in the
experimental work. This incinerator was build at University of Jordan hospital in

23/5/1998, to apply the needs for hazardous waste treatment in University of Jordan
Hospital and in the neighboring area.
Also, this incinerator considered the modern incinerator build in Jordan. The parts
that are related to the experimental procedure and the preparation ofthe machine setup are
presented in Figure (4.4).
(4.9.2.2) Flue Gas Analyzer

A model no. 6500 Lancom flue gas analyzer was used to analyzed the gases that
flue from the incinerator chimney. The serial number of this instrument is 9555626 and the
calibration certificate was made in 18/3/1999.
The flue gas analyzer was taken from the Royal Scientific Society (RSS) toward
this study end.
173
~-;;
13
14
2\
-;
\
H-
10
6
12
1-1--
v=
...
1 1 ~1
.... 11
r-f
-----.
...,. 3
0
L..-
4_.
9
Figure (4.4) Instruments that used in the experimental work
174
Where:
Item No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Description
Incinerator.
Control panel- 240 Vll pH/50 Hz ,AMP supply
Feed/Ashing door
Primary air fan
Ignition burner
Ignition burner shutter plate
After burner
Fuel terminal point-oil1 9 mm, gas 38 mm
Secondary air fan
Feed door locking magnet
Clean out door
Thermocouple
Refractory lined chimney
Flue gas analyzer
175
(4.9.3) Kind of Medical Hazardous Waste that Incinerated
To satisfy the goals of this study, different kind of medical hazardous waste was
chosen as follows:
1.
Plastic syringes.
2.
Needles.
3.
Glass tubes.
4.
Plastic tubes.
5.
Infectious papers and cartons.
6.
Blood.
7.
Human tissues.
8.
Bacterial culture (as a reference).
All these kinds of medical waste (except Bacterial culture) was chosen from
different departments in the University of Jordan
hospital, specially blood bank,
laboratories, and isolated rooms. Needles, syringes, and different kinds oftubes collected
in hard carton boxes, and all other wastes were collected in black plastic bags.
(4.9.4) Properties of Bacterial Culture that Used

Bacterial culture was used in this experiment as a reference, because the total count
ofBacteria in the waste is not known. The properties of this bacterial culture are:
1.
The name is Bacillus Stearothermophilus, NCIMB 8157, and it is equivalent to

ATCC (American Type Collection Culture) no. 7953.
2.
Consist of dry powder sealed in vacuum.
3.
It doesn't have fir hazards.
4.
Initial total count is 1*106 .

176
( 4.9.5) Experimental Procedure

The procedure of the experimental work is:
1. Preparation of the Bacterial culture to be suitable for incineration, and this done at
University of Jordan.
2. Packaging the samples of wastes.
3.
4.
Put the spores of Bacteria in different location inside the waste samples.
Put the prop of the flue gas analyzer inside the incinerator chimney at a distance 1.5
m above the second chamber.
5. Put the waste samples inside the incinerator (in primary chamber).
6.
7.
Open first and second burners, and after 5 minutes open the third one.
Regulate the amount of air inside the incinerator by using primary and secondary air
fan.
8.
After 20 minutes from operation start to take the results at different temperatures
during operation.
9.
When the after burner temperature reach the maximum value take the reading and
then turn offthe incinerator.
10. When the incinerator be cooled open the door and then take the ashes samples.
( 4.9.6) Experimental Results

(4.9.6.1) Results of Gases Analysis
Tables
(4.31 to 4.34) show the results of the experimental work at different
conditions. Table (4.31) shows the emissions of the flue gas from the incinerator chimney
as wood basis. Table ( 4.32) shows normalization for the results in Table (4.31 ), because
the percentage of oxygen is different during the experiment operation and this make
mistakes when the comparison is done between the amounts of gases that emissions. Using
the following equation does the normalization:
177
Cgas, normalized at 10%02 = Cgas*((20.9-1 0)/(20.9-02 gas))

Where:
Cgas, nonnatized at 1o% 02: Normalization for the gas concentration at 10% oxygen percentage.
Cgas: Concentration of the gas before normalization.
20.9: percentage of oxygen in the air.
10: concentration of oxygen that wanted to do normalization.

0 2 gas: percentage of oxygen inside the incinerator.
Also, Table (4.33) shows the emissions of the flue gas from the incinerator
chimney as light fuel oil basis, and Table (4.34) shows normalization for this table.
178
Table (4.31) The emissions of the flue gas from the chimney of the incinerator at University of Jordan Hospital, Jordan 1999.
Result of the Test Carried out on 24th November 1999
2
N umber of test
1
3
4
12.55-1.13
1.13-1.15
Time of test
1.15-1.43
1.43-2.12
Temperature of flue gas
-------------------------- ----------------------------- --- --------- --------------- -- - ------------------ ------------ ---------- --- --- -------- --- --Primary chamber
630
640
780
800
After burner
650
660
740
820
Flue gas
374
392
445
431
i
144
291
Cone. of CO measured
_ppm
52
13
164
ppm
202
208
Cone. of S02 measured
185
ppm
0
0
2
0
Cone. of N0 2 measured
%
12.44
14.03
12.54
16. 85
Cone. of 0 2 measured
ppm
42
31
34
30
Cone. ofNO measured
ppm
Cone. ofNOx measured
42
31
36
30
%
Cone. of C02 measured
8.25
6.70
3.95
8.16
Efficiency of incinerator
%
61.4
50.7
55.9
16.9
%
38.6
49.3
83 .2
44.1
Loss
Excess air
%
141.1
196.0
399.4
144.0
oc
oc
oc
----
Note:
1.
2.
- -
--
- - -
-.
Wood basis.
Ambient temperature = 18 C.
179
Table (4.32) Normalization for the flue gases emissions that presented in Table (4.31) at 10%02 percentage.
Result of the Test Carried out on 24th November 1999
1
2
3
4
Number of test
12.55-1.13
1.13-1.15
1.15-1.43
1.43-2.12
Time of test
Temperature of flue gas -------- --------- ----- -- -- -------------------- --------- -------- ---- ---- -------------------- ---------------- -- --- -- --- -------- ---- ---- ---- ------oc
630
640
780
Primary chamber
800
oc
650
820
660
740
After burner
oc
374
392
445
Flue gas
431
16.952
ppm
186
461.7
139.93
241 .24
260.2
559.728
ppm
261
Cone. of S0 2 measured
ppm
0
0
5.382
0
Cone. ofN02 measured
10
%
10
10
10
54
49.186
91.494
Cone. ofNO measured
ppm
39.12
39.12
ppm
54
49.186
96.876
Cone. ofNox measured
%
10.9
10.9
10.9
10.9
55.9
%
61.4
50.7
16.9
44.1
%
38.6
49.3
83 .2
Loss
%
144.0
Excess air
141.1
196.0
399.4
Note:
1. Wood basis.
2. Ambient temperature = 18 C.
18C
Table (4.33) The emissions of the flue gas from the chimney of the incinerator at University of Jordan Hospital, Jordan 1999.
Result of the Test Carried out on 241h November 1999
Number of test
1
2
3
4
Time of test
12.55-1.13
1.13-1.15
1.15-1.43
1.43-2.12
--------------- ----- ---- -- ---- ----- -- -- -------------- -- ---- ----- --- -- --- --------- ---- ---- ------------- --- ---- --- -- - -- --- -- ------ -- ---------- -- --oc
630
Primary chamber
640
780
800
oc
650
660
After burner
740
820
oc
374
392
Flue gas
445
431
ppm
112.24
226.81
40.529
10.134
ppm
157.44
127.82
162.12
144.191
ppm
0
0
1.558
0
%
12.44
14.03
16.85
12.54
32.73
ppm
24.162
Cone. ofNO measured
26.5
23 .38
ppm
32.73
24.162
28.06
23 .38
%
6.436
5.22
3.08
6.36
%
61.4
50.7
16.9
55.9
%
38.6
49.3
83.2
Loss
44.1
I
Excess air
%
141.1
196.0
399.4
144.0
J
--- -
Note:
3. Light fuel oil basis.
4. Ambient temperature= 18 o C.
181
Table (4.34) Normalization for the flue gases emissions that presented in Table (4.33) at 10%02 percentage.
Result of the Test Carried out on 241h November 1999
2
3
4
Number of test
1
1.43-2.12
12.55-1.13
1.13-1.15
1.15-1.43
Time of test
------ ---- ---------------- ----------------------------- --------------------- --------- ----------------------- --- -- -- ----------------- ------ ----- -630
640
780
800
Primary chamber
650
660
740
820
After burner
374
392
445
431
Flue gas
06
13
.21 5
359.856
109.
ppm
144.61
188.025
202.799
ppm
202.59
436.26
5.382
0
0
0
ppm
10
10
10
10
%
ppm
42.156
38.335
71.3115
30.487
Cone. ofNO measured
30.487
75.778
ppm
42.156
38.335
8.29
%
8.29
8.29
8.29
Cone. of C0 2 measured
50.7
16.9
55 .9
61.4
%
44.1
49.3
83.2
%
38.6
Loss
144.0
141.1
196.0
399.4
%
Excess air
oc
oc
oc
Note:
3. Light fu el oil basis.
4. Ambient temperature = 18 C.
182
- --
- - - --
---
-- -
(4.9.6.2) Results of ashes Analysis

The initial total count of the Bacterial culture is 1*106 , and after incineration the
microbiological lab. in the University of Jordan shows the total count of the Bacterial
culture is not detected, and this mean there is no Bacteria in the ashes.
(4.9. 7) Discussion of the Results

(4.9. 7.1) Discussion of the Gases Analysis Results
From Tables (4.32 and 4.34) it is found that when the temperature ofthe incinerator
increased at constant oxygen and excess air percentages the percentages of the flue gases
initially increased until the incinerator temperature reach the maximum value which is 820
o
C, then the percentages of these gases start to decrease. In the opposite direction the
incinerator efficiency initially decreased and the increased. From table (4.34) it is seen the
average efficiency of the UJH incinerator is 46.2%.
High destruction efficiency is achieved by exposmg the waste to optimal
incineration conditions. Incinerators are designed to provide excess oxygen (only in the
secondary chamber for controlled air units), atomization, and turbulence.
Optimal conditions also depend on waste characteristics. Large amounts require
more oxygen. Wet waste will take longer to heat and volatize. When comparing a waste
that occupies the same volume, waste with greater surface area and having a lower density
will heat more rapidly and thoroughly.
Longer retention times or higher
temperatures don't necessary increase the
destruction efficiency. Because retention time depends on the combustion gas flow rate,
and flow rate depends on temperature, retention time and temperature have an inverse
relationship ; increasing temperature usually decreases retention time. Sometimes a lower
temperature will result in a better destruction efficiency by allowing a longer retention time
as shown in Tables (4.31 to 4.34). Because of the variation in institutional waste streams
183
and incineration engineering, conditions necessary for destruction can vary with each
institution and sometimes even with each load.
Still, time and temperature are important conditions; they are often the basis for
some state regulations. Reference time and temperature conditions for infectious waste
incinerators have increased over the years as shown in Table (2.42).
Table (4.35) Shows the typical maximum concentration (that is not allowed to
exceeded) of gases that flue out from the incinerator chimney as follows:
Material
Chlorine component
Carbon mono oxide (CO)
Sulfur dioxide (S02)
Organic material
Heavy metals (Cadmium, Mercury, and
Lead).
NOx
-For temperature less than 1200 o C.
-For temperature more than 1200 C.
Maximum concentration(mgfm~
100 (as HCl)
100 (as ratio per hour)
300
20 (represent bv carbon)
5 (from the total concentration)
200
1800
so)
150
10
H2S
Pb
30
30
Ch
HF
15
20
Cu
20
Ni
20
F2
Source: (WHO, Western Pacific Region, 1994), (Environmental Protection Agency in
Oman, 1986, and Egypt, 1995).
The typical maxtmum percentage of C0 2 that allowed to emission to the air is not
exceeding 6% by the total weight of gases. Al so, the typical maximum temperature that is
no allowed to exceed for the flue gases from the chimney will be 150 C, by a maximum
speed 15m/s.
184
Table (4.36) shows comparison between the concentration of gases that emission
from the incinerator chimney obtained in this study and the typical values showed in Table
(4.35), as follows:
Component
co
SOz
COz
Nox
-For temperature less than
1200 c.
Typical maximum
concentration
1.66 (mg/mo)/min
300 (mg/m')
6%
Concentration that
obtained in this study
1.58 (mg/m0 )/min
422.9 (mg/m0 )
5.27%
200 (mg/m3)
96 (mg/m3 )
The temperature of the flue gases to the air that obtained in this study is 410.5 o C
and it is ver high than the maximum temperature that allowed to be which is 150 o C.
From the results that
presented in Tables (4.35, 4.36), it is found that the
concentration of gases that flue out from the chimney in this study is less than the typical
value except the concentration of S02 which is higher than the typical value. And this
because, the UJH incinerator need light fuel oil to work and this fuel contain high amount
of sulfur components. But the WHO values evaluated without fuel present.
Also, it is found that the temperature of the flue gases in this study is higher than
the typical maximum temperature of the flue gases.
(4.9.7.2) Discussion of the Ashes Analysis Results

The total count of the Bacterial culture after incineration is not detected, and this
refers to the good efficiency of the UJH incinerator.
185
CHAPTER FIVE
CONCLUSIONS AND RECOMMENDATIONS
(5.1) Conclusions
The general situation in Jordan, regarding hospital waste management, is typical to

that in other countries in the Eastern Mediterranean region. Health authorities are a ware of
the need to proper and safe hospital waste management. Decision-makers have started to
seek technical guidance as a step towards establishing solutions to this issue. From this
study we can conclude the following:
In this work a complete review of potential hazardous wastes produced by medical
1.
laboratories, hospitals and pharmaceutical plant in Jordan was performed.

2.
Data shows that the generation rates of hospital solid wastes for the university of
Jordan hospital ranged from 5.102 kg/pat./day to 4.646
kg/pat./day, and for private
hospital ranged from 3.95 kg/pat./day to 3.503 kg/pat./day, and for military hospital
4. 906 kg/pat/day.
3.
Generation rates for medical laboratories were found in the range of 0. 0500
kg/test/day to 0.0833 kg/test/day.
4.
Generation rates for pharmaceutical factories was found to be 1.44 exp.-4

kg/drug/day for solid wastes and for liquid wastes was found to be 52.306 lit. Liquid
waste/lit. Liquid medicine/day.
5.
The average of medical waste generated at HCE in Amman City is 17.75 %by wt.,
which lie within the typical values.
186
6.
Kitchen wastes form the highest percentage of the total solid wastes generated from
hospitals. It ranged from 25.51% at University ofJordan hospital to 42.9% at Jordan
hospital.
7.
Physical property analysis data shows that paper, plastic and garbage items are the
major constituents of the generated wastes while, textile, needles, metal, and glass
items are minor categories in the generated wastes.
8.
The general wastes, which form the majority of hospital waste can be recyclable or
disposed in a way similar to domestic wastes, so they should be segregated from the
hazardous wastes so that the quantities of wastes that require special treatment are
m1mmum.
9.
There is no any classification and segregation of wastes in the HCE in Jordan.
10. The current practices ofthe handling, transportation, storage, and disposal practices
of the generated wastes at the hospitals, medical laboratories, and pharmaceutical

factories need revision and major improvements. Such improvements are indicated in
the proposed management scheme in chapter four.
11. Chemical and pharmaceutical wastes collected from hospitals should join industrial
waste of similar nature for treatment. The same applies to radioactive wastes. Small
quantities of other special hazardous wastes, such as pressurized containers, should be
handled appropriately.
/'
) 2. There is no one suitable method for the treatment of all types of medical wastes.
13. The most common method for the treatment of medical wastes {in
J;rdan-i~ '.
--~
incineration.
14. Incineration can be a very effective method for the treatment of infectious wastes,
combustion temperature and duration of combustion have to be sufficient to prevent the

187
6.
Kitchen wastes form the highest percentage of the total solid wastes generated from
hospitals. It ranged from 25.51% at University ofJordan hospital to 42.9% at Jordan
hospital.
7.
Physical property analysis data shows that paper, plastic and garbage items are the
major constituents of the generated wastes while, textile, needles, metal, and glass
items are minor categories in the generated wastes.
8.
The general wastes, which form the majority of hospital waste can be recyclable or
disposed in a way similar to domestic wastes, so they should be segregated from the
hazardous wastes so that the quantities of wastes that require special treatment are
mmtmum.
9.
There is no any classification and segregation of wastes in the HCE in Jordan.
10. The current practices of the handling, transportation, storage, and disposal practices
of the generated wastes at the hospitals, medical laboratories, and pharmaceutical
factories need revision and major improvements. Such improvements are indicated in
the proposed management scheme in chapter four.
11. Chemical and pharmaceutical wastes collected from hospitals should join industrial
waste of similar nature for treatment. The same applies to radioactive wastes. Small
quantities of other special hazardous wastes, such as pressurized containers, should be
handled appropriately.
12. There is no one suitable method for the treatment of all types of medical wastes.
13. The most common method tor the treatment of medical wastes in Jordan ts
incineration.
14. Incineration can be a very effective method for the treatment of infectious wastes,
combustion temperature and duration of combustion have to be sufficient to prevent the
187
formation of prob !ems such as odor, smoke, and sharps in the ash may still be a hazard
after incineration.
15. The average efficiency of the UJH incinerator is found to be 46.2 %.
Long retention times or higher temperatures don't necessary increase the destruction
efficiency, but in the same time, time and temperature ate important conditions.
) 7. The existence of an incinerator in
some hospitals has great advantages by
minimizing the spread of infectious and pathological wastes. But for small health care
establishments,
like health centers, small hospitals, medical laboratories, and
pharmaceutical factories, this option is costly. This points to the requirement of

centralized disposed plants that serve different regions in the country. Private hospitals
may also be included in the system.
18. Plasma Based Pyrolysis Vitrification (PBPV) seems to be one of the best method for
/
the treatment of the medical wastes because its completely destroys the waste it
processes, breaking down waste streams into basic elements, eliminates the need for
landfills, terminating all long-term liability for waste generators. It saves time and
money and valuable resources by avoiding the potential dangers of transporting
hazardous and non-hazardous waste streams over distances, finally the process can
handle all types of waste and results in reduction of up to 90% in volume and 80% in
weight.
188
(5.2) Recommendations
The ministry of health in Jordan should be adopt a power full national legislation to
1.
define medical wastes categories based on the local conditions and to improve the
current management system of such wastes at the different healthcare establishments in
Jordan.
2.
Since Jordan have subsuital amount of hazardous wastes needs to be treated there,
must be regulations, inspection, and enforcement.
3.
Jordan through its newly established environmental agency must outline a matter
conductance and a code establishing approved methods of collection, disposal and
proper landfill.
4.
Hospital managers should develop programs and plans for training, protection, and
motivation of the personnel and strengthen the legislation.
5.
Adequate information and data should be provided to the personnel at the healthcare
establishments related to categories of medical wastes and their sources.
6.
It is recommended that all medical laboratories and pharmaceutical factories should

send their hazardous wastes to the incinerators at some hospitals.
7.
All hospitals,
medical laboratories, and pharmaceutical factories should adopt
proper collection, transportation, storage, and disposal techniques. The recommended

procedures are mentioned in the previous chapter.
8.
Infectious wastes must be disinfected before disposal in landfill. This necessitates

the availability of a disinfection facility at hospitals, medical laboratories, and
pharmaceutical factories.
9.
Hospital personnel, especially nurses and cleaning attendants, being especially at

risk, must be immunized against Hepatitis B & C.
189
10. A great need for classification and segregation of the medical wastes at their point
of sources in different HCE.
11. A great need for using air control devices for the incinerators that used in Jordan
instead of built new incinerators.
12. Radioactive material can not be treated in Jordan, so it must be returned to the
supplier through safe handling because the amount of radio action wastes produced
does not justify the establishing of one extremely expensive waste management
facilities in Jordan.
13. Radioactive waste can be stored, pending decay, for one or two month in a large can
or drum before disposal.
14. Bags containing chemical or infectious waste should be strong and water proof,
containers for sharps should resist puncture; it is advisable not to reuse them in most
cases.
15. Further research is needed in which separation and classification of medical wastes
into their categories determine their effects on health and environment in the
neighboring governess. Also, further research is needed to make a statistical
relationship between the data that given in chapter four to be in a good location to
predict the type and quantity of medical waste in any department or hospital.
16. Using the flue gas analyzer to evaluate the percentages of the emission gases
without fuel existence can do future study.
190
REFERENCES
1.
2.
American Public Work Association, "Municipal Refuse disposal", USA, 1983.

Anderson G.K., Clinical Waste Management, "Multi National Training Course on
Medical Waste Management", Amman-Jordan, 1996.
3.
Annual Statistical Report for Royal Healthcare Services, Amman-Jordan, 1998.
4.
Annual Statistical Report for Royal Healthcare Services, Amman-Jordan, 1997.
5.
Annual Statistical report for Royal Healthcare Services, Amman-Jordan, 1996.
6.
A Pruss, W. K. Townend, "Management of Wastes From Healthcare Activates",

(WHO), Geneva, 1998.
7.
Bdour N. Ahmed. "Medical Wastes; generation Rates, Classification and

Prediction", M.Sc. thesis at Jordan University of Science and Technology, AmmanJordan, December 1997.
8.
Biosterile Technology, lNC., "Electron Beam Infectious Waste Treatment for

Healthcate facilities", 4104 Merchant Road, Fort Wayne, 1N 46816, E-mail: Biosterile
@ aol.com, 1998.
9.
Biosterile Technology, lNC., "The Autoclave and Infectious Medical Waste

potential Liabilities", 4104 Merchant Road, Fort Wayne, 1N 46816, E-mail: Biosterile
@ aol.com, 1998.
10. Categorization of Pathogens According to Hazard and Categories of containment.

Advisory Committee on Dangerous Pathogens. HMSO Fourth Edition, U.K., 1995.
11. David Rhodes, "The Health lndustrv-A report on Medical Wastes",
(www. ahair.et. dekin.edu.au/courses/seb 121/final2a.htm), Internet 1998.
12. El-Far F. Reem, "Medical Waste, Management and Disposal", M.Sc. thesis at
University ofJordan, Amman-Jordan, April 1998.
13. Gary F. Bowser, "Criteria for Evaluation of Infectious Medical Waste
Treatment Technologies", Biosterile Technology, lNC., 4104 Merchant Road, Fort
Wayne, lN 46816, E-mail: Biosterile@ aol.com, 1998.
14. Industrial Development Bank (IDB), "Pre-Feasibility Study For Establishing a
Central Plant For Waste Treatment of Pharmaceutical, Veterinary and Pesticide
Projects", Market Study, Amman, Jordan, August 1998.
15. Medical Waste Treatment, "Eiectrotechnologies for Business Customers",
(www.pepco.com/bsemwt.htm), Internet, 1998.
191
16. Michael H. Eley, Tom Carrington, James Colebaugh, Ben Johnston and Melvin V.
Kilgone, "Wastewater Processing system Permit Validation Testing For Kaiser
Permanent San Diego Medical Center", University of Alabama in Huntsville,
November, 1993.
17. Ministry ofHealth Annual Statistical Report, Amman-Jordan 1998.
18. Peter A. Reinhardt, Judith G. Gordon, "Infectious and Medical waste
Management", Lewis Publishers, INC, 1991.
19. Professor G.k. Anderson, Professor of Environmental Engineering University of
Newcastle U.k. and executive Director environmental Technology Consultants
Newcastle Upon Tyne U.K., "Medical Waste Management", 1994.
20. Qusous K. Suhail, "Composition and Generation Rate of the Solid Waste of
Hospitals and Medical Laboratories in Amman-Jordan", M.Sc. thesis at University
ofJordan, Amman-Jordan, May 1998.
21. Rasras A. Eman, "Hospital Waste Management Status in Jordan", Ministry of
Health. Amman-Jordan. 1997.
22. Report of a Consultation on Medical Wastes Management in Developing Countries,
"Managing Medical Wastes in Developing Countries", WHO, Geneva, (edited by
Dr. Adrian Goad), September 1994.
23. Stefan Wagener Ph.D., Biological Safety Officer, "The Michigan Medical Waste
Regulatory Act of 1990", (www.orcbs.msu.edu/biological/medwaste.htm#A8),
Internet 1998.
24. Topley and Wilson's Principles of Bacteriology, Virology and Immunity. 7th edition.
Vol.3 Bacterial Diseases. General editors G.S. Wilson et al. Edward Arnold, London,
1983.
25. World Health Organization (WHO), Regional office For Europe, EURO Report and
Studies 97, "Management of Waste from Hospitals".
192
APPENDICES
193
APPENDIX A
GENERATION QUANTITIES
194
Table (A.1.1) Summary of the solid waste generation rates at University of Jordan Hospital
Type of wastes
Normal wastes
Medical wastes
Total
Avg. total
weight
generated
(kg/day)
1557.03
301.45
1858.48
Generation rate Generation rate

(kg/pat.!day)
(kg/bed/day)
3.89
0.7536
4.646
3.077
0.5957
3.672
%by total
weight
83.779
16.22
100%
Note:
1. Average number of patients = 400 patients
2. Total number of beds= 506 bed
Table (A.1.2) Summary of the solid waste generation rates at various departments at
university ofJ ordan hospital
Department
Pediatrics
Orthopedic
Surgery
Maternity
Burns unit
Emergency & Traumas,
X-rays unit, out
patients clinics and
administration
Laboratories, blood
bank, laundry and
disinfection
Maintenance
Kitchen
Total
Avg. total
weight
generated
(kg/day)
98.3
250.49
75.76
Avg. no. of
patients
Generation
rate
Kg/pat.!day
%by total
weight
40
96
45
2.457
2.609
1.683
5.289
13.478
4.076
200.05
185.00
68.97
135.02
104
76
7
32
1.923
2.434
9.85
4.219
10.764
9.95
3.711
7.265
200.195
10.77
120.35
6.475
50.27
474.075
1858.48
400
400
1.185
4.6462
2.705
25.51
100%
195
Table (A.1.3) Summary of the solid medical waste generation rates at University of Jordan
Hospital
Type of wastes
Pathological waste
Sharps
Sub-Total
Glasses
Sub-Total
Metals
Plastic
Sub-Total
Infectious papers
Total
Waste contents
Human tissues,
organs and body
parts, blood and
unne
Needles
Pasteur pipettes
Scalpel blades
Quantity (kg/day)
% by total weight
91.0655
30.21
21.350
3.894
6.35
7.08
1.3
2.1
31.594
11.506
10.48
3.8
27.1366
9.0
38.6426
8.0195
1.3698
5.479
99.378
12.8189
3.323
0.45
1.8
32.96
14.2932
4.7
120.52
39.98
Masks, coats, shoes

covers and different
papers
11.61
3.1879
301.45
100%
Glass tubes
Glass wares, Plates
& Slides and
broken glasses
Red plastic bags

Plastic tubes
Syringes
Gloves, blood
containers, urine
containers
196
Table (A.2. 1) Summary of the solid waste generation rates at Al-Hussien Hospital
Type of waste
Avg. total
weight
generated
kg/day
2108.65
491.35
2600
Generation rate Generation rate

kg/pat./day
kg/bed/day
Normal waste
3.617
0.8428
Medical waste
Total
4.4598
Note:
1. Average number of patients = 530 patients.
2. Total number of beds= 583 beds.
3.978
0.9271
4.906
%by total
weight
81.10
18.9
100%
Table (A.2.2) Summary of solid waste generation rates at various departments at AlHussein hospital
Department
Pediatrics
Neurology
Surgery, men
Surgery, women
Psychiatry
Internal, men
Internal, women
Internal, surge:ry
Kidney
Maternity
Operating theatre
ICU, disinfection
Emergency & traumas
Outpatient clinics
X-rays unit
Laboratories
Kitchen
Total
Avg. total
weight
generated
kg/day
117.184
80.904
128.377
77.436
49.533
99.664
56.679
109.33
111.048
132.09
156.22
123.47
80.247
82.22
99.93
71.183
1024.706
2600.2
Avg.no. of
patients
Generation
rate
kg/pat./day
%by total
weight
47
30
59
53
30
56
40
59
38
58
25
15
135
294
2.49
2.697
2.197
1.46
1.651
1.779
1.417
1.853
2.92
2.27
6.2488
8.38
0.59
0.279
452
530
2.267
4.906
4.5
3.11
4.94
2.97
1.9
3.83
2.179
4.20
4.27
5.08
6.01
4.748
3.08
3.162
3.843
2.737
39.41
100%
197
Table (A.2.3) summary of the solid medical waste generation rates at AI-Hussein hospital
Quantity (kg/day}_
117.788
% by_total weight
23.969
24.83
2.13
0.769
0.0887
6.734
5.05
0.433
0.156
O.Dl8
1.37
Sub-Total
Plastic & glasses
a. Urine bags.
b. Nutrition tubes.
c. Stomach & nose tubes
d. Gloves
e. Syringes
34.5517
7.03
19.56
5.216
6.52
38.94
113.526
3.98
1.06
1.326
7.92
23.10
Sub-Total
Infectious wastes
a. Cotton &sponges.
b. Tolerated mild.
c. Adsorbent sponges.
d. Treated sponges.
e. Towels.
f Bandage.
g Face mask.
h. Paper coat.
1. Shoes cover or labor shoes.
J. Sponges soap.
183.762
37.39
8.15
10.712
31.76
16.30
25.15
11.18
3.26
4.075
2.79
41.92
1.658
2.179
6.46
3.317
5.118
2.275
0.66
0.829
0.567
8.53
Sub-Total
155.357
491.4
31.615
100%
a.
b.
c.
a.
b.
c.
d.
e.
TYJle of wastes
Pathological wastes
Human tissues.
Blood & urine.
Organs & body parts
Sharps
Needles.
Cannula
Butterfly.
Needle-spinal.
Given set.
Total
198
Table (A.3.1) Summary of the solid waste generation rates at Islamic Hospital
Type of waste
Avg. total
weight
generated
kg/day
720
150
870
Normal wastes
Medical wastes
Total
Note:
1. Average number of patients= 220.
2. Total number ofbeds = 340 beds.
Generation
rate
kg/pat./ day
Generation rate
kg/bed/day
%by total
weight
3.2727
0.68
3.95
2.117
0.44117
2.558
82.76
17.24
100%
Table (A.3.2) Summary of solid waste generation rates at various departments at Islamic
hospital
Department

Surgery & internal,
women
Pediatric
Maternity
Operating room, ICU,
emergency and
traumas, and X-rays
unit
Laboratory
Kitchen
Total
Note:
': number of tests.
b: kg/test/day.
Avg. total
weight
generated
kg/day
78.736
86.067
Avg.no. of
patients
Generation
rate
kg/pat./day
%by total
weight
94
54
0.8376
1.594
9.05
9.89
89.485
125.23
36
36
2.4857
3.4786
1.028
14.394
62.44
33
1.892
7.177
38.584
21.33
368.22
870
440'
0.08769b
220
220
1.742
3.95
4.43
2.45
42.32
100%
199
Table (A.3 .3) Summary of medical waste generation rates at various departments at Islamic
hospital
Department

Surgery & internal,
women
Pediatric
Maternity
OjJeratingroom & ICU
Laboratory
Emergency and
Traumas
X-rays unit
Total
Note:
': number of tests.
h: kg/test/day.
Avg. total
weight
generated
kg/day
20.28
18.75
Avg.no. of
patients
Generation
rate
kg/pat./day
%by total
weight
94
54
0.215
0.347
13.52
12.5
3.015
50.347
15.09
27
13.518
36
36
33
440'
0.0837
1.398
0.457
0.06136b
2.01
33.56
10.06
18.00
9.01
0.682
1.33
100%
2.00
150
220
200
Table (A.3.4) Summary of the solid medical waste generation rates at Islamic hospital
Quantity
(Kg/day)
4.6
7.4
12.25
%by total
weight
3.00
4.93
8.16
24.25
14.9
16.16
9.33
3.50
2.33
2.20
58.96
9.69
3.31
8.69
0.3
3.84
0.82
1.46
39.31
6.46
2.206
5.79
0.2
2.56
0.546
Masks
Shoes cover
Coats
Isolated room waste
85.61
1.2
1.2
2.7
15.34
57.07
0.8
0.8
1.8
10.22
20.44
150
13.626
100%
Type of wastes
Contents
Pathological wastes
Human tissues
Blood and urine
Sub-Total
Sharps
Glasses
Metals
Plastic
Sub-Total
Infectious wastes
Sub-Total
Total
Needles
Glass tubes
Slides and plates
Broken glasses
Syringes
Gloves
Blood containers
Urine containers
Stool containers
Plates
Red plastic bags
201
Table (A.4.1) Summary of the solid waste generation rates at Jordan hospital
Type of waste
Avg. total
weight
generated
kg/day
347.7955
72.5745
420.37
Generation rate
kg/pat./day
2.898
Normal wastes
0.605
Medical wastes
3.503
Total
Note:
I. Average number of patients= 120 patients.
2. Total number of beds = 177 beds.
Generation
rate
kg/bed/day
%by total
weight
1.965
0.41
2.375
82.74
17.26
100%
Table (A.4.2) Summary of solid waste generation rates at various departments at Jordan
hOSpi'tal
Generation
%by total
Avg.no. of
Avg. total
Department
patients
rate
weight
weight
kg/pat./day
generated
kg/day
Surgery (m & w)
47
0.66
7.46
31.35
49
0.76
8.86
37.27
Internal (m & w)_
21
0.63
13.25
3.15
Pediatric
17.26
20
0.863
4.10
Maternity
15.86
Emergency & traumas
0.1367
3.77
116
0.0473b
832'
39.399
Laboratory
9.37
23.4
85
0.27
5.56
Disinfiction &
pharmacy_
6.34
67
0.09
1.51
X-rays unit
37.45
120
0.3
8.9
Outpatient clinics
8.75
Kidney unit
34
0.227
2.1
45
0.178
8.01
1.9
Operating theatre &
ICU
0.358
1.508
Administration &
maintenance
120
42.94
180.523
Kitchen
1.5
100%
420.37
120
3.503
Total
Note:
': number oftests.
b: kg/test/day.
202
Table (A.4.3) Summary of the solid medical waste generation rates at Jordan hospital
Type of wastes
Pathological wastes
Sub-Total
Sharps
Glasses
Sub-Total
Metals
Plastic
Sub-Total
Infectious wastes
Sub-Total
Chemical wastes
Sub-Total
Total
Contents
Human tissues
Blood and urine
Needles
Tubes
Slides and plates
Broken glasses
Red plastic bags

Gloves
Syringes
Plastic tubes
Plastic plates
Urine containers
Blood containers
Autoclave bags
Paper and carton

Masks
Paper coats
Shoes cover
Head cover and
Isolated room wastes
Corrosive materials
Noncorrosive materials
203
Quantity
(Kg/day)
4.25
5.45
1.5
%by total
weight
5.8
7.51
2.1
11.2
9.75
15.43
13.43
0.275
3.56
1.75
0.379
4.9
2.4
5.585
2.31
1.658
2.75
2.584
0.345
0.246
1.11
6.75
0.14
7.69
3.18
2.28
3.78
35.6
0.475
0.338
0.0153
9.3
0.193
38.839
1.39
0.6
0.95
0.45
53.51
1.9
0.826
1.3
0.62
0.41
0.565
3.8
0.82
0.27
5.23
1.12
0.372
1.09
72.545
1.5
100%
Table (A.5.1) Summary of the solid waste generation rates at Al-Basher hospital
Type of waste
Avg. total
weight
generated
kg/day
3069.53
680.47
3750
Generation rate
kg/pat./day
Generation
rate
kg/bed/day
%by total
weight
3.698
0.8198
4.518
81.85
18.146
100%
Normal wastes
4.176
Medical wastes
0926
5.102
Total
Note:
1. Average number of patients= 735 patients.
2. Total number of beds= 830 beds.
Table (A.5.2) Summary of solid waste generation rates at various departments at AI-Basher
hospital
Department
Pediatrics
Internal
Surgery
Maternity
Nose, Ear,
Throat and
orthopedic
Emergency &
traumas
Psychiatry
X-rays unit
Operating
theatre
ICU, CCU
Labs and
blood bank
Outpatient
clinics
Kitchen
Total
Avg. total
weight
generated
kg/day
169.002
225.47
454.498
190.499
Avg. no.
of
patients
Avg.
no. of
beds
65
133
230
125
91.585
Generation rates
%by
total
weight
124
168
226
144
Kg/pat./d
ay
2.6
1.695
1.976
1.524
Kglbed/d
ay
1.37
1.34
2.01
1.323
55
32
1.665
2.86
2.44
115.73
135
36
0.857
3.21
3.1
71.436
144.12
225.3
52
1.37
75
3.004
1.9
3.84
6.01
178.1
145.66
69
40
--2.58
4.45
4.75
3.88
260.77
407
60
0.64
1.35
6.95
1477.83
3750
626
735
2.36
5.102
39.41
100%
830
204
4.518
4.51
6.01
12.12
5.1
Table (A.5.3) Summary of the solid medical waste generation rates at Al-Basher hospital
Quantity
kg/day
130.094
%by total
weight
19.12
68.047
10
90.729
34.023
34.023
13.33
5
5
356.917
30.303
4.201
3.5
7.35
52.45
4.45
0.617
0.514
1.08
45.36
98.89
20.616
6.6
13.35
8.67
0.65
6.6
14.53
3.03
0.969
1.96
1.27
0.09
158.776
23.33
90.729
13.33
12.006
1.76
16.682
2.45
680.47
100%
Type of waste
Contents
Pathological
wastes
a. Human wastes
tissues, organs, body parts and urine
b. animals wastes
Tissues, organs, body parts, blood and
infectious body liquids, and carcasses.
c. Laboratories wastes
d. wastes from artificial kidney room
e. Wastes from isolated rooms.
Sub-Total
Sharps
Sub-Total
Plastic
Sub-Total
Toxic wastes
Radioactive
wastes
Pressurized vial
Total
Needles
Pasteur pipettes
Scalpel blades
Broken glasses
Syringes
Gloves
Red plastic bags
Urine containers
Blood containers
Stool containers
Invalid medicine, medicine containers,

chemical waste, materials that caused
cancer, and corrosive materials.
a. Sealed sources (liquids)
b. Open sources.
c. Materials that used in radioactive
substances like gloves, needles, and
addresses
Medicine containers and different cans
that closed under pressure
205
Table (A.6.1) Summary of the solid waste generation rates at Jabal Al-Hussein Consulting
Medical Laboratory
Quantity (Kg[day)_
0.08
0.216
0.25
0.475
0.481
0.27
0.024
% by total weight
2.13
5.76
6.66
12.66
12.81
7.2
0.64
0.090
0.065
0.024
2.40
1.73
0.64
Sub-Total
0.179
Paper, carton, metal, glasses, garbage,
1.775
textile
3.75
Total
Average number of tests= 45 tests.
Average solid wastes generation rates= 0.0833 kg/day
4.77
4.733
Components
Sharps and needles
Plates
Black bags
Injectors
Urine containers
Blood containers
Stool containers
Human wastes
1. Blood.
2. Urine.
3. Stool.
100%
Table (A.6.2) Summary of the medical solid waste generation rates at Jabal Al-Hussein
Consulting Medical Laboratory
Components
1.
2.
3.
4.
5.
Sharps & needles

Plastic
Plates
Injectors
Urine containers
Blood containers
Stool containers
Sub-Total
Human wastes
1. Blood.
2. Urine.
3. Stool.
Avg. total generation rate

(kg/day)
0.08
% by total weight
0.216
0.475
0.481
0.27
0.024
12.52
27.53
27.88
15.65
1.39
1.466
84.98
0.09
0.065
0.024
5.217
3.768
1.390
4.637
10.375
Sub-Total
0.179
100%
Total
1.725
Average med1cal sohd wastes generation rates= 0.0383 kg/test/day.
206
Table (A.7.l) Summary of the solid medical waste generation rates at laboratory ofJordan
hospital
Type of wastes
Avg. total weight

generated kg/day
3.2
21
0.04
Sharps
Syringes
Blades
l
Slides
2.52
Plates
Papers
0.067
0.714
Carton
0.328
Plastic bags
Autoclave bags
0.14
6
Blood containers
Urine containers
1.11
Blood
1.97
Urine
0.147
Not corrosive materials
0.082
0.027
Corrosive materials
Human tissues
3.28
41.625
Total
Average number of tests = 83 2 tests.
Average solid wastes generation rates= 0.05 kg/test/day
207
% by total weight
7.687
50.45
0.096
2.4
6.054
0.16
1.715
0.78
0.336
14.41
2.66
4.73
0.35
0.1969
0.06
7.879
100%
Table (A.8.1) Summary of the wastes generation rates at Hikma for sterilizes
Type
Contents
Solid wastes
Liquid wastes
Total
Laboratory wastes
Spent solvents
Quantity
(Kg/day)
0.0493
136.98
137.03
%by total
weight
0.0359
99.96
100%
Table (A.8.2) Summary of the solid waste generation rates at Hikma for medicine
Type
Quantity (Kg/day)
% by total weight
Invalid medicaments
23.287
14.33
Laboratory wastes
2.19
1.348
Plastic packaging
Metal packaging
136.986
84.32
Glass packaging
Total
162.46
100%
Total amount of drugs that manufactunng = 1121189.24 drugs/day
Average generation rates for solid wastes= 1.448 exp.-4 kg/drug/day
Table (A.8.3) Summary of the liquid waste generation rates at Hikma for medicine
Types
Quantity (Lit./day)
%by total
weight
0.0469
Invalid medicaments and spent solvent

32.876
Very small quantity
Industrial wastes water
70000
99.95
Total
70032.876
100%
..
Total amount ofhqmd med1cme that manufactunng = 1338.91/day
Average generation rates for liquid wastes= 52.306 I. liquid waste/!. liquid medicine/day
208
APPENDIXB
CONTRIBUTION THE GENERATED WASTES
TO THE VARIOUS DEPARTMENTS
209
Kitchen
26o/o
Pediatrics
5%

13%
J

Orthopedic
4o/o
Surgery
Maintenance
11/o
3/o
laboratory
Maternity
6/o
Emergency
11%
Burns unit
4%
10/o
7/o
Figure (B.1.1) Departments contribution of generated wastes at UJH

210
Surgery, men
5%
Surgery, women
3%
Pediatrics
5%
Psychiatry
2%
Kitchen
Internal, men
4%
Internal , women
2%
,.
Internal, surg ery

4%
Kidney
4%
Laboratories
3%
X-rays unit
4%
Outpatient clinics
3%
Maternity
5%
Operating theatre
6%
Emergency & traumas
3%
ICU, disinfection
5%
Figure (8.2.1) Departments contribution of generated wastes at AI-Hussein Hospital

2 11
Surgery & internal,

men
10%
Surgery & internal,

women
11 /o
Kitchen
46%
Pediatric
1/o

3%
operatin room & ICU

8o/o
Laboratory
5%
Figure (8.3. 1) Departments contribution of wastes generated at the Islamic hospital
2 12
Emergency and
Traumas
9%
X-rays unit
1%
Laboratory
18/o
Surgery & internal,

men
14%
Surgery & internal,
women
13/o
Pediatric
2%
10%
Figu re (8 .3.2) Departments contributions of medical wastes at the Islamic hospital
213
Surgery (m & w)
7%
Kitchen
43%
Internal (m & w)
9%
Pediatric
3%
Maternity
4%
/'
\
\
/
Emergency & traumas
Laboratory
9%
Administration &
maintenance
0%
O perating theatre & ICU
2%
4%
Kidney unit
X-rays unit
2%
2%
Outpatient clinics
9%
Disinfiction & pharmacy

6%
Figure (8.4.1) Departments contributions of wastes generated at Jordan hospital

2 14
Pediatrics
5%
Kitchen
39% -,
Internal
6%
Surgery
12%
I
/
-
I
I
Maternity
5%
,/
I
I
/
Outpatient clinics _
7%
Labs and blood bank ___/
4%
'
'

orthopedic
~2%
"'-,._
~- Emergency & traumas
. - -so/c0 - -
\
I
Operating theatre
6%
Psychiatry
2%
3%
X-rays unit
%
4
Figure (8.5.1) Departments contributions of wastes generated at AI- Basher hospital

2 15
APPENDIXC
PHYSICAL PROPERTIES OF THE
GENERATED WASTES AT UNIVERSITY OF
JORDAN HOSPITAL
216
Table (C.!) Summary of physical properties of solid wastes generated at various departments at the University of Jordan Hospital
Department
Paper
Plastic
Textiles
Garbage
Metals
Glass
Needles
Pediatrics
Nose, ear, throat and orthopedic
Surgery
Maternity
Burns unit
Operating room
Emergency & traumas, X-rays
unit, out patients clinics and
administration
Laboratories, blood bank
Maintenance
Average
51.65
36.56
39.108
50.55
50.53
35.50
25.63
52.78
23.517
24.99
15.35
25.63
20.67
8.996
22.13
25.9
0.88
6.75
8.84
8.17
5.07
44.26
40.30
7.46
4.99
12.85
18.66
8.86
4.76
4.16
3.52
1.137
3.539
3.78
2.44
4.68
2.35
0.83
2.375
10.25
7.10
9.19
6.67
3.217
1.92
7.53
5.485
4.286
2.56
1.286
1.671
1.708
0.534
2.59
1.268
Human
wastes
3.29
5.651
3.786
11.009
11.921
2.28
0.99
1.211
24.45
55.02
42.178
36.28
14.73
21.82
2.29
11.136
7.12
3.309
0.886
2.53
20
3.235
7.46
1.75
9.365
1.7
4.9
12.173
217
Table (C.2) Summary of physical properties of medical wastes generated at various departments at the University of Jordan hospital
Waste items
Pediatrics
Internal
&
kidney
room
10.29
Pathological
5.992
wastes
4.75
Sharps
6.807
5.307
3.676
Glasses
1.10
Metals
0.348
13.81
Plastic
13.00
1.452
Infectious
1.42
papers
35.078
32.874
Total
11.64
%by total
10.91
weight
Note: * Generation rates in (kg/day)
Nose, Ear,
Throat and
orthopedic
surgery
maternity
Bums
unit
Operating
theatre
6.895
20.1
22.1
4.15
2.389
4.758
1.2
8.486
1.07
3.10
3.453
0.96
14.169
1.51
3.173
1.66
!.52
11.427
1.39
24.798
8.23
43.292
14.36
41.27
13.69
218
Labs&
blood
bank
maintenance
Total
2.1885
Emergency&
traumas, X-rays
unit, outpatient
clinics
2.25
17.1
0.992
0.99
0.744
4.97
0.976
4.81
3.899
0.227
12.234
0.705
2.355
2.84
0.537
14.318
1.01
3.25
10.35
1.05
20.01
1.39
1.675
0.3497
7.91
0.67
91.06
55
31.56
38.64
8.03
120.5
11.6
12.822
4.25
24.06
7.98
23.31
7.73
53.125
17.62
10.6
3.51
301.4
100%
Table (C.3) Percentages of components of overall hospital solid wastes at University of

Jordan Hospital
Components
Paper
Plastic
Textiles
Garbage
Needles
Metals
Glasses
Pathological wastes
Total
Percentages
42.178
21.82
12.173
7.12
1.7
2.53
7.46
4.9
100%
219
APPENDIXD
TYPE OF THE MEDICAL WASTES THAT
PRODUCED, AND THE APPLIED METHODS
FOR DISPOSED OF THESE WASTES AT ALBASHER HOSPITAL
220
Table (D.l) Summary of solid hazardous waste that produced at Al-Basher Hospital
Types
Sharps
SQecial medical wastes

a. Human waste
b. Animals wastes
Contents
Needles, injectors, Scalpel
blades, and broken glasses
Sources
Clinics, labs., surgery
departments, all the
patient's departments

parts, blood, urine, others
parts, blood, infectious
body liquids and carcasses
Different surgery
departments.
c. Laboratory wastes
(Microbiology lab.)
Microbiology lab.
d. Waste from artificial

kidney units.
Artificial kidney units.
e. Waste from isolated

rooms.
Toxic wastes
Radioactive wastes
a. Sealed sources
b. Open sources
c. Materials that used
in radioactive materials
Pressurized vials
Invalid medicine, medicine

containers, chemical
wastes, materials that
caused cancer, and
corrosive materials.
As a liquid
Needles, gloves and
addresses
Medicine containers
221
All the hospital

departments.
Nuclear department and Xrays unit.
Table (D.2) Summary of the disposal methods for different types of medical wastes at AlBasher hospital:
Types of wastes
Normal wastes
Sharps
Human wastes
Animals wastes
Laboratories wastes
Wastes from isolated rooms and from
artificial kidney rooms
Toxic wastes
Radioactive wastes
a. sealed sources
b. open sources
c. materials that used for radioactive
materials
Pressurized vials
Methods of disposal
Landfills
Some time autoclaving, incineration and
then to the landfills
For the chemical wastes the kind of
disposal of them depend upon the
information from the product company,
and the waste that remain incinerated.
Returned back to the contractor
Dilution and then to the sewers
Only landfills, without incineration or

broken.
222
APPENDIXE
DISPOSAL METHODS FOR DIFFERENT
TYPES OF MEDICAL WASTES (COMILED
FROM AMERICAL HOSPITAL ASSOCIATION
HANDBOOK, PP 130-11)
223
Table (E.l) Some waste recovery and reuse activities generally adopted in the
industry
Material
Human tissue
Waste recovery/reuse
Organ donations
Blood
Blood plasma, white

blood cell and other
blood products reuse
Water recovery
Sterilization
water
Domestic water
Water treatment plants
Surgical
equipment's
Autoclaving and other

forms of re-sterilization
Use of ultrasonic
cleaning machines
Comment
Organ donation not only serves to reduce a
waste product that is morally and ethically
difficult to dispose of, but also has been of
benefit to those whose lives it may have
increased.
This process may be more restricted due to
the presence of infectious and possibly total
contaminates.
Autoclaves have reservoirs, which collects
and cools the steam from the sterilization
process so it can be used again in future
batch.
Wastewater may be collected and stored for
treatment. After treatment the water is then
used for hospital gardens, etc.
As mentioned previously, the items that can
be resterilized method required. For example,
syringe barrels may be made of metallic
material, and therefore easy to resterilized,
where as the needles that attach to the end of
them while still being made of metal, are
prone to blunt with use, and are difficult to
clean.
224
Table (E.2) Wastes generated in through the healthcare industry

Direct Generation
Waste
Solid waste
Obsolete/Unusable
equipment
Paper product
Plastic product
Human originating
wastes.
Liquid waste
Process
Example
-----------------------------------------------------------Any equipment which has been replaced and

no longer serves a function in the hospital
Preparation of meals. Packaged foods, and products.
Office management. Filling, account generation.
Patient care
Paper towels, etc.
sterilization
Wrapping of gowns etc. in paper bags for
sterilization.
Patient care.
One use syringes.
Preparation of meals. Plastic wrap used for microwaving.
Daily management.
Disposable pens, plastic packaging.
Normal bodily
Face's, and other bodily excretions.
functions.
Surgical treatment
Removal of pathological tissue.
M~M--------------
N/A
Blood waste
---------------------------- -----------------------------------------------------------Patient care

Water from pre and post scrubbing of hands.
Water from the washing of used utensils.
Kitchen care
Halogenated waste solvents
Non-halogenated waste solvents
Organs chemical residues
Pharmaceuticals
High-inert-contaminated waste
Activated ingredients in rejects and returned
goods
Heavy metal washes.
Patient care
Blood lost in surgical procedures.
Other liquid waste
Cleaning wastes
Human originating
wastes
Gases
Normal bodily
functions.
Wastewater
Chemical liquid
waste
Various
Detergents and disinfectants of "hospital

grade" strength.
Urine, bodily secretions.
---------------------------- -----------------------------------------------------------Mixing of gases for

Surgical procedures.
anesthesia.
Heat generation.
Furnaces.
Use of on-site
incinerators.
225
Table (E.3) Disposal methods for differing types of medical wastes

Method of disposal
Incineration is preferred method
of disposal.
(Where incineration is not
Sharps wastes
available, disposal at a properly
managed Sanitary landfill site;).
Disposal by incineration is
preferred method. Autoclaving
to render waste non-infectious
Infectious wastes
and then disposal by domestic
landfill. Sanitary landfill.
Packaging, labeling and
incineration under supervision.
Small amounts of body fluids if
suitable diluted, can be disposed
Human tissues
of in the normal sewerage
system.
Incineration using high
Cytotoxic waste
temperature combustion is
preferred method of disposal due
to high toxicity.
Placed in no reactive containers,
and incinerated. Non-flammable
liquids should be absorbed by
Pharmaceutical
sawdust enclosed in a wet or
wastes
plastic bag and then incinerated.
Evaporative processes can only
be used for low toxicity products
due to the potential for air
pollution.
Mercury waste must not be
incinerated due to resulting toxic
Chemical wastes
emissions. Not to be disposed of
via sewerage system.
If under limits provided by state
legislation may be disposed of
Radioactive wastes by incineration, Sanitary landfill
at an approved site, or by the
sewerage system.
Incineration may cause toxic
Plastic wastes
fumes. Reduction by
compaction, and possible
landfill.
Typ_e of waste
226
Comments
Placed in designed and
appropriately marked 'Sharps'
container as soon as possible after
use.
Only involves visually

recognizable body tissues not
requiring legal burial. Other body
tissues may be disposed of by
other methods deemed acceptable
by state legislation.
Low cytotoxic waste
concentrations may be disposed of
via the sewerage system once
suitable diluted.
Not landfill, as eventually would
get leaching in to the water table.
Mercury is used widely in dental

work. Disposal of chemical waste
into sewerage system may cause
corrosion.
Must consider possibility of
radioactive gas on incineration,
and plume characteristics.
Included as hazardous waste due

to possible fumes.
Continue to Table (E.3)

Food wastes
Paper wastes
Grinding or pulping, with

disposal into the sewerage
system or incineration.
Compaction.
Incineration, compaction.
227
For many sources.
Energy produced can be used for

other things such as heating.
APPENDIXF
VEHICLE DESIGN FOR OFF-SITE
TRANSPORTATION OF HAZARDOUS
HEALTHCARE WASTE
228
Vehicle design for off-site transportation of hazardous healthcare waste

1.
The body of the vehicle should be of a suitable size, with an internal body height of
2.2 meters.
2.
There should be a bulkhead between the driver's cabin and the body, which is
designed to retain the load, if the vehicle is involved in a collision.
3.
A suitable system should secure the load during transport.
4.
A separate compartment on the vehicle should contain empty plastic bags, suitable
protective clothing, cleaning equipment, tools and disinfectant, together with special
kits for dealing with liquid spills.
5.
The internal finish of the vehicle should allow it to be steam cleaned and the internal
corners should be covers.
6.
Name and address of the waste carrier must be on the vehicle.
7.
The international hazard sign should be displayed on the vehicle or container, as

well as an emergency telephone number.
8.
Open-topped skips or containers should never be used for transporting hazardous

healthcare waste.
229
APPENDIXG
ABBREVIATIONS
AIDS
Acquired immune Deficiency Syndrome
APWA
American Public Works Association
CDC
Center of Disease Control
DOT
Department Of Transportation
EIA
Enviromnental Impact Assessment
EPA
Enviromnental Protection Agency
GLC
Grotmd Level Concentration
HCW
Health Care Waste
IDB
Industrial development Bank
JEPA
Jordan Enviromnental Protection Agency
WST
Jordan University of Science and Technology
PVC
Halogenated plastic (Poly Vinyl Chlorine)
RCRA
Resources Conservation and Recovery Act
UJH
University of Jordan Hospital
WHO
World Health Organization
230
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12 Evaluation of Medical Wastes DISPOSAL METHODS AND THEIR APPLICATIONS IN JORDAN

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12 Evaluation of Medical Wastes DISPOSAL METHODS AND THEIR APPLICATIONS IN JORDAN

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EVALUATION OF MEDICAL WASTES

DISPOSAL METHODS AND THEIR

EVALUATION OF MEDICAL WASTES

Omar Mohammad Ali Al-Qudah

A thesis submitted in partial fulfillment of the requirements for the degree

Signature and Date:

Dr. Nabil Abdel-Jabbar

t\..no. to ffi':J cou.n.t1:':J w\t\\ a\\ ffi':J \()'le.

At the beginning I wish to thank Allah (God) the most

1.1 General Background .... .................... .................................................. .... 1

Literature Review ........................................ ...... .................................. ... ... 5

2.1 Introduction ............................ ........... .... ... .................... .... ..................... 5

2.4.4.2 Hazards from Sharps .... .. ... ................................... .. ... ................. 28

2.8.7 Steam Reforming ............ ....................................................... ..... .. 67

2.8.9 Plasma Based Pyrolysis Vitrification (PBP.Y) ......................... ..... 68

4.2.5 Al-Basher Hospital. ... ...... .. ................... ................. .. .................... 138

4.9.6.2 Results of Ashes Analysis ............................................... .... ..... 183

CHAPTER FIVE ......................... ......................................................... 186

Comparison between the medical waste compositions that obtained in

Comparison between the medical waste compositions that obtained in

Comparison between the medical waste compositions that obtained in

Sources and quantities of medical waste generated in USA by

Categories of clinical waste produced by various types ofhealthcare

Types of medical waste designated as infectious by the CDC and the

Typical composition of healthcare waste .................... ............ .. .. ........... 21

Breakdown of daily waste production by types of waste in (kg) at Los

Summary of solid waste generation at New York University Medical

Average daily of hospital waste of29 hospitals in USA with Average

Hospital waste generated according to regions ................. ........... .......... 36

Hospital waste generated according to waste type in Western Europe ... 36

Hazards healthcare waste quantities produced in healthcare facilities

Generation rate of solid waste in some industrialized countries .... ......... 38

E stimated amount of healthcare waste in different countries ......... ......... 39

Summary of solid waste generation by units at St. Anthony hospital,

Summary of solid waste generation by units at Fair hospital, USA ........ 41

Sources of solid wastes within the hospitals ....................... .................. .41

Healthcare waste according to source size ........................ .. .............. .... .43

Summary of generation rates, by the type of hospital in the

Summary of generation rates, by size of hospital in the United States

Generation rates at Washington area hospitals ...................... ................ .44

Recommend segregation and color coding for healthcare waste ............ 54

Segregation and color coding for HCW in minimal programs .. .. ........... 54

Labeling............ ....................... .............................................. .... ........... 55

Waste storage periods ........................................................................... 51

Time and temperature requirements for steam sterilization .................... 63

Autoclave sterilization requirements ................................. .. .. .............. ..63

Dry heat sterilization ............................................. ....... ..... ... ............. .... 65

Components of an infectious waste incinerator ..................................... 70

Concentration of gases that flue from the incinerator chimney that is

Standard reference combustion temperatures for infectious waste

Characterization of different types of incinerators .. ... ........... ... ......... .. .. . 76

Incinerator Institute of America Waste, classification ofwaste .............. 77

Air pollution control devices (scrubbers) used for incineration .............. 80

Comparison between the infectious waste treatments .............. ............ .. 82

Summary of main advantages and drawbacks of treatment and

Overview of disposal and treatment methods for healthcare waste

Methods for waste minimization for general medical and surgical

Wastes generation rates in selected hospital in Amman ... ...................... 96

Solid wastes components in the UJH ........................................ ......... .... 97

Summary of solid waste generation rates for local hospitals at Irbid

Physical properties of solid wastes generated at the specialized

Summary of generation rates at governmental and private

Estimated production size ofpharmaceutical factories ................. ......... 99

Estimated annual quantities of solid hazardous wastes by waste type .. 100