Lebanese Sterilization Network

1. Lebanese Sterilization Network of Potentially Infectious Health Care Waste: creation and management system

2. Health Care Waste issue • "Health Care Waste" refers to materials accumulated as a result of patient diagnosis, treatment or immunization of human beings or veterinary activity.

3. Health Care Waste issue potentially infectious health care waste (PIHCW) ~ 25% hazardous healthcare waste (HHCW) ~ 30% Health care waste (HCW) waste comparable to household waste (HCHW) ~ 70% Non infectious hazardous health care waste (NIHHCW) ~ 5%

4. Health Care Waste issue • Potential health hazards and pollution effects of wastes may be categorized as follows: • Infectious wastes containing micro-organisms capable of causing illness to a susceptible host. Through this path, AIDS, Hepatitis B, C and D, allergies, gastro-enteric infections, respiratory infections, skin infections can be transferred. • Toxic chemicals that can cause poisoning when inhaled ingested or brought into contact with the skin. • Carcinogens (cancer-causing agents) in wastes from bio-medical research laboratories. • Flammable liquids and explosive gases that can cause injury to personnel or damage to the hospital structure by fire and explosion. • Packaged caustic materials (acids or bases) that can cause injury. • Physically injurious wastes that can produce punctures, cuts, or abrasions. • Radioactive contaminated wastes.

5. Health Care Waste issue • In Lebanon, until 2003, hospital wastes... • ...have been disposed with the municipal wastes in landfills. • ...eliminated through incineration. • ...not segregated at source within hospital.

6. Health Care Waste issue • In Lebanon, until 2003, hospital wastes... • ...have been disposed with the municipal wastes in landfills. • ...eliminated through incineration. • ...not segregated at source within hospital. Medical waste disposal can be considered dangerous for common population if thrown away without any safety measures.

7. Health Care Waste issue • Ministry of environment and Ministry of Public Health obliged hospitals to treat waste through: decree 8006/13389 Hospital accreditation

8. Health Care Waste issue • Infectious wastes containing micro-organisms capable of causing illness to a susceptible host. Through this path, AIDS, Hepatitis B, C and D, allergies, gastro-enteric infections, respiratory infections, skin infections can be transferred. • Independently of any treatment strategy, segregation must be considered one of the most important steps • "PIHCW are susceptible to contain pathogens or their toxins in sufficient concentration to cause diseases to a potential host (HIV, HBV, gastro-enteric infections, respiratory infections…)" • PIHCW production in Lebanon was estimated to be 10 T/day, which corresponds to de 0.4% of total solid waste. • The PIHCW forms 85% of the hazardous HCW.

9. Health Care Waste issue • Infectious wastes containing micro-organisms capable of causing illness to a susceptible host. Through this path, AIDS, Hepatitis B, C and D, allergies, gastro-enteric infections, respiratory infections, skin infections can be transferred. • Independently of any treatment strategy, segregation must be considered one of the most important steps • "PIHCW are susceptible to contain pathogens or their toxins in sufficient concentration to cause diseases to a potential host (HIV, HBV, gastro-enteric infections, respiratory infections…)" • PIHCW production in Lebanon was estimated to be 10 T/day, which corresponds to de 0.4% of total solid waste. • The PIHCW forms 85% of the hazardous HCW. PIHCW must be segregated and treated first.

10. Methodology for Handling the problem of PIHCW in Lebanon • Who should be in charge of the treatment for PIHCW? • Which kind of service provider is needed? • How should the PIHCW be managed in Lebanon? • What technique should be used?

11. Methodology for Handling the problem of PIHCW in Lebanon • A. The treatment provider • The mission of health care institutions is to treat the patient. • Difficulty to achieve profitability when working on an individual basis. • Difficulty of maintaining control. • Chronic economical crisis. • Low production: only 165 hospitals, less than 0.4% of the solid waste. • Difficulty of managing a successful coordination between competing institutions in case of failure. • Profit-making service shows no interest establishing training programs for PIHCW reduction.

12. Methodology for Handling the problem of PIHCW in Lebanon • cost Control, Economy of scale • competition Control • ensuring Public funding • A. The treatment provider • The mission of health care institutions is to treat the patient. • Difficulty to achieve profitability when working on an individual basis. • Difficulty of maintaining control. • Chronic economical crisis. • Low production: only 165 hospitals, less than 0.4% of the solid waste. • Difficulty of managing a successful coordination between competing institutions in case of failure. • Profit-making service shows no interest establishing training programs for PIHCW reduction. • global & national solutions • awareness and training • ensuring Quality Service • Cost Control, Economy of Scale • Competition Control • Ensuring Public funding • Global and national Solutions • Awareness and Training • Ensuring Quality service + Performance Zone Inappropriate Assignment Zone = management for PIHCW by an NGO Strategic axe of Profitability = Monopole of a profit-making company Financial Blockade Zone Failure Zone = Several non profit-making organizations = Several profit-making companies + Strategic axe of Preservation of Environment

13. Methodology for Handling the problem of PIHCW in Lebanon • B. The treatment methodology • Incineration can’t be considered as an optimal solution because of its major drawbacks: possibility of toxic emissions, expensive controls techniques, generation of hazardous ashes containing heavy metals, dioxins and furans that may pollute the soil and water, high investment and operating costs... • Autoclaving associated to shredding optimal from environmental, economical and social point of view: safe, low-emissions technique, low investment and operating costs...

14. Methodology for Handling the problem of PIHCW in Lebanon Minimal environmental impact investment and operational costs Efficient sterilization • B. The treatment methodology • Incineration can’t be considered as an optimal solution because of its major drawbacks: possibility of toxic emissions, expensive controls techniques, generation of hazardous ashes containing heavy metals, dioxins and furans that may pollute the soil and water, high investment and operating costs... • Autoclaving associated to shredding optimal from environmental, economical and social point of view: safe, low-emissions technique, low investment and operating costs... Autoclaving associated to Shredding = Optimal solution

15. Methodology for Handling the problem of PIHCW in Lebanon • Who should be in charge of the treatment for PIHCW? • Which kind of service provider is needed? • How should the PIHCW be managed in Lebanon? • What technique should be used? the producer? [hospitals, clinics, laboratories…] a service provider.

16. Methodology for Handling the problem of PIHCW in Lebanon • Who should be in charge of the treatment for PIHCW? • Which kind of service provider is needed? • How should the PIHCW be managed in Lebanon? • What technique should be used? a profit-making service provider? a non profit-making service provider, recognized of public utility.

17. Methodology for Handling the problem of PIHCW in Lebanon • Who should be in charge of the treatment for PIHCW? • Which kind of service provider is needed? • How should the PIHCW be managed in Lebanon? • What technique should be used? by different independent service providers? by a national network.

18. Methodology for Handling the problem of PIHCW in Lebanon • Who should be in charge of the treatment for PIHCW? • Which kind of service provider is needed? • How should the PIHCW be managed in Lebanon? • What technique should be used? by incineration? by autoclaving associated with shredding.

19. Methodology for Handling the problem of PIHCW in Lebanon 7 programs agriculture employment environment health rehabilitation social youth • A Lebanese non profit organization • Since 1985, with and for every person in difficulty • Recognized of public utility in 1995 • Mission: participate to society’s lasting development by supporting fragilized groups and integrating marginalized people.

20. Methodology for Handling the problem of PIHCW in Lebanon

21. Methodology for Handling the problem of PIHCW in Lebanon = a national network strategy, for an integrated and sustainable solution • 5 treatment centers for the country… [semi-centralized] • secures a back up system, easy to activate... [since the network managed by one operator]. • ensures training for PIHCW reduction... [since the network is managed by a non-profit organization] • cares for public awareness. • takes in charge the whole process : training, collection, treatment… • guaranties a quality and reliable traceability system. • puts all findings and experience at the disposal of relevant authorities, in order to upgrade regulations... [through a research and a development unit]

22. Results 5 treatment centers…. • Today, arcenciel provides through a unique specialized comprehensive service in Lebanon: • The proper and efficient training of health care institutions staff. • the PIHCW collection of the PIHCW from the health care institutions in specialized vehicles. • The sterilization by autoclaving associated to grinding, in five treatment centers covering the whole Lebanese territory. • The monitoring of the process • The public awareness.

23. Results • training of Health Care Staff: more than 7000 persons trained. • Special training sessions for health care staff, cleaning staff, administrative staff • Risks prevention • Emergency procedures • Sorting at the source and PIHCW minimization • Monitoring of the process

24. Results • PIHCW collection • Specially equipped collection vehicle in compliance to the WHO recommendations. • Trained staff. • Occupational health and safety system. • Bins traceability. 1111

25. Results • 5 treatment centers….

26. Results Treatment by autoclaving coupled with shredding of 6.5 tons of PIHCW per day 1:PIHCW are placed in the sterilizer 2:The compartment is sealed and the waste is shredded 3:a level of 138 ˚ C and a pressure of 3.8 bars for 10 minutesis maintained 4:The shredded and sterilized sorting waste is similar to household waste

27. Results • treatment by autoclaving coupled with shredding • Environmentally friendly • Low investment and operating costs • Proper sterilization in 40 minutes • Volume reduction of 80% • Unrecognizable ground waste assimilated to domestic waste

28. Results • Traceability and monitoring • Traceability • = Follow-up notebooks slips: the name of the center, the date, the quantity received, signatures... • Treatment monitoring • = Cycles reports printed by the • autoclave. • = A chemical test, performed daily. • = A biological test, performed • everyday by an independent • laboratory.

29. Results • Traceability and monitoring • production monitoring

30. Results • Public awareness

31. prospects • arcenciel is still pursuing its objective of research and development of eco-friendly treatment technologies, alternatives to incineration for hazardous waste (mainly solvents, chemicals and pharmaceuticals) in cooperation with ministries and universities.