medical waste in Serbiamedical waste in Serbia

Doc. Dr Goran VujiDoc. Dr Goran Vujićć

Medical waste and infectiMedical waste and infectiousous medical medical waste (IMW)/1waste (IMW)/1

Medical waste is defined as any waste, generated in Medical waste is defined as any waste, generated in provision of health services:provision of health services: diagnosis; diagnosis; prevention;prevention; treatment;treatment; research in the field of human and veterinary medicine. research in the field of human and veterinary medicine.

MW is created in medical institutions, medical centers MW is created in medical institutions, medical centers or laboratories.or laboratories.

It is a heterogeneous mixture of waste, while 10-25% is It is a heterogeneous mixture of waste, while 10-25% is hazardous waste. hazardous waste.

In addition to health risk (result of direct contact) MW In addition to health risk (result of direct contact) MW may have irreversible health effects through indirect may have irreversible health effects through indirect contamination of water and land during the treatment contamination of water and land during the treatment and final disposal or air pollution due to insineration.and final disposal or air pollution due to insineration.

Medical waste and infectiMedical waste and infectiousous medical medical waste (IMW)/2waste (IMW)/2

Current situation in Current situation in R.Serbia R.Serbia in terms of in terms of MW maMW management nagement

Medical waste in health care facilities in the RS is Medical waste in health care facilities in the RS is generated in uneven amounts, depending on:generated in uneven amounts, depending on: the type of facilities,the type of facilities, numbers of beds,numbers of beds, type of diseases,type of diseases, conditions of care and types of servicesconditions of care and types of services provided. provided.

In 2007 Ministry of Health of the Republic of Serbia In 2007 Ministry of Health of the Republic of Serbia started the specific activity in the introduction of started the specific activity in the introduction of uniform system of managing medical waste, a special uniform system of managing medical waste, a special category of infectious medical waste.category of infectious medical waste.

Only a Only a limited numberlimited number of health institutions in RS of health institutions in RS carries out sterilization of IMW, mostly in very old but carries out sterilization of IMW, mostly in very old but regularly maintained autoclaves. regularly maintained autoclaves.

In individual health facilities used needles and syringes, In individual health facilities used needles and syringes, cotton tufers and other IMW are mainly mixed with cotton tufers and other IMW are mainly mixed with municipal waste municipal waste withoutwithout separation nor sterilization. separation nor sterilization.

Current situation in Current situation in R.Serbia R.Serbia in terms of in terms of MW maMW managementnagement

The goal for treatment of IMW is that it can be turned The goal for treatment of IMW is that it can be turned into into harmless household wasteharmless household waste..

If the IMW is sterilized first, and then comminute in If the IMW is sterilized first, and then comminute in small pieces so it can not be recognized then it can be small pieces so it can not be recognized then it can be disposed to the MSW landfills.disposed to the MSW landfills.

There are There are 50,988 beds50,988 beds in hospitals across RS in hospitals across RS, t, the he average useaverage use of beds is of beds is 72%72% on a year level. on a year level.

TThere is an here is an additional 2700 bedsadditional 2700 beds in military hospitals in military hospitals and private clinics. and private clinics.

Estimated Estimated average amountaverage amount of MW waste generated in of MW waste generated in health care facilities in RS is health care facilities in RS is 1.8kg1.8kg of MW per hospital of MW per hospital bed per day, this quantity is valid for the countries of bed per day, this quantity is valid for the countries of Eastern Europe (WHO).Eastern Europe (WHO).

About 9.600t of the total amount of medical waste is About 9.600t of the total amount of medical waste is considered hazardous waste.considered hazardous waste.

The concept of "central places for the The concept of "central places for the treatment of IMtreatment of IMWW""

Estimated quantities of IMW generated in health Estimated quantities of IMW generated in health facilities do not including the private sector and the facilities do not including the private sector and the sector of veterinary medicine.sector of veterinary medicine.

Research from 2008. showed that Research from 2008. showed that 100 registered visits 100 registered visits to health centers produce 1kg IMW.to health centers produce 1kg IMW.

Central place for treatment of IMW system requires the Central place for treatment of IMW system requires the existence of a central treatment institutions (CTI) existence of a central treatment institutions (CTI) according to model of administrative districts. according to model of administrative districts.

Under this system, autoclaves are set in places where is Under this system, autoclaves are set in places where is the higest production of IMW, which is inside the the higest production of IMW, which is inside the hospitals and clinical centers, which are by far the hospitals and clinical centers, which are by far the largest producers of waste.largest producers of waste.

Each of the mentioned Each of the mentioned districts was appointed districts was appointed and equipped with at and equipped with at least one health care least one health care institution, which is the institution, which is the largest manufacturer of largest manufacturer of IMW in a given district. IMW in a given district. Appointed CTI has the Appointed CTI has the obligation to treat its obligation to treat its own IMW and IMW own IMW and IMW generated from public generated from public sector health facilities in sector health facilities in the county, and the the county, and the network of health network of health institutions.institutions.

"Regulation of the "Regulation of the plan network of plan network of health institutions" health institutions" (article 47 of the (article 47 of the Health Care, Official Health Care, Official Gazette of the RS, Gazette of the RS, No. 107/05).No. 107/05).

Plan for distribution Plan for distribution equipment for IMW equipment for IMW treatmenttreatment

Plan for distribution Plan for distribution equipment for IMW equipment for IMW treatmenttreatment

Medical waste management Medical waste management system is based on the system is based on the assessment and analysis of assessment and analysis of the current situation in the the current situation in the Republic of Serbia, which Republic of Serbia, which takes into account the takes into account the constraints imposed by constraints imposed by equipment that was equipment that was purchased for thermal purchased for thermal processing of IMW.processing of IMW.

Model Model for for medical waste medical waste management for the management for the city of Belgrade.city of Belgrade.

Conceptual model relies on a generic Conceptual model relies on a generic topic with the following three variations:topic with the following three variations:

City/area health insti-City/area health insti-tution with tertiary tution with tertiary health care (Nihealth care (Nišš, , Kragujevac and Novi Kragujevac and Novi Sad).Sad).

Conceptual model relies on a generic Conceptual model relies on a generic topic with the following three variations:topic with the following three variations:

The health area with an The health area with an institution of secondary institution of secondary level health care, level health care, general hospitals, as general hospitals, as well as central place of well as central place of treatmenttreatment..

Conceptual model relies on a generic Conceptual model relies on a generic topic with the following three variations:topic with the following three variations:

Handling infectious waste by steam Handling infectious waste by steam sterilization sterilization

Device which is made of waste steam sterilization Device which is made of waste steam sterilization (autoclave)(autoclave) must not carry a risk for personnel or general must not carry a risk for personnel or general population. population.

The basic requirement is that the process of steam The basic requirement is that the process of steam sterilization leads to a sterilization leads to a sufficient degree of reductionsufficient degree of reduction of of the biological agents content in waste. the biological agents content in waste.

The following categories of waste can be treated by The following categories of waste can be treated by steam sterilizationsteam sterilization used sharp objects, syringes, tubes…used sharp objects, syringes, tubes… broken glass, objects from the smaller health facilitiesbroken glass, objects from the smaller health facilities blood and contaminated fluids…blood and contaminated fluids… nonrecognizable tissue from diagnostic procedures, nonrecognizable tissue from diagnostic procedures,

nonsurgicla waste originated from hemodialysis and nonsurgicla waste originated from hemodialysis and peritoneal dialysisperitoneal dialysis

tufers, materials stained with blood and other bodily tufers, materials stained with blood and other bodily secretions and excretions, towels, diapers messy bodily secretions and excretions, towels, diapers messy bodily fluids and/or excretions…fluids and/or excretions…

Health institutions equipped with Health institutions equipped with system for treatment of IMWsystem for treatment of IMW

"Technical assistance in"Technical assistance in management of management of medical waste“medical waste“ Administrativ district of Administrativ district of SSouth Baouth Bačkačka::

Clinical center of Vojvodina,Clinical center of Vojvodina, Institute for Pulmonary Diseases of VojvodinInstitute for Pulmonary Diseases of Vojvodina,a, Institute for Public health of Vojvodina,Institute for Public health of Vojvodina, Health center of Novi Sad.Health center of Novi Sad.

Clinical center of Vojvodina: Clinical center of Vojvodina: General Hospital in Novi Sad,General Hospital in Novi Sad, Maternity and nursery in Novi Sad,Maternity and nursery in Novi Sad, ChildrenChildren‘‘s Hospital in Novi Sad.s Hospital in Novi Sad.

Health center of Novi Sad – all health centers Health center of Novi Sad – all health centers in administrativ district of Novi Sad.in administrativ district of Novi Sad.

Steps in the process of IMW treatmentSteps in the process of IMW treatment

SeparationSeparation of waste in the place of generation; of waste in the place of generation; Transportation of the waste to treatment facility;Transportation of the waste to treatment facility; MeasurmentMeasurment of obtained waste; of obtained waste; Treatment of the IMW in Treatment of the IMW in autoclavesautoclaves;; Sterilized IMW is Sterilized IMW is fragmentedfragmented;; After fragmentation, infectiv medical waste (IMW) is After fragmentation, infectiv medical waste (IMW) is

ready to be disposed;ready to be disposed; Sterilized and fragmented IMW is desoposed in to Sterilized and fragmented IMW is desoposed in to

conventional containers for comunal waste and then conventional containers for comunal waste and then transported to a landfill;transported to a landfill;

Once closed bages and containers do not have to be Once closed bages and containers do not have to be open throughout the whole treatment proces.open throughout the whole treatment proces.

Clinical center of Clinical center of VojvodinaVojvodina

3 autoclaves in clinical center of Novi Sad are donation from EU3 autoclaves in clinical center of Novi Sad are donation from EU

Clinical center of Clinical center of VojvodinaVojvodina

equippementequippement for waste for waste fragmentationfragmentation isis also donat also donateded from EU from EU

Clinical center of Clinical center of VojvodinaVojvodina

Containers and bags for IMW which are in use in Clinical Containers and bags for IMW which are in use in Clinical center of Novi Sadcenter of Novi Sad (yellow colour is reserved for IMW) (yellow colour is reserved for IMW)

Health Center of Novi SadHealth Center of Novi Sad

There are 36 Health centers which are included in There are 36 Health centers which are included in institution of Health center of Novi Sad and which use institution of Health center of Novi Sad and which use one facility one facility equippeequipped d for treatment of IMWfor treatment of IMW..

Employees who work Employees who work iin the plant for treatment of IMW n the plant for treatment of IMW are are trained trained technical technical workerworkers of Health Center of Novi s of Health Center of Novi Sad. Sad.

Some private clinics have sigened contract with Health Some private clinics have sigened contract with Health center of Novi Sad for use of their facilitiy, as they do center of Novi Sad for use of their facilitiy, as they do not own the equippementfor treatment of IMW.not own the equippementfor treatment of IMW.

Maintenance of equippement for IMW treatment is Maintenance of equippement for IMW treatment is performened by privete thired party licenced for this performened by privete thired party licenced for this operation.operation.

CConclusions onclusions

DONATION EU to SERBIA

who pay now for operational, transport, maintenance and how much, why and where

Landfill?