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  1. Moderator
  2. la chaîne d'approvisionnement et de la logistique
  3. lundi 10 octobre 2005
POST 00842E : DESTRUCTION OF PLASTIC SYRINGES Follow-up on Posts 00819E, 00824E, 00830E, 00832E and 00835E 10 October 2005 _____________________________________ This posting contains five contributions. The first is from Michael R. Werner (mailto:mwerner@npautomation.com) from the United States. Note : I would suggest that Michael and others interested in the system he described also consult Annex 3 of the Antalya Meeting report. The second contribution, originally in French is from Bibata Pare (mailto:bibatapare@yahoo.fr) from Burkina Faso. The third and fourth contributions are respectively from Anil Varshney (mailto:anilvarshney@yahoo.com) from India and Ville Lehto (mailto:ville.lehto@mediburner.com) from Finland, who continue their exchange. I am not too clear on which basis Anil's cost calculations are made. However, he rightly raises the issue of poorly-operated, poorly maintained and/or non-functional incinerators, not only in India, but around the world. Finally, a contribution from Yves Chartier (mailto:chartiery@who.int) from WHO in Geneva. _____________________________________ I am new to this forum and would beg forgiveness in advance if this message is off topic. My group just completed a project in which the intent was to create a simple robust and inexpensive device that would render used sharps safe while reducing their volume and obviate the need for, and the problems associated with, incineration. The system was to use locally available fuels and no electricity. We developed a stove capable of melting ten ounces of syringe/needle combination (roughly equivalent to a small collection box) using between four and six ounces of locally available fuel (sticks, crop waste, dung or equivalent from a btu/lb standpoint). The sharps are fully encapsulated in the syringe/box matrix material rendering them 'safe'. The system : The process does not reach decomposition temperatures so very little emissions result aside from those produced by the fuel. Temperatures and cycle duration ensure sterilization of pathogens. The final product is a compact poly brick that could be buried safely or transported more easily and at a much lower cost. This system is simple, scalable, durable and relatively compact. We expect the system could easily be produced for between US$50 and US$100. At this time the project is shelved as it is not clear that there is a need/interest for this device or a channel through which to distribute it. I intend to post a summary of our development project on the web in the next week or two. Any input or thoughts on this matter would be appreciated. Sincerely, Michael R. Werner, New Paradigm Automation Williston, Vermont 05495 --------------------------- I do agree with the moderator's comments. I am not sure if this is recommended by WHO, but it seems logical that a waste collection circuit be identified within a region or district in order to have all the wastes at a single point. There incineration could be better controlled with adequate destruction means, instead of having them scattered in multi9ple sites. In any event this is the system we are trying to put in place in our countries. For that purpose, the circuit for vaccines supply could be used effectively and at a lower cost, at least for routine EPI. While waiting for better solutions for the destruction of medical wastes (in cases where incineration is unsuitable), it is our duty to do everything possible to protect our populations from risks. Mme PARE Bibata Logistique/Burkina Faso -------------------------- Dear Ville Thanks for the information on uncontrolled burning. My inference has been drawn from the field, where small incinerators at CHC, District hospitals have failed to function thus syringes and hospital waste lies half burnt to unburnt and later ends up in the municipal waste while absolute total additions of the waste burning will be constant , the difference is when burnt in large quantities emissions are confined to small area while small amounts are sufficiently burnt with good air circulation by prodding with a wooden stick ( In India people use lots of material like cow dung, wood, old news paper, dried leaves, wood etc for burning and prodding the fire to have good air supply thus ensuring full burning in small towns and villages) When small amounts say 10 syringes are burnt at a distance of 20 - 40 kms apart the pollution due to emission is relatively is very very low than burning 10000 syringes at one spot ( which will be 1000 times more) The system to collect and store syringes is non existant and not cost effective. For example : The ANM will have to bring back the syringes from immunization site to Sub centre every week. Carrying a 100 syringes box or small boxes is in addition to other weights, when most of them do not have any transport support. Find safe storage at SC rather than every month carry them to PHC Vaccine are delivered at PHC ; Sub centre collects from PHC ; no mechanism of delivery to sub centre Storage at PHC to be picked up every month thus needing additional space in the vehicle that delivers vaccines in cold boxes or the PHC will have to carry the syringes to District when they go for collecting the vaccines. The choice is between carrying used syringes or staff and other items to district. An independent collection system will cost USD 2 dollars per SC to PHC = 15 dollars a month, from PHC to district 20 USd a month = 20 x 50 = 1000 USd a month on an average = total 15 x 50 + 20 x 50 = 1750 USd a month = 20000 USD a year. This is many times more than the cost of vaccines, syringes. The choice is to choose to spend on this or buy more medicines for the people which will have greater benefit and value ( not counting cost of reforestration) and loss of value of the trees hence the inference that burning in a tin box or burying is the most suitable practical answer at the moment, until we are able to make finances available and functioning incinerators that burn the waste completely. with kind regards Anil Varshney -------------------------- Dear Claude and Anil, Many thanks for your comments! First of all I would like to correct what seems to be a misunderstanding. On-site solution doesn't necessary mean open burning. Uncontrolled burning will most probably result in harmful emissions whether or not the safety boxes are used, and I do not support that! When comparing the features of different waste management options I guess we have had visions of a different scale in our minds, and I think this has caused the confusion. For the sterilization and recycling to be feasible, the scale should be very large, the distances short and there should be a buyer for the recycled material. When I talked about an on-site solution, I thought about a site that produces less waste that is required for the profitable recycling (need for transport), but enough for the on-site small scale incineration to be cost effective. In a well controlled process the POPs would not be created and the solution would be well in line with the requirements of the Stockholm Convention. Anil's example instead is of totally different scale, when on average 10 syringes is used per site and the distance between sites is 20-40km. At this scale, I feel the suggestion of Claude is reasonable. As approximately 100 syringes can be stored in one 5 liter safety box, the additional load for the immunization team would be only one box per 10 sites (journey of 200-400km). I don't have practical experience of conducting the immunization campaigns, but one could presume that the space occupied by the safety boxes would not be too much. There would be no other related additional transport costs, as the team would visit the site anyway. I hope this time I could make things more clear than confusing! Thank you again and kind regards! Ville Lehto Marketing Manager, Mediburner Ltd Oulu, FINLAND -------------------------- Regarding the current exchange on the destruction of plastic syringes, comments made by Claude (the Moderator) reflect rather well WHO's position on the subject. The Health Care Waste Management policy document published in 2004 clearly states WHO's position regarding incineration (http://www.technet21.org/pdf_file/SHCWMen.pdf). Burning or incinerating plastic materials without any smoke control system is not a sustainable solution because of its impact on the environment and communities. Even if incinerated volumes are small, WHO adheres to the Stockholm Convention and therefore can not promote this method of waste handling. The option of removing needles from syringes is strong, but although there is a need to validate it regarding the safety of medical personnel, it has nevertheless an important advantage for the safety of waste handlers and communities. Needles can be discarded in a protected pit while syringes are collected and sent to a treatment facility that can ensure disinfection in line with country policies and shredding to reduce volume. Final disposal can be on a ground specially set for the purpose or, depending on countries materials can be recycled for producing non-food and non-medical sector items. Yves CHARTIER Public health engineer Water, Sanitation and Health Protection of the Human Environment World Health Organization ______________________________________________________________________________ ___________________________ Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:LISTSERV@listes.ulaval.ca Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de coopération internationale en santé et développement, Québec, Canada (http://www.ccisd.org) ______________________________________________________________________________


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