In a holistic concern about the safety aspects of our kit, our team was wondering where medical devices like Rapidemic would end up after use, and whether the end-of-life could pose a threat to a population group. Members of our team had the opportunity to visit the Dutch national medical waste treatment plant, Zavin, in Dordrecht (NL), with the hope to obtain some answers to our questions. We also sat down with the head of operations, Ron Roffel and exchanged ideas and doubts about our project. Yearly, the company processes 10 000 tons of medical waste from the entire country and is expected to process 12 200 tons next year. This is way over their capacity and has therefore made a partnership with a Belgian waste treatment company. Zavin was originally designed to dispose of 6000 tons per year.
Zavin Operations
Incinceration is still a golden standard for high throughput and safe management of medical waste management. More local waste management options are autoclavation and subsequent separation and landfilling, or the Pharmafilter technology, which enables breakdown of biomaterials. "Medical waste" comprises used needles, vaccines, antibiotica, hormones, genetically modified organisms, protective gear or tissue samples, or any material that may have been in contact with potentially infected patients. However, the definition may vary regionally.
In the Netherlands, this waste is disposed off in blue or grey (90% recycled content) platic bins, specially designed for the company that are hermetically sealed off on-site and picked up by large waste companies. About 3 to 6% of the total hospital waste generated is sent to Zavin. The bins are brought to Zavin, where the bins are deposited on a conveyer belt to the incinerator where they are burnt at 850-1100°C in their entirety. This way, workers are not exposed to any health risks due to contact with the dangerous waste. The waste is burnt by a pretreatment oven (850 centigrade) and the oven (1100 centigrade). The remains are transported upwards for cooling and then put in a water bath while the waste that was not sufficiently desintegrated is sorted and subjected to another round of incineration. The toxic gasses that are generated are burned in the post-treatment oven at 1200 centigrade and carefully monitored. Whilst cooling down, the gas is then further purified using an extraction column (the gas is purified by passing through water). Brown coal cokes pellets and a 18% NH3 solution is also put into the post-treatment to reduce emissions, the latter to reduce NOx emissions. The remaining product, called slack, is then transported for landfilling.
Legally, it is not allowed the recover any energy or materials from medical waste, as it is considered dangerous. However, Zavin recovers energy from the burning process to sustain their activities and some of the other companies on the Dordrecht Industrial Parc. For example, they collect their steam and transport it to their neighbours HVC to be used in their turbine. When compared to other methods, incineration is considered to be a rather sustainable option for medical waste processing. Autoclaving still requires large amounts of energy but also intensive labor for subsequent sorting or polluting landfilling. Another downside of autoclaving is that the product will still eventually be incinerated at the end of its life, which begs the question if the autoclaving option is pure for economics.
And Beyond?
The Netherlands and surrounding West European countries like Belgium and Germany have similar waste treatment processes. However, medical waste from small medical practices, but more importantly from general practitioners or even individuals is not always disposed off properly (as dangerous and contaminated waste), and can end up in the waste streams for regular household waste. This is due to the fact that laws and regulations for businesses and organizations are more vigorously reinforced than for individuals. Pregnancy tests, antibiotics and other medicines, syringes and other medical waste disposed by the latter are therefore processed in a manner than can pose a real threat for workers. Nonetheless, these are countries where the systems and regulations in place are rather efficient, and they are the rare few. Indeed, the vast majority of countries do not have such waste collection systems in place. Medical waste is then disposed off and treated inasmuch the facilities present can enable and sustain it. This can be, (informal) landfilling or backyard incineration. In some countries, it is not unusual to see children play in heaps of mixed waste, which poses a very serious health risk for the communities.
Responsibility
Companies in the field of medical devices are making efforts towards increasing the accessibility of tests and their ease-of-use, for instance, by developing self-tests. Through contacting various business stakeholders, we have understood that developers do not actively reflect on the end-of-life of their products nor adopt an integrated, holistic attitude or an anticipative approach in the product development process. Indeed, businesses do not take on the responsibility for potential safety or the environmental risks that might occur after the product has exited the factory gates.
Regulations on (medical) waste differ regionally or nationally, sometimes further complicated by a dubious/ debatable implementation. As a consequence, even when these regulations are enforced, the waste may still present risks for communities (as seen for the NL). As a consequence, we truly believe that the responsibility for ensuring the safety of medical devices lies with the manufacturer, and the latter should integrate these, regardless of the theoretical regulations set in the intended geographical share of its market. This is why in this project, we actively aimed to address all the hazards that can arise along with the lifespan of a single device when commercialized even in the most isolated or less developed areas of the world.
