Dioxin-like potencies and extractable organohalogens (EOX) in medical, municipal and domestic waste incinerator ashes in Japan

Dioxins emissions from bio-medical waste incineration: A systematic review on emission factors, inventories, trends and health risk studies

COVID-19 has aggravated the biomedical waste generation all over the world and the concern for its safe disposal is on the rise. The vast majority of healthcare systems employ incineration as their treatment method considering its agility to reduce the waste volume by up to 95-96% and high-temperature inactivation of infectious biological materials. However, incinerator emission is a significant contributor of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and dioxin-like polychlorinated biphenyls (dl-PCBs) according to various national inventories across the globe. Bio-Medical Waste Incinerators (BMWIs) are the dominant form of incinerator plants in developing nations and hence BMWI emissions were found to contribute lion's share of national dioxins inventories in most of these countries. The Stockholm Convention on POPs played a key role in imbibing significant urge on the dl-POPs monitoring studies of incinerators internationally and on controlling the average incinerator emission levels. Though many national/international agencies endorse a stringent incinerator stack emission standard of 0.1 ngTEQ/Nm3, there are some differences observed in nation-to-nation regulatory scenarios. This paper reviews and reports on the dioxins emission and health risk studies associated with bio-medical waste incineration over the last three decades (1990-2020) with a comprehensive spatial and temporal emission trend analysis. An overview of important national and international regulations, national inventories and emission factors for the biomedical waste incineration sector is also reviewed in detail. The study observes that continuous regulatory monitoring and logical relaxations can enhance the performance of the existing facilities ensuring low emissions and minimal risk.

Chemical and mineral composition of fly ashes from home furnaces, and health and environmental risk related to their presence in the environment

The study presents the results of an analysis of fly ashes produced from burning of solid fuels mixed with municipal waste and assesses the environmental and health risk associated with infiltration of the selected metals to the environment. The phase composition suggests that the material is extremely mixed and diverse. Low-temperature components were mixed with substances formed in high temperatures. The variable composition of waste from different home furnaces with high content of the amorphous phase (which dissolves in water more easily than its crystalline equivalents) may be harmful to the environment and for the people. The dominant elements were silicates and aluminosilicates, such as: quartz, feldspar and plagioclase (albite). Clay minerals (kaolinite and mullite), carbonates (calcite), oxides/oxidehydroxides of iron and sulfate minerals (gypsum and anhydrite) were also abundant. The particles' major constituents were Si, Al, Ca and Fe oxides (85.5%), while S, Mg, Na, K and Ti oxides accounted for 12.6% of the total content. The risk assessment code suggested: Low Risk for As, Co, Cr, Ni, Medium Risk for Cd, Cu and Pb, and High Risk for Zn. Hazard Index (HI) calculated for non-cancerogenic substances for children was 2.35E+00. The total Risk index for children was 4.88E-05. As for adults, HI was 2.42E-01 for women, and 2.89E-01 for men, while the Risk index value was 6.85E-05 for women, and 8.48E-05 for men. The value HI > 1 points to the risk of adverse health impact on children exposed to fly ashes.

Vitrified medical wastes bottom ash in cement clinkerization. Microstructural, hydration and leaching characteristics

The present investigation focuses on the utilization of medical wastes incineration bottom ash (MBA), vitrified with soda lime recycled glass (SLRG), as an alternative raw material in cement clinkerization. Bottom ash is recovered from the bottom of the medical wastes incineration chamber, after being cooled down through quenching. It corresponds to 10-15 wt% of the initial medical wastes weight and since it has been classified in the category of hazardous wastes, its safe management has become a major environmental concern worldwide. MBA glasses of various syntheses were initially obtained during the MBA vitrification simultaneously with various amounts of silica scrap (20, 25 and 30 wt% correspondingly). The produced MBA glasses were in turn used for the production of Portland cement clinker, after sintering at 1400 °C, thus substituting traditional raw materials. Both evaluation of vitrification and sintering products was carried out by chemical and mineralogical analyses along with microstructure examination. The final cements were prepared by clinkers co-grinding in a laboratory ball mill with appropriate amounts of gypsum (≈5.0 wt%) and the evaluation of their quality was carried out by determining setting times, standard consistency, expansibility and compressive strength at 2, 7, 28 and 90 days. Finally, the leaching behaviour of the vitrified MBA and hydrated cements, together with the corresponding of the "as received" MBA, was further examined using the standard leaching tests of the Toxicity Characteristic Leaching Procedure (TCLP) and the EN 12457-2. According to the obtained results, the quality of the produced cement clinkers was not affected by the addition of the vitrified MBA in the raw meal, with the trace elements detected in all leachates measured well below the corresponding regulatory limits.

Study of PCDD/Fs distribution in fly ash, ash deposits, and bottom ash from a medical waste incinerator in China

Over the past decades in China, the number of medical waste incinerators (MWIs) has been rising rapidly, causing emissions of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs). In this study, samples of fly ash, ash deposits, and bottom ash from typical MWIs were analyzed for PCDD/Fs and their distribution characteristics. Results showed international toxic equivalent (I-TEQ) values in the range of 6.9-67 ng I-TEQ/g in fly ash and ash deposits, whereas the concentration in bottom ash was extremely low (only 1.33 pg I-TEQ/g), yet the generation of PCDD/Fs was mostly de novo synthesis in fly ash and ash deposits according to the ratio of PCDFs to PCDDs; the major distribution differences of PCDD/Fs in fly ash was manifested by the content of toxic furan 2,3,7,8-TCDF but other toxic PCDD/Fs showed similar distribution. Other findings are that 2,3,4,7,8-PeCDF had the most contribution to TEQ concentration, and that the most abundant toxic furan congener is 1,2,3,4,6,7,8-HpCDF. Correlation analysis showed that there was no significant correlation between PCDD/Fs concentration and several other physical and chemical parameters.

IMPLICATIONS

This paper is of interest because it presents the emission performances of PCDD/Fs in ash from medical waste incineration in China. PCDD/F contents in fly ash and ash deposits vary between 6.9 and 67.3 ng I-TEQ/g. However, the concentration in bottom ash was extremely low (only 1.33 x 10(-3) ng I-TEQ/g). The fingerprints of PCDD/Fs in fly ash are almost similar, except for 2,3,7,8-TCDF. There is no marked correlation between PCDD/Fs and other physicochemical properties.

Infectious risk assessment of unsafe handling practices and management of clinical solid waste

The present study was undertaken to determine the bacterial agents present in various clinical solid wastes, general waste and clinical sharp waste. The waste was collected from different wards/units in a healthcare facility in Penang Island, Malaysia. The presence of bacterial agents in clinical and general waste was determined using the conventional bacteria identification methods. Several pathogenic bacteria including opportunistic bacterial agent such as Pseudomonas aeruginosa, Salmonella spp., Klebsiella pneumoniae, Serratia marcescens, Acinetobacter baumannii, Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus pyogenes were detected in clinical solid wastes. The presence of specific pathogenic bacterial strains in clinical sharp waste was determined using 16s rDNA analysis. In this study, several nosocomial pathogenic bacteria strains of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Lysinibacillus sphaericus, Serratia marcescens, and Staphylococcus aureus were detected in clinical sharp waste. The present study suggests that waste generated from healthcare facilities should be sterilized at the point of generation in order to eliminate nosocomial infections from the general waste or either of the clinical wastes.

Treatment of clinical solid waste using a steam autoclave as a possible alternative technology to incineration

A steam autoclave was used to sterilize bacteria in clinical solid waste in order to determine an alternative to incineration technology in clinical solid waste management. The influence of contact time (0, 5, 15, 30 and 60 min) and temperature (111 °C, 121 °C and 131 °C) at automated saturated steam pressure was investigated. Results showed that with increasing contact time and temperature, the number of surviving bacteria decreased. The optimum experimental conditions as measured by degree of inactivation of bacteria were 121 °C for 15 minutes (min) for Gram negative bacteria, 121 °C and 131 °C for 60 and 30 min for Gram positive bacteria, respectively. The re-growth of bacteria in sterilized waste was also evaluated in the present study. It was found that bacterial re-growth started two days after the inactivation. The present study recommends that the steam autoclave cannot be considered as an alternative technology to incineration in clinical solid waste management.

Characterization and hazard evaluation of bottom ash produced from incinerated hospital waste

The uncontrolled disposal of bottom ash from incineration units of hazardous and infected wastes in many countries causes significant scale damage, since it contaminates the soil as well as surface and underground waters, putting both the environment and the public health at risk. In view of the above, a study of bottom ash produced at a hospital medical waste incinerator (HMWI) in Greece was conducted, in order to detect the presence of heavy metals and therefore assess its toxicity; this led to conclusions on the possible contamination of the soil as well as surface and underground waters as a result of its disposal in landfills. The study was conducted at a typical general hospital with 500-bed capacity. About 880 kg of infectious waste coming from a general hospital with all medical departments are pyrolyticly incinerated at the HMWI every day. International literature contains many references to research that characterizes bottom ash as either dangerous, not dangerous, or inert, in an effort to diagnose its proper management and disposal. For this reason, this study focuses on the characterization of bottom ash. Samples were collected from a combustion chamber, over a period of 1 year, and a series of tests were conducted, including an analysis of particle size distribution, morphology, mineralogical and chemical composition, heavy metal leaching behavior and PCDD/F.

Risk assessment of PCDD/Fs levels in human tissues related to major food items based on chemical analyses and micro-EROD assay

Nine groups of food items (freshwater fish, marine fish, pork, chicken, chicken eggs, leafy, non-leafy vegetables, rice and flour) and three types of human samples (human milk, maternal serum and cord serum) were collected for the analysis of PCDD/Fs. Results of chemical analysis revealed PCDD/Fs concentrations (pg g(-1) fat) in the following ascending order: pork (0.289 pg g(-1) fat), grass carp (Ctenopharyngodon idellus) (freshwater fish) (0.407), golden thread (Nemipterus virgatus) (marine fish) (0.511), chicken (0.529), mandarin fish (Siniperca kneri) (marine fish) (0.535), chicken egg (0.552), and snubnose pompano (Trachinotus blochii) (marine fish) (1.219). The results of micro-EROD assay showed relatively higher PCDD/Fs levels in fish (2.65 pg g(-1) fat) when compared with pork (0.47), eggs (0.33), chicken (0.13), flour (0.07), vegetables (0.05 pg g(-1) wet wt) and rice (0.05). The estimated average daily intake of PCDD/Fs of 3.51 pg EROD-TEQ/kg bw/day was within the range of WHO Tolerable Daily Intake (1-4 pg WHO-TEQ/kg bw/day) and was higher than the Provisional Tolerable Daily Intake (PMTL) (70 pg for dioxins and dioxin-like PCBs) recommended by the Joint FAO/WHO Expert Committee on Food Additives (JECFA) [Joint FAO/WHO Expert Committee on Food Additives (JECFA), Summary and conclusions of the fifty-seventh meeting, JECFA, 2001.]. Nevertheless, the current findings were significantly lower than the TDI (14 pg WHO-TEQ/kg/bw/day) recommended by the Scientific Committee on Food of the Europe Commission [European Scientific Committee on Food (EU SCF), Opinions on the SCF on the risk assessment of dioxins and dioxin-like PCBs in food, 2000.]. However, it should be noted that micro-EROD assay overestimates the PCDD/Fs levels by 2 to 7 folds which may also amplify the PCDD/Fs levels accordingly. Although the levels of PCDD/Fs obtained from micro-EROD assay were much higher than those obtained by chemical analysis by 2 to 7 folds, it provides a cost-effective and rapid screening of dioxin levels in food and human samples.

Healthcare waste management in Algeria and Mostaganem department

Algeria as other developing countries faces an array of challenges for healthcare waste management. The management of healthcare waste is of major importance due to its public health risks and potential environmental hazards. Many efforts have been made by the government authorities in order to better manage the waste from healthcare facilities. However most healthcare facilities do not comply with the principles stated in Algerian legislation. A data study was made on 95 hospitals across the country, and the three health sectors of Mostaganem department (Mostaganem, Ain Tédles, and Sidi Ali) were surveyed. The yearly production of infectious healthcare waste in this Algerian department is estimated at 92 tons, which is 1.38% of the national waste production. This represents an average of 0.15 kg/bed/day, which is lower than the national value of 0.72 kg/bed/day. The total healthcare waste by sector ranges from 0.7 to 1.22 kg/bed/day, and healthcare waste comprises 16% of total waste, which is equal to the national percentage.

Rules and management of biomedical waste at Vivekananda Polyclinic: a case study

Hospitals and other healthcare establishments have a "duty of care" for the environment and for public health, and have particular responsibilities in relation to the waste they produce (i.e., biomedical waste). Negligence, in terms of biomedical waste management, significantly contributes to polluting the environment, affects the health of human beings, and depletes natural and financial resources. In India, in view of the serious situation of biomedical waste management, the Ministry of Environment and Forests, within the Government of India, ratified the Biomedical Waste (Management and Handling) Rules, in July 1998. The present paper provides a brief description of the biomedical waste (Management and Handling) Rules 1998, and the current biomedical waste management practices in one of the premier healthcare establishments of Lucknow, the Vivekananda Polyclinic. The objective in undertaking this study was to analyse the biomedical waste management system, including policy, practice (i.e., storage, collection, transportation and disposal), and compliance with the standards prescribed under the regulatory framework. The analysis consisted of interviews with medical authorities, doctors, and paramedical staff involved in the management of the biomedical wastes in the Polyclinic. Other important stakeholders that were consulted and interviewed included environmental engineers (looking after the Biomedical Waste Cell) of the State Pollution Control Board, and randomly selected patients and visitors to the Polyclinic. A general survey of the facilities of the Polyclinic was undertaken to ascertain the efficacy of the implemented measures. The waste was quantified based on random samples collected from each ward. It was found that, although the Polyclinic in general abides by the prescribed regulations for the treatment and disposal of biomedical waste, there is a need to further build the capacity of the Polyclinic and its staff in terms of providing state-of-the-art facilities and on-going training in order to develop a model biomedical waste management system in the Polyclinic. There is also a need to create awareness among all other stakeholders about the importance of biomedical waste management and related regulations. Furthermore, healthcare waste management should go beyond data compilation, enforcement of regulations, and acquisition of better equipment. It should be supported through appropriate education, training, and the commitment of the healthcare staff and management and healthcare managers within an effective policy and legislative framework.

Perfluorinated compounds and total and extractable organic fluorine in human blood samples from China

An improved extraction (ion pairing) and cleanup (ENVI-carb and solid phase extraction) method was developed for analysis of perfluorinated compounds (PFCs) in human whole blood samples from China. Ten PFCs including PFOS, PFHxS, PFOSA, PFDoDA, PFUnDA, PFDA, PFNA, PFOA, PFHpA, and PFHxA were detected in the blood samples (n=30) from five cities (Jintan, Nanjing, Guiyang, Beijing, and Shenyang). PFOS was found to be the dominant PFC ranging from 0.446-83.1 ng/mL. Total fluorine (TF) and extractable organic fluorine (EOF) also were measured in the blood samples using combustion ion chromatography for fluorine. Analysis of known PFCs and extractable organic fluorine showed that known PFCs could account for >70% of EOF in samples from Beijing, Shenyang, and Guiyang, whereas known PFCs could only account for approximately 30% of EOF in samples from Jintan. Results of the present study indicated the presence of substantial amounts of unidentified organic fluorine in human blood samples from Jintan. Characterization and identification of these unidentified fluorinated compounds will be instructive.

Toxic environmental releases from medical waste incineration: a review

Toxic releases from medical waste incineration comprising organic emissions such as polychlorinated dibenzo-dioxin/furan (PCDD/Fs) and polycyclic aromatic hydrocarbons (PAHs), inorganic emissions and ashes containing toxic metals have been reviewed. Attempts made by various investigators to reduce/eliminate emissions have also been included. Legislations concerning emission standards for medical waste incinerators have been discussed.

Prenatal exposures to persistent organic pollutants as measured in cord blood and meconium from three localities of Zhejiang, China

Prenatal exposures to persistent organic pollutants were assessed using the levels of PCBs and organochlorine pesticides (OCPs) measured in cord blood and meconium samples from Luqiao and two other localities of the Zhejiang province in China. Luqiao is a town with the largest site for disassembly of PCB-containing obsolete transformers and electrical waste in China. The other two localities Pingqiao (100 km NW of Luqiao) and Lin'an (500 km NW of Luqiao) are towns without known electronic or electrical waste sites. A total of 23 PCB congeners (including 12 dioxin-like) and 6 OCPs were measured using the traditional GC-muECD technique. Micro-EROD bioassay was additionally used to measure TCDD-based TEQ levels of the 12 dioxin-like PCBs. Significant correlations were found between the TEQs measured by the two methods, supporting the application of micro-EROD as a practical tool for complementing the chemical analysis. The data showed that beta-HCH, p,p'-DDE, and 6 PCB congeners (101, 138, 153, 180, 183, and 187) were the predominant pollutants, with PCB138 being the best indicator (predictor) for total PCB levels. Cord blood and meconium from Luqiao have higher levels of PCBs than those from the other two localities, suggesting that a disassembly site for electronic and electric waste would provide an environment for greater exposure to these chemicals. The cord blood or meconium levels of beta-HCH, though likewise considerably high, were comparable in the three localities. Similar findings were observed for p,p'-DDE. Pollution by these OCPs might have come from past use of agricultural pesticides in the three localities.

Analysis of organic pollutants in sewage sludges from the Valencian community (Spain)

Seventeen sewage sludges were studied to analyse, with the minimum number of steps, the organic pollutants that the European Union proposes to be controlled for land application. The compounds determined were a selection of polycyclic aromatic hydrocarbons (PAHs); a selection of polychlorinated biphenyls (PCBs); di(2-ethylhexyl)phthalate (DEHP); nonylphenolic compounds, including nonylphenol (NP) and nonylphenol ethoxylates with 1 and 2 ethoxy groups (NP1EO + NP2EO); extractable organic halides (EOX); and linear alkylbenzene sulphonates (LAS) with an alkylic chain of 10 to 13 carbon atoms. The results were compared with the proposed regulatory limit values, and it was observed that NP + NP1EO + NP2EO and LAS exceeded the maximums in most samples, and DEHP exceeded some of them, whereas PAHs, PCBs, and EOX almost always went beyond the limits. The values obtained are similar to those from other countries, and it can be said that it is difficult to comply with the limits for NP + NP1EO + NP2EO and LAS in many of them, although this latter parameter was not considered in the study carried out by Leschber (2004) concerning the toxicity of sewage sludge. Statistical multivariant analysis was used to look for some relationship between the results of pollutants and the characteristics of the samples, and it was found that the ratio of NP1EO + NP2EO to NP was related to sludge treatment at the sewage plant. At the same time, it was seen that the higher values of organic pollutants belonged to digested sludges.

Metals leachability from medical waste incinerator fly ash: A case study on particle size comparison

This paper presents the results from a study of metals leachability of medical waste incinerator fly ash in Japan on the basis of particle size. Sequential extraction and Toxicity Characteristic Leaching Procedure (TCLP) analysis were carried out in order to quantify the leaching amount of metals in each categorized particle size. Sequential extraction was also subjected to identify the preference of binding matrix of metals. The results of sequential extraction showed an increase both exchangeable and carbonate associated chromium concentrations in the bigger particle size fractions. Likewise, concentrations of carbonate matrix of arsenic and tin tended to increase in the bigger particle size fractions. In contrast, exchangeable associated cadmium as well as both exchangeable and carbonate matrices of barium were found higher in the smaller particle size fractions. However, no correlation was found in Kendal-tau correlation analysis between particle size of the ash and metals leachability of the TCLP.

PCDD/F and related compounds in solid residues from municipal solid waste incineration--a literature review

Emissions of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/F) from waste incineration into the air have been a major focus of interest during the last two decades. An integrated approach to clean waste disposal has to take the occurrence of PCDD/F in all residues into account. This paper compiles published data on concentration ranges of PCDD/F and the related compounds polychlorinated biphenyls (PCB), chlorinated benzenes and phenols, as well as polyaromatic hydrocarbons (PAH) in solid residues from waste incineration in grate furnaces and their development since 1985. A short description of inertization processes for PCDD/F loaded materials is added.

Medical waste management in Korea

The management of medical waste is of great importance due to its potential environmental hazards and public health risks. In the past medical waste was often mixed with municipal solid waste and disposed of in residential waste landfills or improper treatment facilities (e.g. inadequately controlled incinerators) in Korea. In recent years, many efforts have been made by environmental regulatory agencies and waste generators to better manage the waste from healthcare facilities. This paper presents an overview of the current management practices of medical waste in Korea. Information regarding generation, composition, segregation, transportation, and disposal of medical wastes is provided and discussed. Medical waste incineration is identified as the most preferred disposal method and will be the only available treatment option in late 2005. Faced with increased regulations over toxic air emissions (e.g. dioxins and furans), all existing small incineration facilities that do not have air pollution control devices will cease operation in the next few years. Large-scale medical waste incinerators would be responsible for the treatment of medical waste generated by most healthcare facilities in Korea. It is important to point out that there is a great potential to emit air toxic pollutants from such incinerators if improperly operated and managed, because medical waste typically contains a variety of plastic materials such as polyvinyl chloride (PVC). Waste minimization and recycling, control of toxic air emissions at medical waste incinerators, and alternative treatment methods to incineration are regarded to be the major challenges in the future.

Adsorbable organic halogens (AOXs) in solid residues from hazardous and clinical waste incineration

Trace concentrations of a variety of chemicals remain in solid residues following combustion even in properly designed and operated incinerators. In the present study, the adsorbable organic halogen (AOX) levels of the solid residues, i.e., bottom ash, fly ash, and filter cake, were investigated during a 82-day of continuous operation of a Hazardous and Clinical Waste Incinerator. The distribution of halogens in the waste input prior to the incineration was also determined. The AOX levels measured in bottom ash, fly ash and filter cake were in the range of 0.014-1.879, 0.012-0.263, and 0.004-0.062 mg-Cl(-)/kg, respectively. The AOX levels are significantly low in the fly ash and filter cake due to the post-combustion process in the incinerator. At the end of the 82 days, the total AOX output in the bottom ash, fly ash, and filter cake were 571, 3.71, and 6.26 g, respectively. The partitioning of the total AOX in solid residues was 98.28, 0.64, and 1.08% for the bottom ash, fly ash and filter cake, respectively. This shows that the bottom ash is more contaminated with AOX than the other two residues.