COMPLIANCE (YES, NO or COMMENT)
Item Description			Medical Waste Incinerator, 100 to 120 Kg/hr
Item Quantity			3 No.
Support			East African Networking Project
Point of Installation (Hospitals)			Wajir, Kitale, and Busia District Hospitals
General Description Supply, delivery, installation and commissioning of a medical waste incinerator suitable for disposal of Medical, General and Pathological waste in a safe and clean environment. The unit shall consist of two chambers and operate on the principal of controlled air and temperature. The unit shall consist a particulate remover (scrubbers) as stipulated in waste management regulations, 2006 (Legal notice NO. 121 of 29th September, 2006). The Unit shall be fully automatic and controlled by an automatic electronic controlled system except loading system which shall be manual.   The unit shall be capable of incinerating between 100 to 120 kg of solid medical waste per hour. It shall be constructed from mild or aluminized steel lined with refractory material.
Composition 2.1     Main unit 2.2   Accessories
Performance specifications
3.1	Main unit
3.1.1	Application	For incineration, general and pathological
3.1.2	Capacity	100 – 120 kg/h burn rate
3.1.3	Type	Two combustion chambers type; primary and Secondary, controlled/forced combustion air type with a flue gas emission scrubbing unit
3.1.4	Operating time	Minimum 8 hours daily
3.1.5	Operating temperature	From 850 0C to 1200 0C, Automatic controlled
3.1.6	Residual Ash	5 to 10%
3.2     Primary Chamber
3.2.1	Construction	Constructed from heavy duty mild or aluminized steel Or equal and approved equivalent
3.2.2	Insulation material	Refractory material lining similar or equal to calcium Silicate and hot face combination of heavy duty brickwork
3.2.3	Internal Construction	Fixed hearth type complete with gratings, concave bottom and charging door, lined with refractory material
3.2.4	Charging Door	Suitable for manual loading of wastes and with smooth Dear seal equivalent of Ceramic seals with hinges.
3.2.5	Door Lock	Automatic, Electric type
3.2.6	Ash removal door	Provided, for removing resultant bottom ash leftovers                             from the Primary chamber
3.2.7	Gratings	Provided
3.2.8	Loading	Manual loading of waste
3.2.9	Primary Burner	Fully automatic, with fuel, temperature and speed   controls with ignition system   flame detector                                                           Air fan Complete with safety features, flame failure                                                                     Diesel fired fuel injector type Flange mounted
3.2.10	Blower	Provided. 3 phase for supplying excess combustion air through the distribution system with speed control system
3.2.11	Temperature	Minimum exit 850 0C
3.2.12	Observation port	To be provided with protective glass type
3.3     Secondary chamber
3.3.1	Construction	Constructed from heavy duty mild or aluminized steel or equal and approved equivalent
3.3.2	Insulation	Refractory material lining
3.3.3	Combustion Temperatures	Above 850 0C, controlled electronically
3.3.4	Gas residue or retention time	> 2 second at minimum 850 0C
3.3.5	Secondary Burner	Provided, Diesel fired, Fully automatic, with fuel, temperature and speed controls With ignition system Flame detector Air fan Complete with safety features, flame failure Diesel fired fuel injector type Flange mounted
3.3.6	Ejector	Provided, Venturi type, for cooling the flue gases
3.3.7	Combustion Air Fan	Provided for supplying combustion and creating a negative drift and turbulences with variable speed control
3.3.8	Temperature	Maximum 1600 0C
3.4         Chimney
3.4.1	Construction	Constructed from heavy duty mild or aluminized steel   or equal and approved equivalent Refractory material lining
3.4.2	Length	10 m above ground
3.4.3	Bore	about 350mm diameter
3.4.4	Discharge temperatures	About 850 0C
3.4.5	Emissions	To comply with standards in section 9 of third schedule of the waste management regulations, 2006.
3.5       Electrical System
3.5.1	Control unit	Fully automatic with microprocessor based control unit (PLC) automating all operations of the incinerator Capable of monitoring all incinerator parameters With large LCD or similar for display of all progress Parameters i.e. temperature of primary and second chambers , turbulence and time With status lamp With user of defined and differed programmed operating cycles for different type of loads/conditions With safety interlocks, display of errors and visible and audio alarms. System for continuous emission monitoring
3.5.2	Isolator switch	Supply and install isolator switch 100A, 3 phase, 415V, 50Hz, for the incinerator unit , including all necessary cables 10m
3.5.3	Distribution Board	Supply and install distribution board 100 A, 3 phase 415V, 50Hz, complete with MCBs suitable for the rating of the incinerator unit and associated equipment. Wiring   to be done according IEE regulations.
3.5.4	Wiring	Make provisions for wiring the isolator switch, Distribution Board control unit to Incinerator and all associated equipment inside to incinerator room. Working length 20m. Wiring to be done using PVC Sheath cable on steel conduits and trucking and in accordance with IEE regulations
3.6     Fuel System
3.6.1	Fuel Tank	Supply and install storage fuel tank inside the incinerator room at an elevated position (about 1.5 m above the floor)
		Tank capacity, 500 liters, constructed from preferable suitable metallic material or high temperature resistance material
	Fuel type	Diesel
3.6.2	Fuel Lines	Supply and install fuel lines, complete with fuel filters, pump, sight glass, fuel level and all other safety devices and connect from fuel tank to incinerator. Working length , 20m
	Fuel pipe material	Special copper pipes or similar and approved materials
Physical characteristics
4.1	Main unit	Floor mounted, stand alone, fixed hearth type
	Dimensions	About 2.5 x 2.8m (WxD)
Operating environment
5.1	Power Requirements	415V, A/C 50Hz, Three phase, with PE
	Ambient temperature	10 0C to 40 0C
	Relatively humidity	40% to 90%
6               Accessories
6.1	Rack, 2 m long	1 piece
	Waste cart, stainless steel	1 piece
Spare parts
7.1	Burner	1 set
7.2	Fuel Filters	6 sets
7.3	All other spare parts                 required for replacement during and after 12 months of operations.	2 pieces of each
8               Quality Standards
8.2	Manufacturing standards	Environmental Management and Coordination Act, 1999 Legal Notice No.121 of 29th September 1999 on                                                                           waste Management Regulations EU waste incinerator Directive- EC 76/2000 BS 3316 WHO Emission Standards World Bank Emission Standards or any other internationally recognized standards
	Conformity to standards	CE marked or any other internationally recognized documents
9           Local back up service
9.1	Available	Should be available locally
9.2	Capacity to service equipment	Manufacturer/Agent shall have adequate facilities, spare parts, qualified and skilled technical staff to offer comprehensive maintenance   service and spare parts sales for the lifespan of the incinerator
10         Delivery point
10.1	KEMSA	For inspection and verification
10.2	Moi Voi, Makindu Maragua, Eldama Ravine and Isiolo Hospitals	For installation, testing, NEMA Certification and commissioning
11	Pre installation works	Provide for foundation plinth, necessary plumbing works, Fuel piping works, Elevated Diesel oil storage tank, electrical works including cabling, trunking and switch gears required to install the incinerator and all its accessories to required IEE standards
12	Installation and testing	Complete installation and setup of the incinerator at designated as per manufacturer’s instructions Provide fuel and test run the incinerator for 3 hours daily for 7 days
13	Training
13.1	User training	On site user training on operation and daily up keep
13.2	Maintenance training	On-site maintenance training on Preventive Maintenance, repair and trouble shooting
14	Technical Documentations
14.1	User manuals	2 sets
14.2	Service manuals	2 sets
14.3	Drawings	2 sets
15         Commissioning
15.1	Testing and Commissioning of the machine to the satisfaction of the user
16	Warranty
16.1	Equipment	Minimum of one year after commissioning on all parts.
16.2	Equipment system	Nil
Maintenance contract
17.2	Comprehensive preventive & repair           service	Provided a 12 months comprehensive preventive and repair service contract inclusive of spare parts and material from date of commissioning

incenratory

Gilgit-Baltistan Environmental Protection Agency intends to mange hospital waste through piloting of three major districts headquarter hospitals (Hunza/Nagar, Skardu, Chillas and Gilgit and city hospital Gilgit) through integrated Solid/Biomedical Waste management.

 

For this purpose GBEPA has planned to procure solid/biomedical waste incinerators with other necessary equipment through open competitive Single stage (two envelop technical and financial) bidding as per PPRA Rules on the criteria as under:

 

 

		All bids will be evaluated under Single stage two envelope bidding
		procedures,  The bidders will be evaluated on technical and financial grounds.
		Price will be taken into account after technical evaluation.
1.		CRITERIA FOR TECHNICAL EVALUTAION

For technical evaluation the bidder/firm has to be evaluated under the following criteria;

1. Relevant past experience of establishment of integrated solid/bio-medical waste management system
2. Capabilities with respect to personnel, equipment, technical expertise, and supply networ

• Appropriate capacity building opportunities

 

1. Repair and maintenance of equipment and machinery to be supplied

 

1. Capacity building of staff to operate machinery/equipment

 

1. Manufacturing/ dealerships within Pakistan

 

• Financial strength of bidder/firm
• Technical, financial capabilities with adequate managerial capabilities of the fir

 

1. Legal status of firm, blacklisting /any litigation in any court of law within Pa
2. The bidders have to submit bidding documents in a sealed package with Single Stage two envelop bidding (technical and financial).
3. Technical and financial Evaluation committee reserves the right to accept or reject any or all bidders/firms without assigning any reason there

• The evaluation of Bids will be based on technical evaluation by the Evaluation Committee which is based on 500 points (100 points for each technical capacities)

TECHNICAL EVALUATION POINT 500

S#	Technical Expertise	Maximum Points	Points obtained
01	Past     experience     and   proof   of     Installation       &operation/manufacturing/distribution of integrated solid/bio-medical waste Incinerators in working conditions in any public sector hospitals in Pakistan	100
02	Personnel, equipment, technical expertise,manufacturing /dealership of machinery within Pakistan.	100
03	Capacity building opportunities for running andmaintenance of machinery/equipment (Trainings of hospital staff)	100
04	Repair Maintenance of machinery and equipment aftersale and service facility	100
05	Financial strength of firm/bidder	100

 

 

After acceptance of technical and financial bids the bidder/firm has to supply the equipment/machinery as per specifications provided by GBEPA, equipment will be supplied on respective districts as per agreement with 30 days of the issuance of supply order.

 

2. Equipment List

Following is the list of Machinery and Equipment

1. Incinerators 05 Nos
2. Primary Waste Collection Bins Sets (Red, Yellow, Green) Bulk

• Secondary Containers (Red, Yellow, Green) Bulk

1. Tertiary Containers Eight (optional)
2. Personal Protective Equipment (PPEs) Bulk
   1. Gloves
   2. Masks
   3. Shoes
   4. Coverall (protective Clothing for waste handling workers)

 

VI.	Trolleys for Waste Transfer	Thirty
VII.	Signage’s	Bulk
VIII.	Standard shovels or tools for waste loading/unloading	Bulk
IX.	Tagging Bags for waste handling at primary level	Bulk
3.	Specifications

Following are the detailed specifications and terms and conditions for each equipment / machines;

• Incinerator:

Chamber                                           Double

Burning Rate                                  10 kg per hour (for two incinerators)

Burning Rate                                  20 kg per hour (for three incinerators)

Loading Method                          Manual

No of Burners                                Single for 10 kg/hour and Double for 20 kg per hour Fuel       Diesel and Natural Gas

Warm Up Time                              Not more than 20 minutes

Temperature controller          Digital

Power Supply                                 Single Phase 220V

Chimney Height                            20 feet from ground level

Wet and Dry Scrubbers           Optional

 

Terms and Conditions for Incinerator Supply:

 

• General

 

1. Bidders shall provide 5% of the total cost as bid securit
2. Bidders are   required   to    provide    warranty    of    the    equipment    as    per recommendations of the Original Equipment Manufacturer (OEM).

 

 

• Bidders should provide printed brochures of the equipment elaborating details of specifications, brand name, model and capacity etc.

 

1. Bidders / firms should also provide proof of past experience of establishment of hospital waste management system and piloting with training and capacity building of procuring agency /authorities with proof of dealership within Pakistan and availability of spare parts in fut

 

• Specific
  1. Installation and Operation:

 

1. Transportation and installation at selected points in the project are
2. Construction of civil infrastructure as per requirement of the Incinerators, transfer and transport system in consultation and consent of GB-EP
3. Fixing of incinerators at designated sites with standardized procedures as per agreed by GBEP
4. Technical testing of the installed incinerators for minimum of two week

1. Training:
   1. Develop standard operating procedures in consultation with GBEP
   2. Develop training module for plant operator’s in-lines with agreed SOPS.
   3. Impart training to Hospital Plant operators (incinerator operators).

• Maintenance:
  1. Develop manual for minor maintenance for troublesh
  2. Provide basic accessories required to maintain operation as spare parts of the equipmen
  3. Provide one year free of cost maintenance of the system according to the warranty provided by OEM

1. Work Plan/Documentation
   1. Provide detailed work plan including BOQ’s (bill of quantities).

 

1. Submit detailed design of the each project with spe

 

1. Submission of project completion report

 

1. Financial Plan
   1. 50% of the approved tender cost will be given on transportation and installation off machinery/equipment at project
   2. 30% of the remaining cost will be paid on completion of II & III.
   3. 20% will be paid after satisfactory results of the project or mutual agreement of both partie

 

• Specifications for Primary and Secondary Waste Collection Bins:

Color                           Red, Yellow and Green

Material                      Plastic or Composite

Strength                      Strong enough to handle waste

Made                           By any reputed company

 

• Specifications for Waste Transfer Trolleys

Color                           Any

Material                      Metallic

Strength                      Strong enough to carry waste of 10 kg to a distance of 100 meters

Made                           By any reputed company

• Specifications for Signage’s

Signage’s and billboards of standard designs and material for installation at various locations of Hospitals carrying waste handling and awareness messages.

 

• Specifications for PPE’s

Gloves, Masks and Safety shoes made by any reputed company complying international safety standards.

 

• Specifications for Standard Shovels or Tools for Waste Loading / Unloading

Metallic or any other standard material made any reputed company

 

• Specifications for Tagging Bags

Plastic bags with printed identification of the purpose of infectious waste handling at primary level

TABLE OF CONTENTS

1. OBJECTIVE OF THE PROGRAMME 4
2. STRUCTURE OF THE PROGRAMME 4
3. COLLABORATORS INVOLVED IN THE PROGRAMME 4
4. STAKEHOLDERS INVOLVED IN THE PROGRAMME 4
5. LABORATORY TRIALS 5
6. FIELD TRIALS 13

 

 

 

1.     OBJECTIVE OF THE PROGRAMME

 

The objective of the programme is to select technical criteria suitable for tender specification purposes that will enable the South African Department of Health to obtain the services and equipment necessary for the primary health care clinics to carry out small-scale incineration for the disposal of medical waste.

 

2.     STRUCTURE OF THE PROGRAMME

 

The test programme is being carried out in phases, as follows:

Phase 1         A scoping study to decide the responsibility of the different parties and

consensus on the test criteria and boundaries of the laboratory tests. The criteria for accepting an incinerator on trial was approved by all parties involved.

Phase 2         Laboratory tests with a ranking of each incinerator and the selection of the incinerators to be used in the field trials.

Phase 3         Completion of field trials, to assess the effectiveness of each incinerator under field conditions.

Phase 4         Preparation of a tender specification and recommendations to the DoH for the implementation of an ongoing incineration programme.

 

This document provides feedback on phases 2 and 3 of the work.

 

 

 

3.     COLLABORATORS INVOLVED IN THE PROGRAMME

 

SA Collaborative Centre for Cold Chain Management SA National Department of Health

CSIR

Pharmaceutical Society of SA World Health Organisation UNICEF

 

 

 

4.     STAKEHOLDERS INVOLVED IN THE PROGRAMME

 

The following stakeholders participated in the steering committee:

 

• Dept of Health (National & provincial levels) (DoH)
• Dept of Occupational Health & Safety (National & provincial levels)
• Dept of Environmental Affairs & Tourism (National & provincial levels) (DEAT)
• Dept of Water Affairs & Forestry (National & provincial levels) (DWAF)
• Dept of Labour (National & provincial levels) (DoL)
• National Waste Management Strategy Group
• SA Local Government Association (SALGA)
• SA National Civics Organisation (SANCO)
• National Education, Health and Allied Workers Union (NEHAWU)

 

 

• Democratic Nurses Organisation of SA (DENOSA)
• Medecins Sans Frontieres
• SA Association of Community Pharmacists
• Mamelodi Community Health Committee
• Pharmaceutical Society of SA
• CSIR
• UNICEF
• WHO
• SA Federation of Hospital Engineers

 

 

International visitors:

• Dr Luiz Diaz – WHO Geneva and International Waste Management , USA
• Mr Joost van den Noortgate – Medecins Sans Frontieres, Belgium

 

 

 

 

5.     LABORATORY TRIALS

 

5.1.   Objective of the laboratory trials

 

• Rank the performance of submitted units to the following criteria:

y Occupational safety

y Impact on public health from emissions

y The destruction efficiency

y The usability for the available staff

 

• The panel of experts for the ranking consisted of a:

y Professional nurse; Mrs Dorette Kotze from the SA National Department of Health

y Emission specialist; Dr Dave Rogers from the CSIR

y Combustion Engineer; Mr Brian North from the CSIR

 

5.2.   Incinerators received for evaluation

 

Name used in report	Model no.	Description	Manufacturer
C&S Marketing incinerator	SafeWaste Model Turbo 2000Vi	Electrically operated fan supplies combustion air – no auxiliary fuel	C&S Marketing cc.
Molope Gas incinerator	Medcin 400 Medical Waste Incinerator	Gas-fired incinerator	Molope Integrated Waste Management
Molope Auto incinerator	Molope Auto Medical Waste Incinerator	Auto-combust incinerator – uses wood or coal as additional fuel to facilitate incineration	Molope Integrated Waste Management

 

Name used in report	Model no.	Description	Manufacturer
PaHuOy incinerator	Turbo Stove	Auto-combust unit, using no additional fuel or forced air supply	Pa-Hu Oy

 

 

5.3.   Emission testing: laboratory method

 

Sampling of emissions followed the US-EPA Method 5G dilution tunnel method for stove emissions. Adjustments to the design were made to account for flames extending up to 0.5 m above the tip of the incinerator and the drop out of large pieces of ash. Emissions were extracted into a duct for isokinetic sampling of particulate emissions. The sampling arrangement is shown by a schematic in Figure 1. A photograph of the operation over the Molope gas fired incinerator unit is shown in Figure 2.

 

All tests were performed according to specified operating procedures. The instructions provided by the supplier of the equipment were followed in the case of the C&S Marketing Unit. No operating procedures were supplied with the Molope Gas, Molope auto-combustion and PaHuOy units. These procedures were established by the CSIR personnel using their previous experience together with information provided by the supplier.

 

Test facilities were set up at the CSIR and measurements were carried out under an ISO9001 system using standard EPA test procedures or modifications made at the CSIR.

 

 

 

Figure 1. Schematic diagram of the laboratory set-up

 

 

 

 

 

Figure 2:Photograph of air intake sampling hood over Molope gas incinerator

 

 

 

5.4.   RANKING RESULTS OF THE LABORATORY TRIALS

 

Using the criteria listed under section 4.1 above, the incinerators were ranked as followed:

 

	Molope gas-fired unit	Molope wood-fired unit	C&S electric unit	PaHuOy wood-fired unit
Safety	6.8	4.8	5.5	3.3
Health	5.5	3.5	4.3	2.3
Destruction	9	2	6	1
Usability	2	3	3	5
Average	5.8	3.3	4.7	2.9

 

 

5.5.   EMISSION RESULTS OF THE LABORATORY TRIALS

 

Quantitative measurements were used to rank the units in terms of destruction efficiency and the potential to produce hazardous emissions.

 

Conformance to the South African Department of Environmental Affairs and Tourism’s (DEAT) recommended guidelines on emissions from Large Scale Medical Waste Incinerators is summarized in Table 1. The measurements are listed1 in Table 2.

 

 

 

Table 1: Summary qualitative results

 

Parameter Measured	Units	Molope   Gas-fired	Molope   Wood-fired	C&S   Electric	PaHuOy   Wood-fired	SA DEAT Guidelines
Stack height	m	×	×	×	×	3 m above nearest building
Gas velocity	m/s	×	×	×	×	10
Residence time	s	×	×	×	×	2
Minimum combustion temperature	ºC	4	×	×	×	> 850
Gas combustion efficiency	%	×	×	×	×	99.99
Particulate emissions	mg/Nm3	4	×	4	×	180
Cl as HCl	mg/Nm3	×	4	4	×	< 30
F as HF	mg/Nm3	4	4	4	4	< 30
Metals	mg/Nm3	4	×	×	4	< 0.5 and < 0.05

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1 Emission concentrations are reported in accordance with the South African reporting requirements, ie, normalized to Normal Temperature (0

oC) and Pressure (101.3 kPa) and corrected to a nominal concentration of

8 % of CO2 on a dry gas basis. If a measurement fell below the detection limit for the method is it either reported as the detection limit or as N.D., ie, not detectable.

 

 

Table 2: Detailed quantitative results

 

Parameter Measured *	Units	Molope gas	Molope auto	C&S	PaHuOy	SA Process Guide1	Comments
Stack height	m	1.8	1.8	1.9	0.3	3 m above nearest building	None of these unite has a stack. The height of the exhaust vent is taken as the stack height. If it is above the respiration zone of the operator it provides some protection from exposure to smoke.
Gas velocity	m/s	0.8	0.5	1.1	0.5	10	Gas velocities vary across the stack for the Molope gas, Molope auto-combustion, and the PaHuOy units.
Residence time	s	0.4	0.7	0.6	0.4	2	Residence time is taken to be the total combustion time, and the maximum achievable
Minimum combustion zone temperature	oC	800 -900	400 – 650	600 – 800	500 – 700	> 850	Molope auto-combustion temperatures are expected to be higher as the centre of the combustion zone is not expected to be at the measurement location.
CO2 at the stack tip	% vol	2.64	3.75	4.9	3.25	8.0	Actual emission concentrations are less than the values reported here, which are normalized to 8 % CO2 and Normal temperature and pressure for reporting purposes. They are lower between 4 to 8 times.
Gas	%	99.91-	98.8 -98.4	99.69-	98.9	99.99	Most accurate measurement in
Combustion		99.70		99.03			the duct where mixing of exhaust
efficiency							gases is complete. Results of two trials.
Particulate emissions entrained in exhaust gas	mg/Nm3	102	197	130	338	180	The total emissions are the sum of the both entrained and un- entrained particulates. Emissions are lower than expected for such units and this is attributed to the absence of raking which is the major source of particulate emissions from incinerators without an emission control system.
Particulate fall- out	mg/Nm3	42	105	n.d.	n.d.	–	Large pieces of paper and cardboard ash rained out of the emissions. Totalling 0.8 to 2 g over a +/- 2 minute period.
Soot in particulates	%	42.2	58.1	48.7	84.8	–	Correlates directly with gas combustion efficiency

 

1 Emission concentrations are reported in accordance with the South African reporting requirements, ie, Normalized to Normal Temperature (0

oC) and Pressure (101.3 kPa) and corrected to a nominal concentration of

8 % of CO2 on a dry gas basis. If a measurement fell below the detection limit for the method is it either reported as the detection limit or as N.D., ie, not detectable.

 

Parameter Measured *	Units	Molope gas	Molope auto	C&S	PaHuOy	SA Process Guide1	Comments
% ash residual from medical waste	%	14.8	12.9	15.6	21.7	–	Measurement of destruction efficiency of the incinerator. Typical commercial units operate at 85-90 % mass reduction. PaHuOy is lower due to the melting and unburnt plastic.
Cl as HCl	mg/Nm3	46	13	25	35 & 542	< 30	PaHuOy chloride concentrations varied considerably. This is expected due to the variability of the feed composition.
F as HF	mg/Nm3	< 6	< 1	<2	< 1	< 30	Fluoride not found in this waste.
Arsenic (As)	mg/Nm3	< 0.2	< 0.2	< 0.2	< 0.2	0.5	Arsenic is not expected as a solid.
Lead (Pb)	mg/Nm3	< 0.4	< 0.4	< 0.4	< 0.4	0.5	Lead not expected in waste
Cadmium (Cd)	mg/Nm3	< 0.2	< 0.2	< 0.2	< 0.2	0.05	Sensitivity of the x-ray method is adequate for ranking. Higher sensitivity not sought for this trial.
Chromium (Cr)	mg/Nm3	< 0.1	0.7	0.7	< 0.1.	0.5	Chromium relative to iron ranges between 12 and 25% which is consistent with stainless steel needles
Manganese (Mn)	mg/Nm3	< 0.1	0.3	0.3	< 0.1	0.5	Manganese may be a component in the stainless steel needle.
Nickel (Ni)	mg/Nm3	< 0.1	0.3	< 0.1	< 0.1	0.5	Nickel may be a component in the needle.
Antimony (Sb)	mg/Nm3	< 0.2	< 0.2	< 0.2	< 0.2	0.5	Not expected in this waste.
Barium (Ba)	mg/Nm3	< 0.5	< 0.5	< 0.5	< 0.5	0.5	Lower sensitivity due to presence in the filter material
Silver (Ag)	mg/Nm3	< 0.2	< 0.2	< 0.2	< 0.2	0.5	Not expected in this waste.
Cobalt (Co)	mg/Nm3	< 0.1	< 0.1	< 0.1	< 0.1	0.5	Cobalt might be present in stainless steel.
Copper (Cu)	mg/Nm3	< 0.5	< 0.5	< 0.5	< 0.5	0.5	Lower sensitivity due to copper in the sample blanks. May be background in the analytical equipment.
Tin (Sn)	mg/Nm3	< 0.2	< 0.2	< 0.2	< 0.2	0.5	Tin not expected in this waste.
Vanadium (V)	mg/Nm3	< 0.1	< 0.1	0.4	< 0.1	0.5	Vanadium might be present in stainless steel.
Thallium (Tl)	mg/Nm3	< 0.4	< 0.4	< 0.4	< 0.4	0.05	Not expected in this waste. Sensitivity of the x-ray method is adequate for ranking. Higher sensitivity not sought for this trial.

 

 

 

5.6.   MAIN FINDINGS OF THE LABORATORY TRIALS

 

The main conclusions drawn from the trials are as follows:

 

:::          All four units can be used to render medical waste non-infectious, and to destroy syringes or render needles unsuitable for reuse.

:::                           The largest potential health hazard arises from the emissions of smoke and soot.              (the combustion efficiency of all units lies outside the

regulatory standards). The risk to health can be reduced by training operators to avoid the smoke or by installation of a chimney at the site.

:::          The emissions from small scale incinerators are expected to be lower than those from a wood fire, but higher than a conventional fire-brick-

lined multi-chambered incinerator.

:::          Incomplete combustion, and the substantial formation of smoke at low height rendered the PaHuOy unit unacceptable for field trials. Figure 3

below shows this unit during a trial burn. Molten plastic flowed out of

the incinerator, blocked the primary combustion air feed vents, and burnt outside of the unit.

 

 

 

Figure 3: Photo of PaHuOy incinerator during trial burn

 

 

5.7.   COMPARISON OF THE FIELDS TRIALS WITH THE LABORATORY TRIALS

 

The CSIR performed a quantitative trial in the field for gas combustion efficiency, temperature profiles and mass destruction rate on the Molope Auto wood-fired unit at the Mogale Clinic.

 

The results of this trial are compared to the laboratory trial results below:

 

• Waste loading: Disposable rubber gloves were observed in addition to needles syringes, glass vials, bandages, dressings, and paper w
• Temperatures and combustion efficiency: The same performance in gas combustion        efficiency   was    obtained    for    wood    .

Temperatures were higher but for a shorter time and this was

correlated with the type of wood available to the clinic. The fuel was burnt out before the medical waste was destroyed completely and this resulted in lower temperatures, lower combustion efficiency and higher emissions while burning the waste.

• Emissions: Large amounts of black smoke were observed and this was correlated directly to cooling of the unit as the wood fuel was exhausted

prior to full ignition of the waste.

• Destruction efficiency: The destruction efficiency was similar to that in the laboratory measurem
• Usability: The unit is difficult to control as the result of the variability of the quality of wood
• Acceptability: the smoke was not acceptable to the clinic, the community, or the local

 

It was concluded that:

• The performance with fuel alone indicates that laboratory trial data can be used to predict emissions in the
• The Molope Auto unit is too difficult to control for the available staff and fuel at the

 

 

 

5.8.   RECOMMENDATIONS FROM THE LABORATORY TRIALS

 

The following recommendations are made as the result of the laboratory trials:

:::     A comprehensive operating manual must be supplied with each unit.

Adequate training in the operation of the units must be provided, especially focussed on safety issues.

:::     It is recommended that the height of the exhaust vent on all units be

addressed.     In order to facilitate the dispersion of emissions and reduce the exposure risk of the operators.

:::     The suppliers of the incinerators must provide instructions for the safe handling and disposal of ash.

 

 

 

5.9.   RECOMMENDATIONS FROM THE STEERING COMMITTEE

 

 

 

After completion of the laboratory trials, the project steering committee recommended that the Molope Gas and C&S Marketing units be submitted for field testing. The Molope Auto was recommended for field testing on the condition that the manufacturer modified the ash grate so as to prevent the spillage of partially burnt needles and syringes.

 

 

 

6.     FIELD TRIALS

 

6.1.   OBJECTIVE OF THE FIELD TRIALS

 

The objective of the field trials was to obtain information in the field and assess the strengths and weaknesses of each of the incinerators during use at primary health care clinics.

 

A participative decision making process was used for the trials. It was based on expert technical evaluation by the CSIR and the National Department of Health as well as participation in the trials by experienced end users and participating advisors. All decisions were made by the Steering Committee, which consisted of representatives of stakeholders in the clinical and medical waste disposal process. These included representatives from the National, Provincial, and Local Government departments of Health, Safety and the Environment, as well as Professional Associations, Unions, NGOs, UNICEF, the WHO and local community representatives.

 

6.2.   CLINIC SELECTION

 

The Provinces in which the trials were done selected clinics for the field trials. The criteria set by the Steering Committee for the selection of the clinics were the following:

 

• Location must be rural or under-serviced with

y No medical waste removal

y No existing incineration

y No transport

• It must be in a high-density population area
• Acceptable environmental conditions must prevail
• Community acceptance must be obtained
• Operator skill level to be used must be at a level of illiteracy

 

The clinics that were selected were as follows:

 

• Steinkopf Clinic – Northern Cape Province – Gas incinerator

 

 

• Marydale Clinic – Northern Cape Province – Gas incinerator
• Mogale Clinic – Gauteng Province             – Auto combustion

incinerator, wood-fired.

• Chwezi Clinic – KwaZulu-Natal Province – Gas incinerator
• Ethembeni Clinic- KwaZulu-Natal Province – Auto-combustion electrical

incinerator

 

 

 

 

 

 

MAP OF SOUTH AFRICA INDICATING WHERE THE CLINICS ARE SITUATED

 

 

 

 

 

 

 

 

NORTHERN PROVINCE

 

GAUTENG PROVINCE

 

 

 

 

 

NORTH WEST PROVINCE

MPUMALANGA PROVINCE

 

 

 

 

 

 

FREE STATE PROVINCE

 

 

NORTHERN CAPE PROVINCE

 

 

KWAZULU-NATAL PROVINCE

 

I:\UnitPublic\Valerie\Technet 99\Working papers\Session 3\rogers.doc

 

 

 

EASTERN CAPE PROVINCE

 

 

WESTERN CAPE PROVINCE

 

 

6.3.   COORDINATION OF THE TRIALS

 

The criteria for the ranking of the incinerators in accordance with performance in the field were:

 

• Safety (occupational and public health)
• Destruction capability
• Usability
• Community acceptability

 

The South African National Department of Health coordinated the field trials.

 

Information regarding the field trials as well as questionnaires were supplied to the coordinators in the participating provinces.

 

The team in the field consisted of the operator, supervisor and inspector (coordinator). The manufacturer of the incinerators did the training of the operators.

 

The questionnaires used during the trials were set so as to obtain information with regard to the criteria set for the ranking of the incinerators in accordance with performance in the field. The questionnaires were received from the clinics at two-weekly intervals.

 

Questions with regard to the criteria were the following:

 

A.  SAFETY (occupational and public health)

 

• Smoke Emission

y Volume and thickness

y Colour

y Odour

• Ash Content
• Are the filled sharps boxes and soiled dressings stored in a locked location while waiting to be incinerated?

 

 

 

B.  DESTRUCTION CAPABILITY

 

• Destruction Rate

y Complete

y Partial

y Minimal

y Residue content

 

C.  USABILITY (for the available staff)

• Can the incinerator be used easily?

 

 

• Is the process of incineration safe?
• Has training been successful?
• Is protective clothing such as gloves, goggles, dust masks and safety boots available?

 

D.  COMMUNITY ACCEPTABILITY

 

• What is the opinion of the following persons on the use of the incinerator?

y Operator

y Nurse

y Head of the clinic

y Local Authority representative

y Community leader

 

During the trials the clinics were visited and the incinerators evaluated by members of the Steering Committee and the CSIR as well as Dr L Diaz from WHO, Mr M Lainejoki from UNICEF and the coordinator from the National Department of Health.

 

6.4.   QUESTIONNAIRE RESULTS

 

6.4.1.      MOGALE CLINIC

 

Type of incinerator at the clinic: Molope Auto-Combustion (Fired with wood)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Figure 4 & 5: Molope Auto wood-fired incinerator during field trials at Mogale clinic

 

 

A.               SAFETY (occupational and public health)

 

1. The process of incineration with this unit was considered by the operator, supervisor and the inspector as unsafe because there is no protective cage around the During the process the incinerator becomes very hot and this could result in injury to the operator.

 

2. The smoke emission of this incinerator had a volume and thickness which was heavy and black, with a distinct unpleasant odour, and was considered This could cause a pollution problem.

 

 

 

B.               DESTRUCTION CAPABILITY

 

1. The needles and vials were not completely destroyed but were rendered unsuitable for re-use.

 

2. The soft medical waste was completely destroy

 

 

 

C.               USABILITY

 

Difficulty in controlling the operating temperature and avoiding smoke emissions made this incinerator user unfriendly.

 

D.               COMMUNITY ACCEPTABILITY

 

As a result of the heavy, black smoke emission the unit was not acceptable to the community.

 

 

6.4.2.      ETHEMBENI CLINIC:

 

 

Figure 6: C&S Marketing Auto Combust Electrical Incinerator At Ethembeni Clinic

 

 

 

Type Of Incinerator: C&S Auto-Combustion (Uses an electrically actuated fan)

 

 

 

A.               SAFETY (occupational and public health)

 

1. The operator, supervisor and inspector considered this incinerator easy to operate with no danger to the Removal of the ash from the drum for disposal in a pit is, however, considered difficult, as the drum is heavy. Removal of the incinerator lid before it has been allowed to cool has been identified as a potential danger to the operator.

 

2. Emission of smoke from this incinerator was not considered ex The volume and thickness was evaluated as moderate with no pollution experienced.

 

 

 

B.               DESTRUCTION CAPABILITY

 

1. The needles and vials were not completely destroyed but were rendered unsuitable for re-use.
2. The soft medical waste was completely destroy

 

 

 

C.               USABILITY

 

Considered user friendly by operator, supervisor and inspector.

 

D.               COMMUNITY ACCEPTABILITY

 

The incinerator was accepted by the community and was not considered to be harmful.

 

 

 

6.4.3.      CHWEZI CLINIC, MARYDALE CLINIC AND STEINKOPF CLINIC:

 

Type of incinerator: Molope Gas incinerator

 

Figure 7:       Molope Gas incinerator during field trials at Marydale clinic

 

A.               SAFETY (occupational and public health)

 

1. The operator, supervisor and inspector considered this incinerator easy to operate with minimal danger to the
2. Smoke emissions were not excessive and were reported to be minim

 

B.               DESTRUCTION CAPABILITY

 

1. Sharps not completely destroyed but were rendered unsuitable for re-use.

 

 

2. Soft medical waste completely destroy

 

C.               USABILITY

 

This incinerator was considered user friendly.

 

 

 

D.               COMMUNITY ACCEPTABILITY

 

 

 

The incinerator was accepted by the community and was not considered to be harmful.

 

 

 

6.5.   RANKING

 

 

INCINERATOR	RANKING
Molope Gas	1
C&S Auto-Combustion (Uses electrical fan)	2
Molope Auto- Combustion (Fired with wood, coal also an option)	3

 

 

 

 

6.6.   OUTCOME OF THE FIELD TRIALS

 

Incinerator	Safety	Destruction Capability	Usability	Community Acceptability
Molope Gas	Good	Good	Good	Good
C&S Auto- Combustion (Uses Electricity)	Good	Good	Good	Good
Molope Auto- Combust Incinerator	Un-Acceptable	Good	Un-Acceptable	Un-Acceptable

 

Controlled air medical waste incinerator designed for incineration of bio-medical waste generated at a blood-processing center. The waste to be treated mainly includes bio-waste (i.e. bodily fluids), infectious and hazardous waste such as syringes, needles, and other medical waste (i.e. silicon rubbers, plastic, textiles, papers, packs, etc.)

Standards
1) Bidder or Manufacturer ISO 9001 Certified
2) Respecting international emission standards
Electrical characteristics
3) A 230V, 60Hz single-phase electrical source.
4) Protections against over-voltage and over-current line conditions.
5) Compliance with applicable Ghanaian standards and regulations.
Operational characteristics
6) Two-stage incineration with dual chamber combustion
7) Burn rate: 15 – 20 Kg/h
8) Capacity: not less than 130 L
9) Concentrations of most pollutants in stack gases below detection limits
10) Diesel fuel
11) Electronic system control
12) Easy to operate and minimal training
13) Any accessory or dedicated device necessary to the proper functioning and utilization of the equipment included

Description        Minimum Requirements
Design standard    Multiple chamber incinerator to the design of EPA  standards, Air pollution control
Description of the Chimney    Top mounted, self supporting
Incinerator performance    150kg/hr
Refuse     Hospital waste and carcasses
Recommended Temperatures    Minimum 1000⁰C
Dimensions:
•    Length
•    Width
•    Height
•    Extra width for burners    At least 3000mm
Loading door opening    Minimum 700mm x 600mm
Hearth area    5.00square meters
Description or grate/hearth    A full hearth supplied to prevent contaminated liquids from flowing into the ash pit without being incinerated
Primary chamber volume    At least 3 cubic meters
Mixing chamber volume    At least 1 cubic meters
Settling chamber volume    At least 3 cubic meters
Weight excluding chimney    15, 000kg at manufacture
Firing tools supplied    Hoe, Poker and rake
Material of construction    •    Case – 5mm mild steel.
•    Bracing – Heavy angle and channel.
•    Hearth – 1550⁰C castable general purpose high strength, high abrasion resistant monolithic refractory concrete.
•    Ashing door – High grade cast iron.
•    Loading door – 5mm mild steel lined with 1550⁰C castable  general purpose high strength, high abrasion resistant monolithic refractory concrete.
Refractory  concrete:
•    Alumina content of refractory
•    Refractory thickness
•    Minimum 49%
•    At least 127mm.
Insulation  to walls     1000⁰C Castable insulation
Chimney stack:
•    Chimney
•    Height from base    •    3.5 mm mild steel
•    9 meters above ground level and clear the highest point of the building by not less than 3 meters
•    At least 560mm
•    At least 750Kg
Controls:
Draught

Air supply

Electric

•    Barometric indicator, door operated draught limiter

•    Built-in forced heated air ducts, primary and secondary (intensifier)
•    Control panel – Circuit breakers, main switch, timer, pilot lights, 2 set point pyrometer and one set point pyrometer.
Electricity supply required    415 Volts Three phase.
Auxiliary  fuel    Electrically operated only
Emission     Multiple chamber design with inbuilt emission control
Paint: Case and stack    400⁰C Heat Resistant Grey
Temperature of case    100⁰C

INCINERATOR (WASTE INCINERATOR)
Designed to burn disposables that can and should be destroyed on-site. Theses wastes include infectious and

contaminated “red bag.” Surgical dressings, plastic test devices and other wastes
Fast, complete, efficient waste disposal
Dual chamber combustion, Chambers insulated and lined with high temperature refractory. Programmable digital

temperature controls, temperature indicators and charge recorder. Modulating control for fuel and air lowers

fuel consumption.
Minimum installation and start up time
Aluminized steel jacket lined with refractory and firebrick. Monitors recorders and other accessory equipment

should be available.
Charging system:
•    Vertical charge door on primary chamber.
•    Pneumatic or hydraulic ram charging system.
•    Auto shut down of the door after charging.
•    Primary and secondary chamber temperature displayed and recorded (optional)
Charging rate:
•    Up to 100kgs per hour of waste or red bag waste rated at 2200 BTU’s per kg.
Fuel:-     Natural Gas
Capacity (Cubic Mtr):    1.65M3 or more
Ave Capacity:    100kg per hour
Secondary Chamber Capacity (CubicMtr) :3.88 or more
Length (mm):    1880 or better
Width (mm):    1280 or better
Height Incl. Flue (mm):    7700 or better
Ash  Door Opening (mm):    475×900 or better
Min. Operating temperature:    90 degree centigrade
Max, Operating Temperature:    1350 degree centigrade
Residency time in Second Chamber:    2 sec
Temperature Monitoring: Both for primary and secondary chambers.
Loading SystemManual/semi-automatic
Waste destruction efficiency:> 90% by weight
Filter: Ceramic or other equivalent filters in order to reduce the induction of hazardous air pollutants,

particulates, co,dioxin/furane into the atmosphere.
De ashing system: Manual/semi-automatic.
The System must be quoted complete with:-
•    Plumbing
•    Electrical panels
•    Civil works
•    Waste collection Trolleys

Finish/ Paint:-
High Quality heat resistant, two layers high-grade epoxy Paint coating.
Installed Power (Electric Voltage): 440V/ 50 Hz
Waste Management Equipment must have ;
Mobile loading trolley:    06 No’s – For transportation of hospital waste from wards to incinerator site/ room,

Opening from the top.
WASTE BINS MOBILE:    06 No’s-Made of Plastic, in blue color with a cover flap.
Plastic Bags:    2000 no’s each in Red and Yellow color.
Heavy Duty Gloves Pairs: For Waste handling staff-06 Pairs
Long Shoes Pairs:    For waste handling – 06 Pairs.
Make:  UK, EEC, USA.

1) minimum with a burning area (kiln) of at least 2.8 m3   (KG/Hour is not the driving factor)

2) Large – Must reach 1300 degree temperature or higher and approved for medical waste burning and be capable of burning > 4 m3 of materials at one time (the Hurikan 500 incinerator model or equivalent).
– fully EU legislation ABPR 1069/2009 compliant and for efficiency and clean emissions

Construction:
Mild steel welded fabrication consisting of sheet steel and structural section supports and bracings. Articulated trailer supplied in compliance with the country of destination.

Lining:
Primary chamber – Consists of a monolithic high grade refractory concrete with high grade insulation backing, . Utilising a refractory hearth or equivalent for continuous ash removal.

Secondary Chamber – Consists of high density, low thermal mass refractory ceramic fibre with an innovative low emissivity protective coating.

SPECIFICATIONS OF THE MEDICAL/BIOLOGICAL WASTE INCINERATOR

• It should be a three chambered incinerator
• The load capacity of 250 kg
• The housing for the incinerator should be able to withstand the temperatures and other operational requirements.
• The chimney should have a strong refractory lining of special type of cement to withstand temperatures more than 1200^o
• It should have a strong base for the machine to keep it stable, firm and secure during its operational lifespan.
• The primary (combustion) and the secondary (scorching) chambers to be fitted with burners for effective combustion.
• In the third chamber, scrubbers and precipitators will need to be installed as pollution control equipment before emission of gases into the atmosphere.
• A system for continuous emission Monitoring and Environmental Monitoring.
• A mechanism with which to treat the waste water before discharge into the sewerage system.
• Temperature control and monitoring devices (probe thermometer) should be availed to ensure that the right temperatures are attained in the chambers during operation.
• Motor (fans) sufficient to induce enough air into the combustion chambers and direct the gases towards the flue 9 chimney).
• High power electricity and emergency generator connection for automated ignition purposes.
• The chimney should be tall enough and be at least one meter above the tallest building in the vicinity.
• The fuel tank (industrial diesel) to be constructed next to but out side the incinerator housing for security purposes and to prevent fire hazards. Capacity of 250.

Other Requirements

• Training of all the personnel involved in health care waste (HCW) management.

The Automatic Feeding system of the Incinerator

• Automatic waste loading mechanism with conveyor belts. These will lead the waste into the first primary chamber.
• An Automatic bottom ashes discharge system.