San-i-pak - Articles & Issues

Dr. Jacob George, a consultant for Al Essa Medical, takes a look at the options for the safe disposal of hazardous infectious waste

Management of ever-increasing quantities of wastes is an environmental crisis that is presently affecting Kuwait. The cost of solid waste management in Kuwait is expected to rise to over KD 20 million ($68 m) in 2005. Experts predict that by the year end, over 1,117,000 tonnes of solid waste will be generated which would require 189,000 sq m of landfill area. This would result in an additional burden on land, 70-80 per cent of which is allocated for the petroleum industry. The post-war scenario in Iraq has witnessed a boom in housing projects in Kuwait. Prime land for housing is becoming scarcer day by day and remains exorbitantly priced. The economic growth in Kuwait has resulted in increasing levels of population and human activity that have resulted in a tremendous increase in waste generation.

In Kuwait, domestic industrial and non-infectious medical waste was usually disposed of in domestic waste pits, which were decommissioned gravel and sand quarries that served as landfills. The results of this were methane, odour, leachate and land slides.

However, a few years ago the government took the bold initiative to rehabilitate a solid waste disposal site at Sabah Al-Salem into a 306 unit housing scheme, at a cost of KD 2.23 million. Another noteworthy initiative was the pivotal role played by the Kuwait Environmental Protection Agency in the KD 5.3 million rehabilitation project for sites in the Al-Qurain residential area.

Generation of medical waste is an integral part of healthcare activity in Kuwait. The increasing awareness of the quantity and diversity of medical waste generated by hospitals and clinics and the risk it poses to environmental quality and human health have raised public concerns world over. According to a report published by the Kuwait Municipality, a total of 13 tonnes of hazardous waste is being generated everyday from the local healthcare industry.

The most commonly practices method for treatment of infectious medical waste in Kuwait has been by incineration. However, due to problems with the long term operational efficiency of incinerators and the proximity of some incinerators to residential areas, leading to air pollution and increasing health and environmental problems, have resulted in decommissioning of several incinerator sites and the shifting of incineration to Mina Al-Shuaiba industrial area. Therefore, a sound biomedical waste management treatment alternative is required and the establishment of native industries to promote alternative, environmentally sound waste treatment technologies remains the need of the hour.

Under Article 37 of Management of Healthcare Waste by Kuwait EPA, healthcare waste is divided into non-hazardous waste (not considered a biohazard) and infectious waste. Hazardous waste is defines as ‘waste produced by contaminated sources or possible contamination by liquid or chemical or radioactive contaminants which are considered hazardous to individuals and society and to the environment during its production, usage, storage and movement or when trying to get rid of it’.

With a view to promoting environmentally sustainable treatment of infectious medical waste in Kuwait, Al Essa Medical and Scientific Company has been pioneering the introduction of steam sterilization of waste. Based on environmental impact assessment (EIA) studious on this environmental friendly technology to the US and Europe, the company embarked on the road to achieving some objectives of sustainable development in 1999. That is, to prevent air quality degradation and protect the health of the people in the short and long term. The proposal was envisaged to be in line with integrated waste management policies of the Environmental Affairs Department, Kuwait Municipality and health officials’ recommendations from the Gulf Co-operation Council (GCC).

In 1999, Al Essa Medical was instrumental in equipping the Al-Mowassat hospital with alternative waste treatment systems. With approval from Kuwait EOA, Al-Mowassat became the first private hospital in Kuwait to install an alternative waste treatment system from Sanipak Inc of USA. Two waste sterilizers, the 130-2P, which runs at 11.4 kg per hour and the 230-3P (39.5 kg per hour) were commissioned and are running successfully until now.

In 2004, the Ministry of Public Health dispatched its teams to study existing waste treatment facilities at private hospitals and issued directives for the hospitals to install their own in-house alternative waste treatment systems, wither autoclaving or microwaving, with shredding facilities. Although presently Al-Mowassat hospital is considering the purchase of a shredding device in compliance with Ministry of Public Health directives, the hospital remains a pioneer in successfully employing this facility for treating only its in-house generated waste. This facility could also be extended to treat infectious waste from other smaller clinics and hospitals in Salmiya area.

In 2004, Al Essa Medical successfully installed, commissioned a state-of-the-art waste sterilization system fro the prestigious Health Science Centre in the Faculty of Medicine at Kuwait University. The Sanipak 341-L, comprising the sterilizer, shredder and compactor, was approved by Kuwait EPA. As a Kuwaiti company experienced in the field of alternative technologies, Al-Essa Medical has the capabilities to offer other treatment technologies like microwave based disinfection and e-beam technology. In tune with its motto ‘A Commitment to Excellence…’ the company is committed to working with the environment and health authorities in promoting environmentally safe and health-safe technologies to all healthcare institutions and ensuring a safe and healthy environment for all people in Kuwait.

The Sanipak Process in a nutshell
Red infectious waste bags are automatically or manually loaded into the sterilizer and the chamber liner is unclamped and the bag is tucker into the sterilizer. The chamber is then rotated into the sterilize position, the load door closed and the sterilization cycle initiated. The sterilizer first creates a vacuum within the chamber by removing the air. This air and any airborne microorganisms are mixed with 307° F (153°C) steam. Then steam enters the sterilization chamber until the chamber reaches a minimum of 38 psi (1.82kPa) of pressure. After a temperature of 270°F is achieved, a 30-minute timer is automatically activated. Within minutes, the chamber will reach its ultimate temperature of 281-284°F. Test run by various certification agencies have proven that temperatures in excess of 270°F, combined with a pre-vacuum cycle, will kill Bacillus stearothermophilus. Upon the completion of the sterilization cycle, the system then vents down and the steam is run through a diffuser where it is recondensed to water. After the sterilization cycle is completed, the operator will open the load door and initiate the dump cycle. The waste within the sterilization chamber is then automatically discharged to the compaction chamber and compacted into the roll-off container. One of the unique advantages of the Sanipak system is that it is a dual waste system, that simultaneously compacts general waste while sterilizing infectious waste. General waste is dumped directly from the tilt truck cart (or other specified cart) into the compactor. Once the compactor ‘start’ button is pressed, the compactor ram pushes the waste into the roll-off container. When the roll-off container is full, it is disconnected from the hauler truck and hauled to the landfill area or designated disposal site.

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