Military Hygiene and Hygiene in Emergency Situations - K.O. Pashka 2005

Fundamentals of organizing sanitary and hygienic measures in the ground forces during peacetime emergencies and wartime. Hygiene of field quartering of troops and the population.
Sanitation and waste management of healthcare facilities in emergency areas

The disinfection of waste from healthcare facilities (HCFs) located in emergency zones or deployed for disaster relief is an urgent public health and environmental issue. When organized systems for the collection, transportation, and disposal of waste generated in HCFs are disrupted or absent, the risk of infection among patients and staff increases, along with the contamination¹ of clinical and diagnostic facilities by pathogenic microorganisms, as well as environmental pollution.

WHO classifies HCF waste into 5 categories according to their hazard level:

Category 1 - general (administrative): minor trash, packaging Materials, paper, kitchen and food waste, Glass, porcelain, and general office refuse.

Category 2 - potentially hazardous: sharp objects (needles, syringes, broken glass, ward cleaning waste), anatomical pathology waste, unused medicines, used bandages and tampons, Blood-stained spoiled clothing, blood, and blood products.

Category 3 - chemical: toxic waste - Solvents, Reagents, cleaning agents, paints, varnishes, lubricants, etc.

Category 4 - special: waste containing pathogenic microorganisms and Viruses that require special control, collection, and disposal measures; mercury-containing waste.

Category 5 - radioactive: low- and high-level radioactive waste requiring special storage, collection, and disposal conditions (subject to state regulation).

¹ contaminato, -onis, f, (Lat.) - contamination, pollution.

In addition, waste generated in HCFs is divided into 5 groups:

- municipal solid waste and similar waste with which patients have no contact (Group A);

- food waste (Group B);

- epidemiologically safe medical waste (Group C);

- epidemiologically hazardous medical waste (Group D);

- waste very similar in composition to industrial waste (Group E).

To prevent any epidemiologically hazardous situation that may arise during the disposal of medical waste classified as Group D, mandatory preliminary disinfection is required. The specific method to be applied in each HCF is further defined by internal guidelines. Group B food waste undergoes thermal Treatment only if, According to the veterinary service's Conclusion, it can be used in subsidiary farming after such disinfection. However, food scraps from infectious disease, dermatovenereological, and phthisiatric departments must be pre-disinfected without fail, as they belong to Group D. Group E waste, being environmentally hazardous, requires special care during collection, storage, and transportation. The requirements for organizing the collection and removal systems for Groups A and C waste are roughly similar and have no significant peculiarities.

Establishing an integrated system for the collection, temporary storage, and disposal of medical waste within HCFs must comply with key organizational principles that ensure epidemiological and environmental safety, such as:

- optimal placement of primary collection points within HCF departments, equipped with appropriate hermetically sealed containers tailored to the profile of the diagnostic and treatment units and The Nature of the waste collected;

- reliable transportation of epidemiologically hazardous sealed packages or other containers from primary collection points to temporary storage sites (container yard), and onward to the disposal facility, achieved through a rational transport network within each HCF and dedicated vehicle fleets;

- installation of refrigeration equipment in HCFs for the temporary storage of certain waste groups when ambient temperatures rise above 20 °C;

- thermal disposal of medical waste within HCFs and the organized removal of slag and ash;

- Organization and Execution of disinfection at all Stages of the transport chain, including the provision of a technically equipped area for washing and disinfecting transport containers and HCF-owned specialized vehicles;

- development and Structure/175.html">Implementation of a rational system of organizational and anti-epidemic measures in the event of an emergency;

Depending on available equipment, various technologies can be used for waste disposal: incineration; pyrolysis; steam and gas sterilization (disinfection); chemical, microwave, electrothermal, plasma, laser, and electron beam treatment; infrared and gamma irradiation.

The most widespread disposal technologies abroad are incineration, pyrolysis, and the plasma method. They ensure complete waste sterilization, reduce waste mass and volume by up to 90%, and maintain environmental cleanliness during the disposal process.

When installing waste incineration units (for the destruction of any type of waste), it is essential to consider that:

- waste incineration plants should be located aside and topographically lower than camps or temporary housing, on the leeward side relative to them;

- waste incineration equipment must be installed on a waterproof base made of cement or compacted soil;

- air intake openings in the unit should be sufficiently wide. To ensure efficient aeration, they are made cone-shaped with the narrow end pointing inward;

- grate bars are movably mounted on Supports, which prevents Interference with their thermal expansion during heating;

- the positioning of the waste charging door should allow for feeding new portions of material into the unit from above;

- stoking holes must be designed to allow for intensive stoking and cleaning of the internal surfaces of the waste incineration unit;

- to ensure effective draft in a closed waste incinerator, a tall exhaust stack must be installed.