United States Air and Energy Engineering EPA-600/8-89-062
Environmental Protection Research Laboratory
Agency Research Triangle Park, NC 27711 July 1989
Research and Development
MUNICIPAL WASTE COMBUSTION
ASSESSMENT:
MEDICAL WASTE COMBUSTION
PRACTICES AT MUNICIPAL WASTE
COMBUSTION FACILITIES
Prepared for
Office of Air Quality Planning and Standards
Prepared by
Air and Energy Engineering Research Laboratory
Research Triangle Park, NC 27711
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RESEARCH REPORTING SERIES
Research reports of the Office of Research and Development. U.S. Environmental
Protection Agency, have been grouped into nine series. These nine broad cate-
gories were established to facilitate further development and application of
environmental technology. Elimination of traditional grouping was consciously
planned to foster technology transfer and a maximum interface in related fields.
The nine series are:
1. Environmental Health Effects Research
2. Environmental Protection Technology
3., Ecological Research
4. Environmental Monitoring
5. Socioeconomic Environmental Studies
6. Scientific and Technical Assessment Reports (STAR)
7. Interagency Energy-Environment Research and Development
8. "Special" Reports
9. Miscellaneous Reports
This report has been assigned to the SPECIAL REPORTS series. This series is
reserved for reports which are intended to meet the technical information needs
of specifically targeted user groups. Reports in this series include Problem Orient-
ed Reports, Research Application Reports, and Executive Summary Documents.
Typical of these reports include state-of-the-art analyses, technology assess-
ments, reports on the results of major research and development efforts, design
manuals, and user manuals.
REVIEW NOTICE AND DISCLAIMER
The Information in this document has been funded wholly by the United
States Environmental Protection Agency under Contract No. 68-03-3365 to Energy
and Environmental Research Corporation. It has been subject to the Agency's
peer and administrative review (by both the Office of Research and Development
and the Office of Air Quality Planning and Standards), and it has been
approved for publication as an Agency document. Mention of trade names or
commercial products does not constitute endorsement or recommendation of a
commercial product by the Agency.
This document is available to the public through the National Technical Informa-
tion Service. Springfield, Virginia 22161.
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EPA-600/8-89-062
July 1989
MUNICIPAL WASTE COMBUSTION ASSESSMENT:
MEDICAL WASTE COMBUSTION PRACTICES
AT MUNICIPAL WASTE COMBUSTION FACILITIES
Prepared by
V.J. Landrum and R.G. Barton
Energy and Environmental Research Corporation
3622 Lyckan Parkway. Suite 5006
Durham. NC 27707
Under Contract No. 68-03-3365
Work Assignment No. 1-05
EPA Project Officer James D. Kilgroe
Air and Energy Engineering Research Laboratory
Research Triangle Park, NC 27711
Prepared for
U.S. Environmental Protection Agency
Office of Research and Development
Washington. DC 20460
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ABSTRACT
The EPA's Office of Air Quality Planning and Standards (OAQPS) is
developing emission standards and guidelines for new and existing municipal
waste combustors (MWCs) under sections lll(b) and lll(d) of the Clean Air Act.
This report provides background information on the burning of medical waste in
MWCs. The components of medical waste are defined and the potential air
pollution emission impacts from burning medical waste in MWCs are discussed.
MWCs in the U.S. which have reported burning medical waste are identified.
The methods employed in handling and burning the medical waste at each
facility are summarized. Important transportation, handling, and operating
procedures which must be considered with respect to potential worker safety
and health problems are discussed. Finally, current practices and regulations
concerning the incineration of medical waste in Canada and Europe are
summarized. Additional research and field tests are "needed to fully evaluate
the impacts of burning medical waste on the emission of acid gases.
dioxin/furans, and trace metals. Further work is also needed to define
combustion conditions necessary for the complete destruction of solvents.
cytotoxic chemicals, and pathogens.
This work was sponsored by the EPA's Office of Research and Development.
Air and Energy Engineering Research Laboratory in support of OAQPS.
11
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FOREWORD
Based upon its analysis of Municipal Waste Combustors (MWCs). the
Environmental Protection Agency (EPA) has determined that MWC emissions may
reasonably be anticipated to contribute to the endangerment of public health
and welfare and warrant further legislation. As a result. EPA's Office of Air
Quality Planning and Standards is developing emission standards for new MWCs
under Section lll(b) of the Clean Air Act (CAA) and guidelines for existing
MWCs under Section lll(d) of the CAA.
In support of these regulatory development efforts, the Air and Energy
Engineering Research Laboratory in EPA's Office of Research and Development
has conducted an in-depth assessment of combustion control practices to
minimize air emissions from MWCs. The results of this assessment are
documented in the following reports:
Municipal Waste Combustion Assessment: Combustion Control at New
Facilities. August 1989 (EPA-600/8-89-057)
Municipal Waste Combustion Assessment: Combustion Control at
Existing Facilities. August 1989 (EPA-600/8-89-058)
Municipal Waste Combustion Assessment: Fossil Fuel Co-Firing.
July 1989 (EPA-600/8-89-059)
Municipal Waste Combustion Assessment: Waste Co-Firing. July 1989
(EPA-600/8-89-060)
Municipal Waste Combustion Assessment: Fluidized Bed Combustion.
July 1989 (EPA-600/8-89-061)
Municipal Waste Combustion Assessment: Medical Waste Combustion
Practices at Municipal Waste Combustion Facilities, July 1989 (EPA-
600/8-89-062)
Municipal Waste Combustion Assessment: Technical Basis for Good
Combustion Practice. August 1989 (EPA-600/8-89-063)
Municipal Waste Combustion: Multi-pollutant Study. Emission Test
Report. Maine Energy Recovery Company. Refuse-Derived Fuel
Facility. Biddeford. Maine, Volume I. Summary of Results. July
1989 (EPA-600/8-89-064a)
Municipal Waste Combustion: Multi-Pollutant Study. Emission Test
Report. Mass Burn Refractory Incinerator. Montgomery County South,
Ohio. Volume I. Summary of Results. August 1989 (EPA-600/8-89-
065a)
111
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The specific objectives of this report. "Municipal Waste Combustion
Assessment: Medical Waste Combustion Practices at MWC Facilities", were to
examine and define the practice of incinerating medical waste in MWCs and to
identify the potential air pollution emission impacts, as well as potential
worker safety and health problems associated with this practice.
iv
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CONTENTS
PAGE
FOREWORD iii
1.0 INTRODUCTION 1-1
2.0 MEDICAL WASTE 2-1
2.1 Cytotoxic Chemicals 2-1
2.2 Hazardous Chemicals 2-1
2.3 Pathogens 2-2
2.4 Toxic Chemicals 2-2
2.5 Radioactive Materials 2-2
3.0 IMPACT OF MEDICAL WASTE ON COMBUSTOR EMISSIONS 3-1
4.0 IMPORTANT CONSIDERATIONS 4-1
4.1 Waste Transportation and Handling 4-1
4.2 Operation 4-2
4.3 Ash Handling 4-2
5.0 CURRENT PRACTICES - U.S. MWCs 5-1
5.1 Mass Burn Waterwall MWCs 5-1
5.2 Mass Burn Refractory MWCs 5-6
5.3 Modular Starved Air Systems 5-9
5.4 Modular Excess Air Systems 5-11
5.5 Fluidized Bed Combustors (FBCs) 5-14
6.0 CURRENT PRACTICES - EUROPEAN AND CANADIAN MWCs 6-1
6.1 Austria 6-1
6.2 Canada 1 6-3
6.3 Denmark 6-3
6.4 Federal Republic of Germany 6-5
6.5 Norway 6-7
6.6 Spain 6-7
6.7 Sweden .,6-7
6.8 Switzerland 6-7
7.0 MWC MANUFACTURERS'/SYSTEM SUPPLIERS' RECOMMENDATIONS 7-1
7.1 U.S. Manufacturers/System Suppliers 7-1
7.2 European Manufacturers/System Suppliers 7-2
8.0 PRELIMINARY RECOMMENDATIONS AND RESEARCH NEEDS 8-1
REFERENCES R-l
APPENDIX A. FOREIGN ENVIRONMENTAL PROTECTION AGENCIES A-l
-------
TABLES
TABLE
5-1 Design and Operating Procedures of MWCs
Accepting Medical Waste 5'2
5-2 Waste Types. Handling Procedures, and Reported Problems
in MWCs Accepting Medical Waste 5-3
6-1 Emission Limits for Austrian Hazardous Waste Combustors 6-2
6-2 Emission Standards for Existing Austrian MWCs with Boilers 6-4
6-3 Emission Standards for New Austrian MWCs with Boilers 6-4
6-4 Medical Waste Incineration Practices in Municipal Waste
Combustors in the Federal Republic of Germany 6-6
vi
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1.0 INTRODUCTION
The U.S. EPA is currently developing air emission standards for new and
existing municipal waste combustors (MWCs) under Section 111 of the Clean Air
Act. In addition, as part of the Medical Waste Tracking Act of 1988. EPA must
prepare a comprehensive report to Congress identifying sources, handling
procedures, transportation, treatment, and disposal of medical waste. This
report must also include an assessment of the present and potential threat
that medical waste represents to human health and the environment. It was
determined in the MWC information gathering effort that a number of MWCs burn
medical waste. The impacts of this practice on air emissions are currently
not known. Based on these uncertainties, a study was conducted to examine and
define the practice of incinerating medical waste in MWCs and identify
potential air pollution emission impacts, as well as the potential worker
safety and health problems associated with this practice. Section 2.0 of this
report defines and characterizes types of medical waste. Section 3.0
discusses possible impacts of burning medical waste on combustor emissions.
and Section 4.0 outlines important handling and operating considerations.
Facility-specific design, handling, and operating practices are discussed in
Section 5.0 for those U.S. MWCs that reportedly accept medical waste. Section
6.0 outlines European and Canadian medical waste incineration practices in
MWCs. Section .7.0 discusses the handling and operating guidelines and
philosophies of U.S. and European MWC manufacturers regarding medical waste
incineration. Section 8.0 concludes the report with a discussion of
preliminary findings, recommendations, and research needs.
1-1
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2-0 MEDICAL WASTE
Medical waste is defined as any type of waste generated by a biomedical
institution, including hospitals, medical laboratories, animal experimentation
units, and clinics. Two features of medical waste are of key importance.
First, the physical and chemical characteristics of the waste are highly
variable. The heat content of the waste can vary from a low of 1000 Btu/lb
(2.326 x 106 J/kg) for human tissues, organs, and body parts to a high of over
15.000 Btu/lb (3.489 x 10? J/kg) for plastic containers and disposable
equipment.1.2 in addition to heat content, the ash. moisture, chlorine, and
metals contents can also vary significantly from one batch of waste to
another.
Second, some of the components of medical waste require special atten-
tion. These components are:
Cytotoxic chemicals
Hazardous chemicals
Pathogens
Toxic metals
Radioactive materials
Although medical waste may contain components from one or more of the above
categories, it may also consist primarily of general refuse similar to
commercial and household waste. This general refuse often makes up the bulk
of a particular medical waste.
2.1 Cvtotoxic Chemicals
Cytotoxic chemicals are substances capable of impairing, injuring, or
killing cells. These hazardous Pharmaceuticals are used in chemotherapy.
Available information indicates that these agents may not be effectively
destroyed at temperatures below 1800°F (982°C).3
2.2 Hazardous Chemicals
A number of laboratory solvents found in medical waste are listed as
hazardous under the Resource Conservation and Recovery Act (RCRA). Included
among these hazardous solvents are:
2-1
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Acetone Ethyl alcohol Petroleum ether
2-Butanol Heptane 2-propanol
Butyl alcohol Hexane Sec-butyl alcohol
Cyclohexane Methyl alcohol Tert-butyl alcohol
Diethyl ether Methyl cellosolve Tetrahydrofuran
Ethyl acetate Pentane Xylene
These compounds present concerns due to their own hazardous characteristics.
and in addition, some serve as potential dioxin precursors.
2.3 Pathogens
Infectious waste is defined as medical waste which is capable of
producing infectious disease due to the presence of pathogens of sufficient
virulence and exposure routes to the host. (Examples: isolation waste.
cultures and infectious agents, human blood, and body parts.) Pathogens are
defined as agents capable of causing disease, such as bacteria or viruses.
Infectious waste represents about 10 percent of the total medical waste stream
and generally can be completely destroyed in a well designed and operated
incinerator. The destruction of infectious waste is one of the primary
reasons incineration is recommended for medical waste.
2.4 Toxic Chemicals
Medical waste contains toxic metals such as lead, cadmium, and mercury.
These metals may be emitted into the air or may be leached from the solid
residuals into groundwater. The principal mechanisms for the emission of
metals are entrainment of metal-bearing particles or vaporization of the metal
and transport in the gas phase from the combustion device. The vaporization
escape mechanism is particularly important because the vapor condenses into a
fine fume which may be difficult to capture with some air pollution control
devices.
2.5 Radioactive Materials
Low level radioactive waste can be present in medical waste. The
Nuclear Regulatory Commission (NRC) considers incineration to be an excellent
means of disposing of radioactive medical waste.3 Medical waste materials
deregulated by the NRC include scintillation vials and research animal
2-2
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carcasses with less than 0.05 microcuries of tritium or carbon-14 per gram.
Hazardous waste sites have been reluctant to accept this deregulated material.
and incineration has been seen as an important alternative to shallow land
burial.
MWCs burning even small percentages of medical waste must be able to
accommodate highly variable waste compositions and heat content as well as
many of the components discussed above.
2-3
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3-0 IMPACT OF MEDICAL WASTE ON COMBUSTOR EMISSIONS
Limited information is available on the emission impacts associated with
combustion of medical waste in MWC facilities. However, these impacts can be
qualitatively discussed based on the composition of medical waste and
emissions data from medical waste incinerators.
Halogenated polymers and copolymers make up a significant fraction of
medical waste. Plastic items commonly found in medical waste include
disposable instruments, syringes, petri dishes, plasticized paperware.
cutlery, plastic containers, packaging, bedpans, urine bags, respiratory
devices, and dialysis equipment. The high chlorine content of these materials
will increase the production of HC1. Baseline HC1 emissions from MWCs burning
municipal waste may range from 100 to 1000 ppm. Co-firing large amounts of
medical waste may increase baseline HC1 emissions.
Medical waste incinerators have been found to emit dioxins at about the
same concentrations as typical municipal waste incinerators (100-2000
ng/dscm).4 Although dioxin formation is more strongly correlated with system
design and operation, dioxin emissions may also be affected to some extent by
waste characteristics. Medical waste has a number of characteristics that
could lead to dioxin formation. A significant amount of aromatic compounds
are present that may serve as dioxin precursors. These compounds include
cytotoxins. laboratory wastes such as xylene. and components of various
packing materials. Medical waste also contains a high concentration of
chlorinated plastics and is highly non-homogeneous. Some components of the
waste have high moisture contents. These materials may create localized low
temperature zones within the waste bed. resulting in fuel-rich pockets that
may escape complete destruction in the furnace.
Medical waste contains such toxic metals as mercury, cadmium, and
arsenic. These metals are volatile and may vaporize in the incinerator. The
metal vapors would then be carried away in the exhaust gases. As the exhaust
gases cool, the metals would be adsorbed on the surface of particles or
condense to form small particles which are difficult to capture. A
significant fraction of the fine condensed particles may be emitted to the
atmosphere. Mercury, cadmium, and arsenic have been detected in hospital
waste incinerator exhausts.*• 5
3-1
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4-° IMPORTANT CONSIDERATIONS
Beyond emissions concerns, a number of other factors must be considered
when burning medical waste in MWCs. Transportation and handling is an
important factor when medical waste is incinerated off-site as compared to an
on-site hospital incinerator. Incinerator operation characteristics such as
temperature, and time at a given temperature are also important factors
relating to pathogen and cytotoxic chemical destruction. Ash handling and
disposal are important as well due to potential pathogen survival, radio-
activity, and metals content of the ash.
4.1 Waste Transportation and Handling
The transportation of medical waste to municipal waste combustors and
the subsequent handling of the waste at the combustor site are areas of
significant concern. As mentioned earlier, a number of medical waste
components are extremely dangerous and must not be allowed to enter the
environment. Precautions must be taken to ensure that none of the waste
materials escape during transportation. These precautions include placing the
waste in sealed, secure containers and employing procedures to deal with
accidental releases such as those that may occur during a traffic accident. A
truck itself is not considered a suitable containment system; rather it is a
transport mechanism only. All medical waste should be placed in rigid or semi-
rigid leakproof containers before being loaded onto a truck.6
Storage time and temperature are important considerations. Microbial
growth and putrefaction rates increase with temperature, resulting in
increased potency. In addition, unpleasant odors associated with decaying
organic matter are produced. Storage times should be kept as short as
possible.6
Once the waste is on site, transport containers must not be opened or
breached until they are either in the combustor or in a secure environment.
Medical waste cannot be preprocessed because of the resulting increased chance
of exposure. All personnel handling medical waste should be aware of its
nature and take proper precautions. However, if the integrity of the
containers has not been compromised, it is unlikely that specialized clothing
or respirators would be needed. All equipment used to handle waste containers
should be sterilized periodically.6
4-1
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4.2 Operation
When medical waste is burned in municipal waste incinerators, several
operational precautions must be observed. It is generally believed that
temperatures above 1800°F (982°C) are required to destroy cytotoxic
compounds.3 In addition, temperatures must be maintained at sufficient levels
to ensure the complete destruction of all pathogens in the waste. However.
one current study indicates that typical MSW operating conditions may be suffi-
cient to accomplish this.7 One final requirement is that medical waste be
rendered "unrecognizable." That is. one should not be able to recognize body
parts and medical equipment in the residual ash. This essentially requires
good burnout of all incoming waste types. This is challenging because some
materials (hospital gowns) are treated with flame retardant for safety reasons
during their normal use.
4.3 Ash Handling
The primary concern in handling the ash from an incinerator burning
medical waste is to ensure that all infectious agents have been destroyed. In
general, the conditions found in a municipal waste incinerator will be
sufficient to destroy most pathogens. However, additional concerns exist with
regard to the ability of some viruses to survive incineration. Although some
pathogen testing has been conducted on ash from both medical and municipal
waste combustors. a standardized, generally accepted test that demonstrates
the destruction of infectious agents has not yet been developed.
A second concern stems from the fact that radioactive materials may be
present in medical waste. Radioactive materials may be concentrated in the
ash. producing a material that cannot be placed in a municipal landfill. The
radioactive nature of the waste must be carefully monitored to ensure that it
does not exceed acceptable levels.
The metals present in medical waste are a third area of concern.
Studies of the ash from hospital incinerators indicate that relatively large
quantities of cadmium and lead are present.8 These metals may potentially
leach from the ash into groundwater reservoirs. The metals content of MSW ash
is currently an important issue. Therefore, the impact on the metals content
of the ash produced by an MWC also burning medical waste presents a definite
concern as well.
4-2
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5-0 CURRENT PRACTICES - U.S. MWCS
Medical waste is routinely fired in at least 12 MWC facilities.
including three mass burn waterwall. one mass burn refractory, five modular
starved air. and three modular excess air combustors. Medical waste comprises
less than 5 percent by weight of the total feed for 11 of these systems and 50
percent by weight for 1 of the modular starved air units. Three additional
MWC facilities—two mass burn refractory and one fluidized bed combustor--
previously accepted medical waste but have ceased this practice. Design and
operating characteristics of these 15 facilities are summarized in Table 5-1.
The waste types, handling procedures, and reported problems are summarized in
Table 5-2. A more detailed description of each of the facilities is outlined
in the following sections.
5.1 Mass Burn Waterwall MWCs
The Walter B. Hall Resource Recovery facility in Tulsa, OK and the Ogden
Martin Systems facility in Marion County, OR are both mass burn waterwall
combustors supplied by Ogden Martin Systems. Inc.9-10 Martin Gmbh
manufactured the grates, and Zurn supplied the boilers. The Tulsa facility
comprises three units, each with 375 tpd (340 tonnes/day) capacity. The
Marion County facility includes two units rated at 275 tpd (249 tonnes/day)
each. Both plants are state-of-the-art combustors. with only minor
differences in design and operation. Tulsa reports firing 0.2 percent by
weight medical waste and Marion County reports firing less than 1 percent.
Both facilities have ram feeders. Feed rates are automatically controlled
according to steam demand and excess oxygen levels. Five underfire air
plenums supply 60-80 percent of the total combustion air. Three rows of
overfire air jets supply the remaining portion of air to the primary
combustor. Only the underfire air is preheated. Marion uses natural gas as
auxiliary fuel to achieve temperatures of 1800°F (982°C) at the top of the
furnace prior to waste feed during start-up and until all the waste is burned
off the grate during shutdown. Tulsa does not use auxiliary fuel. The Tulsa
units are equipped with three-field ESPs with typical operating inlet gas
temperatures ranging from 375 to 5058F (190 to 263°C). Marion County is
equipped with spray dryers and fabric filters.
The Tulsa facility receives medical waste from commercial haulers. A
significantly higher tipping fee is charged for the medical waste than for
5-1
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Table 5-1. Design and Operating Procedures of MWCs Accepting Medical Waste
PLANT
INDIVIDUAL
0 OF UNIT CAPACITY
UNITS (tpd) (tonnes/day)
COMBUSTION TYPE
MEDICAL WASTE
MASS INPUT
(X. average)
AIR POLLUTION
CONTROL DEVICE
1 Tulsa. OK
2 Marlon County. OR
3 01 instead County, MN
4 Washington. DC
5 Sheboygan. MI*
6 Louisville. KY*
7 Belllngham. WA
8 Ulndham. CT
9 Fort 01x. NJ
10 Hampton. SC
11 Cattaraugus. NY
12 Pascagoula. MS
13 S1tka. AK
14 Clebourne. TX
15 Duluth. MN*
3
2
2
4
2
4
2
3
4
3
3
2
2
3'
375
275
100
250
120
250
50
36
20
90
38
75
25
38
340
249
90
227
109
227
45
33
18
82
34
68
23
34
2 105-120 95-109
Mass burn waterwall 0.2
Mass burn waterwall <1
Mass burn waterwall <1
Mass burn refractory 1
Mass burn refractory <1
Mass burn refractory 0.4
Modular starved air 0-5
Modular starved air <3.
Modular starved air <1
Modular starved air 50
Modular starved air £l
Modular excess air 2
Modular excess air <1
Modular excess air 1
FBC 5
ESP
SD/FF
ESP
ESP
Water sprays
Wet scrubber
ESP
Fabric filter
Fabric filter.
wet scrubber,
packed tower
Dry 1nject1on/ESP
None
ESP
ESP
ESP
Venturl
* No longer accepting medical waste.
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Table 5-2. Waste Types. Handling Procedures, and Reported Problems In NWCs
Accepting Medical Waste
FACILITY
Mass Burn Waterwall
Mass Burn Refractory
Modular Starved Air
Modular Excess Air
FBC
1
2
3
-,4
5*
6*
7
8
9
11
12
13
15*
HASTE TYPE ACCEPTED
Ul
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PROBLEMS EXPERIENCED
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HANDLING
Hauler places In grapple
Separate In pit
Hauler places on conveyor
Hauler places In crane
Separate In pit
Hauler places In hopper
Hauler places In hopper
Hauler places In hopper
Hauler places In hopper
Hauler places In loader
Separate In pit
Hauler places In crane
Shredded
* No longer accepting medical waste
-------
municipal waste." No body parts, animal carcasses, or radioactive wastes are
accepted. Sharps are accepted. The waste is delivered in lined boxes. The
haulers manually load the boxes into a closed grapple which is unloaded
directly to the charging hopper. The medical waste is mixed with municipal
waste in the hopper in approximately equal amounts and incinerated
immediately- The crane is cleaned after every load and the haulers are
responsible for cleaning any spill from broken boxes. Coveralls, dust masks,
and gloves are worn at all times by facility personnel. Facility personnel,
as well as the haulers, receive training in the handling and operating
procedures required by the facility.
The Marion County facility also receives medical waste from commercial
haulers.11 Prior to the end of January 1989. 70 tons/month (63 tonnes/month)
of medical waste were being delivered from out of state at a tipping fee of
$300/ton ($331/tonne). This contract expired at the end of the month with no
plans for its renewal. The facility plans to continue receiving 15-20
tons/month (14-18 tonnes/month) of medical waste from within the county for
$26/ton ($29/tonne). the same amount charged for municipal waste. Like Tulsa,
no body parts, animal carcasses, cytotoxic wastes, or radioactive wastes are
accepted. Sharps are accepted. Before the expiration of the out-of-state
contract., the waste was delivered in sealed boxes, unloaded to a conveyor, and
transported directly to the hopper. The in-county medical waste is delivered
in red plastic bags and dumped into a separate area in the pit. An overhead
crane is used to transport the red bags from the pit to the hopper. The crane
sometimes penetrates the bags and plant personnel are presently in the process
of requesting that all medical waste be delivered in sealed boxes. The
medical waste is mixed with municipal waste in alternating layers in the
hopper and incinerated immediately after delivery. The conveyor is cleaned
after' every load. The tipping floor and edges of the pit are decontaminated
periodically and the crane is cleaned prior to maintenance. Surgical gloves,
goggles, and respirators are available if any close contact or exposure to
medical waste is required. Personnel training includes instruction from local
medical professionals regarding infectious disease transmission,
decontamination procedures, and precautions.
Both Tulsa and Marion County report good burnout and routinely test the
bottom ash for pathogens.n The test results reportedly have always been
negative. Neither facility reported any combustion problems or increased HC1
or metals emission attributed to the medical waste. Reportedly, mixing the
5-4
-------
medical waste with the municipal waste prior to combustion eliminates any
potential problems associated with the widely variable heat content of the
medical waste. Both facilities did report that sharps occasionally fall
through the grate system into the riddlings hoppers. Facility personnel are
specifically instructed not to reach into this area with their hands during
maintenance to avoid injury.
The Olmstead County Waste-to-Energy Facility in Rochester. MN comprises
two 100 tpd (95 tonnes/day) mass burn waterwall combustors and reportedly
fires less than 1 percent by weight medical waste.12 A ram feed system is
used. The underfire air is preheated. Natural gas is used to maintain 1800°F
(982°C) measured 54 feet (16 m) above the combustion grate prior to waste feed
for start-up and until waste is burned off the grate during shutdown. During
continuous operation, the furnace exit gas temperature is maintained at 1700°F
(927°C). Steam is generated at a rate of 25.000 Ib/hr (11.340 kg/hr). The
Olmstead County facility is equipped with a three-field ESP.
Commercial haulers deliver medical waste from a prison hospital and a
county hospital.11 Sharps are accepted, but animal carcasses are not. A
significantly higher tipping fee is charged for medical waste as compared to
municipal waste. The medical waste is- delivered in plastic bags contained in
plastic or cardboard drums which are carried up in an elevator and emptied
into the feed hopper. The drums are reusable. The medical waste is mixed
with the municipal waste in the hopper. No combustion problems were reported
due to the small amount of medical waste received. No increase in HC1
emissions was observed. Sharps pass through the combustor intact. The bottom
ash is tested for metals, but no increase was attributed to the medical waste.
The medical waste handling procedures were evaluated and approved by an
industrial hygienist. In addition, a medical doctor discussed infectious
disease transmission and precautions, and provided Hepatitis-B vaccines to all
facility personnel coming in contact with the medical waste. Full
respirators, dust masks, gloves, and paper suits are available. However, the
biggest problem associated with accepting medical waste is reportedly
personnel concerns over handling the waste due to potential health risks. For
this reason, the Olmstead County facility will eventually discontinue
accepting medical waste. The waste will then be sent to a new infectious
waste incinerator to be operated by the Mayo Clinic in Rochester, MN.
5-5
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5.2 Mass Burn Refractory MWCs
There are three mass burn refractory facilities that report firing
medical waste along with MSW: the Solid Waste Reduction Center in Washington,
DC. the Sheboygan. WI facility, and the Louisville Refuse Incinerator of
Kentucky. The Washington. DC facility consists of four 250-tpd (227 tonnes/
day) rectangular refractory wall combustors with rocking grates manufactured
by Flynn and Emrich.13 The waste is gravity fed. Medical waste reportedly
contributes 1 percent of the total waste feed. The feed rate is controlled
automatically by the furnace exit temperature and manually adjusted based on
waste characteristics and overall waste volume reduction. The furnace exit
temperature ranges from 1400 to 1800°F (760 to 982°C). Combustion air is not
preheated and no auxiliary fuel is used. There is no heat recovery. The air
pollution control devices include a water quench chamber for temperature
reduction and two-field ESPs for particulate control. The ESP inlet gas
temperature is 500°F (260°C).
Commercial haulers deliver approximately 300 boxes of medical waste per
day to the Washington. DC facility.11 No radioactive waste, body parts,
animal carcasses, or sharps are accepted at the plant. The tipping fee for
medical waste is more than twice the municipal waste fee. Haulers unload the
boxes to a conveyor which transports the waste directly to the charging
hopper, as opposed to the municipal waste which is dumped into a pit and
loaded into the hopper with an overhead crane. Boxes occasionally fall off
the conveyor exposing the contents, in which case the hauler is responsible
for cleaning and decontaminating the area. Washington. DC does not provide
facility personnel with any special training or protective clothing or
equipment since the commercial haulers are totally responsible for waste
handling. Washington. DC facility personnel did not report any combustion
problems or emission increases attributed to the medical waste. Reportedly,
the medical waste helped to maintain temperatures in the combustor and good
burnout is achieved. Neither the stack emissions nor the bottom ash have
reportedly been tested for pathogens.
Prior to the passage of recent state medical waste regulations, the
Sheboygan. WI facility fired less than. 1 percent medical waste in two
rectangular refractory-wall combustors that utilize three rocking grate
sections per combustor.i< Each unit has a firing capacity of 120 tpd (109
tonnes/day) of MSW. In light of these regulations, the facility is no longer
5-6
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accepting medical waste. In addition to burning MSW. the plant also burns
skimmings from the sewage treatment plant. A total of 417 tons (378 tonnes)
of sludge was reportedly burned in 1986. Waste is charged from a holding pit
into a water-cooled hopper which feeds each combustor by gravity. The feed
rate is controlled by varying the speed of the first (drying) grate section.
The majority of the burning takes place on the second grate section, and
burnout is completed on the third (finishing) grate. Bottom ash is discharged
from the finishing grate to a wet quench. A drag chain conveyor transports
the ash to a truck for disposal in a nearby landfill.
Underfire air is supplied by forced-draft fans (one per combustor).
Siftings hoppers are located beneath the drying grate. Separate forced-draft
fans (one per combustor) located adjacent to the underfire air fans supply
overfire air. All adjustments in air flow are made manually based on visual
observation of the burning bed and flame patterns. Grate speeds are also
varied manually by controls on the side of the combustor. The speed of each
grate section can be independently set and varied.
There are no auxiliary fuel burners in either combustor. The combustor
is started up by establishing a bed of waste on the first grate-section and
igniting the waste by hand. Plant operators reported that during start-up it
takes approximately 1 to 2 hours to achieve a temperature of 1400°F (760°C) in
the combustion chamber. When this temperature is achieved, the overfire air
is introduced and the furnace temperature is established at 1700 to 1800°F
(927 to 982°C).
Combustion products leaving the active burning region flow through a
three-pass wet baffle system which both cools the hot flue gases and reduces
particulate matter (PM) emissions. After passing through the wet baffle
system, flue gases from both combustion trains are combined in a short run of
ducting to the stack. Water and PM collected in the baffle system flow to a
concrete lagoon where the ash settles out from the water. Every 3 to 4 months
this ash is dredged out and disposed of at a nearby landfill.
During the period in which the Sheboygan facility was receiving medical
waste, no radioactive waste was accepted.11 Pathological waste, animal
carcasses from the humane society, and sharps were accepted. Commercial
haulers delivered the waste in red plastic bags and sharps in rigid boxes.
The haulers manually placed the medical waste into the crane bucket or carried
5-7
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the waste up in an elevator and dumped the waste directly into the charging
chute. The medical waste was then immediately incinerated. Some medical
waste believed to be from doctors' or dentists' offices was also mixed in with
the municipal waste. No combustion problems were attributed to the widely
variable heat content of the waste because of the small amount of medical
waste received. Likewise, no increase in HC1 or metals emissions was noted.
Neither the stack emissions nor the bottom ash were ever tested for pathogens.
The two main problems attributed to medical waste were sharps and animal
carcasses. Needles fell through the grates into the riddlings hopper creating
potential hazards for maintenance personnel. Also, needles were caught in the
front end loader used to transport municipal waste and were discovered during
maintenance. Animal carcasses also caused problems because of poor burnout
and recognizability after the combustion process.
Prior to the expiration of a special permit, Louisville. KY was firing
0.4 percent by weight medical waste. However, due to operational problems
attributed to the medical waste, the facility did not seek permit renewal and
no longer accepts medical waste, n.is The Louisville facility consists of four
split-flow rotary kiln mass burn refractory combustors each with a capacity of
250 tpd (227 tonnes/day). The waste is gravity fed.- There are two grate
sections, drying grates, and ignition grates prior to the rotary kiln.
Preheated underfire air is supplied to the ignition grate section. No
auxiliary fuel is used. The combustor gas temperature is maintained at 2000°F
(1093°C) at the exit of the ignition chamber and 1800°F (982°C) at the exit of
the mixing chamber. There is no heat recovery. The facility is equipped with
a water spray chamber and a venturi scrubber.
During the period in which Louisville was receiving medical waste, no
radioactive waste was accepted. Pathological waste and sharps were accepted.
Commercial haulers were required to deliver medical waste between 6 and 8 AM
so as not to interfere with municipal waste deliveries. A slightly higher
tipping fee was charged for medical waste than for municipal waste. Medical
waste was delivered in red plastic bags and rigid sharps containers. The
waste was dumped into a separate area in the pit and loaded into the hopper by
an overhead crane. Louisville did not provide facility personnel with any
special training or protective equipment since the commercial haulers were
responsible for all handling of medical waste. Many problems were attributed
to the medical waste including increased temperature due to the high Btu
content, reduced throughput, increased HC1 emissions, sharps falling through
5-8
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the grates, and poor burnout. No pathogen testing was ever conducted on the
stack emissions or the bottom ash.
5.3 Modular Starved Air
There are five modular starved air facilities that fire medical waste
along with MSW. The Bellingham. WA facility includes two Consumat units with
design capacities of 50 tpd (45 tonnes/day) each." The Windham. CT facility
has three Consumat units designed to fire 36 tpd (33 tonnes/day) each.1? For
both facilities, the feed rate is manually adjusted based on the primary
chamber temperature. Exit gas temperatures are typically 1200-1600°F (649-
871°C) from the primary chamber and 1800-2000°F (982-1093°C) from the
secondary (upper) chamber. Natural gas is used at Bellingham for start-up.
The units are required to achieve 700°F (371°C) in the upper chamber prior to
initiating waste feed. Auxiliary fuel is not used for shutdowns. Windham has
auxiliary oil burners available, although they are not used for start-up or
shutdown. Both facilities have heat recovery and generate 25.000 Ib/hr
(11.340 kg/hr) and 20.000 Ib/hr (9072 kg/hr) of steam, respectively, per unit.
Bellingham is equipped with a two-field ESP which operates at an inlet gas
temperature of 526°F (274°C). Windham is equipped with a fabric filter.
A commercial hauler delivers 5 tpd (4.5 tonnes/day) of medical waste to
Bellingham in heavy cardboard boxes with plastic liners and rigid leakproof
plastic sharps containers.11 No radioactive waste, body parts, or sharps are
accepted. A higher tipping fee is charged for the medical waste than for the
municipal waste. The boxes are first unloaded to the tipping floor in an area
separate from the municipal waste and then manually loaded into hoppers where
it is mixed with municipal waste. Since all containers are leakproof. no
routine decontamination procedures are followed: however, in case of a spill.
any exposed area is decontaminated immediately. Facility personnel receive
special training and are provided protective clothing and equipment for
medical waste handling. Bellingham does not report any combustion problems or
increased HC1 or metals emissions attributed to the medical waste. Good
burnout is reportedly achieved with no recognizability of the ash. Neither
the stack emissions nor the bottom ash is tested for pathogens. Reportedly,
mixing the medical waste with the municipal waste prior to combustion
eliminates any potential problems associated with the widely variable heat
content of the medical waste.
5-9
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Commercial haulers deliver 1 to 2 tons per week (0.9 to 1.8 tonnes/week)
of medical waste to the Windham facility in plastic bags and boxes.n A
slightly higher tipping fee is charged for the medical waste. No radioactive
waste or body parts are accepted. The haulers manually place the medical
waste in the hoppers and it is incinerated immediately. Facility personnel
are not provided any special training, clothing, or equipment since the
commercial haulers are totally responsible for medical waste handling. No
combustion problems or increased HC1 or metals emissions were attributed to
the medical waste. Good burnout is reportedly achieved. The facility does
not test the stack emissions or the bottom ash for pathogens.
The Fort Dix. NJ facility consists of four Clear Air units rated at 20
tpd (18 tonnes/day) each and reportedly fires less than 1 percent by weight
medical waste.is A ram waste feed system is used. There is no air preheat.
Natural gas is used during start-up to attain a temperature of 1500°F (816°C)
measured at the secondary chamber outlet before waste feeding is initiated.
Natural gas is also used during shutdown, although no specific temperature is
required. The gas temperature is maintained at 1750 to 1850°F (954 to 1010°C)
at the exit of the primary chamber and 1800 to 2000°F (982 to 1093°C) at the
exit of the secondary chamber. Steam is produced in each unit at a rate of
7000 Ib/hr (3175 kg/hr). The air pollution control devices include a fabric
filter, a wet scrubber, and a packed tower.
Fort Oix receives approximately 20 boxes per day of medical waste.11 No
radioactive waste, body parts, carcasses, or liquids are accepted. Commercial
haulers manually place the boxes into the hopper separate from the municipal
waste. The boxes are not allowed to touch the tipping floor. The hopper is
checked daily for spills or leaks from the boxes and decontaminated if
necessary. Facility personnel routinely wear respirators while on the tipping
floor. No combustion problems or increased HC1 or metals emissions were
attributed to the medical waste. An increase in operating temperature was
reported for the medical waste as compared to the municipal waste but was not
viewed as a problem. Due to the small amount of medical waste being inciner-
ated, the combustion control system responded adequately to the increased
temperature. Good burnout is reportedly achieved. No pathogen testing has
been conducted. Reportedly, needles occasionally fall through the grate
system to the riddlings hopper, but no injuries have ever resulted.
5-10
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The Hampton. SC facility, consisting of three units rated at 90 tpd (82
tonnes/day) each, fires 50 percent by weight medical waste and utilizes dry
sorbent (sodium bicarbonate) injection with an ESP for air pollution control.
All other design and operating characteristics have been declared confidential
business information by the facility owner/operator.
The Cattaraugus. NY facility consists of three Clear Air units each with
a 38-tpd (34 tonnes/day) capacity and reportedly fires less than 1 percent by
weight medical waste.19 A ram waste feed system is used. There is no air
preheat. Natural gas is used for start-up so that 1800°F (982°C) is achieved
in the secondary chamber prior to waste feed. The gas temperature is
maintained at 1600-1800°F (871-982°C) at the exit of the primary chamber and
1800-2000°F (982-1093°C) at the exit of the secondary chamber. Steam is
produced at a rate of 10.000 Ib/hr (4536 kg/hr). Cattaraugus is not equipped
with an air pollution control device.
Cattaraugus was receiving autoclaved medical waste in red plastic bags
mixed in with municipal waste since, at that time, state regulations allowed
autoclaved medical waste to be treated exactly like municipal waste.11 This
was not acceptable to the facility personnel because of safety concerns and
because they had no way of knowing if the waste had in fact been autoclaved.
Therefore, the facility implemented their own medical waste handling
procedures. The autoclaved medical waste must be delivered separately from
municipal waste. The hauler is required to manually place the bags into a
front end loader whose operator is required to wear a respirator and
protective coveralls. The waste is unloaded to the hopper where it is mixed
with municipal waste and incinerated immediately. The coveralls are
incinerated and the front end loader is steam cleaned after every load. No
sharps or radioactive wastes are accepted and an extremely high tipping fee is
charged. Since implementing these changes, no medical waste has been
delivered to the facility and no operating information is available. The
facility does not plan to implement any pathogen testing since only autoclaved
medical waste is accepted.
5.4 ^odular Excess Air Systems
Three modular excess air facilities reportedly fire medical waste along
with MSW. Two facilities use combustion technology supplied by Sigoure
Freres: Pascagoula. MS and Sitka. AK. The third facility is in Cleburne. TX
5-11
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and the combustion technology was supplied by Cadoux International.
Pascagoula has two rotating annular hearths with capacities of 75 tpd (68
tonnes/day) each.20 The hearths intermittently rotate on a horizontal plane
about a vertical shaft. The waste is gravity fed. Automatic pokers stoke the
fuel bed at regular intervals when the hearth is at rest. The combustion
chamber temperature is maintained at 1850°F (1010°C). The combustion gases
leave the rotary annular hearth and are tangentially fired into a cyclonic
secondary chamber which serves the dual purposes of providing initial
particulate matter separation and a high degree of mixing. The secondary
chamber exit gas temperature is maintained at 1800°F (982°C). The ash is
discharged from the hearth by a fixed plow into a water quench tank.
Pascagoula has waste heat boilers that generate 16.000 Ib/hr (7258 kg/hr) of
steam per unit. Oil' is used as auxiliary fuel during start-up in order to
achieve a boiler exit temperature of 320°F (160°C) prior to initiating waste
feed. Auxiliary fuel is reportedly not used for shutdown although a
temperature of 700°F (371°C) is maintained in the secondary chamber until all
the waste is burned off the grate. Pascagoula is equipped with two-field ESPs
which operate at an inlet gas temperature of 550-650°F (288-342°C).
Commercial haulers deliver boxed medical waste from a local hospital to
the Pascagoula facility.11 The hospital incinerator is used for disposing of
pathological waste, cytotoxic chemicals, and fluid-filled containers. All
other medical wastes, except radioactive and hazardous wastes, are delivered
to the Pascagoula facility. Sharps are sterilized prior to delivery. A
higher tipping fee is not currently charged for the medical waste but is being
considered. The boxed medical waste is dumped into a separate area of the pit
and loaded into the hopper by an overhead crane which occasionally penetrates
the boxes. The medical waste is incinerated immediately in the presence of
the delivery personnel who must verify that all of the medical waste was in
fact incinerated. Occasionally, if temperatures become too high, operators
will mix the medical waste with municipal waste. Throughput is reduced
considerably to ensure good burnout. No increase in HC1 or metals emissions
is attributed to the medical waste. No pathogen testing has been conducted.
Due to the small "pin hole" design of the grate system, there are no reported
problems of sharps falling through into riddlings hoppers.
The Sitka. AK facility consists of two 25-tpd (23 tonnes/day) Sigoure
Freres modular excess air combustors with waste heat boilers and ESP
controls.21 The plant has been operating commercially since May 1985. and the
5-12
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normal operating schedule is 24 hours per day. 5 days per week. Sitka fires
less than 1 percent medical waste as well as 8 percent sewage sludge. A feed
pump transfers the sludge to the combustor charging hopper where it is metered
into the MSW feed. The waste is fed by a charging ram and is moved through
the unit by a series of pneumatically driven pokers. The combustor operates
with nearly 115 percent excess air and combustion takes place on stepped
hearths in the primary combustion chamber, where the temperature reportedly
averages 1700°F (927°C). The flue gas flows to a post-combustion chamber
where average temperatures are reportedly near 1900°F (1038°C). There is no
air injection in the secondary chamber; combustion air control is achieved by
an induced draft (ID) fan. The flue gases flow from the combustor through the
firetube boilers and ESPs. which are designed to operate at 450°F (232°C).
The ESP plates are constructed of Corten steel to reduce corrosion effects.
Each ESP has one field. The units include oil burners which are used during
start-up and shutdown conditions. The ash is co-disposed of in a lined
landfill with leachate collection.
Commercial haulers deliver red plastic bags and boxes of medical waste
to the Sitka facility.u Radioactive waste is not accepted. There is not a
higher tipping fee for medical waste. The haulers manually place the medical
waste into the crane, which is unloaded into hoppers and the medical waste is
incinerated immediately. Facility personnel are not provided any special
training, protective clothing, or equipment since the commercial haulers are
totally responsible for all medical waste handling. The medical waste is not
mixed with municipal waste. Resulting higher temperatures are controlled by
reducing throughput. Reportedly, animal carcasses are occasionally recogniz-
able in the ash. The ash has been tested for pathogens, although not
routinely, with negative results. No increase in HC1 or metals emissions is
attributed to medical waste.
The Cleburne. TX facility reportedly fires 1 percent medical waste in
three 38-tpd (34 tonnes/day) units each equipped with a ram feed system.22
There is no air preheat. The average gas temperatures exiting the primary and
secondary chambers are 2000°F (1093°C) and 1500°F (815°C). respectively. Each
boiler produces steam at a rate of 7100 Ib/hr (3220 kg/hr). Natural gas is
used as auxiliary fuel for start-up to attain a temperature of 400°F (204°C)
at the top of the primary chamber prior to initiating waste feed. Auxiliary
fuel is also used for shutdown although there is no requirement to maintain a
specific temperature until all of the waste is burned off the grate. Cleburne
5-13
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is equipped with a two-field ESP which operates at an inlet gas temperature of
450°F (232°C).
Reportedly, the Cleburne facility receives medical waste mixed in with
the municipal waste: the medical waste is believed to be generated by doctors'
and dentists' offices.n The facility is currently retrofitting one of their
three units to burn only medical waste. Facility personnel were not willing
to discuss any of the details of the retrofit or medical waste handling and
operating procedures.
5.5 Fluidized Bed Combustors (FBCs)
The Western Lake Superior Sanitary District (WLSSD) facility in Ouluth.
MN combusts a mixture of sewage sludge and refuse derived fuel (RDF) in two
Copeland Systems FBCs.*3 The units were primarily designed as sewage sludge
incinerators that use RDF as a cheap auxiliary fuel. The WLSSD facility
consists of two identical bubbling bed FBCs with individual waste heat
boilers. The combustors are each 45 ft (14 m) high and the reactor vessels
have an inside diameter of 34 ft (10 m) at the freeboard. Each combustor is
capable of firing 120 tons/day (109 tonnes/day) of fluff-RDF and 345 tons/day
(313 tonnes/day) of sewage sludge (18 percent solids): thus. RDF represents
approximately 26 percent of the total waste input at full load. RDF is
produced at the WLSSD facility 8 hours/day. 5 days/week. Input waste to the
processing plant consists of approximately 60 percent residential. 25 percent
commercial. 10 percent industrial, and 5 percent medical waste. RDF is
pneumatically injected into the bed through four ports which extend approxi-
mately 5 feet (1.5 m) from the reactor wall about 18 in (0.46 m) above the gas
distribution plate. The feed ports are angled downward at the ends to
introduce the RDF low in the bed. Sewage sludge is pumped through a nozzle
which penetrates the top of the reactor vessel and extends approximately 12 ft
(3.7 m) below the roof. Each 160 x 10« Btu/hr (169 x 10* J/hr) boiler can
provide 49.000 Ib/hr (22.226 kg/hr) of steam, and all steam is used on site.
Wood chips are fired as a supplemental fuel whenever sufficient heat input
cannot be derived from RDF. Usually, wood is required only when all of the
RDF feeding tubes plug simultaneously or when the RDF supply is occasionally
exhausted at the end of the weekend. Wood chips account for about 7.5 percent
of the facility heat input on an annual basis. Oil is fired for cold start-
ups and as a second supplemental fuel: the boilers can be fired at up to 100
percent load using oil. The sewage sludge provides less heat input than is
5-14
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required to dry it and is. therefore, not considered a fuel by the facility.
At typical operating conditions, the FBC has a bed temperature of about 1475°F
(802°C) and a freeboard (furnace exit gas temperature, or FEGT) of about
1650°F (899°C). Typically all of the combustion air is supplied as underfire
air. Although the FBCs are configured for overfire air injection, it is
seldom used. The flue gas has 5 to 7 seconds residence time between the
combustor and the boiler entrance, and the gas temperature at the entrance to
the first convective section is about 1400°F (760°C). Each of the units is
equipped with a venturi scrubber, a quench tower, and a demister.
The WLSSO facility is no longer accepting medical waste because of the
potential hazards associated with shredding in RDF processing.n WLSSD
assigned one employee to work with the area hospitals to ensure that only
general refuse and no medical waste was sent to the MWC facility.
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6.0 CURRENT PRACTICES - EUROPEAN AND CANADIAN MWCS
Several European and the Canadian environmental protection agencies were
contacted regarding medical waste incineration practices in municipal waste
combustors. Appendix A contains the agency addresses. The following sections
summarize the responses.
6.1 Austria
According to the Umweltbundesamt in Vienna. Austria (EPA equivalent),
federal medical waste disposal regulations have been in place since March 1.
1988. These regulations, known as ONORM S 2104. "Wastes from Medical
Institutions", overlap with ONORM S 2100. "Catalogue for Special and Hazardous
Waste", and ONORM S 2101. "Hazardous Wastes Requiring Supervision." Medical
waste is classified into three categories:
Wastes without infectious risks which need not be treated in a
special way.
Wastes which can be infectious or which represent an injury risk
only within the medical center. They do not need special
treatment outside of the medical area.
Wastes representing danger inside and outside of the medical area.
They must be treated in a special way. This category includes
also hazardous waste (ONORM S 2100) and hazardous waste requiring
supervision (ONORM S 2101). e.g. batteries, clinical thermometers.
used medicine, solvents.
According to these regulations, body parts, organs, experimental animal
carcasses, and certain hazardous wastes, if incinerated, must be done so in a
hazardous waste combustor. Other medical waste types can be combusted in an
MWC.
Reportedly, there is only one hazardous waste combustor in Austria, and
this facility has emission limits as shown in Table 6-1. There are currently
only two MWC facilities in operation: the Wels MWC facility in OberSsterrich
and the Fiatzersteig MWC facility in Vienna. The emissions standards for
existing MWCs with boilers are set in the Clean Air Act for Steam Boilers as
6-1
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Table 6-1. Emission Limits for Austrian
Hazardous Waste Combustors
mg/m3
SUBSTANCE (11X 02. dry)
Particles 10
Gaseous Substances
Chloric acid, as Cl- 15
Fluoric acid, as F- 0.1
Sulfur dioxide, as S02 100
Nitrogen oxides, as N02 350
Heavy metals (gaseous and particles)
Pb 0.5
Zn 0.8
Cd 0.05
Cr 0.2
Ni 0.2
Cu 0.1
As 0.2
Hg 0.05
6-2
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shown in Table 6-2. New MWC facilities are regulated under the Ordinance to
the Clean Air Act for Steam Boilers as outlined in Table 6-3.
6-2 Canada
Although no response was received from the Waste Management Division of
Environment Canada regarding federal regulations, recent developments in the
province of Alberta seem to suggest that medical waste issues may be handled
by the provinces.
In Alberta, a task force on infectious waste disposal has been formed
and is trying to create a long-term plan for disposing of the province's
infectious and medical waste. According to the Environmental Health Services
for the Alberta Ministry of Health, the task force is considering three
options: upgrading existing hospital incinerators: creating seven regional
incineration facilities: or disposing of all the province's infectious wastes
at a state-of-the-art hazardous waste incineration facility.
Reportedly, medical wastes have not been a problem for Alberta, but due
to public concerns, the province wants to create a long-term plan for handling
medical waste. The province generates approximately 90 to 130 tons (82 to 118
tonnes) of infectious wastes per day. Current Alberta medical wastes
regulations make it illegal to dispose of non-treated wastes in a landfill.
Treated infectious wastes may go to a landfill and be buried in a separate
cell, but the province discourages this. Incineration is the preferred method
of disposal.
6.3 Denmark
According to the National Agency of Environmental Protection (NAEP).
Denmark has about 30 relatively small facilities burning a mixture of
municipal waste and what is termed "special hospital waste." These combustors
burn approximately 20.000 tonnes (22,046 tons) per year including between
3.000 and 6.000 tonnes (3307 to 6614 tons) of special hospital waste.
In 1984. the NAEP issued a guideline defining the following types of
waste as "special hospital waste": waste from hospitals, nursing homes,
maternity clinics, other treatment and health care institutions, clinics of
6-3
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Table 6-2. Emission Standards for Existing
Austrian MWCs with Boilers
SUBSTANCE
Particles
Gases:
Cl-
F-
S02
CO
N02
Heavy Metals (gases and particles)
Pb, Zn. Cr combined
As, Co. Ni combined
Cd
Hg
Organic Matter (as total carbon)
SMALL
FACILITY
(mg/m3)
50
30
0.7
-
100
-
5
1
0.1
0.1
20
LARGE
FACILITY
(mg/m3)
25
15
0.7
100
100
100
4
1
0.1
0.1
20
Table 6-3. Emission Standards for New Austrian
MWCs with Boilers
SUBSTANCE
Particles
Gases
Cl-
F-
S02
CO
N02
Heavy Metals (gases and particles)
Pb. Zn. Cr combined
As. Co. Ni combined
Cd
Hg
Organic Matter (as total carbon)
SMALL
FACILITY
50
30
0.7
-
100
-
5.0
1.0
0.1
0.1
20
MEDIUM
FACILITY
(mg/m3)
20
15
0.7
100
50
300
3.0
0.7
0.05
0.1
20
LARGE
FACILITY
15
10
0.7
50
50
100
2.0
0.5
0.05
0.05
20
6-4
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general practitioners and dentists, which are either infectious or biological
waste. Infectious or biological waste includes:
all wastes from patients with infectious diseases, for instance
waste from patients in epidemical wards, dialysis wards and
isolation wards, and some types of waste from patients treated
with special medicine
all pointed or sharp objects: needles, knives, drop equipment
from infusion apparatus and the like
infectious wastes from clinical/microbiological laboratories (not
autoclaved)
infectious waste from some cl inical/chemical laboratories and
blood bank laboratories (not autoclaved)
biological waste from surgery, delivery room, autopsy rooms and
the like
biological waste from animal bedding, etc.
According to the guideline, the special hospital waste shall be burned in
combustors designed for that purpose. The combustor must have two chambers
with the secondary chamber temperature at least 850°C (1562°F) with a minimum
residence time of 0.5 sec. Also, the first chamber must have a solid floor so
that needles and glass cannot fall through.
6.4 Federal Republic of Germany
According to the federal environmental agency (Umweltbundesamt), there
are at least seven MWCs in the Federal Republic of Germany that accept medical
waste. At least two of those facilities use separate combustion chambers for
the medical waste. The combustors firing municipal and medical wastes, and in
some cases sewage sludge, range in size from 10 to 20 tons/hr (9 to 18
tonnes). The separate medical waste combustion chambers are 0.375 and 1.7
tons/hr (0.34 to 1.5 tonnes). The design and operating characteristics of
these facilities are summarized in Table 6-4.
6-5
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Table 6-4. Medical Waste Incineration Practices 1n Municipal Waste Combustors
1n the Federal Republic of Germany
LOCATION
Bielefeld
Coburg
Gopplngen
Kassel
Krefeld
Leverhusen
Hunchen
MANUFACTURER t OF
STOKER/BOILER UNITS
Uldmer & Ernst
Baumgarte
Frohllng-Slegota
Hartln/Werle
—
VKW/VKU
Balcke-Ourr/
Balcke-Durr
VKW/VKU
Von Roll /MAN
KiK/Lentjes
.Hartln/VKW
3
3
2
1
2
2
3
2
1
2
UNIT SIZE
(tons (tonnes
/hr) /hr)
16
1.7
11
.375
12
10
12
10
12
20
14.5
1.5
10
.340
11
9
11
9
11
18
WASTE TYPES
Municipal
Sewage Sludge
Medical
Municipal
Sewage Sludge
Medical
Municipal
Sewage Sludge
Medical
Municipal
Medical
Municipal
Sewage Sludge
Medical
Municipal
Medical
(Total In all
Municipal
Sewage Sludge
Medical
YEAR OF
TONS/YR TONNES/YR START-UP
230.000
19.900
2.600
140.000
2.600
—
145.700
11.000
2.650
120.000
(Total)
210.000
(Total)
153.000
three units)
228.000
(Total)
208.655
18.053
2.359
127.007
2.359
—
132.178
9.979
2.404
108.863
190.511
138.801
206.840
1981
1989
1988
—
1975
1968
1974
1970
1986
1964
APCD
ESP
—
Fabric Filter.
ESP
—
Cyclone. ESP
Fabric Filter
ESP
ESP
ESP
Cyclone
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6-5 Norway
The State Pollution Control Authority (SPCA) in Oslo, Norway divides
medical waste into two categories: "household type" waste and "hazardous"
waste. The "hazardous" waste category is further sub-divided into three
categories: infectious, sharps, and biological (pathological) wastes. Most
hospitals in Norway have on-site incinerators. Some hospitals burn all
generated wastes on site; however, some hospitals burn only the "hazardous"
portion on site and send the "household type" waste to a municipal waste
combustor. For those hospitals that do not have on-site incinerators, the
"household type" waste, sharps, and infectious wastes can be sent to an MWC.
The SPCA believes that MWCs are not well suited for biological waste
incineration as they do not provide sufficient residence times to ensure
complete combustion. The Norwegian MWCs that do incinerate medical waste are
the Oslo Renholdsverk in Oslo, the Tafjord Kraftselskap in Alesund. the
Trondheim Elektrisitetsverk in Trondheim. and the Fredrickstad og Omegn
Avldpsanlegg in Fredrikstad.
6.6 Spain
The Ministry of Public Works and Town Planning in Madrid. Spain reports
that there is only one MWC in the entire country. This facility does accept
some types of medical waste and is located in Valdemingomez. Spain.
6.7 Sweden
The National Environmental Protection Board in Solna. Sweden reports
three MWCs that incinerate medical waste for which there are no special
requirements. The facilities are the SYSAV in Malmo. the UEAB in Uppsala, and
the Tekniska Verken in LinkSping.
6.8 Switzerland
According to the Federal Office of the Environment. Forests and
Landscape in Bern. Switzerland, municipal waste and sterilized infectious
waste can be incinerated in MWCs. Non-sterilized infectious waste and
pathological waste must be incinerated in hazardous waste or infectious waste
incinerators with flue gas cleaning devices.
6-7
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7.0 MWC MANUFACTURERS'/SYSTEM SUPPLIERS' RECOMMENDATIONS
In addition to contacting MWC facilities. several MWC
manufacturers/system suppliers were also contacted to determine whether any
special design and operating recommendations are made to facilities that
accept medical waste. The U.S. manufacturers/system suppliers contacted
include Sigoure U.S. Associates: Cadoux. Inc.; Consumat Systems. Inc.; and
Ogden Martin Systems. Inc. The European manufacturers contacted include Von
Roll. Deutsche Babcock. Volund. Martin, and Steinmuller.
7.1 U.S. Manufacturers/System Suppliers
7.1.1 Siooure U.S. Associates
Sigoure U.S. Associates are the U.S. supplier of the French Sigoure
Freres MWC systems. The two known U.S. MWC facilities supplied by Sigoure
that accept medical waste are Pascagoula. MS and Sitka. AK. According to a
Sigoure representative, as well as plant personnel from both facilities.
Sigoure does not make any special recommendations regarding the incineration
of medical waste in their MWCs.
7.1.2 Cadoux. Inc.
Cadoux. Inc. is the U.S. supplier of the French Cadoux International MWC
systems. The only known U.S. MWC facility supplied by Cadoux that accepts
medical waste is the Cleburne. TX facility. According to Cadoux. Inc.
representative, no special recommendations are made to MWCs accepting medical
waste. Facility personnel indicated that Cadoux did not participate in the
retrofit of their facility to accommodate medical waste.
7.1.3 Consumat Systems. Inc.
Consumat Systems. Inc. is the manufacturer of the modular MWC system
accepting medical waste in Hampton. SC. Consumat did not provide any
guidelines or special recommendations to the Hampton. SC facility.
7-1
-------
7.1.4 Qaden Martin Systems. Inc.
Ogden Martin Systems. Inc. is the U.S supplier of the grate technology
developed by Martin GMBH in Germany. Both the Tulsa. OK and the Marion
County. OR facilities are owned and operated by Ogden Martin. Therefore, the
current practices of these facilities discussed in Section 5.0 is
representative of Ogden Martin's recommendations regarding medical waste
incineration in MWCs.
7.2 European Manufacturers/System Suppliers
No responses were received from Von Roll. Deutsche Babcock. Volund, or
Steinmuller regarding handling and operating guidelines for medical waste
incineration in their systems. Due to the infectious and hazardous nature of
medical waste. Martin GMBH in Munchen. FRG. feels that hazardous waste
incinerators are more appropriate to handle medical waste than MWCs. One
problem noted by Martin is that frequently, when incinerating medical waste in
MWCs. all of the medical waste is incinerated in separate batches. In these
cases, the MWC is essentially being used as an infectious waste incinerator.
Because the system was not designed for" medical waste and in some cases the
facility personnel have not been trained to handle medical waste, handling and
operating problems may arise.
7-2
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8.0 PRELIMINARY RECOMMENDATIONS AND RESEARCH NEEDS
The 15 municipal waste combustors In the U.S. that have previously
accepted or are currently accepting medical waste include a variety of
combustor design types. The amount of medical waste burned in these units
ranges from less than 1 percent by weight to 50 percent. Some of the major
concerns regarding medical waste Incineration in MWCs include waste handling
procedures prior to combustion, identification of appropriate waste types to
be burned in MWCs, and evaluation of potential problems associated with
residue handling, including ash and effluent streams. Based on the
preliminary findings, it appears that sharps pose a potential problem in MWCs
with grate systems. Sharps in the ash represent potential worker safety and
health problems to facility personnel or landfill operators handling the ash.
Animal carcasses also represent a significant problem if poor burnout does not
result in complete destruction of the carcasses. Prior to incineration,
attention must be given to the medical waste handling procedures to prevent
penetration of containers and exposure of containerized wastes. For example,
it is recommended that medical waste not be processed into refuse derived
fuel. There are very limited data available on the emission impacts
associated with combustion of medical waste in MWCs. More research is needed
to fully evaluate the potential impacts of burning medical waste on the
emissions of acid gas, dioxin, and metals. Also, further studies and field
tests are needed to determine the design and operating requirements for
complete destruction of solvents, cytotoxic chemicals, and pathogens.
8-1
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REFERENCES
1. Tsaveras. T.. M. Gaskin and J. Maidhof. Hospital Waste Incineration and
Emissions Test Results. Presented at the Meeting of the Mid-Atlantic
States Section of the Air Pollution Control Association. Atlantic City.
New Jersey. November 3-6, 1987.
2. Radian Corporation. "Hospital Waste Combustion Study Data Gathering
Phase: Final Report." EPA-450/3-88-017 (NTIS PB89-148308). December
1988.
3. Doyle. B.W... D.A. Drum and J.D. Lauber. The Smoldering Question of
Hospital Wastes. Pollution Engineering. July 1985.
4. Lauber. J.D. New Perspectives on Toxic Emissions from Hospital Inciner-
ators. Presented at the Conference on Solid Waste Management and
Materials Policy. NY State Legislative Commission on Solid Waste
Management. New York. February 12. 1987.
5. State of California Air Resources Board. "Evaluation of Test on Hospital
Refuse Incinerator at Saint Agnes Medical Center, Fresno, CA," January
1987.
6. EPA. "EPA Guide for Infectious Waste Management." EPA/530-SW-86-014
(NTIS PB86-199130). May 1986.
7. Barberto. M.S. and M. Shapiro. Microbiological Safety Evaluation of
Salid and Liquid Pathological Incinerator. J. Med. Primatol. 6:264-
273. 1977.
8. Clapp. T.L.. C. .Hayes, D.S. Kosson and R.C. Ahlert. Leaching Character-
istics of Residual Ashes from the Incineration of Infectious Hospital
Waste. In! Proceedings of the Fourth Conference on Solid Waste
Management and Materials Policy. New York. January 27-30. 1988.
9. Clean Air Act Section 114 and Resource Conservation and Recovery Act
Section 3007 Municipal Waste Combustion Information Request, provided to
U.S. EPA on June 7. 1988 by Z. Semanyshyn. Senior Operations Engineer,
Ogden Martin Systems of Tulsa. Tulsa, OK.
10. Clean Air Act Section 114 and Resource Conservation and Recovery Act
Section 3007 Municipal Waste Combustion Information Request, provided to
U.S. EPA on June 7. 1988 by Russel B. Johnson, Chief Engineer. Ogden
Martin Systems of Marion, Inc., Brooks, Oregon.
11. V.J. Landrum, Energy and Environmental Research Corporation, telecon
with facility personnel. January 20, 1989 to February 23. 1989.
12. Clean Air Act Section 114 and Resource Conservation and Recovery Act
Section 3007 Municipal Waste Combustion Information Request, provided to
U.S. EPA on May 16. 1988 by Michael T. Cousino. P.E.. Public Works
Director. Olmstead County. Rochester, Minnesota.
13. Clean Air Act Section 114 and Resource Conservation and Recovery Act
Section 3007 Municipal Waste Combustion Information Request, provided to
U.S. EPA on June 1, 1988 by Sylvestre K. Yorrick, Facility Manager.
R-l
-------
District of Columbia Government. D.C. Department of Public Works.
Washington. DC.
14. Clean Air Act Section 114 and Resource Conservation and Recovery Act
Section 3007 Municipal Waste Combustion Information Request, provided to
U.S. EPA on May 16. 1988 by Frank Calco. Superintendent. City of
Sheboygan. Sheboygan. Wisconsin.
15. Clean Air Act Section 114 and Resource Conservation and Recovery Act
Section 3007 Municipal Waste Combustion Information Request, provided to
U.S. EPA on May 9. 1988 by Dennis Minks. Technical Operations Manager.
City of Louisville. Louisville. Kentucky.
16,
v. i tjr u i i_uu i av i i i c, uuu i a v i i i c , i\ciibu\.i\j.
Clean Air Act Section 114 and Resource Conservation and Recovery Act
Section 3007 Municipal Waste Combustion Information Request, provided to
U.S. EPA on July 12. 1988 by James R. Anderson. President, Thermal
D/a/Hii/»4--irtr\ Prt T n /* Par*n/Ha1a Uachinn + nn
u.b. tPA on July 12, iyas oy dames K.
Reduction Co.. Inc., Ferndale. Washington.
17. Clean Air Act Section 114 and Resource Conservation and Recovery Act
Section 3007 Municipal Waste Combustion Information Request, provided to
U.S. EPA on July 11. 1988 by Donald E. White. Plant Superintendent.
Windham Energy Recovery Facility, Town of Windham. Wi 11 imantic.
Connecticut.
18. Clean Air Act Section 114 and Resource Conservation and Recovery Act
Section 3007 Municipal Waste Combustion Information Request, provided to
U.S. EPA on April 29, 1988 by Alan D. Gibson, Environmental Engineer.
USATC and Fort Dix. Directorate of Engineering and Housing. Fort Dix.
New Jersey.
19. Clean Air Act Section 114 and Resource Conservation and Recovery Act
Section 3007 Municipal Waste Combustion Information Request, provided to
U.S. EPA on May 25. 1988 by Todd Dobmeier. Plant Manager. Cattaraugus
County Waste-to-Energy Plant. Cuba. New York.
20. Clean Air Act Section 114 and Resource Conservation and Recovery Act
Section 3007 Municipal Waste Combustion Information Request, provided to
U.S. EPA on June 3. 1988 by Lloyd J. Compton. P.E., President. Compton
Engineering. PA. Pascagoula, Mississippi.
21. Clean Air Act Section 114 and Resource Conservation and Recovery Act
Section 3007 Municipal Waste Combustion Information Request, provided to
U.S. EPA on May 23. 1988 by Larry Harmon. City Engineer. City and
Borough of Sitka. Alaska.
22. Clean Air Act Section 114 and Resource Conservation and Recovery Act
Section 3007 Municipal Waste Combustion Information Request, provided to
U.S. EPA on July 15. 1988 by Fred Watson. Sanitation Superintendent.
City of Cleburne. Cleburne. Texas.
23. Clean Air Act Section 114 and Resource Conservation and Recovery Act
Section 3007 Municipal Waste Combustion Information Request, provided to
U.S. EPA on May 16. 1988 by Gary Baker. Manager of Operations. Western
Lake Suoerior Sanitary District. Duluth. Minnesota.
u.i. tr* on nay it>. iyao oy aary Baker. Manager ol
Lake Superior Sanitary District. Duluth. Minnesota.
R-2
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Appendix A. Foreign Environmental Protection Agencies
Umweltbundesamt
Biberstrasse 11
A-1010 Vienna
AUSTRIA
Environment Canada
Mr. J. Myslicki. Chief
Waste Management Division
Industrial Programmes Branch
351 St. Joseph Boulevard. 13th Floor
Ottawa. Ontario K1A OH3
CANADA
National Agency for Environmental Protection
Strandgade 29
DK 1401 Copenhagen K
DENMARK
Unweltbundesamt
President: Dr. Heinrich Freiherr von Lersner
Bismarckplatz 1
1000 Berlin 33
FEDERAL REPUBLIC OF GERMANY
The Ministry of Environment
Pollution Control Department
Box 8013. Dep. 0030. Oslo 1
NORWAY
Ministerio de Obras Publicas y Urbanismo
Direccion General del Medio Ambiente
Nuevos Ministerios - Paseo de la Castellana
Madrid. SPAIN
Federal Office for Environmental Protection
BUS
Hallwylstrasse 4
3003 Bern
SWITZERLAND
The Swedish Ministry of the Environment and Energy
(Miljo- och Energidepartementet)
Stockholm
SWEDEN
A-l
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TECHNICAL REPORT DATA .
(Please read Instructions on the reverse before completing)
1. REPORT NO.
EPA-600 78-89-062
3. RECIPIENT'S ACCESSION NO.
4. TITLE AND SUBTITLE
Municipal Waste Combustion Assessment: Medical
Waste Combustion Practices at Municipal Waste
Combustion Facilities
S. REPORT DATE
July 1989
6. PERFORMING ORGANIZATION CODE
7. AUTHOR(S)
V. J. Landrum and R. G. Barton
8. PERFORMING ORGANIZATION REPORT NC
10. PROGRAM ELEMENT NO.
9. PERFORMING ORGANIZATION NAME AND ADDRESS
Energy and Environmental Research Corporation
3622 Lyckan Parkway, Suite 5006
Durham, North Carolina 27707
11. CONTRACT/GRANT NO.
68-03-3365, Task 1-05
12. SPONSORING AGENCY NAME AND ADDRESS
EPA, Office of Research and Development
Air and Energy Engineering Research Laboratory
Research Triangle Park, NC 27711
13. TYPE OF REPORT AND PERIOD COVERED
Final; 11/88 - 6/89
14. SPONSORING AGENCY CODE
EPA/600/13
is.SUPPLEMENTARY NOTES AEERL proa'cct officer is James D. Kilgroe, Mail Drop 65, 919/
541-2854.
is. ABSTRACT
repOrt defi.nes and characterizes types of medical waste, discusses the
impacts of burning medical waste on combustor emissions, and outlines important —
handling and operating considerations. Facility- specific design, handling, and oper-
ating practices are also discussed for municipal waste combustors (MWCs) that re-
portedly accept medical waste in the U. S. , Europe, and Canada. Only very limited
data are available on the emission impacts associated with the combustion of medi-
cal waste in MWCs. Especially lacking is information needed to fully evaluate the
impacts on acid gas, dioxin, and metals emissions, as well as the design and opera-
ting requirements for complete destruction of solvents, cytotoxic chemi-
cals, and pathogens. The EPA's Office of Air Quality Planning and Standards is
developing emission standards and guidelines for new and existing MWCs under Sec-
tions lll(b) and lll(d) of the Clean Air Act. In support of these regulatory development
efforts, the Air and Energy Engineering Research Laboratory in EPA's Office of
Research and Development has conducted an assessment to examine the incineration
of medical waste in MWCs from an emission standpoint. Potential worker safety and
health problems associated with handling of medical wastes and residues were also
identified.
17.
KEY WORDS AND DOCUMENT ANALYSIS
DESCRIPTORS
b.lOENTIFIERS/OPEN ENDED TERMS
c. COSATI Field/Group
Pollution
Assessments
Combustion
Medical Equipment
Waste Disposal
Emission
Metals
Toxicity
Solvents
Pathology
Pollution Control
Stationary Sources
Medical Waste
Municipal Waste Com-
bustion
Cytotoxicity
13B 11F, 07B
14B 06 T
21B UK
06L 06E
05E
14G
18. DISTRIBUTION STATEMENT
Release to Public
Of
19. SECURITY CLASS (ThisReport)
Unclassified
21. NO. OF PAGES
42
20. SECURITY CLASS (This page)
Unclassified
22. PRICE
EPA Form 2220-1 (S-73)
A-2
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