Ecodas (Medical Waste Sterilizer)

Serial No : 019/06
Prepared by : Puan Mariammah A/P Krishnasamy
Reviewed by : Datin Dr Rugayah Bakri


1. INTRODUCTION

There are many ways and technologies available for treating medical waste. The technology
utilised in the Ecodas equipment is a modified autoclave technology, whereby it uses steam
sterilization with the new feature of shredders incorporated in the equipment. The more recent
designs have incorporated vacuuming, continuous feeding, shredding, mixing, fragmenting,
drying, chemical treatment and compaction. The examples of these advanced autoclaves are
ECODAS, Hydroclave, Sterival, STICHEM Clav, STS, and System Drauschke
(www.noharm.org).

Several factors and criteria should be considered by the health care facilities when considering a
non-incineration technique for medical waste treatment. The factors include:-
Regulatory acceptance
Throughput capacity
Types of waste treated
Microbial inactivation efficacy
Environmental emissions and waste residues
Space requirements
Utility and other installation requirements
Waste reduction
Occupational safety and health
Noise
Odour
Automation
Reliability
Level of commercialization
Background of the technology manufacturer
Cost
Community and staff acceptance

ECODAS autoclaves are installed in several places in France, mostly in individual medical
facilities. They are also operated as central units at some hospitals, such as in Santes or Loos.
These systems are also operated in Cyprus, Hungary, Poland, Russia, Spain and some non-
European countries such as Argentina, Brazil, Mexico, J apan, Egypt, Lebanon, Guyana and
Morocco.





A company named Syarikat N.A.Z. Medical Supplies Sdn. Bhd. has promoted the usage of the
ECODAS equipment to be placed at all hospitals in Ministry of Health, Malaysia (MOH).
Following that they had a demonstration on ECODAS sterilization to the Medical Development
Division on 13 March 2003. As a follow up from the above demonstration, a technology review
was requested by the Director of Medical Development Division to ensure the appropriateness of
this equipment for placement at MOH.

2. OBJECTIVE

To assess the safety, effectiveness and cost-effectiveness of the ECODAS equipment.
(MEDICAL WASTE STERILIZER).

3. TECHNICAL FEATURES

There are three types of ECODAS models available for different capacity of medical wastes.
They are the T300, T1000 and T2000.The major difference between T1000 and T300 is the
height, and between T2000 and T1000 is the diameter. The T2000 and T1000 require a hoist
loading system.



ECODAS T300 has a treatment capacity of 300 litres per 30 minutes average cycle time.






ECODAS T1000 has a treatment capacity of 1000 litres per 40 minutes average cycle time






ECODAS T2000 has a treatment capacity of 2000 litres per 60 minutes average cycle time.
(www.ecodas.com)

1.1 Technical features of ECODAS

ECODAS has been commercialised since 2003.

Medical waste is loaded from the top of the machine into a chamber equipped at the bottom with
a heavy duty shredder. If the medical waste contains some unbreakable objects, like metal parts,
the shredder stops automatically, and the chamber is not opened until waste is sterilized by
steam. Shredded waste falls by gravity into the lower chamber. The machine is steam heated to a
temperature of 138C and pressure is increased to 3.8 bars.
The fully automated and online-controlled process has a cycle time of 40-60 minutes, depending
upon the size of plant and the amount of waste. Sterile fragments (8 log
10
reduction) are
discharged from the bottom of the machine and disposed off in the environment landfill site. The
original volume of waste is reduced by 80%.

4. METHODOLOGY

The electronic database of Pubmed, OVID search engine, PROQUEST search engine, and
Google search engine were searched. The following were the key words used either singly or in
combination: safety, effectiveness, efficacy, cost-effectiveness, steam sterilizer, steam autoclave,
medical waste treatments, medical waste disposable techniques, medical waste sterilization,
Ecodas and incineration.

5. RESULTS AND DISSCUSSION

5.1 Safety

The Ecodas system is equipped with a safety system, fully automated batch process. The
shredding and sterilization are enclosed in a compact system. This ECODAS equipment,
however, does not have intermediate waste handling. A study by Cofiell et al. (2003) indicated
that compared to other methods, the steam sterilizer is relatively safe, inexpensive and reliable.
Therefore, it has become the most widely used method of sterilization.

The ECODAS system also uses the steam sterilization technology.
The Ecodas system is fully automated with several safety features which ensures correct
operating procedures such as:

i) It can be opened only when the temperature and pressure are acceptable. The process
cannot start if all locks are not in place and the process cannot be interrupted until
sterilization is complete.

ii) As soon as a failure occurs, an automatic diagnosis is made by the machine which
displays the nature of the failure. A security cycle can be activated before opening the
machine. Therefore, the inside of the machine is sterilized, as well as the shredder,
before the maintenance personnels intervention.

iii) The remarkable feature of the system is the shredder. As it is well known by waste
experts, it is difficult to achieve shredding of all types of waste, particularly of an
unexpected item like a screw driver, which could ruin the mechanism, or melting
plastic which can clog the moving parts. The shredders design eliminates those
eventualities.

The ECODAS process has been tested by the Pasteur Institute and approved under the
supervision of the French Higher Council of Public Health in the French Ministry of Health and
Ministry of Environment. The ECODAS process is recognized and accepted by the Ministries of
Health and Environment of the following countries: Algeria, Argentina, Brazil, Denmark,
Cyprus, Egypt, England, France, Honduras, Hungary, Iran, J apan, Kuwait, Lebanon, Mexico,
Morocco, Poland, Russia, Spain, Tunisia and USA.

5.2 Effectiveness

Guideline document by Infection Prevention Guidelines, Sterilization, adapted from: Tietjen,
Cronin and McIntoh (1992), revealed that sterilization by steam is an effective sterilant for two
reasons. Firstly, saturated steam is an extremely effective carrier of thermal energy. It is many
times more effective in conveying this type of energy to item than hot (dry) air. Secondly, steam
was an effective sterilant because any resistant, protective outer layer of the microorganisms can
be softened by the steam, allowing coagulation of sensitive inner portions of the microorganism
(Cofiell et al., 2003).

Steam sterilization requires four conditions: adequate contact, sufficiently high temperature,
correct time and sufficient moisture. As an alternative to incineration, steam sterilization
(autoclaving) places first as a medical waste treatment option. Decontamination by steam
sterilization depends on the time and temperature, and it is determined by the minimum time
required to kill bacillus stearothermophilus spores exposed to saturated steam (wet heat) at a
particular temperature. (Cofiell et al., 2003).

The ECODAS equipment does have an inactivation efficacy test which had been conducted by a
controlled study of Waste Decontamination: ECODAS T1000 in Institute Pasteur de Lille,
October 21
st
, 2002 with the sterilization time of 10 minutes and cycle duration of 35 minutes.
The experiments were conducted on the Spore strips containing Bacillus stearothermophilus
spores that were kept in test tubes capped with water impregnated cotton and placed in the
apparatus. A satisfactory result of 10
6
reductions in bacillus stearothermophilus was observed,
following decontamination with ECODAS T- 1000 at 138C. (Material provided by ECODAS).

Another study indicated that infectious clinical wastes which are most suited for steam
sterilization are those with a relatively low density and low-to-moderate water content.
Contaminated plastic single-use items and cellulose products are easy to decontaminate,
provided that they are not packed tightly or encased whereby steam penetration is hindered.
Conversely, materials such as body tissue, parts, and fluids are relatively dense and high in water
content, thus inhibiting the amount of heat directly transferred by steam contact (Slavik, 1991).

A review by Urbanowicz (1998) evaluated the technology between incinerators and other
alternative treatment systems in American healthcare hospitals. In the review fifty states of
America recognized steam sterilization as an acceptable method of treatment for medical waste
prior to disposal.

Another study done by Melbourne's WasteEnergy Pty Ltd. found that around 95 percent of the
hospital and biomedical waste currently processed by incinerators can instead be sterilized.
Furthermore, the steam-injection sterilization technology enables such generating facilities as
hospitals to process biomedical waste autonomously and in-house. (Field Trial study by the
Royal Melbourne Hospital, Melbourne, Australia, of a highly advanced sterilization alternative
to conventional incineration of biomedical wastes).

Autoclave with steam sterilization continue to be one of the most popular methods of treating
medical waste .These technologies now incorporated maceration or shredding during the
treatment process to ensure better penetration of steam. These systems achieve significant
volume reduction up to 85% (http://www.oecs.org/esdu/documents/
waste%20Management%20Medical%20Waste%20Technologies.pdf.).

5.3 Cost Effectiveness

No evidence was retrieved on the economy evaluation of the ECODAS equipment. However,
there were some studies which indicated the cost aspects of the equipment.

A study found that an efficient and cost-effective on-site infectious waste management program
can be implemented by integrating the decontamination advantages offered by both steam
sterilization and incineration. (Slavik, 1985).

In a trial, results found that the capital and operating costs of sterilization are less than half that
of conventional incineration. (Royal Melbourne Hospital, Melbourne, Australia, of a highly
advanced sterilization alternative to conventional incineration of biomedical wastes-report).

Autoclaving or steam sterilization represents the ability for generators to treat their waste in a
cost-effective way. The equipment saves space, is easy to maintain and the destruction of
pathogens is highly effective. The only problem that often arises after autoclaving is the
transportation of the treated medical waste materials to the land fill. (Environmental
Chemistry.com Environmental, chemistry & Hazardous Materials News, Information and
resources. Traditional Medical waste treatments by Lupe Perez).

6. CAUTIONS

Steam sterilization is limited in the types of medical waste it can treat but is appropriate for
laboratory cultures and/or substances contaminated with infectious organisms. The waste is
subjected to steam in a sealed, pressurized chamber. The liquid that may form is drained off to
the sewer or sent for processing. The unit is then reopened after a vapour release to the
atmosphere, and the solid waste is taken out for further processing or disposal. One advantage of
steam sterilization is that it has been used for many years in hospitals to sterilize instruments and
containers and to treat small quantities of waste. A disadvantage is ensuring that the proper
time/temperature relationship has been met. Sterilization does not change the appearance of the
waste; this poses a problem in gaining acceptance of the waste for land filling. (Cheremisinoff et
al., 1990).The Ecodas technology uses steam sterilization and has a shredder to treat the medical
waste prior to the treatment of heat and pressure. It ensures smaller waste volume and
transportation to the landfill.







7. CONCLUSION

ECODAS technology using steam sterilization is found to be an effective mechanism to treat and
decontaminate medical waste. Steam sterilization is effective in killing the potential
microorganism at the high temperature of 138C, 3.8 bar, with an exposure time of 10 minutes.

In summary, the process of the ECODAS invention provides a highly reliable and safe method
for treatment of potentially infectious medical waste. The product of the operation is a residue
that can be accepted in regular landfill disposal sites. The waste residue is significantly reduced
in volume up to 80%, unrecognizable as medical waste. Such medical waste is essentially free of
"sharps", and poses no chemical or microbiological hazard to the waste sites or the operators.
The process further renders all equipment surfaces which are exposed to infectious matter
completely sterile since the machinery and equipment cannot be opened and accessed for
loading, unloading or maintenance until after the completion of the sterilization process.

8. RECOMMENDATION

The ECODAS sterilization system can be recommended as a method for treating medical waste.
However, there is a concern on the use of ECODAS system which should be assessed and
certified by our local environmental safety agency. This ECODAS system also needs to be
certified by the necessary agency on the safety aspects, with regards to its high temperature,
pressure and trained authorized person whom should be certified to handle this kind of
equipment.






















REFERENCES

Cofiell A, Narance D, Davius S, Klscik S, Koncur P, Lind N. Self study Lessonas.
(2003).Central Services Technical Manual. Sixth Edition. Chicago, IL. International Association
of Healthcare Central Services Material Management.

Cheremisinoff, Paul, and M.K. Shah., (1990). "Hospital Waste Management." Pollution Engineering,
April 1990. pp. 60-66,

Edward Krisiunas, MT (ASCP), CIC, MPH, Emerging Technologies for the treatment of medicalwaste.
http://www.oecs.org/esdu/documents/waste%20Management%20Medical%20 Waste
%20Technologies.pdf.

Environmental Chemistry.com.Enviromental, chemistry & Hazardous Materials News,
Information and resources. Traditional Medical waste treatments by Lupe Perez

Infection Prevention guidelines Sterilization. Adapted from: Tietjen, Cronin and McIntoh
1992.www.ipas.org/publications/CD/ ADVPACK-X05/PDF2s/Port-PAC-Reference.pdf

Phillips G., (1999).Microbiological aspects of clinical waste. Ninewells Hospital. Dundee J Hosp Infect.
J an; 41(1): 1-6.
Municipality of Anchorage, Solid Waste Services Revised Date: January 31, 2001.
Emial:wwsws@ci.anchorage.ak.us

RACHEL'S HAZARDOUS WASTE NEWS #179---May 2, 1990---, News and resources for
environmental justice. Medical Incinerators Emit Dangerous Metals And Dioxin, New Study Says,
Environmental Research Foundation.

Slavik, N.S., (1985). How to increase efficiency, safety and cost control in hospital infectious waste
treatment. Hosp Top. J an-Feb; 63(1):8-15, 27.

Slavik, N.S., (Dec 1991).Hospitals Have Several Methods, Available To Treat and Dispose of
Medical Wastes, Hospital. Ann Arbor:Vol.16, Iss. 12; pg. 14, 2 pgs.

STERILIZING BIOMEDICAL WASTE, Hospital Topics, 00185868, Spring92, Vol. 70, Issue 2,
Dat abase: Biomedical Reference Collection: Comprehensive Source: Hospital Topics, Spring 92,
Vol. 70 Issue 2, p46, 1p Item: 9707300167, Field trials are being completed at the Royal Melbourne
Hospital, Melbourne, Australia, of a highly advanced sterilization alternative to conventional incineration
of biomedical wastes.

Urbanowicz GR., (1998). Medical waste autoclaves: not just a lot of hot air. Prof Dev Ser (Chic Ill). Apr;
4-24.

University of Ottawa, Environmental Health and Safety Services, J uly 9, 2003 Guideline.
(http//www.uottawa.ca/services/ehss/autoclave.pdf)