Healthcare Waste
Management
Prof Dr Sonja Šostar Turk
HEALTHCARE WASTE MANAGEMENT
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Waste
Types of waste
Legislation
Health care wastes
Procedures for waste management
Waste recycling
Waste incineration
Waste depositing
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1. WASTE
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Waste is any substance that currently no longer benefits us, we do not need it, or we
are bored by it and would therefore like to get rid of.

Waste is a substance or object which its producer discards, intend to discard or is
required to discard.
The concept of waste is created by the industrial revolution, which created a multitude
of products from materials that fall apart slowly or not at all.
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1. WASTE
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An important factor that increases the amount of waste is better living standard and
the creation of disposable items.
Most waste means packaging of stuff we buy.
In the generation of our grandfathers and grandmothers the useful objects (eg.,
furniture, kitchen items, baby clothes, etc.) passed on from generation to generation.
Now days these objects are often changed already in one generation.
We also do not fix defective appliances (washing machine, mobile phone), but simply
buy new and discard the old one in landfill.
This is one of the reasons that there are more waste in the developed countries, than
in the less developed.
The life of the inhabitants of the less developed areas is easier and also less wasteful.
They often built homes from the waste materials. Documentary: Waste land (2010)
Interestingly this materials are often very resistant and persistent even for centuries.
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The waste must be handled in a way that do not:
 endanger human health
 excessive pollute water, air and soil
 produces unwanted noise or odors,
 significantly worsen the life chances of animal and plant etc.
Underdeveloped countries have less than 50 kg of municipal waste per year per
Citizen and the most developed more than 1500 kg. Slovenia is considered as a
medium-developed country and has around 300 kg of waste per year per citizen.
Among all this waste is about 80 kg package.
Waste are generated wherever the human foot steps.
An exception are not even the universe and the highest parts of the world.
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2. TYPES OF WASTE
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Dividing waste in the aspect of their formation, there are municipal waste that
incurred as a result of human existence and everything associated with human and
other waste.
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Dividing can also be according to other criteria, for example, regardless of whether
they can be reused or not, according to the degree of their danger, according to the
container to which they belong ...
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MUNICIPAL WASTE
Municipal waste is waste from households or by its nature and composition similar waste
from manufacturing, trade, service or other activity. These wastes arising from human
physiological activity.
The structure of municipal solid waste is very difficult to define, therefore, they are
usually classified according to the source of their creation.
Among municipal waste there are:
 paper
(newspapers,
magazines,
cardboard, mixed paper waste)
 glass (white, brown and green glass) and
ceramic
 packaging (which are synthetic materials:
foil, plastics, metals ...)
 biological waste (organic waste, food
waste and residues from the processing
of food)
 mixed municipal waste (waste that end
up in this container are deposited in
landfills after a thorough examination)
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Industrial waste
These include all waste generated as a result of industrial production. Waste are generated
in the whole production chain, from extraction of raw materials and their transport to the
finished product in factories and installing them in the shops.
They are characterized by a high degree of classification in the aspect of the source of their
creation, which significantly facilitate their further processing (recycling, deposit).
Typical representatives are:
 inert waste (ash, slag, industrial dust ...)
 special waste and hazardous waste,
 construction waste
 radioactive waste ...
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HAZARDOUS WASTE
Hazardous waste is one that is due to certain natural ingredients or features, on the basis
of the regulations, classified as hazardous waste. They represent any potential immediate
or time-dependent hazards for humans, animals and plants.
Typical representatives are:
 batteries,
 pesticides,
 medications,
 varnishes and paints,
 waste engine oil,
 chemicals ...
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SPECIAL WASTE
These are wastes that are neither municipal, not dangerous, but because of their quantity
or properties is necessary to be handled in a special way.
These include:
 sludge from sewage treatment plants,
 slag from electroplating,
 ash ...
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WASTE CLASSIFICATION IN ASPECT TO PLACE OF ORIGIN
ELECTRONIC WASTE
Electronic waste (including e-waste) contains various corrupt, useless, abandoned and
broken electronic devices. These wastes are ecologically disputed and can be dangerous
because of the nature of themselves, they do not fall apart and are not naturally
degradable.
While e-waste include:
 computers,
 televisions,
 phones,
 all household appliances ...
Disused mobile phones, home appliances and batteries contain
environmentally harmful substances.
It is therefore important that they are properly deposited and removed.
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Bulky waste
Utility companies often organize an annual collection of such waste, that because of their
size should be collected separately.
 bathroom accessories,
 furniture,
 carpets,
 upholstered furniture and mattresses,
 lighting and blinds ...
GARDEN WASTE
The branches from pruning, grass clippings, leaves, weeds ... Ideally, garden waste can be
composted.
Compost include kitchen waste,
garden weeds, pieces of lawns,
withering flower, leaves, peat, straw, fern, litter,
grass, wood ashes, sawdust ...
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WASTE TIRES
Tires do not belong to the classical municipal waste.
Tires can be separate delivered to the landfill, where
they are prepared and transported to the heat
treatment in the cement.
Tires can be also placed to the tire depot, that will
properly take care of them.
TEXTILE WASTES
Textile waste and old clothes can be recycled, but
also the wiping cloths can be manufactured from
this material. Better clothes that are still good and
whole can also be donated to charities (Caritas
Slovenia, Unicef).
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3. LEGISLATION
LEGAL PREMISES
In the Republic of Slovenia the main regulations for waste are:
 The Environmental Protection Act
 Regulation on waste management
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THE ENVIRONMENTAL PROTECTION ACT
Specifies the starting point with regard to:
 reducing, and preventing the emergence of negative impacts of waste on the
environment,
 processing,
 proper disposal,
 transport and trading with waste,
 environmental claims,
 environmental benefits
 measures in cases of illegally deposited waste etc.
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THE REGULATION ON WASTE MANAGEMENT
Determines the following:
 mandatory waste treatment,
 the conditions for the implementation of collection, transportation, transmission,
trading, processing and disposal of the waste,
 classification list
 reporting obligations (elaboration of reports, the storage of waste record sheets ..)
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4. HEALTHCARE WASTE
Management of waste from healthcare is determined by the Slovenian Regulation on the
management of waste generated in the course of medical and veterinary activities and
related research.
The producer of healthcare waste must ensure the following:
 That waste is airtight and not as mixed municipal waste,
 That waste is deposited in containers or bags, which are designed for the storage of
waste arising from healthcare
 That the waste packages are collected separately from other waste arising from
healthcare
 That waste is collected in containers or bags, which have visible indication of the type of
waste,
 That healthcare waste is not mixed with other waste,
 That the waste is handed over to waste collectors in containers or bags with written
information about the time and place of origin, type of health care wastes with
classification numbers and the amount of waste arising from healthcare.
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This legislation is not used for:
 Body parts and organs including blood bags and blood preserves (crematorium)
 Waste from cytotoxic and cytostatic medicines
 Waste from healthcare medicine
 Amalgam waste from dental care
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COLLECTION OF HEALTHCARE WASTE
CONTAINERS OR BAGS FOR WASTE STORAGE
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The producer of waste must ensure that the containers or bags intended for
temporary storage of waste arising from healthcare are made of a material which, in
the normal conduct in relation to the physical, chemical and biological properties of
the waste arising from healthcare prevent harm to the environment and human
health.
Existing standards, if applicable, for the material of the containers or bags should be
taken into account.
Labelling of containers or bags
 A visible indication of the type of waste must be on the containers or bags,
 The collector of waste shall receive the waste in containers or bags with written
information about the time and place of origin, type of health care waste according to
numbers of the waste classification list, as well as the quantity of waste arising from
healthcare.
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STORAGE OF WASTE
 The storage of waste must be a covered space separate from other rooms and the
outside in a way that prevents access by unauthorized persons.
 The storage must be marked with a visible sign on the purpose of the area, a
prohibition on the entry of unauthorized persons and warning of the possibility of
damage to their health.
 The storage must be locked when not in operation.
 Floors and walls must be made of materials that can be cleaned and disinfected.
 It should have a waste water discharge and mechanical ventilation.
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TRANSPORT OF HEALTHCARE WASTE
 The producer of waste must ensure that the waste inside a building or between
buildings is transferred and transported in containers or bags that are designed for
storage of waste.
 Transport vehicles intended solely for the transport of waste must be used.
 The vehicles must have smooth, impervious and impermeable surfaces that can be
wet cleaned and dried, and inaccessible to insects and rodents.
 Transport vehicles must enable safe loading and unloading.
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HEALTHCARE WASTE MANAGEMENT PLAN
The healthcare waste management plan includes the following: :
 The method of separation of certain types of healthcare waste
at the place of origin,
 The method of marking containers or bags and the type of
material from which containers or bags designed,
 The transport of healthcare waste from the place of origin,
 Maintenance and cleaning of storage of waste,
 The timetable of transport of waste from storage
 Internal guidance on handling healthcare waste and other
wastes from medical activities and related studies,
 Employee training on relation of healthcare waste
management,
 Financial evaluation of healthcare waste management plan,
 Timetable for the implementation of the waste management
plan,
 Responsible person and the description of work and
obligations relating to the transport and temporary storage.
The director of the healthcare institution is responsible for the
healthcare waste management plan .
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HEALTHCARE WASTE TYPES
18 01 WASTE FROM NATAL CARE, DIAGNOSIS, TREATMENT AND PREVENTION IN HUMAN
HEALTH
18 01 01 Sharp objects (18 01 01-non-infective, 18 01 03infective)
 All sharp objects that are thrown away after use.
 This includes needles, blades, saws, lancets, broken
glass, irrespective of contamination.
 They are disposed in approved sharps collector made
of hard plastic.
18 01 02 Body parts and organs including blood bags and
blood preserves
 All human tissues, organs, fetuses, limbs, placenta and
blood and corpses and tissues of experimental
animals.
 They are disposed into hermetically closed disposable
containers.
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18 01 03 Waste that requires special handling in order to prevent infection
Infectious waste include:
 respiratory devices and materials used in the care of
patients SARS, TBC, pneumonic plague, hemorrhagic
fever,
 all materials contaminated with blood and bloody
body fluids, hepatitis B, hepatitis C, HIV,
 and material from the treatment of Creutzfeldt
Jacobs disease.
Guidelines for preparing the program for the control and
prevention of nosocomial infections define infectious
waste as waste that contains more than 100 ml of blood,
or abscess or waste soaked with blood.
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18 01 03 Waste that requires special handling in order to prevent infection
This waste also includes technical medical supplies and disposable
items that have come into contact with infected persons or their
secretions or liquids.
Including:
 Cultures and devices used in laboratory work with infectious
materials, equipment parts, clothing, gloves, towels and other
hygiene supplies used in dialysis,
 Waste, contaminated with patient secretions in isolation
rooms, as well as any other materials which may contain
pathogenic germs in such a quantity that could cause disease,
 blood bags with the remains of the blood and blood products,
drainage systems, aspiration bags which can not be emptied,
disposable material overlapping surgical fields heavily
impregnated with blood, dressings soaked with blood, purulent
or diagnostic materials
 Devices used in laboratory work with infectious materials.
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18 01 04 Waste that does not requires special handling in order to prevent infection
This includes:
 linen,
 plaster bandages,
 diapers,
 disposable clothing,
 infusion systems with traces of blood,
 drained and protected transfusion systems,
 syringes without needles with traces of blood,
 vascular and urinary catheters,
 emptied urinary bags,
 intestinal relief tube feeding probe emptied drainage tubes and equipment,
 respirators, hoses, tubes of aspiration,
 endotracheal tube,
 cannula,
 bloodless or unfertilized dressings,
 tampons, masks, hats, gloves,
 incontinence proposals wipes.
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18 01 06* Chemicals that contain dangerous substances
18 01 07 Chemicals not listed under 18 01 06
 solid, liquid or gaseous chemicals used in medical procedures, experimental work,
cleaning, disinfection
 arising in the process of work in organizational units, in particular in the lab, x-ray and
pathology.
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18 01 08 Cytotoxic and cytostatic medicine
 includes waste generated in the preparation and
administration of cytostatic therapy and are
directly contaminated with cytostatic content.
 includes drugs that have one or more of the
following characteristics:
 are carcinogenic,
 teratogenic, or have any other effect on fetal
development or reproductive toxicity
 toxic to organs and tissues at low doses.
18 01 09 Medicine not included in 18 01 08
unused medicines packaged for end-uses which have been placed on the market, but
they must be discarded due to the expiration of the period of use or other reasons.
18 01 10* Amalgam waste from dentistry
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5. WASTE MANAGEMENT OPERATIONS
First of all we should instead of the question 'What to do with waste?', ask ourselves
'Is it necessary to generate the waste?'. In other words, the best way is to prevent the
waste. When the waste is already generated, we tray to look at them differently and use
them.
One of the most important processes in solid waste management are processes which
reduce the volume of waste – solid waste compacting. Some of the waste can be
recycled and then reused. The other wastes have a certain amount of energy that can
be exploited.
3R
Reduce
Reuse
Recycle
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DIAGRAM OF THE WASTE HIERARCHY
Most favored
option
Prevention
Minimization
Re-use
Recycling
Energy recovery
Least favored
option
Disposal
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It is prohibited to leave and dispose waste in a natural environment. Waste treatment has
the advantage before disposal. Preparation of waste re-use has priority over recycling.
There are several waste management options:
 SEPARATE COLLECTION AND SORTING
 RECYCLING
 MECHANICAL AND BIOLOGICAL TREATMENT
 INCINERATION – ENERGY EXPLOITATION OF WASTE
 LANDFILLING
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6. WASTE RECYCLING
Recycling is a process to convert waste materials into new, useful products. Recyclable
materials include many kinds of wood, glass, paper, metal, plastic and textiles. With
recycling we reduce the need for new raw materials, which may be in short supply, and at
the same time we can save the energy.
In Slovenia, according to the quantity of recycled waste, we are lagging behind our
European neighbors. For example, the Netherland recycles 65 percent of the waste, while
in Slovenia we recycle only 15 percent.
Recycling can be divided into two parts:
 material recovery of waste,
 energy recovery from the waste, energy utilization of residues after recovery
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MATERIAL UTILIZATION OF BIO-WASTE
The most known method is the production of humus (highly nutritious biomass) or
compost. Aerobic composting takes place in the presence of oxygen. In this process,
aerobic microorganisms break down organic matter and produce carbon dioxide (CO2),
ammonia, water, heat and humus. We get a relatively stable organic end product.
ORGANIC
SUBSTANCE
+ O2
AEROBIC BACTERIA
NEW CELLS + CO2 + H2O + NH3 + SO4
The newer method is an anaerobic composting process, which produces natural biogas.
In this process the solid residues are dried and used for firewood.
ORGANIC
SUBSTANCE
- O2
ANEROBIC BACTERIA
NEW CELLS + CO2 + H2O + CH4
COMPOSTING PROCESS:
 In the air blowing channel: the process takes about 3 months.
 In aerated piles: the process takes several weeks.
 In the reactors: the process of microbial metabolism can be completed within a few
hours.
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MATERIAL UTILIZATION OF PLASTICS
Waste plastics consists different types of polymers, where each
type is distinguished by a particular combination of physicalchemical properties, which affect the area of application and the
manufacturing possibilities.
For each polymer, there are the specific processing steps. The
polymers that occur most commonly are incompatible with each
other. Even small amounts of one polymer in another can
significantly deteriorate the mechanical properties. Furthermore,
the waste plastic is additionally contaminated with other waste
(paper, metal, glass, textiles….).
Another problem lies in the fact that many of the plastic items
consist the parts from different types of plastic. Depending on the
thermostability the plastic is crumbling or melting during
processing.
Health problem bisphenol A / BPA
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COMPATIBILIZATION
The properties of incompatible polymers blend can be improved by compatibilization:
addition of block or graft copolymers with blocks identical or compatible with the blend
components. The copolymers are premade (additive compatibilization) or are formed
during mixing by chemical reaction (reactive compatibilization).
Plastic items that are discarded in nature, pose a threat to the natural environment, due
to their stability. There are several known cases, where they found a pieces of plastic,
inside the intestines corpse of sea animals and birds. This plastic probably contributed to
their deaths. Therefore the researchers are exploring biodegradable plastics, which
decomposes under the action of UV rays, microorganisms, water or other environmental
factors.
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RATE OF EXPLOITATION OF ARTIFICIAL MATERIALS
PRODUCT QUALITY
GRANULAR
HOMOGENOUS
REGRANULAT
SIMILAR
REGRANULAT
MIXED
POLYMERIC
MATERIALS
COMBUSTION
Thin foils
Shrink foils
Packaging
Carrying bags
Packaging
Waste bags
Pallets
Coasters
RATE OF POLLUTION
LANDFILL
Energy sources
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MATERIAL UTILISATION OF WASTE GLASS
The proportion of recycled container glass is very high and still rising. The most economical
use of glass is by remelting in the glass furnace followed by processing a glass product.
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IMPURITIES THAT RESULT IN MANUFACTURING MISTAKES OF NEW GLASSWORK:
 Ceramic, stone, porcelain: do not dissolve and remain as an error in the product.
 Wire, metal particles: cause the formation of spherical iron inclusions in the glass.
 Aluminium: causes the formation of metallic silicon in the form of spherical inclusions,
which cause the formation of cracks on the surface of the cooling glass.
 special glass waste (glass-ceramic, quartz glass) do not melt and cause the appearance
of inclusions in the glass.
 Organic impurities (paper, plastics, food scraps): act as reducing agents and differently
affect various glass.
 Impurities in the form of dyes (oxides of chromium, iron and copper) cause major
problems for melting white and brown glass.
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Glass is cleansed and transformed.
Thus energy and quartz sand is saved.
Waste glass is the only material that can be recycled 100 %, because in this process no
by-products are produced.
For successful recycling it is important to separate collection of brown, green and
colorless glass waste.
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MATERIAL UTILISATION OF PAPER AND CARDBOARD
Waste paper and cardboard represent 20% of overall waste. Waste paper is irrigated in
order to be cleaned. From the drained residue lower quality paper is produced.
MATERIAL USE:
 Paper waste can be used as a secondary
raw material in the manufacture of paper
and paperboard, thereby reducing the
consumption of raw materials (pulp) and
thereby preserving the forest.
 Purity is important.
 Waste can also be used as a raw material
for composting.
ENERGY USE:
 Is carried out by thermal treatment in
which the product is thermal energy,
which can be used in unmodified form or
is converted into electrical energy.
 Purity is not so important, except for the
elimination of metal particles.
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Why is it so important to recycle paper?
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for 1 ton of paper it is necessary to destroy 17 trees,
1 tree can purify 25 pounds of air pollution in one year,
1 ton of recycled paper :
 uses 64% less energy
 uses 50% less water,
 74% reduced emissions of hazardous substances into
the air,
 save 17 trees
 creates 5 times more jobs than 1 ton of paper made
from wood,
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MATERIAL UTILISATION OF METAL COMPOUNDS
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metal recycling is carried out mainly with physical and rarely with chemical
processes.
The type of technological process depends primarily on the physical properties of
the waste and the accompanying material that must be removed during processing.
removed
The specialty of recycling waste metals is that the final product of the metal or metal
alloy is the same quality as the orginally produced metal from ore.
Aluminium cans are worth five times more than the glass or plastic bottles
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7. INCINERATION – ENERGY UTILISATION OF WASTE
In incineration plants with treatment of waste at high temperatures, various gases, water
vapor and ash are formed while releasing energy.
The volume of waste is reduced by 95-96%. The resulting heat energy in most cases can
be used for municipal or thermal energy purposes.
Specially designed incinerators can even handle hazardous waste: the burning process
reduces the toxicity of organic compounds. However, the incinerator should have
regulated release of smoke.
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BENEFITS OF INCINERATION PLANTS
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High energy production,
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Simple procedure (waste is burnt)
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Small amount of waste,
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Waste treatment plant determines the
quality of incinerators
WEAKNESS OF INCINERATION PLANTS
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the residue (ash) is disposed of as a hazardous
substance or further processed
air pollution (SO2, NO2, HCL, organic compounds,
dioxins, heavy metals, POP‘s)
water pollution (discharge of hazardous substances
into surface water)
soil pollution (disposal of incinerator ashes and
smoke cleaning residues).
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8. WASTE DEPOSITING LANDFILLS
Depositing means the controlled disposal of waste on the surface of the earth or in
some cases even below it. When planning the following aspects are taken into
account:
 selection of appropriate locations for the construction of landfills,
 the manner and method of distribution of the waste at the landfill,
 the formation and removal of gases and leachate.
The bottom of the landfill must be constructed so as to prevent leekage of wastewater
into groundwater. Leachate must be captured and treated as municipal waste water.
Uncontrolled disposal or deposit of waste (disorganized, unregulated) in an
unregulated area is still very common (illegal deposits).
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BENEFITS OF WASTE DEPOSITING
LANDFILLS
they are cheap,
They produce methane, which can be
collected and reused,
They save electricity, because there is
little work with processing and
treatment,
waste volume is reduce by
compression.
WEAKNESSES OF WASTE DEPOSITING
LANDFILLS

They require a large surface area,

They are quickly filled,
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care must be taken that the waste does
not come into ground water,
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The oldest ones are not built according to
standards
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anaerobic digestion (methane-burning).
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THANK YOU
FOR YOUR ATTENTION!
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