Hospital waste management and toxicity evaluation: A case study M. Tsakona, E. Anagnostopoulou, E. Gidarakos * Laboratory of Toxic and Hazardous Waste Management, Department of Environmental Engineers, Technical University of Crete, GR-73100 Polytechnioupolis, Chania, Crete, Greece Accepted 26 April 2006 Available online 26 July 2006 Abstract Hospital waste management is an imperative environmental and public safety issue, due to the waste’s infectious and hazardous character. This paper examines the existing waste strategy of a typical hospital in Greece with a bed capacity of 400–600. The seg- regation, collection, packaging, storage, transportation and disposal of waste were monitored and the observed problematic areas documented. The concentrations of BOD, COD and heavy metals were measured in the wastewater the hospital generated. The wastewater’s toxicity was also investigated. During the study, omissions and negligence were observed at every stage of the waste management system, particularly with regard to the treatment of infectious waste. Inappropriate collection and transportation pro- cedures for infectious waste, which jeopardized the safety of staff and patients, were recorded. However, inappropriate segregation practices were the dominant problem, which led to increased quantities of generated infectious waste and hence higher costs for their disposal. Infectious waste production was estimated using two different methods: one by weighing the incinerated waste (880 kg day 1 ) and the other by estimating the number of waste bags produced each day (650 kg day 1 ). Furthermore, measurements of the EC 50 parameter in wastewater samples revealed an increased toxicity in all samples. In addition, hazardous organic compounds were detected in wastewater samples using a gas chromatograph/mass spectrograph. Proposals recommending the application of a comprehensive hospital waste management system are presented that will ensure that any potential risks hospital wastes pose to pub- lic health and to the environment are minimized. Ó 2006 Elsevier Ltd. All rights reserved. 1. Introduction Hospital waste is a special category of waste, which is highly hazardous due to its infectious and/or toxic charac- teristics. Furthermore, in healthcare units the direct expo- sure of waste management workers and members of the public to this type of waste increases the hazard that emerges from their treatment. Despite the fact that current medical waste management practices differ from hospital to hospital, the problematic areas are approximately the same for all healthcare units and at all stages of management, including segregation, collection, packaging, storage, trans- port, treatment and disposal. In Greece, considerable problems exist in this area, as lit- tle action has been taken to apply a complete system of hos- pital waste management. The recently passed Joint Ministerial Decision 37591/2031/03 regarding the measures and conditions for the management of healthcare waste can be considered as the first important step in this direction. According to this decision, all healthcare units in Greece are obliged to design and implement a comprehensive management strategy so as to safeguard the public and the environment. In light of such heightened concerns regarding healthcare waste, the feasibility of managing the wastes pro- duced in a modern hospital with a 400–600 bed capacity in a developing country such as Greece is examined in this paper. The quantity and composition of the wastes were mon- itored, as well as the hazard related to their infectious character. In addition, all stages of the existing waste management system were monitored and the problematic areas of each stage will be presented here. With a scarcity of data available on toxicity levels in the wastewater produced at healthcare facilities and other 0956-053X/$ - see front matter Ó 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.wasman.2006.04.019