Automated Medical Waste Tracking

AUTOMATED MEDICAL WASTE TRACKING

AND INFORMATION SYSTEM

HENNIE VISSER

Managing Director, Opto Africa (Pty)Ltd

Biography

1983: BSc(Eng) - University of Pretoria

1984-85: Process Control Engineer, Siemens, Karlsruhe, Germany

1985-86: Signal Officer, Natal Command

1987-88: Process Control & Instrumentation, Babcock Engineering

1989-1996: Systems Engineer and Technical Director, Mass Measuring Systems (Pty)Ltd

1997-Present: Managing Director, Opto Africa (Pty)Ltd

Abstract

Opto Africa (Pty)Ltd, in conjunction with Pikitup (Pty)Ltd, has embarked on a Pilot Project where Cellular(GSM), GPS (Global Positioning System) and RFID (Radio Frequency Identification) -technologies have been implemented successfully to track and manage Medical Waste Containers.

A brief description of the following topics will be presented:

·  Identification of Waste Containers via RFID Technologies

·  Tracking of Transporters of Medical Waste

·  Automated Weighing of Waste at Origin

·  Automated confirmation of the destruction of Medical Waste

AUTOMATED MEDICAL WASTE TRACKING

AND INFORMATION SYSTEM

On the 27th February 2001, the following article appeared in various newspapers in South Africa:

Medical waste disposal crisis in SA
The disposal of medical waste in South Africa is characterised by illegal dumping, pollution, little or no enforcement of regulations and a lack of clear guidelines and policies
The disposal of medical waste in South Africa is characterised by illegal dumping, pollution, little or no enforcement of regulations and a lack of clear-cut guidelines and policies.
And insufficient training of staff at government hospitals in the handling of such waste is costing the institutions tens of thousands of rand a month. These were among some of the details made clear to Parliament's environmental affairs portfolio committee on Tuesday during hearings on the state of medical waste management nationally.
"Medical waste management in our country is not up to standard," committee chairwoman Gwen Mahlangu said at the start of proceedings. Management strategist David Crawford, of Quality Strategies International, told committee members the country needed to urgently train people to implement rules and regulations around the disposal of medical waste.
"We see companies out there going blatantly against the environmental laws of this country." Crawford said South Africa had a crisis on its hands. The country had enacted first-class legislation, but this was not being enforced. "We need to get our people trained to go out and implement the requirements of the law.
"This is not a political issue; it is an environmental issue; it needs to be solved by environmental engineers," he said. Susanne Dittke of EnviroSense CC, which is currently advising the City of Cape Town on waste disposal methods, said a "typical" government hospital generated over 20 tons of so-called medical waste a month - 675kg a day.
The monthly cost to remove this was about R43,800. "From hospital waste manager's daily experience, education on prevention, and better separation of domestic and medical waste in the wards, would reduce (this) to about 180kg a day," she said. Possible savings would be about R32,000 a month. She described waste management procedures at government hospitals as a "nightmare".
"People couldn't care less, there is no education in place... we must get our priorities right," Dittke said. Peter Novella of the Institute of Waste Management said there was a lack of policy and guidelines for health-care waste handling and disposal - at national, provincial and local level. There was also a lack of policy and guidelines on crematoriums and cemeteries.
"Everybody in South Africa is going to end up in one of these two places," he said. "And cemeteries create major pollution problems on the environment." Novella also said there was a "lack of capacity of enforcing agents for monitoring and control of standards of health-care waste facilities".
Dittke said the current method of burning medical waste in incinerators had both a local and regional impact on people's health. The process generated high levels of poisonous chemicals and heavy metals. The resulting ash was also highly toxic, she said. In its briefing, KwaZulu-Natal's health department admitted that management systems for medical waste in the province were "unsatisfactory, both in government and private health care facilities".
Rural health care facilities in the province were characterised by "extremely limited... technologies and difficult logistics". "In some instances there is little control over how medical waste is stored, handled and disposed of," provincial environmental health director Wilson Khanyile told the committee.
Out of a total of 67 government hospitals in the province, only 27 institutions had signed contracts for the proper removal of medical waste, he said. Eddie Hanekom of the Western Cape's department of health said the province had been plagued by several incidents of illegal dumping of medical waste in the past two years.
A task team appointed to investigate the incidents had reported that medical legislation was fragmented and difficult to apply. Fines for this type of offence were also too low, if the possible risk to the community was taken into account, he said
By Sapa
27-02-2001

Following these events, Gauteng Province initiated the drafting of the GAUTENG HEALTH CARE WASTE MANAGEMENT REGULATIONS, extracts of which we would like to point out:

(Refer to http://www.csir.co.za/ciwm/legislation.html http://www.csir.co.za/ciwm/HCW%20REG%20FINAL.pdf)

“Tracking documents

(1)  A health care risk waste transporter must maintain completed tracking documents for all health care risk waste it transports. At the time the health care risk waste transporter receives health care risk waste from any person, the transporter shall provide that person with a copy of the tracking document for that person’s health care risk waste records. The transporter must maintain a copy of such tracking documents for a minimum of three years. The transporter must submit to the competent authority, upon request, copies of any tracking documents the transporter is required to maintain.

(2)  The tracking document shall include, but shall not be limited to the information contained in the form as set out in Schedule 8.

(3)  Any health care risk waste transporter transporting health care risk waste in a vehicle must have a tracking document in his or her possession while transporting the waste. The tracking document shall be shown upon demand to any personnel of the competent authority or any law enforcement officer. If the waste is transported by rail, vessel, or air, the railway operator, vessel operator, or airline must enter on the shipping papers any information concerning the waste, which the competent authority may require.

(4)  A health care risk waste transporter must provide the person receiving the health care risk waste with the original tracking document, and at all times during transit, must be able to identify the generator of all waste transported.”

In addition to the above, the GAUTENG WASTE INFORMATION REGULATIONS stipulate that:

(Refer to http://www.csir.co.za/ciwm/legislation.html

http://www.csir.co.za/ciwm/WIS%20Reg3.pdf)

“There must be a provision for:

·  The establishment of a Waste Information System

·  Reporting formats and intervals

·  Registering of relevant persons

·  Access to waste reporting to the public

·  Penalties to be “enforced”

By effectively implementing the latest communication technologies, the above information can be obtained electronically via the Internet thereby reducing the need of cumbersome documents and in the same process, assist local Government in the policing of the legislation:

Let’s have a look at each of the technologies in their own right, and then at the strength in the combination of the technologies as we implemented them to provide a cost-effective, yet powerful tool to effectively manage Medical Waste:

Tagging of Medical Waste Containers

Radio Frequency Identification (RFID, or commonly referred to as ”tagging”) has come of age and is currently becoming more and more an “intelligent” replacement technology for barcoding.

The concept of RFID can be simplified to that of an electronic barcode.

First emerging in the 1980s, RFID was primarily used to track objects in industrial environments where barcodes were unable to sustain the harsh surroundings. Today, RFID is being used to authenticate official memorabilia, track proprietary assets, automate access control and, since the late 1990s, manage inventory and thus Medical Waste Containers.

Unlike barcodes, RFID tags can be read:

·  Through walls and ceilings (no line of sight is required).

·  in any orientation to the reader/antenna (although this could be important over long distances)

·  while moving (i.e. while being deposited through a return chute)

·  several at a time (for instance, in the back of a medical waste vehicle)

·  from distances of several meters to the antenna

However, the ability to conduct inventory counts without removing a single item from the shelf is what really separates RFID from preceding technologies such as barcodes.

During the Pilot Phase conducted at a NetCare Hospital by Pikitup(Pty)Ltd and Opto Africa(Pty)Ltd, RFID Readers were strategically placed at the following positions:

i) Inside the Medical Waste Transport Vehicle

ii) At the Incinerator Entrance

iii) At the Washing Bay where the Bins are decontaminated

Unfortunately, identifying the Medical Waste Container alone does not solve the problem. The actual location of the container is of importance, and this is where GPS (Global Positioning System via Satellite) comes into play:

GLOBAL POSITIONING SYSTEM (GPS)

Since the “public-making” of the US military Satellite Navigation System, GPS receivers have become more affordable to the man in the street. It is predicted that cellphones will soon incorporate them as a standard feature, mainly to assist 911 Emergency Services in locating people in distress.

Intentional degradation of the satellite signal by the US Department of Defence

This intentional degradation of the signal is known as "Selective Availability (SA)" and is intended to prevent adversaries from exploiting highly accurate GPS signals and using them against the United States or its allies. However, on May 1, 2000, U.S. President Bill Clinton ordered Selective Availability (SA) turned off at midnight (Coordinated Universal Time). Now, civilian GPS users around the world will no longer experience the up to 100 meter (approximate 300 feet) random errors that SA added to keep GPS a more powerful tool for the military. Today, GPS units are accurate to within 20 meters (approximately 60 feet); although in good conditions, units should display an error of less than 10 meters. The combination of these errors in conjunction with poor satellite geometry can limit GPS accuracy to 100 meters 95% of the time and up to 300 meters 5% of the time. Fortunately, many of these errors can be reduced or eliminated through a technique known as "Differential." Sophisticated receivers can now achieve accuracies of 1 meter or less.

A typical example of where GPS technology is used, is the “Digital Angel”:

http://www.digitalangel.net/works_demo.asp

http://www.digitalangel.net/medical.asp

Although obviously not cost-effective or practically possible to provide each and every medical waste bin with a GPS receiver, it made sense to track the actual Medical Waste Vehicle that transports the containers to and from the incinerator and source of waste.

Combining the RFID reader data with GPS data gave us the capability of pinpointing Medical Waste Containers to within a few metres, but this was only possible once the data was collated at a computer system with some extensive mapping features. Hence the solution of GSM / GPRS : Getting the information, in real-time, to the nearest computer database.

CELLULAR COMMUNICATIONS and GPRS

With the introduction of the General Packet Radio Service (GPRS) on our cellular GSM networks, the possibility of real-time 24/7 communications became a reality. This feature is used to communicate raw data from the Medical Waste Vehicle as well as from the source of the medical waste (in the case of the Pilot Project, the NetCare Hospital) to a central database on the Internet.

Besides the fact that we can track the movement of the vehicle (and thus all of the Medical Waste Containers) in real-time, events such as the “loss” of a container during transit as well as the capture of the actual Nett Mass of the waste are recorded and transmitted to a central database server on the internet.

This was accomplished by modifying the weigh scale at the hospital to transmit every weight of the container at the point of collection. A simple coding system allows the operator to punch in the source of the waste such as X-Rays or dialysis, which in turn helps the hospital to categorise the billing more effectively:

INTERNET REPORTS AND QUERIES: How does it help?

The ultimate advantage of real-time data acquisition in this Pilot Project is the immediate availability of the information on the Internet:

Benefit to the Waste Generators

The generator of the waste (in this case NetCare Hospital) can access information and query the frequency of waste collection; the type of waste generated; the actual total tonnages on a daily, weekly or monthly basis.

Benefit to the Waste Transporters

The Transporters of the waste can query the movements of the vehicle as well as the deployment of each and every container.

Benefit to the Health Authorities

The Health Authorities can query the decontamination of the containers as well as the actual tonnages generated per area. Also the authorities can access the information to ensure that the operators do comply with the health regulations as mentioned in the opening of our presentation.

Benefit to the Waste Disposal Company

The Waste Disposal Company can ensure that the waste actually was incinerated properly and timeously, as well as automate their billing process.

CONCLUSION

The effective application of state-of-the-art technologies in this Pilot Project proves that, without complicating the waste collection and destruction process, control can be exercised remotely from a central point to satisfy all players in this potentially hazardous circumstance.