VERSO L’OSPEDALE VERDE: UNA VALUTAZIONE ECONOMICA TRA TECNICHE DI IN E OUT - SOURCING PER LA GESTIONE DEI RIFIUTI OSPEDALIERI.

[Autom. eng. transl.] INTRODUCTION: Efficiency problems are increasingly central to health service debates. Recent studies have shown that energy consumption in hospitals and hospital waste management costs are constantly increasing, amounting to over € 1.2 billion in the Italian national health service. The European guidelines, aimed at the promotion of the green economy, incentivize the expenses for the reduction of energy consumption, favor the self-production of energy from renewable sources and the reduction of waste as well as their recycling. Our study aims to carry out an economic evaluation through the comparison between out-sourcing techniques for the disposal of hospital waste and internal disposal systems for healthcare facilities, suggesting the construction of a waste-to-energy plant with energy recovery in a large hospital. MATERIALS AND METHODS: A simple cost-benefit analysis model was used to compare two different hospital waste management strategies: the first considering the current set-up that uses out-sourcing techniques for the disposal of medical waste and the second considering the hypothesis of internal disposal using the waste-to-energy technique with energy recovery. The data concerning the production of medical waste were acquired from the administrative archives of the hospital under examination, while the data for the construction and operating costs of a hypothetical waste-to-energy plant with energy recovery were acquired from the scientific literature. We estimated the cost of managing and maintaining the waste-to-energy plant at 0.50 Euro / kg and we used the 'EcoTransIT' software to calculate energy consumption and the related environmental impact deriving from the transport of medical waste to the currently used incineration plant for the disposal of medical waste. The hazardous waste sent to incineration by the hospital in question is approximately 1,151,719 kg / year, therefore we have determined that the capacity of the incinerator to be realized is equal to 150 kg / h. RESULTS: The results showed that, at the end of the amortization plan for the purchase of the waste-to-energy plant with energy recovery, a saving of 65% was made compared to the current management costs (564.062 vs. € 1.606.039) . A further analysis has shown that, in the case where more hospitals choose to deliver waste to a single waste-to-energy plant, a further optimization of costs is determined. CONCLUSIONS: This economic evaluation shows that, through the technique of waste-to-energy treatment with energy recovery, significant savings can be made on hospital waste management costs with positive effects on the environment in terms of reducing atmospheric emissions for failure to transport waste to incineration plants far from the place of production.