ACTION B – Implementation actions

B1 – Involvement and support the screening of medical institutions and veterinary clinics that discard medical equipment

From 1-7-2014 to 30-06-2017

Aim action B1:
to perform the analysis of the discarded equipment, trying to highlight macro categories useful to define for each component the target destination channels.

This action targets the organisations/structures/centres that use medical equipment and devices for which discard has been decided.

The target institutions fall into several diversified categories: hospitals, residential or semi-residential socio-medical structures, outpatient and territorial centres. Veterinary centres for pets and farm animals are also involved in the action, in particular: veterinary clinics, sector analysis laboratories.

The first activity concerns the planning of contacts with the medical institutions in Italy, in order to involve them in the Life+ project. We start with those who have already declared their interest to cooperate within the project Life-MED.
We use various channels of contacts: sending information materials, attendance at meetings, advertisement and online communication.

The action foresees the signature of an agreement between CAUTO and the interested medical centres for a specific evaluation of the discarded devices and equipment.
After the agreement, CAUTO performs the assessment by using various tools: data and photographs collection, interviews with operators who have used the equipment.
The main tool for this screening activity is the on-site inspections at the medical institution to collect technical information: presence of manuals, scheduled maintenance, weights and sizes.

Expected results:
– 250 contacts with medical institutions
– 60 answers and requests of information
– 30 agreements

B2 – Analysis for the correct characterization as waste of medical equipment

Aim of Actions B2:
– to develop scientific criteria for the correct characterisation of some medical equipment, in relation to the presence inside them of dangerous substances or other problems related to their classification as waste.

These criteria are indispensable in particular during the transport, recovery or disposal phases for this equipment, since it is necessary to treat the medical equipment turned into WEEE in a proper manner, by determining the most appropriate type of WEEE.

In concrete terms, the correct attribution of an identification EWC (European Waste Code), in particular concerning the class of danger, depends on the components identified within a WEEE.

In details the activities to develop:
– a study of the RoHS (Restriction of Hazardous Substances Directive) set of rules on eco-design of EEE products, included the new Directive 2011/65/EU to supplement Directive 2008/98/EC, Regulation (EC) n.1907/2006 /REACH) and Directive 2009/125/EC.
The provisions concern the restriction in the use of certain dangerous substances in electrical and electronic equipment.
– Sample analysis on some medical equipment formed by different type of components. We identify some complex equipment, checking the different parts. For some kind of equipment we analyse the components considered as separated items typical of WEEE (batteries, capacitors, printers..)
– Sample analysis on some medical equipment to verify the presence of dangerous substances. We examine the substances covered by RoHS legislation: Lead, Mercury, Cadmium, Hexavalent Chromium, Polybrominated Biphenyls (PBBs), Polybrominated ethers (PBDEs).
– Sample analysis of some medical equipment to verify their radioactivity. We consider also radioactive components, since they are often present in medical equipment. The analysis is carried out on frequently used sample pieces of equipment.

Expected results:
– Study of the RoHS regulations with respect to medical equipment
– Analysis of 15 complex pieces of medical equipment for a proper characterisations of the danger of individual components and materials.

B3 – Management of waste of medical equipment from medical institutions (included veterinary clinics), in particular WEEE

Aim of action B3:

- to modulate the management system the medical equipment that a institution have decided to discard as waste. (waste which has characteristic of infectivity – which accounts for about 15% of hospital waste – is not taken into consideration).

The system is implemented on the basis of compliance and fairness guarantees for the manufacturer, and also respecting the standards to prevent environmental, health and safety risks.
Discarded equipment, that doesn’t find a destination as a donation, is managed as a waste.
The system implemented pays specific attention to the management of biomedical equipment.
CAUTO is available to manage WEEE, in particular the equipment falling under category 8 of Directive 2012/19/UE: medical devices (with exception of all implanted and infected products), such as: nuclear medicine, radiotherapy, cardiology, dialysis equipment, analysers, freezers, fertilization tests. Other appliances for detecting, monitoring, treating, alleviating illness, injury or disability.

CAUTO operates according the standards WEEELABEX (Waste Electrical and Electronic Equipment – Label of Excellence) defined under the LIFE+ Programme by WEEE Forum.
CAUTO signs a subsidy contract with medical institutions for the disposal of waste.

To ensure a proper management and the effectiveness of the action, both in Italy and Romania, joint training days between CAUTO’s operators and Ateliere Fara Frontiere are scheduled to transfer the skills acquired during the start-up project (8 one week’s trips are foreseen).

Expected results:
Management of 200 tons of waste coming from medical institutions.

B4 – Laboratory for the recovery of medical equipment

Aim of action B4:

- promoting the charitable donation of medical equipment by establishing procedures within the proposed integrated system that can ensure a proper management of the equipment (diagnostic and therapy equipment, instruments for laboratory tests, rehabilitation equipment, electro-medical products, equipment for professional medical centres (dental, optical,…).

Subject in charge of this action is Medicus Mundi.

Some basic information about the identification of the asset (class, manufacturer and model, working condition and operation, date of purchase), the method of discard (date, reason, location) and some technical information about the asset (presence of manual, scheduled maintenance, weight and dimension) are immediately collected and recorded.

Their donation is one through s declaration or an invoice of free donation.

The laboratory activity is organised as a full production process, which begins with the acquisition of medical and biomedical equipment picked up at the institutions or, in the case of small amounts or small instruments, accepted at the laboratory.

After that, there is the recovery phase, that is usually particularly complex because of the sensitivity of some specific equipment and the possible risk for the staff’s health and patients’ one in the destination areas.

– accurate cleaning
– reconditioning into mechanical, electrical and electronic laboratories.
– Adaptation of the equipment in order to guarantee its functionality. Where necessary, spare parts are bought to restore full efficiency for the asset received.

Unusable parts, metallic, electrical and /or electronic from other materials are designed for treatment as waste and taken over by CAUTO.

Functionality tests are used for measuring electrosurgical equipment, ECG, defibrillators. Safety tests are used for measuring grounding of medical equipment.

The foreseen cycle includes also a photographic survey of the property, its labelling and recovery.

The last step is the packaging for storage in a dedicated area in the laboratory.

MED partners give instruction to local staff to ensure proper use and maintenance of donated equipment with on-site training and internship session.

Expected results:
n.200 medical equipment withdrawn and revised.
n.120 heath care facilities withdrawn
n.100 spare parts disassembled
n.70 tons of waste not produced.

Achieved results:

List of available medical equipment, latest update 30th September 2016


B5 – Donation of recovered medical equipment to medical institutionsn and recipients all over the european territory

Aim of action B5:
– setting-up of a correct process of donation for medical equipment to individuals and organisations operating on the territory of the EU, in particular to health and social entities carrying out charity activities. The donation is extended to veterinary clinics that deal with pets/animals care.

Subjects in charge: Medicus Mundi Attrezzature cares for the destination path in Western countries, the cooperative Ateliere Fara Frontiere on Eastern Europe.

Medical equipment abandoned by medical institutions represents a unique opportunity to offer low-cost and technologically appropriate and compatible equipment to health centres in Eastern Europe and charities operating within the EU, keeping the equivalent functional standards.

The project Life-MED provides a set of modulated procedures to control the donation process and it outlines a proper system to allow the reuse.

WE start with the collection of requests for equipment, technology, medical and biomedical furniture by potential recipients: local authorities managing health care facilities and/or social and health activities, religious congregations, single professionals, reception facilities for pets, associations that deal with pet/animals care or protection.

The following step is the verification of the request appropriateness in relation to the context and the real needs.
The it is possible to identify the medical equipment and devices that are designated to donation ensuring the coincidence between the request and the equipment available in storage.

A key step for an effective use of the equipment is the relationship with the local health care professionals that will take care of it.

Joint training days between the operators of Medicus Mundi Attrezzature and the cooperative Ateliere Fara Frontiere are scheduled and see the involvement of the marketing managers to help them.

Expected results:
n. 80 institutions benefiting of the equipment to be reused
n. 150 electro medical devices donated
n. 100 healthcare facilities donated

B6 – Distribution to privates of home health care equipment and small devices

Aim of action B6:
– organisation of a system of distribution of home healthcare equipment on the territory around Medicus Mundi Attrezzature intervention area, such as hospital beds, walkers, wheelchairs, crutches, various medical devices (anti-bedsore mattresses, aerosols, blood pressure detectors…)

Beneficiaries could be: people discharged from health facilities in need of temporary support fro trauma, patients with chronic conditions in need of devices and equipment for home care, people with diseases requiring specific occasional or continuous therapies.

A space for exhibition of some sample home healthcare equipment to be shown to potential users is identified.
Procedures for equipment divestiture or rental is set through the definition of a temporary transfer agreement, foreseeing delivery times, civil liability over usage.

There is a “on-call service” throughout the day to give the chance to benefit from the initiative also to individuals in a situation of urgency, as in the case of hospital discharge. The availability is defined by telephone contact, email and physical presence.

The entire distribution process service is supported by an action of dissemination of the service through the production of promotional materials and contacts with the health professionals.

Expected results:
– n. 500 contacts for information on distribution
– n. 200 home health care equipment distributed
– n. 50 small medical devices distributed

B7 – Application of the integrated system in Romania and Eastern Europe

Aim of the action B7:
– to apply the integrated system launched on the Italian territory also in Western Europe, in the Romanian context and Eastern Europe.

The mechanisms for the discard of medical devices and equipment in Eastern Europe differ to some extent from the procedures implemented in Western Europe.

There are also different re-use opportunities at public and private medical institutions, where different functionality standards are accepted. On the contrary, rules and procedures in relation to the management of waste are the same.

The Romanian cooperative Ateliere Far Frontiere proposes itself on the Romanian territory and Eastern Europe for the activities described under actions B1, B3, B4 , B5.

Contacts with the health services in Romania is planned to involve them in Life-MED project. Appointments are foxed with interested organisations in order to present the project and to sign agreements for the implementation of the integrated system and for a specific evaluation of discarded devices.

After that, AFF proceeds to an assessment of the medical equipment that the centre is willing to discard, proposing them the best solutions for disposal or recovery.

Expected results:
n.100 contacts with medical institutions
n. 150 pieces od medical equipment treated
n.30 tons of waste not produced
n. 50 tons of waste treated

B8 – National working table of consultation for the definition of guidelines in the field of management of discarded medical equipment 

Aim of Action B8:
– to involve various national institutions and consortia operating in the field ofwaste management for the comparison of results, the definition of common procedures and the collection of proposals for simplification or legislative change.

The action allows to get the implementation of the integrated management system of discarded medical equipment – in particular medical WEEE – more viable, efficient and sustainable, both in term of cost effectiveness and environmental impact.

The actors involved in the negotiation talks are the Ministry of Environment and Protection of Land and Sea, the Ministry of Health, CONAI (Chain consortia for the management of packaging and waste), WEEE coordination centre, National associations of clinical engineers and medical technicians, Universities.

The working table, coordinated by Legambiente, opens a confrontation with the goal of defining guidelines for the proper management of medical waste, in particular WEEE, following these steps: identification and analysis of the needs of the integrated management system and of the stakeholders involved; analysis of existing European and non European legislation regarding waste management, in specific WEEE; dedicated section, inside MED website, with a moderator (Legambiente), in charge to collect inputs and giving information; meetings with the actors involved in the negotiation.

The partners involved in the other actions (A, B1, B2, B3, B7) are in close contact with Legambiente in order to identify on the field operational difficulties, the constrains, the ambiguity of legislation and in general the critical aspects.
Also companies and consortia that have already manage WEEE are contacted.

Expected results:
– 10 meetings with stakeholders
– draft of guidelines for the management of the discard of medical equipment in particular electro-medical WEEE

B9 – Life cycle assessment (LCA)

Aim of Action B9:

– The comparison of the new MED integrated management system with common alternatives in terms of their environmental performance in order to quantify the environmental advantages achieved with the innovation introduced.

This is key action in the project, since it can demonstrate the effectiveness of the objectives.

The methodological tool to perform the comparison of the new MED integrated management system with the possible alternatives is the Life Cycle Assessment (LCA).
LCA aims at identifying and assessing the significance of the environmental impacts during the whole life cycle of a product system.

The action is organised in 2 phases: state of art in the field of LCA of discarded medical equipment, Life Cycle Assessment of at least 3 different types of medical equipment.

In particular each LCA is carried out through the following tasks (in according to the most recognised international standards, to which the action is referred):

Task1: LCA goal and scope definition
Task2: Life Cycle Inventory analysis (LCI)
Task3: Life Cycle Impact Assessment (LCIA)
Task4: Life cycle interpretation

Expected results:
– Study of the bibliography concerning the LCA of discarded medical equipment
– Analysis of the LCA of n.3 specific discarded medical equipment