Medical waste is not “waste”, and it will be too late if it is not done.
Text | Mysterious plexus
Edit || Gao Shiming
In the past three months, as the center of the new crown epidemic, Wuhan produced 240 tons of medical waste every day during peak hours, which is 6 times the usual production waste. These disposable medical supplies, waste human tissue from surgery, and excreta from patients have huge viral infectivity.
Where did the surge in medical waste go? Has the existing processing capacity properly treated these medical wastes? During the period of SARS in 2003, the problems concerning the treatment of medical waste had already emerged. At that time, China almost only had medical waste treatment centers in first-tier cities. After SARS, the construction of the medical waste disposal center has spread to prefecture-level cities.
According to the data of the National Annual Report on the Prevention and Control of Solid Waste Pollution in Large and Medium Cities issued by the Ministry of Ecology and Environment, nearly two-fifths of urban medical waste disposal facilities in 2018 have a load rate of over 90%, and nearly one-third Of medical waste disposal facilities are basically in full or overloaded operation. In addition, more than a quarter of prefecture-level cities do not yet have the capacity to centrally dispose of medical waste, and some rural and mountainous medical wastes have not yet been included in the collection and disposal scope.
However, 17 years later, the shortage of medical waste disposal infrastructure has become more anxious. During the new crown, many medical waste treatment companies provided mobile equipment and technical personnel to Hubei for support. Due to the lack of incinerators for treatment of medical waste, even cement companies have used cement kilns to co-dispose of medical wastes involving epidemic diseases.
This emergency solution for “headaches, head pains and feet” is not sustainable, which may not only increase the risk of infections of the treatment personnel, but also have the hidden danger of air pollution caused by insufficient treatment of medical waste. In the 1970s, there was an accident in China that caused hepatitis B epidemic due to improper treatment of medical waste. Therefore, on the “front” of blocking the COVID-19 virus, medical waste disposal is the “last mile.” Whether it can prevent secondary infections in the last link depends on the speed and means of medical waste treatment, and this industry is undergoing turbulent changes.
Drawing
One of the reasons for the slow development of the medical waste disposal industry is the obvious policy-driven attributes of this industry. After the end of SARS, the State Council began to plan the medical waste treatment system. Most of the current medical waste disposal centers were built and put into production in 2005-2011. The earliest equipment put into operation has been in operation for nearly 15 years now. The insufficient capacity of medical waste disposal equipment will not be able to meet the growing demand for medical waste treatment.
At the same time, because the daily output of medical waste is stable, when there is no sudden outbreak, the medical waste disposal market is regarded as a stock market by capital, and the technology empowerment space is limited, which leads to the slowdown of the marketization of the medical waste industry. Once an epidemic occurs, there will be the phenomenon of difficulty in handling medical waste, backlog and incomplete disposal.
If you refer to the development trend of the industry after SARS, the new crown epidemic situation may accelerate the marketization of the medical waste treatment field. Coupled with the long tail of COVID-19, the impact far exceeds SARS, and medical waste treatment may become one of the most important needs. According to statistics, the output of newly-added mask waste nationwide this year is about 162,000 tons, and the increase in national medical waste output may exceed 25%.
Where will an abandoned needle go during the epidemic? To this end, I interviewed investors and companies in related fields at home and abroad, and analyzed the existing constraints and future potential of the medical waste disposal industry from the following questions: < / p>
1. What kind of industry is medical waste treatment?
2. How much technology can change the medical waste treatment industry?
3. Who pays for medical waste treatment?
4. Can medical waste treatment go further to market?
5. Is this field about to usher in an outbreak? Where is the investment value?
What kind of industry is medical waste treatment?
Medical waste mainly refers to wastes with direct or indirect infectivity, toxicity and other hazards generated by medical and health institutions in medical, prevention, health care and other related activities .
There are five types of medical waste, including infectious waste, pathological waste, damaging waste, pharmaceutical waste, and chemical waste. In fact, medical wastes are hazardous wastes. Due to the particularity of their pollution, the classification of medical wastes is carried out in accordance with the “Catalogue of Medical Wastes Classification”.
Drawing
What is the path from medical waste generation to disappearance? Human tissues ranging from waste to small needles must be tightly packed, sealed and monitored for transportation from generation to disposal, and finally destroyed by high temperature incineration and other means.
The specific route of this route is: the departments in the hospital are responsible for sorting, eliminating and packing daily medical waste, and transferring it to the storage point in the hospital; and then transporting it to the medical waste disposal center by special vehicles. Generally, each prefecture-level city has a special medical waste disposal center, which is allowed to operate after the government issues a license.
Drawing
The treatment methods of medical waste treatment center include high temperature incineration method, high temperature steam sterilization method, chemical disinfection method, plasma method, sanitary landfill method, etc. Among them, the high temperature incineration method is the mainstream technology in the field of medical waste treatment, because the incineration method is applicable to various infectious medical wastes, because 92% of the weight of medical waste is flammable components, and non-combustible components are only 8%. Under the condition of temperature and sufficient oxygen, it can be completely burned into ashes.
Drawing
The picture comes from the website of Shantou Municipal Government
In the entire medical waste treatment process, the medical waste treatment center is crucial as the last link. Usually, the participants of these medical waste treatment centers mainly include government, individuals and social capital. Some of them are traditional hazardous waste disposal companies, some are semi-institutional disposal companies under the jurisdiction of local governments, and some are franchised medical waste disposal companies.
Most of these medical waste disposal companies are non-market operating companies. They must first obtain an “operating license” before they can enter normal operation. This also makes it relatively difficult for the disposal center to introduce social capital and limited market openness, resulting in a slow iteration of medical waste disposal technology. Taking the examination and approval of medical waste business licenses in Jiangsu Province and counties as an example, the application materials have special requirements for technicians, transportation vehicles, equipment and technology.
There are three main business models for medical waste disposal companies: BOT (Build-Operate-Transfer), OT (Operate-Transfer) and self-operated. The BOT model is build-operate-transfer, which means that the government commissionIt is the most mainstream business model in this field to entrust enterprises to establish a medical waste disposal center to give up the right to operate in the future, that is, the right to charge, and finally transfer it to the government. The OT model is “operation-transfer”, compared with BOT, there is no need to bear the construction cost; the self-operated is the medical waste disposal enterprise responsible for construction and operation.
“(BOT) is one step further is PPP.” Ma Rui, vice president of Fengrui Capital’s environmental protection project, said in an interview. The PPP (Public-Private Partnership) model, that is, government and social capital cooperation, encourages private enterprises and private capital to cooperate with the government and participate in the construction of public infrastructure. The government becomes a partner of the enterprise and shares risks with social capital.
In terms of pricing, medical waste treatment companies mostly charge by bed or weight. One is that the disposal fee is borne by the patient and is included in the cost of medical services, and no longer charged to the patient. The other is to charge according to the weight and withdraw from the profits of the hospital. The unit price of medical waste disposal is relatively fixed, and is set by the prefectural and municipal price bureaus. In 2018, medical and health institutions with beds in Shanghai will charge 3.9 yuan per bed per day for beds; 3.3 yuan per kg for weight.
Furthermore, the medical waste disposal fees in a few cities are shared by hospitals and patients. There are government subsidies for medical waste disposal in some cities, such as Jiyuan City, Henan Province, which annually subsidizes 600,000 yuan in medical waste disposal fees from the municipal finance.
At present, according to the scale of China’s medical waste output, it can be estimated that the current volume of the medical waste disposal market is about 10 billion yuan.
Here we do a math problem:
According to the data released by the National Bureau of Statistics, in 2019 China’s medical and health institutions have 8.92 million beds, usually with a bed utilization rate of around 80%.
According to the statistics of the World Health Organization, each hospital bed in developing countries generates 0.5-2.5kg of medical waste per day. We assume that China produces 1kg / day of medical waste per bed, then in 2019, the country will generate approximately 2.6 million tons of medical waste; The price of medical waste disposal for bed pricing is calculated at 2.5 yuan / kg. In 2019, the scale of China’s medical waste disposal market exceeds 6.5 billion yuan.
With the recent medical waste treatment demand driven by the new crown epidemic, according to Ping An Securities research, the national medical waste output will increase by more than 25% in 2020, so the market size in this field will exceed 8 billion yuan.
At present, the domestic medical waste treatment industry chain includes upstream hospitals that generate medical waste, midstream equipment providers and engineering contractors, and downstream participant operators. Among them, the concentration of downstream industries is not high, and the competition pattern is scattered. Data shows that downstream leading companies such as Dongjiang Environmental Protection, Runbang, High Energy Environment, Snow Wave Environment, Wanbangda, Qidi Environment, Veolia, etc., together dispose of about 10% of the industry’s production waste.
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cartography
The daily output of medical waste is relatively stable. The medical waste treatment market is usually regarded as the stock market, which also leads to the slow development of this field. However, after the new crown epidemic occurred, this situation has undergone new changes: the epidemic shows the shortage of resources for medical waste disposal, as well as the slow and inefficient update of medical waste disposal technology.
With the recent development of technologies such as the Internet of Things, there is room for urgent development in areas such as dependence on human resources and lagging supervision in the field of medical waste disposal. Therefore, the new crown epidemic orIt will promote the further systematization and marketization of the industry.
Technology can bring to the medical waste treatment industry How much has changed?
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De-articulation
During the outbreak, the medical waste treatment industry is facing two major challenges. One is to standardize disposal, reduce personnel contact to avoid infection; the second is to produce Nissan and clean up, the process is transparent, to avoid the backlog of medical waste and become a new source of infection.
However, at present, the main links in the classification and transfer of medical waste still rely on labor, and the process supervision has not been digitized, and the circulation of each link is still guaranteed in the form of paper joint orders (triple orders or quintuple orders). For example, from the depot to the disposal center, the staff needs to confirm the quantity and type of medical waste through the transfer order, which results in lower medical waste disposal efficiency and greater human influence.
Two-dimensional codes can replace some labor in labeling and entering information, and the cost is lower, which can partially solve the above problem. There are already a lot of technology companies that are deploying such applications, and Xiao Chuang Technology is one of them. “In the stage of medical waste sorting in the department, we provide the seal of the cable tie and attach a QR code to mark it. After scanning, the bag of medical waste information is uploaded to the background system.” Zhang Fengxiang, CEO of Xiaochuang Technology In an interview, it was stated that the company established a medical waste traceability management platform on the basis of two-dimensional codes, and data was uploaded in real time during the process of medical waste handover, transshipment, storage, and storage.
Medical waste traceability management platform (picture from Xiaochuang Technology)
the flow of medical waste in the hospital area (picture from Xiaochuang Technology) < / span>
Xiaochuang Technology was established in 2016 and began to deploy medical waste disposal in 2019. It is an IoT medical device developer, providing IoT mobile medical solutions, medical big data analysis, and wearable device research and development. Its main products include intelligent AP (Access Point) and bed area recognizers.
According to Zhang Fengxiang, the business of Xiaochuang Technology in the field of medical waste treatment is mainly concentrated in the management of the hospital, including the packaging of medical waste produced by the departments, the transfer of medical waste in the hospital, and the storage of the temporary storage of medical waste in the hospital.
In practical application promotion, Xiaochuang TechnologyI also encountered some problems. For example, the staff of the hospital logistics department (responsible for transshipment and storage of medical waste) are generally older and have difficulty in technical operations. Xiaochuang first introduced a portable scale. The staff reported that they would not operate it. Later, they tried to set up a platform scale next to the transportation vehicle, and still received feedback on the difficulty of operation. “In order to reduce the operation steps, we later developed the whole vehicle weighing, that is, just throw the waste into the car to know how many.” Zhang Fengxiang said.
The picture of the intelligent medical waste collection and transfer vehicle (non-automatic weighing) from Xiaochuang Technology
The picture of intelligent medical waste collection and transfer vehicle (automatic weighing) from Xiaochuang Technology
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Mobile monitoring
After the safe circulation of medical waste in the hospital, special transport vehicles are needed to transfer the medical waste to the disposal center. According to regulations, medicalThe medical waste should be transferred to the disposal facility within 48 hours. In addition, transportation routes try to avoid densely populated areas, and transportation times avoid peak commuting periods. Due to the harmfulness of medical waste, in this process, the loss and change of waste has become the top priority of monitoring, and the Internet of Things technology is expected to solve this pain point and make data transparent.
In the view of Zhang Lu, CEO of Fusion Fund (Silicon Valley Venture Capital), low-cost sensors have become widespread in the past few years, which has enabled some startups to develop data analysis and tracking into the waste treatment field by developing hardware. “But their technology is not just for the medical waste field, this is just one of the application directions.” She added.
Longitudinal Technology, established in 2013, is a domestic company that develops such hardware. It is a low-power IoT technology and solution provider. Its ZETA low-power wide-area network protocol is an unlicensed-band low-power wide area network (LPWAN) standard that supports ultra-narrowband multi-channel communication and multi-hop Distributed access to mesh networks and two-way communication with low power consumption.
According to Li Zhuoqun, CEO of Longitudinal Technology, compared with the short-distance transmission of QR codes, ZETag flexible wide-area sensor labels can transmit 3 kilometers. “After a kilometer-level transmission, a small number of receiving points can be deployed to receive 3 kilometers of label information.” He said that the stickers attached to medical waste can regularly report their location information, where they are, and whether they are shipped. go. Currently, Longitudinal Technology has established a solid waste treatment platform. According to reports, the platform can be improved and applied to the field of medical waste treatment.
In the loading and transportation stage, Longitudinal Technology mainly empowers the transportation of medical waste from the following three aspects: first, the medical waste enters the vehicle and is protected by the on-board AP, and the information is uploaded to the regulatory department; when the transportation vehicle deviates In the given route, when the goods on the vehicle are discarded and disassembled, the stickers are uploaded to the management platform, and there will be reminders and alarms. In addition, the city tower AP can also be used to find the missing goods and grasp the first-hand information of the accident. In addition to transportation, the platform can also be dynamically managed in hospitals and solid waste centers.
dynamic management of the whole process of medical waste (picture from vertical technology)
“ This label may look small, but it is likely to become part of future public health or new infrastructure.” Li Zhuoqun said. However, at present, the price is higher than that of a QR code label with a price of less than 1 yuan. It is reported that Longitudinal Technology plans to reduce the cost of ZETag labeling to less than RMB 3-5 in the future.
Whether it’s Xiaochuang Technology or Longitudinal Technology, they have to a certain extent liberated manpower, reduced personnel contact, and made the process more transparent and intelligent. But in this process, they all encountered the same cost problem: because the hospital is the payer, then the technology empowerment is paid by the hospital. In the absence of policy encouragement or subsidies, the hospital should consider introducing technology The cost required.
“Is the cost of using your system and technology more cost-effective than hiring a few more people? This is a question that the hospital will consider.” Zhang Fengxiang, CEO of Xiaochuang Technology, added that if there is no policy promotion, The promotion of technology and systems is more difficult because hospitals do not want to incur additional expenses.
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Promised land where technology has not yet arrived
At the last stop of the medical waste “journey” —the medical waste disposal center, these technology companies do not have much use, and currently this ring is still professional The home of the medical waste disposal company. They are usually relatively long-established, relatively traditional enterprises, and most of them will have 1-2 medical waste treatment production lines, each of which is equipped with an incinerator and a post-treatment facility that emits exhaust gas and wastewater.
Recently interviewed a private enterprise in the field of medical waste treatment, Oerdong Environmental Protection Group Co., Ltd. (hereinafter referred to as Oerdong), which was established in 2003 and is currently in Liaoning Province, Jiangxi Province, Jiangsu Province, Fujian Province, etc. Multiple citiesDozens of disposal centers have been built. In February this year, the company supported the treatment of medical waste in Huanggang City, Hubei Province.
According to Ou Erdong CEO Weng Gan, Huanggang City produced an average of more than 20 tons of waste during the month of February, which is 6 times the amount of waste normally produced. Medical waste. Therefore, the newly added incineration equipment is just needed for the epidemic-prone areas.
“We provide compact all-in-one equipment that can process 10-15 tons of waste, which can basically meet the daily processing needs.” The Simplex500 high-temperature dry heat sterilization equipment provided by the company is divided into upper and lower parts. Erdong was transported to Huanggang for rapid installation and use. Its height is about 2 meters, and its length and width are about 3 meters.
Compact all-in-one device (picture from Orton) < / span>
In addition, mobile medical waste treatment equipment, such as mobile incinerators, high-temperature steam treatment equipment, dry chemical treatment equipment, and microwave disinfection treatment equipment, also appeared at the site of medical waste treatment in Hubei. “But the disposal capacity of this type of mobile equipment is low, and the maximum daily processing capacity is about 3 tons.” Weng Gan said.
The newly added incinerator solves the need to deal with the surge in production waste, but the pollution caused by incomplete incineration is still unavoidable. For example, in the process of starting and stopping the incinerator, the temperature usually cannot reach 800 degrees. At this time, burning medical waste is very easy to produce highly toxic substances such as dioxins and sulfur dioxide. According to data from Windy, an overseas weather station, the concentration of sulfur dioxide in Wuhan in February was 10 times the prescribed concentration.
-
De-articulation
During the outbreak, the medical waste treatment industry is facing two major challenges. One is to standardize disposal, reduce personnel contact to avoid infection; the second is to produce Nissan and clean up, the process is transparent, to avoid the backlog of medical waste and become a new source of infection.
However, at present, the main links in the classification and transfer of medical waste still rely on labor, and the process supervision has not been digitized, and the circulation of each link is still guaranteed in the form of paper joint orders (triple orders or quintuple orders). For example, from the depot to the disposal center, the staff needs to confirm the quantity and type of medical waste through the transfer order, which results in lower medical waste disposal efficiency and greater human influence.
Two-dimensional codes can replace some labor in labeling and entering information, and the cost is lower, which can partially solve the above problem. There are already a lot of technology companies that are deploying such applications, and Xiao Chuang Technology is one of them. “In the stage of medical waste sorting in the department, we provide the seal of the cable tie and attach a QR code to mark it. After scanning, the bag of medical waste information is uploaded to the background system.” Zhang Fengxiang, CEO of Xiaochuang Technology In an interview, it was stated that the company established a medical waste traceability management platform on the basis of two-dimensional codes, and data was uploaded in real time during the process of medical waste handover, transshipment, storage, and storage.
Medical waste traceability management platform (picture from Xiaochuang Technology)
the flow of medical waste in the hospital area (picture from Xiaochuang Technology) < / span>
Xiaochuang Technology was established in 2016 and began to deploy medical waste disposal in 2019. It is an IoT medical device developer, providing IoT mobile medical solutions, medical big data analysis, and wearable device research and development. Its main products include intelligent AP (Access Point) and bed area recognizers.
According to Zhang Fengxiang, the business of Xiaochuang Technology in the field of medical waste treatment is mainly concentrated in the management of the hospital, including the packaging of medical waste produced by the departments, the transfer of medical waste in the hospital, and the storage of the temporary storage of medical waste in the hospital.
In practical application promotion, Xiaochuang TechnologyI also encountered some problems. For example, the staff of the hospital logistics department (responsible for transshipment and storage of medical waste) are generally older and have difficulty in technical operations. Xiaochuang first introduced a portable scale. The staff reported that they would not operate it. Later, they tried to set up a platform scale next to the transportation vehicle, and still received feedback on the difficulty of operation. “In order to reduce the operation steps, we later developed the whole vehicle weighing, that is, just throw the waste into the car to know how many.” Zhang Fengxiang said.
The picture of the intelligent medical waste collection and transfer vehicle (non-automatic weighing) from Xiaochuang Technology
The picture of intelligent medical waste collection and transfer vehicle (automatic weighing) from Xiaochuang Technology
-
Mobile monitoring
After the safe circulation of medical waste in the hospital, special transport vehicles are needed to transfer the medical waste to the disposal center. According to regulations, medicalThe medical waste should be transferred to the disposal facility within 48 hours. In addition, transportation routes try to avoid densely populated areas, and transportation times avoid peak commuting periods. Due to the harmfulness of medical waste, in this process, the loss and change of waste has become the top priority of monitoring, and the Internet of Things technology is expected to solve this pain point and make data transparent.
In the view of Zhang Lu, CEO of Fusion Fund (Silicon Valley Venture Capital), low-cost sensors have become widespread in the past few years, which has enabled some startups to develop data analysis and tracking into the waste treatment field by developing hardware. “But their technology is not just for the medical waste field, this is just one of the application directions.” She added.
Longitudinal Technology, established in 2013, is a domestic company that develops such hardware. It is a low-power IoT technology and solution provider. Its ZETA low-power wide-area network protocol is an unlicensed-band low-power wide area network (LPWAN) standard that supports ultra-narrowband multi-channel communication and multi-hop Distributed access to mesh networks and two-way communication with low power consumption.
According to Li Zhuoqun, CEO of Longitudinal Technology, compared with the short-distance transmission of QR codes, ZETag flexible wide-area sensor labels can transmit 3 kilometers. “After a kilometer-level transmission, a small number of receiving points can be deployed to receive 3 kilometers of label information.” He said that the stickers attached to medical waste can regularly report their location information, where they are, and whether they are shipped. go. Currently, Longitudinal Technology has established a solid waste treatment platform. According to reports, the platform can be improved and applied to the field of medical waste treatment.
In the loading and transportation stage, Longitudinal Technology mainly empowers the transportation of medical waste from the following three aspects: first, the medical waste enters the vehicle and is protected by the on-board AP, and the information is uploaded to the regulatory department; when the transportation vehicle deviates In the given route, when the goods on the vehicle are discarded and disassembled, the stickers are uploaded to the management platform, and there will be reminders and alarms. In addition, the city tower AP can also be used to find the missing goods and grasp the first-hand information of the accident. In addition to transportation, the platform can also be dynamically managed in hospitals and solid waste centers.
dynamic management of the whole process of medical waste (picture from vertical technology) “ This label may look small, but it is likely to become part of future public health or new infrastructure.” Li Zhuoqun said. However, at present, the price is higher than that of a QR code label with a price of less than 1 yuan. It is reported that Longitudinal Technology plans to reduce the cost of ZETag labeling to less than RMB 3-5 in the future.
Whether it’s Xiaochuang Technology or Longitudinal Technology, they have to a certain extent liberated manpower, reduced personnel contact, and made the process more transparent and intelligent. But in this process, they all encountered the same cost problem: because the hospital is the payer, then the technology empowerment is paid by the hospital. In the absence of policy encouragement or subsidies, the hospital should consider introducing technology The cost required.
“Is the cost of using your system and technology more cost-effective than hiring a few more people? This is a question that the hospital will consider.” Zhang Fengxiang, CEO of Xiaochuang Technology, added that if there is no policy promotion, The promotion of technology and systems is more difficult because hospitals do not want to incur additional expenses.
-
Promised land where technology has not yet arrived
At the last stop of the medical waste “journey” —the medical waste disposal center, these technology companies do not have much use, and currently this ring is still professional The home of the medical waste disposal company. They are usually relatively long-established, relatively traditional enterprises, and most of them will have 1-2 medical waste treatment production lines, each of which is equipped with an incinerator and a post-treatment facility that emits exhaust gas and wastewater.
Recently interviewed a private enterprise in the field of medical waste treatment, Oerdong Environmental Protection Group Co., Ltd. (hereinafter referred to as Oerdong), which was established in 2003 and is currently in Liaoning Province, Jiangxi Province, Jiangsu Province, Fujian Province, etc. Multiple citiesDozens of disposal centers have been built. In February this year, the company supported the treatment of medical waste in Huanggang City, Hubei Province.
According to Ou Erdong CEO Weng Gan, Huanggang City produced an average of more than 20 tons of waste during the month of February, which is 6 times the amount of waste normally produced. Medical waste. Therefore, the newly added incineration equipment is just needed for the epidemic-prone areas.
“We provide compact all-in-one equipment that can process 10-15 tons of waste, which can basically meet the daily processing needs.” The Simplex500 high-temperature dry heat sterilization equipment provided by the company is divided into upper and lower parts. Erdong was transported to Huanggang for rapid installation and use. Its height is about 2 meters, and its length and width are about 3 meters.
Compact all-in-one device (picture from Orton) < / span>
In addition, mobile medical waste treatment equipment, such as mobile incinerators, high-temperature steam treatment equipment, dry chemical treatment equipment, and microwave disinfection treatment equipment, also appeared at the site of medical waste treatment in Hubei. “But the disposal capacity of this type of mobile equipment is low, and the maximum daily processing capacity is about 3 tons.” Weng Gan said.
The newly added incinerator solves the need to deal with the surge in production waste, but the pollution caused by incomplete incineration is still unavoidable. For example, in the process of starting and stopping the incinerator, the temperature usually cannot reach 800 degrees. At this time, burning medical waste is very easy to produce highly toxic substances such as dioxins and sulfur dioxide. According to data from Windy, an overseas weather station, the concentration of sulfur dioxide in Wuhan in February was 10 times the prescribed concentration.
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