Handling and Processing of Hospital Waste

Hospital activity produced a variety of liquid waste, solid waste and gas.Pengelolaan hospital is part of environmental sanitation activities in the hospital that aims to protect the public from the dangers of environmental pollution originating from hospital waste.

As stipulated in Law no. 9 years in 1990 on the Principles of Health, that every citizen deserves a medical degree as high.

Conditions are the basis for the government to organize activities such as prevention and eradication of diseases, prevention and mitigation of pollution, restoration of health, information and health education to the public (Siregar, 2001).

Community health improvement efforts can be done through various ways, namely prevention and eradication of communicable diseases, environmental sanitation, better nutrition, clean water supply, health education and maternal and child health services. In addition, protection against the dangers of environmental pollution should also be given special attention (Said and Ineza, 2002).

The hospital is a means of implementing health improvement efforts, and health services can be utilized also as an institution for health education, and research. Health service conducted a hospital patient healing and recovery activities of state bodies and disabled people (Said and Ineza, 2002).

Activity produced a variety of hospital waste in the form of liquid, solid and gas. Hospital waste management is part of environmental sanitation activities in the hospital that aims to protect the public from the dangers of environmental pollution originating from hospital waste. Elements associated with the facilitation of hospital services (including waste management), ie (Giyatmi. 2003):

* Initiator or the hospital responsible.

* Users hospital services.

* The experts, experts and institutions that can give you advice.

* The private entrepreneurs and that can provide the necessary infrastructure and facilities.

The management of hospital waste has been carried out by setting up the software in the form of regulations, guidelines and policies governing the management and improvement of environmental health at the hospital. In addition, a gradual and continuous efforts of Health Department of the hospital waste management installations. So far most government hospitals have been equipped with waste management facilities, although the need to be improved. However, it should be realized that the hospital waste management still need to be increased again (Barlin, 1995).

1.2. Hospital Role In Waste Management

The hospital is a tool that organizes health efforts efforts of health services which include outpatient services, inpatient staying, emergency services, medical and non medical services are in the process can affect the outcome of the social environment, culture and in organized efforts intended to use the technology estimated to have a great potential for the environment (Agustiani et al, 1998).

Hospital generated waste can endanger public health, the waste in the form of viruses and germs that come from and Laboratory of Virology and Microbiology, which until now there is no antidote tool so it is difficult to detect. Liquid and solid wastes that waste originating and the hospital can serve as a medium for the spread of disorder or disease workers, patients and society. Interference may be air pollution, water pollution, soil, food contamination and minunian. Pollution is an environmental health agency agent that can have a major impact on humans (Agustiani et al, 1998).

Law Number 23 Year 1992 concerning the Principles of Health states that every Indonesian citizen who is entitled to health status as high. Therefore, the Government organized efforts in the field of prevention and eradication penyakitpencegahan and mitigation of pollution, restoration of health, information and health education to the people and so forth (Karmana et al, 2003). Business improvement and health maintenance should be carried out continuously, according to the development of knowledge in the field of health, the pollution prevention and control efforts are expected to progress. As for the ways of pollution prevention and control of hospital waste, among others, is through (Karmana et al, 2003):

* The process of hospital solid waste management.

* The process of preventing food contamination in the hospital.

Means treatment / disposal of hospital sewage works basically receives wastewater from various tools sanitair, channeling through the installation of sewers in the next building over the sewer installation outside the building to the liquid waste treatment plant. From the installation of waste, liquid treated sewage flowing into the soil or seep into the city sewers (Sabayang et al, 1996). Solid waste originating from the wards, kitchens, operating rooms and so forth both medical and non medical needs to be managed so well that health care workers, patients and the community around the hospital could avoid possible effects of hospital waste pollution (Sabayang et al, 1996).

1.3. Hospital Waste Pollution Potential

In Indonesia's health profile, the Ministry of Health, 1997 disclosed the entire hospital in Indonesia amounted to 1090 with 121 996 beds. Studies on 100 hospitals in Java and Bali showed that the average production of 3.2 kg of waste per bed per day. While the production of 416.8 liters of liquid waste per bed per day. Further analysis shows, the production of garbage (solid waste) consisting of 76.8 per cent of domestic waste and waste form infektius of 23.2 percent. It is estimated that national production of garbage (solid waste) RS of 376 089 tons per day and production amounted to 48985.70 tonnes of waste water per day. From these images can imagine how big the potential to contaminate the hospital environment and cause harm and likelihood of disease transmission (Sebayang et al, 1996). Hospitals generate large amounts of waste, some of which membahyakan in environmental health. In developed countries, the amount of waste estimated 0.5 to 0.6 kilograms per hospital bed per day (Sebayang et al, 1996).

Meanwhile, East Jakarta City Government has cast a reprimand to the 23 hospitals (RS), which ignores the warning letter regarding the necessity to have the wastewater treatment plant (WWTP). Based on data from the Regional Environmental Management Agency (BPLHD) East Jakarta received updates, from the 26 existing hospital in East Jakarta, only three hospitals are having wastewater and worked fine. The rest, some do not have wastewater and some of his hospital wastewater in damaged condition (Sebayang et al, 1996). The data are also mentioned, only nine hospitals with incinerators only. The tool, used to burn the form of solid waste remains waste of human organs that can not be discarded just like that. According to the Head BPLHD East Jakarta, Surya Darma, his side has submitted a circular letter which requires the hospital's waste management report every three months. Unfortunately, since dilayangkannya circularize the end of September 2005, only three hospitals are giving a report. According to Surya, hospital waste, particularly infectious medical waste, is not managed properly. Most of the infectious waste management is equated with medical waste noninfectious. In addition, often mixed with medical and nonmedical waste. Promiscuity is actually enlarge the problem of medical waste. In fact, medical waste requires special management that are different from non-medical waste. That includes medical waste is infectious waste, radiological waste, waste sitotoksis, and laboratory waste. The reason of such disposal tank in Indonesia, most do not qualify as waste disposal areas. Ironically, even the majority of hospital waste discharged into sewage tank like that (Sebayang et al, 1996). Meanwhile, the Environmental Health Section Chief suspect Sudin Kesmas East Jakarta, poor management of hospital waste because waste management is not a requirement of hospital accreditation. While the process of packaging solid waste regulations issued by the Ministry of Health in 1992 was largely not run properly. Whereas every hospital, in addition to having WWTP, also must have a statement of environmental management (SPPL) and wastewater treatment permit. While the waste of human organs should be burned in incinerators. Trouble is, the price is quite expensive incinerator so that not all hospitals can have it (Sebayang et al, 1996).

Some things that ought to be thinking for the hospital manager, and so the cause of the high level of environmental degradation from activities of the hospital were attributable to lack of management awareness of environmental management because they do not understand the technical issues that can be obtained from pollution prevention activities, lack of funding commitments for pollution control effort because they think that the management of hospitals to generate money rather than throwing money taking care of pollution, lack of understanding of what is called business products and many more other deficiencies (Sebayang et al, 1996). Therefore, efforts should be done is the hospital, started and getting used to identify and categorize types of waste based on management techniques (B3 waste, infectious, can digunapakai or to reset). Improving the management and supervision and control over the purchase and use, disposal of chemicals and non-B3 B3 well. Monitor the flow of drugs includes purchasing and inventory and increase employee knowledge of environmental management through training with the materials processing of materials, pollution prevention, maintenance equipment and emergency action (Sebayang et al, 1996). 1.4. Type of Hospital Waste And Its Impact On The Environment And Health
Hospital waste is all waste generated by the activities of hospitals and other supporting activities. Given the possible impact, it needs good management effort include the management of human resources, equipment and facilities, financial and management organization established with the aim of obtaining the condition of hospitals that meet the requirements of environmental health (Said, 1999). Hospital waste can contain a variety of microorganisms depends on the type of hospital, the level of processing is done before discharge. Hospital wastewater may contain organic and inorganic material which is generally measured and the parameters of BOD, COD, TSS, and others. While the hospital solid waste consisting of easily decomposing garbage, combustible waste, and others. Wastes are likely to contain pathogenic microorganisms or toxic chemicals that cause harmful diseases and infections can spread into the hospital environment caused by poor technique memadal health services, error handling contaminated materials and equipment, as well as the provision and maintenance of sanitation facilities a bad masib (Said, 1999).

Disposal of large amount of waste is best when done by sorting the waste into various categories. For each type of category adopted different ways of waste disposal. General principles of hospital waste disposal is as far as possible avoid the risk kontaminsai and trauma (injury). types of hospital waste include the following (and Djustiana Sahib, 1998):

a. Clinical Waste

Waste generated during routine patient care, surgery, and in high risk units. This waste may be dangerous and result in a high risk of bacterial infection and the general population and hospital staff. Therefore it needs to be clearly labeled as high risk. examples of these types of waste is a dirty bandage or wrap, body fluids, amputated limbs, needles and syringes used, the bag of urine and blood products.

b. Pathology Waste

This waste is also deemed high risk and should diotoklaf before exiting from pathology units. Waste must be labeled biohazard.

c. Waste Not Clinic

This waste includes paper and plastic wrappers or bags that are not in contact with body fluids. Although not present a risk is sick, the waste can be quite cumbersome because it requires a great place for transporting and mambuangnya.

d. Kitchen Waste

This waste includes leftover food and dirty water. Various insects such as cockroaches, fleas and rodent like rats are a nuisance to staff and patients at the hospital.

e. Radioactive Waste

Although this waste does not cause problems in hospital infection control, safe disposal should be regulated properly.

1.5. Waste Prevention In Health Care

Wastewater treatment is basically an attempt to reduce the volume, concentration or danger of waste, after the production process or activity, through a process of physical, chemical or biological. In the implementation of waste management, the first attempt to do are preventive measures that reduce the volume of dangerous wastes discharged into the environment, including efforts mengunangi waste at source, and the efforts of waste utilization (Sahib, 1999). Waste minimization programs in Indonesia only began in earnest, for the hospital is still a new thing, which aim to reduce the amount of waste and waste were still economic mempunyainilai (Sahib, 1999).

Various efforts have been used to reveal where the best technology options for waste management, particularly hazardous wastes such as waste reduction (waste reduction), minimization of waste (waste minimization), elimination of waste (waste Abatement), prevention of pollution (waste prevention) and reduction in its source (source reduction) (Hananto, 1999).

Waste reduction at source is an effort that must be implemented first because it is preventive efforts that prevent or reduce the occurrence of waste that comes out and the production process. Waste reduction at source is an effort to reduce the volume, concentration, toxicity and hazard rate of waste that will come out into the environment directly preventively on the sources of pollution, this is a lot to give the advantage of increasing efficiency and reducing costs of wastewater treatment and its implementation is relatively cheap (Hananto, 1999 ). Various methods used for waste reduction at source is the (Arthono, 2000):

Keeping

1. House good, business is conducted by the hospital in maintaining the cleanliness of the environment by preventing spills, spillage or leakage of waste materials and handle the matter with the possible.

2. Segregasi waste stream, which separates the different types of waste streams by type of component, concentration or condition was, so it can make things easier, reduce the volume, or reducing wastewater treatment costs.

3. Implementation of preventive maintenance, ie maintenance / replacement tool or tool part according to the time schedule.

4. Pengelolaan material (material inventory), is an effort to make inventories of materials are always sufficient to ensure smooth processing of activities, but not excessive sehiugga not cause environmental disturbances, while the storage to keep it tidy and controlled.

5. Ordering process and operating conditions are good: in accordance with operating instructions / use of tools can increase efficiency.

Net technology, namely ownership 6.Penggunaan process technology activities that are less potential to remove the B3 waste with high efficiency, best done when the development of new hospitals or replacement of some units.

Codification of policy for the use of color sorting of waste throughout the hospital must have a corresponding color, so that waste can be separated at source, should consider the following things (Haryanto, 2001):

1. Bangsal must have two kinds of waste places in two colors, one for clinical waste and the other for non-clinical.

2. Semua waste from operating rooms are considered as clinical waste.

3. Limbah from the office, usually in the form of stationery, regarded as clinical waste.

4. Semua waste out of the pathology unit should be considered as clinical waste and need to be declared safe before disposal.

Some things to consider in formulating policies concerning the codification of the color of the following things (Sundana, 2000):

1. Waste Separation

* Waste should be separated from the source

* All high limbahberesiko should be clearly labeled

* Need to use a plastic bag with different colors, which shows where the plastic had to be

transported for incineration or disposal. In some countries, plastic bags instead of expensive enough so that you can use leak-resistant paper bags (made locally so it can be easily obtained). This paper bags can be plastered with colored stripes, then placed in a barrel with a color code dibangsal and other units

2. Waste storage

* These pouches with the color should be discarded if it has filled 2 / 3 parts. Then tied the top and be clearly labeled

* Poke should be transported by holding his neck, so that swung away from the body if taken, and placed in certain places to be collected

* Officers must ensure that waste collection bags with colors that samatelah put together and sent to the appropriate place

* Bags should be stored in sealed boxes to tick and destructive animals before transportation to the disposal

3. Waste handling

* Poke-sac with a color code may only be transported if they have closed

* Held at his throat sac

* Staff should wear protective clothing, such as by wearing strong gloves and clothing overalls (overalls), at the time of transporting the bag

* If there is contamination outside the bag needed a new bag to wrap a clean new bags are dirty seisinya (double bagging)

* Officers are required to report if it finds sharp objects that can mencederainya in the wrong pockets Dalma

* No one is allowed to put his hand in the bag waste

4. Transporting waste

Seklaigus bag waste is collected and separated according to color code. The waste part is not brought to the clinic kompaktor eg, waste incinerators brought to the clinic. Pengankutan with a special vehicle (there may be collaboration with the Department of Public Works) vehicles used for mengankut waste should be emptied and cleaned every day, if necessary (eg when there is leakage of waste bag) is cleaned using a chlorine solution.

5. Waste disposal

When used with kompaktor, not a clinical waste can be disposed of waste landfill site (land-fill site), clinical waste must be burned (incineration), if not may be backfilled with limestone and planted kitchen waste should be disposed of on the same day so as not to rot.

Then about the waste of gas, their management efforts more modest compared with the wastewater, waste gas can not be separated from efforts to restructure the room and building in particular in maintaining the quality of air conditioner (indoor), which among others required that (Agustiani et al, 2000):

* No smell (terutania by H2S gas and Anioniak);

* Dust levels do not exceed 150 Ug/m3 in measuring the average during 24 hours.

* Germ. Operating room: less than 350 air and germ-free kalori/m3 padao genes (especially alpha streptococcus haemoliticus) and spores gangrer gas. Treatment room and isolation: less and 700 kalorilm3 germ-free air and pathogens. Concentration of gas and hazardous materials in the air does not exceed the maximum concentration has been determined.

Large hospitals may be able to buy their own incinerators. Small or medium-sized incinerators can burn at temperatures 1300 - 1500o C or higher and probably can recycle up to 60% of heat produced for energy needs of the hospital. A hospital can also earn additional income by serving the incineration of municipal waste comes from homes sakitlain sakityang. A good modern incinerators certainly has some advantages such as its ability to accommodate the clinic and non-clinical waste, including sharps and unused pharmaceutical products (Rostiyanti and Solomon, 2001).

If incineration facilities are not available, the clinic can be backfilled with waste lime and planted. Liming steps (Liming) include the following (Djoko, 2001):

* Digging a hole, with a depth of about 2.5 meters.

* Sprinkle based clinical waste pit to a height of 75 cm.

* Add a layer of lime.

* Coating layer of lime dumped waste can still be added to a height of 0.5 meters below ground surface.

* Finally, it should dituutup hole with soil.

1.6. Ozonisation Medical Waste Treatment

The liquid waste generated from a house sakitumumnya lot containing the bacteria, viruses, chemicals, and drugs that could endanger public health around the house sakittersebut. Of the many sources of waste in hospitals, waste from the laboratory to be carefully watched. Chemicals used in the process of laboratory tests can not be decomposed only by aeration or activated sludge. These materials contain heavy metals and inveksikus, so that should be sterilized or normalized before "thrown" into harmless waste. For x-rays for example, there are certain fluids that contain enough radioactive hazardous. After these ingredients are used. waste disposed (Suparmin et al, 2002).

1.7. Waste Treatment Technology

Medical waste treatment technologies are now plural operated only range between the problem of septic tank and incinerator. Both are now proven to have a large negative value. Septic tank in question because a lot of water seepage from the tank which is feared could harm the soil. Sometimes there are some hospitals who throw the ultimate outcome of septic tank directly into the rivers, ensuring the river began to contain medical substances (Suparmin et al, 2002).

While the incinerator, which applied the techniques of medical waste incineration in, also not without flaw. U.S. Environmental Protection Agency found the technique of incineration is the main source of highly toxic substance dioxin. Recent research shows this is the dioxin substances that trigger the growth of cancer in the body (Suparmin et al, 2002). A very interesting part of this problem is found with the method of waste processing technologies ozonisation. One method of sterilization of hospital sewage recommended United States Environmental Protection Agency (USEPA) in 1999. This technology can also be applied to actually manage the textile mill waste, paint, leather, etc. (Christiani, 2002).

1.7.1. Ozonisation

Ozonisation process has been known for more than a hundred years ago. Ozonisation process or processes using NIES ozone was first introduced from France as a sterilization method in drinking water in 1906. Use ozonisation process then develops very rapidly. In a period of less than 20 years there are approximately 300 drinking water treatment plant uses to process sterilisasinya ozonisation in America (Berlanga, 1998).

Today, the widely used method ozonisation for sterilization of food, medical equipment washing, sterilizing the air in the room to work in offices. The extent of the use of ozone is not independent of the nature of ozone is known to have radical character (easily react with substances around it) and have the potential oxidation 2:07 V. In addition, ozone has can easily be made by using plasma as the corona discharge (Berlanga, 1998). Through the oxidation process ozone is also capable of killing various microorganisms such as bacteria Escherichia coli, Salmonella enteriditis, hepatitis A virus and various other pathogenic microorganisms (Crites, 1998). Through a process of direct oxidation of ozone will damage the outer wall of microorganism cells (cell lysis) as well kill him. Also through the process of oxidation by free radicals such as hydrogen peroxy (HO2) and hydroxyl radical (OH) is formed when ozone decomposes in water. Along with technological development, today began much ozone is applied in treating domestic and industrial wastewater (Akers, 1993).

1.7.2. Wastewater ozonisation hospital

The liquid waste from various laboratory activities, kitchen, laundry, toilet, etc. are collected in an equalization pool and then pumped into the reactor tank to be mixed with ozone gas. Ozone gas into the reactor vessel to react oxidize organic compounds to kill bacteria and pathogens in wastewater (Harper, 1986).

Liquid waste that has been oxidized and then poured into the tank for mixed coagulant coagulation. Then the process of sedimentation on the next tank. In this process, micro pollutants, heavy metals and other residual products of oxidation in the reactor tank can be deposited (Harper, 1986).

Further filtering process is carried out on the filtration tank. In this tank the adsorption process occurs, ie the absorption process pollutan substances missing in the coagulation process. Pollutant substances will be eliminated surface of activated carbon. If the entire surface of the activated carbon is already saturated, or no longer able to absorb the absorption process will be stopped, and currently active carbon must be replaced with a new activated carbon or recycled by washing. Water that comes out of an activated carbon filter to the next can be disposed safely to the river (Harper, 1986).

Ozone will dissolve in water to produce hydroxyl radicals (-OH), a free radical that has a very high oxidation potential (2.8 V), far exceeding the ozone (1.7 V) and chlorine (1:36 V). Hydroxyl radical is an oxidizing material that can also oxidize various organic compounds (phenols, pesticides, atrazine, the TNT, etc.). For example, phenol is oxidized by hydroxyl radikalakan transformed into hydroquinone, resorcinol, cathecol to then re-oxidized into oxalic acid and formic acid, organic acid compounds smaller easily oxidized with oxygen content in the vicinity. As the end result of the oxidation process will only get carbon dioxide and water (Harper, 1986). Hydroxyl radicals to oxidize organic compounds strength can also be used in the sterilization process various kinds of microorganisms, eliminate odors, and eliminating the wastewater color. Thus will be able to oxidize organic compounds and kill pathogenic bacteria, which many contained in hospital wastewater (Wilson, 1986). In activated carbon filters will happen adsorption process, namely the process of absorption of substances to be absorbed by the surface of activated carbon. If the entire surface of the activated carbon is already saturated, the absorption process will stop. Thus, the activated carbon should be replaced new or recycled by washing (Wilson, 1986).

In applications ozonisation system is often combined with ultraviolet light or hydrogen peroksida.Dengan doing this combination will be obtained easily and hydroxyl radicals in water that is needed in the process of oxidation of organic compounds. Oxidation technology is not only able to describe chemical compounds that are toxic in the water, but also at the same time eliminate them so that solid waste (sludge) can be minimized to near 100%. By exploiting this system can ozonisation sakittidak house party can only treat the waste but will also be able to reuse the waste water that has been processed (recycling). This technology, in addition to time efficiency is also fairly economical, because it does not require extensive installation site (Wilson, 1986).

Hospital activity is very complex, not only a positive impact on the surrounding community, but also may impact negatively. Negative impacts such as pollution caused by waste processing activities as well as discarded without proper management. Waste management is not good sakityang house will trigger the risk of transmission of occupational injuries and illnesses to workers Darin patient, from patient to patient from worker to patient or from the public and hospital visitors. Therefore, to ensure the safety and health of workers or other people who are in the hospital environment surrounding the fund, it should be the implementation of safety management system policy and health, to conduct monitoring activities and management of municipal waste astu sakitsebagai one important indicator to consider. Hospital as a socio-economic institutions because of his duty to provide health services to the community, not apart from the responsibility of managing the waste generated (Wilson, 1986).

REFERENCES

Agustiani E, Slamet A, Winarni D (1998). Addition of PAC to activated sludge process for treatment of hospital wastewater: a research report. Singapore: Faculty of Engineering of Technology IndustriInstitut

Agustiani E, Slamet A, Rahayu DW (2000). Addition of powdered activated carbon (PAC) in activated sludge process for treatment of hospital waste water. Science & Technology Magazine: a journal of natural science and technology: 11 (1): 30-8

Akers (1993). Paperboard container of hospital waste. United States Patent: 5,240,176 Arthono A (2000). Wastewater treatment planning for hospitals with active sludge method. Media palace: 3 (2) 2000: 15-8 Barlin (1995). Analysis and evaluation of the law concerning hospital waste pollution caused by Jakarta: Agency for National Legal Development

Berlanga B (1998). Process, formula and installation for the treatment and Sterilisation of biological, solid, liquid, ferrous metallic, non-ferrous metallic, toxic and dangerous material hospitalwaste. United's States Patent: 5,820,541

Christiani (2002). Utilization of solid substrate for cell immobilization on the activated sludge wastewater treatment hospital. Bulletin Keslingmas

Djoko S (2001). Hospital waste management. Civil Soepra: civil journal 3 (8): 91-9

Giyatmi (2003). Effectiveness of home wastewater treatment sakitDokter Sardjito Yogyakarta against radioactive contamination. Yogyakarta: Gadjah Mada University Post Graduate

Hananto wm (1999). Pathogenic microorganisms wastewater sakitdan home health impacts caused. Arises Keslingmas: 18 (70) 1999: 37-44

Harper (1986). Hospital waste disposal system. United States Patent: 4,619,409

Haryanto (2001). Analysis of the chemical compounds of hospital sewage Jambi Municipality. Sparks: 31 (May): 54-9

Karmana O, Nurzaman M, Sanusi S (2003). Influence of hospital solid waste incineration and the results of NPK fertilizer for plant growth of spinach (Amaranthus sp) var. Gitihijau: research report. Canberra: Faculty of Mathematics and Sciences, Padjadjaran AlamUniversitas

Rostiyanti SF, Solomon F (2001). Studies of building maintenance and incinerator waste water treatment at a hospital in Jakarta. Journal of Technology Assessment: 3 (2): 113-23

Said NI (1999). Municipal waste water treatment technology systems sakitdengan "anaerobic-aerobic biofilter." Seminar on Waste Management Technology II: proceedings, Jakarta, 16 to 7 February 1999.

Said and Ineza (2002). Test performance of hospital waste water treatment with a submerged biofilter. Jakarta: Center for Environmental Assessment and Application of Technology

Sabayang P, Muljadi, Budi P (1996). Construction and evaluation of solid waste incinerators for hospitals. Indonesian Institute of Sciences. Research and Development Center of Applied Physics Geological Research and Development Center of Applied Physics Sahib MN (1999) Application of the technique of "Polymerase Chain Reaction" (PCR) to monitor environmental contamination by mercury compounds (Hg) at hospital limbahcair. Toxicological Association of Indonesian Congress: proceedings, Jakarta, 22-23 February 1999 Sahib MN, Djustiana N (1998). Plasmid DNA profile of E. coli isolated from hospital sewage. Bandung Medicine Magazine: 30 (1) 1998: 328-41

Siregar, TM (2001). Effect of inoculum on the hospital wastewater treatment: a case study of hospital wastewater treatment Market Rebo, Jakarta, is using M-bio on the fixed-film aerobic reactor. Jakarta: Indonesian University Graduate Program

Sundana EJ (2000). Hospital waste minimization case studies in Indonesia: Muhammadiyah Bandung General Hospital (RSMB). Journal Itenas: 4 (1): 43-9

Suparmin, Tri C, Budiono Z (2002). Waste water treatment evaluation study hospitals Jateng diPropinsi 2002. Bulletin Keslingmas

Wilson (1986). Hospital waste disposal system. United States Patent: 4,618,103

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Marine Corps Integrated Exercises

Ramadhian Fadillah - DAILY
Jakarta - Marine Corps integrated stabilization exercises held in Lampung. In addition to combat exercise involving almost the entire strength of the Marines, the unit of purple beret was also held in the form of social health services to communities around the Navy base.



"The event was organized by the Marine Corps Jalasenatri. The aim is to improve the welfare of Marines and their families and communities around the Navy base," said Kadispen Marines, Lt. Col. Said Latuconsina told AFP in March, Sunday (07/02/2010).

According to Said, the social event was held at the Clare Coast, Mirror Padang, Lampung, 6 to February 7, 2010. Total patients treated 2463 people. This event was chaired by the Chairman of the Marine Corps Jalasenatri PG, Nita Alfan Baharudin.

106 doctors were deployed in this social event. Consisting of doctors from Mako Marine Cilandak, doctors RSAL Ramelan Surabaya. Indonesia assisted by Project Comunity of HMT Comunty, and FMU Faculty of Dentistry and Dental University School of Medicine Mustopo. No lag of Health 2nd Marine Battalion, Cilandak.

Patients consisted of 153 participants circumcision, 10 people hernia surgery, cataract surgery 12 people. Besides those 28 minor surgeries, dental treatment of 187 people. Eye treatment 44 patients, treatment of heart 56, ENT 44 people, 112 people poly child, midwifery 36 people, 64 of poly surgery, general medicine remaining.

Marine Corps exercise itself will take place from January 24 until March 7, 2010.

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Indonesian Marine & USA, Social Health and School Renovation

Situbondo, beritabaru.com - United States Marine Corps (USMC) and U.S. Navy Marine Corps joined the Navy Elementary School building (SDN) 2005 Banyu Putih in Situbondo, East Java. It was part of a series of Joint Exercise (Latma) Indonesian Marines and America, since October 17, 2009, titled "Interoperability Field Training Exercise, FTX Marine IIP Exercise 2009" which led the Marine Commander Colonel Nur Alamsyah Exercise.


According to teachers at SDN 5, Juma'ani, this school was established in 1983 without its own building. Therefore, he was pleased the social work undertaken Indonesian and American marines in their school. "In 1983, the process of learning and teaching carried out on the terrace house hamlet Bugeman RT 02.01. There, the number of students is only 20 kids, then get an extra students from Hamlet Cottage Langgar, to 73 students," he said, accompanied by the Vice Principal of SDN 2005 Banyu White, Burawi.

In 1985, he continued, Banyu Putih Branch Office of Education established in 2005 Banyu Putih SDN building with three classrooms and a staffroom which berlantaikan cement. Subsequently, in 2000, carried out the renovation of the floor replaced with concrete tiles used until now.

Major renovation work was led Edi Riyaldi Marines and Marine First Lieutenant Platoon Commander Rudik Kuskundarto conducted mutual assistance between the Navy Marine Corps with the U.S. Marines (USMC) and U.S. Navy.

"Now, the building measures 8 x 30 feet built on a land area of 1500 m2 area was undergoing renovation at the walls, roofs, ceilings, door frames and windows, locks and the hook," said Juma'ani.

In addition to renovating the school, members of the Marines two countries also held a free medical social work at the Banyu Putih Health Center. Social Service held for three days was recorded 257 patients who came with the majority suffering from eye disease, gout, and asthma. Although there are several patients suffering from hernia disease, skin, diarrhea, teeth, and so forth.

"We could have difficulties communicating with patients who are only capable of speaking regions, because the committee only prepared the Indonesian language and English, so we use a friend as a language translator Madura," said Good Kresno March Letda interpreters.

In fact, there is a unique scene, he said, when a patient's eye disease called Miskaya (61) of the Village of Rainfall Retrieval Banyu Putih district will be checked for eye doctors. "We are commanded to read letters from lowercase to uppercase can not always answer, then after being asked to my friend that, turned out to have a grandmother who has five grandchildren that are illiterate," he said. (*)

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