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Marciano: Discarding Flow Proposition for Hospital Electric and Electronic Equipment 

J Global Clinical Engineering Vol.3 Issue 2: 2020  32

Received April 2, 2019, accepted August 13, 2020, date of publication December 1, 2020

Discarding Flow Proposition for Hospital Electric and 
Electronic Equipment

By M. A. Marciano    

Moinhos de Vento Hospital/Hospital and Clinical Engineering, Porto Alegre, Brazil 

ABSTRACT

This work proposes a project establishing a staged workflow to ensure any electric or electronic equipment used in a hospital 
environment that is being discarded would be subject to all possible reuse of its equipment and components through to the 
manufacturing of new equipment. The workflow would apply to all the electronic equipment used in the hospital (i.e., biomedi-
cal, electro-mechanical, computer, refrigeration, air conditioning). This appropriate discarding workflow would address socio-
environmental as well as economic/financial concerns.
Keywords – Discarding, Electronic Equipment, Hospital, Socio-environmental.

Copyright © 2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY): Creative Commons - Attribu-
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INTRODUCTION
Technological progress has brought benefits to society 

but has also resulted in increasing levels of waste which 
has worried organizations and environmentalists. The en-
vironmental damage involved in the disposal of electronic 
waste is very relevant. The production process to make 
these components involves the expenditure of natural 
resources, burning of fossil fuels and increased solid, 
liquid, and gas pollution emission (including Greenhouse 
Gas Emissions – GEE).1

In the assembly of electronic equipment various 
component are used that have other constituent heavy 
metals, such as mercury (used in thermostats, sensors, 
relays, and switches); lead (used in printed circuit board 
welding); cadmium (used in printed circuit boards, SMD 
resistor chips, semi-conductors, and infra-red detectors), 
and PVC stabilizers (such as the silicon used in the manu-
facturing of microprocessors and halogenated substances 
like polyvinyl chloride [PVC] etc.).2 Other materials often 

used are iron and steel, used in cabinets and frames; glass, 
used in screens and counters; plastics, used in cabinets, 
cable coatings, and printed circuit as well as rubber. 
These substances when disposed of inadequately can 
cause ground, water, and air contamination in addition 
to having an accumulative effect in all trophic levels that 
can bring harm to human health.1 Research shows that 
the residue from electronics manufacturing has a direct 
relation to 22 types of diseases. Physical and chemical 
effects observed include headache, nausea, impaired vi-
sion, respiratory and pulmonary problems, hearing loss, 
nervous tension, and hypertension. Chronic conditions as 
allergies, bronchitis, teratogenic effects, cancers, organ 
damage, central nervous system issues are affected by 
heavy metal exposure and have cumulative effects.2 Table 
1 outlines some relevant toxic substances and notes their 
uses in electric and electronic equipment (EEE) and their 
effects on health.3

The residue from the disposal of EEE becomes a 
technological, social, and environmental problem and its 
proportions are growing larger. That is why it is neces-
sary to develop environmental management planning to 
reduce their negative effects. Only in 2010, was a law ap-
proved regulating the Solid Residue National Policy (law 
12.305) defining, among other issues, reverse logistics 
and the manufacturer’s responsibilities for the lifecycle 
of products. Still, in said law, there was, for the first time, 
the incentive to develop recycling sectors, the select and 
providing technical training to staff that work in recy-
cling, as well as encouraging environmental and business 
management systems including programs like the 3Rs 
(reduce, reuse, and recycle), aimed at the improvement 
of productive processes, a reduction in residue exploita-
tion, and recovery and energy reuse.1 

The Federal Law n. 12.305 of 02/08/2010, establishing 
the Solid Residue National Policy defined in article 33 that: 

“Are required to structure and implement reverse 
logistics systems, by returning products after use by 
the consumer, independently of the public service 
of urban cleaning and solid waste management, 
manufacturers, importers, distributors and trad-
ers of: ... VI - electro-electronic products and their 
components.”4

“The electro-electronic equipment is small and 
large and includes all the computing, sound, video, 
telephony, ventilators, exhaust fans, and other de-
vices equipped, in general, with electronic controls 
or using electric activation.”4 

For the residue from EEE (REEE) it can be considered the 
is an annual generation rate of 2.6 kg per capita, based on 
academic works and trace estimates.1,4 REEE comes from 
outdated electric and electronic equipment that is selected 
for disposal, including all the consumable components, 

TABLE 1. Relevant Toxic Substances, Its Uses in Electric and Electronic Equipment and Its Effects in Health 

Substance Uses Health Effects

Arsenic Semi-conductors, alloys, and transistors Carcinogenic and gene-altering

Beryllium Copper alloys, mechanical arts, 
connectors and springs

Skin sensitization, emphysema and fibrosis in the 
lungs, carcinogenic

Cadmium
Printed circuit boards, chip resistors, 

semi-conductors and infra-red detectors, 
batteries, switches, fluorescent materials 

Damage to kidneys, liver, pancreas, increased blood 
pressure, carcinogenic and gene-altering

Lead
Printed circuit boards welding, glass, 
cathode ray tubes, welding, and lamp 

glass

Damage to the nervous, endocrine, circulatory, 
urinary, digestive and skeletal systems (it is the 

most toxic of the elements)

Copper Present in several components Liver damage

Hexavalent
Chromium and
Chromium VI

Decorative surfaces, pigments and covers, 
stainless steel

Irritations in the nose, throat, lungs (cancer), 
muscles, eye, skin, and liver damage

Mercury

Thermostats, switch sensors, 
data transmission systems, 

telecommunications, cellphones, 
flourescent lamps and batteries

Damage to the brain, central nervous system and 
kidneys, reproductive problems

PBB and PBDE
Printed circuit boards, components like 
connectors, plastic covers and TV cables 

and home appliances
Damage to the endocrine system

Aluminum Computer structures and connections One of the factors for Alzheimer's disease

Nickel Computer docking structures Genetic mutation
PBB = POLYBROMINATED BIPHENYL; PBDE = POLYBROMINATED DIPHENYL ETHER

http://www.globalce.org
http://globalce.org
http://globalce.org
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Marciano: Discarding Flow Proposition for Hospital Electric and Electronic Equipment 

35 J Global Clinical Engineering Vol.3 Issue 2: 2020J Global Clinical Engineering Vol.3 Issue 2: 2020  34

Marciano: Discarding Flow Proposition for Hospital Electric and Electronic Equipment 

subcategories and materials needed to function. In general 
terms, the composition of the present materials in REEEs 
is characterized by the high presence of metal (ferrous and 
non-ferrous), glass, and plastic. Televisions, computers, 
and monitors present, on average, 49% in metal weight, 
33% in plastic weight, 12% in cathode ray tubes, and 
6% other material. In studies performed it was found 
that printed circuit boards – PCI must be considered as 
dangerous residue and be disposed of in appropriate 
places mainly due to the presence of lead and cadmium. 
Therefore, recycling those materials present in the REEE 
through the shared socio-environmental responsibility in 
which manufacturers, importers, public power, and con-
sumers are responsible can aid in environmental protec-
tion and demonstrate to present and future generations 
that is the most viable option. EEE is made of a variety 
of high commercial value material that can be recycled.5 

With the right action on the appropriate environmental 
management of this residue, value can be added to what, 
until then, was considered “waste.” 

To attenuate this issue there are several residue disposal 
avenues such as landfills and incineration although recy-
cling is the best and most efficient. As the toxic substances 
can be found in bigger concentration than they were in 
nature, the recycling of this residue provides the recovery 
of toxic substances as well as reducing the exploitation of 
natural resources. The environmental management of solid 
waste is a set of activities aiming to reduce or eliminate 
the damage that these can cause in the environment. Also, 
as well as being a source of material for other technology 
manufacturing and generating jobs, material recycling 
offers great savings to organizations and shows a positive 
corporate image to the consumer market (an example 
of “Green Marketing”). The separation and destination 
of unwanted electronics promote residue reduction, the 
reuse and recycling of raw material, generate income, and 
promote social inclusion and the reduction of waste in 
landfills and helps mitigate environmental degradation 
from incorrect disposal.1 

For EEE, the suggested control approaches are: general 
data and description, generation, collection and transport, 
destination and final disposal, costs, competence, and re-
sponsibilities, needs and deficiencies, relevant initiatives, 
applicable legislation and applicable standards. There is 
also the suggestion about the unity of residue processing, 

such as guidelines, the strategies, the quantitative goals 
and the programs and actions.4 Table 2 highlights the 
categories of the REEEs, by the European Parliament, 
through the directive 2002/96/CE.6

Considering that the Resolution, RCD 16, in 2013, 
Manufacturing Good Practices, defines the responsibili-
ties of the manufacturer to installation stages, according 
to the item 6.4.1: “Each manufacturer must establish and 
maintain procedures to the components identification, 
manufacturing material, intermediate products and 
finished products during all the storage, production, dis-
tribution and installation stages to avoid confusion and 
to guarantee the correct order fulfilments,”7 considering 
that the draft CONAMA Resolution, which regulates the 
management of waste electrical and electronic equip-
ment in Brazil, suggests “the need to discipline correct 

TABLE 2. Categories of Electric and Electronic Equipment 
Residue 

Category Examples

1. Large home Appliances
Refrigerators, washing machines, 
dishwashers, stoves, microwaves, 

vacuums 

2. Small house home 
appliances

Toasters, electric knives, 
hairdryers

3. Computing and 
telecommunications 
equipment

Desktop computer, laptop 
computer, printer

4. Consumer equipment
Cellphone and telephone, 

Television equipment, DVD 
devices 

5. Lighting equipment Fluorescent lamps

6. Electronic Tools (except 
consumer equipment)

Saws, sewing machines, 
lawnmowers

7. Toys, sports and leisure 
equipment

Video games, slot machines, 
sports equipment

8. Medical equipment 
(except the implanted and 
infected products)

Nuclear medicine equipment, 
radiology, cardiology, dialysis

9. Control and monitoring 
instruments Thermostats, smoke detectors

10. Automatic distributors Dispensers of money, beverages, 
and solid products

environmental management and disposal of electrical and 
electronic equipment residue, concerning the collection, 
reuse, recycling, treatment or final disposal.”8 This work 
proposes a project establishing a staged workflow that 
would make sure any electric/electronic equipment used 
in a hospital environment that is being discarded would 
be subject to any and all possible reuse of its equipment 
and components through to the manufacturing of new 
equipment.

METHOD
With the reference to the proposition of the disposal 

flow of hospital EEEs were used the researched references, 
according to what is described below.

Art. 7 of the Resolution, RCD 16, of 2013, about Manu-
facturing Good Practices states: 

“Are obligations: I – From the manufacturers and im-
porters of EEE and its components: (a) adopt technologies 
or processes of acquisition that take into consideration 
the “ecodesign,” that allows reducing, reusing or recycling 
the REEE; (b) the REEE management (collect, transport, 
handling, storage, processing and environmentally ap-
propriate disposal). The manufacturers and importers 
should be able to choose to fulfil this management either 
individually, adhering to a collective regime or through a 
third part; (c) collect the REEE, creating accredited collection 
points and/or in articulation with its commercialization 
network, technical assistance and with the public power 
as the implementation of the necessary structure to guar-
antee the reverse logistics of this waste and to give them 
environmentally appropriate destination; (d) to recover, 
when possible, the REEE in form of new raw material or 
new products, in its cycle or in other productive cycles; 
(e) the management of REEE applies to current products 
and historical passages; (f) to establish collection points 
for the REEE that are accessible to consumers / users and 
to provide environmentally adequate disposal for tail-
ings; (g) to articulate the reverse logistics of REEE with 
its commercialization network and technical assistance; 
(h) to disclose information on the location and operation 
of REEE collection points and to promote environmental 
awareness campaigns to combat inadequate disposal; (i) 
to ensure that the products and electric and electronic 
components commercialized in Brazil indicate with 
emphasis, the following to the consumer, at least in the 

equipment manual and in the producer’s official site or 
importer on the internet.”8 

And item III of the same draft suggests: 
“III – Of consumers: (a) to adopt practices that make 

it possible the reduction of its generation; (b) after the 
use of the product, condition adequately and to deliver 
of REEE to the dealers/distributors or to destine them 
to the collection points, according to the information 
provided by the producer/importer.”8

The recycling stages of REEEs are similar for and in-
clude the steps outlined below.

Disassembly
Done at a sorting center, this stage involves the removal 

of parts that contain dangerous substances (chlorofluo-
rocarbons, mercury, polychlorinated biphenyl, etc.), parts 
that contain valuable substances (copper cables, steel, 
iron, and precious metals). The environmental risk in this 
stage is from ground contamination by improper storage 
of REEEs or oil or CFCs leaking from removed parts. 

Separation of Ferrous and Non-ferrous Metals, 
and Plastics

This step is normally performed manually in a sorting 
center. 

Recycling/Recovery of Valuable Material
Items containing ferrous and non-ferrous metals, 

plastics, and precious metals are sent to specific recycling 
companies for recovery.

Processing/Disposal of Dangerous Material and 
Residue

Any remaining non-recovered/recycled material is 
sent to landfills or industrial landfills for further disposal 
following the appropriate legislation.5

Figure 1 illustrates the sorting scheme for materials 
present in EEE.4

Also described are possible process indicators:
• The number of producers, importers, and dealers 

for used EEE.
• The number of establishments receiving REEEs.
• The number of agents involved in the waste collec-

tion program.



Marciano: Discarding Flow Proposition for Hospital Electric and Electronic Equipment 

37 J Global Clinical Engineering Vol.3 Issue 2: 2020J Global Clinical Engineering Vol.3 Issue 2: 2020  36

Marciano: Discarding Flow Proposition for Hospital Electric and Electronic Equipment 

• The percentage of employment and income generated.
• The quantity of generated residue and the estimate 

of the amount of waste that is no longer being sent 
to landfills.5

The implementation of a plan for the disposal of EEE 
makes it possible to improve environmental conditions, 
encourages future generations to continue the process 
of environmental education, and generates the potential 
for increased employment and income. Establishing an 
evaluation and monitoring program is of great importance 
to help identify the stages that need correction and to 
continuously improve the process. The monitoring must 
evaluate all the stages from environmental education to 
final disposal. The results found by monitoring must be 
available to those involved in the work. The implementa-
tion of monitoring activities also needs a preestablished 
selection of indicators to simply illustrate the functioning 
of the plan.5

RESULTS
Based on our results and shown in Figure 2 we have 

a proposed flow for discarding hospital EEE.

DISCUSSION
There are some points worth taking into consideration 

to clarify the process of defining and executing the man-
agement plan for disposal of hospital EEEs:

FIGURE 1. Sorting scheme for material present in electric and 
electronic equipment. 

FIGURE 2. Proposed flow for discarding hospital electric and 
electronic equipment. Adapted from Meta-recycling.1 

• Local issues
• Use of dedicated personnel (own or outsourced)
• Partners to conduct the external stages
• Internal policies as well as any relevant municipal, 

state, or federal guidelines

This project should be continuously evolving in the 
hospital and include the involvement of various depart-
ments such as environmental management, patrimony 
management, and accounting in addition to hospital 
and clinical engineering. This is important so that after 
well-defined and detailed stages are in place the results 
can be taken to the hospital’s directors for analysis and 
validation. 

CONCLUSION

The reality demonstrates the need for definition by 
standardization, detailing, and validation of the EEEs flow 
disposal. The proper disposal management of the com-
ponents of EEEs can eliminate potential environmental 
damage and be a source of material for other applications. 
There is also the possibility to generate new jobs and cre-
ate potential saving for health organizations. Hospitals 
can contribute considerably in this issue by instituting 
the right processes in handling and disposal of EEEs.

CONFLICT OF INTEREST

The authors declare that they have no conflict of interest.

REFERENCES

1. Del Grossi AC. II Brazilian Congress of Environmental 
Management. Unopar. Disposal of Waste Electrical and 
Electronic Equipment (REEE). Londrina; 2011.

2. Pallone S. Electronic waste: reduction, reuse, recycling 
and recovery. Available at: http://www.comciencia.
br/comciencia/handler.php?section=8&edicao= 
32&id=379. Accessed: 26 April 2017. 

3. Del Grosi A. Electronic Waste Task Force. Back of Flyer. 
Londrina, Paraná, Brasil; 2010.

4. Federal Government Ministry of the Environment. Lo-
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Management Plans: Guidance Manual Supporting the 
Implementation of the National Solid Waste Policy: 
From National To Local. Brasília – DF, Brasil; 2012.

5. Belo Horizonte: State Environment Foundation: Foun-
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Waste Electrical And Electronic Equipment- PGIREEE 
/ Eualdo Lima Pinheiro; 2009.

6. EUROPEAN PARLIAMENT Directive 2002/96 / EC of the 
European Parliament and of the Council of 27 January 
2003. Concerning Waste Electrical and Electronic Equip-
ment – REEEs. Available at: https://eur-lex.europa.eu/
legal-content/EN/TXT/?uri=CELEX%3A32002L0096

7. ANVISA. Good Manufacturing Practices RDC 16, 2013.
8. CONAMA Resolution Draft. Regulates the Management 

of Waste Electrical and Electronic Equipment in Brazil. 
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https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32002L0096
https://eur-lex.europa.eu/legal-content/EN/TXT/?uri=CELEX%3A32002L0096

