APPLICATION OF INTELLIGENT SYSTEMS USING

KNOWLEDGE HUB AND RFID TECHNOLOGY IN

HEALTHCARE WASTE MANAGEMENT IN THE UK AND

CHINA

Anthony S. Atkins

, Lizong Zhang

, Hongnian Yu

and Weiya Miao

Faculty of Computing, Engineering and Technology, Staffordshire University

Octagon, Beaconside, Stafford ST16 9DG, U.K.

Chengdu University of Traditional Chinese Medicine, Chengdu, China

Keywords: Intelligent systems, Healthcare waste, Knowledge hub, Radio Frequency Identification (RFID), Digital

imagery.

Abstract: The paper describes an intelligence system using a knowledge hub integrated Radio Frequency

Identification (RFID) technology and digital imagery in the management of healthcare waste. This paper

outlines the definition of healthcare waste both in the United Kingdom and China together with recent

changes in the classification of this waste in the last few years with regard to clinical, laboratory testing and

biological waste etc. Statistical information regarding the quantity of healthcare waste is outlined indicating

predicted interpretation of future of waste production and the issues involved in traditional incineration and

land fill operations. The paper describes a knowledge hub to provide monitoring, tracking and verification

systems to assist government agents in providing audited records for anticipated legislation and public

scrutiny. The system using rule-based intelligence systems linked to developed simulation software to

provide logistical support via what- if scenarios.

1 INTRODUCTION

Healthcare waste or medical waste is mainly

produced from clinical treatment, laboratory testing,

biological culture and animal experiments

(SEPA(China), 2003). It usually contains infectious

materials, drugs and sharp objects such as syringes,

which are undoubtedly harmful waste that contains

a large number of viruses, bacteria and harmful

chemical reagents. Healthcare wastes are some of

the most dangerous wastes due to the high pollution

risk that will damage both our health and the

environment (DEFRA, 2006, Zhan and Jiang, 2008).

The disposal and treatment of healthcare waste is

a concern of many countries’ government initiatives

and environmental pressure groups. Simply burning

and then landfilling them as normal waste was

historically the case, however this may spread

harmful components for example from exhaust gas

emissions and toxic metal substances that could

cause serious pollutions (EA, 2008b, SEPA(China),

2003). In addition, uncontrolled and low-technology

treatment of healthcare waste usually results in

public unrest or panic and could cause a risk of

epidemical disasters. Therefore, healthcare waste or

medical waste is usually treated as hazardous waste

in most countries. For example, it is listed on the

“National Hazardous Waste List” of China since

1998 and also listed in the hazardous categories in

UK (DEFRA, 2007, EC, 2000, SEPA(China), 2008).

The UK Department for Environment, Food and

Rural Affairs (DEFRA) estimates that approximately

200,000 tonnes of healthcare waste is produced

annually in the UK with 26,450 tonnes of this

requiring high-temperature processing, and 173,600

tonnes suitable for alternative technology treatment

(DEFRA, 2007). Controlling all the healthcare waste

and sending them to the correct treatment facility is

not an easy procedure for most countries,

particularly in developing countries, such as China.

Healthcare waste is a significant environmental

issue. However, due to the complex situation

concerning the treatment requirements of different

types of healthcare waste and also the large volume,

S. Atkins A., Zhang L., Yu H. and Miao W. (2009).

APPLICATION OF INTELLIGENT SYSTEMS USING KNOWLEDGE HUB AND RFID TECHNOLOGY IN HEALTHCARE WASTE MANAGEMENT IN

THE UK AND CHINA.

In Proceedings of the International Conference on e-Business, pages 44-49

DOI: 10.5220/0002207500440049

 SciTePress

there is a lack of a suitable system to track and audit

the healthcare waste. The paper proposes the design

of a system that can provide tracking, verification

and auditing for the disposal of healthcare waste and

can also provide logistic support.

This paper firstly explains the current situation of

healthcare waste in UK and China, and discusses

two cases that concern the knowledge management

system or RFID applications. Finally, the proposed

system is discussed, and its process and application

are outlined.

2 HEALTHCARE WASTE IN UK

AND CHINA

The UK and China have different definitions about

the waste from healthcare services. However, they

have similar concerns about the waste in that it

needs to be treated and controlled circumspectly.

2.1 Current Situation in UK

Currently, ‘Healthcare waste’ is the official name in

UK which replaced the term ‘medical waste’,

‘clinical waste’ and ‘hospital waste’ since the

‘Hazardous Waste Regulations’ came into force in

July 2005 (DEFRA, 2007).

In the UK, not all healthcare waste is hazardous

waste, in fact, about 33% of healthcare waste is

normal waste, which is from hospital offices – most

of them are paper or office supplies etc. The

‘Hazardous Waste Regulation’ describes healthcare

waste as the waste generated in the healthcare

environment, and the ‘European Waste Catalogue’

(EWC) gives a clear definition in C18 (‘EWC 18’)

(EC, 2000). These wastes are divided into two

categories which respectively concern human and

animals, and contain 16 sub-categories. However,

only 7 of them are hazardous, and their hazards are

categorised by ‘Hazardous Waste Regulation’ in H9

(infectious), H6 (toxic), H7 (carcinogenic) and H11

(mutagenic) respectively (DEFRA, 2007).

The UK produces about 200,000 tonnes of

healthcare waste annually. Currently, there is no

detailed statistic to show healthcare waste in the

entire UK (excludes Scotland and Northern Ireland)

and only the hazardous healthcare waste statistics of

England and Wales are available from the

Environment Agency (EA). This indicates that the

amount of waste in 2006 is 142,305 tonnes, and this

accounts for almost 8 times more than in the year

2000 (only 16,456 tonnes) as shown in Figure 1. The

data for 2005 is influenced by the new regulations

on waste management system and new data

gathering introduced in mid-2005 to coincide with

the new Hazardous Waste Regulations (EA, 2008a),

and this effects comparability of the information.

However, Figure 1 does indicate that the waste

tonnage has increased since 2003, and certainly, will

continue to increase in future years with predicated

population growth (Zhang et al., 2008).

Figure 1: Trends of Healthcare Waste in England and

Wales from 2000 to 2006, source: EA.

2.2 Current Situation in China

In China, this type of waste is normally referred to

as ‘medical waste’, as there is no official translation.

According to the Healthcare Waste Management Act

published in June 2003, medical waste which is

produced in healthcare organizations in medical-

related activities were all treated as hazardous waste.

In addition, the latest version of ‘National

Hazardous Waste List’ of China published in June

2008, has categorized them into HW01 (Medical

Waste), HW03(Waste Drug or Pharmaceuticals)

and HW16(Sensitization Material Waste)

(SEPA(China), 2003, SEPA(China), 2008).

Currently, there is no detailed data about medical

waste in China. The only information published is

by the ‘National Development and Reform

Commission of China’ in 2006 which is based on

information relating to the number of clinical beds.

It indicates that China produces about 0.65 Mt

medical waste annually and this will increase by

30,000 tonnes to 0.68 Mt in 2010 (NDRC, 2006).

Although there is no accurate statistics, it is assumed

that the increasing trends of waste will be similar to

the UK.

2.3 Treatment Methods

Normally, the treatment methods for healthcare

waste have two broad categories, high-temperature

50.000

100.000

150.000

2000 2001 2002 2003 2004 2005 2006

Tons/year

APPLICATION OF INTELLIGENT SYSTEMS USING KNOWLEDGE HUB AND RFID TECHNOLOGY IN

HEALTHCARE WASTE MANAGEMENT IN THE UK AND CHINA

and non-burn/low temperature alternative methods

(DH, 2006). Some typical treatment methods are as

follows:

• Incineration – Normally operated at 800-1000

It is widely used throughout the world, as is low

cost, easy operation with low technology

requirement. It can completely destroy the

bacteria, viruses and most of chemical

components, in addition, the volume and weight

of treated waste will be reduced to

approximately 20%. However, during the

incineration, harmful gases may be produced

and may give rise to emission into the

atmosphere, particularly for low-technology

incinerators (DH, 2006).

• Autoclave – This technology uses saturated

steam in a vessel above atmospheric pressure to

treat the material for disinfecting. It is a

traditional method used in hospitals and is

appropriate for healthcare wastes (Zhao et al.,

2005).

• Microwave – The system uses electromagnetic

waves to destroy the microbes by thermal

energy (DH, 2006). Currently, most of the waste

is required to be wet. This method is more

complex than incineration technology (Zhao et

al., 2005).

3 CASE REVIEW

The paper outlines two case studies relating to RFID

application in medical waste and/or knowledge

management technology.

Firstly, a trial of RFID applied to medical waste

management in Japan in 2004. It was launched by

‘Kuregha Environmental Engineering Ltd’, which is

a leading Japanese waste management company, and

IBM who provided the technical support for the trial.

They attached RFID tags to containers which are

made from different materials such as cardboard and

plastic to test them in IBM’s RFID Solution Centre

(IBM, 2004). IBM claimed, that this is the “first

medical waste traceability testing” (IBM, 2004).

This trial was launched in July 2004, and there is no

further evidence as to whether this trial was

successful. Taiwan has also launched a trail by its

environment Protection Administration January

2006, and the latest reports have shown that the

RFID read/write function is in the process of testing.

The second case the ‘iKnow’ system which was

developed by a paediatric research group at British

Columbia's Children's Hospital is a system ‘used by

clinicians at the hospital to develop knowledge rules

for improving patient care in surgical operations’. A

decision support system based on the rules in the

operating room to assist anaesthesiologists in

dealing with adverse events (Dunsmuir, 2007).

Figure 2 shows the system, and also its functions.

This is an expert system which uses rule-based

reasoning mechanism. These rules allow reasoning

from physiological and demographic data sources to

provide clinical explanations and advice (Dunsmuir,

2007), and the knowledge base of the system can

contain some other types of data such as pictures.

This system is more complex than the previous cases

outlined, as it includes reasoning and maintenance

and decision making support functions.

Figure 2: The iKnow System Work Process (Dunsmuir,

2007).

4 PROPOSED TRACKING AND

AUDITING SOLUTION

Healthcare waste management and auditing to

prevent illegal disposal is becoming an urgent

environmental issue, particularly in developing

countries. A proposed solution using a knowledge

technology system (knowledge hub) to audit and

track healthcare waste from its source to treatment

facility and/ or disposal location is discussed.

The design will use RFID technology and digital

imagery to integrate records including location,

volume and weight, container movement, delivery

tracking inventories and scheduling etc (Atkins et

al., 2008). It works with the support of a knowledge

management system which helps management to

make decisions of scheduled logistics of waste to

treatment plants and also provides the instruction to

deal with the hazardous healthcare waste for the

operating staff.

The design of the proposed system can be

viewed from two aspects: firstly, providing the

evidence of healthcare waste being sent to the

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Figure 3: Proposed Medical Tracking and Verification System using RFID Technology.

correct treatment facility and preventing fly-tipping

during transportation. This relies on comparison of

the information from destination and the source site,

including RFID records, image or video records,

operators checking and the possible use of built-in

weight systems. The second aspect is the logistic /

instruction support that helps management to choose

the appropriate treatment facility to dispose the

waste and real-time instructions to the operating

staff.

Figure 3 illustrates the system of a ‘Community

Healthcare Facility’ and ‘Hospital/Healthcare

Organization’ which are the two typical healthcare

facilities and healthcare source sites. The healthcare

waste must be classified and bagged in the source

sites and a RFID tag is then attached to the container

(bag, sealed box, or bins etc.) with a unique ID. The

ID relates to information about the waste such as

weight, type, and current location etc. The

information is located in the central server, and can

be checked by a hand-held RFID device. The

operators can update the information as appropriate.

The storage points for temporary holding the

healthcare waste are all equipped with RFID sensors

and digital imagery cameras, which can generate

records of waste movement. Once the waste arrives

at or leaves from these points, the records will be

updated to the central server. The destination sites

are also equipped with similar equipment to monitor

the waste arrivals.

The records include the time and date, container

ID, waste type, weight, which are related to the

RFID tags ID, and the image / video records are

associated with the RFID data to eliminate fraud in

the system and preventing fly-tipping. The status of

the waste in the system is updated in real-time based

on records that are generated each time the container

passes the RFID sensors. In addition, hand-held

devices can also be used to update information

manually by the operators to prevent the system

reading errors and to correct any mistakes.

Figure 3 indicates, that before the waste goes to

be treated (e.g. incineration); an RFID sensor will

record and then upload the information. Then the

RFID tag on the container will be removed and a

new ID will be given for future utilization.

Alternatively, the tags can be discarded if they are

the low-price passive tags. The next step is to re-bag

the treated waste with a new RFID tag to enable

tracing it to the correct destination for disposal such

as landfill sites.

Hand-held devices are used by the operating staff

involved in the system, including vehicle drivers,

cleaners, and management etc. The device is a small

sensor that links to the central server, and can

display information from the system. The instruction

and logistical support information will be

automatically downloaded from the knowledge

management system when it is required. The

information notifies the operators which container

should be transported or moved to the correct

location in a specific time, and also notifies the

procedure of transporting this type of waste and any

particular cautionary instructions.

APPLICATION OF INTELLIGENT SYSTEMS USING KNOWLEDGE HUB AND RFID TECHNOLOGY IN

HEALTHCARE WASTE MANAGEMENT IN THE UK AND CHINA

Figure 4: Structure of the Knowledge Base.

The proposed system is designed using a

knowledge system as the back end support, and

includes a knowledge base system and reasoning to

provide the logistical support for the waste

management. The reasoning system is designed

using Rule-based Reasoning and may associate with

Case-based reasoning (CBR) system. The structure

of the knowledge base is illustrated in Figure 4.

There are three proposed databases operating in the

system which are as follows:

• RFID database that stores the information

from the RFID equipment;

• Image database for auditing and tracking

evidence;

• A possible Case database that provides the

data for Case Based Reasoning.

These three databases are integrated and their

information is sent to a central database, referred to

as a ‘knowledge hub’, which offers the integrated

information for the reasoning process.

Figure 5 illustrates the structure of the

knowledge system, and it is designed in four layers.

The lowest layer (layer 4) is the hardware layer,

which is the route for inputting the data and

information from the RFID and imagery equipment

to the knowledge system. Layer 3 is the knowledge

base layer, and there are three databases that store

different data which integrates into the knowledge

hub. The data will be used in the reasoning layer,

but the imagery data will only be used in the top

layer for providing evidence of transportation and

logistics. The second layer is the reasoning layer.

Rule-based reasoning is the main reasoning

mechanism for generating the best solution for

logistical and tracking support and Case-based

reasoning may be adopted as a backup in future

work. The result of the reasoning layer provides a

multiple solution by identifying the optimal solution

after checking from the rule-based reasoning and the

field data is then passed to the highest layer

visualisation to provide the resolutions for decision

support. This visualisation layer is designed using

web application for easy access, and represents the

logistical solution and records of the waste

transportation using appropriate simulation software

developed for the project to provide what-if

scenarios (Zheng et al., 2008). This layer can also be

designed to support the individual software or

application for more detailed security and

verification checking.

Figure 5: Structure of the Knowledge System.

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5 CONCLUSIONS

The paper reviews the current urgent situation of

healthcare waste production, treatment and disposal,

and the trend of increasing tonnage in the UK and

China. Currently there is no successful automated

auditing and tracking system available for healthcare

waste management. Healthcare or medical waste is

one of most dangerous hazardous wastes in that it

can contain viruses, bacteria and harmful chemical

reagents. Uncontrolled or just low-technology

treatment of healthcare waste usually results in

public unrest or panic and could produce epidemic

disasters for example SARS. A proposed system

which is based on RFID and knowledge technology

to provide auditing, tracking, verification and

logistical support is outlined in this paper. This

system can ensure that the waste is directed to the

correct destination and provide verifiable evidence

for auditing purposes and for independent scrutiny.

The proposed system can also be used with other

types of waste either for recycling purposes or safe

disposal of for example, plasterboard, tyres, wood

and glass to make the waste disposal more

environmentally friendly and contribute to viable

recycling solutions.

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APPLICATION OF INTELLIGENT SYSTEMS USING KNOWLEDGE HUB AND RFID TECHNOLOGY IN

HEALTHCARE WASTE MANAGEMENT IN THE UK AND CHINA