Healthcare waste management in Asian developing countries: A mini review

Circular Economy in Conjunction with Treatment Methodologies in the Biomedical and Dental Waste Sectors

In this review, life cycle assessment (LCA) principles are coupled with circular economy (CE) in order to address LCA examples in the biomedical sector worldwide. The objectives were (1) to explore the application of LCA in the medical, pharmaceutical, and dental fields; (2) to describe the ways of biomedical waste management; (3) to emphasize on the problem of dental waste in private and public dental sectors; and (4) to propose ways of “green circulation” of the dental waste. A literature search was performed using the Google Scholar, PubMed, and Scopus search engines covering the period from January 2000 until May 2020, corresponding to articles investigating the LCA and circular economy principles and legislation for biomedical and dental waste, their management options, and modern ways of recycling. The results showed that incineration seems to be the best management way option involved despite the mentioned drawbacks in this technology. Different adopted models are well defined for the dental field based on the 3Rs’ module (reduce, reuse, recycle). Replacing disposable products with reusable ones seems to be a good way to tackle the problem of waste in medical and dental sectors. Interventions on the selection and better biomedical and dental waste management will ensure eco-medicine and eco-dentistry of the future. These new terms should be the new philosophies that will change the way these fields operate in the future for the benefit of the professionals/patients and the community.

Review of Current Healthcare Waste Management Methods and Their Effect on Global Health

Healthcare is a rapidly growing industry as medical treatments become more sophisticated, more in demand due to increasing incidence of chronic disease and more widely available worldwide. This booming industry is also creating more waste than ever before and, as such, there is a growing need to treat and dispose of this waste. Healthcare waste (HCW) disposal includes a multitude of disposal methods, including incineration, landfilling and chemical treatments. These rudimentary methods and their growing use present their own problems that negatively impact both the environment and, in turn, damage public health, thus contributing to a global healthcare crisis. The aim of this review was to examine the current HCW disposal methods in place and the harmful effects they have on the environment and on public health. The findings accumulated in this review demonstrate a heavy reliance on basic, low tech HCW disposal techniques and uncovered the negative impacts of these methods. There is a notable lack of employment of "greener" HCW disposal methods on a largescale due to cost, access and feasibility. Despite innovations in HCW disposal, there is no scalable, global green solution at present. Further, the review highlights that global health consequences of HCW disposal methods often differ depending on how developed the country is.

Emergency response to the explosive growth of health care wastes during COVID-19 pandemic in Wuhan, China

During the Coronavirus Disease 2019 (COVID-19) as a worldwide pandemic, the security management of health care wastes (HCWs) has attracted increasing concern due to their high risk. In this paper, the integrated management of HCWs in Wuhan, the first COVID-19-outbreaking city with over ten millions of people completely locking down, was collected, investigated and analyzed. During the pandemic, municipal solid wastes (MSWs) from designated hospitals, Fangcang shelter hospitals, isolation locations and residential areas (e.g. face masks) were collected and categorized as HCWs due to the high infectiousness and strong survivability of COVID-19, and accordingly the average production of HCWs per 1000 persons in Wuhan explosively increased from 3.64 kg/d to 27.32 kg/d. Segregation, collection, storage, transportation and disposal of HCWs in Wuhan were discussed and outlined. Stationary facilities, mobile facilities, co-processing facilities (Incineration plants for MSWs) and nonlocal disposal were consecutively utilized to improve the disposal capacity, from 50 tons/d to 280.1 tons/d. Results indicated that stationary and co-processing facilities were preferential for HCWs disposal, while mobile facilities and nonlocal disposal acted as supplementary approaches. Overall, the improved system of HCWs management could meet the challenge of the explosive growth of HCWs production during COVID-19 pandemic in Wuhan. Furthermore, these practices could provide a reference for other densely populated metropolises.

Fate and toxicity of pharmaceuticals in water environment: An insight on their occurrence in South Asia

Pharmaceutically active compounds are newly recognized micropollutants which are ubiquitous in aquatic environment mainly due to direct discharge of treated and untreated wastewater from wastewater treatment plants. These contaminants have attracted mounted attention due to their toxic effects on aquatic life. They disrupt biological processes in non-target lower organisms upon exposure. Biodegradation, photo-degradation, and sorption are key processes which determine their fate in the environment. A variety of conventional and advanced treatment processes had been extensively investigated for the removal of pharmaceuticals from wastewater. However, due to structural complexity and varying operating parameters, complete removal seems ideal. Generally, due to high energy requirement of advanced treatment technology, it is considered cost ineffective. Transport of pharmaceutical compounds occurs via aquatic channels whereas sediments and aquatic colloids play a significant role as sinks for these contaminants. The current review provides a critical understanding of fate and toxicity of pharmaceutical compounds and highlights their vulnerability and occurrence in South Asia. Antibiotics, analgesics, and psychiatric drugs were found predominantly in the water environment of South Asian regions. Despite significant advances in understanding pharmaceuticals fate, toxicity, and associated risks since the 1990s, still substantial data gaps in terms of monitoring, human health risks, and legislation exist which presses the need to develop a more in-depth and interdisciplinary understanding of the subject.

Green nephrology and eco-dialysis: a position statement by the Italian Society of Nephrology

High-technology medicine saves lives and produces waste; this is the case of dialysis. The increasing amounts of waste products can be biologically dangerous in different ways: some represent a direct infectious or toxic danger for other living creatures (potentially contaminated or hazardous waste), while others are harmful for the planet (plastic and non-recycled waste). With the aim of increasing awareness, proposing joint actions and coordinating industrial and social interactions, the Italian Society of Nephrology is presenting this position statement on ways in which the environmental impact of caring for patients with kidney diseases can be reduced. Due to the particular relevance in waste management of dialysis, which produces up to 2 kg of potentially contaminated waste per session and about the same weight of potentially recyclable materials, together with technological waste (dialysis machines), and involves high water and electricity consumption, the position statement mainly focuses on dialysis management, identifying ten first affordable actions: (1) reducing the burden of dialysis (whenever possible adopting an intent to delay strategy, with wide use of incremental schedules); (2) limiting drugs and favouring "natural" medicine focussing on lifestyle and diet; (3) encouraging the reuse of "household" hospital material; (4) recycling paper and glass; (5) recycling non-contaminated plastic; (6) reducing water consumption; (7) reducing energy consumption; (8) introducing environmental-impact criteria in checklists for evaluating dialysis machines and supplies; (9) encouraging well-planned triage of contaminated and non-contaminated materials; (10) demanding planet-friendly approaches in the building of new facilities.

A Study on Small Clinics Waste Management Practice, Rules, Staff Knowledge, and Motivating Factor in a Rapidly Urbanizing Area

Thousands of small clinics in Pakistan are generating dispersed medical waste, unlike large hospitals, small clinic waste management is often ignored. This study was conducted on 135 small clinics in Hyderabad, Pakistan, with the aim to determine small clinics' waste management practices in contrast to rules, level of knowledge, the environmental impact of disposal methods, and motivating factor analysis to understand the current situation from multiple perspectives. Overall, the waste generation rate was calculated to be 2.01 kg/clinic/day and the hazardous waste generation rate was 0.89 kg/clinic/day, whereas the general waste generation rate was 1.12 kg/clinic/day. The hazardous waste generation rate percentage is found to be higher than those found in large hospitals by 20%. The waste management practice among surveyed clinics was deplorable; none of the clinics were completely following hospital waste management rules of 2005 and thus the absence of proper segregation, storage, transportation, and disposal was commonly encountered during the study. Clinic staff possessed low level of knowledge and awareness, and acquired no training about waste management practice and rules, moreover, frequent employee turnover was noticed too. Additionally, two hypotheses were checked for creditability of motivating factors with an exploratory factor analysis to check their contribution to motivating clinic staff to practice sound healthcare waste management. Out of 10 indicators, nine were found in support of the hypotheses. Hence, it was discovered that active government involvement and financial support in providing training and inspecting small clinics could help in improving the condition. The findings of the present study can play a vital role in documenting evidence, and for policymakers and governments to plan solid waste management of small clinics and other healthcare facilities.