Assessment of Environmental and Health Risks Associated with the Management of Medical Waste in Mauritius

Healthcare Waste-A Serious Problem for Global Health

Healthcare waste (HCW) is generated in different healthcare facilities (HCFs), such as hospitals, laboratories, veterinary clinics, research centres and nursing homes. It has been assessed that the majority of medical waste does not pose a risk to humans. It is estimated that 15% of the total amount of produced HCW is hazardous and can be infectious, toxic or radioactive. Hazardous waste is a special type of waste which, if not properly treated, can pose a risk to human health and to the environment. HCW contains potentially harmful microorganisms that can be spread among healthcare personnel, hospital patients and the general public, causing serious illnesses. Healthcare personnel are the specialists especially exposed to this risk. The most common medical procedure, which pose the highest risk, is injection (i.e, intramuscular, subcutaneous, intravenous, taking blood samples). The World Health Organization (WHO) estimates that around 16 billion injections are administered worldwide each year. However, if safety precautions are not followed, and needles and syringes are not properly disposed of, the risk of sharps injuries increases among medical staff, waste handlers and waste collectors. What is more, sharps injuries increase the risk of human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV/HCV), tuberculosis (TB), diphtheria, malaria, syphilis, brucellosis and other transmissions. Disposing of medical waste in a landfill without segregation and processing will result in the entry of harmful microorganisms, chemicals or pharmaceuticals into soil and groundwater, causing their contamination. Open burning or incinerator malfunctioning will result in the emission of toxic substances, such as dioxins and furans, into the air. In order to reduce the negative impact of medical waste, waste management principles should be formulated. To minimize health risks, it is also important to build awareness among health professionals and the general public through various communication and educational methods. The aim of this paper is to present a general overwiev of medical waste, its categories, the principles of its management and the risks to human health and the environment resulting from inappropriate waste management.

Instrument Development to Measure the Medical Waste Management Performance in Healthcare Centers, Bandung, West Java

BACKGROUND: Medical waste produced by healthcare centers needs to be managed according to the requirements to prevent disease transmission and environmental pollution. An instrument is required to assess the performance of healthcare centers in Indonesia in managing their medical waste. AIM: This study aims to develop an instrument to assess medical waste handling performance indicators in Indonesia’s healthcare centers (Puskesmas). METHODS: We used qualitative and quantitative methods to ensure performance indicator instruments’ validity, reliability, and quality. Data samples were taken from 70 healthcare centers in Bandung city. The performance assessment tools were created using 20 indicators, taking into account the instrument’s validity and reliability. RESULTS: Results revealed that medical waste management’s performance in healthcare centers in Bandung was under the good category (60.0%). The best waste management performance categories were shown by healthcare centers level 1 (100.0), level 2 (66.7%) and level 3 (46.2%), also healthcare centers with Basic Emergency Neonatal Obstetrics Services (PONED) services (100.0%). Our results showed that financial, storage and healthcare with PONED services correlate with the amount of medical waste managed. CONCLUSIONS: The instrument developed can be used to assess, monitor, and evaluate medical waste management performance in healthcare centers and become part of healthcare centers’ accreditation.

Assessment of knowledge, attitude, and practice about biomedical waste management among healthcare workers during COVID-19 pandemic in a health district of West Bengal

Background

Efforts to combat Coronavirus disease (COVID-19) pandemic have significantly increased the quantity of bio-medical waste (BMW) generation.

Objectives

A cross-sectional study was performed to assess the knowledge, practice, and attitude and factors affecting knowledge on BMW management among Health Care Workers (HCWs) when taking care of patients with COVID-19.

Methods

This cross-sectional study was conducted among 384 HCWs, actively involved in caring of COVID-19 patients in Healthcare settings of North 24 Parganas Health District, West Bengal. Data were collected using a structured self-administered questionnaire (through Google Forms) and an observational checklist after selection criteria and having consent. The Questionnaire included four sections like the sociodemographic information, knowledge related to BMW management, observational questionnaire assessing the practice of HCWs on BMW management and rating scale related to attitudes towards BMW management.

Results

166 HCWs (43.2%) had an excellent knowledge with overall mean score 13.5 ± 3.6. A high mean score (14.4 ± 3.2) was obtained by doctors followed by nurses (13.6 ± 3.8). Regarding practice, the majority of HCWs (52.8%) followed the color-coding of BMW and 49.5% followed policies in separating the wastes according to hazard. Doctors (91%) and nurses (81%) had more favorable attitude than others. There was a statistically significant association found among knowledge level and educational qualification (P = 0.0001), gender (P = 0.001), and work experience (P = 0.05) and work area (P = 0.05).

Conclusion

Emphasis should be given to aware and train all HCWs regarding proper BMW management during this pandemic to prevent infection transmission.

Site selection and environmental risks assessment of medical solid waste landfill for the City of Kermanshah-Iran

In this study, an integration of multi-criteria evaluation, geographic information system, and remote sensing techniques were used for site selection of medical waste landfills in Kermanshah, Iran. Also, an environmental risk assessment for the selected site has been conducted in order to minimize the possible hazardous. The GIS and remote sensing were used for acquiring and preparing layers and maps and the multi-criteria evaluation was used for setting aim, criteria selection, criteria weighting, and final decision making. The results showed that only 1.2% of the study area is scored high-suitable, while 90% of the area is considered unsuitable that makes this region critical for preservation. After further assessment and field visits, a suitable site was selected for landfilling. Environmental risk assessment showed that the selected site poses a low-level of risks to the environment and surrounding areas and this is because various environmental and health aspects have been considered in the site selection process.

Vermiremediation and comparative exploration of physicochemical, growth parameters, nutrients and heavy metals content of biomedical waste ash via ecosystem engineers Eisenia fetida

Vermicomposting of Biomedical waste ash (BA) by the earthworm Eisenia fetida was studied with cow dung (CD) as nutrient medium. For 105 days, experiment was carried out in seven vermireactors containing varying ratios of BA and CD. Earthworm activity significantly reduced the pH (8.61-7.24), Electrical conductivity (EC) (4.1-1.62), Total organic carbon (TOC) (38.6-14.92), and Carbon and nitrogen (C/N ratios) (145.4-8.2) of all BA ratios. Levels of Total kjeldahl nitrogen (TKN) (0.26-1.82), Total available phosphorus (TAP) (0.22-0.64), Total potassium (TK) (2.05-12.08), and Total sodium (TNa) (47.53-92.26) were found to be increasing in the postvermicompost mixture. Although heavy metals content decreased from initial to final, it becomes below the permissible limits in the end product. The results showed that earthworm growth and fecundity were best in vermireactors containing 10-25% of BA. The best reproduction and growth of earthworms, demonstrate the vermicomposting's ability to manage hazardous solid wastes like BA. Use of vermitechnology to manage BA has not been performed yet in any kind of the research. Finally, it was determined that vermicomposting can be incorporated into overall plan for BA management. Thus nutrient-rich, detoxified, and physiochemically stable product may be used safely in agricultural processes.

Increase in SARS-CoV-2 infected biomedical waste among low middle-income countries: environmental sustainability and impact with health implications

Studies have shown that severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) is a highly infectious disease, with global deaths rising to about 360,438 as of 28 May 2020. Different countries have used various approaches such as lockdown, social distancing, maintenance of personal hygiene, and increased establishment of testing and isolation centers to manage the pandemic. Poor biomedical waste (BMW) management, treatment, and disposal techniques, especially SARS-CoV-2 infected BMW, may threaten the environmental and public health in most developing countries and, by extension, impact the economic status of individuals and the nation at large. This may increase the potential for the transmission of air/blood body fluid-borne pathogens, increase the growth of microorganisms, risk of mutagenesis, and upsurge of more virulent strain. In contrast, uncontrolled substandard burning could increase the potential spread of nosocomial infection and environmental exposure to toxic organic compounds, heavy metals, radioactive, and genotoxic bio-aerosols which might be present in the gaseous, liquid, and solid by-products. The paucity of understanding of pathophysiology and management of the SARS-CoV-2 pandemic has also necessitated the need to put in place appropriate disposal techniques to cater for the sudden increase in the global demand for personal protective equipment (PPE) and pharmaceutical drugs to manage the pandemic and to reduce the risk of preventable infection by the waste. Therefore, there is a need for adequate sensitization, awareness, and environmental monitoring of the impacts of improper handling of SARS-CoV-2 infected BMWs. Hence, this review aimed to address the issues relating to the improper management of increased SARS-CoV-2 infected BMW in low middle-income countries (LMICs).

Design of Automatic Isolated Medical Waste Bin Cover for Drying Waste

Background. The recent outbreak of COVID-19 has led to an increase in isolated medical waste, making the disposal of isolated medical waste a significant problem. There is the dedicated waste bin with four-sided locking-type at the top, causing contact during waste disposal. And it has infection possibility with high humidity. Purpose. In this article, we suggest automatic isolated medical waste bin cover for drying waste.

Assessment of Knowledge, Practice and Attitude about Biomedical Waste Management among Healthcare Professionals during COVID-19 Crises in Al-Ahsa

Biomedical waste (BMW) management is an essential practice of healthcare professionals (HCPs) for preventing health and also environmental hazards. Coronavirus disease (COVID-19) has become a global pandemic, posing significant challenges for healthcare sectors. A cross-sectional study was performed to assess the knowledge, practice, and attitude on BMW management among HCPs when taking care of patients with COVID-19 and associated with demographic variables. From Al-Ahsa healthcare sectors, 256 HCPs were selected randomly, of which 105 (41%) had excellent knowledge, 87 (34%) had good knowledge, and 64 (25%) had poor knowledge with a mean score of 13.1 ± 3.6. A higher mean score was (14.4 ± 3.2) obtained by physicians, and (13.6 ± 3.8) nurses than the other HCPs. Regarding practice, 72 (28.1%) HCPs used and discarded PPE while handling biomedical wastes. Additionally, 88 (34.4%) followed proper hand hygiene before and after each procedure and whenever needed. Physicians, nurses, and respiratory therapists had a more favorable attitude than other HCPs. There was a statistically significant association found among knowledge level and educational qualification (p < 0.0001), gender (p < 0.001), and work experience (p < 0.05). Emphasis is needed to train all HCPs regarding proper BMW management during this pandemic to prevent infection transmission.

Assessment of water and sanitation systems at Palestinian healthcare facilities: pre- and post-COVID-19

The availability of safe drinking water and the proper management of wastewater in healthcare facilities are important pillars for maintaining safety of workers, patients, and visitors and protecting human health and environment. Water and sanitation services at 495 healthcare facilities in the West Bank of Palestine are assessed using the results of PCBS and MoH (2014) survey study. Services are reassessed after the COVID-10 pandemic using personal interviews with experts from healthcare facilities, regulatory authorities, and service providers. The results show that 92.1% of healthcare facilities were connected to public water networks, 12.9% of them purchased water tanks, and 10.8% of them depended on harvested rainwater which may cause contamination and waterborne diseases. Regardless the source of freshwater, the water quality has to be regularly examined and compared to local guidelines and international standards for health promotion. Almost 63.4% of healthcare facilities were not connected to wastewater networks and used either tight or porous cesspits. Once these cesspits are filled off, wastewater is randomly disposed into nearby valleys causing adverse environmental impacts on air, water, and land resources. Medical wastewater of hazardous substances should be treated before discharged to wastewater networks. Experts assured that although heightened procedures have been made by service providers to curb the spread of the COVID-19 disease, yet, more consistent protocols and stringent procedures are crucial. There have not been any new directives or procedures regarding the management of water supplies and wastewater services in the healthcare facilities. Stakeholder collaboration can help prevent the COVID-19 disease.

Medical waste management at three hospitals in Jenin district, Palestine

Medical wastes are considered hazardous because they may possess infectious agents and can cause unsafe effects on the environment and human health. This study is to analyze and evaluate the current status of medical waste management at Jenin's district in light of medical waste control regulations recommended by the World Health Organization. The results demonstrated that the average hazardous healthcare waste generation rate ranges from 0.54 to 1.82 kg/bed/day with a weighted average of 0.78 kg/bed/day. There was no established waste segregation of healthcare waste types in all hospitals, and these wastes were finally disposed of in a centralized municipal sanitary landfill, namely Zahrat Al-Finjan. The results suggest that there is a need for activation and enforcement of medical waste laws. This can be achieved through cooperation among key actors: Ministry of Health, Environmental Quality Authority, Ministry of Local Government, and Non-Governmental Organizations working in related fields. Additional remediation measures proposed to tackle the problematic areas of medical waste management in Jenin's district hospitals are addressed. Some recommendations to minimize potential health and environmental risks of medical waste are also introduced.

Healthcare waste management in Asian developing countries: A mini review

Healthcare waste encompasses a significant quantity of hazardous substances. Poor healthcare waste management can result in serious environmental and human health risks. Asian developing countries are densely populated, and some are highly resource constrained. These countries commonly fail to practice appropriate healthcare waste management. Moreover, facilities in these countries extensively lack proper waste segregation, collection, safe storage, transportation, and disposal. This mini-review recapitulates key issues of healthcare waste management confronting Asian developing countries. Regulations, legislation, and policies are found to be recent, and their implementation varies from one another. Variation in waste generation rate is common. Contradictory methods of waste measurement used by researchers leave these variations questionable. The absence of waste management training programmes roots ignorance among staff and handlers, which leads to unsafe waste handling and causes different health risks. Unsafe and illegal recycling of hazardous waste is a threat to human health, also landfilling is often confused with open dumping, causing environmental damage. Outdated incineration plants need to be replaced with autoclaving, steam sterilisation, and comparatively reasonable new practice of pyrolysis to avoid the emission of toxic gases. The significance of proper healthcare waste management cannot be ignored, especially in Asian developing countries; substantial improvements are required in order to protect the environment and human health from serious risks.

LCA of Hospital Solid Waste Treatment Alternatives in a Developing Country: The Case of District Swat, Pakistan

Improper management of hospital waste leads to serious health and environmental issues, particularly in the case of developing countries, where, often, applied technologies are obsolete and there is a lack of compliance with respect to international best practices. The present study is designed to assess the environmental impacts of hospital waste management practices in Swath District, Pakistan. For this purpose, a life-cycle assessment (LCA) is applied for the estimation of different impacts of current and alternative hospital solid waste (HSW) treatment practices. Two scenarios are used to describe the current alternative practices (Scenario A and Scenario B), referring either to incineration or to direct landfilling of HSW without any sorting of collected materials. Conversely, Scenario C, which includes the use of pyrolysis and chemical disinfection, are considered as an up-to-date alternative, based on current international recommendations in this field. Prior to the analysis of impacts, due to the lack of available information, data were directly collected from both government and private hospitals in District Swat, involving measurements and a characterization of collected waste. In parallel, interviews were conducted, involving the hospitals’ personnel. With respect to waste generation, government hospitals produce a larger amount of waste (74%) compared to private hospitals (24%). Poor regulatory indications and the absence of clear obligations for collection, disposal and management still represent a first obstacle to implement good practices. After defining the boundary of the system and the functional unit, according to standardized LCA practices, a life--cycle impact assessment (LCIA) was conducted, considering eight impact categories: human toxicity, freshwater eco-toxicity, marine aquatic eco-toxicity, terrestrial eco-toxicity, acidification potential, climate change, eutrophication and photochemical oxidation. The current practices (Scenario A and Scenario B) turned out to be the worst for all categories. In particular, the largest impact of all is recorded for human toxicity generated by incineration. In parallel, it must be considered that, currently, no recycling or reusing practices are implemented. Conversely, Scenario C (alternative up-to-date practices) would generate lower impacts. In detail, the highest value was recorded for marine aquatic ecotoxicity in relation to pyrolysis. Applying Scenario C, it would be possible to recover some materials, such as plastics, paper and sharps. In detail, considering the observed compositional characteristics, it would be possible to recover up to 78% of sharps and recycle 41% of plastic and paper from the general waste stream. Moreover, energy could be recovered from the pyrolysis process, generating a further benefit for the surrounding area. A lack of awareness, knowledge and infrastructures prevents the application of correct management practices, further degrading life and environmental conditions of this remote region of Pakistan. The huge difference in impacts between current practices and alternatives is demonstrated, showing a clear alternative for future management plans in this remote region and supporting future actions for local policymakers and hospital managers.

Healthcare waste management current status and potential challenges in Ethiopia: a systematic review

Objective

During the healthcare delivery process, hazardous wastes can be generated from the health facilities. Improper healthcare waste management is responsible for the transmission of more than 30 dangerous bloodborne pathogens. The aim of this systematic review was to evaluate the healthcare waste management practice and potential challenges in Ethiopia.

Results

Electronic databases and direct Google search yielded 1742 articles from which 17 studies met the inclusion criteria. The proportion of hazardous waste generated in Ethiopian healthcare facilities was unacceptably high which ranged from 21 to 70%. Most studies indicated the absence of proper waste segregation practice at the source of generation. Treatment of the healthcare waste using low combustion incinerator and/or open burning and open disposal of the incinerator ash were very common. Lack of awareness from the healthcare staff, appropriate waste management utilities and enforcement from the regulatory bodies were mainly identified as a common factor shared by most of the studies. The healthcare waste management practice in Ethiopian healthcare facilities was unsatisfactory. There should be close supervision of the waste disposal process by the regulatory bodies or other stakeholders.

Medical waste generation and management in medical clinics in South of Iran

Medical wastes account for around 1–2% of urban wastes, which are very important in terms of health. In this regard, they are very important and can jeopardize human health. The aim of this study was to determine the qualitative and quantitative characteristics of the wastes in medical clinics in the south of Iran and in order to present suitable management solutions. First, 14 medical clinics were chosen and 24 samples were taken from each clinic (two samples per month) with a total 336 samples. Considering the special properties and the risk potential, the wastes generated in medical clinics were categorized as infections and special waste groups. In terms of properties, they were classified as pseudo-household, infectious, sharp, pharmaceutical, and paper wastes. Once the samples were collected, they were weighed and the results were analyzed by SPSS. The results indicated that in terms of quantity, the waste generated in the first and second groups was 8550.377 and 8053.71 kg/year, respectively. Furthermore, most of the wastes generated in the first and second groups accounted for pseudo-household (80.7%) and infectious (72.77%) wastes, respectively. Due to presence of the specialty of pathology laboratory in the second group, the quantity of infectious waste has increased. Therefore, for proper management of medical wastes in the studied clinics, the clinics of the studied study should implement and apply the rules of waste management properly. Furthermore, training physicians and employees in clinics about reducing, recycling, and collecting wastes in a separate form in clinics should be done in priority.

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In this study, the classification of Basel convention and World Health Organization was considered as the basis of waste classification.

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The results indicated that in the first group of the studied clinics, the order of the waste quantity was as follows: pseudo-household > infectious > sharp > paper.

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Due to large amounts of hazardous infectious wastes in the second group of the studied medical clinics, it necessitates proper management of collection and disposal of these wastes.

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Results can be used to improve the management of waste generation practices in medical clinics with high risk and special wastes potential.

Awareness of Biomedical Waste Management in Dental Students in Different Dental Colleges in Nepal

Aim

The aim of this study is to assess the awareness of biomedical waste management in dental students of various dental colleges of Nepal.

Methodology

A structured pretested questionnaire was used among 434 (323 males and 111 females) undergraduate dental students of five different dental colleges of Nepal. First part of the questionnaire was used to describe demographic profile of the participants. Second part of the questionnaire assessed the knowledge, attitude, and practice regarding biomedical waste management. Chi-square test was applied to find out the association between different responses obtained from different colleges.

Result

Majority (91.82%) of participants had a positive attitude towards safe management of biomedical waste. Regarding the knowledge of BMW management policies, majority of the students (83.1% to 98.9%) had positive attitude towards the safe management of biomedical waste, whereas more than 50% of the students were unaware of the guidelines laid down by Government of Nepal. Regarding biomedical waste disposal technique in the hospital, only 29.9% to 79.8% are aware; this shows that there is lack of strict protocol in the BMW management. Association between different responses and colleges for “improper waste management causes various health hazards” ranged from 93.3% to 98.9%.

Conclusion

There exists a lacuna in the knowledge and practice of biomedical waste management among the undergraduate dental students in Nepal. Since the students had positive attitude towards addressing this concern, workshops and trainings related to proper biomedical waste management would be a step forward towards attaining a healthy environment for the future.

Evaluate the types and amount of genotoxic waste in Tehran University of Medical Science's hospitals

PURPOSE

Genotoxic wastes are one type of hospital wastes that are extremely dangerous and may cause cell mutation or cancer and their disposal should be taken seriously. Cytotoxic drugs are main component of these wastes. The purpose of this study was to determine the types and quantities of genotoxic wastes in hospitals of Tehran University of Medical Sciences and evaluation of genotoxic waste management index.

METHODS

For this purpose, a questionnaire was used to collect data. Each question was scored according to compliance or non-compliance with the law, and genotoxic hospital waste management index was calculated for each hospital.

RESULTS

Various parameters including waste generation rate, segregation, collection, transportation, storage, disposal and the hygiene of personnel were evaluated. The results showed that 60% of hospitals ranked medium, 27% ranked poor and 13% ranked as very poor according to this index.

CONCLUSIONS

Since the condition of genotoxic waste management in this study was ranked as medium, therefore some steps of hospital waste management system require improvement.

Healthcare Waste Management: A Case Study from Sudan

Healthcare waste (HCW) represents a major public health issue, especially in developing countries. Among HCW categories, sharps waste is one of the most hazardous. Exposure to needle-stick injuries can lead to blood-borne pathogens, therefore HCW should be managed in an effective manner. The main aims of this study were to assess the current management of used needles and to suggest suitable recommendations for an improved and safer system for needle management in Khartoum, Sudan. The study showed that the management of both healthcare and home-generated HCW in Sudan is inefficient, as all wastes are mixed together and disposed of improperly, especially used needles. The study attributes this to many reasons, including lack of waste segregation at the source, lack of policies, failure of planning, inadequate training, lack of awareness of the hazardous nature of such kinds of waste, weak infrastructure, and a lack of suitable treatment technologies. The estimated average generated rate of HCW ranged from 0.38 to 0.87 kg/bed/day in 2009 and 2012, respectively. Such ineffective healthcare waste management HCWM, especially used needles, can put public health as well as the environment at risk, particularly waste workers, thus urgent action needs to be taken by all involved parties and at all levels.