Adverse health effects for populations living near waste incinerators with special attention to hazardous waste incinerators. A review of the scientific literature

Recognition of screening out hierarchical toxic contaminants tuned by quantified pseudo-components from complex engineering co-combustion

Co-combustion of industrial and municipal solid wastes has emerged as the most promising disposal technology, yet its effect on unknown contaminants generation remains rarely revealed due to waste complexity. Hence, six batches of large-scale engineering experiments were designed in an incinerator of 650 t/d, which overcame the inauthenticity and deviation of laboratory tests. 953-1772 non-targeted compounds were screened in fly ash. Targeting the impact of co-combustion, a pseudo-component matrix model was innovatively integrated to quantitatively extract nine components from complex wastes grouped into biomass and plastic. Thus, the influence was evaluated across eight dimensions, covering molecular characteristics and toxicity. The effect of co-combustion with biomass pseudo-components was insignificant. However, co-combustion with high ratios of plastic pseudo-components induced higher potential risks, significantly promoting the formation of unsaturated hydrocarbons, highly unsaturated compounds (DBE≥15), and cyclic compounds by 19 %- 49 %, 17 %- 31 %, and 7 %- 27 %, respectively. Especially, blending with high ratios of PET plastic pseudo-components produced more species of contaminants. Unique 2 Level I toxicants, bromomethyl benzene and benzofuran-2-carbaldehyde, as well as 4 Level II toxicants, were locked, receiving no concern in previous combustion. The results highlighted risks during high proportion plastics co-combustion, which can help pollution reduction by tuning source wastes to enable healthy co-combustion.

Regulatory compliance of PCDD/F emissions by a municipal solid waste incinerator. A case study in Sant Adrià de Besòs, Catalonia, Spain

Despite incineration is an important emission source of toxic pollutants, such as heavy metals and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), it is still one of the most widely used methods for the management of municipal solid waste. The current paper summarizes the results of a 20-year follow-up study of the emissions of PCDD/Fs by a municipal solid waste incinerator (MSWI) in Sant Adrià de Besòs (Catalonia, Spain). Samples of ambient air, soils and herbage were periodically collected near the facility and the content of PCDD/Fs was analyzed. In the last (2017) survey, mean levels in soil were 3.60 ng WHO-TEQ/kg (range: 0.40-10.6), being considerably higher than the mean concentrations of PCDD/Fs in soil samples collected near other MSWIs in Catalonia. Moreover, air PCDD/F concentrations were even higher than those found in a previous (2014) survey, as they increased from 0.026 to 0.044 pg WHO-TEQ/m3. Ultimately, the PCDD/F exposure would be associated to a cancer risk (2.5 × 10-6) for the population living in the surrounding area. Globally, this information indicates that the MSWI of Sant Adrià de Besòs could have had a negative impact on the environment and potentially on public health, being an example of a possible inappropriate management for years. The application of Best Available Techniques to minimize the emission of PCDD/Fs and other chemicals is critical.

Human and ecotoxicological risk assessment of heavy metals in polymer post treatment sludge from Barekese Drinking Water Treatment Plant, Kumasi

The disposal of polymer post-treatment sludge (PTS) from Barekese Water Treatment Plants (WTPs) as organic fertilizer and aquatic feed is a common practice in Ghana, necessitating a thorough evaluation of its ecological and human health risks. This study aims to assess the suitability of PTS samples for soil amendment and fish feed, scrutinizing potential hazards to consumer health and soil. PTS samples were collected from five distinct lateral sections of three clariflocculator tanks. Potentially toxic metals such as Cd, Zn, Pb, Cu, Ni, and Cr were determined using a flame atomic absorption spectrophotometer. The mean concentration of 7.82 ± 2.43, 0.31 ± 0.021, and 0.78 ± 0.042 mg/kg for Mn, Zn, and Pb respectively. The concentrations of Ni, Cr, and Cd were below their detection limits (BDL) in all PTS samples. Upon detailed exposure assessment, ingestion emerged as the primary exposure route for both adults and children, with non-cancer risks (NCR) determined to be below 1 for both age groups. Additionally, an exploration of potential cancer risks (CR) associated with heavy metal exposure in the PTS samples revealed values below the tolerable intake levels ranging from 10-4 to 10-6 for both adults and children (10-8 and 10-9, respectively). This study also employs various ecological indices, such as Nemerow's synthetic pollution index (PN), single factor pollution index (PI), geo-accumulation index (Igeo), contamination factor (CF), potential ecological risk index (PERI), pollution load index (PLI), polymetallic contaminant index (IPD), and ecological risk index (ERI). These indices consistently highlight a low contamination status and ecological sensitivity. Consequently, the study indicates that the presence of metals in the PTS samples does not pose a significant threat to the surrounding environment and human health. Furthermore, this research underscores the inadequacy of relying solely on regulatory limit values in assessing the health risks of waste materials. Such comprehensive assessments are crucial for safeguarding aquatic and human populations.

Dioxins emissions from bio-medical waste incineration: A systematic review on emission factors, inventories, trends and health risk studies

COVID-19 has aggravated the biomedical waste generation all over the world and the concern for its safe disposal is on the rise. The vast majority of healthcare systems employ incineration as their treatment method considering its agility to reduce the waste volume by up to 95-96% and high-temperature inactivation of infectious biological materials. However, incinerator emission is a significant contributor of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and dioxin-like polychlorinated biphenyls (dl-PCBs) according to various national inventories across the globe. Bio-Medical Waste Incinerators (BMWIs) are the dominant form of incinerator plants in developing nations and hence BMWI emissions were found to contribute lion's share of national dioxins inventories in most of these countries. The Stockholm Convention on POPs played a key role in imbibing significant urge on the dl-POPs monitoring studies of incinerators internationally and on controlling the average incinerator emission levels. Though many national/international agencies endorse a stringent incinerator stack emission standard of 0.1 ngTEQ/Nm3, there are some differences observed in nation-to-nation regulatory scenarios. This paper reviews and reports on the dioxins emission and health risk studies associated with bio-medical waste incineration over the last three decades (1990-2020) with a comprehensive spatial and temporal emission trend analysis. An overview of important national and international regulations, national inventories and emission factors for the biomedical waste incineration sector is also reviewed in detail. The study observes that continuous regulatory monitoring and logical relaxations can enhance the performance of the existing facilities ensuring low emissions and minimal risk.

Environmental and health impacts assessment of long-term naturally-weathered municipal solid waste incineration ashes deposited in soil-old burden in Bratislava city, Slovakia

Municipal solid waste incineration (MSWI) is an effective method for reducing the volume/mass of waste. However, MSWI ashes contain high concentrations of many substances, including trace metal (loid)s, that could be released into the environment and contaminate soils and groundwater. In this study, attention was focused on the site near the municipal solid waste incinerator where MSWI ashes are deposited on the surface without any control. Here, combined results (chemical and mineralogical analyses, leaching tests, speciation modelling, groundwater chemistry and human health risk assessment) are presented to assess the impact of MSWI ash on the surrounding environment. The mineralogy of ∼forty years old MSWI ash was diverse, and quartz, calcite, mullite, apatite, hematite, goethite, amorphous glasses and several Cu-bearing minerals (e.g. malachite, brochantite) were commonly detected. In general, the total concentrations of metal (loid)s in MSWI ashes were high, following the order: Zn (6731 mg/kg) > Ba (1969 mg/kg) ≈ Mn (1824 mg/kg) > Cu (1697 mg/kg) > Pb (1453 mg/kg) > Cr (247 mg/kg) > Ni (132 mg/kg) > Sb (59.4 mg/kg) > As (22.9 mg/kg) ≈ Cd (20.6 mg/kg). Cadmium, Cr, Cu, Pb, Sb and Zn exceeded the indication or even intervention criteria for industrial soils defined by the Slovak legislation. Batch leaching experiments with diluted citric and oxalic acids that simulate the leaching of chemical elements under rhizosphere conditions documented low dissolved fractions of metals (0.00-2.48%) in MSWI ash samples, showing their high geochemical stability. Non-carcinogenic and carcinogenic risks were below the threshold values of 1.0 and 1 × 10^-6, respectively, with soil ingestion being the most important exposure route for workers. The groundwater chemistry was unaffected by deposited MSWI ashes. This study may be useful in determining the environmental risks of trace metal (loid)s in weathered MSWI ashes that are loosely deposited on the soil surface.

Air Pollutant Emission Inventory of Waste-to-Energy Plants in China and Prediction by the Artificial Neural Network Approach

The waste-to-energy (WTE) plant has been deployed in 205 cities in China. However, it always faces public resistance to be built because of the great concerns on flue gas pollutants (FGPs). There are limited studies on the socioeconomic heterogeneity analysis and prediction models of WTE capacity/ FGP emission inventories (EIs) based on big data. In this study, the incinerator level emission factors (EFs) in 2020 of PM, SO₂, NO_x, CO, HCl, dioxins, Hg, Cd + Tl, and Sb + As+ Pb + Cr + Co + Cu + Mn + Ni were calculated based on 322,926 monitoring values of all the 481 WTE plants (1140 processing lines) operating in China, with uncertainties in the range of ±34.70%. The EFs were significantly 45-96% lower than the national standard (GB18485-2014) and had negative relationships with local socioeconomic elements, while WTE capacity and FGP EIs had significantly positive correlations. Gross domestic product, area of built district, and municipal solid waste generation were the main driving forces of WTE capacity. The WTE capacity increased by 150% from 2015 to 2020, while the total emission of PM, SO₂, CO, dioxins, Hg, and Sb + As + Pb + Cr + Co + Cu + Mn + Ni decreased by 42.46-88.24%. The artificial neural network models were established to predict WTE capacity and FGP EIs in the city level, with the mean square errors ranging from 0.003 to 0.19 within the model validation limits. This study provides data and model support for the formulation of appropriate WTE plans and a pollutant emission control scheme in different economic regions.

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.

Breastfed infants' exposure to polychlorinated biphenyls, polychlorinated dibenzo-p-dioxins and dibenzofurans, and per- and polyfluoroalkyl substances: A cross-sectional study of a municipal waste incinerator in China

A municipal waste incinerator (MWI) in Zhejiang, China, operating since 2008 was completely reconstructed from 2016 to 2019. In 2013, we conducted a cross-sectional study of breastfeeding mothers living near the MWI. We evaluated the concentrations of polychlorinated biphenyls (PCBs) and polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in the mothers' breast milk and their infants' estimated daily intake (EDI). To investigate the temporal variations of these pollutants, we conducted a cross-sectional study of 29 mothers in 2019. We assessed the levels of 18 PCB congeners, 17 PCDD/F congeners, and 21 per- and polyfluoroalkyl substance (PFAS) congeners in breast milk and estimated the EDI. The mean total concentrations of PCDD/Fs (ΣPCDD/Fs) and PCBs (ΣPCBs) were 81.2 and 4.90 ng/g lipid, respectively, while the toxic equivalent quantity (TEQ) levels of ΣPCDD/Fs and dioxin-like PCBs (ΣDL-PCBs) were 2.7 and 1.4 pg WHO-TEQ/g lipid, respectively. Compared to our 2013 measurements, the mass concentrations of ΣPCDD/Fs and ΣPCBs decreased by 13% and 35%, respectively (3.361 vs. 2.915 pg/g wet weight [ww] and 269.1 vs. 175.0 pg/g ww, respectively). The TEQ-ΣPCDD/F levels decreased by 67% (0.241 vs. 0.080 pg/g ww), but the TEQ-ΣDL-PCB levels increased by 11% (0.046 vs. 0.051 pg WHO-TEQ/g ww). The median concentration of PFASs was 0.250 ng/mL, ranging from 0.151 to 0.833 ng/mL. The infants' mean EDI of total PCDD/Fs and DL-PCBs was 17.7 pg TEQ/kg body weight [bw], representing a 20% decline compared to 2013. The average EDI levels of PFOS, PFOA, and PFNA were 5.8, 17.9, and 1.7 ng/kg bw, respectively. A comprehensive comparison of the results with studies from around the world showed that the potential health risks posed by legacy PCDD/F and PCB pollutants were not as grave for mothers and infants living near this MWI, but the emerging PFAS pollutants represented a new cause for concern. MAIN FINDINGS: The potential health risks posed by legacy PCDD/F and PCB pollutants were not particularly serious for mothers and infants living near the MWI, but the emerging PFAS pollutants raised new concerns.

The longitudinal biomonitoring of residents living near the waste incinerator of Turin: Polycyclic Aromatic Hydrocarbon metabolites after three years from the plant start-up

The waste-to-energy (WTE) incinerator plant located in the Turin area (Italy) started to recover energy from the combustion of municipal solid waste in 2013. A health surveillance program was implemented to evaluate the potential health effects on the population living near the plant. This program included a longitudinal biomonitoring to evaluate temporal changes of some environmental pollutants, including polycyclic aromatic hydrocarbons (PAHs), in residents living in areas near the Turin incinerator (exposed group, E) compared to those observed in subjects living far from the plant (not exposed group, NE). Ten monohydroxy-PAHs (OH-PAHs), consisting in the principal metabolites of naphthalene, fluorine, phenanthrene, and pyrene, were analyzed in urines collected from the E and NE subjects after one (T₁) and three years (T₂) of plant activity and compared with those determined in the same cohort established before the plant start-up (T₀). Spearman correlation analysis was undertaken to explore possible associations between OH-PAHs and personal characteristics, lifestyle variables, and dietary habits. A linear mixed model (LMM) approach was applied to determine temporal trends of OH-PAHs observed in the E and NE subjects and to evaluate possible differences in trend between the two groups. Temporal trends of OH-PAHs determined by LMM analysis demonstrated that, at all times, the E group had concentrations lower than those assessed in the NE group, all other conditions being equal. Moreover, no increase in OH-PAH concentrations was observed at T₁ and T₂ either in E or in NE group. Significant positive correlations were found between all OH-PAHs and smoking habits. Regarding variables associated to outdoor PAH exposure, residence near high traffic roads and daily time in traffic road was positively correlated with 1-hydroxynaphthalene and 1-hydroxypyrene, respectively. In conclusion, no impact of the WTE plant on exposure to PAHs was observed on the population living near the plant.

Cancer risk in the residents of a town near three industrial waste incinerators in Korea: a retrospective cohort study

BACKGROUND

Three industrial waste incinerators (IWIs) were built in 1999, 2001, and 2010, within a 3 km radius of a town with a population of around 5000 in Korea. This study evaluated whether residents near these three IWIs had increased cancer incidence than those from other areas in Korea using regional health data.

METHODS

Standardized incidence ratios (SIR) were calculated using the frequency of cancer cases in the National Cancer Registry of the exposed area (Buki-myeon), Chungcheongbuk-do (Chungbuk, state including Buki-myeon), and whole Korea from 1999 to 2017. A retrospective cohort was created using National Health Insurance System data from 2002 to 2018. The exposed group was defined as those having a residential history in the exposed area. The control group was defined as those having a residential history in nearby towns or counties in Chungbuk, excluding counties having living and cultural areas in other provinces and cities. Hazard ratio (HR) and 95% confidence intervals (CI) were estimated using the Cox proportional hazard model adjusted for age, level of health insurance fee, and smoking history.

RESULTS

In the ecological study using National Cancer Registry data, the risk of all cancers, all cancers excluding thyroid, esophageal, stomach, and lung cancers in the exposed area were 1.13 (95% CI 1.03-1.24), 1.15 (95% CI 1.04-1.26), 1.91 (95% CI 1.13-2.89), 1.39 (95% CI 1.14-1.66), and 1.29 (95% CI 1.03-1.57) times higher than in whole Korea among exposed males, respectively. In the retrospective cohort, 4300 males (26,821 person-years) and 3796 females (24,746 person-years) in exposed group, 150,964 males (1,212,010 person-years) and 134,535 females (1,104,025 person-years) in control group were analyzed. After adjusting for several confounding factors, the risks for gallbladder cancer among males and kidney cancer among females were 2.65 (95% CI 1.38-5.06) and 2.82 (95% CI 1.13-7.03) times higher in the exposed group versus the control group, respectively.

CONCLUSIONS

Cancer risk was higher in Koreans having residential history living near IWIs compared to the other areas. Further study warrants nationwide effects and longer follow-up of WIs for cancers in Korea.

Short-term effects on emergency room access or hospital admissions for cardio-respiratory diseases: methodology and results after three years of functioning of a waste-to-energy incinerator in Turin (Italy)

This study is part of the health surveillance system set up with the construction of a waste-to-energy (WTE) plant in Turin (Italy). Circulatory and respiratory diseases in emergency room (ER) accesses and first hospital admissions were considered. Main concerns of population living in the area near WTE were to know whether single and repeated peaks in emissions would correspond to adverse health effects. We tackle this issue using spatio-temporal analyses, comparing an exposed group (EXP) living near the WTE with a reference group (NOEXP). Age-standardized rates of ER accesses between EXP and NOEXP were temporally compared, testing whether there have been significantly different changes over time. We also examined the relationship between emission peaks and ER accesses in the following days. Finally, with time-series analysis, we investigated variations in ER accesses and pollutants before and after WTE start-up. No significant relationship has been found for the outcome considered.

Occupational Exposures and Lung Cancer Risk-An Analysis of the CARTaGENE Study

OBJECTIVE

To determine the associations between prevalent occupational agents and lung cancer risk.

METHODS

A case-cohort design (ncases= 147; nsub-cohort= 1,032) was nested within the CARTaGENE prospective cohort study. The Canadian Job Exposure Matrix was used to determine the probability of exposure to 27 agents in participants' longest-held jobs. Multivariable logistic regression with robust variance estimators was used to determine the associations between each agent and lung cancer risk while adjusting for established lung cancer risk factors.

RESULTS

Increased lung cancer risk was observed among those exposed to ashes, calcium sulfate, formaldehyde, cooking fumes, alkanes, aliphatic aldehydes, and cleaning agents. Lower lung cancer risk was found among participants exposed to carbon monoxide and polycyclic aromatic hydrocarbons from petroleum.

CONCLUSION

Our findings support the role of several occupational agents, for which we have limited knowledge, in contributing to lung cancer risk.

Polybrominated dibenzo-p-dioxins/furans (PBDD/Fs) in soil around municipal solid waste incinerator: A comparison with polychlorinated dibenzo-p-dioxins/furans (PCDD/Fs)

Polybrominated dibenzo-p-dioxins/furans (PBDD/Fs) and polychlorinated dibenzo-p-dioxins/furans (PCDD/Fs) share similar toxicities and thermal origins, e.g., municipal solid waste incinerator (MSWI). Recently, PBDD/Fs from MSWI attracted rising concern because their important precursors, i.e., brominated flame retardants (BFRs), were frequently found in various wastes for landfill or MSWI feedstock. So far, however, little is known about PBDD/Fs and their associated risks in the vicinal environments of MSWI. Here we analyzed PBDD/Fs and PCDD/Fs in 29 soil samples collected around a multiyear large-scale MSWI, and compared their spatial distributions, sources and risks. PBDD/Fs demonstrated comparable concentrations and toxic equivalent quantities (TEQs) to PCDD/Fs in these samples. Spatially, both the concentrations of PBDD/Fs and PCDD/Fs decreased outwards from the MSWI, and exhibited significant linear correlations with the distances from the MSWI in the southeast downwind soil, suggesting the influence of the MSWI on its vicinal soil environment. However, the existence of other dioxin sources concealed its influence beyond 6 km. PBDD/Fs in the soils were characterized by highly-brominated PBDFs, especially Octa-BDF, and their sources were diagnosed as the MSWI and diesel exhaust; PCDD/Fs, however, were dominated by highly-chlorinated PCDDs, particularly Octa-CDD, and were contributed individually or jointly by the MSWI, automobile exhaust and pentachlorophenol (PCP)/Na-PCP. The non-carcinogenic risks of dioxins in all the soil samples were acceptable, but their carcinogenic risks in 17% of the samples were unacceptable. These samples were all located close to the MSWI and highways, therefore, the land use of these two high-risk zones should be cautiously planed.

Mapping healthcare waste management research: Past evolution, current challenges, and future perspectives towards a circular economy transition

Improper healthcare waste (HCW) management poses significant risks to the environment, human health, and socio-economic sustainability due to the infectious and hazardous nature of HCW. This research aims at rendering a comprehensive landscape of the body of research on HCW management by (i) mapping the scientific development of HCW research, (ii) identifying the prominent HCW research themes and trends, and (iii) providing a research agenda for HCW management towards a circular economy (CE) transition and sustainable environment. The analysis revealed four dominant HCW research themes: (1) HCW minimization, sustainable management, and policy-making; (2) HCW incineration and its associated environmental impacts; (3) hazardous HCW management practices; and (4) HCW handling and occupational safety and training. The results showed that the healthcare industry, despite its potential to contribute to the CE transition, has been overlooked in the CE discourse due to the single-use mindset of the healthcare industry in the wake of the infectious, toxic, and hazardous nature of HCW streams. The findings shed light on the HCW management domain by uncovering the current status of HCW research, highlighting the existing gaps and challenges, and providing potential avenues for further research towards a CE transition in the healthcare industry and HCW management.

Heavy metal pollution in the soil around municipal solid waste incinerators and its health risks in China

OBJECTIVE

In China, municipal solid waste (MSW) incineration (MSWI) has been increasing in recent years. However, little is known about how the operation of incinerators can affect levels of heavy metals (HMs) in nearby soils or about the possible associated health risks. It is necessary to understand the degree of enrichment of HMs and health risks to people living nearby.

METHODS

Previous studies (2002-2021) regarding soil HMs near MSW incinerators were collected, and a cluster and factor analysis was used to evaluate the accumulation trends and distribution characteritics of HMs. The soil contamination degrees and the consequent health risks were then assessed.

RESULTS

Cd (0.24 ± 0.16 mg kg-1) is typically accumulated in the topsoil near incinerators, and this is followed by Hg (0.13 ± 0.09 mg kg-1). Most of the health risk due to the total HMs is derived from dermal contact. Dermal contact with Cd and As contributes to more than 67% of the non-carcinogenic risk, while dermal contact with As contributes to more than 99% of the carcinogenic risk (CR). Furthermore, 81.43% of adult males and 76.85% of adult females suffer from CR levels greater than 10-4 due to dermal exposure to As.

CONCLUSIONS

Soils near incinerators indicated light pollution and moderate potential ecological risk, especially with regard to Cd and Hg contamination. Undeniably, there was no significant difference between the health risks from soil HMs near incinerators and from arable land at the national level. It is suggested to reduce the input quantity of HMs by taking advantage of the nationwide implementation of MSW classification and upgrading air pollution control devices for further HM emission reductions.

Healthcare waste management in the Tamale Central Hospital, northern Ghana. An assessment before the emergence of the COVID-19 pandemic in Ghana

Healthcare waste (HCW) poses several environmental and public health challenges. However, much attention has not been given to its management. The present study sought to assess the healthcare waste management (HCWM) practices in the Tamale Central Hospital (TCH) by characterizing and measuring the quantities of waste generated and the associated implications. Observation of the value chain of healthcare waste management, waste quantification using a weighing scale (Top-pan-spring balance), and semi-structured interviews were used in the data collection. The study revealed that, except for sharps, there was no segregation of infectious and non-infectious waste, and healthcare waste was not treated before final disposal. The study showed that a daily record of 5.1 kg of sharps, 24.46 kg of infectious waste and 59.45 kg of general waste was generated. The maternity ward produced more general waste (14 kg), whereas the theatre generated the highest infectious waste (5.70 kg) and sharps (0.8 kg) daily. Generally, the maternity ward recorded the highest daily waste generation of 17.9 kg. The waste treatment method available in the hospital was incineration. However, the incinerator was found to be dysfunctional. Thus, an improvised method (dug pit) was used irrespective of the associated health and environmental implications. The study also revealed that the hospital did not quantify the amount of solid waste that was generated. Inadequate finance and lack of supervision were linked to the problem of poor healthcare waste management in the study area. Also, 82% of the workers mentioned that there was poor HCW segregation at the departments whereas 76% of the patients who received healthcare at the facility were unsatisfied with the HCWM practices. A strong linear relationship in the responses made was recorded. The healthcare waste management index showed that the HCWM practice at the facility was unsatisfactory as it was medium-ranked. The study, therefore, recommends that the hospital considers constructing an on-site waste treatment facility, segregate and quantify waste for effective allocation of resources for treating healthcare waste.

Fate of dioxins in a municipal solid waste incinerator with state-of-the-art air pollution control devices in China

The variation of municipal solid waste (MSW) components and the improvement of incinerators have an obvious effect on dioxin emissions. However, there is a knowledge gap on dioxin distribution characteristics following China's implementation of MSW classification. To reveal the fate of dioxins under ultra-low emission standards in leading cities in China, a systematic investigation was carried out in a typical modern MSW incinerator in Shenzhen, China. The dioxin mass balance was built using improved models, which included expanded samples, e.g., the leachate, the raw gas and raw ash from boiler, and the chemicals and residuals from air pollution control devices (APCDs). The results indicated a positive dioxin balance of 0.88 μg I-TEQ/t MSW according to the conventional method containing fly ash, bottom ash, and stack gas. In the new model revealing dioxin characteristics after APCDs, a higher value of 0.89 μg I-TEQ/t MSW was found due to the leachate, slaked lime, and activated carbon-containing dioxins. The distribution of dioxins in output samples of fly ash, bottom ash, stack gas, and leachate were 149.0 %, 41.8 %, 1.6 %, and 0.6 % of MSW, respectively. For incineration itself, the balance was 0.85 μg I-TEQ/t MSW, which indicated the possible release owing to the "memory effect" for the other two methods. This study provided new insight for the accurate estimation of dioxin emissions and a typical case report of MSW incineration with ultra-low dioxin emissions.

Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in food and human dietary intake: An update of the scientific literature

It is well established that for non-occupationally exposed populations, dietary intake is, by far, the main way of human exposure to polychlorinated dibenzo-p-dioxins and polychlorinated dibenzo-p-furans (PCDD/Fs), a family of environmental POPs with a well-known potential toxicity -including carcinogenicity-in humans. We here summarize the results of recent studies (2010-2021) (databases: Scopus and PubMed), focused on determining the levels of PCDD/Fs in food samples of different origins, as well as the dietary intake of these pollutants. We have revised studies conducted in various Asian, American and European countries. However, information is rather limited, with no recent data for most countries over the world. Due to the enormous differences in the methodologies of the studies, to conduct a detailed comparison of the results for the different regions and countries has not been possible. Notwithstanding, where data over time are available, important reductions have been observed. These reductions have been linked to the decreases in the environmental emissions of PCDD/Fs noted in recent years. Interestingly, reductions in the levels of PCDD/Fs in biological tissues are also occurring in parallel. In general, the tolerable daily/weekly/monthly dietary intakes of PCDD/Fs are not being currently exceeded where data are available.

Decreasing temporal trends of polychlorinated dibenzo-p-dioxins and dibenzofurans in adipose tissue from residents near a hazardous waste incinerator

Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) are very toxic chemicals which are emitted in waste incineration and whose exposure has important adverse effects for the human health. In 2019, adipose tissue samples were collected from 15 individuals with a median age of 61 years, who had been living near a hazardous waste incinerator in Constantí (Spain). The content of PCDD/Fs in each sample was analyzed. The results were compared with data from previous studies, conducted before (1998) and after (2002, 2007 and 2013) the facility started to operate, and based on populations of similar age. In 2019, the mean concentration of PCDD/Fs in adipose tissue was 6.63 pg WHO-TEQ/g fat, ranging from 0.95 to 12.95 pg WHO-TEQ/g fat. A significant reduction was observed with respect to the baseline study (1998), when a mean PCDD/Fs concentration of 40.1 pg WHO-TEQ/g fat was found. Moreover, the current level was much lower than those observed in the 3 previous studies (9.89, 14.6 and 11.5 pg WHO-TEQ/g fat in 2002, 2007 and 2013, respectively). The body burdens of PCDD/Fs were strongly correlated with age. The significant reduction of PCDD/Fs levels in adipose tissue fully agreed with the decreasing trend of the dietary intake of PCDD/Fs by the population of the zone (from 210.1 pg I-TEQ/day in 2018 to 8.54 pg WHO-TEQ/day in 2018). Furthermore, a similar decrease has been also observed in other biological, such as breast milk and plasma. The current data in adipose tissue, as well as those in other biological monitors, indicate that the population living near the HWI is not particularly exposed to high levels of PCDD/Fs. However, biomonitoring studies cannot differentiate the impact of the HWI emissions from food consumption patterns. This question can be only solved by conducting complementary investigations and contrasting the results of monitoring and epidemiological studies.

The concentration of BTEX compounds and health risk assessment in municipal solid waste facilities and urban areas

In this study, human exposure to benzene, toluene, ethylbenzene, xylenes (BTEX), along with their respective risk assessment is studied in four major units (n = 14-point sources) of the largest municipal solid waste management facilities (MSWF) in Iran. The results were compared with four urban sites in Tehran, capital of Iran. Workers at the pre-processing unit are exposed to the highest total BTEX (151 μg m^-3). In specific, they were exposed to benzene concentrations of 11 μg m^-3. Moreover, the total BTEX (t-BTEX) concentrations measured over the conveyor belt was 198 μg m^-3 at most, followed by trommel (104), and active landfills (43). The mean concentration of ambient t-BTEX in Tehran is 100 μg m^-3. On average, xylenes and toluene have the highest concentrations in both on-site and urban environments, with mean values of 24 and 21, and 41 and 37 μg m^-3, respectively. Even though the non-carcinogenic risk of occupational exposure is negligible, BTEX is likely to increase the chance of carcinogenic risks (1.7E-05) for workers at the pre-processing unit. A definite carcinogenic risk of 1.3E-04, and non-carcinogenic effect, of HI = 1.6 were observed in one urban site. With the exception of the pre-processing unit, the citizens of Tehran had higher exposure to BTEX. Overall, BTEX concentrations in the largest MSWF of Iran remains an issue of public health concern.

Assessment of COVID-19 Waste Flows During the Emergency State in Romania and Related Public Health and Environmental Concerns

This paper provides a rapid assessment method of potentially infectious waste flow related to the coronavirus disease (COVID-19) pandemic in Romania focusing on the emergency state (from 16 March to 14 May 2020) where a national lockdown was in force with restrictive and social distancing measures concerning population mobility and economic activities. Medical and municipal waste management systems are critical services in combating the virus spread in the community. This assessment is useful due to poor available data of medical waste flow in environmental reports and it covers COVID-19 patients, quarantined, and self-isolated persons as the main potential infectious waste sources. The proposed model estimates that COVID-19 related waste flow is 4312 t at the national level from 25 February to 15 June of which 2633 t in the emergency state period. This assessment is correlated with deficiencies of medical and municipal waste management systems in Romania before the COVID-19 pandemic as stress factors of public health and environment. This study points out the main challenges of waste operators and reveals some best practices during this pandemic crisis. Based on the results and discussion section, several recommendations are proposed to COVID-19 waste-related issues and points out the crucial role of the reliable medical and municipal waste database in managing such biologic hazards at national and EU levels. Monitoring of COVID-19 waste flow through such models are important for decision-makers, particularly in low and middle-income countries which are facing waste management deficiencies and gaps in waste statistics, to reduce other contamination risks or related environmental threats.