Evaluating the link between the management of clinical waste in the National Health Service (NHS) and the risk of the spread of infections: A case study of three hospitals in England

Do closed waste containers lead to less air contamination than opened? A clinical case study at Jena University Hospital, Germany

Nosocomial infections are a growing challenge at hospitals. This clinical study aimed to investigate the influence of waste container construction ((open (O), closed (C), and hands-free opening (HF)) on microbial air contamination in a hospital setting. The results are intended to help develop guidelines for waste containers for the collection of non-infectious waste at hospitals and medical facilities. The clinical experiment was conducted at the University Hospital Jena, Germany. Air Impactor samples were performed and microbiologically evaluated for bacteria and fungi both quantitatively and qualitatively. The results were statistically determined using generalized estimating equations. Quantitatively, the lowest bacterial counts in ambient air were found around closed waste containers (114.74 CFU/m³) in comparison to HF (129.28 CFU/m³) and O (126.28 CFU/m³). For fungi, the surrounding air of C (2.08 CFU/m³) and HF (1.97 CFU/m³) waste containers showed a lower impact of fungal air contamination than for O (2.32 CFU/m³). Overall, it was shown that C are more preferable to HF and O waste containers from the point of view of microbial air contamination at hospitals.

An Evaluation of Staff Engagement with Infectious Healthcare Waste Management Policies: A Case Study of Tunisia

This study evaluated the engagement of staff regarding infectious healthcare waste management, in two case-study universities in Tunisia. Using a questionnaire survey, it was found that the most significant reported factors that influenced engagement were the availability of technical sheets and posters, training and education programs, and the age range of the staff. While there was some accordance with the Tunisian Decree application n° 2008–2745 of July 28th, 2008, as well as international guidelines and best practice (e.g. the use of color coded bins, waste management teams, and infection control measures), there were also limitations in the provision of training. This limitation in training and, to a lesser extent, awareness impacted on the beliefs about infectious healthcare waste management of staff and their practices. Recommendations for addressing these issues are suggested.

International governance structures for health-care waste management: a systematic review of scientific literature

Significant differences exist in the management of health-care waste management, globally. This is particularly so between low, middle and high-income countries. A systematic review of scientific literature on global healthcare waste management spanning the period 2000 - current was undertaken, in order to identify key policies, practices, challenges and best practice. The findings were analysed considering the Gross National Income and the Human Development Index of each country. Effective regulation and operative definitions of waste categories are key-factors requiring improvement at the national level. The economic conditions in the country are an important factor, especially regarding treatment and disposal. Areas for improvement (e.g. the need for improved governance structures, the development of regional clusters, as well as sharps waste segregation) are suggested.

Understanding the perceptions, roles and interactions of stakeholder networks managing health-care waste: A case study of the Gaza Strip

The sustainable management of waste requires a holistic approach involving a range of stakeholders. What can often be difficult is to understand the manner in which different types of stakeholder networks are composed and work, and how best to enhance their effectiveness. Using social network analysis and stakeholder analysis of healthcare waste management stakeholders in the case study region of the Gaza Strip, this study aimed to understand and examine the manner in which the networks functioned. The Ministry of Health was found to be the most important stakeholder, followed by municipalities and solid waste management councils. Some international agencies were also mentioned, with specific roles, while other local institutions had a limited influence. Finally while health-care facilities had a strong interest in waste management, they were generally poorly informed and had limited links to each other. The manner in which the networks operated was complicated and influenced by differences in perception, sharing of information, access to finance and levels of awareness. The lack of a clear legal framework generated various mistakes about roles and responsibilities in the system, and evidently regulation was not an effective driver for improvement. Finally stakeholders had different priorities according to the waste management issues they were involved with, however segregation at the source was identified as a key requirement by most. Areas for improving the effectiveness of the networks are suggested. The analysis utilized an innovative methodology, which involved a large number of stakeholders. Such an approach served to raise interest and awareness at different levels (public authorities, health providers, supporting actors, others), stimulate the discussion about the adoption of specific policies, and identify the effective way forward.