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

Medical waste generation rate and management practices among government hospitals in Eastern Ethiopia. A descriptive survey

Introduction

Healthcare facilities generate medical waste, also known as healthcare waste or health facility waste, during the healthcare delivery process, which is improperly managed as a result of underfunded healthcare systems, poor training, and lack of awareness of policies and legislation on handling medical waste as well as do not have national guidelines in place to adhere to the correct disposal of such wastage in developing countries like Ethiopia.

Objectives

To estimate the healthcare waste generation rate among selected public hospitals in eastern Ethiopia.

Methods

A cross-sectional study design was conducted in eight public in eastern Ethiopia from 1st June 2023 to 30th July 2023. The "Bed-Patient-healthcare wastes" model was used to estimate the healthcare waste generation rate based on WHO and empirical evidence. HCW generation rate = No of (Inpatients (Inpts) + Outpatients (Outpts))/day*0.53 kg/day. Meanwhile, general (GW), infectious (IW), pharmaceutical (PW), sharps (SW), and pathological (PtW) are computed as follows: GW = No. of (Inpt + Oupt)/day*0.53 kg/day and IW, PW, SW, and PtW = No. of Inpts/day*0.53 kg/day. In contrast, for hazardous and non-hazardous healthcare wastes, No of HCWs/day*0.8 and no. of HCWs/day*0.2 were utilized, and Key informant interviews and field observational were also applied. Descriptive analysis such as percentage, mean, and standard deviation were presented.

Result

According to the current assessment, 105.1-142.8 kg/day healthcare waste was generated from outpatient and 167.3-244.2 kg/day from inpatients of public hospitals. From these, the Mean ± SD of daily healthcare waste generation rate estimated by non-hazardous and hazardous waste were 164.6 ± 80.9 kg/patients/day and 41.2 ± 20.2 kg/patients/day, respectively. In daily generation, the mean and standard deviations (Mean ± SD) of general wastes, infections waste, pharmaceutical wastes, sharp wastes, and pathological waste/patient were 62% (521.9), 23% (194.8), 4% (35.4), 2% (17.7), and 9% (70.9), respectively.

Conclusion

The current assessment concluded that a large volume of healthcare waste is generated from selected public hospitals, which were not effectively segregated, separated at the source, and haven't conventional or standard treatment. As a result, the study advised that regional and global collaboration in hospital waste and wastewater management be encouraged.

Healthcare waste management practice and associated factors among healthcare workers in public healthcare facilities of Southwest Shewa Zone, Oromia regional state, Ethiopia

Poor management of waste can cause serious disease to healthcare personnel, cleaners, waste handlers, patients and the public. An observation-supported cross-sectional study was conducted to assess healthcare waste (HCW) management practice and professional, management and resource availability-associated factors among healthcare workers of 23 public health facilities in Southwest Shewa Zone, Oromia regional state, Ethiopia, 2021. A total of 424 health workers participated in this study. The level of proper healthcare waste management (HCWM) practice was 38.4%. Lack of knowledge on different methods of healthcare waste treatment (adjusted odds ratio (AOR): 0.101, 95% confidence interval (CI) (0.042, 0.242, p < 0.05)), lack of knowledge about the types of healthcare waste (AOR: 0.136, 95% CI (0.039, 0.481, p < 0.05)), lack of knowledge on the use of different colour-coded waste bin and safety box (AOR: 0.145, 95% CI (0.040, 0.520, p < 0.05)), and healthcare workers who had no training/orientation on HCWM practice (AOR: 0.396, 95% CI (0.245, 0.639, p < 0.05)) were less likely to practice effective HCWM compared to their counterparts. The current HCWM practices in studied health facilities was inadequate. Professional knowledge and availability of training were independently associated with HCWM practice. Therefore, regular orientation during employment and on-job training on HCWM practice, regular monitoring and supervision of HCWM are important. Further research should be conducted on the area of HCWM, and its associated environmental impacts by using more strong methods and wider health facilities.

Management of healthcare waste collection and segregation for developing countries

Healthcare waste (HCW) consists of hazardous material that may be radioactive, toxic or infectious. Inappropriate treatment and disposal of HCW may pose health risks to humans indirectly through the release of pathogens and toxic pollutants into the environment. The biggest problem in HCW management is its handling, which causes anxiety over sorting and categorizing the waste. Hence, the current study identifies and addresses the challenges towards sustainable environmental development by managing infectious HCW in developing countries. Fuzzy Delphi method is used in the present study to carefully examine the barrier drawn from the literature and experts' opinions. The number of barriers taken into consideration for study are 30, which are then grouped into four main categories, that is, social, environmental, technological and economic barriers. Additionally, a hybrid strategy based on the fuzzy decision-making trial and evaluation laboratory is developed in this work to examine the significance and interrelationships of the identified barrier. The research outcome is a hierarchy and classification model based on the relative importance of the barriers. The results of this study indicate that: 'Lack of segregation', 'Inconsistency in waste collection', 'Unregulated disposal site' and 'Inadequate programme for training and awareness' require quick action. The conclusions obtained through the study would facilitate the preparation of check sheets for documenting HCW management procedures by the healthcare administration and Pollution Control Boards. Understanding the priority cause-group barrier would improve the long-term protection of the hospital environment from the spread of infection caused by the HCW.

Comparison of medical waste management methods in different countries: a systematic review

Medical waste status is a severe public health problem worldwide. Proper medical waste management is of paramount importance. However, there is insufficient information about medical waste management and lack of management in different countries. The aim of this research was to investigate and evaluate the present status of medical waste management in different countries. We systematically searched Embase, PubMed/MEDLINE, Scopus, PubMed Central, Google Scholar databases, as well as medRxiv using the following keywords: medical waste, waste management, disposal, healthcare per-capita generation, gross domestic product (GDP), and hospital. A total of 38 eligible articles were identified. Correlations were calculated between the amount of medical waste generated (kg bed.day^-1) vs. GDP per capita ($) and ranking of healthcare system performance. A negative correlation was found between medical waste generation rate and ranking of healthcare system performance. According to the findings of this study, the medical waste generation rate in different countries ranged from 0.14 to 6.10 kg bed.day^-1. About 25% of countries segregated medical waste, and about 17% used standard storage for all medical waste. Shortcomings were also found in waste collection, storage, transportation and transfer, and disposal of medical waste management activities in different countries. Only about 25% of countries simultaneously used three techniques, such as autoclaving, incineration, and landfill for disposal and treatment of medical waste, and 91% used incineration method. This study highlights an essential need for particular medical waste management guidelines and regulations, technologies, knowledge and financing to upgrade medical waste management worldwide. This study can be considered to be a good guide for further research on medical waste management in developing and developed countries.

Multi-criteria evaluation of medical waste management process under intuitionistic fuzzy environment: A case study on hospitals in Turkey

Waste management has come to the fore in the whole world with the increasing impact of the Covid-19 pandemic along with concerns about human health, environmental threats, and socio-economic factors, etc. Medical waste is one of the waste types that need special management processes including particularly collection, storage, separation, and disposal. Healthcare activities create a great amount of medical waste deriving from the hospitals. This study aims to determine the hospital that carries out medical waste management in the most effective way in Erzurum, Turkey. To handle intense uncertainty in the evaluation process, the case is analyzed by Intuitionistic Fuzzy Multi-Criteria Decision-Making (IFMCDM) methods. The present study contributes to the literature by focusing on a real case problem under IF environment in a Group Decision-Making (GDM) framework. Additionally, based on the literature review and expert judgments, the evaluation criteria relevant to the case are defined in this paper. To this end, a four-phased integrated methodology that involves Intuitionistic Fuzzy Weighted Averaging (IFWA), IF Analytical Hierarchy Process (IFAHP), IF Technique for Order Preference by Similarity to Ideal Solution (IFTOPSIS) and One-Dimensional Sensitivity Analysis, is conducted. Firstly, IFWA is aimed to express the significance levels of decision makers (DMs) based on their knowledge, qualifications and experiences. Secondly, IFAHP is used to calculate the importance weights of the decision criteria and IFTOPSIS is preferred to rank the available hospitals. Then, sensitivity analysis is employed to display robustness. According to the results, the most important criteria are Qualified personnel, Health institution infrastructure, and Control of waste, respectively and the most efficient hospital is determined.

Biomedical waste management associated with infectious diseases among health care professionals in apex hospitals of a typical south asian city

Biomedical waste from healthcare activities poses a higher hazard of infection and damage than other types of trash. The main objective of the study was to assess the awareness knowledge and practices of biomedical waste management (BMWM) among health care professionals in the health care units. The cross-sectional study was carried out to access the awareness, knowledge and practices of health care professionals for BMWM. Using a qualitative approach, the study was escorted in two Apex hospitals i.e. the Allied Hospital and the District Head Quarter Hospital, Faisalabad, Pakistan from August 5, 2019 to October 15, 2019. More than 90% of respondents knew the phrase BMWM, but just 35.4% had awareness about biomedical waste regulations. About 71.6% of the respondents were familiar with biomedical waste's color-coding segregation. The study concludes gap in the awareness, knowledge and practices for BMWM. The sanitary workers of the hospitals had no knowledge about BMWM and the BMWM/healthcare waste management rule 2005 established in Pakistan due to the lack of training regarding waste management and the segregation process. Some of the staff members were aware of the BMWM practices under the rules and regulations of Pakistan but were unable to implement at their work place. It is necessary to dispose of the biomedical waste according to the established terms and conditions of BMWM rules (2005) of Pakistan. Weak structure of BMWM was observed at the study sites due to the lack of training, liabilities and absence of penalties against improper biomedical waste disposal as violation of the rules and regulations. It's a dire need of the time to consider the biomedical waste as hazardous waste and make policies for its safe disposal and ensure the implementation of the policies in all the medical centers of Pakistan.

Analysis of healthcare waste management in hospitals of Belo Horizonte, Brazil

Healthcare waste (HCW) management is a challenge for establishments that generate this type of waste, especially hospitals, as they are one of the largest generators. A determining factor in waste management is the amount of waste generation, which must be used for management planning. This study aims to compile and evaluate information on the management of HCW generated in Belo Horizonte's (located in Brazil) hospitals declared in their respective Healthcare Waste Management Plans (HCWMP) sent for approval by the municipality's Superintendency of Urban Cleaning. Therefore, a comparative analysis of the hospitals' generations in relation to their characteristics (nature, specialty, and size) was carried out, using the Kruskal-Wallis statistical test with post hoc in Nemenyi. For the study hospitals, a generation rate of 7.18 (6.17-8.23) kg·bed^-1·day^-1 was estimated, a generation rate close to that of developed countries. When comparing the generation according to the specialty of the hospitals, it was identified that the maternity hospitals (9.00 (7.05-10.90)) kg·bed^-1·day^-1 had a significantly higher generation rate than the low-complexity hospitals (4.75 (3.28-6.18)) kg·bed^-1·day^-1. It was also possible to demonstrate that the specialty and size of hospitals influence the structure available for waste storage. Finally, it can be observed that there are few treatment alternatives, with incineration and autoclaving being the technologies most commonly used by hospitals. It is expected that the results presented can serve as a reference for waste managers, in a context where there is little shared information on the subject.

Comparing Environmental Policies to Reduce Pharmaceutical Pollution and Address Disparities

Pharmaceutical products, including active pharmaceutical ingredients and inactive ingredients such as packaging materials, have raised significant concerns due to their persistent input and potential threats to human and environmental health. Discourse on reducing pharmaceutical waste and subsequent pollution is often limited, as information about the toxicity of pharmaceuticals in humans is yet to be fully established. Nevertheless, there is growing awareness about ecotoxicity, and efforts to curb pharmaceutical pollution in the European Union (EU), United States (US), and Canada have emerged along with waste disposal and treatment procedures, as well as growing concerns about impacts on human and animal health, such as through antimicrobial resistance. Yet, the outcomes of such endeavors are often disparate and involve multiple agencies, organizations, and departments with little evidence of cooperation, collaboration, or oversight. Environmental health disparities occur when communities exposed to a combination of poor environmental quality and social inequities experience more sickness and disease than wealthier, less polluted communities. In this paper, we discuss pharmaceutical environmental pollution in the context of health disparities and examine policies across the US, EU, and Canada in minimizing environmental pollution.

Medical Waste Management: An Assessment of District-Level Public Health Facilities in Bangladesh

Background Due to the huge patient load and different types of services, public health facilities produce a bulk of medical waste (MW) in Bangladesh. Improper disposal of MW increases the risk of infection among healthcare service personnel, patients, and attendants. To ensure quality services, this study aimed to assess the practices of MW management and quantify those to find out the shortcomings in the specific steps of waste management. Methodology As part of a larger interventional study, a facility assessment was conducted from February to April 2016 at a District Hospital (DH) and a Mother and Child Welfare Centre (MCWC) in one district. Non-participatory observation of MW management was done using a checklist that was developed following the Guideline for Medical Waste Management of Bangladesh. Scoring was applied for various activities of MW management performed in the study facilities. Results The overall scores for bin management, segregation, and collection of waste were 64.5%, 58.1%, and 62.0% in DH and 53.1%, 41.5%, and 48.0% in MCWC, respectively. The performance of operation theater in MCWC was the lowest among different corners (16.7% to 36.0%). Reusable waste was segregated poorly (32% in DH and 0% in MCWC), and almost none was shredded (4% in DH and 0% in MCWC). Waste was transported from in-house to out-house temporary storage area in an open bin without any trolley or specific route. The storage area was accessible to unauthorized persons, for example, a waste picker in DH. While DH segregated 84% of its infectious waste at the source, it eventually got mixed up with other waste in the storage area and delivered to the municipality to be dumped. MCWC could segregate only 40% of its infectious waste at the source and disposed of them using the pit method. Both the facilities disposed of sharp MW by open-air burning and liquid waste through sewerage without any treatment. Conclusions The performance of MW management was poor in both study facilities. Advocacy to the healthcare personnel and refresher training along with supportive supervision and monitoring may improve the situation. Moreover, a larger study is needed to find out the reasons behind such poor MW management.

A robust fuzzy multi-objective programming model to design a sustainable hospital waste management network considering resiliency and uncertainty: A case study

With the increase in the number of patients and activity of hospitals, the issue of hospital waste management (HWM) is becoming more and more challenging and worrying. In addition to financial losses, there will be irreparable damage to the ecosystem and environment which will create many problems for people (because the job of some people in the area is livestock and agriculture and they have a lot to do with their surroundings). It also doubles the need to pay attention to the issue of sustainable development (simultaneous attention to social, economic and environmental dimensions) in waste management. Moreover, the climatic and geographical conditions and lack of proper waste management in this area lead to major problems. Therefore, in this research, by developing a novel multi-objective mixed integer linear programming model, HWM is addressed in the hospitals of Sari, Iran. The aim is to design an HWM network considering sustainability, resiliency and uncertainty. In order to deal with uncertainty, a robust fuzzy programming approach is employed, and then an improved goal programming technique and Lp-metric method is proposed to solve the model. It was revealed that goal programming outperforms the Lp-metric method in terms of all objectives. Furthermore, the obtained results demonstrate the applicability and efficiency of the proposed methodology to design an efficient sustainable HWM network.

Sustainable Human Development at the Municipal Level: A Data Envelopment Analysis Index

The development of indexes for human development and environmental sustainability issues are an emerging topic in the current literature. However, the literature has put less emphasis on municipal indexes, which is the focus of this research. In this paper, we considered municipal environmental management as the adoption of environmental activities and the development of infrastructural and technical capacities in municipalities. This article aims to create a sustainable human development index with municipal data from the state of São Paulo in Brazil. Using information from the Municipal Human Development Index (IDHm) and the GreenBlue Municipal Program (PMVA), we applied the data envelopment analysis (DEA) technique to connect human development and environmental sustainability in 645 Brazilian municipalities. Our findings show that regions with higher human development present better DEA scores on the Sustainable Human Development Index. In contrast, regions with a low or a middle level of human development do not present significant change considering both dimensions. Moreover, our findings reveal that PMVA certification has a different and statistically significant impact on the DEA score considering certified, qualified, or not qualified regions. We found similar results for urbanized and service-oriented municipalities. Our indicator is an essential and straightforward tool for regional policymakers, helping to allocate resources and to find human development and environmental sustainability benchmarks among developing regions.

Plastic waste release caused by COVID-19 and its fate in the global ocean

Plastic waste causes harm to marine life and has become a major global environmental concern. The recent COVID-19 pandemic has led to an increased demand for single-use plastic, intensifying pressure on this already out-of-control problem. This work shows that more than eight million tons of pandemic-associated plastic waste have been generated globally, with more than 25,000 tons entering the global ocean. Most of the plastic is from medical waste generated by hospitals that dwarfs the contribution from personal protection equipment and online-shopping package material. This poses a long-lasting problem for the ocean environment and is mainly accumulated on beaches and coastal sediments. We call for better medical waste management in pandemic epicenters, especially in developing countries.

The COVID-19 pandemic has led to an increased demand for single-use plastics that intensifies pressure on an already out-of-control global plastic waste problem. While it is suspected to be large, the magnitude and fate of this pandemic-associated mismanaged plastic waste are unknown. Here, we use our MITgcm ocean plastic model to quantify the impact of the pandemic on plastic discharge. We show that 8.4 ± 1.4 million tons of pandemic-associated plastic waste have been generated from 193 countries as of August 23, 2021, with 25.9 ± 3.8 thousand tons released into the global ocean representing 1.5 ± 0.2% of the global total riverine plastic discharge. The model projects that the spatial distribution of the discharge changes rapidly in the global ocean within 3 y, with a significant portion of plastic debris landing on the beach and seabed later and a circumpolar plastic accumulation zone will be formed in the Arctic. We find hospital waste represents the bulk of the global discharge (73%), and most of the global discharge is from Asia (72%), which calls for better management of medical waste in developing countries.

How to Dispose of Medical Waste Caused by COVID-19? A Case Study of China

The rapid increase in novel coronavirus (COVID-19) patients also means a rapid increase in medical waste that could carry the novel coronavirus (SARS-CoV-2). How to safely dispose of medical waste caused by COVID-19 is a huge challenge that needs to be solved urgently. The outbreak of the COVID-19 has led to a significant increase in the daily generation of medical waste in China and has placed a severe test on the Chinese medical waste disposal system. Unlike ordinary wastes and garbage, medical waste that is untreated or incompletely treated will not only cause environmental pollution, but also directly or indirectly cause infections and endanger people's health. Faced with difficulties, the Chinese government formulated a policy for medical waste management and a response plan for the epidemic, which provides policy guarantee for the standardized disposal of epidemic medical waste. In addition, the government and medical institutions at all levels formed a comprehensive, refined, and standardized medical treatment process system during research and practice. China has increased the capacity of medical waste disposal in various places by constructing new centralized disposal centers and adding mobile disposal facilities. China has achieved good results in the fight against COVID-19, and the pressure on medical waste disposal has been relieved to a certain extent. However, the global epidemic situation is severe. How to ensure the proper and safe disposal of medical waste is related to the prevention and control of the epidemic situation. This study summarizes China's experience in the disposal of medical waste in the special case of COVID-19 and hopes to provide some reference for other countries in the disposal of medical waste.

Selection of healthcare waste disposal firms using a multi-method approach

The aim of this study is to propose a hybrid multi criteria decision making model with a linear programming (LP) model to tackle the issue of safe disposal of hazardous and infectious healthcare waste. For this, ten criteria in this study have been identified from literature and field surveys which are modelled using Decision making trial and evaluation (DEMATEL) and Analytic network process (ANP) methods to select the best disposal firm i.e. single sourcing for a hospital. We found that Experience of the firm, Technology for disposal, and Waste collection infrastructure acts as the most vital criteria in selecting a healthcare waste disposal firm for single sourcing. Furthermore, to optimize the total value of disposal and mitigating the risk involved in disposing waste through single sourcing; the LP model considering constraints such as waste lose constraint and waste processing constraint etc. Is solved for multiple sourcing using Lingo 18.0. The solution to LP results into allocation of 500, 500, and 1000 (kg/day) disposables to healthcare waste disposal firms D1, D2 and D3, respectively. The multi-method approach proposed in this study helps the hospital management in selecting economically, socially, and environmentally sustainable healthcare waste disposal firm.

Sustainable waste management of medical waste in African developing countries: A narrative review

Africa is the second populous continent, and its population has the fastest growing rate. Some African countries are still plagued by poverty, poor sanitary conditions and limited resources, such as clean drinking water, food supply, electricity, and effective waste management systems. Underfunded healthcare systems, poor training and lack of awareness of policies and legislations on handling medical waste have led to increased improper handling of waste within hospitals, healthcare facilities and transportation and storage of medical waste. Some countries, including Ethiopia, Botswana, Nigeria and Algeria, do not have national guidelines in place to adhere to the correct disposal of such wastage. Incineration is often the favoured disposal method due to the rapid diminishment of up to 90% of waste, as well as production of heat for boilers or for energy production. This type of method - if not applying the right technologies - potentially creates hazardous risks of its own, such as harmful emissions and residuals. In this study, the sustainability aspects of medical waste management in Africa were reviewed to present resilient solutions for health and environment protection for the next generation in Africa. The findings of this research introduce policies, possible advices and solutions associated with sustainability and medical waste management that can support decision-makers in developing strategies for the sustainability by using the eco-friendly technologies for efficient medical waste treatment and disposal methods and also can serve as a link between the healthcare system, decision-makers, and stakeholders in developing health policies and programmes.

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).

Big Data-Enabled Solutions Framework to Overcoming the Barriers to Circular Economy Initiatives in Healthcare Sector

Ever-changing conditions and emerging new challenges affect the ability of the healthcare sector to survive with the current system, and to maintain its processes effectively. In the healthcare sector, the conservation of the natural resources is being obstructed by insufficient infrastructure for managing residual waste resulting from single-use medical materials, increased energy use, and its environmental burden. In this context, circularity and sustainability concepts have become essential in healthcare to meliorate the sector’s negative impacts on the environment. The main aim of this study is to identify the barriers related to circular economy (CE) in the healthcare sector, apply big data analytics in healthcare, and provide solutions to these barriers. The contribution of this research is the detailed examination of the current healthcare literature about CE adaptation, and a proposal for a big data-enabled solutions framework to barriers to circularity, using fuzzy best-worst Method (BWM) and fuzzy VIKOR. Based on the findings, managerial, policy, and theoretical implementations are recommended to support sustainable development initiatives in the healthcare sector.

Analysis of medical waste management and impact analysis of COVID-19 on its generation in Taiwan

Medical waste management in Taiwan is a crucial issue due to its highly environmental and human health risks. The main objectives of this paper were to analyse the status of medical waste generation and treatment in recent years, and also address the discussions on the impacts of coronavirus disease 2019 (COVID-19) on its generation in the first half of 2020. It showed that the reported quantities have slightly increased from 35,747 metric tonnes (Mt) in 2016 to 40,407 Mt in 2019, showing an average increase by 4.17%. This rate of increase was consistent with the hospital services. When classified by the reported codes, the C-type waste (infectious waste) accounted for about 89% of the reported quantities, which indicated an annual increase by 4.14% during the same period. In addition, the medical waste treatment in 2019 was mainly dependent on the commissioned treatment (80.18%), followed by the recycling (18.53%) and the self-treatment (1.29%). Furthermore, the impact of COVID-19 on the medical waste generation in Taiwan was not significant in the first half of 2020 compared to the data during the years of 2016-2019. It was indicated that the consistent trend was observed at the daily confirmed COVID-19 cases in Taiwan during this period. Obviously, the reduction in the hospital medical services during the COVID-19 outbreak should be offset by the increase in medical waste generation from the medical services. In order to try to ensure safe and complete destruction of the COVID-19 virus, all the waste generated from the healthcare facilities should be treated in the incineration plants.

Intraoperative waste segregation initiative among anesthesia personnel to contain disposal costs

Approximately 90% of medical waste generated in the operating room (OR) is considered to be non-infectious and non-regulated (Wyssusek, Keys & van Zundert, 2019). Frequently, this waste is inappropriately disposed of into infectious regulated medical waste containers. Due to differences in waste treatment, improper segregation can lead to the misuse or inappropriate allocation of resources, environmental pollution, and increased cost for institutions. A waste segregation initiative was instituted in a tertiary care medical center in the anesthesia work-space of 35 ORs. This initiative included education of medical waste management to increase anesthesia staff knowledge and compliance with waste segregation and optimization of existing waste disposal containers to decrease waste disposal costs. After implementation, there was an increase in overall provider knowledge (p < 0.001) particularly in the categories of medication vial disposal, medication disposal and identification of items for disposal in the sharps containers (p ≤ 0.05). Data suggests a 34.7% increase in providers reporting to always practice waste segregation (p ≤ 0.05). Additionally, there was a statistically significant decrease in overall weight of regulated medical waste items from 0.33 kg/case to 0.09 kg/case (p < 0.001). This decrease in regulated waste supports an improvement in waste segregation and inappropriate items being disposed of in the general trash container. The omission of inappropriate waste was further confirmed by a segregation audit that showed an overall increase in correctly segregated regulated waste of 65%. Collectively, this lead to a cost savings of $15.60 per OR per week, or $28,392 annually.

Insights of healthcare waste management practices in Vietnam

Nowadays, together with the economic development, public health activities have gained substantial attention with increasing number of hospitals during the past decades. A multi-method approach involving site visits, questionnaires, and interviews, in combination with secondary data revealed that the healthcare waste (HCW) generation, varied with different specialties (general or pediatric/obstetric hospitals) and different level of hospitals (central, provincial, district levels). The HCW generation from different kinds of surveyed hospitals varied from 0.8 to 1.0 kg/bed/day for domestic waste, 0.15 to 0.25 kg/bed/day for infectious and hazardous waste, and less than 0.1 kg/bed/day for recycled waste. Only 94.3% of central hospitals, 92% of provincial hospitals, and 82% of district hospitals complied with national regulation in hazardous medical waste treatment. For healthcare wastewater treatment, the actual operating rates were 91%, 73%, and 50% for central, provincial, and district hospitals, respectively. The cost for HCW management accounted for only 10-15% of the total budget allocated for the medical facilities. Most of the provincial hospitals spent about $0.2-$0.4/bed/year for HCW management. This is the root cause of ineffective HCW management.

The interplay of circular economy with industry 4.0 enabled smart city drivers of healthcare waste disposal

Generation of healthcare waste from different patient care activities in hospitals, pathology labs and research centres has been a matter of great concern for environmental and social bodies across the world. This concern comes from its infectious and hazardous nature which brings life taking disease such as human immunodeficiency virus and Hepatitis-B. Moreover, with the outbreak of corona virus disease 2019 (COVID-19) pandemic across the world, healthcare waste has become even more infectious like never before and showing its potential for claiming lives if not disposed properly. Additionally, the COVID-19 has put up another challenge in terms of exponentially increasing demand for personal protective equipments for healthcare workers such as doctors, nurses, ward boys, and sanitation workers. In this paper, seven criteria related to smart healthcare waste disposal system infused by circular economy aspects to recover value from disposables are identified and analysed using a decision making trial and evaluation laboratory (DEMATEL) method. The criteria have been prioritized by its importance and net cause and effect relationship through a causal diagram. Two criteria, (i) digitally connected healthcare centres, waste disposal firms and pollution control board, and (ii) providing a pollution control board's feedback app to public and other stakeholders, feature as strong reasons for a smart healthcare waste disposal system. Conclusively, this study provides a causal relationship model among the intertwined drivers of industry 4.0 and circular economy for developing a smart healthcare waste disposal system enriched with the benefits of circular economy.

Healthcare waste management in Ghanaian hospitals: Associated public health and environmental challenges

Healthcare waste generation is an integral part of healthcare operations. Improper healthcare waste management and disposal can be detrimental to humans and the environment. The objective of this paper is to investigate the healthcare waste management practices, aiming to provide needed data to inform policy decisions. The study was conducted using a cross-sectional study. Quantitative data was obtained from 497 respondents who worked in 25 major healthcare facilities. Data was analyzed using (SPSS) version 23.0. Results indicated that 52.4% of respondents had knowledge about healthcare waste management. However, only 12% of the respondents were open to training in healthcare/biomedical waste management. Less than half of the respondent (47.5%) practiced waste segregation at the sources of generation. There were significantly more healthcare waste disposal materials available (P = 0.001) in private than government and quasi-government hospitals. Based on the major findings of the study, we recommend that adequate training as well as Personal Protective Equipment (PPE's) should be provided to healthcare professionals to improve healthcare waste management. Complacence in adhering to Healthcare waste disposal guideline must be addressed.

A reverse supply chain for medical waste: A case study in Babol healthcare sector

Medical waste generation is rapidly rising, which may cause a serious risk for both humans and environment if it is not properly managed. Designing an efficient and reliable medical waste reverse supply chain (MWRSC) is extremely beneficial to society. Most studies on this issue have only considered the generated waste and have not reported the uncertainty in the amount of medical waste generation and other MWRSC parameters. Sustainability criteria and environmental issues in choosing treatment technology are rarely considered as well. In this research, a linear programming model under uncertainty is developed to design an MWRSC. The proposed model is multi-item and multi-period with three objective functions. The first objective function minimizes total costs, the second objective function is relevant to the best treatment technology selection and the third objective function minimizes the total medical waste stored. A robust possibilistic programming approach is utilized to handle imprecise parameters in the model and a fuzzy goal programming method is employed to build up a multi-objective model. A real case study is conducted to illustrate the potential of the proposed model which involves different attributes and problems, such as the location and capacity of facilities, and the type of treatment technology. Furthermore, the transferring amount of medical waste among different nodes is calculated.

An approach to assess and identify polymers in the health-care waste of a Brazilian university hospital

This work presents the health-care waste (HCW) management and an approach to assess and identify polymers in a General Surgery Unit - Internment Service (GSU) of a Brazilian university hospital, to estimate the main polymers presenting in medical devices that are consumed during a year, discarded either as infecting (Group A) or as scarifying residue (Group E). Among the waste produced from the medical devices, 3.14 ton (98.79%) were composed of polymers (63.06% of plastics and 35.73% elastomers) while around 0.03 ton (1.21%) by metals. The proposed approach is composed of 4 steps: (1) Collecting data about consumed medical devices to be categorized into the residues Groups (A and E); (2) Identifying the polymeric composition with information provided by suppliers; (3) Characterizing the polymer functional groups by Fourier-Transform Infrared Spectroscopy (FTIR) and (4) Determining the polymer melting point by Differential Scanning Calorimetry (DSC). According to the results, the analyzed HCW was composed mainly of polypropylene (80.88%), high-density polyethylene (5.28%), polystyrene (4.51%), and cellulose (3.58%), from a total of 11 different polymers.

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.

Application of healthcare waste indicators for assessing infectious waste management in Bolivia

In the developing world, healthcare waste management is a human health and environmental burden that should be solved for improving sustainability. Solutions should be introduced in the short term, concerning management, planning, financial assistance and expertise. The paper introduces an indicator set for assessing healthcare waste management in developing cities, implemented in La Paz (Bolivia) as a case study. The objective is to suggest an integrated management tool as a first assessment technique to identify the prevailing problems with a healthcare waste management system. Results suggest that, in La Paz, the application of such indicators is useful for evaluating which priorities should be addressed for improving the healthcare waste management system. The tool was applied for introducing a study necessary for the application of new management plans, especially concerning healthcare waste treatment. The method can be replicated in other contexts worldwide, with a focus on the developing world, for comparing cities, management solutions and improvements carried out along the years. The approach is of interest for boosting sustainability and human health, improving the awareness of the actors and policy-makers involved in waste management.

Dynamic assessment of economic and environmental performance index and generation, composition, environmental and human health risks of hospital solid waste in developing countries; A state of the art of review

Many studies have been conducted on hospital solid waste management (HSWM) throughout the world, especially developing countries. This interdisciplinary study aims to summarize the available knowledge on the health and environmental risks of hospital solid waste (HSW) and also, develop a dynamic associational assessment among hospital solid waste generation rate (HSWGR), hospital solid waste composition (HSWC), gross domestic product (GDP) per capita, and environmental performance index (EPI) in some developing countries for the first time. The results of this study showed that researchers from India, China, Pakistan, Brazil, and Iran had found more evidence about the health, economic, and environmental issues in HSW than the other developing countries. The literature showed that the highest and lowest reported HSWGR (in national average level) belonged to Ethiopia (6.03) and India (0.24) kg bed ^-1 day^-1, respectively. It has also been shown that all studied countries except Serbia, have higher levels of hazardous waste in their HSWC, based on the WHO's standard. Furthermore, the quantity and quality of HSW in developing countries depend on the service provided by the hospital, type of hospital, HSWM system, and the level of regional economic and culture. The association analysis showed that the EPI and GDP per capita of developing countries were significantly (p-value <0.05) associated with HSWGR, non-hazardous HSW, and hazardous HSW by the Spearman coefficients equal to 0.389, 0.118, -0.118, and 0.122, 0.216, and -0.346, respectively. However, it can be concluded that GDP per capita and EPI have a weak correlation with hazardous HSW and non-hazardous HSW. Moreover, HSW has many hazardous health and environmental risks such as dioxin and furan, that must be controlled and managed through implementing programs and policies based on sustainable development. As a final point, we believed that the present study can be considered to be a guide for future studies on HSWM in developing countries.

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.

Healthcare waste management at primary health centres in Mon State, Myanmar: the comparisons between hospital and non-hospital type primary health centres

Improper healthcare waste management (HCWM) poses a serious public health problem worldwide. Primary health centres (PHCs) provide public health and medical care services as the basic structural and functional units of healthcare services in Myanmar. However, no study has been conducted in Myanmar about HCWM at PHCs. This study aims to assess the practice of HCWM at PHCs in Mon State, Myanmar. A cross-sectional study was conducted in all ten townships in Mon State, Myanmar. In total, 93 PHCs (71 non-hospitals and 22 hospitals) were selected using simple random sampling. The observational checklist which was developed based on the World Health Organization’s standard guideline procedure of HCWM was used to determine the practice of HCWM at PHCs. Binary logistic regression was used for final data analysis. The burning in pits method was used as the final disposal method of healthcare waste in 78.5% of PHCs. Non-hospital type PHC were more likely not to have colour coding system for HCWM (odds ratio [OR] 7.54; 95% confidence interval [CI] 2.15–26.52), did not have equipment for accidental spillage of healthcare waste (OR 3.92; 95% CI 1.3–11.77) and did not have separate staff for HCWM (OR 8.27; 95% CI 2.77–24.64), relative to hospitals. Non-hospital type PHCs practices poorly on the colour coding for waste segregation, assigning separate staff for HCWM, and possessing equipment for accidental spillage of healthcare waste than hospital type PHCs. The Ministry of Health and Sports should issue technical guidelines of safe HCWM as a compulsory policy for both hospitals and non-hospital type PHCs.

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.

Profile of highly infected wastes generated by hospitals: A case in Belo Horizonte, Brazil

Healthcare wastes are generated in facilities whose activities are related to human or animal healthcare. Wastes with high infectious potential risk to human health and the environment must be managed carefully, from generation to its final disposal. However, there is an absence of consolidated data addressing the healthcare waste qualitative classification generated by hospitals of a large city. Therefore, the present study aims to characterise qualitatively the high infectious waste generated by hospitals from Belo Horizonte city, Brazil, whose Health Services Waste Management Plan were approved and certificated by the municipal cleansing autarchy. Differences in the types of infectious wastes generated in maternity hospitals were identified ( p 0.034), when compared with general ( p 0.189), low ( p 0.549) and high complexity ( p 0.619), which can be explained owing to the extended hospital activities. This information suggests a similar profile of the qualitative generation of infectious wastes by hospital categories, as expected. The largest generation and diversity of high-infected wastes are associated with a greater variety of activities provided. The segregation can be considered as the main step in healthcare waste management, therefore, it is concluded that the correct classification leads to a better understanding of all those involved in the healthcare waste management.

Determining a conceptual framework for safe and sustainable health-care waste management (SSHCWM) implementation in health-care facilities

Purpose

This paper aims to explore current sustainable facilities management knowledge and practice, focussing specifically on sustainable waste management implementation in health-care facilities with an aim to conceptualize a framework for assessing performance and impact of successful implementation of safe and sustainable health-care waste management on health-care provision.

Design/methodology/approach

This paper used a review of existing literature in relation to health-care waste management in the context of sustainable facilities management and facilities management performance and forms a basis for further research.

Findings

The growing significance of the strategic role of facilities management is established. Building on this recognition, a conceptual framework for assessing both implementation of sustainable facilities management practice in the context of waste management in health-care facilities and its impact on health-care provision is proposed.

Originality/value

This paper conceptualizes a framework for optimizing safe and sustainable waste management implementation in health-care facilities and assessing its impact on the bottom-line of health-care provision.

Nursing professionals' knowledge regarding the management of waste produced in primary health care

OBJECTIVE

To evaluate the knowledge of Nursing professionals regarding waste management in primary healthcare services.

METHOD

Descriptive study with a mixed approach, developed with 42 nursing professionals who worked in basic health units of a capital in the Brazilian Northeast Region. Quantitative variables were analyzed by the SPSS 20.0 program. Reports were processed by the IRaMuTeQ software, analyzed according to the descending hierarchical classification, and grounded on the Collective Subject Discourse.

RESULTS

Low knowledge scores were obtained, associated with specific socioeconomic and training variables. Analysis of collected reports allowed to identify three classes: "Inadequate waste disposal: first and main step"; "Correct disposal improves service quality and prevents diseases"; and "Consequences associated with incorrect disposal".

CONCLUSION

The knowledge of professionals falls short of the expectations to adequately manage waste produced in primary health care and is concentrated on the initial steps, mainly the disposal process.

Assessment of Knowledge, Attitude, and Practice about Biomedical Waste Management and Associated Factors among the Healthcare Professionals at Debre Markos Town Healthcare Facilities, Northwest Ethiopia

Background

Healthcare activities restore health and save lives at the same time; however, they can generate hazardous biomedical wastes to a human being or the environment. Generation and disposal of biomedical wastes have become an emerging problem worldwide.

Objective

To assess knowledge, attitude, and practice about biomedical waste management and associated factors among healthcare professionals in Debre Markos town healthcare facilities, northwest Ethiopia.

Methods

A cross-sectional study was employed, and data were collected through structured self-administered questionnaire and observational checklist. Data were entered into the Epi-data 3.1 software and exported into SPSS version 20 for analysis. Bivariate and multivariate logistic regression analyses were computed. Variables with a P value of <0.05 in the multivariate logistic regression analysis were considered to explain the presence of statistically significant associations.

Result

Among 296 healthcare professionals studied, 168 (56.8%), 196 (66.2%), and 229 (77.4%) had adequate knowledge, favorable attitude, and adequate practice score, respectively. Regarding associated factors, MSc and MD+ (AOR: 4, 95% CI: (1.37, 149.52)), BSc holders (AOR: 2.53, 95% CI: (1.47, 4.38)), and availability of color-coded bins (AOR: 7.68, 95% CI: (3.30, 17.89)) were identified more likely to contribute for adequate knowledge, favorable attitude, and adequate practice scores, respectively.

Conclusion

The level of knowledge, attitude, and practice scores were not satisfactory. Majority of the healthcare professionals did not access biomedical waste management training. Educational level, use of visual aid, and availability of color-coded bins in the department were identified as a factor for biomedical waste management. Regular training should be given to healthcare professionals.

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.

Microwave Technologies: An Emerging Tool for Inactivation of Biohazardous Material in Developing Countries

Inappropriate treatment and disposal of waste containing biohazardous materials occurs especially in developing countries and can lead to adverse effects on public and occupational health and safety, as well as on the environment. For the treatment of biohazardous waste, microwave irradiation is an emerging tool. It is a misbelief that microwave devices cannot be used for inactivation of solid biohazardous waste; however, the inactivation process, and especially the moisture content, has to be strictly controlled, particularly if water is required to be added to the process. Appropriate control allows also inactivation of waste containing inhomogeneous compositions of material with low fluid/moisture content. Where appropriate, especially where control of transport of waste cannot be guaranteed, the waste should be inactivated directly at the place of generation, preferably with a closed waste collection system. In waste containing sufficient moisture, there are direct useful applications, for example the treatment of sewage sludge or human feces. A number of examples of microwave applications with impacts for developing countries are presented in this review. In respect to energy costs and environmental aspects, microwave devices have clear advantages in comparison to autoclaves.

Medical waste management in three areas of rural China

Objective

The purpose of this paper is to describe current practices of medical waste management, including its generation, investments, collection, storage, segregation, and disposal, and to explore the level of support from upper tiers of the government and health care system for medical waste management in rural China.

Methods

The authors draw on a dataset comprised of 209 randomly selected rural township health centers (THCs) in 21 counties in three provinces of China: Anhui, Shaanxi and Sichuan. Surveys were administered to health center administrators in sample THCs in June 2015.

Results

The results show that the generation rate of medical waste was about 0.18 kg/bed, 0.15 kg/patient, or 0.13 kg/person per day on average. Such per capita levels are significant given China’s large rural population. Although investments of medical waste facilities and personnel in THCs have improved, results show that compliance with national regulations is low. For example, less than half of hazardous medical waste was packed in sealed containers or containers labeled with bio-hazard markings. None of the THCs segregated correctly according to the categories required by formal Chinese regulations. Many THCs reported improper disposal methods of medical waste. Our results also indicate low levels of staff training and low rates of centralized disposal in rural THCs.

Conclusions

Medical waste is a serious environmental issue that is rising on the agenda of policymakers. While a large share of THCs has invested in medical waste facilities and personnel, it appears that actual compliance remains low. Using evidence of low rates of training and centralized disposal, we surmise that a lack of support from upper tiers of management is one contributing factor. Given these findings, we recommend that China’s policymakers should enhance support from upper tiers and improve monitoring as well as incentives in order to improve medical waste management.

A computer-based approach for data analyzing in hospital's health-care waste management sector by developing an index using consensus-based fuzzy multi-criteria group decision-making models

BACKGROUND

Proper Health-Care Waste Management (HCWM) and integrated documentation in this sector of hospitals require analyzing massive data collected by hospital's health experts. This study presented a quantitative software-based index to assess the HCWM process performance by integrating ontology-based Multi-Criteria Group Decision-Making techniques and fuzzy modeling that were coupled with data mining. This framework represented the Complex Event Processing (CEP) and Corporate Performance Management (CPM) types of Process Mining in which a user-friendly software namely Group Fuzzy Decision-Making (GFDM) was employed for index calculation.

FINDINGS

Assessing the governmental hospitals of Shiraz, Iran in 2016 showed that the proposed index was able to determine the waste management condition and clarify the blind spots of HCWM in the hospitals. The index values under 50 were found in some of the hospitals showing poor process performance that should be at the priority of optimization and improvement.

CONCLUSION

The proposed framework has distinctive features such as modeling the uncertainties (risks) in hospitals' process assessment and flexibility enabling users to define the intended criteria, stakeholders, and number of hospitals. Having computer-aided approach for decision process also accelerates the index calculation as well as its accuracy which would contribute to more willingness of hospitals' experts and other end-users to use the index in practice. The methodology could efficiently be employed as a tool for managing hospitals' event logs and digital documentation in big data environment not only for the health-care waste management, but also in other administrative wards of hospitals.

A Review of Medical Waste Management in South Africa

Background:

Poor medical waste management has been implicated in an increase in the number of epidemics and waste-related diseases in the past years. South Africa is resource-constrained in the management of medical waste.

Objectives:

A review of studies regarding medical waste management in South Africa in the past decade was undertaken to explore the practices of medical waste management and the challenges being faced by stakeholders.

Method:

Published articles, South African government documents, reports of hospital surveys, unpublished theses and dissertations were consulted, analysed and synthesised. The studies employed quantitative, qualitative and mixed research methods and documented comparable results from all provinces.

Results:

The absence of a national policy to guide the medical waste management practice in the provinces was identified as the principal problem. Poor practices were reported across the country from the point of medical waste generation to disposal, as well as non-enforcement of guidelines in the provinces where they exit. The authorized disposal sites nationally are currently unable to cope with the enormous amount of the medical waste being generated and illegal dumping of the waste in unapproved sites have been reported. The challenges range from lack of adequate facilities for temporary storage of waste to final disposal.

Conclusion:

These challenges must be addressed and the practices corrected to forestall the adverse effects of poorly managed medical waste on the country. There is a need to develop a medical waste policy to assist in the management of such waste.

Waiting too long: bottlenecks and improvements – a case study of a surgery department

Purpose

The purpose of this paper is to promote a business process approach for developing and improving the efficiency of hospital service quality in order to reduce clinical risks and increase patients satisfaction. The problems healthcare facilities face are how to reduce waste and risk and improve quality. The adoption of a process-focused organization could reduce organizational errors which have a negative influence on performance.

Design/methodology/approach

The research is based on a case study methodology, analyzing a specific real-life case. It is shown a practical example in the surgery department of an Italian hospital, identifying, analyzing and managing critical situations, in terms of improvement. To this end, national and international contributions, public documents, institutional websites, conference papers, books, workshops and hospital websites have been analyzed. Moreover, other data were collected through questionnaires.

Findings

Results show how a comprehensive view of the processes may lead to improvement in operations by identifying different risks and bottlenecks, suggesting the rapid implementation of corrective policies and improvements, in terms of overall efficiency.

Practical implications

By implementing innovative organizational processes to identify and reduce bottleneck a healthcare system could achieve a competitive advantage.

Originality/value

Within the Italian healthcare system, limited attention has been paid to the design of healthcare facilities. Flexible solutions are necessary for lean management. The originality of this work lies in the analysis applied to a complex organization, through which hidden critical situations have been identified, and solutions to improve and provide better healthcare management have been suggested.

Waste management barriers in developing country hospitals: Case study and AHP analysis

Healthcare waste management is an essential field for both researchers and practitioners. Although there have been few studies using statistical methods for its evaluation, it has been the subject of several studies in different contexts. Furthermore, the known precarious practices for waste management in developing countries raise questions about its potential barriers. This study aims to investigate the barriers in healthcare waste management and their relevance. For this purpose, this paper analyses waste management practices in two Brazilian hospitals by using case study and the Analytic Hierarchy Process method. The barriers were organized into three categories - human factors, management, and infrastructure, and the main findings suggest that cost and employee awareness were the most significant barriers. These results highlight the main barriers to more sustainable waste management, and provide an empirical basis for multi-criteria evaluation of the literature.

Costs associated with the management of waste from healthcare facilities: An analysis at national and site level

Given rising spend on the provision of healthcare services, the sustainable management of waste from healthcare facilities is increasingly becoming a focus as a means of reducing public health risks and financial costs. Using data on per capita healthcare spend at the national level, as well as a case study of a hospital in Italy, this study examined the relationship between trends in waste generation and the associated costs of managing the waste. At the national level, healthcare spend as a percentage of gross domestic product positively correlated with waste arisings. At the site level, waste generation and type were linked to department type and clinical performance, with the top three highest generating departments of hazardous healthcare waste being anaesthetics (5.96 kg day^-1 bed^-1), paediatric and intensive care (3.37 kg day^-1 bed^-1) and gastroenterology-digestive endoscopy (3.09 kg day^-1 bed^-1). Annual overall waste management costs were $US5,079,191, or approximately $US2.36 kg^-1, with the management of the hazardous fraction of the waste being highest at $US3,707,939. In Italy, reduction in both waste arisings and the associated costs could be realised through various means, including improved waste segregation, and linking the TARI tax to waste generation.

Investigating cross-contamination by yeast strains from dental solid waste to waste-handling workers by DNA sequencing

Trying to widen the discussion on the risks associated with dental waste, this study proposed to investigate and genetically compare yeast isolates recovered from dental solid waste and waste workers. Three samples were collected from workers' hands, nasal mucosa, and professional clothing (days 0, 30, and 180), and two from dental waste (days 0 and 180). Slide culture, microscopy, antifungal drug susceptibility, intersimple sequence repeat analysis, and amplification and sequencing of internal transcribed spacer regions were performed. Yeast strains were recovered from all waste workers' sites, including professional clothes, and from waste. Antifungal susceptibility testing demonstrated that some yeast recovered from employees and waste exhibited nonsusceptible profiles. The dendrogram demonstrated the presence of three major clusters based on similarity matrix and UPGMA grouping method. Two branches displayed 100% similarity: three strains of Candida guilliermondii isolated from different employees, working in opposite work shifts, and from diverse sites grouped in one part of branch 1 and cluster 3 that included two samples of Candida albicans recovered from waste and the hand of one waste worker. The results suggested the possibility of cross‐contamination from dental waste to waste workers and reinforce the need of training programs focused on better waste management routines.

Hospital waste management in developing countries: A mini review

Health care activities can generate different kinds of hazardous wastes. Mismanagement of these wastes can result in environmental and occupational health risks. Developing countries are resource-constrained when it comes to safe management of hospital wastes. This study summarizes the main issues faced in hospital waste management in developing countries. A review of the existing literature suggests that regulations and legislations focusing on hospital waste management are recent accomplishments in many of these countries. Implementation of these rules varies from one hospital to another. Moreover, wide variations exist in waste generation rates within as well as across these countries. This is mainly attributable to a lack of an agreement on the definitions and the methodology among the researchers to measure such wastes. Furthermore, hospitals in these countries suffer from poor waste segregation, collection, storage, transportation and disposal practices, which can lead to occupational and environmental risks. Knowledge and awareness regarding proper waste management remain low in the absence of training for hospital staff. Moreover, hospital sanitary workers, and scavengers, operate without the provision of safety equipment or immunization. Unsegregated waste is illegally recycled, leading to further safety risks. Overall, hospital waste management in developing countries faces several challenges. Sustainable waste management practices can go a long way in reducing the harmful effects of hospital wastes.

Microwave as an emerging technology for the treatment of biohazardous waste: A mini-review

Microwave is an emerging technology to treat biohazardous waste, including material from healthcare facilities. A screen of the peer-reviewed literature shows that only limited information may be found in this area of work and, furthermore, analysis of the references reveals that sometimes not all necessary aspects for the appropriate use of the technology are considered. Very often conventional microwave technology is applied for the inactivation of pathogens, which might make sense for certain applications but, on the other hand, may lead to the misbelief that microwave systems cannot be used for the inactivation of a solid "dry" waste. However, conventional microwave units have no means to control the inactivation process, and especially moisture content. But there are a few sophisticated microwave technologies with appropriate measurements allowing a validated inactivation of biohazardous materials. These technologies are an effective tool for inactivation and some of them are commercially available. It must also be considered that the waste should be preferably inactivated either directly at the place where it is generated or biohazardous waste should be transported only in closed systems. Moreover, microwave technology presents a possibility to save energy costs in comparison to the more widely used autoclaves. This mini-review will discuss important aspects for the use of microwave technology for the treatment of biohazardous waste.

Environmental audits and process flow mapping to assess management of solid waste and wastewater from a healthcare facility: an Italian case study

In Europe, there are an increasing number of policy and legislative drivers for a more sustainable approach to the management of natural resources as well as for the mitigation of environmental health risks. However, despite significant progress in recent years, there is still some way to go to achieve circularity of process, as well as risk mitigation within organisations. Using a case study of the Gardone Val Trompia hospital in northern Italy, this manuscript offers a novel holistic examination of strategies to enhance resource efficiency and environmental health within a key sector, i.e. the healthcare sector. Through the use of environmental audits and process flow mapping, trends in waste and wastewater arisings and the associated financial and environmental costs and risks were identified. Recommendations for developing more resource efficient approaches as well as mitigating the environmental and public health risks are suggested. These include strategies for improved resource efficiency (including reduction in the hazardous waste) and reduced environmental impacts during the containment, transport and treatment of the waste.

An integrated decision making approach for assessing healthcare waste treatment technologies from a multiple stakeholder

With increased worldwide awareness of environmental issues, healthcare waste (HCW) management has received much attention from both researchers and practitioners over the past decade. The task of selecting the optimum treatment technology for HCWs is a challenging decision making problem involving conflicting evaluation criteria and multiple stakeholders. In this paper, we develop an integrated decision making framework based on cloud model and MABAC method for evaluating and selecting the best HCW treatment technology from a multiple stakeholder perspective. The introduced framework deals with uncertain linguistic assessments of alternatives by using interval 2-tuple linguistic variables, determines decision makers' relative weights based on the uncertainty and divergence degrees of every decision maker, and obtains the ranking of all HCW disposal alternatives with the aid of an extended MABAC method. Finally, an empirical example from Shanghai, China, is provided to illustrate the feasibility and effectiveness of the proposed approach. Results indicate that the methodology being proposed is more suitable and effective to handle the HCW treatment technology selection problem under vague and uncertain information environment.