Unlocking the surge in demand for personal and protective equipment (PPE) and improvised face coverings arising from coronavirus disease (COVID-19) pandemic - Implications for efficacy, re-use and sustainable waste management

Adherence to Personal Protective Equipment practices during the COVID-19 pandemic: A pilot study

A direct observational pilot project of healthcare personnel (HCP) was conducted to validate a tool that measures personal protective equipment (PPE) adherence at a large pediatric institution. Overall unit PPE adherence for all moments ranged from 50-61%. Masking was the most adhered to PPE moment (100%); hand hygiene prior to donning PPE had the lowest adherence (13%). Using data from this standardized tool, researchers can evolve PPE standards to maximize their adherence, effectiveness, and ease of utilization.

Protective personal equipment on coastal environments: Identifying key drivers at a global scale

The contamination of coastal ecosystems by personal protective equipment (PPE) emerged as a significant concern immediately following the declaration of the COVID-19 pandemic by the World Health Organization (WHO). Hence, numerous studies have assessed PPE occurrence on beaches worldwide. However, no predictors on PPE contamination was so far pointed out. The present study investigated social and landscape drivers affecting the PPE density in coastal environments worldwide using a meta-analysis approach. Spatial variables such as urban modification levels, coastal vegetation coverage, population density (HPD), distance from rivers (DNR), and poverty degree (GGRDI) were derived from global satellite data. These variables, along with the time elapsed after WHO declared the pandemic, were included in generalized additive models as potential predictors of PPE density. HPD consistently emerged as the most influential predictor of PPE density (p < 0.00001), exhibiting a positive effect. Despite the presence of complex non-linear relationships, our findings indicate higher PPE density in areas with intermediate GGRDI levels, indicative of emerging economies. Additionally, elevated PPE density was observed in areas located further away from rivers (p < 0.001), and after the initial months of the pandemic. Despite the uncertainties associated with the varied sampling methods employed by the studies comprising our database, this study offers a solid baseline for tackling the global problem of PPE contamination on beachesguiding monitoring assessments in future pandemics.

Mechanical upcycling of single-use face mask waste into high-performance composites: An ecofriendly approach with cost-benefit analysis

The COVID-19 pandemic created an unprecedented demand for PPE, with single-use face masks emerging as a critical tool in containing virus transmission. However, the extensive use and improper disposal of these single-use face masks, predominantly composed of non-biodegradable plastics, has exacerbated environmental challenges. This research presents an innovative method for mechanically upcycling PPEs used in medical sectors i.e. single use face masks. The study investigates a facile approach for reclamation of infection-free and pure polypropylene (PP) plastic from discarded single use face masks (W-PP) and blends it with various vegetable oil percentages (5, 10 and 20 %), resulting in a versatile material suitable for various applications. Melt flow index, rheological behaviour, DSC and FTIR were employed to investigate the effect of vegetable oil/radical initiator through chemical grafting on W-PP properties. The results demonstrate significant enhancements in the tensile strength and modulus of W-PP when blended with vegetable oil and a radical initiator. There was a marked increase in tensile strength (33 %) and strain (55 %) compared to untreated W-PP, rendering W-PP both robust and flexible. Furthermore, we employed this upcycled W-PP in the fabrication of glass fibre-reinforced composites, resulting in notable enhancements in both tensile strength and impact resistance. The upcycled W-PP demonstrates excellent potential for various applications, such as sheet forming and 3D printing, where the non-brittleness of plastics plays a pivotal role in manufacturing high-quality products. The cost-benefit analysis of this approach underscores the potential of upcycling PPE waste as a sustainable solution to mitigate plastic pollution and conserve valuable resources. The applications of this upcycled material span a wide range of industries, including automotive composites, packaging, and 3D printing.

Microscopy of Woven and Nonwoven Face Covering Materials: Implications for Particle Filtration

A suite of natural, synthetic, and mixed synthetic-natural woven fabrics, along with nonwoven filtration layers from a surgical mask and an N95 respirator, was examined using visible light microscopy, scanning electron microscopy, and micro-X-ray computed tomography (µXCT) to determine the fiber diameter distribution, fabric thickness, and the volume of solid space of the fabrics. Nonwoven materials exhibit a positively skewed distribution of fiber diameters with a mean value of ≈3 μm, whereas woven fabrics exhibit a normal distribution of diameters with mean values roughly five times larger (>15 μm). The mean thickness of the N95 filtration material is 1093 μm and is greater than that of the woven fabrics that span from 420 to 650 μm. A new procedure for measuring the thickness of flannel fabrics is proposed that accounts for raised fibers. µXCT allowed for a quantitative nondestructive approach to measure fabric porosity as well as the surface area/volume. Cotton flannel showed the largest mean isotropy of any fabric, though fiber order within the weave is poorly represented in the surface electron images. Surface fabric isotropy and surface area/volume ratios are proposed as useful microstructural quantities to consider for future particle filtration modeling efforts of woven materials.

aPDI meets PPE: photochemical decontamination in healthcare using methylene blue-where are we now, where will we go?

Personal protective equipment (PPE) reuse, first recommended in the context of the SARS-CoV-2 pandemic, can mitigate shortages in crisis situations and can greatly reduce the environmental impact of typically single-use PPE. Prior to safe reuse, PPE must be sanitized and contaminating pathogens-in current circumstances viruses in particular-must be inactivated. However, many established decontamination procedures are not equitable and remain unavailable in low-resource settings. In mid-2020, an interdisciplinary consortium of researchers first studied the potential of implementing cheap and easy-to-use antimicrobial photodynamic inactivation (aPDI) using methylene blue as photosensitizer to decontaminate face masks and filtering facepiece respirators. In this perspective piece, we describe the development of this novel method, discuss recent advances, and offer insights into how equitable PPE decontamination via methylene blue-based aPDI may be integrated into circular economy policies in the healthcare sector.

Elastomeric half-mask respirator disinfection practices among healthcare personnel

BACKGROUND

Disposable N95 respirator shortages during the COVID-19 and 2009 H1N1 influenza pandemics highlighted the need for reusable alternatives, such as elastomeric half-mask respirators (EHMRs). Two US medical organizations deployed reusable EHMRs during the COVID-19 response. In addition to wipe-based disinfection following patient care episodes expected per local policies at both organizations, postshift centralized cleaning and disinfection (C&D) was expected at one site (A), permitting shared-pool EHMR use, and optional at the other (Site B), where EHMRs were issued to individuals. Using a survey, we evaluated disinfection practices reported by EHMR users and predictors of disinfection behaviors and perceptions.

METHODS

Surveys assessed EHMR disinfection practices, occupational characteristics, EHMR use frequency, training, and individual-issue versus shared-pool EHMR use.

RESULTS

Of 1080 EHMR users completing the survey, 76% reported that they disinfect the EHMR after each patient encounter, which was the expected practice at both sites. Increasing EHMR use, recall of disinfection training, and work in intensive care or emergency settings significantly influenced higher reporting of this practice. 36% of respondents reported using centralized C&D, although reporting was higher at the site (A) where this was expected (53%). Confidence in cleanliness of the EHMR following centralized C&D was not influenced by individual versus shared-pool EHMR issue.

CONCLUSIONS

Most EHMR users reported adherence with expected post-care individual-based disinfection of EHMRs but did not necessarily use standardized, centralized C&D. Future efforts to limit reliance on behavior related to respirator disinfection may improve EHMR implementation in healthcare to avert dependence on single-use, disposable N95 respirators.

Identifying the determinants of face mask disposal behavior and policy implications: An application of the extended theory of planned behavior

A study in Nigeria examined the psychological factors affecting face mask disposal behavior (DB) during the COVID-19 pandemic. The Theory of Planned Behavior (TPB) was used, with awareness of consequences and institutional barriers added. 1183 respondents completed an online survey, and structural equation modeling was used to analyze the data. The original TPB model revealed that attitudes, perceived behavioral control, and subjective norms explained 65% of the variance in respondents' behavior. Behavioral intention and perceived behavioral control accounted for 59.3% of the variance in DB. The extended TPB model, which included awareness of consequences and perceived institutional barriers, improved the model's explanatory power by 12.8%. Both TPB models adequately predicted face mask (FM) disposal behavior, with implications for policymakers and waste management authorities to design interventions to promote proper FM disposal behavior.

Rapid In Situ Thermal Decontamination of Wearable Composite Textile Materials

Pandemics stress supply lines and generate shortages of personal protective equipment (PPE), in part because most PPE is single-use and disposable, resulting in a need for constant replenishment to cope with high-volume usage. To better prepare for the next pandemic and to reduce waste associated with disposable PPE, we present a composite textile material capable of thermally decontaminating its surface via Joule heating. This material can achieve high surface temperatures (>100 °C) and inactivate viruses quickly (<5 s of heating), as evidenced experimentally with the surrogate virus HCoV-OC43 and in agreement with analytical modeling for both HCoV-OC43 and SARS-CoV-2. Furthermore, it does not require doffing because it remains relatively cool near the skin (<40 °C). The material can be easily integrated into clothing and provides a rapid, reusable, in situ decontamination method capable of reducing PPE waste and mitigating the risk of supply line disruptions in times of need.

Personal protective equipment waste management behavior of undergraduates in Xi'an City based on extended theory of value-identity-personal norm model

The COVID-19 pandemic has changed people's lives, with the most prominent change being the use of Personal Protective Equipment (PPE). In this study, we used the extended Value-Identity-Personal (VIP) norm model to empirically analyze the influencing factors of Pro-Environmental Behavior (PEB) among college students in Xi 'an, China, while considering the usage of PPE as an example of PEB. We proposed nine hypothetical questions, and the VIP model was established through the SmartPLS software to test the valid questionnaires of 414 college students. The verification results indicated that all the nine hypotheses were supported statistically, with personal environmental social responsibility and personal norms showing the most significant direct impact on PEB; notably, personal norms were also strongly influenced by environmental personal social responsibility. Biosphere values affected PEB indirectly, through self-identity and individual norms. This study proposes viable countermeasures and suggestions for college students to improve PEB; our findings can serve as a reference for policymakers and stakeholders to ensure the effective waste management of personal safety equipment.

Biomedical waste plastic: bacteria, disinfection and recycling technologies-a comprehensive review

Plastic recycling reduces the wastage of potentially useful materials as well as the consumption of virgin materials, thereby lowering the energy consumption, air pollution by incineration, soil and water pollution by landfilling. Plastics used in the biomedical sector have played a significant role. Reducing the transmission of the virus while protecting the human life in particular the frontline workers. Enormous volumes of plastics in biomedical waste have been observed during the outbreak of the pandemic COVID-19. This has resulted from the extensive use of personal protective equipment such as masks, gloves, face shields, bottles, sanitizers, gowns, and other medical plastics which has created challenges to the existing waste management system in the developing countries. The current review focuses on the biomedical waste and its classification, disinfection, and recycling technology of different types of plastics waste generated in the sector and their corresponding approaches toward end-of-life option and value addition. This review provides a broader overview of the process to reduce the volume of plastics from biomedical waste directly entering the landfill while providing a knowledge step toward the conversion of "waste" to "wealth." An average of 25% of the recyclable plastics are present in biomedical waste. All the processes discussed in this article accounts for cleaner techniques and a sustainable approach to the treatment of biomedical waste.

Graphical abstract

Challenges and future opportunities to unlock the critical supply chain of personal and protective equipment (PPE) encompassing decontamination and reuse under emergency use authorization (EUA) conditions during the COVID-19 pandemic: Through a reflective circularity and sustainability lens

Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2), and the resulting coronavirus disease (COVID-19), was declared a public health emergency of global concern by the World Health Organization (WHO) in the early months of 2020. There was a marked lack of knowledge to inform national pandemic response plans encompassing appropriate disease mitigation and preparation strategies to constrain and manage COVID-19. For example, the top 16 "most cited" papers published at the start of the pandemic on core knowledge gaps collectively constitute a staggering 29,393 citations. Albeit complex, appropriate decontamination modalities have been reported and developed for safe reuse of personal and protective equipment (PPE) under emergency use authorization (EUA) where critical supply chain shortages occur for healthcare workers (HCWs) caused by the COVID-19 pandemic. Commensurately, these similar methods may provide solutions for the safe decontamination of enormous volumes of PPE waste promoting opportunities in the circular bioeconomy that will also protect our environment, habitats and natural capital. The co-circulation of the highly transmissive mix of COVID-19 variants of concern (VoC) will continue to challenge our embattled healthcare systems globally for many years to come with an emphasis placed on maintaining effective disease mitigation strategies. This viewpoint article addresses the rationale and key developments in this important area since the onset of the COVID-19 pandemic and provides an insight into a variety of potential opportunities to unlock the long-term sustainability of single-use medical devices, including waste management.

Development of a reusable low-cost facemask with a recycled hydrophobic layer for preventive health care

The current work focuses on designing a low-cost, reusable, and highly efficient facemask for protection from respiratory droplets that cause COVID-19, other infection-causing organisms, and dust allergies. Several masks available in the market are single-use that would choke the environment through plastic pollution or are expensive for the commoner to afford. In the present study, the facemask incorporates a waste-derived polyethylene terephthalate (PET) layer and a non-woven polypropylene (PP) layer sandwiched between two tightly woven cotton layers. Combining these layers provides comfort and breathability, besides high bacterial and particulate filtration efficiency. Moreover, the unique PET layer provides mechanical strength and a 3D shape that enables hindrance-free speaking and prevents spectacle fogging. Compared to commercial N95 masks, the developed mask can be reused up to 30 washes and recycled with zero waste discharge ensuing green technology. Moreover, the mask was produced at an affordable cost of Rs. 17 (0.22 USD), including labor charges, and sold at a 100% profit margin @ Rs.35 (0.45 USD) per unit. Further, the mask was certified by neutral testing agencies and provided to a population of more than 6 lakhs, thus significantly contributing to the mitigation of COVID-19.

Personal protective equipment (PPE) disposal during COVID-19: An emerging source of microplastic and microfiber pollution in the environment

Waste generated by healthcare facilities during the COVID-19 pandemic has become a new source of pollution, particularly with the widespread use of single-use personal protective equipment (PPE). Releasing microplastics (MPs) and microfibers (MFs) from discarded PPE becomes an emerging threat to environmental sustainability. MPs/MFs have recently been reported in a variety of aquatic and terrestrial ecosystems, including water, deep-sea sediments, air, and soil. As COVID-19 spreads, the use of plastic-made PPE in healthcare facilities has increased significantly worldwide, resulting in massive amounts of plastic waste entering the terrestrial and marine environments. High loads of MPs/MFs emitted into the environment due to excessive PPE consumption are easily consumed by aquatic organisms, disrupting the food chain, and potentially causing chronic health problems in humans. Thus, proper management of PPE waste is critical for ensuring a post-COVID sustainable environment, which has recently attracted the attention of the scientific community. The current study aims to review the global consumption and sustainable management of discarded PPE in the context of COVID-19. The severe impacts of PPE-emitted MPs/MFs on human health and other environmental segments are briefly addressed. Despite extensive research progress in the area, many questions about MP/MF contamination in the context of COVID-19 remain unanswered. Therefore, in response to the post-COVID environmental remediation concerns, future research directions and recommendations are highlighted considering the current MP/MF research progress from COVID-related PPE waste.

Carbon footprint assessment of face masks in the context of the COVID-19 pandemic: Based on different protective performance and applicable scenarios

Widespread concerns have been raised about the huge environmental burden caused by massive consumption of face masks in the context of the COVID-19 pandemic. However, most of the existing studies only focus on the environmental impact associated with the product itself regardless of the actual usage scenarios and protective performance of products, resulting in unrealistic conclusions and poor applicability. In this context, this study integrated the product performance into the existing carbon footprint assessment methodology, with focus on the current global concerns regarding climate change. Computational case studies were conducted for different mask products applicable to the scenarios of low-, medium- and high-risk levels. The results showed that reusable cotton masks and disposable medical masks suitable for low-risk settings have a total carbon footprint of 285.484 kgCO2-eq/FU and 128.926 kgCO2-eq/FU respectively, with a break-even point of environmental performance between them of 16.886, which implies that cotton masks will reverse the trend and become more environmentally friendly after 17 washes, emphasizing the importance of improving the washability of cotton masks. Additionally, the total carbon footprints of disposable surgical masks and KN95 respirators were 154.328 kg CO2-eq/FU and 641.249 kg CO2-eq/FU respectively, while disposable medical masks and disposable surgical masks were identified as alternatives with better environmental performance in terms of medium- and high-risk environments respectively. The whole-life-cycle oriented carbon footprint evaluation further indicated that the four masks have greater potential for carbon emission reduction in the raw material processing and production processes. The results obtained in this study can provide scientific guidance for manufacturers and consumers on the production and use of protective masks. Moreover, the proposed model can be applied to other personal protective equipment with similar properties, such as protective clothing, in the future.

Plastic wastes in the time of COVID-19: Their environmental hazards and implications for sustainable energy resilience and circular bio-economies

The global scope of pollution from plastic waste is a well-known phenomenon associated with trade, mass consumption, and disposal of plastic products (e.g., personal protective equipment (PPE), viral test kits, and vacuum-packaged food). Recently, the scale of the problem has been exacerbated by increases in indoor livelihood activities during lockdowns imposed in response to the coronavirus disease 2019 (COVID-19) pandemic. The present study describes the effects of increased plastic waste on environmental footprint and human health. Further, the technological/regulatory options and life cycle assessment (LCA) approach for sustainable plastic waste management are critically dealt in terms of their implications on energy resilience and circular economy. The abrupt increase in health-care waste during pandemic has been worsening environmental quality to undermine the sustainability in general. In addition, weathered plastic particles from PPE along with microplastics (MPs) and nanoplastics (NPs) can all adsorb chemical and microbial contaminants to pose a risk to ecosystems, biota, occupational safety, and human health. PPE-derived plastic pollution during the pandemic also jeopardizes sustainable development goals, energy resilience, and climate control measures. However, it is revealed that the pandemic can be regarded as an opportunity for explicit LCA to better address the problems associated with environmental footprints of plastic waste and to focus on sustainable management technologies such as circular bio-economies, biorefineries, and thermal gasification. Future researches in the energy-efficient clean technologies and circular bio-economies (or biorefineries) in concert with a "nexus" framework are expected to help reduce plastic waste into desirable directions.

Shedding a light on ultraviolet-C technologies in the hospital environment

Ultraviolet (UV)-C light for disinfection has experienced a surge in popularity since the outbreak of COVID-19. Currently, many different UV-C systems, with varied properties that impact disinfection performance, are available on the market. Therefore this review aims to bundle the available information on UV-C disinfection to obtain an overview of its advantages, disadvantages, and performance-influencing parameters. A literature search was performed using the snowball search method in Google Scholar and PubMed with the following keywords: UV-C disinfection, UV-C dose, UV-C light source, UV-C repair mechanism, UV-C photoreactivation, and UV-C disinfection standards. The main parameters of UV-C disinfection are wavelength, dose, relative humidity, and temperature. There is no consensus about their optimal values, but, in general, light at a high dose and a spectrum of wavelengths containing 260 nm is preferred in an environment at room temperature with low relative humidity. This light can be generated by mercury-vapour, light-emitting diode (LED), pulsed-xenon, or excimer lamps. Multiple factors are detrimental to disinfection performance such as shadowing, a rough surface topography, a high level of contamination, repair mechanisms, and the lack of standardization. Also, there are health and safety risks associated with the UV-C technology when used in the proximity of people. UV-C disinfection systems have promising features and the potential to improve in the future. However, clarifications surrounding the different parameters influencing the technologies' effectiveness in hospital environment are needed. Therefore UV-C disinfection should currently be considered for low-level rather than high-level disinfection.

End-user acceptability of personal protective equipment disinfection for potential reuse: a survey of health-care workers in Aotearoa New Zealand

BACKGROUND

The COVID-19 pandemic has highlighted personal protective equipment (PPE) supply, distribution, and disposal issues worldwide. Calls to conserve PPE stocks and increase supply resulted in the rapid development of potential disinfection methods, with the possibility of improvements in medical waste reduction. However, how receptive health-care workers are to PPE reuse remains unknown. We aimed to examine the views of health-care workers who used PPE during the first COVID-19 wave in Aotearoa New Zealand, in relation to acceptability of PPE disinfection and reuse.

METHODS

In this multi-methods survey, health-care workers in New Zealand, were invited via a multimodal recruitment strategy to complete a survey regarding use of PPE during the first COVID-19 wave. Gender question options were male, female, gender diverse, or prefer not to say. Demographic differences in self-reported PPE reuse and acceptability were examined. The survey included closed (single-response, multi-response, ranking, and Likert-scale questions) and open-text questions. Any open-text comments were analysed with thematic analysis. The survey was built and deployed using Qualtrics software.

FINDINGS

1411 health-care workers completed the survey between Oct 7 and Nov 30, 2020. 1397 participants had gender data available (1140 [82%] female and 257 [18%] male) and 995 (74%) of 1347 were of New Zealand European ethnicity. PPE reuse was common and reported by 628 (45%) of the 1411 participants, with 396 (63%) of the 628 reporting reusing PPE multiple times in 1 day. Acceptability of the concept of PPE disinfection for potential reuse was high overall (1196 [85%] of 1411) but varied depending on the type of PPE. Thematic analysis confirmed that PPE reuse was already occurring and respondents recognised the potential benefits of reduced medical wastage and increased PPE supply. Important caveats for consideration included the availability of scientific evidence, level of negotiated risk, and trust in the organisation undertaking PPE disinfection, with clear communication about decontamination processes being crucial to acceptability.

INTERPRETATION

PPE reuse occurred frequently during the first wave of COVID-19 in New Zealand. Although support for the disinfection of PPE for reuse was high, the success of any future programmes to reuse PPE will require meaningful engagement and clear communication with health-care workers. Further research into PPE disinfection safety and logistics is warranted, alongside the development of standard operating procedures and clearly communicated policies for the end user, should this more sustainable health-care practice be planned for adoption in certain settings.

FUNDING

New Zealand Ministry of Business, Innovation and Employment (COVID-19 Innovation Acceleration Fund) and the Medical Assurance Society Foundation.

Conservation Practices for Personal Protective Equipment: A Systematic Review with Focus on Lower-Income Countries

During the start of the COVID-19 pandemic, shortages of personal protective equipment (PPE) necessitated unprecedented and non-validated approaches to conserve PPE at healthcare facilities, especially in high income countries where single-use disposable PPE was ubiquitous. Our team conducted a systematic literature review to evaluate historic approaches for conserving single-use PPE, expecting that lower-income countries or developing contexts may already be uniquely conserving PPE. However, of the 50 included studies, only 3 originated from middle-income countries and none originated from low-income countries. Data from the included studies suggest PPE remained effective with extended use and with multiple or repeated use in clinical settings, as long as donning and doffing were performed in a standard manner. Multiple decontamination techniques were effective in disinfecting single use PPE for repeated use. These findings can inform healthcare facilities and providers in establishing protocols for safe conservation of PPE supplies and updating existing protocols to improve sustainability and overall resilience. Future studies should evaluate conservation practices in low-resource settings during non-pandemic times to develop strategies for more sustainable and resilient healthcare worldwide.

Effectiveness of front line and emerging fungal disease prevention and control interventions and opportunities to address appropriate eco-sustainable solutions

Fungal pathogens contribute to significant disease burden globally; however, the fact that fungi are eukaryotes has greatly complicated their role in fungal-mediated infections and alleviation. Antifungal drugs are often toxic to host cells and there is increasing evidence of adaptive resistance in animals and humans. Existing fungal diagnostic and treatment regimens have limitations that has contributed to the alarming high mortality rates and prolonged morbidity seen in immunocompromised cohorts caused by opportunistic invasive infections as evidenced during HIV and COVID-19 pandemics. There is a need to develop real-time monitoring and diagnostic methods for fungal pathogens and to create a greater awareness as to the contribution of fungal pathogens in disease causation. Greater information is required on the appropriate selection and dose of antifungal drugs including factors governing resistance where there is commensurate need to discover more appropriate and effective solutions. Popular azole fungal drugs are widely detected in surface water and sediment due to incomplete removal in wastewater treatment plants where they are resistant to microbial degradation and may cause toxic effects on aquatic organisms such as algae and fish. UV has limited effectiveness in destruction of anti-fungal drugs where there is increased interest in the combination approaches such as novel use of pulsed-plasma gas-discharge technologies for environmental waste management. There is growing interest in developing alternative and complementary green eco-biocides and disinfection innovation. Fungi present challenges for cleaning, disinfection and sterilization of reusable medical devices such as endoscopes where they (example, Aspergillus and Candida species) can be protected when harboured in build-up biofilm from lethal processing. Information on the efficacy of established disinfection and sterilization technologies to address fungal pathogens including bottleneck areas that present high risk to patients is lacking. There is a need to address risk mitigation and modelling to inform efficacy of appropriate intervention technologies that must consider all contributing factors where there is potential to adopt digital technologies to enable real-time analysis of big data, such as use of artificial intelligence and machine learning. International consensus on standardised protocols for developing and reporting on appropriate alternative eco-solutions must be reached, particularly in order to address fungi with increasing drug resistance where research and innovation can be enabled using a One Health approach.

Influence of COVID-19 on the 10-year carbon footprint of the Nagoya University Hospital and medical research centre

BACKGROUND

Amidst the climate crisis, a key goal of the medical sector is to reduce its large carbon footprint. Although the Coronavirus disease 2019 (COVID-19) pandemic greatly impacted the medical sector, its influence on carbon footprints remains unknown. Therefore, the aim of this study was to evaluate changes in the carbon footprint of a university hospital with a medical research centre over the past 10 years.

METHODS

Data on electricity, gas, and water usage, pharmaceutical and medical supply costs, and waste amounts were recorded for Nagoya University Hospital from April 2010 to March 2021. The relevant emission factors were obtained from the Japanese government and the overall monthly carbon footprint was reported according to the Greenhouse Gas Protocol. The effect of the COVID-19 pandemic on the carbon footprint was then compared for three types of emission sources. Moreover, a regression model was used to plot quadratic functions as approximate functions using monthly carbon emissions and monthly average external temperatures. Finally, the monthly carbon footprint was calculated per hospital admission.

RESULTS

The overall carbon footprint of the hospital was 73,546 tCO2e in 2020, revealing an increase of 26.60% over the last 10 years. Carbon emissions from electricity consumption represented 26% of total emissions. The individual carbon footprints of pharmaceuticals, medical supplies, waste, and water usage also increased from 2010 to 2020. The overall monthly carbon footprint was positively correlated with the average monthly temperature (R2 = 0.7566, p < 0.001). Compared with 2019, the overall carbon footprint decreased by 2.19% in 2020. Moreover, the monthly carbon footprint per hospital admission increased significantly between 2018 (0.24 tCO2e/admission) and 2020 (0.26 tCO2e/admission) (p = 0.002).

CONCLUSION

The overall carbon footprint of the hospital generally increased over the last decade. During the COVID-19 epidemic in 2020, the carbon footprint decreased slightly, likely because of the reduced number of patients. However, the carbon footprint per admission increased, which was attributed to more complicated patient backgrounds because of the ageing population. Therefore, evaluation of carbon emissions in the medical sector is urgently required in order to act on the climate crisis as soon as possible.

Environmental policies for the treatment of waste generated by COVID-19: Text mining review

The rapid transmission of COVID-19 has meant that all economic and human efforts have been focused on confronting it, ignoring environmental aspects whose consequences are causing adverse situations all over the planet. The saturation of the sanitary system and confinement measures have multiplied the waste generated, which implies the need to adapt environmental policies to this new situation caused by the pandemic. It is a review article whose objective was to identify the environmental policies that would facilitate an adequate treatment of the waste generated by the pandemic. It was proposed to analyse the current lines of research developed on this paradigm, applying the text mining methodology. A systematic review of 111 studies published in environmental journals indexed in the Web of Science was carried out. The results identified three areas of interest: knowledge of transmission routes, management of the massive generation of plastics and appropriate treatment of solid waste in extreme situations. Leaders are called upon to implement the contingency plans to sustainably alleviate the enormous waste burden caused by society's adaptation to the restrictions imposed by the pandemic. Specifically, innovation aimed at achieving the reuse of medical products, the promotion of the circular economy and educational campaigns to promote clean environments should be encouraged.

Thermal degradation of hazardous 3-layered COVID-19 face mask through pyrolysis: Kinetic, thermodynamic, prediction modelling using ANN and volatile product characterization

Nowadays, wearing a 3-layered face mask (3LFM) to protect against coronavirus illness (COVID-19) has become commonplace, resulting in massive, hazardous solid waste. Since most of them are infected with viruses, a secure way of disposal is necessary to prevent further virus spread. Pyrolysis treatment has recently developed as an effective method for disposing of such hazardous waste and consequently converting them into energy products. In this regard, the goal of the present study is to physicochemically characterize the 3LFM followed by pyrolysis in a TGA to evaluate the pyrolysis performance, kinetic, and thermodynamic parameters and in a semi-batch reactor to characterize the volatile product. Furthermore, an artificial neural network (ANN) was used to forecast thermal deterioration data. The results demonstrated a strong correlation between real and anticipated values. The study proved the relevance of the ANN model and the applicability of pyrolysis for disposing of 3LFM while simultaneously producing energy products.

Personal protective equipment (PPE) and plastic pollution during COVID-19: strategies for a sustainable environment

Amid the COVID-19 pandemic, plastic medical waste poses significant threat to our land, aquatic and atmospheric ecosystems via generation of criteria pollutants (micro/nano plastics and greenhouse gas emissions). Global strategic planning is urgently needed for environmental sustainability coupled with integrated efforts by the governments, industries and academia. Rational utilization of single-use plastic-based PPE with efficient recycling and waste disposal methods should be adopted as interim strategies till more sustainable solutions are designed and implemented. Redesigning plastic production decoupled from fossil fuels, such as Bioplastics, is a way towards sustainable plastic alternatives.

Biomedical waste disposal practices among healthcare workers during COVID-19 pandemic in secondary and tertiary care facilities of Tamil Nadu

Purpose

The ongoing COVID-19 crisis has drastically changed the practice of biomedical waste (BMW) generation and management. Studies venturing into the facility level preparedness at various levels of healthcare delivery during pandemic situation is the need of the hour. Hence, we did this study to assess the BMW disposal practices amongst secondary and tertiary health facilities during COVID-19 pandemic in Tamil Nadu.

Materials and methods

This cross-sectional survey was conducted amongst doctors, nurses and allied healthcare staffs across various departments in 18 public health facilities across six districts of Tamil Nadu. Multivariable logistic regression analysis was done based on the random-intercept model to assess the determinants of BMW disposal practices. The effect size was reported as adjusted odds ratio (aOR) with 95% confidence interval (CI).

Results

In total, 2593 BMW disposal observations were made. During nearly three-fourth of the observations (73%), the BMW was disposed of appropriately. Nurses (aOR ​= ​1.54; 95%CI: 1.06–2.23) and doctors (aOR ​= ​1.60; 95%CI: 1.05–2.45), healthcare workers in Paediatrics department (aOR ​= ​1.77; 95%CI: 1.13–2.76), healthcare workers in inpatient department (aOR ​= ​2.77; 95%CI: 1.95–3.94) and injection outpatient department (aOR ​= ​2.69; 95%CI: 1.59–4.47) had significantly better odds of having appropriate BMW disposal practices.

Conclusion

Our study shows that nearly during three-fourth of the observations, healthcare workers performed appropriate BMW disposal practices. However, measures should be taken to achieve 100% compliance by healthcare workers especially the target groups identified in our study by allocating appropriate resources and periodically monitor the BMW disposal practices.

Effects of chemical and autoclave sterilization treatments on medical personal protective equipment made of nonwoven polypropylene fibers for recycling

Medical personal protective equipment (PPE) made from nonwoven thermoplastic fibers has been intensively used, resulting in a large amount of biohazardous waste. Sterilization is indispensable before recycling medical waste. The aim of this work is to evaluate the effects of the decontamination treatments and help properly recycle the PPE materials. The study investigated the effects of three disinfection treatments (NaClO, H₂O₂, and autoclave) on chemical composition, molecular weight, thermal properties, crystallinity, crystallization kinetics, and mechanical tension of three types of PPE (Gown #1, Gown #2, and Wrap) made of isotactic polypropylene fibers. The chemical compositions of the materials were not evidently affected by any of the treatments. However, the M_w of the polymers decreased about 2–7% after the treatments, although the changes were not statistically significant. The treatments barely affected the melting and crystallization temperatures and the maximum force at break, but they tended to elevate the thermal degradation temperatures. Although the treatments did not notably influence the crystallinities, crystallization rates and crystal growths were altered based on the Avrami model regression. Since the detected changes would not significantly affect polymer processing, the treated materials were suitable for recycling. Meanwhile, evident differences in the three types of raw materials were recorded. Their initial properties fluctuated notably, and they often behaved differently during the treatments, which could affect recycling operation. Recyclers should test and sort the raw materials to assure product quality. The results in this study provide fundamental data for recycling medical PPE to reduce its environmental footprint.

To what extent do waste management strategies need adaptation to post-COVID-19?

The world has been grappling with the crisis of the COVID-19 pandemic for more than a year. Various sectors have been affected by COVID-19 and its consequences. The waste management system is one of the sectors affected by such unpredictable pandemics. The experience of COVID-19 proved that adaptability to such pandemics and the post-pandemic era had become a necessity in waste management systems and this requires an accurate understanding of the challenges that have been arising. The accurate information and data from most countries severely affected by the pandemic are not still available to identify the key challenges during and post-COVID-19. The documented evidence from literature has been collected, and the attempt has been made to summarize the rising challenges and the lessons learned. This review covers all raised challenges concerning the various aspects of the waste management system from generation to final disposal (i.e., generation, storage, collection, transportation, processing, and burial of waste). The necessities and opportunities are recognized for increasing flexibility and adaptability in waste management systems. The four basic pillars are enumerated to adapt the waste management system to the COVID-19 pandemic and post-COVID-19 conditions. Striving to support and implement a circular economy is one of its basic strategies.

Examining challenges and multi-strategic approaches in waste management during the COVID-19 pandemic: A systematic review

The COVID-19 pandemic has a negative impact on the environment. Waste generation and improper management during the COVID-19 pandemic posed a major threat to human health and the environment. Irregular and improper waste collection, handling, suspension of waste recycling and unsanitary disposal were all important issues in the processing and management of generated waste. This study emphasised a systematic review and content analysis to categorise all types of waste management (WM) during the COVID-19 pandemic to accomplish a well understanding of the relation between the COVID-19 pandemic and its impacts on WM within the literature. In this systematic review, a number of published papers on different aspects of WM during March 2020 to February 2021 were considered in order to identify major challenges in handling WM during the pandemic time and highlight multi-strategic approaches suggested. A content analysis of the 58 relevant papers was carried out by incorporating different types of WM at local as well as global scales. The present review results revealed that the COVID-19 has impacted the quantity and composition of waste, and the crisis caused by the pandemic has also altered the nature of global WM system. A comprehensive analysis on how the systems of WM were affected through the advancement of COVID-19 and what would be the healthier solutions was also highlighted in this systematic review. The results of this systematic review would be beneficial for better policymakers to holistically address potential future pandemics, if any.

Disaster preparedness in assisted reproductive technology

The American Society for Reproductive Medicine compels centers providing reproductive medicine care to develop and implement an emergency preparedness plan in the event of a disaster. Reproductive care is vulnerable to disruptions in energy, transportation, and supply chains as well as may have potential destructive impacts on infrastructure. With the relentless progression of events related to climate change, centers can expect a growing number of such disruptive events and must prepare to deal with them. This article provides a case study of the impact of Hurricane Sandy on one center in New York City and proposes recommendations for future preparedness and mitigation.

Environmental impact of COVID-19 Vaccine waste: A perspective on potential role of natural and biodegradable materials

The mass immunization is the prioritised post-pandemic phase offering preventive countermeasure for COVID-19 pandemic. However, it is crucial to tackle the environmental impact of COVID-19 vaccine waste for sustainable vaccination management because a prolonged immunisation campaign is expected. As the pace of vaccine production, distribution and mass vaccination has been expedited, there is a simultaneous rise in plastic derived vaccine waste including syringes, needles, used/unused vaccine vials, vaccine packaging, and protective gear (surgical facemasks, gloves, face shields, etc). Henceforth, in view of the repercussions of heaping plastic waste in the environment, this article provides a perspective on the usage of synthetic and natural materials as potential substituents for vaccination tools. The biodegradable polymeric gums such as cellulose, gellan, pectin, etc. have been successfully applied for the fabrication of surgical facemasks. The highly suggestive practice is replacement of conventional polypropylene based plastics with bioplastics or paper for vaccine packaging. The usage of biodegradable bio-plastics as packaging material along with environmentally friendly face masks can help to achieve the zero waste approach. The discussion in the article significantly highlights the necessity of opting sustainable solutions of disinfecting and substituting vaccination tools for an environment friendly ongoing vaccination campaign.

Impact of waste of COVID-19 protective equipment on the environment, animals and human health: a review

During the Corona Virus Disease 2019 (COVID-19) pandemic, protective equipment, such as masks, gloves and shields, has become mandatory to prevent person-to-person transmission of coronavirus. However, the excessive use and abandoned protective equipment is aggravating the world's growing plastic problem. Moreover, above protective equipment can eventually break down into microplastics and enter the environment. Here we review the threat of protective equipment associated plastic and microplastic wastes to environments, animals and human health, and reveal the protective equipment associated microplastic cycle. The major points are the following:1) COVID-19 protective equipment is the emerging source of plastic and microplastic wastes in the environment. 2) protective equipment associated plastic and microplastic wastes are polluting aquatic, terrestrial, and atmospheric environments. 3) Discarded protective equipment can harm animals by entrapment, entanglement and ingestion, and derived microplastics can also cause adverse implications on animals and human health. 4) We also provide several recommendations and future research priority for the sustainable environment. Therefore, much importance should be attached to potential protective equipment associated plastic and microplastic pollution to protect the environment, animals and humans.

A novel hybrid multi-criteria group decision-making approach with intuitionistic fuzzy sets to design reverse supply chains for COVID-19 medical waste recycling channels

The COVID-19 pandemic has led to exponential growth in COVID-19 medical waste (CMW) generation worldwide. This tremendous growth in CMW is a major transmission medium for COVID-19 virus and thus brings serious challenges to medical waste (MW) management. Designing an efficient and reliable CMW reverse supply chain in this situation can help to prevent epidemic spread. Nowadays, the assessment of CMW recycling channels has become a challenging mission for health-care institutions, especially in developing countries. It can be seen as a complex multi-criteria group decision-making (MCGDM) problem that requires the consideration of multiple conflicting tangible and intangible criteria. Nevertheless, few academics have been concerned about this issue. Moreover, current MCGDM methods have limited support for CMW recycling channel evaluation and they do not consider hospitals' reverse supply chain strategy when evaluating. Thus, this study presents a novel MCGDM approach based on intuitionistic fuzzy sets (IFSs) and the VIKOR method for assessing the capacity of CWM recycling channels. According to the characteristics of CMW, processing flow and the TOE (Technology, Organization and Environment) theoretical framework, we established a new CMW recycling channel capacity evaluation index system which makes our proposed method more targeted and efficient. In the decision-making process, we integrate the best-worst method (BWM) and entropy to determine the decision makers (DMs) weighting in a more comprehensive way, considering both subjective and objective criteria, which was ignored by many MCGDM methods. A new aggregation operator called IFWA is proposed by us, considering the priority of DMs. Based on both the ranking of capacity and disposal charges, we then position the alternatives in the recycling channel priority index (RCPI) matrix constructed by us. According to this PCPI matrix and the reverse supply chain strategy of hospitals, a more reasonable CMW allocation strategy is determined and a more efficient CMW reverse supply chain is designed. Finally, a real case study from Wuhan was examined to illustrate the validation of our approach.

Use of COVID-19 single-use face masks to improve the rutting resistance of asphalt pavement

Today, the world faces an enormous increase in plastic waste pollution caused by the emergence of the COVID-19 pandemic. Plastic pollution has been already one of the greatest threats to our planet before the Coronavirus outbreak. The disposal of millions of personal protective equipment (PPE) in the form of face masks has significantly contributed to the generation of plastic waste and has exacerbated plastic pollution. In an attempt to mitigate pollution caused by the excess PPE waste, an innovative way was developed in this research to reduce pandemic-generated wastes by using the shredded face mask (SFM) fibers as an additive to hot mix asphalt (HMA) to enhance rutting resistance. Rutting or permanent deformation is one of the major distresses of asphalt pavement. Since the SFM behaves as a semi-liquid between 115.5 and 160 °C, which is in the range of HMA mixing and paving temperature, it can function as a binding agent to glue the aggregates. When the pavement is cooled down to ambient temperature, the hardened SFM can provide stability and stiffness to HMA. Based on the results of this study, the modified mixes exhibited excellent resistance to permanent deformation under the Asphalt Pavement Analyzer (APA), as rutting depth values were reduced from 3.0 mm to 0.93 mm by increasing the SFM content from 0% to 1.5%. From the rutting test results and premature distress mechanism study, the appropriate addition of SFM modifiers could improve the high-temperature properties of HMA that can be used to strengthen high-compression and shearing zones in the pavement structure.

Supercritical CO2 sterilization: An effective treatment to reprocess FFP3 face masks and to reduce waste during COVID-19 pandemic

The outbreak of COVID-19 pandemic unveiled an unprecedented scarcity of personal protective equipment (PPE) available in sanitary premises and for the population worldwide. This situation fostered the development of new strategies to reuse PPE that would ensure sterility and, simultaneously, preserve the filtering properties of the materials. In addition, the reuse of PPEs by reprocessing could reduce the environmental impact of the massive single-use and disposal of these materials. Conventional sterilization techniques such as steam or dry heat, ethylene oxide, and gamma irradiation may alter the functional properties of the PPEs and/or leave toxic residues. Supercritical CO2 (scCO2)-based sterilization is herein proposed as a safe, sustainable, and rapid sterilization method for contaminated face masks while preserving their performance. The functional (bacterial filtration efficiency, breathability, splash resistance, straps elasticity) properties of the processed FFP3 face masks were evaluated after 1 and 10 cycles of sterilization. Log-6 sterilization reduction levels were obtained for face masks contaminated with Bacillus pumilus endospores at mild operating conditions (CO2 at 39 °C and 100 bar for 30 min) and with low contents of H2O2 (150 ppm). Physicochemical properties of the FFP3 face masks remained unchanged after reprocessing and differences in efficacy were not observed neither in the filtration tests, following UNE-EN 14683, nor in the integrity of FFP3 filtration after the sterilization process. The herein presented method based on scCO2 technology is the first reported protocol achieving the reprocessing of FFP3 masks up to 10 cycles while preserving their functional properties.

Microplastics waste in environment: A perspective on recycling issues from PPE kits and face masks during the COVID-19 pandemic

During the COVID-19 pandemic, the extensive use of face masks and protective personal equipment (PPE) kits has led to increasing degree of microplastic pollution (MP) because they are typically discarded into the seas, rivers, streets, and other parts of the environment. Currently, microplastic (MP) pollution has a negative impact on the environment because of high-level fragmentation. Typically, MP pollution can be detected by various techniques, such as microscopic analysis, density separation, and Fourier transform infrared spectrometry. However, there are limited studies on disposable face masks and PPE kits. A wide range of marine species ingest MPs in the form of fibers and fragments, which directly affect the environment and human health; thus, more research and development are needed on the effect of MP pollution on human health. This article provides a perspective on the origin and distribution of MP pollution in waterbodies (e.g., rivers, ponds, lakes, and seas) and wastewater treatment plants, and reviews the possible remediation of MP pollution related to the excessive disposal of face masks and PPE kits to aquatic environments.

Plastic Waste Management towards Energy Recovery during the COVID-19 Pandemic: The Example of Protective Face Mask Pyrolysis

This paper presents an assessment of the impact of the COVID-19 pandemic on the waste management sector, and then, based on laboratory tests and computer calculations, indicates how to effectively manage selected waste generated during the pandemic. Elemental compositions—namely, C, H, N, S, Cl, and O—were determined as part of the laboratory tests, and the pyrolysis processes of the above wastes were analysed using the TGA technique. The calculations were performed for a pilot pyrolysis reactor with a continuous flow of 240 kg/h in the temperature range of 400–900 °C. The implemented calculation model was experimentally verified for the conditions of the refuse-derived fuel (RDF) pyrolysis process. As a result of the laboratory tests and computer simulations, comprehensive knowledge was obtained about the pyrolysis of protective masks, with particular emphasis on the gaseous products of this process. The high calorific value of the pyrolysis gas, amounting to approx. 47.7 MJ/m3, encourages the management of plastic waste towards energy recovery. The proposed approach may be helpful in the initial assessment of the possibility of using energy from waste, depending on its elemental composition, as well as in the assessment of the environmental effects.

Impacts of Export Restrictions on the Global Personal Protective Equipment Trade Network During COVID-19

The COVID-19 pandemic has caused a dramatic surge in demand for personal protective equipment (PPE) worldwide. Many countries have imposed export restrictions on PPE to ensure the sufficient domestic supply. The surging demand and export restrictions cause shortage contagions on the global PPE trade network. Here, an integrated network model is developed, which integrates a metapopulation model and a threshold model, to investigate the shortage contagion patterns. The metapopulation model captures disease contagion across countries. The threshold model captures the shortage contagion on the global PPE trade network. Due to the Pareto distribution in global exports, the shortage contagion pattern is mainly determined by the export restriction policies of the top exporters. Export restrictions exacerbate the shortages of PPE and cause the shortage contagion to transmit even faster than the disease contagion. To some extent, export restrictions can provide benefits for self-sufficient countries, at the sacrifice of immediate economic shocks at not-self-sufficient countries. With export restrictions, a large amount of PPE is hoarded instead of being distributed to where it is most needed, particularly at the early stage. Cooperation between countries plays an essential role in preventing global shortages of PPE regardless of the production level. Except for promoting global cooperation, governments and international organizations should take actions to reduce supply chain barriers and work together to increase global PPE production.

Application of COVID-19 single-use shredded nitrile gloves in structural concrete: Case study from Australia

The use of single-use nitrile gloves has been on a sharp incline since the Coronavirus pandemic first started in late 2019. This led to a significant increase in the generation of this clinical waste that requires various recycling solutions to reduce its environmental impact from disposal or incineration. This paper explores its application in structural concrete by adding shredded nitrile gloves at 0.1%, 0.2%, and 0.3% of the volume of concrete. The compressive strength, modulus of elasticity, ultrasonic pulse velocity, and SEM-EDS analysis were undertaken to ascertain the effect of different concentrations of shredded nitrile gloves on the mechanical properties, quality of concrete, and its bond performance with the cement matrix. The results demonstrate that the inclusion of up to 0.2% of shredded nitrile gloves can provide ~22% improvement in the compressive strength of blended concrete composites at 28-days of curing. In comparison, the inclusion of 0.3% of shredded nitrile gloves shows improvements of ~20% in compressive strength at 28-days. The SEM-EDS analysis shows a very good bond formation between the nitrile rubber and the cement matrix with no gap identified in the interfacial transition zone (ITZ).

Bioeconomy and green recovery in a post-COVID-19 era

The spread of the COVID-19 pandemic has generated a health crisis and repetitive lockdowns that disrupted different economic and societal segments. As the world has placed hope on the vaccination progress to bring back the socio-economic "normal," this article explores how the bioeconomy can enhance the resilience and sustainability of bio-based, food, and energy systems in the post-COVID-19 era. The proposed recovery approach integrates technological innovations, environment, ecosystem services, "biocities," food, rural economies, and tourism. The importance of integrating culture, arts, and the fashion industry as part of the recovery is underlined towards building a better bioeconomy that, together with environmental safeguards, promotes socio-cultural and economic innovations. This integration could be achieved supporting communities and stakeholders to diversify their activities by combining sustainable production with decarbonization, stimulating private investments in this direction and monitoring the resulting impact of mitigation measures. Food systems should become more resilient in order to allow adapting rapidly to severe crises and future shocks, while it is important to increase circularity towards the valorization of waste, the integration of different processes within the biorefinery concept and the production of bio-based products and biofuels.

Resilience of Brazilian health-care professionals during the pandemic

Purpose

Health-care professionals are caring for patients in unprecedented circumstances during the COVID-19 pandemic, dealing with scarce resources, higher demand and uncertain outcomes. In this context, the purpose of this study is to explore the views of health-care professionals regarding their work conditions and perceived impacts of the pandemic on their health, as well as the role of resilience and improvisation in face of the new challenges.

Design/methodology/approach

This exploratory and qualitative study carried out semi-structured interviews with eleven health-care professionals from three Brazilian states that have been working in intensive care settings during the pandemic.

Findings

The pandemic has posed a great personal and professional burden on the professionals, impacting their physical and mental health. It also has required them greater resilience and improvisation capabilities to adequately perform work-related activities.

Practical implications

In addition to individual-level attitudes, the results suggest that aspects in the government, society, personal relationships and providers domains influence the effects of the pandemic on the health-care professionals and how they cope with the ongoing crisis. Such a multifactorial approach should therefore be considered by health managers.

Originality/value

With no similar effort identified, this study emphasizes the relevance of discussing the pandemic burden on frontline professionals and intends to be useful for health practitioners, managers, academics and policymakers.

Biomedical waste generation and management during COVID-19 pandemic in India: challenges and possible management strategies

The COVID-19 pandemic has resulted in the massive generation of biomedical waste (BMW) and plastic waste (PW). This sudden spike in BMW and PW has created challenges to the existing waste management infrastructure, especially in developing countries. Safe disposal of PW and BMW is essential; otherwise, this virus will lead to a waste pandemic. This paper reviews the generation of BMW and PW before and during the COVID-19 pandemic, the regulatory framework for BMW management, policy interventions for COVID-19-based BMW (C-BMW), the capacity of BMW treatment and disposal facilities to cope with the challenges, possible management strategies, and perspectives in the Indian context. This study indicated that policy intervention helped minimize the general waste treated as C-BMW, especially during the second pandemic. Inadequacy of common BMW treatment facilities' (CBMWTFs) capacity to cope with the BMW daily generation was observed in some states resulting in compromised treatment conditions. Suggestions for better management of BMW and PW include decontamination of used personal protective equipment (PPEs) and recycling, alternate materials for PPEs, segregation strategies, and use of BMW for co-processing in cement kilns. All upcoming CBMWTFs should be equipped with higher capacity and efficient incinerators for the sound management of BMW. Post-pandemic monitoring of environmental compartments is imperative to assess the possible impacts of pandemic waste.

Medical Waste from COVID-19 Pandemic-A Systematic Review of Management and Environmental Impacts in Australia

The coronavirus (COVID-19) pandemic has created a global medical emergency. The unforeseen occurrence of a pandemic of this magnitude has resulted in overwhelming levels of medical waste and raises questions about management and disposal practices, and environmental impacts. The amount of medical waste generated from COVID-19 since the outbreak is estimated to be 2.6 million tons/day worldwide. In Australia, heaps of single-use gowns, facemasks/face shields, aprons, gloves, goggles, sanitizers, sharps, and syringes are disposed everyday as a result of the pandemic. Moreover, the establishment of new home/hotel quarantine facilities and isolation/quarantine centres in various Australian states and territories have increased the risks of transmission among people in these facilities and the likelihoods of general waste becoming contaminated with medical waste. This warrants the need to examine management and disposal practices implemented to reduce the transmission and spread of the virus. This study reviews the various management and disposal practices adopted in Australia for dealing with medical waste from the COVID-19 pandemic and their impacts on public health and the environment. To achieve the aims of this study, prior studies from 2019-2021 from various databases are collected and analysed. The study focuses on generation of medical waste from COVID-19, management and disposal methods, current problems/challenges and environmental and public health impacts. Considering the enormous risks involved and the significance of appropriate handling and disposal of medical waste from COVID-19, this study provides insights on short and long term responses towards managing COVID-19 waste in Australia. The study contributes to Australia's efforts against the transmission and spread of COVID-19 and provides recommendations for the development of workable and sustainable strategies for mitigating similar pandemics in the future.

Facemask Global Challenges: The Case of Effective Synthesis, Utilization, and Environmental Sustainability

Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a rapidly spreading pandemic and is severely threatening public health globally. The human-to-human transmission route of SARS-CoV-2 is now well established. The reported clinical observations and symptoms of this infection in humans appear in the range between being asymptomatic and severe pneumonia. The virus can be transmitted through aerosols and droplets that are released into the air by a carrier, especially when the person coughs, sneezes, or talks forcefully in a closed environment. As the disease progresses, the use and handling of contaminated personal protective equipment and facemasks have become major issues with significant environmental risks. Therefore, providing an effective method for treating used/contaminated facemasks is crucial. In this paper, we review the environmental challenges and risks associated with the surge in facemask production. We also discuss facemasks and their materials as sources of microplastics and how disposal procedures can potentially lead to the contamination of water resources. We herein review the potential of developing nanomaterial-based antiviral and self-cleaning facemasks. This review discusses these challenges and concludes that the use of sustainable and alternative facemask materials is a promising and viable solution. In this context, it has become essential to address the emerging challenges by developing a new class of facemasks that are effective against the virus, while being biodegradable and sustainable. This paper represents the potentials of natural and/or biodegradable polymers for manufacturing facemasks, such as wood-based polymers, chitosan, and other biodegradable synthetic polymers for achieving sustainability goals during and after pandemics.

Unmasking emerging issues in solid waste management: Knowledge and self-reported practices on the discarded disposable masks during the COVID-19 pandemic in the Philippines

The COVID-19 global health crisis has resulted in the emergence of a new type of solid waste-inappropriately discarded disposable masks (DMs)-posing serious risks to the public health and to the environment. This study assessed the knowledge-("K") and self-reported practices-("P") of the general public in DM waste management. A researcher-developed instrument was utilized to gather data with a reliability coefficient index of 0.94. The survey was participated in by 13,116 online users. Pearson r and multiple linear regression were performed to test the relationship between the participants' demographic characteristics and their K and P. Results revealed that the participants obtained a weighted mean and standard deviation of 1.15±0.10, which shows that 11,597 or 88.41% are knowledgeable on solid waste disposal and management. The self-reported practices of the participants obtained weighted mean and standard deviation rating of 2.16±0.10, which is interpreted as "Always Practiced". This signifies that the participants adequately practiced the essentials in disposing DMs. Furthermore, there is a significant relationship between K and P with their demographic characteristics on disposing DMs like age, sex, level of education, annual income, and type of residence. The obtained Pearson r=-0.178 (p<.01) indicates that the level of knowledge of the participants is significantly related to the practices they apply in disposing used DMs. As a recommendation, campaigns and interventions on the proper disposal of DMs should be put forward and implemented, utilizing various social media resources and platforms that are conveniently accessible to the general public.

Additive Manufacturing Interventions during the COVID-19 Pandemic: South Africa

Additive manufacturing (AM), also known as 3D printing, is considered a renaissance of the manufacturing industry. Its unique capability of manufacturing 3D objects with intricate geometrical configurations has been used to produce hospital equipment and personal protective equipment (PPE) in an attempt to curb the spread of the COVID-19 pandemic in South Africa. The technology has been used by different research units to produce ventilators, respirator face masks, oscillating respiratory devices, oxygen connectors, oxygen splitters, non-invasive ventilation helmets, reusable clinician PPE, visor frames for face shields, etc. Despite the efforts of the AM community in South Africa, COVID-19 infections have continued to increase in the country. It came to light that technological interventions (including AM) alone cannot prevent the spread of the virus without the corresponding adaptive behavioural changes, such as adhering to COVID-19 prevention protocols (washing of hands, social distancing, etc.). It could be postulated that the spread of COVID-19 can only be prevented by inter-marrying the technological interventions (AM) with adaptive behavioural changes.

To assess the knowledge, attitude and practices in biomedical waste management among health care workers in dedicated COVID hospital in Bangalore

Background

In this pandemic of COVID-19, the highest amount of infective material, biomedical waste is generated in hospitals and it is frequently handled by the healthcare workers irrespective of cadres. Hence the awareness of healthcare workers in regards with biomedical waste (BMW) management is crucial in this pandemic. This study is therefore conducted to assess the knowledge, attitude and practices in BMW management among health care workers in our institution.

Results

A total of 280 subjects consisting of doctors, nursing staff and group D workers were included in the study after obtaining informed consent. The knowledge among healthcare workers was satisfactory, but comparatively group D workers were lagging behind. Overall they all have a good attitude towards BMW management but practices on BMW management needs improvement mostly among group D workers.

Conclusions

There have to be regular training programmes on biomedical waste management and its hazards for all the healthcare workers including group D workers. Along with educational intervention, strict implementation of biomedical waste management guidelines with its monitoring at all levels is also very much essential.

Environmental impact of increased soap consumption during COVID-19 pandemic: Biodegradable soap production and sustainable packaging

A year into the coronavirus disease 2019 pandemic, the role of washing hands with soap and hand disinfectants is unavoidable as a primary way to control the infection spread in communities and healthcare facilities. The extraordinary surge in demand for handwashing products has led to environmental concerns. Since soaps are complex mixtures of toxic and persistent active ingredients, the prudent option is to promote eco-friendly replacements for the current products. On the other hand, with the increase in soap packaging waste production, soap packaging waste management and recycling become essential to reduce environmental impact. This systematic review aimed to collect some recent methods for identifying biodegradable and sustainable raw materials to produce and package cleaning agents, especially soap.

The impact of COVID-19 on supply decision-makers: the case of personal protective equipment in Spanish hospitals

BACKGROUND

The COVID-19 pandemic has been recognized as a trigger for redefining supply chains at the global level, and has created an intense debate within the academic community and among policy-makers and practitioners. Among other industries, health care has been dramatically hit by the scarcity of "medical products," specifically for personal protective equipment (PPE-like), due to supply chain disruptions coupled with dramatically increased demand. We aimed to analyze how the scarcity of PPE-like during the COVID-19 pandemic has modified the behavior of decision-makers in the PPE-like supply chain at the hospital level, and to explore what changes could be implemented to cope with future PPE-like shortages.

METHODS

We used an explorative approach based on semi-structured interviews with key informants in the Spanish health care industry. More specifically, we held interviews to industry experts at three hospitals in three Spanish regions to map the consequences of the COVID-19 pandemic onto the buying decision-making process.

RESULTS

Different strategies were developed by decision-makers at hospitals before, during, and after the first wave of the COVID-19 pandemic in Spain. Our paper offers two main findings: a) decision-makers changed their purchasing behavior from a cost main driver to guaranteeing the availability of supplies; b) they supported the idea of giving more "strategic autonomy" to Spain or Europe through back and nearshoring decisions.

CONCLUSIONS

This paper could be of interest to health care management at the national, regional, and hospital levels, as well as for policy-makers, since it could help to establish and configure policies to support the sourcing of medical products (specifically PPE-like) to anticipate potential supply disruptions. Our paper contributes to the limited existing literature on how purchasing strategies at the decision-maker level and supply vary in the health care industry when a public health crisis appears, and what potential solutions might be for policy-makers and practitioners involved in the health care industry.