Greenhouse gas emission from small clinics solid waste management scenarios in an urban area of an underdeveloping country: A life cycle perspective

Identifying Environmental Impact Factors for Sustainable Healthcare: A Scoping Review

The healthcare industry has a substantial impact on the environment through its use of resources, waste generation and pollution. To manage and reduce its impact, it is essential to measure the pressures of healthcare activities on the environment. However, research on factors that can support these measurement activities is unbalanced and scattered. In order to address this issue, a scoping review was conducted with the aims of (i) identifying and organizing factors that have been used to measure environmental impact in healthcare practice and (ii) analyzing the overview of impact factors in order to identify research gaps. The review identified 46 eligible articles publishing 360 impact factors from original research in PubMed and EBSCO databases. These factors related to a variety of healthcare settings, including mental healthcare, renal service, primary healthcare, hospitals and national healthcare. Environmental impacts of healthcare were characterized by a variety of factors based on three key dimensions: the healthcare setting involved, the measurement component or scope, and the type of environmental pressure. The Healthcare Environmental Impact Factor (HEIF) scheme resulting from this study can be used as a tool for selecting measurable indicators to be applied in quality management and as a starting point for further research. Future studies could focus on standardizing impact factors to allow for cross-organization comparisons and on expanding the HEIF scheme by addressing gaps.

Evaluation of pre-treated healthcare wastes during COVID-19 pandemic reveals pathogenic microbiota, antibiotics residues, and antibiotic resistance genes against beta-lactams

The disposal of healthcare waste without prior elimination of pathogens and hazardous contaminants has negative effects on the environment and public health. This study aimed to profile the complete microbial community and correlate it with the antibiotic compounds identified in microwave pre-treated healthcare wastes collected from three different waste operators in Peninsular Malaysia. The bacterial and fungal compositions were determined via amplicon sequencing by targeting the full-length 16S rRNA gene and partial 18S with full-length ITS1-ITS2 regions, respectively. The antibiotic compounds were characterized using high-throughput spectrometry. There was significant variation in bacterial and fungal composition in three groups of samples, with alpha- (p-value = 0.04) and beta-diversity (p-values <0.006 and < 0.002), respectively. FC samples were found to acquire more pathogenic microorganisms than FA and FV samples. Paenibacillus and unclassified Bacilli genera were shared among three groups of samples, meanwhile, antibiotic-resistant bacteria Proteus mirabilis, Enterococcus faecium, and Enterococcus faecalis were found in modest quantities. A total of 19 antibiotic compounds were discovered and linked with the microbial abundance detected in the healthcare waste samples. The principal component analysis demonstrated a positive antibiotic-bacteria correlation for genera Pseudomonas, Aerococcus, Comamonas, and Vagococcus, while the other bacteria were negatively linked with antibiotics. Nevertheless, deep bioinformatic analysis confirmed the presence of bla_TEM-1 and penP which are associated with the production of class A beta-lactamase and beta-lactam resistance pathways. Microorganisms and contaminants, which serve as putative indicators in healthcare waste treatment evaluation revealed the ineffectiveness of microbial inactivation using the microwave sterilization method. Our findings suggested that the occurrence of clinically relevant microorganisms, antibiotic contaminants, and associated antibiotic resistance genes (ARGs) represent environmental and human health hazards when released into landfills via ARGs transmission.

Estimating & comparing greenhouse gas emissions for existing intramuscular COVID-19 vaccines and a novel thermostable oral vaccine

BACKGROUND

Climate impacts are rarely considered in health impact and economic assessments of public health programs. This study estimates the greenhouse gas (GHG) emissions averted by a novel oral SARS-CoV-2 (COVID-19) vaccine compared with four existing intramuscular vaccines: AstraZeneca's COVISHIELD®, Pfizer/BioNTech's COMIRNATY®, Moderna's mRNA-1273, and Johnson & Johnson's Ad26.COV2.S COVID-19 vaccine.

METHODS

We estimated GHG emissions averted for five vaccine modalities across nine countries. GHG emissions averted were derived from differences in cold chain logistics, production of vaccine supplies, and medical waste disposal. Countryspecific data including population coverage and electricity production mix were included in GHG emissions calculations. Results are presented in averted GHG per vaccine course and country level based on modeled vaccination demand.

FINDINGS

Per course, an oral vaccine is estimated to avert between 0.007 and 0.024 kgCO₂e compared with Johnson & Johnson, 0.013 to 0.048 kgCO₂e compared with AstraZeneca, 0.23 to 0.108 kgCO₂e compared with Moderna, and 0.134 to 0.466 kgCO₂e compared with Pfizer/BioNTech. The total GHG averted varied across countries based upon predicted demand, mix of electrical production, and vaccination strategy with the largest emissions reductions projected for India and the United States.

INTERPRETATION

Our results demonstrate large potential GHG emissions reductions from the use of oral vs. intramuscular vaccines for mass COVID-19 vaccination programs. Up to 82.25 million kgCO₂e could be averted from utilization of an oral vaccine in the United States alone, which is equivalent to eliminating 17,700 automobiles from the road for one year.

FUNDING

Funding was provided by Vaxart, Inc. Vaxart, Inc. is currently developing an oral COVID-19 vaccine, the characteristics of which were utilized to define the thermostable oral vaccine discussed in this study. Apart from providing data on the characteristics of the oral vaccine under development, the funders had no influence over the study design, methods, statistical analyses, results, framing of results, decision to submit the manuscript for publication, or choice of journal.

Municipal solid waste recycling: Impacts on energy savings and air pollution

In recent years, recycling of municipal solid waste (MSW) has been recognized as one of the most efficient methods of waste management in terms of environmental benefits. This study investigates the energy savings and other environmental benefits of recycling of dry MSW collected in Shiraz, Iran (2018). The impact of different recycling rates (current = 15%, desirable = 50%, ideal = 80%) on environmental benefits and energy savings were assessed. The annual quantity of recycled components were defined as glass (735 tons), plastic carrier bags (555 tons), cardboard (3,874 tons), paper (3,806 tons), disposable plastic containers (287 tons), other types of metals (785 tons), disposable metallic containers (aluminum) (171 tons), other types of plastics (812 tons) and polyethylene terephthalate (PET) (887 tons). The results confirmed that recycling of paper and glass in three different scenarios resulted in a reduction of 1.01, 2.14, and 3.43 million tons of air pollutant emissions, respectively. By improving the recycling rates from 15 to 80%, overall energy savings can improve by between a factor of 3.5 to 5.5. Also, a reduction of approximately 2-3.5% in air pollutant emissions can be achieved by upgrading the current recycling program (15% recycling rate) to favorable and ideal conditions.Implications: In recent years, recycling of municipal solid waste (MSW) has been recognized as one of the most efficient methods of waste management in terms of environmental benefits. This study investigates the energy savings and other environmental benefits of recycling of dry MSW collected in Shiraz, Iran (2018). According to available data, there has been little effort for recycling in developing countries, and waste landfilling is recognized as the most favorable option in MSW management. The aim of this study was to characterize MSW components in Shiraz, Iran, and to quantify the environmental benefits and energy savings as result of paper, glass, and aluminum recycling. This work is novel in that there are no reports to our knowledge of the environmental benefits and energy savings resulting from different recycling scenarios including current (15%), desirable (50%), and ideal (80%) recycling for aluminum, paper, and glass. The results of this work have broad implications both for other regions owing to the pervasiveness of recycling facilities and also for developing countries that can strive towards the infrastructure needed to reach improved recycling scenarios.

Application of Sterilization Process for Inactivation of Bacillus Stearothermophilus in Biomedical Waste and Associated Greenhouse Gas Emissions

This study investigated the biomedical waste collection, transportation, and treatment activities in the city of Kocaeli, Turkey. As an alternative to incineration technology, a steam autoclave was used to sterilize the biomedical waste. Information regarding the collection, transportation, treatment and associated greenhouse gas emissions (GHG) were also investigated. Prior to sterilization, biological indicator vials containing Bacillus stearothermophilus were placed in the center of the load to ensure that the pathogens were destroyed. GHG emissions were calculated based on the fuel consumed by the biomedical waste collection vehicles and the electricity/natural gas used at the sterilization plant. Results of this work revealed that the total biomedical waste generated per year increased from 1362 tons in 2009 to 2375 tons in 2019. The amount of biomedical waste generated per hospital bed was determined as 1.19 kg.bed−1.day−1. Results show that for efficient sterilization of biomedical wastes, the steam treatment system process should be operated at a contact time of 45 min, a temperature of 150 °C, and at a steam pressure of 5 bar. Biological indicator tests showed that the number of living Bacillus stearothermophilus decreased significantly, with removal rates greater than 6log10. Finally, it was determined that the biomedical waste management activities generated a total of GHG emissions of 5573 ton CO2 equivalency (tCO2-e) from 2009 to 2019. Furthermore, the average global warming factor (GWF) was calculated to be 0.269 tCO2-e per ton of biomedical waste generated. This study showed that the sterilization process is very effective in destroying the pathogens and the management of biomedical waste generates considerable amounts of GHG emissions.

A Study on Small Clinics Waste Management Practice, Rules, Staff Knowledge, and Motivating Factor in a Rapidly Urbanizing Area

Thousands of small clinics in Pakistan are generating dispersed medical waste, unlike large hospitals, small clinic waste management is often ignored. This study was conducted on 135 small clinics in Hyderabad, Pakistan, with the aim to determine small clinics' waste management practices in contrast to rules, level of knowledge, the environmental impact of disposal methods, and motivating factor analysis to understand the current situation from multiple perspectives. Overall, the waste generation rate was calculated to be 2.01 kg/clinic/day and the hazardous waste generation rate was 0.89 kg/clinic/day, whereas the general waste generation rate was 1.12 kg/clinic/day. The hazardous waste generation rate percentage is found to be higher than those found in large hospitals by 20%. The waste management practice among surveyed clinics was deplorable; none of the clinics were completely following hospital waste management rules of 2005 and thus the absence of proper segregation, storage, transportation, and disposal was commonly encountered during the study. Clinic staff possessed low level of knowledge and awareness, and acquired no training about waste management practice and rules, moreover, frequent employee turnover was noticed too. Additionally, two hypotheses were checked for creditability of motivating factors with an exploratory factor analysis to check their contribution to motivating clinic staff to practice sound healthcare waste management. Out of 10 indicators, nine were found in support of the hypotheses. Hence, it was discovered that active government involvement and financial support in providing training and inspecting small clinics could help in improving the condition. The findings of the present study can play a vital role in documenting evidence, and for policymakers and governments to plan solid waste management of small clinics and other healthcare facilities.