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Liwinski T, Bocek I, Schmidt A, Kowalinski E, Dechent F, Rabenschlag F, Moeller J, Sarlon J, Brühl AB, Nienaber A, Lang UE, Huber CG. Sustainability initiatives in inpatient psychiatry: tackling food waste. Front Psychiatry 2024; 15:1374788. [PMID: 39026524 PMCID: PMC11254754 DOI: 10.3389/fpsyt.2024.1374788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/17/2024] [Indexed: 07/20/2024] Open
Abstract
Background Food plays a dual role in promoting human health and environmental sustainability. Yet, current food systems jeopardize both. Food waste poses a major global challenge due to its significant economic, social, and environmental impacts. Healthcare facilities generate the largest amounts of food waste compared to other forms of catering provision. Food waste correlates with environmental unsustainability and diminished patient satisfaction, compounding the prevalent challenge of hospital malnutrition and contributing to suboptimal patient outcomes. Materials and methods In a three-year interventional study (2020-2022) at a psychiatric tertiary care center, we assessed and mitigated food waste using evidence-based measures. We conducted systematic food wastage audits over three years (2020-2022) in May and June, each lasting four weeks. Costs were analyzed comprehensively, covering food, staff, infrastructure, and disposal. Environmental impact was assessed using Umweltbelastungspunkte (UBP) and CO2e/kg emissions, alongside water usage (H2O - l/kg). Results Economic losses due to food wastage were substantial, primarily from untouched plates and partially consumed dinners, prompting meal planning adjustments. Despite a >3% increase in meals served, both food waste mass and costs decreased by nearly 6%. Environmental impact indicators showed a reduction >20%. Vegetables, salad, and fruits constituted a significant portion of waste. Overproduction minimally contributed to waste, validating portion control efficacy. Conclusion Our study highlights significant economic and environmental losses due to hospital food waste, emphasizing the importance of resource efficiency. The strategies outlined offer promising avenues for enhanced efficiency. The decrease in food waste observed over the three-year period underscores the potential for improvement.
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Affiliation(s)
- Timur Liwinski
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
| | - Iona Bocek
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
| | - Andreas Schmidt
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
| | - Eva Kowalinski
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
| | - Frieder Dechent
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
| | - Franziska Rabenschlag
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
| | - Julian Moeller
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
- Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Jan Sarlon
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
| | - Annette B. Brühl
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
| | - André Nienaber
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
- Central Institute of Mental Health, Medical Faculty Mannheim and University of Heidelberg, Mannheim, Germany
| | - Undine E. Lang
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
| | - Christian G. Huber
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Basel, Switzerland
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Cook N, Porter J, Goodwin D, Collins J. Diverting Food Waste From Landfill in Exemplar Hospital Foodservices: A Qualitative Study. J Acad Nutr Diet 2024; 124:725-739. [PMID: 38142741 DOI: 10.1016/j.jand.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND The US Environmental Protection Agency Food Recovery Hierarchy suggests methods for diverting food waste from landfill. Knowledge of how hospital foodservices implement food waste management strategies could help modernize food waste practices. OBJECTIVE The aim of this study was to explore hospital staff members' experiences of implementing a food waste management strategy to divert food waste from landfill in their hospital foodservice, including the journey, challenges, and facilitators of this practice change. DESIGN A qualitative study was conducted in 2022-2023 using semi-structured interviews. PARTICIPANTS/SETTING Eighteen participants were staff members with knowledge of the food waste management strategy from 14 exemplar hospitals in United States, Spain, Scotland, and Australia using strategies to divert food waste from landfill within the last 10 years. ANALYSES PERFORMED Mapping and thematic analysis were undertaken to code and identify themes from the interviews that described staff members' experiences of the journey to implement the strategy. RESULTS Six hospitals donated food, 1 transferred food waste for animal feed, 4 used an industrial solution, and 3 sent food waste for composting. A common journey pathway for successful implementation was identified from participants' experiences. It features the following 6 phases: idea, preparation, roll out, maintenance, established practice, and evolution. Facilitators included legislation, enthusiastic staff members, executive support, and "luck." Challenges were smells, occasions when food waste was not collected, equipment breakage, and funding depletion. CONCLUSIONS This study identified a common journey pathway for implementing a food waste management strategy in hospital foodservices that can be used to anticipate and prepare for the steps in the implementation process.
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Affiliation(s)
- Nathan Cook
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia.
| | - Judi Porter
- School of Exercise and Nutrition Sciences, Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia; Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia
| | - Denise Goodwin
- BehaviourWorks Australia Health & Social Programs, Monash University, Clayton, VIC, Australia; Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
| | - Jorja Collins
- Department of Nutrition, Dietetics and Food, Monash University, Notting Hill, VIC, Australia; Eastern Health, Box Hill, VIC, Australia
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Slutzman JE, Bockius H, Gordon IO, Greene HC, Hsu S, Huang Y, Lam MH, Roberts T, Thiel CL. Waste audits in healthcare: A systematic review and description of best practices. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2023; 41:3-17. [PMID: 35652693 PMCID: PMC9925917 DOI: 10.1177/0734242x221101531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
Healthcare generates large amounts of waste, harming both environmental and human health. Waste audits are the standard method for measuring and characterizing waste. This is a systematic review of healthcare waste audits, describing their methods and informing more standardized auditing and reporting. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE, Embase, Inspec, Scopus and Web of Science Core Collection databases for published studies involving direct measurement of waste in medical facilities. We screened 2398 studies, identifying 156 studies for inclusion from 37 countries. Most were conducted to improve local waste sorting policies or practices, with fewer to inform policy development, increase waste diversion or reduce costs. Measurement was quantified mostly by weighing waste, with many also counting items or using interviews or surveys to compile data. Studies spanned single procedures, departments and hospitals, and multiple hospitals or health systems. Waste categories varied, with most including municipal solid waste or biohazardous waste, and others including sharps, recycling and other wastes. There were significant differences in methods and results between high- and low-income countries. The number of healthcare waste audits published has been increasing, with variable quality and general methodologic inconsistency. A greater emphasis on consistent performance and reporting standards would improve the quality, comparability and usefulness of healthcare waste audits.
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Affiliation(s)
- Jonathan E Slutzman
- Center for the Environment and
Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Medicine,
Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | - Hannah Bockius
- Department of Biomedical
Engineering, University of Delaware, Newark, DE, USA
| | - Ilyssa O Gordon
- Robert J. Tomsich Pathology &
Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic,
Cleveland, OH, USA
| | - Hannah C Greene
- Department of Biology, New York
University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sarah Hsu
- Warren Alpert Medical School,
Brown University, Providence, RI, USA
| | | | - Michelle H Lam
- Department of Chemical and
Biomolecular Engineering, NYU Tandon School of Engineering, Brooklyn, NY,
USA
| | - Timothy Roberts
- Health Sciences Library, NYU
Langone Health, Grossman School of Medicine, New York University, New York,
NY, USA
| | - Cassandra L Thiel
- Grossman School of Medicine,
Wagner Graduate School of Public Service, Tandon School of Engineering, New
York University, New York, NY, USA
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Cook N, Goodwin D, Porter J, Collins J. Food and food-related waste management strategies in hospital food services: A systematic review. Nutr Diet 2022; 80:116-142. [PMID: 36168297 DOI: 10.1111/1747-0080.12768] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/30/2022] [Accepted: 07/13/2022] [Indexed: 11/30/2022]
Abstract
AIM This review explored peer-reviewed and grey literature to describe the types and characteristics of food or food-related waste management strategies used in hospital food service settings; their financial, environmental and staffing outcomes; and the barriers and enablers associated with their implementation. METHODS Six electronic databases, 17 Google Advanced searches, and 19 targeted websites were searched for peer-reviewed and grey literature. Literature reporting the financial, environmental, or staffing outcomes of food or food-related waste management strategies that reused, recovered energy from, or recycled waste instead of sending it to landfill were eligible. Document screening and review were completed in duplicate, and included peer-reviewed literature were assessed for quality using the Mixed Methods Appraisal Tool. Data were synthesised narratively. RESULTS Four peer-reviewed and 81 grey literature records reported 85 strategies. When grouped from most to least favourable according to the food recovery hierarchy they managed waste by: donating surplus food (n = 21); feeding animals (n = 2); industrial use (n = 11); composting (n = 34) and other (n = 17). These approaches had the capacity to reduce waste hauling fees (n = 14), reduce staff handling of waste (n = 3), and decrease the amount of waste sent to landfill (n = 85). Barriers included contamination of waste streams, while enablers included leadership and time-neutral changes. CONCLUSION This review summarises the waste management strategies used by hospitals worldwide that divert food and food-related waste from landfill, their outcomes, and position in the food recovery hierarchy to enable hospital food services to implement appropriate practice and policy changes to decrease their environmental footprint.
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Affiliation(s)
- Nathan Cook
- Department of Nutrition, Monash University, Notting Hill, Victoria, Australia
| | - Denise Goodwin
- BehaviourWorks Australia Health Programs, Monash University, Clayton, Victoria, Australia
| | - Judi Porter
- Institute for Physical Activity and Nutrition (IPAN), School of Exercise and Nutrition Sciences, Deakin University, Geelong, Victoria, Australia
| | - Jorja Collins
- Department of Nutrition, Monash University, Notting Hill, Victoria, Australia.,Eastern Health, Box Hill, Victoria, Australia
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Towards Sustainable Food Services in Hospitals: Expanding the Concept of ‘Plate Waste’ to ‘Tray Waste’. SUSTAINABILITY 2020. [DOI: 10.3390/su12176872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Early debates on the sustainability of food-plating systems in hospitals have concentrated mostly on plate waste food served, but not eaten. This study aims to address the need for more comprehensive studies on sustainable food services systems by expanding the concept of plate waste, to that of tray waste (organic and inorganic materials), through a case study of a hospital in Saudi Arabia. Tray waste arising at the ward level was audited for three weeks, covering 939 meals. It was found that, on average, each patient threw away 0.41, 0.30, 0.12, and 0.02 kg of food, plastic, paper, and metal, respectively, each day. All this equated to 4831 tons of food, 3535 tons of plastic, 1414 tons of paper, and 235 tons of metal each year at hospitals across Saudi Arabia. As all of this waste ends up in landfills, without any form of recycling, this study proposes the need for a more comprehensive, political approach that unites all food system stakeholders around a shared vision of responsible consumption and sustainable development.
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Carino S, Porter J, Malekpour S, Collins J. Environmental Sustainability of Hospital Foodservices across the Food Supply Chain: A Systematic Review. J Acad Nutr Diet 2020; 120:825-873. [PMID: 32093919 DOI: 10.1016/j.jand.2020.01.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 11/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospitals have a responsibility to support human health, and given the link between human and environmental health, hospitals should consider their environmental impacts. Hospital foodservices can negatively affect the environment at every stage of the food supply chain (production/procurement, distribution, preparation, consumption, and waste management/disposal). OBJECTIVE To systematically identify and synthesize the following across the hospital patient food/nutrition supply chain: environmental and associated economic impacts of foodservice; outcomes of strategies that aim to improve the environmental sustainability of foodservice; and perspectives of patients, staff, and stakeholders on environmental impacts of foodservice and strategies that aim to improve the environmental sustainability of foodservice. METHODS Eight electronic databases (ie, Cumulative Index to Nursing and Allied Health Literature Plus, Embase via Ovid, Global Health, National Health Service Economic Evaluation Database, Ovid Medline, ProQuest Environmental Science Collection, Scopus, and Web of Science) were searched from database inception to November 2018 for original research conducted across any stage of the hospital food supply chain (from production/procurement to waste management/disposal) that provides food/nutrition to patients, with no restrictions on language or study design. Titles/abstracts then full texts were screened independently by two authors. The Mixed Methods Appraisal Tool was used for quality appraisal for included studies. Data were synthesized narratively. RESULTS From 29,655 records identified, 80 studies met eligibility criteria. Results were categorized into production/procurement (n=12), distribution (n=0), preparation (n=6), consumption (n=49), waste management/disposal (n=8), and multiple food supply chain aspects (n=5). The environmental impact most widely explored was food waste, with many studies reporting on food waste quantities, and associated economic losses. Strategies focused on reducing food waste by increasing patients' intake through various foodservice models. Perspectives identified a shared vision for sustainable foodservices, although there are many practical barriers to achieving this. CONCLUSION The literature provides examples across the hospital food supply chain that demonstrate how environmental sustainability can be prioritized and evaluated and the opportunities for credentialed nutrition and dietetics practitioners to contribute. Future studies are warranted, particularly those measuring environmental impacts and testing the effects of sustainable strategies in the distribution, preparation, and waste management stages.
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Ali M, Wang W, Chaudhry N, Geng Y. Hospital waste management in developing countries: A mini review. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2017; 35:581-592. [PMID: 28566033 DOI: 10.1177/0734242x17691344] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
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.
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Affiliation(s)
- Mustafa Ali
- 1 School of Environmental Science and Engineering, Shanghai Jiao Tong University, China
- 2 Department of Management Science & Engineering, Southeast University, China
| | - Wenping Wang
- 2 Department of Management Science & Engineering, Southeast University, China
| | - Nawaz Chaudhry
- 3 College of Earth & Environmental Sciences, University of the Punjab, Pakistan
| | - Yong Geng
- 1 School of Environmental Science and Engineering, Shanghai Jiao Tong University, China
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Caniato M, Tudor T, Vaccari M. International governance structures for health-care waste management: a systematic review of scientific literature. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2015; 153:93-107. [PMID: 25687810 DOI: 10.1016/j.jenvman.2015.01.039] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 01/19/2015] [Accepted: 01/24/2015] [Indexed: 06/04/2023]
Abstract
Significant differences exist in the management of health-care waste management, globally. This is particularly so between low, middle and high-income countries. A systematic review of scientific literature on global healthcare waste management spanning the period 2000 - current was undertaken, in order to identify key policies, practices, challenges and best practice. The findings were analysed considering the Gross National Income and the Human Development Index of each country. Effective regulation and operative definitions of waste categories are key-factors requiring improvement at the national level. The economic conditions in the country are an important factor, especially regarding treatment and disposal. Areas for improvement (e.g. the need for improved governance structures, the development of regional clusters, as well as sharps waste segregation) are suggested.
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Affiliation(s)
- M Caniato
- Research Laboratory on Appropriate Technologies for Environmental Management in Resource-Limited Countries (CeTAmb LAB), University of Brescia, Brescia, Italy.
| | - T Tudor
- Centre for Sustainable Waste Management, School of Science and Technology, University of Northampton, Northampton, UK
| | - M Vaccari
- Research Laboratory on Appropriate Technologies for Environmental Management in Resource-Limited Countries (CeTAmb LAB), University of Brescia, Brescia, Italy
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Goonan S, Mirosa M, Spence H. Getting a Taste for Food Waste: A Mixed Methods Ethnographic Study into Hospital Food Waste before Patient Consumption Conducted at Three New Zealand Foodservice Facilities. J Acad Nutr Diet 2014; 114:63-71. [DOI: 10.1016/j.jand.2013.09.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Accepted: 09/11/2013] [Indexed: 10/26/2022]
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Debere MK, Gelaye KA, Alamdo AG, Trifa ZM. Assessment of the health care waste generation rates and its management system in hospitals of Addis Ababa, Ethiopia, 2011. BMC Public Health 2013; 13:28. [PMID: 23311573 PMCID: PMC3565894 DOI: 10.1186/1471-2458-13-28] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Accepted: 01/09/2013] [Indexed: 11/30/2022] Open
Abstract
Background Healthcare waste management options are varying in Ethiopia. One of the first critical steps in the process of developing a reliable waste management plan requires a widespread understanding of the amount and the management system. This study aimed to assess the health care waste generation rate and its management system in some selected hospitals located in Addis Ababa, Ethiopia. Methods Six hospitals in Addis Ababa, (three private and three public), were selected using simple random sampling method for this work. Data was recorded by using an appropriately designed questionnaire, which was completed for the period of two months. The calculations were based on the weights of the health care wastes that were regularly generated in the selected hospitals over a one week period during the year 2011. Average generation indexes were determined in relation to certain important factors, like the type of hospitals (public vs private). Results The median waste generation rate was found to be varied from 0.361- 0.669 kg/patient/day, comprised of 58.69% non-hazardous and 41.31% hazardous wastes. The amount of waste generated was increased as the number of patients flow increased (rs=1). Public hospitals generated high proportion of total health care wastes (59.22%) in comparison with private hospitals (40.48%). The median waste generation rate was significantly vary between hospitals with Kruskal-Wallis test (X2=30.65, p=0.0001). The amount of waste was positively correlated with the number of patients (p < 0.05). The waste separation and treatment practices were very poor. Other alternatives for waste treatment rather than incineration such as a locally made autoclave should be evaluated and implemented. Conclusion These findings revealed that the management of health care waste at hospitals in Addis Ababa city was poor.
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Affiliation(s)
- Mesfin Kote Debere
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
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Tudor TL, Townend WK, Cheeseman CR, Edgar JE. An overview of arisings and large-scale treatment technologies for healthcare waste in the United Kingdom. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2009; 27:374-383. [PMID: 19470544 DOI: 10.1177/0734242x09336244] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This paper reviews the current generation and management of healthcare waste in the United Kingdom, with a focus on that produced from healthcare provision in the National Health Service. While the current capacities of large-scale off-site treatment systems are adequate, there are a number of logistical factors that must be considered in future. These include variations in arisings from each country and from various regions within each country, the age and location of treatment/disposal facilities, the quantities, types and sources of healthcare waste, and the impact of waste minimization and recycling strategies. Managing UK healthcare waste is a complex issue that requires the correct technologies and capacities to be available. With increasing quantities and costs there is urgent need for future planning, and healthcare waste issues need to be addressed from a UK-wide perspective. Holistic strategies need to incorporate both minimization and segregation, with treatment using a combination of incineration and alternatives treatment technologies. The need for more research and accurate data to provide an evidence-base for future decision-making is highlighted.
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Affiliation(s)
- Terry L Tudor
- SITA Centre for Sustainable Wastes Management, University of Northampton, Northampton, UK.
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