An overview of arisings and large-scale treatment technologies for healthcare waste in the United Kingdom

Economic evaluation of hazardous healthcare waste treatment systems

The cost estimation and assessment of healthcare waste treatment systems (HCWTSs) for preventing financial and environmental damage are essential. This work reports economic analyses of treatment of hazardous-infectious waste based on WHO approach in HCWTSS of 43 hospitals in Tehran, Iran. The waste generation rate for total hospital waste in 43 HCWTSS was 4.42 ± 2.77 kg/active-bed/day. The mean of chemical, sharps, infectious, and general wastes in 43 HCWTSS were 13.79 ± 19.71, 30.29 ± 37.46, 336.28 ± 291.31, and 539.6 ± 383.13 kg/day, respectively. Economic analyses proved that general hospitals spent 1.63 times more than specialized hospitals on treating hazardous-infectious waste per year. The annual cost of treating each kilogram of hazardous healthcare waste in studied HCWTSS was 0.3 dollars. A range of total annual costs in 43 HCWTSS was limited to 7.9-118 thousand dollars. The results of ANOVA test demonstrated that the age and performance levels of hospitals significantly affect the annual capital and operating costs, respectively. Hence, improving recycling knowledge and increasing source-separated recycling should be considered to control the costs in HCWTSS. The results of this work have implications for the hospital managers in especially developing countries to evaluate previously unknown economic analyses and policies and take action to control wasted costs in HCWTSS.

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

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

Comparison of microwave and autoclave treatment for biomedical waste disinfection

As the world is facing a Covid-19 pandemic, this virus teaches a lesson about the importance of on-site disinfection. On-site disinfection/sterilization with real-time monitoring of biomedical waste generated from the medical facilities is mandatory to prevent hospital-acquired infection (HAI). In this study, the life cycle assessment of two technologies, i.e., microwave (radiation-based) and autoclave (steam-based) were performed to summarize the inside-out evaluation of both technologies in terms of efficiency, efficacy, and cost-effectiveness. The results of disinfection efficacy indicated a log 10 reduction (almost 100%) in the vegetative load of microorganisms compared to the control, showing a similar level of disinfection efficacy of both strategies. Additionally, both technologies were compared on several parameters, and it was discovered that the autoclave uses more time and resources than the microwave. The total cost of an autoclave to the government is approximately double that of a microwave, while the operational cost of an autoclave is more than double that of a microwave. The findings from this study indicate that MACS may be used as a dry technique of biomedical disinfection, and its portability, tunability, and compactness make it a suitable alternative for biomedical disinfection and sterilization.

Graphical abstract

A q-Rung Orthopair Fuzzy FUCOM Double Normalization-Based Multi-Aggregation Method for Healthcare Waste Treatment Method Selection

Healthcare waste (HCW) management is an intricate issue upon which numerous factors, such as technical, economic, environmental, and social factors, have an impact. A determination on the best treatment method for HCW management can be viewed as a challenging multi-criteria decision-making (MCDM) problem in which various options and evaluation criteria are considered. One critical concern when assessing HCW treatment (HCWT) methods is the representation and treatment of dubious data. In this paper, we present a q-rung orthopair fuzzy full consistency method double normalization-based multi-aggregation methodology called q-ROF-FUCOM-DNMA to solve MCDM problems with q-rung orthopair fuzzy information (q-ROFI). In the proposed approach, criteria weights are estimated through the full consistency method (FUCOM) and a ranking of the alternatives is obtained through the double-normalization-based multi-aggregation (DNMA) method with q-ROFI. A HCWT method assessment issue was considered in order to clarify the relevance of the proposed approach. Five HCWT methods, including chemical disinfection, microwave disinfection, incineration, autoclaving (steam sterilization), and reverse polymerization, were considered as alternatives. The results show that autoclaving (steam sterilization) is the most efficient HCWT method. Furthermore, we performed a sensitivity analysis to determine the stability of the proposed approach. Additionally, we compared the presented approach with existing methods.

Review of the valorization options for the proper disposal of face masks during the COVID-19 pandemic

The COVID-19 pandemic has affected not only human health and economies but also the environment due to the large volume of waste in the form of discarded personal protective equipment. The remarkable increase in the global usage of face masks, which mainly contain polypropylene, and improper waste management have led to a serious environmental challenge called microplastic pollution. Potential practices for waste management related to waste valorization of discarded face masks as the major type of waste during the COVID-19 pandemic are explored in this study. Recommendations based on governmental practices, situation of state facilities, and societal awareness and engagement applicable to emergency (including COVID-19 pandemic) and postpandemic scenarios are offered while considering potential solutions and available waste management practices in different countries during emergency conditions. However, multicriteria decision making for a country must determine the optimal solution for waste management on the basis of all affecting factors. Awareness of scientific, governments, and communities worldwide will successfully eradicate this important environmental issue.

Review of Current Healthcare Waste Management Methods and Their Effect on Global Health

Healthcare is a rapidly growing industry as medical treatments become more sophisticated, more in demand due to increasing incidence of chronic disease and more widely available worldwide. This booming industry is also creating more waste than ever before and, as such, there is a growing need to treat and dispose of this waste. Healthcare waste (HCW) disposal includes a multitude of disposal methods, including incineration, landfilling and chemical treatments. These rudimentary methods and their growing use present their own problems that negatively impact both the environment and, in turn, damage public health, thus contributing to a global healthcare crisis. The aim of this review was to examine the current HCW disposal methods in place and the harmful effects they have on the environment and on public health. The findings accumulated in this review demonstrate a heavy reliance on basic, low tech HCW disposal techniques and uncovered the negative impacts of these methods. There is a notable lack of employment of "greener" HCW disposal methods on a largescale due to cost, access and feasibility. Despite innovations in HCW disposal, there is no scalable, global green solution at present. Further, the review highlights that global health consequences of HCW disposal methods often differ depending on how developed the country is.

LCA of Hospital Solid Waste Treatment Alternatives in a Developing Country: The Case of District Swat, Pakistan

Improper management of hospital waste leads to serious health and environmental issues, particularly in the case of developing countries, where, often, applied technologies are obsolete and there is a lack of compliance with respect to international best practices. The present study is designed to assess the environmental impacts of hospital waste management practices in Swath District, Pakistan. For this purpose, a life-cycle assessment (LCA) is applied for the estimation of different impacts of current and alternative hospital solid waste (HSW) treatment practices. Two scenarios are used to describe the current alternative practices (Scenario A and Scenario B), referring either to incineration or to direct landfilling of HSW without any sorting of collected materials. Conversely, Scenario C, which includes the use of pyrolysis and chemical disinfection, are considered as an up-to-date alternative, based on current international recommendations in this field. Prior to the analysis of impacts, due to the lack of available information, data were directly collected from both government and private hospitals in District Swat, involving measurements and a characterization of collected waste. In parallel, interviews were conducted, involving the hospitals’ personnel. With respect to waste generation, government hospitals produce a larger amount of waste (74%) compared to private hospitals (24%). Poor regulatory indications and the absence of clear obligations for collection, disposal and management still represent a first obstacle to implement good practices. After defining the boundary of the system and the functional unit, according to standardized LCA practices, a life--cycle impact assessment (LCIA) was conducted, considering eight impact categories: human toxicity, freshwater eco-toxicity, marine aquatic eco-toxicity, terrestrial eco-toxicity, acidification potential, climate change, eutrophication and photochemical oxidation. The current practices (Scenario A and Scenario B) turned out to be the worst for all categories. In particular, the largest impact of all is recorded for human toxicity generated by incineration. In parallel, it must be considered that, currently, no recycling or reusing practices are implemented. Conversely, Scenario C (alternative up-to-date practices) would generate lower impacts. In detail, the highest value was recorded for marine aquatic ecotoxicity in relation to pyrolysis. Applying Scenario C, it would be possible to recover some materials, such as plastics, paper and sharps. In detail, considering the observed compositional characteristics, it would be possible to recover up to 78% of sharps and recycle 41% of plastic and paper from the general waste stream. Moreover, energy could be recovered from the pyrolysis process, generating a further benefit for the surrounding area. A lack of awareness, knowledge and infrastructures prevents the application of correct management practices, further degrading life and environmental conditions of this remote region of Pakistan. The huge difference in impacts between current practices and alternatives is demonstrated, showing a clear alternative for future management plans in this remote region and supporting future actions for local policymakers and hospital managers.

Healthcare waste management in a Brazilian university public hospital

Some healthcare waste presents hazardousness characteristics and requires specific procedures to ensure the safety management. Waste segregation is an important action to control the risks of each type of waste. Healthcare waste indicators also may improve the waste management system. The aim of this article was to evaluate the healthcare waste management in a Brazilian university hospital, as well as the waste indicators, quantifying and qualifying the waste generation. Weighing of wastes occurred by sampling occurred sampling of seven consecutive days or daily, between 2011 and 2017. General wastes represent more than 55.6% of the total generated, followed by infectious, sharps and chemicals wastes, respectively, 39.1%, 2.9% and 2.4%. The generation rate in 2017 was 4.09 kg bed^-1 day^-1, including all types of wastes. Non-dangerous wastes represented around 93.3%, including infectious wastes with low potential risks, while dangerous was represented by high infectious risk (1.4%), chemicals (2.4%) and sharps (2.9%). Healthcare waste indicators may favour the risk identification and improve the waste management system, in particular when involving hazardous wastes. Failures in healthcare waste segregation could represent, in addition to the health risks, unnecessary expenses.

Proposal of indicators for healthcare waste management: Case of a Brazilian public institution

Healthcare waste (HCW) management represents a big challenge for managers around the world. Segregation is a fundamental action to allow the risk management inherent to each type of wastes. HCW indicators may favour the understanding of the waste management system status. The aim of this paper is to evaluate the HCW indicators applied in a Brazilian public institution, seeking to improve the management system and suggesting methods of applying this tool as an alternative of continuous improvement to the management process. Wastes were weighed every trimester for seven consecutive days, between of 2012 to 2017. The data represent daily, monthly and quarterly averages of the waste generated. Group B (chemical) and Group E (sharps) indicators had statistical non-significant data, suggesting very distant results from the stipulated goal. The generation rate was 355.3-500.7 kg.day^-1 including all types of waste. Considering the approximate values of the non-infected wastes, which may be discarded in a landfill, the percentage represents about 75% of all HCW generated. The other 25% need to be treated at cost of $US0.76kg^-1. An effectively dangerous portion of the infectious waste would be approximately 6%. Failures in segregation could represent, in addition to the health risks, unnecessary expenses of the generating establishments. HCW indicators have good potential to provide adequate risk management in health service environments.

Technology selection for infectious medical waste treatment using the analytic hierarchy process

The overall objective of this paper was to evaluate five different technologies used for infectious medical waste treatment and select the optimum one by means of multicriteria analysis. Steam disinfection was selected as the optimum treatment technology, among others using incineration, microwave disinfection, chemical disinfection with sodium hypochlorite, and reverse polymerization with microwaves. The evaluation was based on four groups of criteria, specifically, environmental, economic, technical, and social criteria, using the analytic hierarchy process. Selection among four commercial systems using steam disinfection was not possible, because it required additional site-specific criteria, e.g., loading capacity and requirements of local regulations.

IMPLICATIONS

The paper can help health care facilities to select the system for infectious waste treatment that best fits their needs. It was concluded that steam disinfection was the optimum technology, using environmental, economic, technical, and social criteria.

Probabilistic modelling of prospective environmental concentrations of gold nanoparticles from medical applications as a basis for risk assessment

BACKGROUND

The use of gold nanoparticles (Au-NP) based medical applications is rising due to their unique physical and chemical properties. Diagnostic devices based on Au-NP are already available in the market or are in clinical trials and Au-NP based therapeutics and theranostics (combined diagnostic and treatment modality) are in the research and development phase. Currently, no information on Au-NP consumption, material flows to and concentrations in the environment are available. Therefore, we estimated prospective maximal consumption of Au-NP from medical applications in the UK and US. We then modelled the Au-NP flows post-use and predicted their environmental concentrations. Furthermore, we assessed the environment risks of Au-NP by comparing the predicted environmental concentrations (PECs) with ecological threshold (PNEC) values.

RESULTS

The mean annual estimated consumption of Au-NP from medical applications is 540 kg for the UK and 2700 kg for the US. Among the modelled concentrations of Au-NP in environmental compartments, the mean annual PEC of Au-NP in sludge for both the UK and US was estimated at 124 and 145 μg kg(-1), respectively. The mean PEC in surface water was estimated at 468 and 4.7 pg L(-1), respectively for the UK and US. The NOEC value for the water compartment ranged from 0.12 up to 26,800 μg L(-1), with most values in the range of 1000 μg L(-1).

CONCLUSION

The results using the current set of data indicate that the environmental risk from Au-NP used in nanomedicine in surface waters and from agricultural use of biosolids is minimal in the near future, especially because we have used a worst-case use assessment. More Au-NP toxicity studies are needed for the soil compartment.

Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States

The healthcare sector is a driver of economic growth in the U.S., with spending on healthcare in 2012 reaching $2.8 trillion, or 17% of the U.S. gross domestic product, but it is also a significant source of emissions that adversely impact environmental and public health. The current state of the healthcare industry offers significant opportunities for environmental efficiency improvements, potentially leading to reductions in costs, resource use, and waste without compromising patient care. However, limited research exists that can provide quantitative, sustainable solutions. The operating room is the most resource-intensive area of a hospital, and surgery is therefore an important focal point to understand healthcare-related emissions. Hybrid life cycle assessment (LCA) was used to quantify environmental emissions from four different surgical approaches (abdominal, vaginal, laparoscopic, and robotic) used in the second most common major procedure for women in the U.S., the hysterectomy. Data were collected from 62 cases of hysterectomy. Life cycle assessment results show that major sources of environmental emissions include the production of disposable materials and single-use surgical devices, energy used for heating, ventilation, and air conditioning, and anesthetic gases. By scientifically evaluating emissions, the healthcare industry can strategically optimize its transition to a more sustainable system.

Applications of life cycle assessment and cost analysis in health care waste management

The establishment of rules to manage Health Care Waste (HCW) is a challenge for the public sector. Regulatory agencies must ensure the safety of waste management alternatives for two very different profiles of generators: (1) hospitals, which concentrate the production of HCW and (2) small establishments, such as clinics, pharmacies and other sources, that generate dispersed quantities of HCW and are scattered throughout the city. To assist in developing sector regulations for the small generators, we evaluated three management scenarios using decision-making tools. They consisted of a disinfection technique (microwave, autoclave and lime) followed by landfilling, where transportation was also included. The microwave, autoclave and lime techniques were tested at the laboratory to establish the operating parameters to ensure their efficiency in disinfection. Using a life cycle assessment (LCA) and cost analysis, the decision-making tools aimed to determine the technique with the best environmental performance. This consisted of evaluating the eco-efficiency of each scenario. Based on the life cycle assessment, microwaving had the lowest environmental impact (12.64 Pt) followed by autoclaving (48.46 Pt). The cost analyses indicated values of US$0.12 kg(-1) for the waste treated with microwaves, US$1.10 kg(-1) for the waste treated by the autoclave and US$1.53 kg(-1) for the waste treated with lime. The microwave disinfection presented the best eco-efficiency performance among those studied and provided a feasible alternative to subsidize the formulation of the policy for small generators of HCW.