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

Addressing the healthcare waste management barriers: A structural equation modeling approach

Due to the growing population and advancing economy, medical waste accumulation has come to the attention of all facets of society. Although the issue of medical waste management planning has been addressed in developed nations, it still exists in several developing nations. This paper examines the effects of barriers under the Organization action, work handling, and Human Resource Practices section on the healthcare waste management (HCWM) sector in a developing country India. In this study, three hypotheses were constructed and tested using Structural equation modeling. The questionnaire was distributed among 200 health professionals to collect their responses. Ninety-seven responses were received, and 15 barriers were identified affecting the healthcare waste management sector. The results show that all three barriers (i.e., Organizational, Waste handling, and Human resources) hinder the Healthcare waste management sector. Organizational Barriers are the most significant among other barriers. So, the hospitals have to take appropriate actions to overcome these barriers. This paper helps to complete the research gap by providing the different characteristics of barriers. The development of a model for the analysis of barriers influencing HCWM is the Author's original contribution.

Barriers to infection prevention and control implementation in selected healthcare facilities in Nigeria

OBJECTIVE

While infection prevention and control are of paramount importance, up until recently an assessment of implementation challenges and performance gaps was lacking. This study explored the barriers to infection prevention and control implementation at selected healthcare facilities, the objective being to find ways to improve their programs.

MATERIAL AND METHOD

A qualitative approach was applied. Purposive sampling was used to select thirty-three healthcare facilities in Ekiti State, Nigeria. They were globally assessed, and an Infection Prevention and Control team, represented by the Infection Prevention and Control referent in each of the selected facilities trained the participants. Data were collected using the Key Informant Interview Guide and analyzed by means of content and thematic analyses using Atlas.ti software.

RESULTS

Inadequate infection prevention and control materials, poor waste management, non-compliance of patients with infection prevention and control protocols, and poor infrastructure were identified as major barriers to infection prevention and control implementation.

CONCLUSION

The study concluded that a number of identified factors hindering infection prevention and control implementation in healthcare facilities in Ekiti State needed to be addressed.

Optimal selection of healthcare waste treatment devices using fuzzy-rough approach

The escalating volume of healthcare waste (HCW) generated by healthcare facilities poses a pressing challenge for all nations. Adequate management and disposal of this waste are imperative to mitigate its adverse impact on human lives, wildlife, and the environment. Addressing this issue in Bosnia and Herzegovina involves the establishment of a regional center dedicated to HCW management. In practice, there are various treatments available for HCW management. Therefore, it is necessary to determine the priority for procuring different treatments during the formation of this center. To assess these treatment devices, expert decision-making employed the fuzzy-rough approach. By leveraging extended sustainability criteria, experts initially evaluated the significance of these criteria and subsequently assessed the devices for HCW treatment. Employing the fuzzy-rough LMAW (Logarithm Methodology of Additive Weights), the study determined the importance of criteria, highlighting "Air emissions" and "Annual usage costs" as the most critical factors. Utilizing the fuzzy-rough CoCoSo (the Combined Compromise Solution) method, six devices employing incineration or sterilization for HCW treatment were ranked. The findings indicated that the "Rotary kiln" and "Steam disinfection" emerged as the most favorable devices for HCW treatment based on this research. This conclusion was validated through comparative and sensitivity analyses. This research contributes by proposing a solution to address Bosnia and Herzegovina's HCW challenge through the establishment of a regional center dedicated to HCW management.

Biomedical waste generation at Ayurveda hospitals in South Asia: A mini review of the composition, quantities and characteristics

Ayurveda hospitals generate biomedical wastes (BMW). However, details on composition, quantities and characteristics are very scarce, details which are important to formulate a proper waste management plan for subsequent implementation and continual improvement. Therefore, this article presents a mini review of the composition, quantities and characteristics of BMW generated from Ayurveda hospitals. Additionally, this article presents some best possible treatment and disposal procedures. Most of the information was gleaned from peer-reviewed journals, although some information was collected by the author and from grey literature available to the author; 70-99% (by wet weight) of the solid waste is non-hazardous; biodegradables contributing to 44-60% by wet weight due to more used Kizhi (medicinal bags for fomentation) and other medicinal/pharmaceutical wastes (excluding waste medicated oils, which is 12-15% of the liquid medicinal waste stream and are not readily biodegradable) largely derived from plants. The hazardous waste component includes infectious wastes, sharps, blood as pathological wastes (from Raktamoksha - bloodletting), heavy metal containing pharmaceutical wastes, chemical wastes and heavy metal rich wastes. Quantities of infectious wastes followed by sharps and blood form a major portion of hazardous wastes. Most of the infectious waste material contaminated with blood or other body fluids and sharps from Raktamoksha are very similar (appearance, moisture content and bulk density) to what is generated from hospitals practicing Western medicine. However, hospital-specific waste studies are required in future to better understand the sources, areas of generation, types, quantities and characteristics of BMW, and hence to formulate more accurate waste management plans.

Presented and prioritizing waste management strategies using SWOT and QSPM approach in two private hospitals in Yazd in 2021

BACKGROUND

This study aimed to present a strategic waste management in two private hospitals in Yazd using models of the strengths, weaknesses, opportunities, and threats (SWOT) and quantitative strategic planning matrix (QSPM).

METHODS

The strengths, weaknesses, opportunities, and threats of the organization was identified according to existing documents and expert team. The internal and external factors were identified by internal factor evaluation (IFE) and external factor evaluation (EFE) matrices. The strategies to improve waste management in two hospitals were presented by comparing internal and external factors. Finally, the attractiveness table was compiled and weighted using the QSPM method to prioritize the strategies.

RESULTS

The results demonstrated that 24 strengths, 30 weaknesses, 16 opportunities, and 22 threats were identified. The final score of internal and external factors for hospital A and B were (X: 2.37, Y:1.88) and (X: 2.37, Y: 2.01), respectively. Based on the results, 12 strategies were presented. Finally, the strategy of "the improvement of green management indicators" was implemented as a priority according to QSPM matrix.

CONCLUSION

The result of this study duplicated that using the QSPM and SWOT models is assist to present viable strategies to improve the health-care waste management.

Assessing and overcoming the barriers for healthcare waste management in India: an integrated AHP and Fuzzy TOPSIS approach

PURPOSE

Due to the coronavirus disease 2019 (COVID-19) pandemic, the world faces different issues, and proper healthcare waste (HCW) treatment is one of them. If appropriate disposal of HCW is not performed, it will have hazardous effects on humanity. This paper has identified the significant barriers hindering the proper treatment of healthcare waste management (HCWM) with the strategies to overcome these barriers.

DESIGN/METHODOLOGY/APPROACH

This paper has identified the significant barriers hindering the proper treatment of HCWM with the strategies to overcome these barriers, and different barriers are identified and categorized into organizational, waste handling, human resource and technical barriers. The analytical hierarchy process (AHP) process is used to rank the barriers and sub-barriers. Then, the Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method evaluates the strategies for proper implementation of HCWM.

FINDINGS

The results show that organizational barriers are the most significant barrier, with a lack of coordination of hospitals with other authorities and no priority given to waste management issues as highly ranked barriers. The results of the Fuzzy TOPSIS method indicate that "Increase govt support and policies" and "Enhance training and awareness of employees" are the most feasible strategies to overcome these barriers for the successful implementation of HCWM.

PRACTICAL IMPLICATIONS

This study will be helpful in policy formulations for the proper treatment of HCW in an efficient manner. This paper helps to complete the research gap by providing the different characteristics of barriers.

ORIGINALITY/VALUE

This paper fills the research gap by expanding the limited knowledge in this field and providing further evidence on this phenomenon. The study also enables the distinctive characteristics of barriers to be understood within a particular context.

Management of healthcare waste collection and segregation for developing countries

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

Integration of LCSA and GIS-based MCDM for sustainable landfill site selection: a case study

The paper aims at developing a framework for decision-support to select a sustainable landfill site in Bardaskan City (Iran) by combining life cycle sustainability assessment (LCSA) concepts and geographic information system (GIS)-based multi-criteria decision-making (MCDM). Overall, 13 criteria were chosen (three constraints and 10 factors) and classified into three main aspects of sustainability (i.e., environmental, social, and economic) to achieve the research goals. Boolean and fuzzy logic were employed to standardize the classified constraints and factors, respectively. Analytic hierarchy process (AHP) was used to calculate the factors' weights and then suitability maps were produced using the GIS analysis. The layers were combined using simple additive weighting (SAW). Next, the most sustainable sites were obtained. The results indicated that distance from city backline, groundwater depth, and distance from rural areas were the most significant factors with the weight of 0.338, 0.141, and 0.129, respectively. The final map of suitable sites was created by classifying the SAW layer according to 75, 80, and 85% of suitability to show the high, medium, and low priority areas for landfill site selection, respectively. Therefore, integration of LCSA and GIS-based MCDM to select the sustainable landfill site for municipal solid waste (MSW) is highly important, which can be effectively employed in regional and urban planning to select the location of appropriate and sustainable landfills.

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

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

Recycling, responsible consumption and nursing: A qualitative study of surgical nurses' recycling and medical waste management

AIM

This study was conducted to examine the opinions of nurses working in surgical wards on recycling and medical waste management.

BACKGROUND

Surgical services and operating rooms are the most waste-generating parts of health institutions. The primary purpose of waste management is to ensure waste minimization and increase recycling.

METHOD

In this qualitative study, in-depth interviews were conducted with 15 nurses. The data were analysed by the content analysis method. The COREQ checklist was used in the study.

RESULTS

As a result of the study, four main themes were determined: Barriers in medical waste and recycling management, solution suggestions in medical waste and recycling management, waste of medical and consumable materials and the effect of the pandemic process on medical waste and recycling management.

CONCLUSION

Medical waste and recycling management was interrupted due to lack of education, emergencies, hiring of untrained personnel and workload. During the pandemic, medical waste increased, and it could not be recycled. The solution suggestions are training at frequent intervals, monitoring by the responsible nurses and imposing sanctions on those who do not comply.

IMPLICATIONS FOR NURSING MANAGEMENT

Knowing nurses' obstacles in managing medical waste and recycling and putting forward solutions in this regard affects sustainability. Knowing the obstacles to the management of medical waste and recycling by nurses could help in solutions.

Healthcare waste generation in hospitals per continent: a systematic review

There are increasing worldwide concerns about the negative impacts of healthcare waste generated in hospitals, especially in low- and middle-income countries. Hazardous type of waste can contribute to adverse effects both in human populations and the environment because of its physical, chemical, and biological characteristics. A comprehensive view on increasing waste in the world has not been conducted to understand the breadth of the issue; thus, this paper sought to provide an analysis of hospitals' healthcare waste generation rate. Comparisons were made with Wilcoxon and Kruskal-Wallis tests for simple and multiple comparisons, to analyze nonparametric data, with post hoc by Nemenyi test. Median values indicated that hospital waste was the highest in North and South America (4.42, 1.64 kg/bed/day, respectively) and was almost nonexistent in Oceania (0.19 kg/bed/day), while the median rates for hazardous waste were the highest in Oceania (0.77 kg/bed/day). Africa was almost the lowest producer of waste in each category (0.19 and 0.39 kg/bed/day for hospital and hazardous waste, respectively). Over time, linear regression indicated that hazardous waste in Asia and Europe has increased, while in Oceania, the total waste also increased. Interestingly, in North America, it was observed a reduction in the generation for both total and hazardous waste. This information highlights the importance of understanding continent-specific characteristics and rates, which can be used to create a more individualized approach to addressing healthcare waste in the world.

Medical Waste Treatment Technologies for Energy, Fuels, and Materials Production: A Review

The importance of medical waste management has grown during the COVID-19 pandemic because of the increase in medical waste quantity and the significant dangers of these highly infected wastes for human health and the environment. This innovative review focuses on the possibility of materials, gas/liquid/solid fuels, thermal energy, and electric power production from medical waste fractions. Appropriate and promising treatment/disposal technologies, such as (i) acid hydrolysis, (ii) acid/enzymatic hydrolysis, (iii) anaerobic digestion, (vi) autoclaving, (v) enzymatic oxidation, (vi) hydrothermal carbonization/treatment, (vii) incineration/steam heat recovery system, (viii) pyrolysis/Rankine cycle, (ix) rotary kiln treatment, (x) microwave/steam sterilization, (xi) plasma gasification/melting, (xii) sulfonation, (xiii) batch reactor thermal cracking, and (xiv) torrefaction, were investigated. The medical waste generation data were collected according to numerous researchers from various countries, and divided into gross medical waste and hazardous medical waste. Moreover, the medical wastes were separated into categories and types according to the international literature and the medical waste fractions’ percentages were estimated. The capability of the examined medical waste treatment technologies to produce energy, fuels, and materials, and eliminate the medical waste management problem, was very promising with regard to the near future.

Identifying and Prioritizing Sustainable Urban Mobility Barriers through a Modified Delphi-AHP Approach

Sustainable urban mobility has been the epicenter both at the scientific and administrative level during the last decades, with a high number of relevant research projects, awareness campaigns, and other initiatives taking place at the local, national, and international level. However, many urban areas have so far achieved limited results in this direction because of political, institutional, organizational, technological, infrastructural, and socio-economic barriers as well as unforeseeable (e.g., COVID-19) conditions. The overall aim of the present research study is to support policy-making by proposing a methodology that identifies and prioritizes the sustainable mobility barriers for a specific urban area, with a view to developing effective policies. Towards this purpose, this work provides, in the first phase, a comprehensive inventory of barriers based on a literature review. In the second phase, a methodology using as a basic scientific tool a modified Delphi-AHP is proposed for the adaptation of this inventory to a specific urban area and for both the evaluation and prioritization of sustainable mobility barriers. The whole process is then applied in Thessaloniki, Greece, a European city suffering from many problems related to sustainable mobility. The above pilot application confirms that this approach can be integrated as a supporting tool in the first steps of sustainable urban mobility plans (SUMPs).

Healthcare waste management assessment: Challenges for hospitals in COVID-19 pandemic times

With the spread of the new Coronavirus, there was an increase in the generation of contaminated waste. Thus, healthcare waste management (HCWM) became even a greater challenge in hospitals due to Coronavirus easily spread. In this context, it was necessary to create tools that could aid healthcare facilities in evaluating their HCWM. Therefore, the objective of this article was to elaborate a support tool that helps in identifying the shortcomings of hospitals' HCWM. For this purpose, the Health Service Waste Management Index was developed based on the selection of indicators in the area. The index was applied to six hospitals in the state of Minas Gerais, Brazil. Its application meet the purpose of this research, since the results in the form of an index objectively summarize the reality of the HCWM in healthcare facilities. From the six hospitals investigated, four were classified as highly efficient. However, even though most of them were well evaluated, they still have difficulties with properly training their employees, which can be even a worse problem during a pandemic, when every precaution is extremely important to reduce the spread of the disease. Therefore, beyond this article contribution related to sustainability by demanding the hospitals to check which points of HCWM should be improved, it also adds academically by developing a tool with indicators that evaluate operational, human, economic and environmental factors in an innovative way.

Nanoparticles impact in biomedical waste management

Effectual management of biomedical waste is obligatory for healthy human beings and for a safe environment. Mismanagement of biomedical waste is a community health problem. Safe and persistent methods for the management of biomedical waste are of vital importance. This article reviews the classification of biomedical waste, sources, colour-coding system of biomedical waste and salient features of biomedical waste rules in 2016, and the future prospective of nanoparticles. The untreated disposal of biomedical waste is associated with a huge amount of risk, so the efficient treatment for biomedical waste is most imperative. The review also highlights the current methods for disposal of biomedical waste, biological treatments given to biomedical waste water in the effluent treatment plant, and impacts due to the current method. Management of biomedical waste is a great challenge in developed and developing countries. To manage the biomedical waste there is a need for cost-effective, ecofriendly and less contaminating approaches for a greener and safe environment. The awareness regarding waste management is of great interest not only for the community but also for associated employees.

Selecting a suitable model for collecting, transferring, and recycling drilling wastes produced in the operational areas of the Iranian offshore oil company (IOOC) using analytical hierarchy process (AHP)

Waste from drilling operations of oil and gas wells in the event of poor management, in addition to imposing costs, can lead to environmental problems. This research was aimed at providing a suitable model for collecting, transferring, and recycling the drilling wastes produced in the operational areas of the Iranian offshore oil company. Data analysis was performed using the Expert Choice and template selection using the analytical hierarchy process method. Based on the results of this study, the method of collecting waste in a cutting skip (weight = 0.576) was identified as a suitable option in the waste-collecting sector. In the waste transfer sector, the waste shipments from the west of the Persian Gulf to Kharg Island (weight 0.623) and the transfer of waste from the Eastern areas to Lavan island (weight 0.625) were selected as suitable options. Among the waste recycling options, the thermal method with of 0.433 was chosen as a top priority.

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

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

Occupational health and safety-oriented medical waste management: A case study of Istanbul

The outstanding pace of technological development around the world coupled with increasing population and rapid urbanization have brought along an ever-increasing demand for healthcare services. This trend results in an increasing amount and variety of medical wastes. Accordingly, the issue of effective collection, transportation and disposal of medical wastes, specifically in large cities, has become a critical concern from the viewpoint of urban logistics and holds great importance in terms of safety. This study aims to determine the safety of hospitals in their medical waste management function. The study involves the determination of medical waste management steps, establishment of a hierarchical structure, and weighting of the criteria within the established hierarchical structure by means of the analytic hierarchy process method. Afterwards, the extent to which these criteria are adopted in hospitals was evaluated by the medical waste management officers of those hospitals, and safety scores were obtained for each hospital by associating the results with the weighted values obtained by the analytic hierarchy process method. The model proposed for medical waste management problems encountered by healthcare institutions in Istanbul was implemented for a specific region of Istanbul province, and the obtained results were analyzed. Evaluation of the opinions of the healthcare officials for determination of the medical waste management safety scores showed that the "collection" criterion has significantly higher importance than the "temporary storage" and "transportation" criteria. "The effect on hospital personnel" sub-criterion of the "collection" criterion had the highest score. This revealed the importance of the collection process that takes place between storage and transportation, for evaluating the human waste-based risks.

Operating room greening initiatives - the old, the new, and the way forward: A narrative review

Healthcare waste is a rampant issue in Australian hospitals. The operating room (OR) contributes disproportionately to total hospital waste. There has been considerable research in the literature concentrating on strategies to improve OR and hospital waste accumulation, in an attempt to provide guidance and direction on how to reduce the healthcare ecological footprint. We reviewed the literature for leading greening initiatives currently utilised in the OR in Australia and internationally. This narrative literature review focuses on the trend of OR greening initiatives over the last 25 years, comparing different innovative approaches, the successes and setbacks, and the financial implications of initiatives. A variety of measures that hospital management, surgeons, anaesthetists, nurses and other healthcare personnel can take to reduce the ecological footprint of their healthcare facility are outlined. Greening initiatives include reducing, recycling, reusing, rethinking and researching, as well as novel technology and smarter architectural design. We also evaluated the barriers to improving waste management, which include lack of leadership, misconceptions among staff, and an overall resistance to change. In conclusion, in a world where greenhouse gas emissions cause unprecedented climate change and landfill space is finite, it is incumbent upon hospitals to help reduce the environmental impact of their facility. Reducing pollution and greenhouse gas emissions would moderate the incidence of human disease, save money for the healthcare system and society as a whole, and contribute to a safer and healthier world we all would like to live in.