[Public and occupational health aspects related to municipal solid waste management]

Coletores de lixo no Brasil em 2013

Os catadores de materiais recicláveis podem ser considerados elementos-chave no processo de sustentabilidade ambiental, desempenhando importantes atividades para o tratamento adequado dos resíduos sólidos. Este trabalho visa analisar a dinâmica de trabalho e as condições de saúde dos coletores de lixo no Brasil no ano de 2013 e estabelecer comparações com a totalidade dos trabalhadores ocupados em outras profissões. Foram utilizados os dados quantitativos da Pesquisa Nacional de Saúde 2013 a partir de modelagem estatísticas. Pôde-se constatar que homens, mais velhos, com baixa escolaridade, de cor/raça preta ou parda, com baixa remuneração e que fazem uso do tabaco e/ou do álcool diariamente apresentam mais chances de ocuparem a profissão de catador. Os resultados retratam que os trabalhadores da coleta de materiais recicláveis do Brasil constituem uma fração da força de trabalho bastante vulnerável, sendo necessário que os agentes governamentais de saúde enfrentem a problemática das condições de trabalho e saúde dos catadores    

[Characterization and quantification of perforating waste generated by diabetics in Umuarama, Paraná, Brazil]

The scope of this research was to characterize and quantify the perforating waste produced domestically by people with diabetes mellitus (DM), as well as to analyze the discard and disposal practices for these materials. The data collection was performed through a questionnaire applied to primary care patients. The sample consisted of 149 people, the majority of whom were elderly and with a low level of schooling. Regarding the generation of waste, 88.64% of the deponents declared the use of one syringe per day, performing 1 to 4 applications. The reuse of the material was reported by 66.67% of the declarants. After being used, the waste was stored - with higher prevalence - in plastic bags (20.8%), plastic bottles, clothes softener and mayonnaise containers, etc. (46.98%). Ordinary household waste was the main disposal site for the perforating waste. Furthermore, it was revealed that those people who did not receive instructions regarding appropriate waste disposal discarded their waste incorrectly. Based on the results, the conclusion drawn is that the diabetics who participated in this study fail to discard and dispose of the perforating waste appropriately due to the lack of adequate guidelines and public programs.

Application of human HAZOP technique adapted to identify risks in Brazilian waste pickers' cooperatives

Waste pickers' cooperatives are an important part of curb side collection, presenting different types of structures and responsible for the sorting and separation of recyclable materials. Within these places, the lack of resources, structure and hygiene are intimately related to the great part of the work accidents and the exposure of these workers to risky situations. Several tools in Security Engineering are being studied to minimize and control risks. Among these techniques, HAZOP (Hazard and Operability study) stands out as one that has proven efficient in managing risks in industrial processes and other areas of study. For the applicability of the technique in this study, interviews were conducted with the co-workers. The data were used to prepare a Preliminary Risk Analysis (PRA) and later to create new guiding words for the modification of HAZOP in order to consider the risk from human aspects in the activities. This work aimed to evaluate the HAZOP applied to evaluate errors related to human aspects in three waste pickers cooperatives in Campinas/SP and to compare the data obtained with the PRA. With the application of the PRA, 189 different deviations were identified and the pre-screening step was the one that most violated workers' risks. With HAZOP and using the content analysis tool to evaluate employees' perceptions, it was possible to identify 209 deviations by having the personal question (45%), followed by the managerial question (29%) as the main causes.

Continued Medical Waste Exposure of Recyclable Collectors Despite Dumpsite Closures in Brazil

BACKGROUND

Brasilia, the capital of Brazil, currently has the largest dumpsite of the Americas at Estrutural, with over 30 million tons of waste accumulated. Recyclable waste collectors are a group of workers who, in addition to having a low socioeconomic status and residing in vulnerable areas, work sorting garbage in inadequate and unsanitary areas. This profession puts individuals at risk, resulting in death, mutilation, and disease for workers.

OBJECTIVES

The aim of this study was to understand the effects of waste on recyclable collectors, along with their perceptions of associated risks.

METHODS

A qualitative study was conducted, using interviews with 34 participants at Estrutural.

RESULTS

Collectors were exposed to several hazards, including biological, physical, and more extreme hazards (e.g. being run over by waste trucks). Personal protective equipment was not adequately used, exposing recyclable collectors to injury. Accidents included cuts, burns, skin lesions, eyes lesions, and arm, leg, head, feet, and hand injuries and amputations. Often, homecare remedies and collected medical waste (e.g. pain killers) were used on these injuries instead of seeking out proper medical care.

CONCLUSIONS

Recyclable collectors were aware of occupational hazards, but lacked education on the risks and consequences associated with exposure to medical hazards. Moreover, Brazil recently formally closed all dumpsites, complicating this issue. The findings of the present study confirm the need to address these hazards to provide a safe working environment for waste pickers.

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

This study was approved by the Research and Ethics Committee of the Health School of Brasília University under Opinion n. 1.517.670/2016.

COMPETING INTERESTS

The authors declare no competing financial interests.

Urban Waste Collectors in Belo Horizonte, Brazil: Their Perceptions of Occupational Health Risk

Frequent contact with hazardous materials makes waste collection a potentially unhealthy activity. This article assesses the perception of waste management workers regarding work-related accidents in domestic and health service contexts in Brazil. Six focus groups were performed between June 2014 and August 2015. The aims of this study were to apprehend different aspects of the participants' health, workers' experiences of work-related accidents and perception of risks. Cuts and puncture injuries were reported most frequently in the line of work and were often considered as irrelevant. Immunization against hepatitis B was not common among all workers, which increases the risk of infection for those individuals. Finally, it is considered urgent to consolidate an inclusive space in which workers can have discussions on their health.

Ineffective waste site closures in Brazil: A systematic review on continuing health conditions and occupational hazards of waste collectors

There are approximately 15 million people engaged in waste collection or recycling activities in the world. Some of these dump sites are informal and people work in environments that are labor-intensive, unregulated, unregistered, low-paid, unrecorded, and environmentally hazardous. A systematic review was conducted to assess consequential health conditions and occupational risks that affect waste collectors in Brazil. The search was limited to Brazil because although the government closed dump sites, open-air dumping-the worst type of waste disposal-still occurs in about half of the country; moreover, Brazil is the only country to systematically collect data on the occupation, with an estimated 229,568 recyclable collectors of all types country-wide, which offers relevant and pertinent data on the topic. The results of the search indicated that nearly every region has individuals that work as recyclable collectors. As expected, the sites are full of occupational hazards to the workers that can include: long working hours; exposures to physical, chemical, mechanical, biological, ergonomic and social agents; and frequent work accidents. Exposure to these risks can result both in physical and psychological illnesses. In view of these findings, public policies could be strengthened by supporting and providing incentives to municipalities, schools, universities, health professionals, and all others who will contribute to the closure of open-air waste or poor waste disposal systems. Moreover, an improved awareness should be provided to the general population about environmental education and correct disposal of garbage. The goal of healthy waste disposal conditions ultimately decreases environmental and public health effects, while improving the working conditions, quality of life, and health outcomes for recyclable collectors.

Assessment of work-related accidents associated with waste handling in Belo Horizonte (Brazil)

As more urban solid waste is generated, managing it becomes ever more challenging and the potential impacts on the environment and human health also become greater. Handling waste - including collection, treatment and final disposal - entails risks of work accidents. This article assesses the perception of waste management workers regarding work-related accidents in domestic and health service contexts in Belo Horizonte, Brazil. These perceptions are compared with national data from the Ministry of Social Security on accidents involving workers in solid waste management. A high proportion of accidents involves cuts and puncture injuries; 53.9% among workers exposed to domestic waste and 75% among those exposed to health service waste. Muscular lesions and fractures accounted for 25.7% and 12.5% of accidents, respectively. Data from the Ministry of Social Security diverge from the local survey results, presumably owing to under-reporting, which is frequent in this sector. Greater commitment is needed from managers and supervisory entities to ensure that effective measures are taken to protect workers' health and quality of life. Moreover, workers should defend their right to demand an accurate registry of accidents to complement monitoring performed by health professionals trained in risk identification. This would contribute to the improved recovery of injured workers and would require managers in waste management to prepare effective preventive action.

Socio-Environmental and Hematological Profile of Landfill Residents (São Jorge Landfill-Sao Paulo, Brazil)

We are experiencing an unprecedented urbanization process that, alongside physical, social and economic developments, has been having a significant impact on a population's health. Due to the increase in pollution, violence and poverty, our modern cities no longer ensure a good quality of life so they become unhealthy environments. This study aims to assess the effect of social, environmental and economic factors on the hematologic profile of residents of Santo André's landfill. In particular, we will assess the effect of social, economic, and environmental factors on current and potential disease markers obtained from hematological tests. The research method is the observational type, from a retrospective cohort, and by convenience sampling in Santo André in the Greater ABC (municipalities of Santo André, São Bernardo do Campo and São Caetano do Sul, southeast part of the Greater São Paulo Metropolitan Area, Brazil). The study determined a socio-environmental profile and the hematologic diseases screening related to a close location to the landfill. The disease manifests itself within a broad spectrum of symptoms that causes changes in blood count parameters. The objective of this work is to show that there is an association between social, environmental and economic factors and a variety of serious disease outcomes that may be detected from blood screening. A causal study of the effect of living near the landfill on these disease outcomes would be a very expensive and time-consuming study. This work we believe is sufficient for public health officials to consider policy and attempt remediation of the effects of living near a landfill.

ASSOCIAÇÕES ENTRE GRAU DE INSTRUÇÃO E RENDA NO COMPORTAMENTO DE SEPARAÇÃO DE MATERIAIS RECICLÁVEIS DOS MUNÍCIPES DE ILHA SOLTEIRA-SP

A gestão dos Resíduos Sólidos Domiciliares - RSD gera impactos no bem estar da população, especialmente nas pessoas que trabalham com a coleta, a separação e a comercialização dos materiais recicláveis. Este trabalho verificou associações entre a renda, a escolaridade e o bairro dos moradores de Ilha Solteira – SP, com o comportamento de separação de materiais recicláveis. Foram entrevistados 216 moradores de diferentes residências em toda área urbana, correspondendo a um nível de confiança de 99,6%. Verificou-se que a parcela da população mais instruída e melhor remunerada separou significativamente menos e menor variedade de materiais recicláveis, devido a falta de motivação e a falta de confiança na gestão municipal. Espera-se que estes resultados propiciem à municipalidade corrigir falhas na gestão dos RSD e planejar ações específicas para cada parcela da população.

[Solid urban waste: socio-environmental impacts and prospects for sustainable management with social inclusion]

Strategies to reconcile development with the protection of ecosystems will yet again be discussed at the forthcoming Rio +20 Summit. The management of solid urban waste is an issue which has barely been touched upon in such discussions. Given the institutionalization of the National Solid Waste Policy, this paper seeks to contribute to this debate and to single out alternatives to tackle this issue with an emphasis on social inclusion. For this purpose, specialized scientific literature was consulted as well as information on solid waste management. It is clearly seen that inadequate management of solid waste has immediate impacts on the environment and health, and contributes to climate change. Considering the limitations of the current options for waste disposal, it is essential to minimize the quantities produced by reducing, reusing and recycling. In this context, the role of independent waste gatherers who have been conducting work of great environmental importance is highlighted. Given the vulnerabilities of this population, it is necessary to devise public policies to ensure that waste gathering is a more respected and less risky activity that guarantees an income, so as to move towards more healthy, equitable and sustainable development.

Manejo de resíduos gerados na assistência domiciliar pela Estratégia de Saúde da Familia

O estudo objetivou analisar o manejo dos resíduos gerados pela assistência domiciliar. A coleta de dados ocorreu pela observação da assistência prestada pelos profissionais e usuários e/ou cuidadores. Os dados foram registrados em check list construído conforme recomendações da RDC 306. Os resíduos gerados foram: seringas (38,1%), agulhas (36,5%), esparadrapos (31,7%), gazes (31,7%) e lancetas (28,5%). Os resíduos do grupo A não foram segregados em todas as oportunidades e os do grupo E foram segregados 100% e 10,5% pelos profissionais e usuários, respectivamente. Conclui-se que, diante das inadequações encontradas, é necessária uma ampla discussão coletiva para a proposta de políticas públicas que atendam às especificidades do manejo dos resíduos de serviços de saúde nos domicílios, com intuito de dar segurança aos trabalhadores, comunidade e ambiente.

Os coletores de lixo urbano no município de Dourados (MS) e sua percepção sobre os riscos biológicos em seu processo de trabalho

A coleta de lixo urbano apresenta vários riscos ocupacionais. O objetivo foi identificar os riscos biológicos a que estão expostos os coletores de lixo urbano de Dourados/MS. Foi feita uma pesquisa qualitativa, segundo o Discurso do Sujeito Coletivo de Lefévre e Lefévre. A população abrangeu 42 trabalhadores, lotados na empresa que presta serviços à Secretaria Municipal de Serviços Urbanos. A coleta de dados através de entrevistas ocorreu de setembro de 2005 a janeiro de 2006. As entrevistas duraram em média 40 minutos, foram realizadas no escritório da empresa, em horário de chegada dos funcionários, gravadas em fita K7 e transcritas. Os riscos biológicos, segundo os coletores, são acidentes com vidro, seringas, espinhos, mordida de cães e contato com substâncias do lixo. Os acidentes com perfurocortantes constituem porta-de-entrada para microorganismos como bactérias, vírus e fungos. A contaminação com vírus (HIV e Hepatites B e C) pode ocorrer através de acidentes com agulhas contaminadas descartadas nos resíduos. Concluímos que os riscos biológicos na coleta de lixo urbano podem diminuir com orientações à população.

Análise preliminar de riscos sobre o gerenciamento dos resíduos de serviços de saúde de uma instituição de ensino em Mato Grosso do Sul: estudo de caso

No presente trabalho foram caracterizados, qualitativa e quantitativamente, os resíduos de serviços de saúde (RSS) do Centro de Ensino em Saúde (CES) de uma instituição pública de ensino localizada em Campo Grande-MS. Foi investigado o gerenciamento dos resíduos de 25 laboratórios de ensino e pesquisa, que geram em média 155,9 kg de RSS por semana. Determinou-se para o CES as taxas de geração de resíduos iguais a 0,29 kg.pesquisa-1.dia-1 e 0,11 kg.aula-1.dia-1; respectivamente, para as atividades de pesquisa e ensino. Após a análise preliminar de riscos, verificou-se que a instituição apresenta riscos químicos e biológicos que se estendem para fora do limite de suas instalações, impactando direta ou indiretamente a sociedade e o ambiente. Muitos laboratórios se enquadraram na categoria de risco máximo, sendo os mais críticos os de Patologia, Histologia, Anatomia Humana e Anatomia Veterinária.

Saúde coletiva, resíduos sólidos urbanos e os catadores de lixo

O artigo aborda a problemática ambiental da produção e da geração de resíduos sólidos urbanos, destacando o conceito de saúde e de ambiente enquanto representação social. A partir de uma revisão bibliográfica, discute a incorporação da temática saúde e ambiente no campo de conhecimento e práticas de interconexão com a saúde coletiva. Associa nesse contexto a questão da exclusão social gerada pela forma de produção e de consumo da sociedade pós-moderna, introduzindo os catadores de lixo, grupo populacional vulnerável.

Modelo para avaliação de planos de gerenciamento de resíduos de serviços de saúde (PGRSS) para Secretarias Municipais da Saúde e/ou do Meio Ambiente

O gerenciamento inadequado de resíduos de serviços de saúde produzidos diariamente, aliado ao aumento significativo de sua produção, vem agravando os riscos à saúde e à população. Cada responsável por estabelecimento gerador destes resíduos deve implementar o Plano de Gerenciamento de Resíduos de Serviços de Saúde - PGRSS. Cabe às Secretarias da Saúde e do Meio Ambiente municipais a principal responsabilidade por orientar e monitorar a construção e a sustentação dos PGRSS. A proposta deste trabalho é a apresentação de um modelo que pode ser utilizado por Secretarias da Saúde e/ou do Meio Ambiente municipais para análise de PGRSS dos estabelecimentos de saúde dos municípios. A análise (incluindo gráficos com os percentuais de questões enquadradas em cada critério pré-estabelecido) é devolvida para que cada estabelecimento de saúde municipal possa proceder a ajustes. Esta análise favorece um retorno para os estabelecimentos de saúde municipais com orientações precisas para melhora da qualidade do plano. Permite ainda que a Secretaria da Saúde ou do Meio Ambiente obtenha parâmetros para o direcionamento das ações de capacitação para a elaboração do plano. O modelo permite um retorno rápido, facilita a avaliação dos PGRSS, é de fácil aplicação e auxilia seu constante aprimoramento.

Heart rate and energy expenditure during garbage collection in Rio de Janeiro, Brazil

Physiological workload is used to estimate the physical demand of tasks in the workforce, but limited information is available for the various work activities in developing countries. Eighty-three randomly selected male workers participated in the present study, aimed at assessing the physiological workload of garbage collection (GC) in Rio de Janeiro, Brazil. Heart rate (HR) was obtained on four consecutive workdays. Energy expenditure (EE) was extrapolated from heart rate data based on individual laboratory-established heart rate/oxygen consumption curve in 70 workers. Mean HR during GC was 104.0 ± 11.7bpm (± SD), representing 56.9 ± 7.5% of maximum heart rate. EE was 1608.3 ± 738.5kcal for an average of 293.1 ± 103.9 minutes of work per day. Based on all measurements, work in garbage collection in Rio de Janeiro can be considered excessively heavy. These data emphasize the need to develop appropriate classification of workload to be used in health-related research and in the development of maximum acceptable work time in association with the physiological workload, particularly in developing countries.

Quantificação dos resíduos potencialmente infectantes presentes nos resíduos sólidos urbanos da regional sul de Belo Horizonte, Minas Gerais, Brasil

O objetivo da pesquisa foi o de conhecer a parcela de resíduos potencialmente infectantes aqueles contendo fezes, urina, sangue e fluidos corpóreos de origem domiciliar, presentes nos resíduos sólidos urbanos. Em agosto e setembro de 2002, os resíduos da região Sul de Belo Horizonte foram coletados e levados ao Centro de Tratamento e Disposição Final de Resíduos Sólidos da BR 040, para segregação e quantificação. Os "perfurocortantes" contribuíram com 0,02±0,02% dos resíduos coletados e a presença dos "não-perfurocortantes" foi de 5,47±1,11%. Na categoria "perfurocortante", os aparelhos de barbear predominaram (0,01±0,01%), enquanto que na categoria "não-perfurocortante" as maiores frações foram de papel higiênico (3,00±0,90%), fraldas descartáveis (2,21±1,08%) e absorventes higiênicos (0,22±0,12%). Os resíduos infectantes de origem domiciliar corresponderam ao dobro da fração total (infectante e comum) dos resíduos de unidades de serviços de saúde. A discussão foi feita sob a égide dos perigos à saúde e segurança dos trabalhadores da coleta formal (garis) e informal (catadores de rua e lixões).

Musculoskeletal pain in ragpickers in a southern city in Brazil

BACKGROUND

Ragpickers are informal workers who collect recyclable materials to earn a small wage. Their life and working conditions are extremely precarious. The ergonomic hazards and musculoskeletal pain in a sample of ragpickers in Pelotas, a city in southern Brazil are examined.

METHODS

Two comparison groups were available: a matched sample of non-ragpickers from the same poor neighborhoods, and a random sample of the general population of the city. The cross-sectional study gathered data by interview on 990 individuals in 2004. Musculoskeletal pain was assessed using the Standardized Nordic Questionnaire.

RESULTS

Ragpickers reported higher prevalences for most awkward postures and ergonomic exposures compared to neighbors with other demanding manual jobs. The prevalence within the last 12 months of low back pain (LBP), lower extremity pain (LEP), and upper extremity pain (UEP) among ragpickers were 49.2%, 45.1%, and 34.9%, respectively; levels similar to those reported by neighborhood controls. Both ragpickers and non-ragpickers reported considerably higher ergonomic exposures, and more prevalent LBP, than the general population.

CONCLUSIONS

Ragpickers experience many occupational hazards and ergonomic stressors. Their overall prevalence of musculoskeletal pain was similar to a comparison group with other physically demanding manual jobs. For LBP, this prevalence was substantially higher (49% vs. 35%) than in the general population.

Lixo, trabalho e saúde: um estudo de caso com catadores em um aterro metropolitano no Rio de Janeiro, Brasil

Este artigo apresenta os resultados de uma investigação sobre condições de vida, trabalho e saúde envolvendo 218 catadores de materiais recicláveis atuando no aterro metropolitano do Rio de Janeiro, Brasil. Recorrendo a um inquérito semi-estruturado, a pesquisa ouviu tais sujeitos sobre seu cotidiano e as percepções acerca de suas condições de vida, trabalho e saúde. Através de uma análise quanti-qualitativa, identificou-se que os catadores entrevistados percebem o lixo como fonte de sobrevivência, a saúde como capacidade para o trabalho e, portanto, tendem a negar a relação direta entre o trabalho e problemas de saúde. Contudo, os riscos levantados e a morbidade referida apontam para a elevada insalubridade e periculosidade dessa atividade, agravadas, possivelmente, pelas condições de vida que apresentam, inclusive no que se refere aos locais de moradia. Ao final, o artigo sugere a construção de políticas públicas que integrem diferentes dimensões do problema, como inclusão social, preservação ambiental, saúde pública e o resgate da dignidade desses trabalhadores.

[Health services waste management: a biosafety issue]

The subject of "health services waste" is controversial and widely discussed. Biosafety, the principles of which include safeguarding occupational health, community health, and environmental safety, is directly involved in the issue of medical waste management. There are controversies as to the risks posed by medical waste, as evidenced by diverging opinions among authors: some advocate severe approaches on the basis that medical waste is hazardous, while others contend that the potential for infection from medical waste is nonexistent. The Brazilian National Health Surveillance Agency (ANVISA) has published resolution RDC 33/2003 to standardize medical waste management nationwide. There is an evident need to implement biosafety procedures in this area, including heath care workers' training and provision of information to the general population.