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Padget M, Devadason A, Blom I, Molinie G, Armand W, Duhaime AC, Sherman JD, Slutzman J, Kringos D. Measuring environmentally sustainable health care: a scoping review. Lancet Planet Health 2024; 8:e675-e683. [PMID: 39243783 DOI: 10.1016/s2542-5196(24)00162-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 09/09/2024]
Abstract
Work to reduce environmental pollution from the health system is hampered by an absence of consensus on the definition of environmentally sustainable health care and the relevant measurement needed. This scoping review aims to encourage standardisation across sustainability efforts by examining how environmentally sustainable health care is defined and measured in current literature. We conducted a scoping review to identify candidate publications that included either a definition or description of environmentally sustainable health care or a measurement of the impact of health care on the environment. 328 publications were included in the final analysis. 52 publications included definitions or descriptions of environmentally sustainable health care. Results of the study highlight the heterogeneity in the current definition, measurement, and measurement calculation methods of environmentally sustainable health care in published literature. Work is needed to create more harmonised definitions and measurement to support progress and reduce environmental pollution from health care.
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Affiliation(s)
- Michael Padget
- Center for the Environment and Health, Massachusetts General Hospital, Boston, MA, USA; Center for the Environment and Health, Harvard Medical School, Harvard University, Boston, MA, USA.
| | - Anitha Devadason
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Iris Blom
- Centre on Climate Change and Planetary Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Guilhem Molinie
- University of Rennes, École des Hautes Études en Santé Publique, The National Centre for Scientific Research, INSERM, Arènes Unité de Recherche Mixte 6051, Recherche sur les Services et le Management en Santé-Unit 1309, Rennes, France
| | - Wynne Armand
- Center for the Environment and Health, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Massachusetts General Hospital, Boston, MA, USA; Center for the Environment and Health, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Ann-Christine Duhaime
- Center for the Environment and Health, Massachusetts General Hospital, Boston, MA, USA; Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA; Center for the Environment and Health, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Neurosurgery, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, Yale University, New Haven, CT, USA; Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT, USA
| | - Jonathan Slutzman
- Center for the Environment and Health, Massachusetts General Hospital, Boston, MA, USA; Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA; Center for the Environment and Health, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Emergency Medicine, Harvard Medical School, Harvard University, Boston, MA, USA
| | - Dionne Kringos
- Department of Public and Occupational Health, University of Amsterdam, Amsterdam UMC location, Amsterdam, Netherlands; Quality of Care, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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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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Nosheen F, Malik N, Mehmood Z, Jabeen F, Mahmood A, Ibrahim M, Bokhari A, Mubashir M, Chuah LF, Show PL. Biomedical waste management associated with infectious diseases among health care professionals in apex hospitals of a typical south asian city. ENVIRONMENTAL RESEARCH 2022; 215:114240. [PMID: 36103930 DOI: 10.1016/j.envres.2022.114240] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/20/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
Biomedical waste from healthcare activities poses a higher hazard of infection and damage than other types of trash. The main objective of the study was to assess the awareness knowledge and practices of biomedical waste management (BMWM) among health care professionals in the health care units. The cross-sectional study was carried out to access the awareness, knowledge and practices of health care professionals for BMWM. Using a qualitative approach, the study was escorted in two Apex hospitals i.e. the Allied Hospital and the District Head Quarter Hospital, Faisalabad, Pakistan from August 5, 2019 to October 15, 2019. More than 90% of respondents knew the phrase BMWM, but just 35.4% had awareness about biomedical waste regulations. About 71.6% of the respondents were familiar with biomedical waste's color-coding segregation. The study concludes gap in the awareness, knowledge and practices for BMWM. The sanitary workers of the hospitals had no knowledge about BMWM and the BMWM/healthcare waste management rule 2005 established in Pakistan due to the lack of training regarding waste management and the segregation process. Some of the staff members were aware of the BMWM practices under the rules and regulations of Pakistan but were unable to implement at their work place. It is necessary to dispose of the biomedical waste according to the established terms and conditions of BMWM rules (2005) of Pakistan. Weak structure of BMWM was observed at the study sites due to the lack of training, liabilities and absence of penalties against improper biomedical waste disposal as violation of the rules and regulations. It's a dire need of the time to consider the biomedical waste as hazardous waste and make policies for its safe disposal and ensure the implementation of the policies in all the medical centers of Pakistan.
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Affiliation(s)
- Farhana Nosheen
- Department of Home Economics, Government College University Faisalabad, Pakistan
| | - Nazia Malik
- Department of Sociology, Government College University Faisalabad, Pakistan
| | - Zaid Mehmood
- Department of Sociology, Government College University Faisalabad, Pakistan
| | - Fariha Jabeen
- Department of Environmental Sciences, Government College University Faisalabad, Pakistan
| | - Abid Mahmood
- Department of Environmental Sciences, Government College University Faisalabad, Pakistan.
| | - Muhammad Ibrahim
- Department of Environmental Sciences, Government College University Faisalabad, Pakistan.
| | - Awais Bokhari
- Department of Chemical Engineering, COMSATS University Islamabad, Lahore Campus, 54000, Pakistan; Sustainable Process Integration Laboratory, SPIL, NETME Centre, Faculty of Mechanical Engineering, Brno University of Technology, VUT Brno, Technická 2896/2, 616 00, Brno, Czech Republic
| | - Muhammad Mubashir
- Department of Petroleum Engineering, School of Engineering, Asia Pacific University of Technology and Innovation, 57000, Kuala Lumpur, Malaysia.
| | - Lai Fatt Chuah
- Faculty of Maritime Studies, Universiti Malaysia Terengganu, Terengganu, Malaysia
| | - Pau Loke Show
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, 43500 Semenyih, Selangor, Malaysia; Zhejiang Provincial Key Laboratory for Subtropical Water Environment and Marine Biological Resources Protection, Wenzhou University, Wenzhou 325035, China; Department of Sustainable Engineering, Saveetha School of Engineering, SIMATS, Chennai, India 602105.
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Deepak A, Kumar D, Sharma V. Developing an effectiveness index for biomedical waste management in Indian states using a composite indicators approach. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:64014-64029. [PMID: 33884553 DOI: 10.1007/s11356-021-13940-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 04/11/2021] [Indexed: 06/12/2023]
Abstract
The waste from healthcare facilities (HCFs) is most devastating as they induce health hazards and pollute the environment. The effective management of biomedical waste is an essential function of the state governments, depending on state policies and facilities in HCFs. The performance assessment at the state level provides explanatory information for the decision-makers to dispose of biomedical waste. Therefore, this paper aims to establish an effectiveness index for assessing the performance of biomedical waste management for the Indian states. The designed conceptual framework, which acts as the building block for the index, interlinks the technical, managerial, and sustainability dimensions. To assess the existing waste management practices, significant sub-indicators are analyzed for India's northern and southern states. The indicators are transformed into comparable units using the proportionate normalization technique. The weight to the respective indicators follows the entropy method and additive aggregation to form the indices for various states. The developed index allows comparing management practices among the states and highlights the alarming situation. Based on the magnitude of indices values, states are categorized as red, yellow, and green zones. The robustness of the model is validated by performing sensitivity analysis and the cluster analysis tests the reliability of indicators and categorization of states with the existing methodology. The analysis will be useful to the decision-makers of state pollution boards by providing special attention to capacity building and waste prevention technologies.
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Affiliation(s)
- Anurag Deepak
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology, Roorkee, Uttarakhand, 247667, India.
| | - Dinesh Kumar
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology, Roorkee, Uttarakhand, 247667, India
| | - Varun Sharma
- Department of Mechanical and Industrial Engineering, Indian Institute of Technology, Roorkee, Uttarakhand, 247667, India
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Pathak DR, Nepal S, Thapa T, Dhakal N, Tiwari P, Sinha TK. Capacity assessment and implementation analysis of common treatment facility for the management of infectious healthcare waste in rapidly urbanising city of Nepal. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2021; 39:64-75. [PMID: 33928811 DOI: 10.1177/0734242x211013910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study is one of the first systematic attempts to examine the possibility of a common treatment facility (CTF) to treat infectious healthcare waste (HCW) in Nepal. First, the survey was conducted in 14 healthcare facilities (HFs) ranging from health posts to large hospitals selected from 120 total HFs in Nepalgunj sub-metropolitan city (SMC), a rapidly urbanising city of Nepal to investigate the current practices of HCW management (HCWM) and to estimate the waste generation and characteristics in the different HFs. The result shows that the average unit waste generation rate for health posts, clinics, urban health centres, and hospitals was estimated at 1.397 kg day-1, 1.608 kg day-1, 0.178 kg day-1 and 1.818 kg bed-1 day-1, respectively. Of the total 1242 kg day-1 HCW generated in Nepalgunj SMC, 73% is infected in the current situation, but if fully sorted at source, only 32% of the waste will be infected. Based on these HCW generation data and fraction of infectious waste, including waste management practices, three different scenarios are proposed for the capacity assessment and designing implementation modality of the CTF to treat infectious waste from all HFs of Nepalgunj SMC as a case study where an integrated solid waste management facility including material recovery facility and sanitary landfill site for municipal solid waste management is already in operation. The different implementation analyses are discussed, and the best implementation arrangement has been recommended for the sustainability of the project. This approach can be replicated in other cities alone or regions with many neighbouring cities of Nepal and explores a workable solution for HCWM in the rapidly urbanising cities of developing countries to help them improve their condition.
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Affiliation(s)
| | - Suvash Nepal
- Deutsche Gesellschaft fürInternationaleZusammenarbeit, Kathmandu, Bagmati, Nepal
| | - Tejendra Thapa
- Deutsche Gesellschaft fürInternationaleZusammenarbeit, Kathmandu, Bagmati, Nepal
| | | | - Pravin Tiwari
- Deutsche Gesellschaft fürInternationaleZusammenarbeit, Kathmandu, Bagmati, Nepal
| | - Tirtha Kumar Sinha
- Deutsche Gesellschaft fürInternationaleZusammenarbeit, Kathmandu, Bagmati, Nepal
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