Healthcare Waste Generation Worldwide and Its Dependence on Socio-Economic and Environmental Factors

A comprehensive study on the factors influencing the generation of infectious healthcare waste in inpatient healthcare institutions in Hungary

Infectious healthcare waste (IHCW) poses a significant biohazard and public health risk. This study examines IHCW formation and influencing factors in Hungarian inpatient healthcare institutions. Factors such as hospital type, regional location, indicators related to patient traffic, educational activity, patients of certain types of medical specialties, and healthcare-associated infections (HAIs) were examined. Univariate and multivariate statistical methods identified significant predictors of IHCW occurrence. The generation rate of IHCW ranged from 0.15 to 0.81 kg/bed/day nationally, and it increased by 40.74% between 2017 and 2021, significantly impacted by the COVID-19 pandemic. The data also showed that as the number of beds increased, the IHCW production rate increased proportionally. The results indicate that IHCW generation rates vary significantly by hospital type, with university hospitals producing the most waste. The incidence of HAI multidrug-resistant (MDR) bacterial infections emerged as the primary driver of IHCW generation, along with educational activity, the number of intensive care unit patients, and regional differences. The Southern Great Plain region had the highest IHCW production (0,42 kg/bed/day) among the seven regions studied. The study highlights the critical impact of HAI MDR infections on IHCW production, emphasizing the need for targeted waste management in high-risk areas. Regional differences indicate the necessity for tailored strategies to address local waste management challenges. This study provides essential insights into IHCW formation and influencing factors in Hungary, offering valuable information for policy and practice.Implication statementNowadays, one of the main problems related to waste management is the uncontrollable amount of waste generated in the healthcare sector. Infectious healthcare waste (IHCW) represents a significant biological hazard and a high public health risk, both on an individual and a community level, so a more precise knowledge of these risks is extremely important.In the Central European region, very few studies have dealt with the infectious waste generated in the healthcare sector, and this is the first such research in Hungary. The primary aim of this study is to measure the amount of IHCW produced in various regions and hospital types in Hungary, and to examine the general and specific factors that affect the generation rate of this waste.The findings reveal that IHCW generation rates (GR) vary considerably across different hospital types and regions. This highlights the need for targeted waste management practices in individual institutions. In addition, the study emphasizes the importance of developing region-specific waste management strategies in view of regional inequalities. A crucial insight from the study is that the incidence of healthcare-associated infections (HAIs), particularly multidrug-resistant (MDR) bacterial infections, has the most significant impact on IHCW GR, surpassing other known factors. This suggests that effective control of HAIs, especially MDR bacterial infections, can lead to a substantial reduction in IHCW. The study also showed the impact of the COVID-19 pandemic not only on the production of IHCW, but also on individual influencing factors.Overall, the study provides valuable insights for informing policy and practice. By understanding the specific factors influencing IHCW production, policymakers and healthcare practitioners can develop more effective waste management policies and practices. This highlights the need for tailored waste management strategies that take into account the unique characteristics of each hospital type and geographic region, ultimately reducing the healthcare waste burden and providing a healthier and safer environment for all.

Evaluation of a training programme on the management of infectious and sharp healthcare waste in Tunisia

INTRODUCTION

The management of healthcare waste is a crucial issue for public health and the environment. To minimise risks, it is essential to ensure that the management of healthcare waste is meticulously applied. Additionally, among the evaluation methods adopted by the hospital hygiene department to monitor the degree of compliance. The aim of this study was to assess the degree of compliance with healthcare waste management before and after a training and support programme.

METHODS

This is a pre-experimental study based on two audits of healthcare waste management at Farhat Hached University Hospital in Sousse, Tunisia. All medical, surgical and laboratory departments were included. The first audit was carried out, followed by training of the responsible staff, which was carried out according to a cycle of training and coaching hygiene technicians, and finally, a second audit was conducted. The compliance rate is compared between 2021 and 2022.

RESULTS

When comparing the averages of the compliance percentages for the four audit areas, there was a statistically significant improvement between the years 2021 and 2022 in the availability of equipment and consumables required for the management of infectious and sharp healthcare waste (p=0.029) as well as intramural transport (p=0.014).

CONCLUSION

The study highlights the central role of effective waste management training in promoting compliance, awareness and responsible practices. Constant attention and training are essential to maintain progress at Farhat Hached University Hospital. This helps create safer care environments, better public health outcomes and long-term sustainability.

Bioplastics: No solution to healthcare's plastic pollution problem

As Canadian policy-makers recognize the urgency for concerted actions to reduce plastics (e.g., Canada's involvement in the international plastics treaty negotiations, zero plastic waste strategy, and single-use plastics regulations), the healthcare sector must also consider a more sustainable plastics system. In this context, the potential for novel bioplastics to mitigate healthcare's substantial plastic waste problem must be carefully interrogated. Our analysis examines the complexities of bioplastics, highlighting the technical challenges of identifying legitimate sustainable alternatives, and the practical barriers for implementing bioplastics as substitutes for consumable plastics in healthcare. We focus on the Canadian healthcare sector and regulatory landscape with the insights gained being applicable to other sectors and countries. Given the limitations identified, the focus on reducing consumption should remain the priority.

Hospital food management: a multi-objective approach to reduce waste and costs

Food waste contributes significantly to greenhouse emissions and represents a substantial portion of overall waste within hospital facilities. Furthermore, uneaten food leads to a diminished nutritional intake for patients, that typically are vulnerable and ill. Therefore, this study developed mathematical models for constructing patient meals in a 1000-bed hospital located in Florida. The objective is to minimize food waste and meal-building costs while ensuring that the prepared meals meet the required nutrients and caloric content for patients. To accomplish these objectives, four mixed-integer programming models were employed, incorporating binary and continuous variables. The first model establishes a baseline for how the system currently works. This model generates the meals without minimizing waste or cost. The second model minimizes food waste, reducing waste up to 22.53 % compared to the baseline. The third model focuses on minimizing meal-building costs and achieves a substantial reduction of 37 %. Finally, a multi-objective optimization model was employed to simultaneously reduce both food waste and cost, resulting in reductions of 19.70 % in food waste and 32.66 % in meal-building costs. The results demonstrate the effectiveness of multi-objective optimization in reducing waste and costs within large-scale food service operations.

A review towards developing a hierarchical model for sustainable hospital solid waste management in rural areas of Zimbabwe

Management of solid waste from rural hospitals is amongst problems affecting Zimbabwe due to diseases, population, and hospital increase. Solid waste from rural hospitals is receiving little attention translating to environmental health problems. Therefore, 101 secondary sources were used to write a paper aiming to proffer a hierarchical model to achieve sustainable solid waste management at rural hospitals. Rural hospitals' solid waste encompasses electronic waste, sharps, pharmaceutical, pathological, radioactive, chemical, infectious, and general waste. General solid waste from rural hospitals is between 77.35 and 79% whilst hazardous waste is between 21 and 22.65%. Solid waste increase add burden to nearly incapacitated rural hospitals. Rural hospital solid waste management processes include storage, transportation, treatment methods like autoclaving and chlorination, waste reduction alternatives, and disposal. Disposal strategies involve open pits, open burning, dumping, and incineration. Rural hospital solid waste management is guided by legislation, policies, guidelines, and conventions. Effectiveness of legal framework is limited by economic and socio-political problems. Rural hospital solid waste management remain inappropriate causing environmental health risks. Developed hierarchical model can narrow the route to attain sustainable management of rural hospitals' solid waste. Proposed hierarchical model consists of five-layered strategies and acted as a guide for identifying and ranking approaches to manage rural hospitals' solid waste. Additionally, Zimbabwean government, Environmental Management Agency and Ministry of Health is recommended to collaborate to provide sufficient resources to rural hospitals whilst enforcing legal framework. Integration of all hierarchical model's elements is essential whereas all-stakeholder involvement and solid waste minimisation approaches are significant at rural hospitals.

Recycling facemasks into civil construction material to manage waste generated during COVID-19

Growing plastic pollution in the context of COVID-19 has caused significant challenges, exacerbating this already out-of-control issue. The pandemic has considerably boosted the demand for personal protective equipment (PPE), such as facemasks and gloves, all over the globe, and mismanaging this growing plastic pollution has harmed the environment and wildlife significantly. To mitigate negative environmental impacts, it is necessary to develop and implement effective waste management strategies. This present study estimated the daily facemask generation throughout the pandemic in Iran based on the distribution of urban and rural populations and, likewise, the daily generation of hand gloves in the COVID-19 era and the amount of medical waste generated by COVID-19 patients were calculated. In the next step, the quantities of discarded facemasks dumped into the Caspian Sea, the Persian Gulf, and the Gulf of Oman from the coastal cities were determined. Finally, the innovative alternatives for repurposing discarded facemasks in civil construction materials such as concrete, pavement, and partition wall panel were discussed.

Reducing waste management scenario space for developing countries: A hierarchical clustering on principal components approach

The complexity of waste management (WM) problems resulted in the explosion of scenarios that challenge focused discussion among stakeholders and hinder the integrity of policy responses in developing countries. Hence, drawing similarities is essential to reduce the number of scenarios to simplify the WM efforts. To extract similarities, measuring WM performance is not enough, but the background factors related to this performance should be incorporated. These factors form a unique system characteristic that facilitates or hinders WM functions. Thus, this study applied multivariate statistical analysis to clarify underlying characteristics that facilitate efficient WM scenario developments for developing countries. The study first analysed drivers associated with improved WM system performance using bivariate correlation analysis. As a result, twelve significant drivers associated with controlled solid waste were identified. Then, it mapped the countries based on their WM system characteristics using the combined principal component analysis and hierarchical clustering approach. Thirteen variables were examined to extract similarities between the countries. The results identified three homogenous clusters. The clusters were found considerably parallel to the global classifications based on income and human development index. Hence, the presented approach is efficient in explaining similarities that reduce WM scenarios and favours cooperation among countries.

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.

Healthcare waste in Bangladesh: Current status, the impact of Covid-19 and sustainable management with life cycle and circular economy framework

COVID-19 has accelerated the generation of healthcare (medical) waste throughout the world. Developing countries are the most affected by this hazardous and toxic medical waste due to poor management systems. In recent years, Bangladesh has experienced increasing medical waste generation with estimated growth of 3 % per year. The existing healthcare waste management in Bangladesh is far behind the sustainable waste management concept. To achieve an effective waste management structure, Bangladesh has to implement life cycle assessment (LCA) and circular economy (CE) concepts in this area. However, inadequate data and insufficient research in this field are the primary barriers to the establishment of an efficient medical waste management systen in Bangladesh. This study is introduced as a guidebook containing a comprehensive overview of the medical waste generation scenario, management techniques, Covid-19 impact from treatment to testing and vaccination, and the circular economy concept for sustainable waste management in Bangladesh. The estimated generation of medical waste in Bangladesh without considering the surge due to Covid-19 and other unusual medical emergencies would be approximately 50,000 tons (1.25 kg/bed/day) in 2025, out of which 12,435 tons were predicted to be hazardous waste. However, our calculation estimated that a total of 82,553, 168.4, and 2300 tons of medical waste was generated only from handling of Covid patients, test kits, and vaccination from March 2021 to May 2022. Applicability of existing guidelines, and legislation to handle the current situation and feasibility of LCA on medical waste management system to minimize environmental impact were scrutinized. Incineration with energy recovery and microwave sterilization were found to be the best treatment techniques with minimal environmental impact. A circular economy model with the concept of waste minimizaton, and value recovery was proposed for sustainable medical waste management. This study suggests proper training on healthcare waste management, proposing strict regulations, structured research allocation, and implementation of public-private partnerships to reduce, and control medical waste generation for creating a sustainable medical waste management system in Bangladesh.

Circular economy of medical waste: novel intelligent medical waste management framework based on extension linear Diophantine fuzzy FDOSM and neural network approach

Environmental pollution has been a major concern for researchers and policymakers. A number of studies have been conducted to enquire the causes of environmental pollution which suggested numerous policies and techniques as remedial measures. One such major source of environmental pollution, as reported by previous studies, has been the garbage resulting from disposed hospital wastes. The recent outbreak of the COVID-19 pandemic has resulted into mass generation of medical waste which seems to have further deteriorated the issue of environmental pollution. This necessitates active attention from both the researchers and policymakers for effective management of medical waste to prevent the harm to environment and human health. The issue of medical waste management is more important for countries lacking sophisticated medical infrastructure. Accordingly, the purpose of this study is to propose a novel application for identification and classification of 10 hospitals in Iraq which generated more medical waste during the COVID-19 pandemic than others in order to address the issue more effectively. We used the Multi-Criteria Decision Making (MCDM) method to this end. We integrated MCDM with other techniques including the Analytic Hierarchy Process (AHP), linear Diophantine fuzzy set decision by opinion score method (LDFN-FDOSM), and Artificial Neural Network (ANN) analysis to generate more robust results. We classified medical waste into five categories, i.e., general waste, sharp waste, pharmaceutical waste, infectious waste, and pathological waste. We consulted 313 experts to help in identifying the best and the worst medical waste management technique within the perspectives of circular economy using the neural network approach. The findings revealed that incineration technique, microwave technique, pyrolysis technique, autoclave chemical technique, vaporized hydrogen peroxide, dry heat, ozone, and ultraviolet light were the most effective methods to dispose of medical waste during the pandemic. Additionally, ozone was identified as the most suitable technique among all to serve the purpose of circular economy of medical waste. We conclude by discussing the practical implications to guide governments and policy makers to benefit from the circular economy of medical waste to turn pollutant hospitals into sustainable ones.

Review on distribution, fate, and management of potentially toxic elements in incinerated medical wastes

Medical wastes include all solid and liquid wastes that are produced during the treatment, diagnosis, and immunisation of animals and humans. A significant proportion of medical waste is infectious, hazardous, radioactive, and contains potentially toxic elements (PTEs) (i.e., heavy metal (loids)). PTEs, including arsenic (As), cadmium (Cd), lead (Pb) and mercury (Hg), are mostly present in plastic, syringes, rubber, adhesive plaster, battery wastes of medical facilities in elemental form, as well as oxides, chlorides, and sulfates. Incineration and sterilisation are the most common technologies adopted for the safe management and disposal of medical wastes, which are primarily aimed at eliminating deadly pathogens. The ash materials derived from the incineration of hazardous medical wastes are generally disposed of in landfills after the solidification/stabilisation (S/S) process. In contrast, the ash materials derived from nonhazardous wastes are applied to the soil as a source of nutrients and soil amendment. The release of PTEs from medical waste ash material from landfill sites and soil application can result in ecotoxicity. The present study is a review paper that aims to critically review the dynamisms of PTEs in various environmental media after medical waste disposal, the environmental and health implications of their poor management, and the common misconceptions regarding medical waste.

The long-term impact of coronavirus disease 2019 on environmental health: a review study of the bi-directional effect

Background

When health systems worldwide grapple with the coronavirus disease 2019 (COVID-19) pandemic, its effect on the global environment is also a significant consideration factor. It is a two-way process where the pre-COVID climate factors influenced the landscape in which the disease proliferates globally and the consequences of the pandemic on our surroundings. The environmental health disparities will also have a long-lasting effect on public health response.

Main body

The ongoing research on the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19 must also include the role of environmental factors in the process of infection and the differential severity of the disease. Studies have shown that the virus has created positive and negative ramifications on the world environment, especially in countries most critically affected by the pandemic. Contingency measures to slow down the virus, such as self-distancing and lockdowns have shown improvements in air, water, and noise quality with a concomitant decrease in greenhouse gas emissions. On the other hand, biohazard waste management is a cause for concern that can result in negative effects on planetary health. At the peak of the infection, most attention has been diverted to the medical aspects of the pandemic. Gradually, policymakers must shift their focus to social and economic avenues, environmental development, and sustainability.

Conclusion

The COVID-19 pandemic has profoundly impacted the environment, both directly and indirectly. On the one hand, the sudden halt in economic and industrial activities led to a decrease in air and water pollution, as well as a reduction in greenhouse gas emissions. On the other hand, the increased use of single-use plastics and a surge in e-commerce activities have had negative effects on the environment. As we move forward, we must consider the pandemic's long-term impacts on the environment and work toward a more sustainable future that balances economic growth and environmental protection. The study shall update the readers on the various facets of the interaction between this pandemic and environmental health with model development for long-term sustainability.

Graphic Abstract

Healthcare Waste Segregation Practice and Associated Factors among Healthcare Professionals Working in Public and Private Hospitals, Dire Dawa, Eastern Ethiopia

Background

The key to the effective management of healthcare wastes is the segregation of the waste at the point of generation; no matter what final strategy for the treatment and disposal of wastes is selected, it is critical that waste streams are separated.

Objective

The aim of the study is to assess the practice of healthcare waste segregation and associated factors among healthcare workers at public and private hospitals in Dire Dawa, Eastern Ethiopia.

Methods

An institution-based cross-sectional study was conducted among 280 healthcare workers from public and private hospitals. Data were collected through self-administered structured questionnaires and observation checklists. Bivariate and multivariable logistic regression were used to identify factors associated with the practice of healthcare workers using SPSS (Statistical Package for Social Sciences) version 25.

Results

This study showed that 56.4% (95% CI: 43.7-60.2) study participants had good healthcare waste segregation practices. Working in a public hospital (AOR = 0.09, 95% CI: (0.03-0.23)), working less than 40 hours a week (AOR = 4.28, 95% CI: (2.11-8.68)), adequate knowledge on healthcare waste management (AOR = 2.42, 95% CI: (1.27-4.61)), ever trained on waste management ((AOR = 2.74, 95% CI: (1.15-6.53)), the presence of guidelines, instructive posters on healthcare waste segregation ((AOR = 8.21, 95% CI: (3.84-17.55)), and availability of color-coded waste bins ((AOR = 9.53, 95% CI: (4.52-20.10)) were factors significantly associated with healthcare waste segregation practices.

Conclusion

The study revealed that healthcare waste segregation practices were unacceptably poor. It is very crucial to address the identified factors through ongoing enforcement of healthcare waste management rules and regulations, by providing training, instructive posters around the work area, and making color-coded bins available.

Integrated MCDM Approaches for Exploring the Ideal Therapeutic Plastic Disposal Technology: Probabilistic Hesitant Fuzzy Domain

The probabilistic hesitant fuzzy set (PHFS) is a useful extended version of the hesitant fuzzy set (HFS), which allows decision-makers greater freedom in espousing their preferences through the use of hesitant evidence in the real DM method. As the implications for individuals and global concerns have grown, efficient clinical diagnosis of medical waste has been a major challenge, particularly in developing countries. Medical waste can be disposed of in a variety of ways. The essential thing is to decide which strategies work best. The optimal healthcare plastic waste disposal (HCPWD) option is a MCDM method involving a wide range of qualitative characteristics. The MCDM technique (ARAS) is then described, whereby the criterion weights are assessed using the recommended entropy weighted method (EWM) proportion and score function in order to increase the process utilisation. Moreover, the above-described approach is used to address a real-world problem by determining the optimal treatment option for healthcare waste (HCW) disposal. Finally, a feasibility analysis is given to support the stated viewpoint on HCPWD options being prioritised.

Healthcare Waste-A Serious Problem for Global Health

Healthcare waste (HCW) is generated in different healthcare facilities (HCFs), such as hospitals, laboratories, veterinary clinics, research centres and nursing homes. It has been assessed that the majority of medical waste does not pose a risk to humans. It is estimated that 15% of the total amount of produced HCW is hazardous and can be infectious, toxic or radioactive. Hazardous waste is a special type of waste which, if not properly treated, can pose a risk to human health and to the environment. HCW contains potentially harmful microorganisms that can be spread among healthcare personnel, hospital patients and the general public, causing serious illnesses. Healthcare personnel are the specialists especially exposed to this risk. The most common medical procedure, which pose the highest risk, is injection (i.e, intramuscular, subcutaneous, intravenous, taking blood samples). The World Health Organization (WHO) estimates that around 16 billion injections are administered worldwide each year. However, if safety precautions are not followed, and needles and syringes are not properly disposed of, the risk of sharps injuries increases among medical staff, waste handlers and waste collectors. What is more, sharps injuries increase the risk of human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV/HCV), tuberculosis (TB), diphtheria, malaria, syphilis, brucellosis and other transmissions. Disposing of medical waste in a landfill without segregation and processing will result in the entry of harmful microorganisms, chemicals or pharmaceuticals into soil and groundwater, causing their contamination. Open burning or incinerator malfunctioning will result in the emission of toxic substances, such as dioxins and furans, into the air. In order to reduce the negative impact of medical waste, waste management principles should be formulated. To minimize health risks, it is also important to build awareness among health professionals and the general public through various communication and educational methods. The aim of this paper is to present a general overwiev of medical waste, its categories, the principles of its management and the risks to human health and the environment resulting from inappropriate waste management.

Waste audits in healthcare: A systematic review and description of best practices

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.

Quantifying the spatiotemporal evolution characteristics of medical waste generation during the outbreak of public health emergencies

Based on the medical waste quantity and patient data during the corona virus disease 2019 (COVID-19) outbreak in China, this study used scenario analysis to quantitatively analyze the temporal and spatial evolution of medical waste generation during the pandemics. First, the results show that the estimated medical waste per capita reached 15.4 kg/day if only patients were considered in Scenario 1, while the figures were reduced to 3.2 kg/day in Scenario 2 and 2.5 kg/day in Scenario 3 when the effects of both the patient type and the number of medical staffs were considered. The estimated results also demonstrated that the per capita medical waste related to the epidemic showed the characteristics of a U-shaped and trailing phenomenon over time. Then, the amount of medical waste related to the COVID-19 generated that generated due to COVID-19 was estimated in Hubei, Heilongjiang, Zhejiang, Henan and Hunan provinces under Scenario 2 and Scenario 3. The results indicated that the spatiotemporal evolution characteristics of five provinces show the significant differences, and the patient type has a remarkable influence on the generation of medical waste. Finally, a novel decomposition-ensemble approach was designed to make a better short-term forecasting effect for future medical waste generation in different provinces.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10163-022-01523-5.

A Review of the Impact That Healthcare Risk Waste Treatment Technologies Have on the Environment

Health-Care Risk Waste (HCRW) treatment protects the environment and lives. HCRW is waste from patient diagnostics, immunization, surgery, and therapy. HCRW must be treated before disposal since it pollutes, spreads illnesses, and causes harm. However, waste treatment increases the healthcare sector's carbon footprint, making the healthcare sector a major contributor to anthropogenic climate change. This is because treating HCRW pollutes the environment and requires a lot of energy. Treating HCRW is crucial, but its risks are not well-studied. Unintentionally, treating HCRW leads to climate change. Due to frequent climate-related disasters, present climate-change mitigation strategies are insufficient. All sectors, including healthcare, must act to mitigate and prevent future harms. Healthcare can reduce its carbon footprint to help the environment. All contributing elements must be investigated because healthcare facilities contribute to climate change. We start by evaluating the environmental impact of different HCRW treatment technologies and suggesting strategies to make treatments more sustainable, cost-effective, and reliable to lower the carbon footprint.

Identifying and Predicting Healthcare Waste Management Costs for an Optimal Sustainable Management System: Evidence from the Greek Public Sector

The healthcare sector is an ever-growing industry which produces a vast amount of waste each year, and it is crucial for healthcare systems to have an effective and sustainable medical waste management system in order to protect public health. Greek public hospitals in 2018 produced 9500 tons of hazardous healthcare wastes, and it is expected to reach 18,200 tons in 2025 and exceed 18,800 tons in 2030. In this paper, we investigated the factors that affect healthcare wastes. We obtained data from all Greek public hospitals and conducted a regression analysis, with the management cost of waste and the kilos of waste as the dependent variables, and a number of variables reflecting the characteristics of each hospital and its output as the independent variables. We applied and compared several models. Our study shows that healthcare wastes are affected by several individual-hospital characteristics, such as the number of beds, the type of the hospital, the services the hospital provides, the number of annual inpatients, the days of stay, the total number of surgeries, the existence of special units, and the total number of employees. Finally, our study presents two prediction models concerning the management costs and quantities of infectious waste for Greece's public hospitals and proposes specific actions to reduce healthcare wastes and the respective costs, as well as to implement and adopt certain tools, in terms of sustainability.

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.

Prioritization of factors and selection of best business practice from bio-medical waste generated using best–worst method

Purpose

Hospital activities restore health and save lives; yet they produce infectious waste that might harm people and the environment if not handled carefully. The sudden increase in bio-medical waste (BMW) generation was caused due to the outbreak of Coronavirus disease (COVID-19) at the beginning of year 2020. There is a huge potential of businesses from BMW generated in the developing economies. The document destruction process would prove to be beneficial in determining the strategies and policies for the business from BMW. Therefore, the purpose of this study was to identify and evaluate the factors that influence the business prospects from BMW in developing economies.

Design/methodology/approach

The study focuses on identifying 18 factors based on an extensive literature review, questionnaire, theoretical foundations and interviews with experts in the context of developing economies. These factors are categorized into four groups namely “Culture, education and microeconomics”, “Infrastructure, social provision, and technology”, “Policy and institution” and “Integrated waste management system”. Consequently, these factors are prioritized to assist the decision-maker in comprehending the most critical aspects of accomplishing the best business practices. A framework based on the Best–Worst Method (BWM) is applied to evaluate and determine the significance of each identified factor.

Findings

The major contribution of this paper is to identify key factors that are responsible for successful implementation of the business practices from the generated BMW. The study also explains their nature, significance and inter-relationship among them using BWM. Current study applied a distinctive modeling approach to examine the contextual relationship among the key factors and to rank them as per their importance. The findings of the study suggest that “Setup for collection and segregation is the best alternative for business from BMW produced”.

Originality/value

The paper also presents strategies, which can be adopted as a guiding step by the decision-makers to formulate policies for the effective business practice from BMW. This research is expected to stimulate future applications of the BWM to facilitate long-term decision-making.

Estimation of the healthcare waste generation during COVID-19 pandemic in Bangladesh

COVID-19 pandemic-borne wastes imposed a severe threat to human lives as well as the total environment. Improper handling of these wastes increases the possibility of future transmission. Therefore, immediate actions are required from both local and international authorities to mitigate the amount of waste generation and ensure proper disposal of these wastes, especially for low-income and developing countries where solid waste management is challenging. In this study, an attempt is made to estimate healthcare waste generated during the COVID-19 pandemic in Bangladesh. This study includes infected, ICU, deceased, isolated and quarantined patients as the primary sources of medical waste. Results showed that COVID-19 medical waste from these patients was 658.08 tons in March 2020 and increased to 16,164.74 tons in April 2021. A top portion of these wastes was generated from infected and quarantined patients. Based on survey data, approximate daily usage of face masks and hand gloves is also determined. Probable waste generation from COVID-19 confirmatory tests and vaccination has been simulated. Finally, several guidelines are provided to ensure the country's proper disposal and management of COVID-related wastes.

Mapping healthcare waste management research: Past evolution, current challenges, and future perspectives towards a circular economy transition

Improper healthcare waste (HCW) management poses significant risks to the environment, human health, and socio-economic sustainability due to the infectious and hazardous nature of HCW. This research aims at rendering a comprehensive landscape of the body of research on HCW management by (i) mapping the scientific development of HCW research, (ii) identifying the prominent HCW research themes and trends, and (iii) providing a research agenda for HCW management towards a circular economy (CE) transition and sustainable environment. The analysis revealed four dominant HCW research themes: (1) HCW minimization, sustainable management, and policy-making; (2) HCW incineration and its associated environmental impacts; (3) hazardous HCW management practices; and (4) HCW handling and occupational safety and training. The results showed that the healthcare industry, despite its potential to contribute to the CE transition, has been overlooked in the CE discourse due to the single-use mindset of the healthcare industry in the wake of the infectious, toxic, and hazardous nature of HCW streams. The findings shed light on the HCW management domain by uncovering the current status of HCW research, highlighting the existing gaps and challenges, and providing potential avenues for further research towards a CE transition in the healthcare industry and HCW management.

Healthcare Waste Management Practices and Associated Factors in Private Clinics in Addis Ababa, Ethiopia

BACKGROUND

Healthcare waste management requires special attention and every healthcare teams should be involved in handling of wastes at point of generation. However, less attention is given to healthcare waste management in Ethiopia and there is no evidence about healthcare waste management practices in private clinics in Addis Ababa. Accordingly, this study was conducted to assess healthcare waste management practices and associated factors in private clinics in Addis Ababa, Ethiopia.

METHODS

A health facility-based cross-sectional study was conducted in 278 randomly selected private clinics in Addis Ababa. Data were collected using questionnaire and observational checklists. Multivariable binary logistic regression analysis was used to identify factors associated with healthcare waste management practices on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and P-values <.05.

RESULT

Results showed that 61.2% of the surveyed clinics had poor healthcare waste management practices, out of which, 56.8% had poor waste segregation practice, 55.0% had poor waste collection practice, 85.6% had poor waste transportation practice, 63.3% had poor waste storage practice, 61.9% had poor waste treatment, and 57.9% had poor disposal system. Healthcare waste management practice in the surveyed clinics was significantly associated with presence of guidelines (AOR: 1.98, 95% CI: 1.06, 3.69), budget allocation (AOR: 2.05, 95%, CI: 1.20, 3.49), and inspection by the regulatory bodies (AOR: 2.47, 95% CI: 1.26, 4.84).

CONCLUSION

Healthcare waste management practice was poor in the surveyed clinics. This suggests that the healthcare industries in the studied region may create health treats to healthcare workers, waste handlers, patients, the community, and the environment at large. The following key elements are needed to improve healthcare waste management practices in private clinics: promoting practices that reduce the volume of waste generated and ensure proper waste segregation; developing strategies and systems, as well as strong oversight and regulation, to incrementally improve waste segregation, destruction, and disposal practices with the ultimate goal of meeting national and international standards; and selecting safe and environmentally-friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing of waste.

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.

Developing an effectiveness index for biomedical waste management in Indian states using a composite indicators approach

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.

Plastic waste release caused by COVID-19 and its fate in the global ocean

Plastic waste causes harm to marine life and has become a major global environmental concern. The recent COVID-19 pandemic has led to an increased demand for single-use plastic, intensifying pressure on this already out-of-control problem. This work shows that more than eight million tons of pandemic-associated plastic waste have been generated globally, with more than 25,000 tons entering the global ocean. Most of the plastic is from medical waste generated by hospitals that dwarfs the contribution from personal protection equipment and online-shopping package material. This poses a long-lasting problem for the ocean environment and is mainly accumulated on beaches and coastal sediments. We call for better medical waste management in pandemic epicenters, especially in developing countries.

The COVID-19 pandemic has led to an increased demand for single-use plastics that intensifies pressure on an already out-of-control global plastic waste problem. While it is suspected to be large, the magnitude and fate of this pandemic-associated mismanaged plastic waste are unknown. Here, we use our MITgcm ocean plastic model to quantify the impact of the pandemic on plastic discharge. We show that 8.4 ± 1.4 million tons of pandemic-associated plastic waste have been generated from 193 countries as of August 23, 2021, with 25.9 ± 3.8 thousand tons released into the global ocean representing 1.5 ± 0.2% of the global total riverine plastic discharge. The model projects that the spatial distribution of the discharge changes rapidly in the global ocean within 3 y, with a significant portion of plastic debris landing on the beach and seabed later and a circumpolar plastic accumulation zone will be formed in the Arctic. We find hospital waste represents the bulk of the global discharge (73%), and most of the global discharge is from Asia (72%), which calls for better management of medical waste in developing countries.

Effectiveness of a multimodal capacity building initiative for upgrading biomedical waste management practices at healthcare facilities in Bangladesh: a 21st century challenge for developing countries

INTRODUCTION

Bio-medical Waste Management (BMWM) has attracted critical attention across the world as its improper management can pose a serious threat for healthcare workers (HCWs), the general population and the environment as well. This study aims to analyse the effectiveness of a multimodal intervention (MMI) in upgrading BMWM practices at healthcare facilities across Bangladesh.

METHODS

This quasi-experimental study, with a pre- and post-test design, was carried out at nine healthcare facilities (five public, three private and one autonomous) over three phases and concluded in 2019. The MMI included various strategies including: i) system change; ii) education and training, iii) visual reminders, iv) monitoring and feedback; v) ensuring sustainability at the study hospitals. The data collected from 2726 HCWs and waste handlers through direct observation was statistically analysed using SPSS 24.

RESULT

Significant improvements were observed in waste segregation practices (rising from 1% to 79%) using colour-coded bins. Use of PPEs during transportation and final management/disposal was also enhanced from 3% to 55%. Compliance to use of standardized methods for collecting and transporting biomedical waste (BMW) increased substantially from 0% to 78% while compliance to standard final management/disposal of BMW practices improved by 39%.

CONCLUSION

Compliance to BMWM practices is very poor in Bangladesh due to a lack of knowledge, manpower and resources. Nevertheless, MMI can be used as a tool to significantly upgrade BMWM practices across healthcare facilities. Such initiatives will assist the government of Bangladesh to achieve sustainable development goal (SDG) 3.3 and universal health coverage by 2030.

Evaluating the Waste Prevention Potential of a Multi- versus Single-Use Surgical Stapler

Purpose

Within the hospital, surgery is recognized as a resource-intensive activity that disproportionately generates large volumes of healthcare waste. Single-use, disposable medical supplies contribute substantially to this problem, and more broadly to the depletion of scarce resources. Given that many surgical procedures utilize surgical stapling techniques, this study uses surgical stapling systems as functional units for evaluating the waste prevention potential of switching from single-use systems (SUSs) to multi-use systems (MUSs).

Materials and Methods

Two frequently used surgical stapling systems, Ethicon’s SUS: ECHELON FLEX™ and Medtronic’s MUS: Signia™ Stapling Technology, were mechanically deconstructed to their individual raw material components to calculate the composition of each system. Total waste as well as extended resource use (the total material requirement [TMR]) were then calculated for three different surgical procedures; laparoscopic sleeve gastrectomy, laparoscopic gastric bypass, and video-assisted thoracoscopic (VATS) lobectomy. The differences in outcomes for SUSs versus MUSs were then calculated.

Results

For each surgical procedure considered, switching from a SUS to a MUS led to a reduction in total waste accumulated per procedure and TMR. Reductions in waste were 40% (sleeve gastrectomy), 70% (gastric bypass), and 62% (VATS lobectomy). The TMR reductions were higher, at 92% (sleeve gastrectomy), 96% (gastric bypass), and 95% (VATS lobectomy). Both waste and TMR reduction were realized with the MUS system as long as the reusable parts were used more than four times. This was true for all analyzed surgical procedures.

Conclusion

Switching from a SUS to MUS facilitates a reduction in total surgical waste and TMR for sleeve gastrectomy, gastric bypass, and VATS lobectomy surgical procedures.

A life cycle assessment of reprocessing face masks during the Covid-19 pandemic

The Covid-19 pandemic led to threatening shortages in healthcare of medical products such as face masks. Due to this major impact on our healthcare society an initiative was conducted between March and July 2020 for reprocessing of face masks from 19 different hospitals. This exceptional opportunity was used to study the costs impact and the carbon footprint of reprocessed face masks relative to new disposable face masks. The aim of this study is to conduct a Life Cycle Assessment (LCA) to assess and compare the climate change impact of disposed versus reprocessed face masks. In total 18.166 high quality medical FFP2 face masks were reprocessed through steam sterilization between March and July 2020. Greenhouse gas emissions during production, transport, sterilization and end-of-life processes were assessed. The background life cycle inventory data were retrieved from the ecoinvent database. The life cycle impact assessment method ReCiPe was used to translate emissions into climate change impact. The cost analysis is based on actual sterilization as well as associated costs compared to the prices of new disposable face masks. A Monte Carlo sampling was used to propagate the uncertainty of different inputs to the LCA results. The carbon footprint appears to be 58% lower for face masks which were reused for five times compared to new face masks which were used for one time only. The sensitivity analysis indicated that the loading capacity of the autoclave and rejection rate of face masks has a large influence on the carbon footprint. The estimated cost price of a reprocessed mask was €1.40 against €1.55. The Life Cycle Assessment demonstrates that reprocessed FFP2 face masks from a circular economy perspective have a lower climate change impact on the carbon footprint than new face masks. For policymakers it is important to realize that the carbon footprint of medical products such as face masks may be reduced by means of circular economy strategies. This study demonstrated a lower climate change impact and lower costs when reprocessing and reusing disposable face masks for five times. Therefore, this study may serve as an inspiration for investigating reprocessing of other medical products that may become scarce. Finally, this study advocates that circular design engineering principles should be taken into account when designing medical devices. This will lead to more sustainable products that have a lower carbon footprint and may be manufactured at lower costs.

Multi-Objective Optimization for Healthcare Waste Management Network Design with Sustainability Perspective

Healthcare Waste Management (HWM) is considered as one of the important urban decision-making problems due to its potential environmental, economic, and social risks and damages. The network of the HWM system involves important decisions such as facility locating, inventory management, and transportation management. Moreover, with growing concerns towards sustainable development objectives, HWM systems should address its environmental and social aspects as well as its economic and technical characteristics. In this regard, this paper formulates a novel multi-objective optimization model to empower companies in making optimized decisions considering the economic, environmental, and social aspects. Within the proposed model, the first objective function aims to minimize the transportation costs, processing costs, and establishment costs. The second objective function aims to minimize environmental risks and emissions related to the transportation of waste between facilities. The third objective function aims to maximize job creation opportunities. Formulating these three functions, an Improved Multi-Choice Goal Programing (IMCGP) approach is proposed to solve the multi-objective optimization model, which is then compared with the Goal Attainment Method (GAM). Finally, to show the applicability and feasibility of the proposed model, an illustrative example of healthcare waste management is analyzed, and the results are discussed.

Consequences of COVID-19 pandemic on solid waste management: Scenarios pertaining to developing countries

Undoubtedly the most searched and spoken word of last year is coronavirus disease 2019 (COVID-19), which initially originated in Wuhan, China near the end of 2019. COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Albeit almost all countries shut down their borders to prevent rapid spread of the virus. However, the number of cases continues to increase in developing countries at a faster rate due to community and cluster transmission. The severity of this epidemic made it a pandemic as it progressed to over 200 countries. The World Health Organization (WHO), governments, and national disease control and prevention units worked together to break the chain and are working to contain the catastrophic impact of COVID-19. They formulated and recommended various guidelines like social distancing, frequent hand washing, and social distancing to inhibit the spread of the virus. WHO also advised that the general population and medical personnel wear face masks, face shields, gloves, and aprons. As a result, this waste category has substantially increased and, if not disposed of properly, may cause the infection or help to catalyze COVID-19. In developing countries, poor solid waste management may aggravate chances of spreading COVID-19. Sustainable solid waste management is a critical parameter for the health, wellbeing, and development of society. The measures adopted to contain and restrict the spread of the COVID-19 pandemic and minimize the degrees of freedom in commercial events affected solid waste management considerably. During this crucial time, the services provided by waste management agencies and personnel are invaluable and these services help to prevent the improper disposal of waste, which may lead to health risks due to the spread of COVID. COVID-19 is a new and novel virus and experts are learning more about it overtime and with evolving science. This review paper provides insight into different types of solid wastes generated during the pandemic, their consequences, and the implication of various policies.

A systematic review of food waste audit methods in hospital foodservices: development of a consensus pathway food waste audit tool

BACKGROUND

To understand, monitor and compare the scope of food waste in hospital foodservices, it is essential to measure food waste using a standardised method. The aims of this systematic review were to: (i) describe and critique the methodological features of waste audits used in hospital foodservice settings that measure aggregate food and food-related waste and (ii) develop a consensus tool for conducting a food waste audit in a hospital foodservice setting.

METHODS

Seven electronic databases were searched for peer reviewed literature, and 17 Google Advanced searches located grey literature that described food waste audit methods previously used or developed for hospital foodservices. Study selection and quality assessment occurred in duplicate. Data describing the audit method, its feasibility, and strengths and limitations were extracted and synthesised to develop a consensus tool.

RESULTS

Eight peer reviewed and nine grey literature documents describing a variety of food waste audit methods were found. The most common practices were 2-week data collection (n = 5), foodservice staff collecting data (n = 6), measuring food waste only (n = 11), measuring food waste at main meals (n = 5) and using electronic scales to measure waste (n = 12). A consensus tool was developed that proposes a method for preparing, conducting and analysing data from a food waste audit.

CONCLUSIONS

This review used published evidence to develop the first ever food waste audit consensus tool for hospital foodservices to use and measure food and food-related waste. Future research is needed to apply and test this tool in practice.

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.

Insights of healthcare waste management practices in Vietnam

Nowadays, together with the economic development, public health activities have gained substantial attention with increasing number of hospitals during the past decades. A multi-method approach involving site visits, questionnaires, and interviews, in combination with secondary data revealed that the healthcare waste (HCW) generation, varied with different specialties (general or pediatric/obstetric hospitals) and different level of hospitals (central, provincial, district levels). The HCW generation from different kinds of surveyed hospitals varied from 0.8 to 1.0 kg/bed/day for domestic waste, 0.15 to 0.25 kg/bed/day for infectious and hazardous waste, and less than 0.1 kg/bed/day for recycled waste. Only 94.3% of central hospitals, 92% of provincial hospitals, and 82% of district hospitals complied with national regulation in hazardous medical waste treatment. For healthcare wastewater treatment, the actual operating rates were 91%, 73%, and 50% for central, provincial, and district hospitals, respectively. The cost for HCW management accounted for only 10-15% of the total budget allocated for the medical facilities. Most of the provincial hospitals spent about $0.2-$0.4/bed/year for HCW management. This is the root cause of ineffective HCW management.

Selection of the best healthcare waste disposal techniques during and post COVID-19 pandemic era

In recent years, municipal authorities especially in the developing nations are battling to select the best health care waste (HCW) disposal technique for the effective treatment of the medical wastes during and post COVID-19 era. As evaluation of various disposal alternatives of HCW and selection of the best technique requires considering various tangible and intangible criteria, this can be framed as multi-criteria decision-making (MCDM) problem. In this paper, we propose an assessment framework for the selection of the best HCW disposal technique based on socio-technical and triple bottom line perspectives. We have identified 10 criteria on which the best HCW disposal techniques to be selected based on extant literature review. Next, we use Fuzzy VIKOR method to evaluate 9 HCW disposal alternatives. The effectiveness of the proposed framework has been demonstrated with a real-life case study in Indian context. To check the robustness of the proposed methodology, we have compared the results obtained with Fuzzy TOPSIS (Technique of Order Preference Similarity to the Ideal Solution). The results help the municipal authorities to establish a methodical approach to choose the best HCW disposal techniques. Our findings indicate that incineration is the best waste disposal technique among the available alternatives. Even if the dataset indicates 'incineration' is the best method, we must not forget about the environmental concerns arising from this method. In COVID time, incineration may be the best method as indicated by the data analysis, but "COVID" should not be an excuse for causing "Environmental Pollution".

Consequences of COVID-19 pandemic on solid waste management: Scenarios pertaining to developing countries

Undoubtedly the most searched and spoken word of last year is coronavirus disease 2019 (COVID-19), which initially originated in Wuhan, China near the end of 2019. COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Albeit almost all countries shut down their borders to prevent rapid spread of the virus. However, the number of cases continues to increase in developing countries at a faster rate due to community and cluster transmission. The severity of this epidemic made it a pandemic as it progressed to over 200 countries. The World Health Organization (WHO), governments, and national disease control and prevention units worked together to break the chain and are working to contain the catastrophic impact of COVID-19. They formulated and recommended various guidelines like social distancing, frequent hand washing, and social distancing to inhibit the spread of the virus. WHO also advised that the general population and medical personnel wear face masks, face shields, gloves, and aprons. As a result, this waste category has substantially increased and, if not disposed of properly, may cause the infection or help to catalyze COVID-19. In developing countries, poor solid waste management may aggravate chances of spreading COVID-19. Sustainable solid waste management is a critical parameter for the health, wellbeing, and development of society. The measures adopted to contain and restrict the spread of the COVID-19 pandemic and minimize the degrees of freedom in commercial events affected solid waste management considerably. During this crucial time, the services provided by waste management agencies and personnel are invaluable and these services help to prevent the improper disposal of waste, which may lead to health risks due to the spread of COVID. COVID-19 is a new and novel virus and experts are learning more about it overtime and with evolving science. This review paper provides insight into different types of solid wastes generated during the pandemic, their consequences, and the implication of various policies.

Face mask and medical waste disposal during the novel COVID-19 pandemic in Asia

The origin of the novel human coronavirus (SARS-CoV-2) and its potential for harm increased face mask and medical waste in the environment, thereby necessitating the urgent prevention and control of the pandemic. The article estimates the face mask and medical waste generation in Asia during the pandemic to convince the waste management and scientific communities to find ways to address the negative impact that the waste disposal has on the environment. Standardisation, procedures, guidelines and strict implementation of medical waste management related to COVID-19, community habitats and public areas should be carefully considered to reduce pandemic risks in hospitals, as proper medical waste disposal effectively controls infection sources.

Waste Segregation FMEA Model Integrating Intuitionistic Fuzzy Set and the PAPRIKA Method

Segregation is an important step in health care waste management. If done incorrectly, the risk of preventable infections, toxic effects, and injuries to care and non-care staff, waste handlers, patients, visitors, and the community at large, is increased. It also increases the risk of environmental pollution and prevents recyclable waste from being recovered. Despite its importance, it is acknowledged that poor waste segregation occurs in most health care organizations. This study therefore intends to produce, for the first time, a classification of failure modes related to segregation in the Nuclear Medicine Department of a health care organization. This will be done using Failure Mode and Effects Analysis (FMEA), by combining an intuitionistic fuzzy hybrid weighted Euclidean distance operator, and the multicriteria method Potentially All Pairwise RanKings of all possible Alternatives (PAPRIKA). Subjective and objective weights of risk factors were considered simultaneously. The failure modes identified in the top three positions are: improper storage of waste (placing items in the wrong bins), improper labeling of containers, and bad waste management (inappropriate collection periods and bin set-up).

Assessing knowledge, attitude, and practice of healthcare personnel regarding biomedical waste management: a systematic review of available tools

Biomedical waste (BMW) management is an important commitment of hospitals both in terms of the possible infectious risk and from the financial point of view. Monitoring the knowledge, attitude, and practice (KAP) of healthcare professionals on this topic represents a source of information on BMW management. The aim of this study is to perform a systematic review to identify the reliable and valid tools able to assess the KAP of professionals in healthcare centers to manage BMW. Two databases (PubMed and Scopus) were searched on 10 May 2018 for cross-sectional studies with tools on BWM management, including original research studies from peer-reviewed journals, case studies, and review studies. Information on validation and reliability were collected. Methodological quality was assessed using the Newcastle-Ottawa scale for cross-sectional studies. Fifty-three articles were included, of which 19 presented a questionnaire on BMW for healthcare workers. Nine proposed a validated questionnaire: four reported Cronbach's alpha, which ranged from 0.62 to 0.86. Results further emphasize the prevalence of Asian studies facing the problem of assessing KAP about BMW management using specific tools. Overall, 14 questionnaires were designed in Asia, two in Africa, one in America, one in Australia, and one questionnaire was elaborated in Europe, in Spain. This systematic review highlighted the need of creation of validated and methodologically high-quality questionnaires. Therefore, there is the need of new cross-sectional studies to investigate these problems, improving generalization, and facilitating international comparison of research findings.

Application of healthcare waste indicators for assessing infectious waste management in Bolivia

In the developing world, healthcare waste management is a human health and environmental burden that should be solved for improving sustainability. Solutions should be introduced in the short term, concerning management, planning, financial assistance and expertise. The paper introduces an indicator set for assessing healthcare waste management in developing cities, implemented in La Paz (Bolivia) as a case study. The objective is to suggest an integrated management tool as a first assessment technique to identify the prevailing problems with a healthcare waste management system. Results suggest that, in La Paz, the application of such indicators is useful for evaluating which priorities should be addressed for improving the healthcare waste management system. The tool was applied for introducing a study necessary for the application of new management plans, especially concerning healthcare waste treatment. The method can be replicated in other contexts worldwide, with a focus on the developing world, for comparing cities, management solutions and improvements carried out along the years. The approach is of interest for boosting sustainability and human health, improving the awareness of the actors and policy-makers involved in waste management.

Socio-economic and environmental factors influenced the United Nations healthcare sustainable agenda: evidence from a panel of selected Asian and African countries

The objective of the study is to evaluate socio-economic and environmental factors that influenced the United Nations healthcare sustainable agenda in a panel of 21 Asian and African countries. The results show that changes in price level (0.0062, p < 0.000), life risks of maternal death (4.579, p < 0.000), and under-5 mortality rate (0.374, p < 0.000) substantially increases out-of-pocket health expenditures, while CO₂ emissions (5.681, p < 0.003), prevalence of undernourishment (15.184, p < 0.000), PM_2.5 particulate emission (1557, p < 0.000), unemployment, and private health expenditures (30.729, p < 0000) are associated with high mortality rate across countries. Healthcare reforms affected by low healthcare spending, unsustainable environment, and ease of environmental regulations that ultimately increases mortality rate across countries. The Granger causality estimates confirmed the different causal mechanisms between socio-economic and environmental factors, which is directly linked with the country's healthcare agenda, i.e., the causality running from (i) CO₂ emissions to life risks of maternal death and under-5 mortality rate, (ii) from depth of food deficit to incidence of tuberculosis and unemployment, (iii) from PM_2.5 emissions to infant mortality rate, (iv) from foreign direct investment (FDI) inflows to PM_2.5 emissions, (v) from trade openness to greenhouse gas (GHG) emissions, and (vi) from mortality indicators to per capita income, while there is a feedback relationship between health expenditures and per capita income across countries. The variance decomposition analysis shows that (i) under-5 mortality rate will increase out-of-pocket health expenditures, (ii) unemployment rate will increase mortality indicators, and (iii) health expenditures will increase economic well-being in a panel of selected countries, for the next 10 years.

Healthcare Waste Management: A Case Study from Sudan

Healthcare waste (HCW) represents a major public health issue, especially in developing countries. Among HCW categories, sharps waste is one of the most hazardous. Exposure to needle-stick injuries can lead to blood-borne pathogens, therefore HCW should be managed in an effective manner. The main aims of this study were to assess the current management of used needles and to suggest suitable recommendations for an improved and safer system for needle management in Khartoum, Sudan. The study showed that the management of both healthcare and home-generated HCW in Sudan is inefficient, as all wastes are mixed together and disposed of improperly, especially used needles. The study attributes this to many reasons, including lack of waste segregation at the source, lack of policies, failure of planning, inadequate training, lack of awareness of the hazardous nature of such kinds of waste, weak infrastructure, and a lack of suitable treatment technologies. The estimated average generated rate of HCW ranged from 0.38 to 0.87 kg/bed/day in 2009 and 2012, respectively. Such ineffective healthcare waste management HCWM, especially used needles, can put public health as well as the environment at risk, particularly waste workers, thus urgent action needs to be taken by all involved parties and at all levels.

Describing health care waste generation rates using regression modeling and principal component analysis

This work examined the dependence of the health care waste generation rates (HCWGR) from economic factors (gross domestic product per capita, health expenditure per capita), social and health-related factors (human development index, life expectancy at birth, mean years of schooling, deaths due to tuberculosis, under-five mortality rate, hospital beds, improved sanitation facilities, physicians, nurses and midwives, diabetes prevalence, deaths due to cancer, deaths due to asthma, deaths due to influenza and pneumonia), and one environmental sustainability factor (carbon dioxide emissions) from 41 countries using multiple linear regression modeling and principal component analysis (PCA). In addition, the Pearson correlation coefficients were calculated for all pairwise comparisons and a geographical grouping of the HCWGR was performed. The examined HCWGR included both the hazardous and the municipal fraction of health care waste (HCW). Results showed that the CO₂ emissions and the life expectancy at birth positively correlated to the HCWGR (kg/bed/d) and can be used as adequate statistical predictors. The resulting best reduced model explained 84.7% of the variability. The hospital beds and the deaths due to cancer were not correlated to any principal component due to their low loadings. Only the diabetes prevalence was correlated to the F2 principal component. The other fourteen variables were correlated to the F1, which was the most significant principal component. Thus, the HCWGR and the other thirteen variables that were grouped to the F1 component have strong autocorrelation and can be treated as one variable.