Biomedical waste management: Incineration vs. environmental safety

Regulated Medical Waste Reduction in the Dermatology Clinic

INTRODUCTION

The disposal of regulated medical waste (RMW) in the healthcare setting can be both costly and environmentally harmful. Prior studies have found large amounts of waste disposed of in RMW containers are inappropriately placed. Few studies to date have investigated the efficacy of waste reduction practices in the dermatology setting.

METHODS

This study aims to evaluate the effectiveness of a practice-wide intervention in reducing RMW in the outpatient dermatology setting. By performing daily waste audits and two concurrent educational interventions, the amount of RMW produced and percent of appropriately placed RMW will be measured. Further analysis will occur by comparing pre-intervention values to post-intervention values.

RESULTS

The percentage of waste properly placed in RMW containers prior to any intervention was 11%. Following both educational interventions, the percentage of waste properly placed in RMW containers increased by 56.1% (CI 43.7-68.5%) and the percentage of total waste produced that was identified and disposed of as RMW decreased by 6.0% (95% CI 1.2-10.8%).

CONCLUSION

Our study provides practical data for dermatology providers to make small changes which can result in significant reductions of regulated medical waste, potentially providing benefits to the environment and cost-savings.

Effective methods for the decontamination of healthcare waste: Ozone and UV-C radiation process

Human-generated waste, including infectious healthcare waste, poses significant risks to public health and the environment. The COVID-19 pandemic has increased the global production of infectious waste, emphasizing the need for safe and sustainable waste management practices. While autoclaves are commonly used for on-site disposal, alternative methods like ozone gas and UV-C radiation offer environmentally friendly options that effectively eliminate pathogens without leaving toxic residues. Inadequate waste management can contribute to disease transmission, while open burning releases harmful pollutants. This study investigated the effectiveness of different disinfection agents - ozone gas and UV-C radiation - on infectious solid waste contaminated with bacteria. The bacterial indicators examined were Staphylococcus aureus, Bacillus subtilis, and Pseudomonas aeruginosa. The experimental methods included operating each ozone and UV-C radiation individually and simultaneously using ozone gas and UV-C radiation. The study also investigated exposure times and various concentrations of ozone gas. The findings demonstrated that the simultaneous application of ozone gas and UV-C radiation was the most effective method for decontaminating infectious solid waste and targeting the selected bacteria. The concentration of ozone gas ranged from 165 to 5000 ppm, depending on generation time and treatment chamber volume, while exposure times varied from 1 to 180 minutes. In applying UV-C rays, complete elimination of S. aureus was observed after 60 minutes up to 6-log, while the reduction of B. subtilis and P. aeruginosa were 2-log and 3-log, respectively. Ozone gas had the ability to inactivate all strains, but when ozone gas and UV-C rays were used simultaneously, this process was accelerated and improved. The total reduction in the bacterial load was 8-log. Considering the increase in population and the subsequent increase in waste generation, adopting an environmentally friendly waste management method can be very advantageous.Implications: This study highlights the effectiveness of simultaneously applying ozone gas and UV-C radiation for decontaminating infectious solid waste, offering an environmentally friendly alternative to traditional thermal treatments like autoclave and incineration. By optimizing ozone concentrations and exposure times, this method reduces disease transmission risks and minimizes environmental impact. These findings are crucial, especially during outbreaks such as the COVID-19 pandemic, providing scalable, sustainable waste management solutions for healthcare facilities. Implementing these techniques can protect public health and the environment, setting a new standard for safe infectious waste disposal worldwide, mitigating hazardous pollutants, and reduce the exposure risk of bio-hazardous residues.

A review on medical waste treatment in COVID-19 pandemics: Technologies, managements and future strategies

Since the outbreak of COVID-19 few years ago, the increasing of the number of medical waste has become a huge issue because of their harmful impact to environment. A major concern associated to the limitation of technologies for dealing with medical waste, especially conventional technologies, are overcapacities since pandemic occurs. Moreover, the outbreak of new viruses from post COVID-19 should become a serious attention to be prevented not only environmental issues but also the spreading of viruses to new pandemic near the future. The high possibility of an outbreak of new viruses and mutation near the future should be prevented based on the experience associated with the SARS-CoV-2 virus in the last 3 yr. This review presented information and strategies for handling medical waste during the outbreak of COVID-19 and post-COVID-19, and also information on the current issues related to technologies, such as incineration, pyrolysis/gasification, autoclaves and microwave treatment for the dealing with high numbers of medical waste in COVID-19 to prevent the transmission of SARS-CoV-2 virus, their advantages and disadvantages. Plasma technology can be considered to be implemented as an alternative technology to deal with medical waste since incinerator is usually over capacities during the pandemic situation. Proper treatment of specific medical waste in pandemics, namely face masks, vaccine vials, syringes, and dead bodies, are necessary because those medical wastes are mediums for transmission of the SARS-CoV-2 virus. Furthermore, emission controls from incinerator and plasma are necessary to be implemented to reduce the high concentration of CO2, NOx, and VOCs during the treatment. Finally, future strategies of medical waste treatment in the perspective of potential outbreak pandemic from new mutation viruses are discussed in this review paper.Implications: Journal of the air and waste management association may consider our review paper to be published. In this review, we give important information related to the technologies, managements and strategies for handling the medical waste and control the transmission of SARS-CoV-2 virus, starting from proper technology to control the high number of medical waste, their pollutants and many strategies for controlling the spreading of SARS-CoV-2 virus. Moreover, this review also describes some strategies associated with control the transmission not only the SARS-CoV-2 virus but also the outbreak of new viruses near the future.

Responsible waste management: using resources efficiently (Part 2)

This chapter aims to describe the types of waste produced in dental practice, the costs associated with disposal of this waste, and the impact that the disposal method has on the environment and on human health. It discusses the waste hierarchy and explores how dental surgeries can reduce their waste generation through simple changes in practice. The chapter continues by highlighting the benefits of performing a waste audit, with examples of how correct segregation of the waste produced in practice is both cost-effective and reduces the environmental impact of its disposal. Finally, we discuss some of the barriers and enablers of changing waste disposal behaviours in the dental practice and identify how the environmentally minded practitioner can encourage pro-environmental behaviour in their dental team.

Climate Change and Healthcare: Creating a Sustainable and Climate-Resilient Health Delivery System

Climate change poses global challenges as rising temperatures, recurring natural disasters, and the resulting increase in the prevalence of acute and long-term climate-related diseases threaten the health and safety of populations worldwide. The healthcare sector, one of the largest sources of greenhouse gas emissions globally, both exacerbates and suffers from these effects. As leaders in their local communities and the national economy, hospitals and health systems have a responsibility to not only build climate resilience to withstand disaster events but also implement sustainability initiatives that will reduce the healthcare sector's carbon footprint. A wide variety of initiatives that can meet all financial plans and timelines are available. This discussion focuses on three of the most impactful areas for opportunity: building resilience through community, operating room sustainability, and renewable energy sources.

Improving the hospital waste management at the Farabi hospital in Malekan -Iran: An action research study

Hospital waste poses numerous concerns for both human health and the environment. Using an action research technique, this study attempts to improve waste management at the Farabi Hospital in Malekan city-Iran. In 2020, integrated (quantitative-qualitative) action research was done. For action research, the Simmons model was employed. First, a list of significant issues was found during the waste management process evaluation using a standard checklist and brainstorming with hospital officials and workers. The identified issues were prioritized using a prioritization matrix. Then, after consulting with hospital officials, 11 interventions were designed and implemented over six months. Finally, waste management performance was re-evaluated. Average knowledge of the participants about hospital waste management (HWM) standards was improved significantly (64 ± 13.8 before the training, 84.6 ± 20.6). General waste production was reduced by 27.7% in terms of garbage bags and 23.4% in terms of waste weight (95.5 kg-73.1 kg), respectively. Infectious waste output was reduced by 22.8% in the number of garbage bags and 32.1% in the weight of waste (57.5 kg-39 kg). The rate of compliance with HWM criteria was improved from 10 to 33 items. Although the interventions in this study improved the HWM to an acceptable level, more interventions and ongoing monitoring are required. The study's findings also show that an action research strategy might address a wide range of issues and weaknesses in hospitals and related facilities.

Anthropogenic emission inventory and spatial analysis of greenhouse gases and primary pollutants for the Galapagos Islands

Climate change and air pollution are critical challenges that humanity is currently facing. Understanding the sources of emissions released into the atmosphere is of great importance to evaluate the local footprint, the impacts of human activities, and the opportunities to develop and implement solutions to mitigate emissions and adapt to climate change particularly in vulnerable places like the Galapagos Islands. In this study, we present an anthropogenic emissions inventory for Santa Cruz, San Cristobal, and Isabela Islands in which emissions were spatially mapped for greenhouse gasses (GHGs) and primary pollutants (PP). Emissions were estimated for the energy stationary sources, energy mobile sources, waste, and other sectors, and emissions for 2019 were spatially distributed along with an uncertainty assessment. Results demonstrated that energy mobile sources which are aerial, terrestrial, and maritime transportation generated the most significant emissions in the Galapagos Islands in terms of PP and GHGs. In fact, maritime transportation was the highest one in 2019, at 41% of total CO₂ emissions for Galapagos, with the most predominant PP being NOx and CO. The aerial transportation made up 36% of emissions, and the electricity generation contributed 15%. Emissions from waste and other sectors comprise a smaller percentage relative to the rest of the emission sectors. These results highlight the strong dependency of the islands on fossil fuels for transportation and electricity generation. Alternatives to mitigate and reduce emissions from the islands are discussed. This spatially mapped emissions inventory for the Galapagos Islands represents a powerful tool to make informed decisions to contribute to the long-term sustainability of the archipelago.

Geographical and temporal analysis of bio-medical waste management in India

In India, a large quantity of bio-medical waste is generated by healthcare facilities. This study analyses the geographical and temporal variations in bio-medical waste management (BMWM) in India systematically. A comprehensive BMWM inventory of India's states and union territories for the period 2008-2017 was prepared and analysed. The objectives of this study were to analyse BMWM implementation geographically across the country to assess its performance, and to understand its policy implementation gaps over time. During 2008-2017, the total bio-medical waste generation increased from 409 to 558 Mg/day. Among all the states and union territories, Maharashtra, Karnataka, and Gujarat have the highest number of healthcare facilities. The quantity of waste generated is the highest in Karnataka, Maharashtra, Tamil Nadu, Uttar Pradesh, Kerala, Bihar, West Bengal, and Gujarat. The quantity of waste treated has also increased with the enforcement of the Bio-Medical Waste Rules (2016). The quantity of bio-medical waste treatment is highest in Karnataka and Maharashtra. This analysis will help to improve the practice of BMWM, and it can be used to bridge the gaps in effective and efficient management of bio-medical waste in India.

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.

Biomedical Waste Management and Its Importance: A Systematic Review

The waste generated in various hospitals and healthcare facilities, including the waste of industries, can be grouped under biomedical waste (BMW). The constituents of this type of waste are various infectious and hazardous materials. This waste is then identified, segregated, and treated scientifically. There is an inevitable need for healthcare professionals to have adequate knowledge and a proper attitude towards BMW and its management. BMW generated can either be solid or liquid waste comprising infectious or potentially infectious materials, such as medical, research, or laboratory waste. There is a high possibility that inappropriate management of BMW can cause infections to healthcare workers, the patients visiting the facilities, and the surrounding environment and community. BMW can also be classified into general, pathological, radioactive, chemical, infectious, sharps, pharmaceuticals, or pressurized wastes. India has well-established rules for the proper handling and management of BMW. Biomedical Waste Management Rules, 2016 (BMWM Rules, 2016) specify that every healthcare facility shall take all necessary steps to ensure that BMW is handled without any adverse effect on human and environmental health. This document contains six schedules, including the category of BMW, the color coding and type of containers, and labels for BMW containers or bags, which should be non-washable and visible. A label for the transportation of BMW containers, the standard for treatment and disposal, and the schedule for waste treatment facilities such as incinerators and autoclaves are included in the schedule. The new rules established in India are meant to improve the segregation, transportation, disposal methods, and treatment of BMW. This proper management is intended to decrease environmental pollution because, if not managed properly, BMW can cause air, water, and land pollution. Collective teamwork with committed government support in finance and infrastructure development is a very important requirement for the effective disposal of BMW. Devoted healthcare workers and facilities are also significant. Further, the proper and continuous monitoring of BMW is a vital necessity. Therefore, developing environmentally friendly methods and the right plan and protocols for the disposal of BMW is very important to achieve a goal of a green and clean environment. The aim of this review article is to provide systematic evidence-based information along with a comprehensive study of BMW in an organized manner.

End-of-life management strategies of pharmaceuticals in Portuguese households

The end of life of pharmaceutical products through environmentally unsafe routes is a growing concern in our society. However, the studies reported so far, apart from being limited in number, do not reflect the current management practices for the end-of-life management of pharmaceuticals. Published work lacks an in-depth analysis in focusing on the pharmaceutical waste in households. The present work focused on (1) performing a state-of-the art overview to compare worldwide studies and the results and (2) implementing a comprehensive survey in Portugal (n = 454 respondents). The results showed that the delivery to pharmacies was used by the majority of the respondents (72%), indicating a good awareness of pharmaceutical waste management issues, when compared to the reviewed studies. Statistically significant variables for the destination of end-of-use pharmaceuticals include gender, age and distance from the residence to the pharmacy (p < 0.05). Most participants believe that educating the population on existing structures of medication and packaging management is of the utmost importance to improve the national managing system. This is the first study conducted in Portugal; it includes statistical analysis of the data and reflects on the practices that should be adopted to reduce incorrect pharmaceutical waste disposal. These findings call upon the strategies to strengthen the pharmaceutical waste management programme.

Waste treatment innovation for infusion bottles using soil solution

The amount of medical waste, especially infusion bottles, is a problem for environmental pollution. Improper management of infusion bottle waste can have an impact on disease transmission. The medical waste treatment used high technology and high costs will be a financial burden, so simple and effective treatment innovations is needed. This study uses an experimental method of removing bacteria from infusion bottles using a mixture of water and Andoso soil as a solution for washing infusion bottle waste. The soil solution concentration used in washing was 45% with a contact time of 2 minutes. The experiment was carried out with two repetitions. The treatment effect on decreasing the number of bacteria using a multiple linear regression mathematical model. The results showed that the disinfection process of bacterial-contaminated infusion bottles using water required rinsing up to six times, whereas using 45% andosol soil solution only rinsed once. The effectiveness of the disinfection of infusion bottles contaminated with bacteria using soil solution reduces the number of bacteria by 98%.

Overcoming challenges due to enhanced biomedical waste generation during COVID-19 pandemic

Biomedical wastes (BMWs) are potentially infectious to the environment and health. They are co-dependent and accumulative during the ongoing coronavirus disease-2019(COVID-19) pandemic. In India the standard treatment processes of BMWs are incineration, autoclaving, shredding, and deep burial; however, incineration and autoclaving are the leading techniques applied by many treatment providers. These conventional treatment methods have several drawbacks in terms of energy, cost, and emission. But the actual problem for the treatment providers is the huge and non-uniform flow of the BMWs during the pandemic. The existing treatment methods are lacking flexibility for the non-uniform flow. The Government of India has provisionally approved some new techniques like plasma pyrolysis, sharp/needle blaster, and PIWS-3000 technologies on a trial basis. But they are all found to be inadequate in the pandemic. Therefore, there is an absolute requirement to micromanage the BMWs based on certain parameters for the possible COVID-19 like pandemic in the future. Segregation is a major step of the BMW management. Its guideline may be shuffled as segregation at the entry points followed by collection instead of the existing system of the collection followed by segregation. Other steps like transportation, location of treatment facilities, upgradation of the existing treatment facilities, and new technologies can solve the challenges up to a certain extent. Technologies like microwave treatment, alkaline hydrolysis, steam sterilization, biological treatment, catalytic solar disinfection, and nanotechnology have a lot of scopes for the treatment of BMWs. Hi-tech approaches in handling and transportation are found to be fruitful in the initial steps of BMW management. End products of the treated BMWs can be potentially fabricated for the application in the built environment. Some policies need to be re-evaluated by the health care facilities or government administrations for efficient BMW management.

Review of hospital plastic waste management strategies for Pakistan

Healthcare waste management is considered one of the biggest challenges that the world is going to face in the future. This threat is becoming reality owing to the worldwide sharp rise in healthcare waste generation particularly during the current COVID-19 pandemic. Like many other environmental crises, hospital plastic waste management is an area that got very little attention despite being highlighted in the literature, local media, as well as in international electronic and print media. This mini-review was conducted to assess the overall prevailing situation regarding hospital plastic waste management in Pakistan. Several illegal and unethical activities have been observed regarding hospital plastic waste management in Pakistan which includes unhygienic recycling, repacking of used hospital plastic items, open dumping on land, and disposal of hospital plastic waste in the ocean. To improve these conditions, suggestions have been made regarding the better management of hospital plastic waste.

Third-party Logistics in Bio-medical Waste System: a Path Towards a Risk-free Sector

After the sudden advent of COVID-19, the amount of medical waste has escalated to a great extent. The incremented medical waste amidst the pandemic exposes the improper waste management system of various developing countries. India, being one of the prominent developing countries, produces the largest waste in the world. Nonetheless, the Indian waste management system is not able to manage the massive amount of waste generated. Henceforth, this research study approaches to reveal the prominent factors which are causing failure in the system of medical waste management in India. This manuscript mainly focuses on two aspects. Firstly, this paper illuminates the factors which are hindering medical waste management by third-party logistics (3PL). Secondly, this study discusses a unique interval-value intuitionistic fuzzy set (IVIFS) based on Decision Making Trial and Evaluation Laboratory (DEMATEL) to depict graphical causal interrelationships among the factors. In addition, the analytic network process (ANP) is utilized to estimate the influence ranking of each factor. The results of this research anticipate that the transportation and disposal-related constraining factors require more attention from 3PL managers. The current study is unique as it enriches the various hindering factors on 3PL BMW management by discussing the ranking and relationship among factors.

Increase in SARS-CoV-2 infected biomedical waste among low middle-income countries: environmental sustainability and impact with health implications

Studies have shown that severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) is a highly infectious disease, with global deaths rising to about 360,438 as of 28 May 2020. Different countries have used various approaches such as lockdown, social distancing, maintenance of personal hygiene, and increased establishment of testing and isolation centers to manage the pandemic. Poor biomedical waste (BMW) management, treatment, and disposal techniques, especially SARS-CoV-2 infected BMW, may threaten the environmental and public health in most developing countries and, by extension, impact the economic status of individuals and the nation at large. This may increase the potential for the transmission of air/blood body fluid-borne pathogens, increase the growth of microorganisms, risk of mutagenesis, and upsurge of more virulent strain. In contrast, uncontrolled substandard burning could increase the potential spread of nosocomial infection and environmental exposure to toxic organic compounds, heavy metals, radioactive, and genotoxic bio-aerosols which might be present in the gaseous, liquid, and solid by-products. The paucity of understanding of pathophysiology and management of the SARS-CoV-2 pandemic has also necessitated the need to put in place appropriate disposal techniques to cater for the sudden increase in the global demand for personal protective equipment (PPE) and pharmaceutical drugs to manage the pandemic and to reduce the risk of preventable infection by the waste. Therefore, there is a need for adequate sensitization, awareness, and environmental monitoring of the impacts of improper handling of SARS-CoV-2 infected BMWs. Hence, this review aimed to address the issues relating to the improper management of increased SARS-CoV-2 infected BMW in low middle-income countries (LMICs).

Waste management in an Italian Hospital's operating theatres: An observational study

BACKGROUND

Each day operating theatres produce lots of waste. The wrong segregation represents both an environmental and economic problem, which is reflected in increased disposal cost and in a loss of resources.

AIM

To examine waste segregation by medical and nonmedical healthcare personnel in an Italian hospital's operating theatres.

METHODS

We used an observational tool, according to the local regulations and validated by a panel of experts.

RESULT

Fifty-seven percent of waste were disposed of incorrectly, of these 71% could have been recycled and 1% recovered. The preoperative phase had the greatest production of waste (48%) and the highest percentage of incorrect differentiation (72%). Sixty-six percent of waste handled as "undifferentiated" could have been recycled. Waste managed as hazardous that could have been recycled, reused or otherwise segregated stood at 54%. Hazardous waste was managed incorrectly in 5% of the disposals.

CONCLUSION

The lack of a variety of bins for waste segregation and improper classification by personnel appear to be the cause of the incorrect segregation, which should be error free.

Disposal Practice of Unfit Medicines in Nongovernmental Hospitals and Private Medicine Outlets Located in Mwanza, Tanzania

Introduction

For a medicine to qualify as safe and effective and to be of good quality, it should be properly labelled, stored, and transported. If a medicine is not handled properly, it ends up being unfit. Improper disposal of unfit medicines contributes to the appearance of their metabolites in the environment.

Methods

A descriptive cross-sectional study was designed to capture quantitative data. The study was conducted in Mwanza region, Tanzania. The study population comprised nongovernmental hospitals and private medicines outlets in the region. The sample size was 111 facilities. This study was conducted between October 2013 and May 2014. The questionnaire was used to assess experience and challenges of dealing with unfit medicines. A review of waste management records was done to capture data of past disposal for unfit medicines. The coded data were analyzed using Statistical Package for Social Sciences (Version 20.0) computer analysis software. Comparison of proportions between groups was performed using Pearson's chi square.

Results

The majority of facilities (41.4%) used methods such as the pouring of unfit medicines into the sink and into the dustbin. About 60.4% of facilities were found with unfit medicines at the time of survey. Majority of unfit medicines found were antibiotics (64.1%). Almost 10% of health facilities maintained a register book for recording unfit medicines.

Conclusion

There was improper disposal of unfit medicines in health facilities studied, whereby commonly reported methods of disposal were pouring into the sink and putting into the street dustbin. In private medicines outlets, there was poor storage management practice as some of the unfit medicines were left unpacked into boxes or separated from the usable medicines and not properly labelled.

Biomedical waste management guidelines 2016: What's done and what needs to be done

The latest biomedical waste (BMW) management guidelines which have been introduced in 2016 are simplified and made easier so that they can be easily followed by various health agencies. The categories of BMW have been reduced from ten (in 1998) to four in the latest (2016) guidelines. Many changes have been made in these latest guidelines, which have been summarised in the article below. The segregation of hospital waste plays a very important role, so the waste has to be sorted out at the source of generation according to the category to which it belongs as given in the newer guidelines. Newer waste treatment facilities such as plasma pyrolysis, encapsulation, inertisation have been introduced, and we have to do away with older facilities such as incineration as toxic fumes (dioxins and furans) are produced which are harmful to both health and environment. We can even think of using these wastewater treatment plants to remove the antimicrobial resistance genes during the processing of the waste, which is being generated from the hospitals.

Impact of waste management training intervention on knowledge, attitude and practices of teaching hospital workers in Pakistan

OBJECTIVE

To evaluate the sustainability and effectiveness of training as an intervention to improve the knowledge, attitude and practices of hospital workers on health care waste management.

METHOD

We conducted this quasi-experimental study in two tertiary care teaching hospitals in Rawalpindi in October 2013. Training, practical demonstrations and reminders on standard waste management were given to 138 hospital workers in one hospital and compared with 137 workers from the control hospital. We collected data 18 months after intervention through a structured questionnaire to assess the impact of the intervention. We used paired t-test to compare the scores on knowledge, attitude and practices at baseline and first follow up and final impact assessment. Chi square test was used to compare group variables between intervention and control groups.

RESULTS

After 18 months since intervention the mean scores on knowledge attitude and practices differed statistically significantly since baseline and intervention group had statistically significantly better knowledge positive attitudes and good health care waste management practices (p < 0.001). Health care and sanitary workers in intervention group scored statistically significantly higher (p < 0.001).

CONCLUSION

Trainings of health and sanitary workers on health care waste management guidelines were sustainable among the intervention group after 18 months which shows the positive impact of our intervention. It is recommended that the trainings as intervention be included in the overall policies of the public and private sector hospitals in Pakistan and other similar settings.

Incineration or autoclave? A comparative study in isfahan hospitals waste management system (2010)

Introduction:

Medical wastes are among hazardous wastes and their disposal requires special methods prior to landfilling. Medical wastes are divided into infected and non-infected wastes and the infected wastes require treatment. Incineration is one of the oldest methods for treatment of medical wastes, but their usage have faced wide objections due to emission of hazardous gases such as CO2 and CO as well as Carcinogenic gases such as Dioxins and Furans which are generated as a result of incomplete combustion of compositions like PVCs. Autoclave is one the newest methods of medical wastes treatment which works based on wet disinfection.

Methods:

The statistical population in this descriptive, comparative study includes hospitals located in Isfahan city and the sample hospitals were selected randomly. To environmentally evaluate the Autoclave method, TST (time, steam, temperature) and Spore tests were used. Also, samples were made from incinerator’s stack gases and their analyses results were compared with WHO standards.

Findings:

TST and spore tests results were negative in all cases indicating the success of treatment process. The comparison of incinerator’s stack gases with WHO standards showed the high concentration of CO in some samples indicating the incomplete combustion. Also, the incineration efficiency in some cases was less than 99.5 percent, which is the efficiency criterion according to the administrative regulations of wastes management law of Iran. No needle stick was observed in Autoclave method during the compaction of bags containing wastes, and the handlers were facing no danger in this respect. The comparison of costs indicated that despite higher capital investment for purchasing autoclave, its current costs (e.g. maintenance, etc) are much less than the incineration method.

Discussion:

Totally, due to inappropriate operation of incinerators and lack of air pollution control devices, the use of incinerators doesn’t seem rational anymore. Yet, despite the inefficiency of autoclaves in treatment of bulky wastes such as Anatomical wastes, their usage seems logic considering the very low amounts of such wastes. Also, considering the amount of generated wastes in Isfahan hospitals, a combination of centralized and non-centralized autoclaves is recommended for treatment of infected wastes. Mobile autoclaves may also be considered according to technical and economical conditions. It must not be forgotten that the priority must be given to the establishment of waste management systems particularly to personnel training to produce less wastes and to well separate them.

Analysis of the health and environmental status of sterilizers in hospital waste management: a case study of hospitals in Tehran

According to the first article of the waste management rule ratified in 2004, healthcare facilities are responsible for sterilizing their own infectious wastes. Nowadays non-incineration techniques are preferred internationally owing to toxic emissions caused by incinerators. Surveys have been conducted in Iran, resulting in ratification of an executive code by the Iranian Board of Ministers, which imposed a ban on incinerators; furthermore, it emphasized, instead, the use of sterilizers. The main objective of this research was evaluating the present status of these facilities to figure out which ones have less effect on the community, personnel and on the environment. A questionnaire was used to collect the data. The results showed that biological tests had not been conducted for most of the sterilizers. As biological testing is the most important factor in assessing autoclave accuracy, a comprehensive program should be initiated to perform these tests to improve functioning of the sterilizers so that the best treating process can be achieved.

Treatment of clinical solid waste using a steam autoclave as a possible alternative technology to incineration

A steam autoclave was used to sterilize bacteria in clinical solid waste in order to determine an alternative to incineration technology in clinical solid waste management. The influence of contact time (0, 5, 15, 30 and 60 min) and temperature (111 °C, 121 °C and 131 °C) at automated saturated steam pressure was investigated. Results showed that with increasing contact time and temperature, the number of surviving bacteria decreased. The optimum experimental conditions as measured by degree of inactivation of bacteria were 121 °C for 15 minutes (min) for Gram negative bacteria, 121 °C and 131 °C for 60 and 30 min for Gram positive bacteria, respectively. The re-growth of bacteria in sterilized waste was also evaluated in the present study. It was found that bacterial re-growth started two days after the inactivation. The present study recommends that the steam autoclave cannot be considered as an alternative technology to incineration in clinical solid waste management.

The use of solar energy for powering a portable autoclave

Climate change and the depletion of fossil fuels have forced the developed world to look for clean energy alternatives. Solar cooking is developing in Asian and African countries blessed with ample sun, but is still at an early stage. A portable autoclave was developed in India using this technology. The Prince-40 Concentrator provided adequate capacity to autoclave culture media and treat biomedical waste in a small laboratory set-up, and could save electricity worth Rs. 15,000 (188.10 GBP)/year or LPG worth Rs. 37,500 (470.25 GBP)/year. This technology would be of immense use in health centres in rural areas with frequent power cuts or no power supply.