"Water or not water: That is the question." Analysis of costs and consumption of the operating theaters in a greener perspective

OBJECTIVE

To compare the amounts of water and plastic used in surgical hand washing with medicated soaps and with alcohol-based products and to compare costs and consumption in a year, based on scheduled surgical activity.

METHOD

This retrospective study was carried out at Udine's Gynecology Operating Block from October to November 2022. We estimated the average amount of water with a graduated cylinder and the total cost of water usage based on euros/m3 indicated by the supplier; for each antiseptic agent we collected the data relevant to wash time, amount of water and product used per scrub, number of handscrubs made with every 500 mL bottle and cost of a single bottle. We put data into two hypothetical contexts, namely WHO guidelines and manufacturers' recommendations. Data were subjected to statistical analysis.

RESULTS

The daily amount of water using povidone-iodine, chlorhexidine-gluconate and alcohol-based antiseptic agents was 187.6, 140.7 and 0 L/day (P value = 0.001), respectively; A total of 69 000 L/year of water would be saved if alcohol-based products were routinely used. A single unit of an alcohol-based product allows three times as many handscrubs as any other product (P value = 0.001) with consequent reduction in plastic packaging.

CONCLUSION

Despite the cost saving being negligible, choosing alcohol-based handrub over medicated soap handrub - on equal antiseptic efficacy grounds - could lead to a significant saving of water and plastic, thus making our operating theaters more environmentally friendly.

Knowledge, perceptions and practices on healthcare waste management and associated occupational health hazards among healthcare professionals in the Colombo District, Sri Lanka: a cross-sectional study

Background

Proper Healthcare Waste (HW) management is directly influenced by the knowledge and attitudes of Healthcare Professionals (HCP). However, studies that characterize the knowledge and practices of HCP on HW management are limited in Sri Lanka. This study was conducted to characterize the knowledge, perceptions and practices of HCP on the management of HW and to determine the risk factors influencing HW related occupational health hazards in the Colombo District of Sri Lanka.

Methods

A total of 407 HCP were recruited as the study population from selected hospitals in the Colombo District. Information on socio-demographic factors, knowledge, attitudes and practices on HW management were gathered using an interviewer-administrated questionnaire. The Binary Logistic Regression (BLR) was used to determine the socio-economic risk factors associated with the occurrence of HW related health issues among the respondents.

Results

The majority of respondents were characterized with a high knowledge level (76.9%) and positive attitudes (53.8%) on HW management. Incineration (82.6%) was recognized as the most widely used HW treatment method. Personal Protective Equipment (PPE) was used at a satisfactory level (85.5%), while liquid waste treatment was limited (57.5%). The occupational designation, level of training received in HW management, professional experience, vaccination status for tetanus, degree of knowledge and attitudes on HW management were recognized as significant risk factors (p < 0.05) associated with the occurrence of HW related occupational hazards.

Conclusion

Even though, the treatment of HW was satisfactory, strengthening the existing mechanisms for monitoring of HW management, provisioning more resources and organizing training and awareness programmes on HW management for HCP are recommended.

"It is unbearable to breathe here": air quality, open incineration, and misinformation in Blantyre, Malawi

Blantyre, Malawi's Queen Elizabeth Central Hospital (QECH), or Queen's, as it's known locally, is the country's largest public hospital. However, Queen's is not served by regular municipal waste collection. Rather, most hospital waste (infectious and non-infectious) is gathered by grounds staff and openly burned, in several constantly smouldering piles, sending up clouds of smoke. Speaking directly to an identified knowledge gap on air quality impacts linked to trash burning and the paucity of African urban dwellers' voices on air quality issues, this study employed a mixed-methods approach to both quantitatively measure the air quality around QECH, and to qualitatively investigate the perceived impacts amongst staff and caregivers. Low-cost sensors measuring particulate matter (PM) with particle sizes less than 10 μm (PM10) and less than 2.5 μm (PM2.5), expressed as the mass of PM per volume of air (μg PMx/m3 air) were recorded every 5 min at 8 locations across the QECH for 2 months. Qualitative data collection consisted of 56 interviews with patients, caregivers and hospital staff (including janitorial and maintenance staff, nurses, doctors, and administrators). Our results show that safe air quality thresholds are consistently exceeded across space and time and that the most problematic air quality surrounds the shelter for caregivers and those receiving treatment for HIV/AIDS. Moreover, staff and visitors are severely impacted by the poor air quality within the space, but feel powerless to make changes or address complaints. Waste management interventions are desperately needed lest the patients who arrive at Queen's leave with more health issues than the ones with which they arrived.

Management of healthcare waste collection and segregation for developing countries

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

Knowledge, attitude, and perceived practice of sanitary workers on healthcare waste management: A descriptive cross-sectional study in Dodoma region,Tanzania

Introduction

Healthcare facilities produce a variety of trash that, if handled improperly, could endanger the environment, the health of patients and clients, healthcare personnel, and the general public. Health staff have been given training on infection control and healthcare waste management. It is not apparent whether similar initiatives are taken for sanitary personnel, though. By evaluating sanitary workers' knowledge, attitudes, and practices about healthcare waste treatment in the Dodoma region of Tanzania, this study sought to clarify the situation.

Methods

From March to August 2022 in Dodoma, Tanzania, a descriptive cross-sectional study using a quantitative methodology was conducted on 156 randomly chosen sanitary workers. The primary data collection instruments were structured questionnaires that were conducted by interviewers and a trash checklist that the research team created. Statistical Package for Social Sciences computer software was used to conduct a descriptive analysis of the data with a 95% confidence level and a 5% level of significance.

Results

The average age was 28 ± 6.2 years, and there were 74.4% females. Of all of the health institutions under study, 78.4% of the generated medical waste was non-infectious, whereas 21.6% of it was infectious. The share of non-infectious and infectious healthcare waste created by regional referral hospitals was 43.5% and 13.2%, respectively. While 67.8% of sanitary workers believed that handling healthcare waste was not their problem and 63.6% of sanitary workers actually displayed subpar practices of handling healthcare waste, 74.4% of sanitary workers had low understanding about handling healthcare waste. Their procedures for handling medical waste were substantially influenced by the kind of healthcare facility, sex, education, job experience, knowledge, and attitude (p < 0.05).

Conclusion

Sanitary staff members had limited understanding and thought they were less concerned with gathering, moving, and storing medical waste. To provide the highest level of health safety, national health policy and facility-based interventions must support and fund participatory waste management training that is tailored to the sociodemographic profiles of sanitary employees.

Advancing Environmental Health and Justice: A Call for Assessment and Oversight of Health Care Waste. (APHA Policy Statement Number 20224, Adopted November 2022)

Health care waste adversely affects society in ways that have been overlooked for decades, an issue that the coronavirus disease 2019 (COVID-19) pandemic has accelerated significantly. This policy statement addresses the human impacts that occur as health care waste is processed, transported, landfilled, or incinerated. With limited federal tracking and lack of regulation, patterns of environmental racism persist. Communities of color and low-income communities most often experience the greatest environmental health burdens through the disposal of waste in their communities. Many communities have called for action for decades, as our massive health care industry contributes greatly to these harms. Centering these communities, public health professionals must advocate for (1) evidence-based federal policies with transparent, accessible data about health care waste generation, type, and fate; (2) leadership within the health care industry (e.g., from hospitals, accrediting bodies, and professional organizations) to address environmental health and justice issues related to waste; (3) health impact assessments, cost-benefit analyses, and circular economy research with health care systems and communities to identify cost-effective, feasible, and just solutions; and (4) federal initiatives to prioritize funding toward mitigation of cumulative exposures and impacts, reparation for harms, and investment in well-being for communities exposed to waste, health care or otherwise. Some public health experts anticipate that we may be entering a "pandemic age," which suggests that, without intervention, intersecting issues of infectious disease, climate change, waste, and environmental health and justice will remain and reoccur.

How comprehensive and effective are waste management policies during the COVID-19 pandemic? Perspectives from the Philippines

This study presents a comprehensive analysis on policies governing the management of COVID-19 waste in the Philippines, highlighting gaps in pre-existing policies and opportunities for further policy development and adaptation in the context of present and future public health emergencies. A hybrid search strategy and consultative process identified fifty (50) policy documents directly impacting the management of wastes (general domestic, healthcare, and household healthcare waste) released prior to and during the pandemic. Content analysis revealed comprehensive policy coverage on managing general domestic waste and healthcare waste. However, there remains a dearth in policies for managing household healthcare waste, an emerging category for waste generated by patients isolating at home or in isolation facilities. Applicable, pre-existing policies were neither adequate nor specific to this category, and may therefore be subjected to variable interpretation and mismanagement when applied to this novel waste category. Assessment using the modified Cradle-to-End-Of-Life (CTEOL) framework revealed adequate policy coverage across the waste lifecycle stages. However, policies on reducing waste generation were relatively minimal and outdated, and policy gaps in waste segregation led to downstream inefficiencies and introduction of environmental health risks in waste collection, treatment, and disposal. The internal validity of policies was also evaluated against eleven (11) criteria adapted from Rütten et al. and Cheung et al. The criteria analysis revealed strong fulfillment of ensuring policy accessibility, goal clarity, provision of human resources, and strength of policy background, but weak fulfillment of criteria on providing adequate financing, organizational capacity building, monitoring and evaluation, and encouragement of opportunities for public participation. We conclude that existing waste management policies in the Philippines leave much room for improvement to ensure effective management of COVID-19 waste from various settings and circumstances. Hence, these policies are expected to adapt and evolve over time, utilizing the best available technology and environmental practices. Integrated, region-wide waste management systems, involving both government and society, and strengthened by equitable provisional support are needed for effective waste management that is both inclusive and resilient in the face of present and future pandemics.

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.

Medical Waste Management: An Assessment of District-Level Public Health Facilities in Bangladesh

Background Due to the huge patient load and different types of services, public health facilities produce a bulk of medical waste (MW) in Bangladesh. Improper disposal of MW increases the risk of infection among healthcare service personnel, patients, and attendants. To ensure quality services, this study aimed to assess the practices of MW management and quantify those to find out the shortcomings in the specific steps of waste management. Methodology As part of a larger interventional study, a facility assessment was conducted from February to April 2016 at a District Hospital (DH) and a Mother and Child Welfare Centre (MCWC) in one district. Non-participatory observation of MW management was done using a checklist that was developed following the Guideline for Medical Waste Management of Bangladesh. Scoring was applied for various activities of MW management performed in the study facilities. Results The overall scores for bin management, segregation, and collection of waste were 64.5%, 58.1%, and 62.0% in DH and 53.1%, 41.5%, and 48.0% in MCWC, respectively. The performance of operation theater in MCWC was the lowest among different corners (16.7% to 36.0%). Reusable waste was segregated poorly (32% in DH and 0% in MCWC), and almost none was shredded (4% in DH and 0% in MCWC). Waste was transported from in-house to out-house temporary storage area in an open bin without any trolley or specific route. The storage area was accessible to unauthorized persons, for example, a waste picker in DH. While DH segregated 84% of its infectious waste at the source, it eventually got mixed up with other waste in the storage area and delivered to the municipality to be dumped. MCWC could segregate only 40% of its infectious waste at the source and disposed of them using the pit method. Both the facilities disposed of sharp MW by open-air burning and liquid waste through sewerage without any treatment. Conclusions The performance of MW management was poor in both study facilities. Advocacy to the healthcare personnel and refresher training along with supportive supervision and monitoring may improve the situation. Moreover, a larger study is needed to find out the reasons behind such poor MW management.

Sustainable waste management of medical waste in African developing countries: A narrative review

Africa is the second populous continent, and its population has the fastest growing rate. Some African countries are still plagued by poverty, poor sanitary conditions and limited resources, such as clean drinking water, food supply, electricity, and effective waste management systems. Underfunded healthcare systems, poor training and lack of awareness of policies and legislations on handling medical waste have led to increased improper handling of waste within hospitals, healthcare facilities and transportation and storage of medical waste. Some countries, including Ethiopia, Botswana, Nigeria and Algeria, do not have national guidelines in place to adhere to the correct disposal of such wastage. Incineration is often the favoured disposal method due to the rapid diminishment of up to 90% of waste, as well as production of heat for boilers or for energy production. This type of method - if not applying the right technologies - potentially creates hazardous risks of its own, such as harmful emissions and residuals. In this study, the sustainability aspects of medical waste management in Africa were reviewed to present resilient solutions for health and environment protection for the next generation in Africa. The findings of this research introduce policies, possible advices and solutions associated with sustainability and medical waste management that can support decision-makers in developing strategies for the sustainability by using the eco-friendly technologies for efficient medical waste treatment and disposal methods and also can serve as a link between the healthcare system, decision-makers, and stakeholders in developing health policies and programmes.

[Fighting global warming in the operating room]

At the Pitié-Salpêtrière hospital group (AP-HP, Paris), the central operating room teams embarked, in 2017, on a project to reduce the ecological impact of the procedures performed there. The results are convincing: reduction of the carbon footprint of anesthetic gases, reduction of waste and improvement of its sorting, recycling of metals. The project has spread to the other operating rooms in the hospital group, with strong support from professionals.

Research on Optimization of Healthcare Waste Management System Based on Green Governance Principle in the COVID-19 Pandemic

At present, strategies for controlling the COVID-19 pandemic have made significant and strategic strides; however, and the large quantities of healthcare treatment waste have become another important “battlefield”. For example, in Wuhan, the production rate of healthcare waste in hospitals, communities, temporary storage, and other units was much faster than the disposal rate during the COVID-19 pandemic. Improving the efficiency of healthcare waste transfer and treatment has become an important task for government health and environmental protection departments at all levels. Based on the situation of healthcare waste disposal in Wuhan during the critical period of the pandemic, this paper analyzes and studies green governance principles and summarizes the problems that exist in the current healthcare waste management system. Through the establishment of temporary storage facilities along transit routes, digital simulation and bionic experiments were carried out in the Hongshan District of Wuhan to improve the efficiency of healthcare waste transfer. Furthermore, this study discusses the coordination and cooperation of government, hospitals, communities, and other departments in the healthcare waste disposal process and provides guiding suggestions for healthcare waste disposal nationwide in order to deal with potential risks and provide effective references in all regions.

[Raising awareness of sustainable development and environmental health among caregivers]

In order to be more consistent with their care giving values, a growing number of health professionals are looking for more environmentally friendly care practices. The health crisis we are going through strongly questions the footprint of care in terms of sustainable development and environmental health. Changes are possible; training courses exist to assimilate eco-actions.

Sustainability assessment of healthcare waste treatment systems using surrogate weights and PROMETHEE method

This study aims to assess the sustainability of healthcare waste treatment systems using surrogate weights and the Preference Ranking Organization METHod for Enrichment Evaluations (PROMETHEE). For this purpose, ten treatment systems, including land disposal, incineration and non-incineration systems, were evaluated in terms of environmental, financial, social, and technical criteria. Firstly, fifteen reputed experts assigned their preferred rankings for the groups of criteria and the sub-criteria. The conversion of these rankings into numerical weights was performed using the SR function, which is an additive combination of Sum and Reciprocal weight functions. Secondly, the alternatives' performance with regards to each criterion allowed PROMETHEE to generate the outranking flows for each alternative. The complete ranking revealed that the rotary kiln (A4) is the most sustainable system followed by steam disinfection (A8), dry heat disinfection and microwave disinfection. However, the municipal landfill is the least sustainable system, while chemical disinfection is ranked in the penultimate position of sustainability. The partial ranking indicated that A4 and A8 are incomparable and both were ranked as most sustainable. Therefore, the sustainability of a system cannot be assessed properly without the exact specification of the system itself. In addition, it is preferable to act on the criteria that affect negatively the system to improve its performance.

Emanating challenges in urban and healthcare waste management in Isfahan, Iran after the outbreak of COVID-19

This study aims to investigate the emanating challenges in urban and healthcare waste management in Isfahan, after the new Coronavirus outbreak. Production of 'dry wastes' in Isfahan, with a population of more than 1.9 million, has increased during the pandemic. Personal protective equipments (PPEs) including face masks, single-use gloves and face shields are an emerging group of materials in Isfahan's waste stream. On average, Isfahanian residents have daily discarded over 1.49 and 2.98 million pieces of facemasks and plastic gloves, respectively, after the new Coronavirus pandemic. Overall production of hospital wastes in Isfahan slightly decreased during the pandemic. COVID-19 related wastes in hospitals are mainly treated by wet autoclave method, then collected and transferred to the Sejzy site to be landfilled. Waste separation, recycling and composting programs have been banned due to the COVID-19 pandemic, and all collected MSW are directly disposed of at Sejzy disposal site. Composting as the main disposal method for 60%-70% of the MSW in Isfahan has been terminated; therefore landfilling of urban wastes has dramatically escalated by 3.6 times. Appropriate urban waste management protocols must be provided to restart safe separation, recycling and composting programs to reduce pressure on land for disposal, while practicing safe waste management measures to minimize the possibility of the spread of the viral disease.

A Study on Small Clinics Waste Management Practice, Rules, Staff Knowledge, and Motivating Factor in a Rapidly Urbanizing Area

Thousands of small clinics in Pakistan are generating dispersed medical waste, unlike large hospitals, small clinic waste management is often ignored. This study was conducted on 135 small clinics in Hyderabad, Pakistan, with the aim to determine small clinics' waste management practices in contrast to rules, level of knowledge, the environmental impact of disposal methods, and motivating factor analysis to understand the current situation from multiple perspectives. Overall, the waste generation rate was calculated to be 2.01 kg/clinic/day and the hazardous waste generation rate was 0.89 kg/clinic/day, whereas the general waste generation rate was 1.12 kg/clinic/day. The hazardous waste generation rate percentage is found to be higher than those found in large hospitals by 20%. The waste management practice among surveyed clinics was deplorable; none of the clinics were completely following hospital waste management rules of 2005 and thus the absence of proper segregation, storage, transportation, and disposal was commonly encountered during the study. Clinic staff possessed low level of knowledge and awareness, and acquired no training about waste management practice and rules, moreover, frequent employee turnover was noticed too. Additionally, two hypotheses were checked for creditability of motivating factors with an exploratory factor analysis to check their contribution to motivating clinic staff to practice sound healthcare waste management. Out of 10 indicators, nine were found in support of the hypotheses. Hence, it was discovered that active government involvement and financial support in providing training and inspecting small clinics could help in improving the condition. The findings of the present study can play a vital role in documenting evidence, and for policymakers and governments to plan solid waste management of small clinics and other healthcare facilities.

Healthcare waste management in Asian developing countries: A mini review

Healthcare waste encompasses a significant quantity of hazardous substances. Poor healthcare waste management can result in serious environmental and human health risks. Asian developing countries are densely populated, and some are highly resource constrained. These countries commonly fail to practice appropriate healthcare waste management. Moreover, facilities in these countries extensively lack proper waste segregation, collection, safe storage, transportation, and disposal. This mini-review recapitulates key issues of healthcare waste management confronting Asian developing countries. Regulations, legislation, and policies are found to be recent, and their implementation varies from one another. Variation in waste generation rate is common. Contradictory methods of waste measurement used by researchers leave these variations questionable. The absence of waste management training programmes roots ignorance among staff and handlers, which leads to unsafe waste handling and causes different health risks. Unsafe and illegal recycling of hazardous waste is a threat to human health, also landfilling is often confused with open dumping, causing environmental damage. Outdated incineration plants need to be replaced with autoclaving, steam sterilisation, and comparatively reasonable new practice of pyrolysis to avoid the emission of toxic gases. The significance of proper healthcare waste management cannot be ignored, especially in Asian developing countries; substantial improvements are required in order to protect the environment and human health from serious risks.

Healthcare waste management in Asian developing countries: A mini review

Healthcare waste encompasses a significant quantity of hazardous substances. Poor healthcare waste management can result in serious environmental and human health risks. Asian developing countries are densely populated, and some are highly resource constrained. These countries commonly fail to practice appropriate healthcare waste management. Moreover, facilities in these countries extensively lack proper waste segregation, collection, safe storage, transportation, and disposal. This mini-review recapitulates key issues of healthcare waste management confronting Asian developing countries. Regulations, legislation, and policies are found to be recent, and their implementation varies from one another. Variation in waste generation rate is common. Contradictory methods of waste measurement used by researchers leave these variations questionable. The absence of waste management training programmes roots ignorance among staff and handlers, which leads to unsafe waste handling and causes different health risks. Unsafe and illegal recycling of hazardous waste is a threat to human health, also landfilling is often confused with open dumping, causing environmental damage. Outdated incineration plants need to be replaced with autoclaving, steam sterilisation, and comparatively reasonable new practice of pyrolysis to avoid the emission of toxic gases. The significance of proper healthcare waste management cannot be ignored, especially in Asian developing countries; substantial improvements are required in order to protect the environment and human health from serious risks.

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

BACKGROUND

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

PARTICIPANT CONSENT

Obtained.

ETHICS APPROVAL

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

COMPETING INTERESTS

The authors declare no competing financial interests.

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

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

Healthcare waste management at primary health centres in Mon State, Myanmar: the comparisons between hospital and non-hospital type primary health centres

Improper healthcare waste management (HCWM) poses a serious public health problem worldwide. Primary health centres (PHCs) provide public health and medical care services as the basic structural and functional units of healthcare services in Myanmar. However, no study has been conducted in Myanmar about HCWM at PHCs. This study aims to assess the practice of HCWM at PHCs in Mon State, Myanmar. A cross-sectional study was conducted in all ten townships in Mon State, Myanmar. In total, 93 PHCs (71 non-hospitals and 22 hospitals) were selected using simple random sampling. The observational checklist which was developed based on the World Health Organization’s standard guideline procedure of HCWM was used to determine the practice of HCWM at PHCs. Binary logistic regression was used for final data analysis. The burning in pits method was used as the final disposal method of healthcare waste in 78.5% of PHCs. Non-hospital type PHC were more likely not to have colour coding system for HCWM (odds ratio [OR] 7.54; 95% confidence interval [CI] 2.15–26.52), did not have equipment for accidental spillage of healthcare waste (OR 3.92; 95% CI 1.3–11.77) and did not have separate staff for HCWM (OR 8.27; 95% CI 2.77–24.64), relative to hospitals. Non-hospital type PHCs practices poorly on the colour coding for waste segregation, assigning separate staff for HCWM, and possessing equipment for accidental spillage of healthcare waste than hospital type PHCs. The Ministry of Health and Sports should issue technical guidelines of safe HCWM as a compulsory policy for both hospitals and non-hospital type PHCs.

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

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

Microwave as an emerging technology for the treatment of biohazardous waste: A mini-review

Microwave is an emerging technology to treat biohazardous waste, including material from healthcare facilities. A screen of the peer-reviewed literature shows that only limited information may be found in this area of work and, furthermore, analysis of the references reveals that sometimes not all necessary aspects for the appropriate use of the technology are considered. Very often conventional microwave technology is applied for the inactivation of pathogens, which might make sense for certain applications but, on the other hand, may lead to the misbelief that microwave systems cannot be used for the inactivation of a solid "dry" waste. However, conventional microwave units have no means to control the inactivation process, and especially moisture content. But there are a few sophisticated microwave technologies with appropriate measurements allowing a validated inactivation of biohazardous materials. These technologies are an effective tool for inactivation and some of them are commercially available. It must also be considered that the waste should be preferably inactivated either directly at the place where it is generated or biohazardous waste should be transported only in closed systems. Moreover, microwave technology presents a possibility to save energy costs in comparison to the more widely used autoclaves. This mini-review will discuss important aspects for the use of microwave technology for the treatment of biohazardous waste.

Black carbon emission reduction strategies in healthcare industry for effective global climate change management

Climate change remains one of the biggest threats to life on earth to date with black carbon (BC) emissions or smoke being the strongest cause after carbon dioxide (CO₂). Surprisingly, scientific evidence about black carbon emissions reduction in healthcare settings is sparse. This paper presents new research findings on the reduction of black carbon emissions from an observational study conducted at the UN Peacekeeping Operations (MINUSTAH) in Haiti in 2014. Researchers observed 20 incineration cycles, 30 minutes for each cycle of plastic and cardboard sharps healthcare waste (HCW) containers ranged from 3 to 14.6 kg. The primary aim was to determine if black carbon emissions from healthcare waste incineration can be lowered by mainstreaming the use of cardboard sharps healthcare waste containers instead of plastic sharps healthcare waste containers. Similarly, the study looks into whether burning temperature was associated with the smoke levels for each case or not. Independent samples t-tests demonstrated significantly lower black carbon emissions during the incineration of cardboard sharps containers (6.81 ± 4.79% smoke) than in plastic containers (17.77 ± 8.38% smoke); a statistically significant increase of 10.96% smoke (95% Confidence Interval ( CI) [4.4 to 17.5% smoke], p = 0.003). Correspondingly, lower bottom burner temperatures occurred during the incineration of cardboard sharps containers than in plastic (95% Cl [16 to 126°C], p = 0.014). Finally, we expect the application of the new quantitative evidence to form the basis for policy formulation, mainstream the use of cardboard sharps containers and opt for non-incineration disposal technologies as urgent steps for going green in healthcare waste management.

Knowledge, attitudes and practices regarding handling mercury containing medical devices among nurses in a tertiary care paediatric hospital in Sri Lanka

BACKGROUND

Mercury is a highly toxic heavy metal used in many medical devices in the healthcare sector, making nurses one of the vulnerable occupational groups.

OBJECTIVE

To assess knowledge, attitudes and practices regarding handling mercury containing devices and factors associated with knowledge among nurses in a paediatric hospital in Sri Lanka.

METHODS

A descriptive cross-sectional study was conducted among nurses (n = 538) working in Lady Ridgeway Hospital, Sri Lanka. Information on the use of mercury containing medical devices, accidental exposure, management of spillage and disposal was gathered using a self-administered questionnaire.

RESULTS

A total of 472 nurses responded with a response rate of 87.7%. Of the 347 mercury thermometer users, 67.1% had experienced breakages while among 405 mercury sphygmomanometer users, 20.0% had experienced mercury spillages, during a three months period prior to the study. A majority (56.8%) had 'good' overall knowledge regarding mercury and its adverse effects while 94.1% had favorable attitudes towards protecting themselves/others from mercury. Practices related to managing a mercury spill were poor. Work experience >10 years (p = 0.032) and favorable attitude (p = 0.007) were associated with good knowledge while having a training on managing a mercury spillage was not (p = 0.850).

CONCLUSIONS

Gaps in practices on managing a mercury spillage were evident. Current training programmes were not found to be effective.

Seroprevalence of hepatitis B and C among domestic and healthcare waste handlers in Belo Horizonte, Brazil

Infection with the hepatitis B and C viruses may occur through contact with infected body fluids, including injury with infected sharps. Collectors of domestic or healthcare wastes are potentially exposed to these infections. The aim of this article is to investigate the risk factors associated with the prevalence of hepatitis B and C viruses (HBV and HCV) infection among domestic and healthcare waste workers in Belo Horizonte, Brazil. A cross-sectional study of hepatitis B and C infection was conducted from November 2014 to January 2015, through blood sample collection and interviews about socio-demographic factors with 61 workers exposed to healthcare waste ('exposed') and 461 exposed only to domestic wastes ('unexposed'). The prevalence of antibodies to HCV (Anti-HCV) antibodies was 3.3% in 'exposed' workers and 0.9% in 'unexposed', and of antibody to hepatitis B core antigen (Anti-HBc) was 9.8% and 5.6% in 'exposed' and 'unexposed' workers, respectively. Only 207 (44.9%) of those exposed to domestic waste and 45 (73.8%) of those handling healthcare waste were effectively immunised against hepatitis B virus (HBV). Exposures to domestic waste and to healthcare wastes were associated with similar risks of infection with HBV. The risk of hepatitis C virus (HCV) infection was marginally higher among healthcare waste workers compared with domestic waste workers, probably because of needlestick accidents owing to deficient sharps management systems. Immunisation against hepatitis B and screening tests to ensure the success of vaccination should be a condition for recruitment for both groups of waste workers.

Healthcare Waste Generation and Management in Public Healthcare Facilities in Adama, Ethiopia

BACKGROUND

Over the past few years there has been rising production of hazardous byproducts, including dioxins, furans, and mercury from indiscriminate handling and treatment of healthcare waste. This situation is worse in developing countries where there is a serious lack of reliable data on factors such as generation and characteristics of healthcare waste.

OBJECTIVES

To investigate healthcare waste generation and current management practices of public healthcare facilities in Adama, Ethiopia.

METHODS

All departments and sections in studied healthcare facilities (one referral hospital and four health centers) were examined for the characterization and determination of healthcare waste generation based on World Health Organization (WHO) guidelines. Wastes were collected and measured daily for seven consecutive days. Plastic buckets and bags of different colors were used for different types of wastes. Plastic bags were removed every morning and their weights were measured every day at 8 am using a scale.

RESULTS

The average daily generation of healthcare waste from studied health centers ranged from 0.02 to 0.03 kg/patient/day, and the average daily waste generation of Adama referral hospital was 1.23 kg/bed/day. The healthcare waste generation rate was statistically different across the health service delivery sectors (p < 0.001). The proportion of hazardous healthcare waste generated in Adama referral hospital and health centers was 34.9% and 75%, respectively. There was no segregation of healthcare waste by type at the point of generation or pre-treatment of infectious waste in the studied healthcare facilities. Open pit burning and single chamber incinerators were the most utilized final treatment methods. Furthermore, there was a low level of awareness about safe healthcare waste management.

CONCLUSIONS

The overall findings of this study indicate that the proportion of hazardous healthcare waste generated from the studied healthcare facilities was above the threshold set by the WHO. There is a lack of proper waste management systems in all public healthcare facilities in Adama, Ethiopia. Awareness raising activities on proper healthcare waste management should be undertaken targeting all healthcare workers.

Assessment of composition and generation rate of healthcare wastes in selected public and private hospitals of Ethiopia

In many developing countries, the inadequacy of data regarding the quantity and composition of healthcare waste is one of the major reasons for improper healthcare waste management. We investigated the generation rate and composition of healthcare wastes in six public and three private hospitals. We conducted healthcare waste composition and characterization measurements for seven consecutive days in the selected hospitals following the protocol described by the World Health Organization (WHO). The results revealed that the total generation rate of healthcare wastes of hospitals ranged from 0.25 to 2.77 kg/bed/day with a median value of 1.67 kg/bed/day for inpatients to 0.21-0.65 in kg/patient/day with a median value of 0.31 kg/patient/day for outpatients. The waste generation rate in private hospitals (median 3.9 kg/bed/day) was significantly greater (Kruskal-Wallis test, P < 0.05) than in government hospitals (median 1.5 kg/bed/day). The median values of percent hazardous waste estimated for private and government hospitals were 63.4% and 52.2%, respectively. These figures are about three times greater than the threshold values recommended by the WHO. This situation might be attributed to the improper practice of healthcare waste segregation by health professionals and auxiliary health workers due to inadequate risk perception and lack of enforced public health regulations. The study revealed that the generation rate and proportion of hazardous waste significantly varies between public and private hospitals and number of patients treated per day.

Dental solid waste characterization and management in Iran: a case study of Sistan and Baluchestan Province

The management of dental solid waste continues to be a major challenge, particularly in most healthcare facilities of the developing world. In Iran, few studies on management of dental solid waste and its composition are available. An effort has been made through this study to evaluate the hazardous and infectious status of dental solid waste, keeping in mind its possible role in cross-infection chain. For this study, 123 private dental centres and 36 public dental centres were selected and the composition and generation rate of dental solid waste produced were measured. Dental solid waste was classified to four main categories: (i) domestic-type; (ii) potentially infectious; (iii) chemical and pharmaceutical; and (iv) toxic, which constituted 11.7, 80.3, 6.3, and 1.7%, respectively, of the total. Also, the results indicated that the dental solid waste per patient per day generation rate for total, domestic-type, potentially infectious, chemical and pharmaceutical, and toxic wastes were 169.9, 8.6, 153.3, 11.2, and 3.3 g/patient/d, respectively. Furthermore, the per day generation rates for total, domestic-type, potentially infectious, chemical and pharmaceutical, and toxic wastes were 194.5, 22.6, 156.1, 12.3, and 3.4 kg/d, respectively. According to findings of this study, for best management of dental waste it is suggested that source reduction, separation, reuse, and recycling programmes be implemented and each section of dental waste be collected and disposed of separately and in accordance with related criteria.

Infectious risk assessment of unsafe handling practices and management of clinical solid waste

The present study was undertaken to determine the bacterial agents present in various clinical solid wastes, general waste and clinical sharp waste. The waste was collected from different wards/units in a healthcare facility in Penang Island, Malaysia. The presence of bacterial agents in clinical and general waste was determined using the conventional bacteria identification methods. Several pathogenic bacteria including opportunistic bacterial agent such as Pseudomonas aeruginosa, Salmonella spp., Klebsiella pneumoniae, Serratia marcescens, Acinetobacter baumannii, Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Streptococcus pyogenes were detected in clinical solid wastes. The presence of specific pathogenic bacterial strains in clinical sharp waste was determined using 16s rDNA analysis. In this study, several nosocomial pathogenic bacteria strains of Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Lysinibacillus sphaericus, Serratia marcescens, and Staphylococcus aureus were detected in clinical sharp waste. The present study suggests that waste generated from healthcare facilities should be sterilized at the point of generation in order to eliminate nosocomial infections from the general waste or either of the clinical wastes.

Hospital generated waste: a plan for its proper management

Hospitals are important sites for the generation of hazardous waste. Each hospital has its own profile for the generation and transportion of waste according to its location. It is extremely important to manage hospital generated waste properly in order to avoid health and environmental risks.This article reports the plan designed and used by the hospital waste management committee in King Fahad Hospital of the University , Alhkobar, Saudi Arabia, for the safe management of hospital generated waste starting from the collection areas to the final disposal procedure. The plan was in four stages: background information, identification of problems, intervention and monitoring. The possible solutions for problems encountered are suggested.This plan which was efficient and cost effective can be used in other medical establishments.