Hospital Wastes as Potential Sources for Multi-Drug-Resistant ESBL-Producing Bacteria at a Tertiary Hospital in Ethiopia

The hospital environment is increasingly becoming an important reservoir for multi-drug-resistant (MDR) Gram-negative bacteria, posing serious challenges to efforts to combat antimicrobial resistance (AMR). This study aimed to investigate the role of hospital waste as a potential source of MDR ESBL-producing bacteria. Samples were collected from multiple sources within a hospital and its vicinity, including surface swabs, houseflies, and sewage samples. The samples were subsequently processed in a microbiology laboratory to identify potential pathogenic bacteria and confirmed using MALDI-TOF MS. Bacteria were isolated from 87% of samples, with the predominant isolates being E. coli (30.5%), Klebsiella spp. (12.4%), Providencia spp. (12.4%), and Proteus spp. (11.9%). According to the double disc synergy test (DDST) analysis, nearly half (49.2%) of the bacteria were identified as ESBL producers. However, despite exhibiting complete resistance to beta-lactam antibiotics, 11.8% of them did not test positive for ESBL production. The characterization of E. coli revealed that 30.6% and 5.6% of them carried blaCTX-M group 1 type-15 and blaNDM genes, respectively. This finding emphasizes the importance of proper hospital sanitation and waste management practices to mitigate the spread of AMR within the healthcare setting and safeguard the health of both patients and the wider community.

Predictors of biomedical waste management practices among staff nurses of a tertiary care teaching hospital in India

BACKGROUND

Inappropriate handling of biomedical waste (BMW) may pose serious threats to the health of patients and hospital personnel. Among all healthcare workers, staff nurses play a vital role in BMW management (BMWM). Thus, the present study aimed to determine the predictors of BMWM practices among staff nurses of a tertiary care teaching hospital in India.

MATERIALS AND METHODS

A prospective cross-sectional study was conducted among 150 staff nurses, working at a tertiary care teaching hospital in South India, from July to August 2018. Data were collected using a pretested, semi-structured, and self-administered questionnaire after taking their written informed consent. Regression analysis was carried out to identify the predictors of satisfactory BMWM practice status.

RESULTS

Of the total 150 staff nurses, most of them were young females with a work experience of ≤ 5 years. Concerning knowledge scores, most staff nurses (63.3%) belonged to the moderate category, whereas a few (24%) were in the high category. Also, most of them (62.7%) were in the high category of attitude scores. For practice scores, half of the participants were in moderate and high categories, each. Female gender, attended training status, and moderate and high knowledge scores were significantly associated with satisfactory BMWM scores in unadjusted analysis. After adjusting for other independent variables, all these three factors were found significantly associated with satisfactory BMWM practice scores.

CONCLUSION

The present study shows that the female gender, attending training in BMWM, and having a moderate and high knowledge of BMWM were significant predictors of satisfactory BMWM practice among staff nurses. Thus, all hospitals must periodically train their staff nurses to strengthen their BMWM practices. Safe BMWM leads to environmental protection and safeguards the health of patients, hospital personnel, and the public.

Deciphering the role of fungus in degradation of polypropylene from hospital waste

Health and environmental consequences are unavoidable when it comes to management of hospital waste (HW) disposables. In order to eradicate the HW, this study isolated a novel fungus SPF21 from a hospital dumping yard to degrade Polypropylene (PP). We measured the attributes of PP inoculated with fungus using mass loss, Fourier trans-form infrared (FTIR), contact angle (CA), and scanning electron microscopy (SEM). The weight of PP exposed to SPF21 was reduced by 25% in 90 days. The SEM images reveal that there are pores all over the sample surface; they alsocaused voids during the biodegradation of PP. FTIR analysis indicates that the spectra of treated mask pieces show the absence of peak at 1746 cm-1 and the appearance of a new peak at 1643 cm-1 . A period of 90-day exposure to the fungal isolate SPF21 reduced the CA of PP by 44.8% when compared to the nonexposed PP samples, suggesting that the surface of PP turned more hydrophilic after exposure. Moreover, our study on PP degradation by the fungus Ascotricha sinuosa SPF21 appears to be promising from the perspective of environmental, health, and economic hazards. Our results indicate that biodegradation greatly facilitates fungus deposition and changes PP film morphology and hydrophilicity.

Knowledge of Staff Nurses on Health Hazards related to Biomedical Waste Disposal in a Tertiary Care Hospital

Objective

The study aimed to assess staff nurses' knowledge of the health concerns connected with biomedical waste disposal.

Materials and Methods

The descriptive study was performed with a sample of 50 staff nurses from a tertiary hospital. The semi-structured questionnaire was made to be used when interviewing participants. It has information about the person's age in years, religion, monthly family income, family type, marital status, previous biomedical waste management education exposure, and the source of information.

Results

Participants were between the ages of 20 and 60. Only five 20-30-year olds are moderately knowledgeable. Out of 50 nurses, 41 (82%) had an adequate level of knowledge, 9 (18%) had a moderate level of knowledge on biomedical waste management, and none of them had too inadequate knowledge.

Conclusions

The proper handling of biomedical waste necessitates that all hospital staff undergo extensive training on the collection, sorting, transportation, and storage of waste in color-coded bins before disposal and treatment.

The Environmental Impacts of Disposable Nonwoven Fabrics during the COVID-19 Pandemic: Case Study on the Francesc de Borja Hospital

Hospitals generate huge amounts of nonwoven residues daily. This paper focused on studying the evolution of nonwoven waste generated in the Francesc de Borja Hospital, Spain, over the last few years and its relation to the COVID-19 pandemic. The main objective was to identify the most impacting pieces of nonwoven equipment in the hospital and to analyze possible solutions. The carbon footprint of the nonwoven equipment was studied through a life-cycle assessment. The results showed an apparent increase in the carbon footprint in the hospital from 2020. Additionally, due to the higher annual volume, the simple nonwoven gown used primarily for patients had a higher carbon footprint over a year than the more sophisticated surgical gowns. It can be concluded that developing a local circular economy strategy for medical equipment could be the solution to avoid the enormous waste generation and the carbon footprint of nonwoven production.

Adsorption Capacity and Desorption Efficiency of Activated Carbon for Odors from Medical Waste

Five types of odor-emitting exhaust gases from medical waste were selected, and their adsorption capacity and desorption efficiency were investigated using activated carbon. The selected gases included polar gases (hydrogen sulfide (H2S) and ammonia (NH3)) and non-polar gases (acetaldehyde (AA), methyl mercaptan (MM), and trimethylamine (TMA))). Commercial activated carbon with a specific surface area of 2276 m2/g was used as the adsorbent. For the removal of odor from medical waste, we investigated: (1) the effective adsorption capacity of a single gas (<1 ppm), (2) the effect of the adsorbed NH3 gas concentration and flow rate, and (3) the desorption rate using NH3 gas. The values of the effective adsorption capacity of the single gas were in the following order: H2S < NH3 < AA < MM < TMA, at 0.2, 4.2, 6.3, 6.6, and 35.7 mg/g, respectively. The results indicate that polar gases have a lower effective adsorption capacity than that of non-polar gases, and that the size of the gas molecules and effective adsorption capacity exhibit a proportional relationship. The effective adsorption performance of NH3 gas showed an increasing trend with NH3 concentration. Therefore, securing optimal conditions for adsorption/desorption is imperative for the highly efficient removal of odor from medical waste.

Impact of COVID-19 on healthcare waste generation: Correlations and trends from a tertiary hospital of a developed country

The SARS-CoV-2 (COVID-19) coronavirus pandemic has represented an emergency not only from a clinical point of view, but also for the environment due to the largely increased waste disposal. This study aimed at estimating, in the context of current trends, the increase in healthcare waste (HW) generation during the outbreak, based on data from a tertiary hospital. From the purveying office statements of 'SS Antonio e Biagio e Cesare Arrigo' Hospital of Alessandria (Italy), monthly HW generation data from January 2015 to March 2021 were retrospectively retrieved. Trends and COVID's impact were evaluated by Interrupted Time Series (ITS) design with linear regression models. Locally Weighted Scatterplot Smoothing was used to model the relation between infectious HW generation and proportion of COVID-related bed days. HW generation rose from 35.9 ± 3.8 tonnes month^-1 (2.4 ± 0.2 kg per patient-day, kg PD^-1) in 2015-2019, to 46.3 ± 6.0 tonnes month^-1 (3.3 ± 0.7 kg PD^-1) during the outbreak. The increasing trend was not appreciably modified as for its slope (p = 0.363), while a significant level change was found between baseline and outbreak (+ 0.72 kg PD^-1, p < 0.001). The proportion of COVID-related bed days non-linearly affected the infectious HW generated per patient-day, with steeper increases for proportions above 20%. The study showed a significant rise in HW generation in 2020-2021, reasonably due to the COVID outbreak; in addition, the generally increasing trend was not affected. Therefore, urgent measures are needed to conciliate safety requirements with HW generation issues.

Field lessons in surveying healthcare waste management activities in Pakistan

Background

Developing countries face difficulties in implementing safe healthcare waste management (HWM) practices. It is important to holistically probe the ground situation to meet this challenge.

Aims

This study aimed to examine HWM practices in public and private healthcare institutions in Pakistan.

Methods

In this study we surveyed 12 public and private hospitals in a major city of Pakistan, Gujranwala. The survey consisted of waste characterization as well as targeted interviews using standardized questionnaires.

Results

The results indicated issues including lack of waste segregation, lack of sufficient knowledge and awareness regarding HWM and a high prevalence of Hepatitis C among hospital housekeeping staff. We also discovered that organizational and administrative solutions for effective HWM are as important as preventive monitoring and control.

Conclusions

Apart from technical improvement, behavioural changes are vital for a positive change regarding HWM. Overall, this study led to an increased awareness of public health issues related to HWM that had hitherto gone unnoticed by hospital staff as well as relevant public authorities in the city.

A multi-criteria decision-making approach to rank supplier selection criteria for hospital waste management: A case from Pakistan

To address environmental issues and cost effectiveness, waste management is necessary for healthcare facilities. Most importantly, segregation of hazardous and non-hazardous waste must be done as in many developing countries; disposal of both types of healthcare waste is done together, which is an unsafe practice. Waste generated in hospitals needs proper management to minimise hazards for patient and healthcare workers. At the same time, it is quite difficult for hospitals to find a systematic way to select appropriate suppliers for hospital waste management. Therefore, the purpose of this article is to identify, validate, and rank criteria that are essential for hospital waste management suppliers' selection. The analytical hierarchal process approach has been used and a survey from Pakistan's largest city (Karachi) has been considered to rank the most appropriate criteria that is necessary to select the supplier, especially in a developing country like Pakistan. Results show that waste management cost (45.5%) and suppliers' details (31.5%) are the top two main criteria for supplier selection; and storage cost (15.7%), waste handling cost (14.7%), and qualification of the suppliers (10.9%) are the top three most important overall sub-criteria for supplier selection for hospital waste management.

[Promoting the sustainable management of hospital waste in Kinshasa]

The management of hospital waste is a high-risk practice in the hospitals of Kinshasa, the largest city of the Democratic Republic of the Congo, from the point of view of public health and the environment. A multi-criteria study carried out in 4 hospitals assessed the situation and put forward solutions.

Absence of vancomycin-resistant enterococci among highly ESBL-positive crows (Corvus splendens) foraging on hospital waste in Bangladesh

Background

Vancomycin-resistant enterococci (VRE) have emerged as a growing problem in hospitals; however, domesticated animals, poultry, and wild birds are acting as potential reservoirs. There is a knowledge gap in the Epidemiology of VRE from Bangladesh.

Methods

To study the prevalence of VRE and the mechanisms of resistance implicated among wild birds, 238 fecal samples were collected in 2010 from house crows (Corvus splendens) foraging on hospital waste in Bangladesh. Fecal samples were screened by analyzing color change in broth and screening for vanA and vanB resistant genes by PCR.

Results

Neither vanA nor vanB genes were detected from the fecal samples. The house crow does not seem to constitute a reservoir for VRE.

Conclusion

The zero prevalence is an indication that foraging on hospital waste does not constitute a major risk of VRE carriage in house crows and this is the first study to focus on the prevalence of VRE from wild birds in Bangladesh.

Dissemination of the multidrug-resistant extended-spectrum β-lactamase-producing Escherichia coli O25b-ST131 clone and the role of house crow (Corvus splendens) foraging on hospital waste in Bangladesh

Two hundred and thirty-eight faecal samples from crows foraging on hospital wastes were analysed for extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. ESBL-producing crow isolates were characterized and compared with 31 patient isolates. Among the crows, 59% carried ESBL producers. These included Escherichia coli, Klebsiella pneumoniae, Raoultella terrigena and Enterobacter cloacae harbouring the genes for CTX-M-1, CTX-M-15, CTX-M-55, CTX-M-79, and CTX-M-14. Human isolates carried only the CTX-M-15 gene. Two-thirds of crow E. coli isolates and all human E. coli isolates were multidrug resistant. Crows and patients shared E. coli sequence types, including the epidemic E. coli O25b-ST131 clone. The scavenging behaviour of crows at poorly managed hospital waste dumps made them potential reservoirs of antibiotic resistance, including ESBLs.