Waste management from dental clinics: A case study in Belo Horizonte, Brazil.

Healthcare waste management is a critical aspect of public health and environmental protection, particularly in establishments such as dental clinics. This study examined the dental clinic waste (DCW) management processes in clinics within the city of Belo Horizonte, Brazil. Utilizing data from Healthcare Waste Management Plans (HCWMP) provided by the Urban Cleaning Superintendence, the study investigated waste generation, segregation, storage, collection, treatment, and final disposal practices. The results revealed that hazardous DCW represented a significant portion (26.5 %) of waste generated in dental clinics, exceeding the World Health Organization's recommended threshold. Biological waste (22.9 %), mainly consisting of cotton, gauze, and gloves contaminated with blood or body fluids, was the most generated hazardous waste group, followed by chemical (2.2 %) and sharps waste (1.3 %). Incineration was the predominant treatment method for hazardous DCW, raising concerns about environmental impacts and greenhouse gas emissions. Non-hazardous waste, primarily destined for landfills, had limited recycling rates (2.4 %), emphasizing the need for improved waste management strategies to minimize environmental impacts and increase circular economy. Challenges in DCW management included inadequate segregation practices, limited recycling initiatives, and incomplete HCWMPs lacking descriptions of waste management beyond establishment boundaries. Addressing these challenges requires comprehensive training programs, strengthened regulations, and increased environmental awareness among healthcare professionals. In conclusion, improving DCW management in dental clinics is crucial for mitigating occupational and environmental risks. Collective efforts are needed to enhance waste segregation, promote recycling, and ensure compliance with regulations, ultimately safeguarding public health and the environment.

A study of the effect of testing for diversification of healthcare waste sterilization and crushing facilities.

This study conducted sterilization testing under different conditions using different strains for sterilization and crushing, the intermediate healthcare waste treatment phase, and proposed strategies for diversifying corresponding facilities in addition to promoting their installation. Five indicator microorganisms were selected to test the sterilization efficiency of steam, microwave, and chemical methods. Steam sterilization testing was conducted in accordance with legal and technological standards, microwave testing was carried out according to the legal standard, and chemical sterilization employed three typical compounds. Steam and microwave sterilization achieved 99.9999 % inactivation rates for all five strains under both conditions used; whereas under the chemical sterilization analyses, sodium hypochlorite (1000 ppm) failed to meet the inactivation requirement of the fungal strain Candida albicans, requiring further investigation. Based on these findings, this study presents strategies for diversifying sterilization·crushing facilities and promoting their installation.

Optimal selection of healthcare waste treatment devices using fuzzy-rough approach.

The escalating volume of healthcare waste (HCW) generated by healthcare facilities poses a pressing challenge for all nations. Adequate management and disposal of this waste are imperative to mitigate its adverse impact on human lives, wildlife, and the environment. Addressing this issue in Bosnia and Herzegovina involves the establishment of a regional center dedicated to HCW management. In practice, there are various treatments available for HCW management. Therefore, it is necessary to determine the priority for procuring different treatments during the formation of this center. To assess these treatment devices, expert decision-making employed the fuzzy-rough approach. By leveraging extended sustainability criteria, experts initially evaluated the significance of these criteria and subsequently assessed the devices for HCW treatment. Employing the fuzzy-rough LMAW (Logarithm Methodology of Additive Weights), the study determined the importance of criteria, highlighting "Air emissions" and "Annual usage costs" as the most critical factors. Utilizing the fuzzy-rough CoCoSo (the Combined Compromise Solution) method, six devices employing incineration or sterilization for HCW treatment were ranked. The findings indicated that the "Rotary kiln" and "Steam disinfection" emerged as the most favorable devices for HCW treatment based on this research. This conclusion was validated through comparative and sensitivity analyses. This research contributes by proposing a solution to address Bosnia and Herzegovina's HCW challenge through the establishment of a regional center dedicated to HCW management.

"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.

Healthcare waste management practice and associated factors among healthcare workers in public healthcare facilities of Southwest Shewa Zone, Oromia regional state, Ethiopia.

Poor management of waste can cause serious disease to healthcare personnel, cleaners, waste handlers, patients and the public. An observation-supported cross-sectional study was conducted to assess healthcare waste (HCW) management practice and professional, management and resource availability-associated factors among healthcare workers of 23 public health facilities in Southwest Shewa Zone, Oromia regional state, Ethiopia, 2021. A total of 424 health workers participated in this study. The level of proper healthcare waste management (HCWM) practice was 38.4%. Lack of knowledge on different methods of healthcare waste treatment (adjusted odds ratio (AOR): 0.101, 95% confidence interval (CI) (0.042, 0.242, p < 0.05)), lack of knowledge about the types of healthcare waste (AOR: 0.136, 95% CI (0.039, 0.481, p < 0.05)), lack of knowledge on the use of different colour-coded waste bin and safety box (AOR: 0.145, 95% CI (0.040, 0.520, p < 0.05)), and healthcare workers who had no training/orientation on HCWM practice (AOR: 0.396, 95% CI (0.245, 0.639, p < 0.05)) were less likely to practice effective HCWM compared to their counterparts. The current HCWM practices in studied health facilities was inadequate. Professional knowledge and availability of training were independently associated with HCWM practice. Therefore, regular orientation during employment and on-job training on HCWM practice, regular monitoring and supervision of HCWM are important. Further research should be conducted on the area of HCWM, and its associated environmental impacts by using more strong methods and wider health facilities.

Prevalence and Cost of Routine Preoperative Care for Low-Risk Cataract Surgery a Decade after Choosing Wisely.

PURPOSE: Examine the frequency and cost of procedural clearance tests and examinations in preparation for low-risk cataract surgery among members of a commercial healthcare organization in the United States. Determine what characteristics most strongly predict receipt of preoperative care and the probability that preoperative care impacts postsurgical adverse events. DESIGN: Retrospective healthcare claims analysis and medical records review from a large, blended-health organization headquartered in Western Pennsylvania. PARTICIPANTS: Members aged ≥ 65 years who were continuously enrolled 6 months before and after undergoing cataract surgery from 2018 to 2021 and had approved surgery claims. METHODS: Preoperative exams or tests occurring in the 30 days before surgery were identified via procedural and diagnosis codes on claims of eligible members (e.g., Current Procedural Terminology codes for blood panels and preprocedural International Classification of Diseases, 10th Revision, Clinical Modification codes). Prevalence and cost were directly estimated from claims; variables predictive of preoperative care receipt and adverse events were tested using mixed effects modeling. MAIN OUTCOME MEASURES: Total costs, prevalence, and strength of association as indicated by odds ratios. RESULTS: Up to 42% of members undergoing cataract surgery had a physician office visit for surgical clearance, and up to 23% of members had testing performed in isolation or along with clearance visits. The combined costs for the preoperative visits and tests were $4.3 million (approximately $107-$114 per impacted member). There was little difference in member characteristics between those receiving and not receiving preoperative testing or exams. Mixed effects models showed that the most impactful determinants of preoperative care were the surgical facility and member's care teams; for preoperative testing, facilities were a stronger predictor than care teams. Adverse events were rare and unassociated with receipt of preoperative testing, exams, or a combination of the two. CONCLUSIONS: Rates of routine preoperative testing before cataract surgery appear similar to those prior to the implementation of the Choosing Wisely campaign, which was meant to reduce this use. Additionally, preoperative evaluations, many likely unnecessary, were common. Further attention to and reconsideration of current policies and practice for preoperative care may be warranted, especially at the facility level. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Infectious healthcare waste management among private dental practitioners in the Rabat-Salé-Kénitra region, Morocco: A cross-sectional study on knowledge, attitudes, and practices.

The increase in dental healthcare facilities and the use of single-use equipment have increased the production of healthcare waste. Their mismanagement exposes healthcare workers, waste managers, and the population to an infectious risk and negatively impacts the environment. Therefore, a correct management procedure has to be adopted from separation through storage to disposal. This study aimed to investigate dentists' knowledge, attitudes, and practices regarding managing infectious healthcare waste in private dental offices. A descriptive and analytical cross-sectional survey was conducted between December 2020 and March 2021 among private dentists registered at the Moroccan National Council of Dentists in the Rabat-Salé-Kénitra region. A questionnaire was developed to assess waste management in dental offices. Of the 500 questionnaires distributed, 190 completed and exploitable questionnaires were collected. Only 27.3% of healthcare waste managers in dental practices received training, 21,5% of practitioners assimilated the used gloves into household waste, 71.5% disposed of the waste generated by their offices directly into public bins, and 86.4% were unaware of Moroccan law 28-00 on waste management and disposal. This study highlights dentists' apparent lack of knowledge regarding healthcare waste management, and significant gaps were identified between actual practices and recommended regulations. To address these issues, developing a comprehensive medical waste management plan is crucial to encourage the practical cooperation of all stakeholders in this sector.

"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.

Management of COVID-19 healthcare waste based on the circular economy hierarchy: A critical review.

The overall objective of this work was to conduct a critical literature review on the application of the circular economy (CE) hierarchy for the management of COVID-19 healthcare waste (HCW). To describe the problem created by COVID-19 HCW, first, the subsystems of the overall management system, including generation, segregation, classification, storage, collection, transport, treatment and disposal, were reviewed and briefly described. Then, the CE hierarchy using the 10R typology was adapted to the management of COVID-19 HCW and included the strategies Refuse, Reduce, Resell/Reuse, Repair, Reprocess, Refurbish, Remanufacture, Repurpose, Recycle and Recover (energy). Disposal was added as a sink of residues from the CE strategies. Using the detailed 10R CE hierarchy for COVID-19 HCW management is the novelty of this review. It was concluded that R-strategy selection depends on its position in the CE hierarchy and medical item criticality and value. Indicative HCW components, which can be managed by each R-strategy, were compiled, but creating value by recovering infectious downgraded materials contaminated with body fluids and tissues is not currently possible. Therefore, after applying the circular solutions, the end of pipe treatment and disposal would be necessary to close material cycles at the end of their life cycles. Addressing the risks, knowledge gaps and policy recommendations of this article may help to combat COVID-19 and future pandemics without creating environmental crises.

A Review of the Applicability of Current Green Practices in Healthcare Facilities.

BACKGROUND: Circular economy (CE) has raised great interest as a concept and as a development model worldwide. This concept aims to provide a substitute for the linear economic model, which was based on production and consumption, continuous growth, and resources depletion. CE allows a greener economy with sustainable development and promotes more balanced societies. The healthcare sector is a major contributor to the climate crisis, with a carbon footprint representing 4.4% of global net emissions. It is thus essential to rethink the applicability of CE in healthcare. METHODS: We conducted a scoping review guided by the Arksey and O'Malley methodological framework and utilised PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) checklist. A systematic search from MEDLINE complete, SCOPUS, and Web of Science databases published between 1992 and 2022. RESULTS: Through database searching a total of 1018 records were identified and 475 duplicates were removed. From the total search, 543 articles were screened by title/abstract according to the inclusion and exclusion criteria. After screening, 38 full-text articles were selected and assessed for eligibility. Forty-seven additional records were also identified through other sources and screened for eligibility. Other sources included: 12 articles from snowballing of previous papers; 9 articles following peer-reviewers suggestions; 19 reports from relevant organisations in CE and healthcare; two webpage, and one book. CONCLUSION: Specific areas were identified where hospitals could reduce their greenhouse gas (GHG) emissions and consequently their negative environmental impact, namely through waste management, energy, water, transportation/travel, hospital design, food optimisation, green procurement, and behaviour. Also, lack of staff awareness and knowledge of the environmental impact of healthcare, and hospitals sustainability were identified as major contributors.

Effect of a waste management intervention program on knowledge, attitude, and practice (KAP) of nurses and housekeepers: a quasi-experimental study, Egypt.

BACKGROUND: Improper healthcare waste management practice is alarming in developing countries because resources are inadequate and waste management is often delegated to poorly educated and untrained laborers. This study aimed to compare the pre-KAP versus post-KAP towards the waste management program for nurses and housekeepers. In addition, it aimed to explore possible factors affecting the pre- and post-KAP in Mansoura Emergency University Hospital, Egypt. SUBJECTS AND METHODS: One hundred thirty-three newly employed nurses, housekeepers, and those who need refreshment training as nominated by head nurses and link occupational health and safety nurses in the hospital were recruited for the study. The study's intervention included multiple training sessions using a PowerPoint presentation in Arabic with appropriate illustrations followed by an open discussion. An Arabic self-administered questionnaire containing demographic and occupational history, knowledge (27 questions), attitude (10 questions), and practice (9 questions) was used pre- and post-intervention. RESULTS: The overall KAP scores among the studied healthcare workers were significantly higher after the intervention. The pre- and post-knowledge scores were significantly different with respect to education, job description, and duration of employment (p < 0.05). The post-attitude scores were significantly different with respect to education and job description only (p < 0.05). The total pre-practice scores were significantly different with respect to education and job description (p < 0.05). However, the post-practice scores were significantly different with respect to sex, age, education, and job description (p < 0.05). CONCLUSION: There was a significant improvement in the KAP scores post-intervention. The post-knowledge and attitude scores were significantly better in nurses and participants with a higher education. The post-practice score was significantly better for females, participants with an age ≥ 30 years, higher education, and nursing jobs. The combination of training and supervision was crucial for the success of waste management programs. Higher education levels are required for housekeepers to be capable of gaining better knowledge, follow rules, and be ready for any challenges in the future.

Assessment of healthcare waste treatment methods using an interval-valued intuitionistic fuzzy double normalization-based multiple aggregation approach.

Healthcare waste management has been an extensively attractive topic recently since it is one of the key concerns regarding both environment and public health, predominantly in developing nations. The optimization of the treatment procedure for healthcare waste is indeed a complex "multi-criteria decision-making (MCDM)" problem that involves contradictory and interweaved critical criteria. To successfully handle this issue, this study extends the original method, named the "double normalization-based multi-aggregation (DNMA)" approach, with "interval-valued intuitionistic fuzzy sets (IVIFSs)" for decision-making problems taking criteria in terms of benefit or cost types. This method involves two target-based normalizations and three subordinate utility models. To estimate the criteria weights, we propose a new parametric divergence measure and discuss the feasibility of the developed divergence measure based on existing divergence measures for IVIFSs. Further, the developed framework is implemented to elucidate the "healthcare waste treatment (HCWT)" problem. The comparative and sensitivity analyses of the outcomes indicate that the proposed approach efficiently tackles the problem of HCWT selection. The outcomes show that steam sterilization (0.462) is the optimal one for HCWT. The prioritization options, obtained by presented approach, are dependable and suitable, which are steam sterilization ≻ microwave ≻ incineration ≻ landfilling.

Designing reverse logistics network for healthcare waste management considering epidemic disruptions under uncertainty.

Population growth and recent disruptions caused by COVID-19 and many other man-made or natural disasters all around the world have considerably increased the demand for medical services, which has led to a rise in medical waste generation. The improper management of these wastes can result in a serious threat to living organisms and the environment. Designing a reverse logistics network using mathematical programming tools is an efficient and effective way to manage healthcare waste. In this regard, this paper formulates a bi-objective mixed-integer linear programming model for designing a reverse logistics network to manage healthcare waste under uncertainty and epidemic disruptions. The concept of epidemic disruptions is employed to determine the amount of waste generated in network facilities; and a Monte Carlo-based simulation approach is used for this end. The proposed model minimizes total costs and population risk, simultaneously. A fuzzy goal programming method is developed to deal with the uncertainty of the model. A simulation algorithm is developed using probabilistic distribution functions for generating data with different sizes; and then used for the evaluation of the proposed model. Finally, the efficiency of the proposed model and solution approach is confirmed using the sensitivity analysis process on the objective functions' coefficients.

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.

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

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

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.

Selection of healthcare waste management treatment using fuzzy rough numbers and Aczel-Alsina Function.

The COVID-19 pandemic led to an increase in healthcare waste (HCW). HCW management treatment needs to be re-taken into focus to deal with this challenge. In practice, there are several treatments of HCW with their advantages and disadvantages. This study is conducted to select the appropriate treatment for HCW in the Brcko District of Bosnia and Herzegovina. Six HCW management treatments are analyzed and observed through twelve criteria. Ten-level linguistic values were used to bring this evaluation closer to human thinking. A fuzzy rough approach is used to solve the problem of inaccuracy in determining these values. The OPA method from the Bonferroni operator is used to determine the weights of the criteria. The results of the application of this method showed that the criterion Environmental Impact ( C 4 ) received the highest weight, while the criterion Automation Level ( C 8 ) received the lowest value. The ranking of HCW management treatments was performed using MARCOS methods based on the Aczel-Alsina function. The results of this analysis showed that the best-ranked HCW management treatment is microwave (A6) while landfill treatment (A5) is ranked worst. This study has provided a new approach based on fuzzy rough numbers where the Bonferroni function is used to determine the lower and upper limits, while the application of the Aczel-Alsina function reduced the influence of decision-makers on the final decision because this function stabilizes the decision-making process.

Knowledge, attitudes and practices of sharps waste disposal by diabetic patients in rural South Africa.

BACKGROUND: Sharps waste is hazardous, and it should be disposed of in a proper manner, as it can contribute to transmission of diseases and create a negative impact on the environment. The aim of this investigation was to determine the knowledge, attitudes and practices regarding sharps waste disposal of diabetic patients who inject themselves at home in uMzinyathi District Municipality, a rural area in KwaZulu-Natal, South Africa. METHODS: A quantitative, descriptive cross-sectional study design was adopted using a self-administered questionnaire. Consecutive sampling with a sample size of 308 insulin-dependent diabetic patients from five selected health facilities of uMzinyathi District Municipality was used. RESULTS: The majority of respondents (62.3%) lacked knowledge regarding proper sharps waste disposal. The vast majority of respondents (90.6%) recognised that sharps waste should be separated from general waste. Among those who acknowledged that someone in their home had been injured by a needle, 53.3% stated that they were motivated to change their method of sharps waste disposal. CONCLUSION: The study findings indicated that the majority of the respondents lacked knowledge regarding proper disposal of sharps waste because they were not taught proper methods of sharps waste disposal. There was a general lack of awareness on proper disposal of sharps waste by diabetic patients in the home setting. The study recommended that healthcare workers must place more emphasis on the awareness of proper sharps waste disposal in order to equip diabetic patients with relevant information regarding sharps waste disposal.