Situational Assessment of Functional Elements, Practices Adopted & Concerns Related to Bio Medical Waste Management in City of Pune, India.

The study was conducted with the objective of leading a situational assessment of Pune city with regard to Bio medical waste management, exploring knowledge, attitude & practices (KAP) of healthcare workers, and identifying challenges of stakeholders. Results revealed 69.2% of the hospitals had a biomedical waste management facility. Facilities like incineration, shredder, sharp pit, encapsulation, deep burial, and chemical disinfection were non- existing in 60% to 90% of hospitals. Bivariate analysis on questions with the type of employees and (KAP) was calculated. The utilization of the existing services and noncompliance are the major findings from the study.

Assessment of Healthcare Waste Management Paradigms and Its Suitable Treatment Alternative: A Case Study.

The management and treatment of healthcare waste (HCW) are of great concern owing to its potential hazard to human health and the environment, particularly in developing countries. Nowadays, various technological alternatives are gaining momentum as efficient and favorable waste management options across the world. However, selecting a suitable technology as well as an effective waste management approach for the treatment of HCW is still a challenging task for the municipal authorities. This study renders a comprehensive analysis of healthcare waste management (HCWM) practices and the technological options for its better management through a case study in Khulna, the southwestern division of Bangladesh. A number of healthcare establishments (HCEs) in the study area were selected and a questionnaire survey, as well as field investigations, was performed to find out the present status of HCWM and its limitations. An assessment of different technological alternatives was also carried out using Sustainability Assessment of Technologies (SAT) methodology which could pave the way for treating hazardous waste more efficiently in the Khulna metropolitan area. The study revealed that the overall HCW generation rate and hazardous HCW generation rate in Khulna city were 0.90 kg bed-1 day-1 and 0.18 kg bed-1 day-1, respectively. Assessment of management system revealed that 56% (n = 38) of workers did not receive any form of training in the handling of hazardous waste. Around 54% (n = 47) of them did not use any safety equipment or clothing. It has been found from the study that, among different technological alternatives based on the final score, incineration was the most suitable option for the treatment of hazardous waste in Khulna. Finally, some guidelines have been put forward to improve its existing management practices.

Thermal treatment of medical waste in a rotary kiln.

This paper presents the results of a study of an experimental system with thermal treatment (incineration) of medical waste conducted at a large complex of hospital facilities. The studies were conducted for a period of one month. The processing system was analysed in terms of the energy, environmental and economic aspects. A rotary combustion chamber was designed and built with the strictly assumed length to inner diameter ratio of 4:1. In terms of energy, the temperature distribution was tested in the rotary kiln, secondary combustion (afterburner) chamber and heat recovery system. Calorific value of medical waste was 25.0 MJ/kg and the thermal efficiency of the entire system equalled 66.8%. Next, measurements of the pollutant emissions into the atmosphere were performed. Due to the nature of the disposed waste, particular attention was paid to the one-minute average values of carbon oxide and volatile organic compounds as well as hydrochloride, hydrogen fluoride, sulphur dioxide and total dust. Maximum content of non-oxidized organic compounds in slag and bottom ash were also verified during the analyses. The best rotary speed for the combustion chamber was selected to obtain proper afterburning of the bottom slag. Total organic carbon content was 2.9%. The test results were used to determine the basic economic indicators of the test system for evaluating the profitability of its construction. Simple payback time (SPB) for capital expenditures on the implementation of the project was 4 years.

Clinical waste incinerators in Cameroon--a case study.

PURPOSE: Incinerators are widely used to treat clinical waste in Cameroon's Northwest Region. These incinerators cause public apprehension owing to purported risks to operators, communities and the environment. This article aims to summarize findings from an April 2008 case study. DESIGN/METHODOLOGY/APPROACH: Three incinerators were randomly selected and investigated for site, design and operating standards. Empirical field observation was adopted and data collected through inventory and informal interviews. Bottom ash samples collected from the incinerators were prepared according to standard procedures and analyzed for heavy metals using Inductively Coupled Plasma (ICP) Emission Spectroscopy. FINDINGS: Shortcomings associated with site selection, design and operation standards were identified. Chemical analysis revealed that Cr, Cu, Fe, Mn, Ni, Pb, Zn, Mg and Ca were present in the bottom ash with mean concentration ranging from 10 mg/kg for Pb to 178080 mg/kg for Ca. RESEARCH LIMITATIONS/IMPLICATIONS: For logistic reasons, feedstock quantity and quality into the incinerators were not investigated. Neither were soil samples around and away from the incinerators. PRACTICAL IMPLICATIONS: Although highly favored, clinical waste incineration methods in this region have to be reconsidered. A thorough health and environmental impact assessment is suggested before subsequent decisions on choice and disposal site is made. This will curb potential negative impacts to the environment and public health. ORIGINALITY/VALUE: This article adds a different perspective and sheds additional information to the debate on unsatisfactory clinical waste incinerators in resources-poor countries. Alternative methods to incineration are presented that will be helpful to practitioners.

Point-of-care testing for disasters: needs assessment, strategic planning, and future design.

Objective evidence-based national surveys serve as a first step in identifying suitable point-of-care device designs, effective test clusters, and environmental operating conditions. Preliminary survey results show the need for point-of-care testing (POCT) devices using test clusters that specifically detect pathogens found in disaster scenarios. Hurricane Katrina, the tsunami in southeast Asia, and the current influenza pandemic (H1N1, "swine flu") vividly illustrate lack of national and global preparedness. Gap analysis of current POCT devices versus survey results reveals how POCT needs can be fulfilled. Future thinking will help avoid the worst consequences of disasters on the horizon, such as extensively drug-resistant tuberculosis and pandemic influenzas. A global effort must be made to improve POC technologies to rapidly diagnose and treat patients to improve triaging, on-site decision making, and, ultimately, economic and medical outcomes.

Evaluation of ceramic and membrane diffusers under operating conditions with the dynamic offgas method.

The aeration systems of two full-scale, activated-sludge basins were compared during a period of three years, under the same operating conditions, using dynamic offgas testing. Only the material of the diffuser was different (membrane versus ceramic-tube diffusers). The investigation has shown that, although the membrane diffusers have higher initial standard-oxygen-transfer efficiency (alphaSOTE) and standard-aeration efficiency (alphaSAE), these decreased over time, while the alphaSAE of the ceramic diffusers started lower, but increased slightly over the whole period. A cost comparison makes clear how important it is to evaluate the aeration system under process conditions. The operating costs were the dominant factor (approximately 10x higher than capital costs), and operating costs were approximately 20% higher for membrane versus ceramic diffusers. The poor performance of the membrane-tube diffusers under process conditions could be explained on the basis of the actual alphaAE values in the basin, not the standardized values.

Needlestick injuries in the United States. Epidemiologic, economic, and quality of life issues.

Best evidence from prospective studies with aggressive monitoring suggests that the incidence of needlestick injuries is significantly higher than reported through passive surveillance, ranging from 14 to 839 needlestick injuries per 1,000 health care workers per year. The economic cost of managing these injuries is substantial, ranging from dollars 51 to dollars 3,766 (2002 U.S. dollars). This amount excludes the cost of treating the long-term complications of needlestick injuries, such as HIV and hepatitis B and C infections, each of which can cost several hundreds of thousands of dollars to manage. In addition, health care workers experience significant fear, anxiety, and emotional distress following a needlestick injury, sometimes resulting in occupational and behavior changes. Despite the availability of engineered injury prevention devices, the implementation of these new technologies has been mixed in part because of the perception that these devices are costly and cost ineffective. However, widespread use of safety devices might be more easily justified on economic grounds when the full clinical and economic benefits of these new technologies are considered, especially within the context of injury prevention.

Cost-effectiveness of removing amalgam from dental wastewater.

Mercury in the form of amalgam is commonly introduced into dental wastewater as a result of amalgam placements and removals. Dental wastewater is primarily discharged to municipal sewers that convey industrial and residential wastewater to publicly owned treatment works (POTWs) for treatment prior to discharge to surface waters. In some localities, the sewage sludge generated by POTWs from the treatment of wastewater is incinerated, resulting in the emission of mercury to the atmosphere. Some of the mercury emitted from the incinerators is deposited locally or regionally and will enter surface waters. An assessment was conducted of the use of mercury in amalgam in California and the discharge of that mercury from dental facilities to surface waters via the effluent from POTWs and air emissions from sewage sludge incinerators (SSIs). The annual use of mercury in amalgam placements conducted in California was estimated to be approximately 2.5 tons. The annual discharge of mercury in the form of amalgam from dental facilities to POTWs as a result of amalgam placements and removals was estimated as approximately one ton. The discharge of mercury to surface waters in California via POTW effluents and SSI emissions was estimated to total approximately 163 pounds. A cost-effectiveness analysis determined that the annual cost to the California dental industry to reduce mercury discharges to surface waters through the use of amalgam separators would range from 130,000 dollars to 280,000 dollars per pound.

Purchasing, installing and operating dental amalgam separators: practical issues.

BACKGROUND: Growing environmental concern over the accumulation of mercury in some fish has led some state and local environmental agencies to pursue stricter regulation of mercury in wastewater. Dental offices are an identifiable source of mercury in the form of dental amalgam. Although mercury in dental amalgam is not immediately bioavailable (that is, it has not been shown to contribute significantly to the problem of mercury in fish tissue), environmental agencies in some locales are asking dental offices to install amalgam separators in an effort to reduce amalgam discharges beyond those already achieved through chairside traps and vacuum filters. Field experience indicates that the configuration and operation of the dental office infrastructure can significantly affect the choice of separator, as well as the operation and maintenance of the installed equipment. OVERVIEW: The authors review factors related to office infrastructure and operation that dentists should consider when investing in an amalgam separator. They also provide a cost-analysis worksheet and checklist that may be useful to dentists who are considering purchasing a separator. CONCLUSIONS AND CLINICAL IMPLICATIONS: Before purchasing or installing an amalgam separator, dentists should consider factors specific to the available models, including size and maintenance requirements. In addition, office-specific actors should be considered (such as the plumbing configuration, available space for installation and subsequent access to that space for equipment replacement and maintenance). Dentists also should research whether any local or state regulations exist that might influence product selection or installation. Dentists should consider the effect an amalgam separator could have on existing suction equipment. Finally, dentists will want to consider the short- and long-term costs (including maintenance and parts replacement) of the available options.

A cc of prevention.

Rarely do saving money and saving lives fit so closely together as they do with sharps safety. Here's how to choose the best devices to reduce injuries in your hospital.

An outbreak of needlestick injuries in hospital employees due to needles piercing infectious waste containers.

OBJECTIVES: To investigate the cause of an outbreak of needlestick injuries (NSIs) in hospital employees. SETTING: A 700-bed university hospital. DESIGN: Outbreak investigation, laboratory evaluation of a medical waste disposal device, cost analysis. METHODS: Employee health department records were reviewed of workers suffering sticks from needles piercing fiberboard-contaminated material containers (CMCs). A laboratory evaluation of needle-puncture resistance properties of the CMCs was performed using a testing apparatus. The cost of a hospital waste disposal program using fiberboard CMCs was compared with the cost of a program using rigid plastic (polypropylene) boxes. RESULTS: During 40 months of surveillance in 1986 and from 1989 to 1991, only one NSI had occurred from a needle piercing a CMC. During 9 months in 1993, 13 NSIs occurred due to needles piercing CMCs (P < .001). No clinical illness resulted from the NSIs. The outbreak was halted by a temporary change to plastic (polypropylene) boxes for sharps disposal ($4.92 to $23.33/cu ft) until receipt of a box with a newly designed solid fiberboard liner ($1.25/cu ft). CMC liners used during the epidemic had a mean needle puncture resistance of 527 g, as compared with 660 g for liners used before the outbreak (P < .001). The new solid fiberboard liner has a mean puncture resistance of 1,765 g. A program of waste disposal using fiberboard CMCs was found to cost approximately one-seventh the cost of a program using plastic boxes for disposal of infectious waste. CONCLUSION: A program for infectious waste disposal using fiberboard CMCs can be safe and cost-effective if appropriate standards for puncture resistance are met.

Assessment of microwave-based clinical waste decontamination unit.

A clinical waste decontamination unit that used microwave-generated heat was assessed for operator safety and efficacy. Tests with loads artificially contaminated with aerosol-forming particles showed that no particles were detected outside the machine provided the seals and covers were correctly seated. Thermometric measurement of a self-generated steam decontamination cycle was used to determine the parameters needed to ensure heat disinfection of the waste reception hopper, prior to entry for maintenance or repair. Bacterial and thermometric test pieces were passed through the machine within a full load of clinical waste. These test pieces, designed to represent a worst case situation, were enclosed in aluminium foil to shield them from direct microwave energy. None of the 100 bacterial test pieces yielded growth on culture and all 100 thermal test pieces achieved temperatures in excess of 99 degrees C during their passage through the decontamination unit. It was concluded that this method may be used to render safe the bulk of of ward-generated clinical waste.