Sustainable practices in hospital and operating theaters.

PURPOSE OF REVIEW: This review aims to provide an update on the results of studies published in the last two years involving the development of sustainable practices in hospital and operating theaters (OT). RECENT FINDINGS: Recently, many studies evaluated various initiatives to better understand the environmental impact of the OT but also to minimize its environmental impact. Many trials evidenced the positive impact of the instrument's reuse using an appropriate reprocessing procedure. Better waste segregation is associated with a reduction of produced waste and contributes to a significant reduction in CO 2 equivalent emissions. Regarding anaesthetic gas, Desflurane is known to have the worst environmental impact and the majority of the study evidenced that its reduction permits to drastically reduce greenhouse gas emission of the OT. SUMMARY: Greening the OT necessitates climate-smart actions such as waste reduction, the improvement of reusable instruments, recycling of our waste and better anaesthetic gas management. Within the last two years, many efforts have been made to reduce and better segregate waste produced in the OT and also to better understand the environmental impact of disposable and reusable devices.

The environmental impacts of anesthesia.

PURPOSE OF REVIEW: The healthcare sector has a substantial environmental footprint, and the delivery of anesthesia contributes significantly. Inhaled anesthetics themselves are potent greenhouse gases, unused intravenous medication exert toxic effects on the environment, and the increasing reliance on single-use devices has led to an ever-growing amount of solid waste produced in operating rooms. This review discusses many of these environmental impacts and suggests practices to mitigate the environmental footprint of anesthetic practice. RECENT FINDINGS: The choice of anesthesia maintenance has significant environmental implications, with nitrous oxide and desflurane having the highest carbon footprint of all anesthetic agents. Using low fresh gas flows and supplementing or replacing inhalational agents with propofol leads to a significant reduction in emissions. Many intravenous anesthetic agents pose a risk of environmental toxicity, and efforts should be made to decrease medication waste and ensure appropriate disposal of unused medications to minimize their environmental impacts. Additionally, consideration should be given to replacing single-use devices in the operating rooms with reusable alternatives that are often both environmentally and economically superior. And solid waste generated in the operating room should be segregated thoughtfully, as processing regulated medical waste is a highly energy-intensive process. SUMMARY: Significant opportunities exist to improve the environmental footprint of anesthesia practice, and with the rapidly worsening climate crisis, the importance of implementing changes is greater than ever.

Developing the green operating room: exploring barriers and opportunities to reducing operating room waste.

The Australian health care system contributes 7% of the national greenhouse gas emission footprint and generates massive waste streams annually. Operating rooms are a particular hotspot, generating at least 20% of the total hospital waste. A systematic search of several global academic databases was conducted in mid-2022 (articles from 1992 to 2022) for peer-reviewed research relevant to waste management in the operating rooms. We then used thematic analysis to enumerate and characterise the strategies and barriers to sustainable waste management in the operating room. The waste reduction strategies focused on avoidance of high carbon products; correct waste segregation and reduced overage; reusing, reprocessing, and repurposing devices; and improved recycling. The first barrier identified was a constrained interpretation of the concept of "first do not harm", ingrained in surgeons' practices, in prioritising single-use surgical products. The second barrier was ineffective or insufficient waste education. The third barrier was the immediate cost of implementing waste management compared with the long term realisation of environmental and economic benefits. The last barrier to implementing institutional practice change was the lack of policies and regulations at the local hospital, federal and international levels. We also evaluated the knowledge gaps in current surgical waste research, including lack of benchmarking data and standardised regulations concerning reusable or reprocessed devices, as well as the methods used to promote pro-sustainability behavioural change.

Resource utilization of medical waste incineration fly ash to activate peroxydisulfate for tetracycline degradation: Synergy between adsorption and PDS activation.

Medical waste incineration fly ash (MWI FA) is classified as a hazardous solid waste. Therefore, the development of recycling technologies to convert MWI FA into useful products is necessary and challenging. In this study, we developed a sustainable approach for preparing a catalyst through the pyrolysis of water-washed MWI FA (WW FA-x, where x corresponds to the pyrolysis temperature). Subsequently, it was applied as a potent peroxydisulfate (PDS) activator to remove tetracycline (TC) from water. The results showed that the WW FA-800 exhibited remarkable adsorption performance as well as highly efficient catalytic activation of PDS, with a 115 mg/g maximum TC adsorption capacity and 93.5% (reaction kinetic rate = 315 µmol/g/h) TC removal within 60 min. A synergistic effect was achieved by adsorption and PDS activation. TC degradation was primarily driven by non-radical (1O2 and electron transfer) processes. WW FA-800 possesses multiple active sites, including defects, π-π*, O-CO groups, Fe0, and Cu(I). Three possible pathways for TC decomposition have been proposed, with the majority of intermediates exhibiting less toxicity than TC. Furthermore, the WW FA/PDS system exhibited an excellent anti-interference ability, and universality in the degradation of various organic contaminants. Notably, energy consumption was minimal, approximately 2.80 kWh/(g·TC), and the leachability of heavy metals in the WW FA-800 was within acceptable limits. This study provides a MWI FA recycling route for the development of highly active catalysts.

Review of sustainable practices for the gynecology operating room.

PURPOSE OF REVIEW: Climate change has immediate impacts on women's health. Hospitals and operating rooms are large contributors to greenhouse gas (GHG) emissions and waste. This article will review current green initiatives designed to minimize environmental impact in the operating room and highlight areas for future improvement. RECENT FINDINGS: From a materials perspective, reusable goods result in less GHG emissions while being just as efficacious, well tolerated, and easy to use. Materials should be opened judiciously, only as necessary. Processing regulated medical waste produces greater GHG emissions, so waste should be properly sorted, and items which are not biohazard waste should be processed separately. Choosing appropriate anesthesia and utilizing an 'off' setting, in which operating rooms are shut down when not in use, can also drastically decrease the environmental impact of surgery. Further research is needed to determine effective implementation in hospitals. SUMMARY: This article summarizes current attempts to make operating rooms more sustainable. Many practices result in a decreased carbon footprint and cost savings without adversely affecting patient outcomes. Gynecologic surgeons and the hospitals in which they practice need to focus on implementing these changes in a timely fashion.

The financial and environmental impact of unopened medical supplies discarded in the emergency department.

BACKGROUND: Inefficient supply chain management within the US healthcare industry results in significant financial and environmental impact. Unopened medical supplies may routinely be discarded in the Emergency Department (ED), contributing as a source of unnecessary medical waste. OBJECTIVES: Quantify the financial and environmental impact of unopened medical supplies that are routinely discarded in two EDs. METHODS: The study utilized a waste audit of collection bins targeting unopened medical supplies that would have otherwise been discarded. Associated financial cost was calculated using data from the purchasing department and from an online search. End-of-life (EOL) environmental impact was calculated using the M+ Wastecare calculator. A lifecycle analysis was performed on a supplier-packaged intubation kit, which the study identified as a significant source of waste. RESULTS: High volumes of unused, unopened supplies (143.48 kg) were collected during the study period with a yearly extrapolated value of 1337 kg. Purchasing costs over 44 days at Hospital A and 37 days at Hospital B for these items amounted to $16,159.71 across both sites with a yearly extrapolated value of $150,631.73. Yearly extrapolated EOL impact yielded 5.79 tons per year of CO2eq. Components from supplier-packaged intubation kits were found to contribute to 45.2% of collected items at one site which purchased them. Lifecycle analysis of an intubation kit yields 23.6 kg of CO2eq. CONCLUSION: This study demonstrates that the disposal of unopened medical supplies contributes a significant source of financial and environmental waste in the ED setting. The results continue to support the trend of procedure kits generating significant environmental and financial waste.

Anti-cancer drug waste disposal practices and wastewater management in hospitals: A Lebanese survey.

INTRODUCTION: To achieve continuous environmental sustainability and protect the population's health, healthcare waste (in liquid or solid form) needs appropriate management and suitable treatment strategies before its final disposal in the environment in order to reduce its adverse impacts. This study aims to identify disparities in the waste management of anti-cancer drugs and the wastewater generated in Lebanese hospitals. METHODS: Three questionnaires were designed to evaluate the level of knowledge, awareness and experience of hospital personnel regardless of their job levels. Data was collected in December 2019 from three departments of each participating hospital: pharmacy, oncology and maintenance departments. A descriptive analysis was conducted to summarise the survey results. RESULTS: The results revealed a lack of transparency and awareness of the participants, with a high frequency of 'prefer not to say' responses when asked about the disposal methods of anti-cancer drugs and with only 5.7% of the participants in the pharmacy department sharing their disposal procedures. The same perception was deduced regarding hospitals' wastewater treatment, where responses were often contradicting, preventing making assumptions about the fate of hospital wastewater. CONCLUSION: The results of this survey support the need to establish a more comprehensive waste management programme in Lebanon that would be maintained through regular training and supervision.

Solid health care waste management practice in Ethiopia, a convergent mixed method study.

INTRODUCTION: Healthcare waste is any waste generated by healthcare facilities that is considered potentially hazardous to health. Solid healthcare waste is categorized into infectious and non-infectious wastes. Infectious waste is material suspected of containing pathogens and potentially causing disease. Non-infectious waste includes wastes that have not been in contact with infectious agents, hazardous chemicals, or radioactive substances, similar to household waste, i.e. plastic, papers and leftover foods. This study aimed to investigate solid healthcare waste management practices and develop guidelines to improve solid healthcare waste management practices in Ethiopia. The setting was all health facilities found in Hossaena town. METHOD: A mixed-method study design was used. For the qualitative phase of this study, eight FGDs were conducted from 4 government health facilities, one FGD from each private health facility (which is 37 in number), and forty-five FGDs were conducted. Four FGDs were executed with cleaners; another four were only health care providers because using homogeneous groups promotes discussion. The remaining 37 FGDs in private health facilities were mixed from health professionals and cleaners because of the number of workers in the private facilities. For the quantitative phase, all health facilities and health facility workers who have direct contact with healthcare waste management practice participated in this study. Both qualitative and quantitative study participants were taken from the health facilities found in Hossaena town. RESULT: Seventeen (3.1%) health facility workers have hand washing facilities. Three hundred ninety-two (72.6%) of the participants agree on the availability of one or more personal protective equipment (PPE) in the facility ''the reason for the absence of some of the PPEs, like boots and goggles, and the shortage of disposable gloves owes to cost inflation from time to time and sometimes absent from the market''. The observational finding shows that colour-coded waste bins are available in 23 (9.6%) rooms. 90% of the sharp containers were reusable, and 100% of the waste storage bins were plastic buckets that were easily cleanable. In 40 (97.56%) health facilities, infectious wastes were collected daily from the waste generation areas to the final disposal points. Two hundred seventy-one (50.2%) of the respondents were satisfied or agreed that satisfactory procedures are available in case of an accident. Only 220 (40.8%) respondents were vaccinated for the Hepatitis B virus. CONCLUSION: Hand washing facilities, personal protective equipment and preventive vaccinations are not readily available for health workers. Solid waste segregation practices are poor and showed that solid waste management practices (SWMP) are below the acceptable level.

Waste management in the operating theatre.

INTRODUCTION: Poor clinical waste management and its effect on the environment is an increasingly recognised concern for global healthcare systems. Approximately two thirds of waste produced in healthcare is from the operating theatre. In the Republic of Ireland, an estimated 580,977 tonnes of hazardous waste was produced in 2019. The cost of incineration of this hazardous waste is approximately €2,125 per tonne and €935 per tonne for sterilisation. Pollution from incineration is substantial and harmful. METHODS: A literature review was performed on the topic of hospital waste management, specifically looking at the Republic of Ireland. A comparison could then be drawn between Ireland, Europe and the United States of America. Observation of our current operating theatre environment and practices were carried out. DISCUSSION: An increased focus towards sustainability and reusable equipment means that there is potentially a decreased amount of waste for disposal, but an increase in the process of sterilisation. Approximately 66% of healthcare related waste is inappropriately contaminated, meaning that significant savings are possible if correct segregation and recycling were to occur. An increase in the amount of bins, identification labels above bins and education of staff results in an increased likelihood of successful segregation of waste. Clear and concise hospital guidelines of what is considered hazardous versus non-hazardous waste will decrease the amount of inappropriately disposed items.

Expiry dates in surgical equipment: What are the options?

INTRODUCTION: Hospitals and the healthcare system contribute significantly to global warming, due to the energy use, water use and waste produce going directly to landfill. The operating theatre environment contributes to 70% of all hospital waste, and a proportion of this is due to unused surgical supplies, such as those stocked but never used as they go past their use-by date. AIM: To evaluate how use-by dates are identified and assigned to surgical equipment, and if there are opportunities to re-use, or re-sterilise this equipment in order to reduce waste from the operating theatre environment. RESULTS: Use-by dates are assigned to ensure sterility and longevity of the device, and are assigned based on risk analysis, retrospective and prospective assessment. Incineration is the mainstay of disposal of unused medical devices, but there are alternative options such as re-processing in specific circumstances. CONCLUSION: A large volume of hospital waste is due to operating theatres, and there is movement towards developing more sustainable methods of dealing with expired surgical equipment. This is however in the early stages, with further research required to confirm if these methods will be safe for patients, and beneficial to the environment.

The environmental impact of hip and knee arthroplasty: An analysis of carbon emissions and disposal costs.

BACKGROUND AND PURPOSE: The rise in hip and knee arthroplasty for osteoarthritis requires addressing healthcare system pollution to support Ireland's climate change goals. This research aimed to quantify waste generated and determine environmental and economic impacts to promote sustainable strategies in joint arthroplasty and shed light on the suboptimal waste management practices. METHODS: The study was conducted at National Orthopaedic Hospital Cappagh (NOHC), measuring waste generated during hip and knee arthroplasty. Clinical, domestic, and recycled waste weights were recorded, including the segregation of Central Sterile Supply Department (CSSD) Blue Wrap waste in ten operations. Kilograms of carbon dioxide emissions (kgCO2e) and disposal costs were calculated. RESULTS: In a sample of 100 joint arthroplasty operations, the study found that revision knees produced 23.58 â€‹kgCO2e per case, revision hips 23.50 â€‹kgCO2e, primary knees 15.82 â€‹kgCO2e, and primary hips 14.64 â€‹kgCO2e. CSSD Blue Wrap contributed on average 13.5% of OT waste. Extrapolating these findings to the estimated number of joint arthroplasties performed in 2022 â€‹at NOHC (1556 hip and knee joint arthroplasties), the emissions were estimated to be 24,576 kgCO2e, with the cost of disposal up to €29,228. Strategies to mitigate this waste have been identified and proposed. CONCLUSION: The research aimed to address the environmental impact of orthopaedic joint arthroplasties, offering strategies to reduce waste generation, carbon emissions, and cost. Utilising our methodology to calculate greenhouse gas emissions will empower sustainability offices to conduct their own waste audits and implementing our strategies for waste management practices can help minimise environmental waste.

Unused, leftover and expired medicine and disposal practices among health sciences faculty students in Burdur, Turkey.

Objective: To evaluate the opinions of university-level Health Sciences students about unused, leftover and expired medicine, as well as their disposal practices, and to classify the medicines. METHODS: The cross-sectional study was conducted from April 1 to May 31, 2023, at the Faculty of Health Sciences, Burdur Mehmet Akif Ersoy University, Turkey, and comprised those studying at the Nursing, Nutrition Dietetics and Physical Therapy and Rehabilitation departments. Data was collected using Google Forms. The Anatomical Therapeutic Chemical classification was used for classifying pharmaceutical active ingredients. Data was analysed using SPSS 24. RESULTS: Of the 373 participants, 272(73%) were females and 101(27%) were males. The overall mean age was 20.8±2.8 years. There were 348(93.3%) subejcts who reported having a total of 845 boxes of leftover and unused medicines in their homes (2.3±1.9 per capita), while 25(6.7%) participants had none. The medicines were stored in the kitchen 261(61.5%) as the storage area, and in the refrigerator 181(40.2%) as the storage unit. The expired medicine was disposed of in the garbage in 328(86.1%) cases. Self-medication was prevalent in 325(87.1%) cases. Anatomical Therapeutic Chemical classification analysis showed that paracetamol, acetylsalicylic acid, paracetamol+caffeine and metamizole sodium was the most common group of leftover and unused medicines 283(81.3%). Conclusion: High prevalence of unused and leftover medicine, disposal of medicine in household garbage, and selfmedication behaviour indicated a serious public health and environmental problem.

Biomedical waste generation at Ayurveda hospitals in South Asia: A mini review of the composition, quantities and characteristics.

Ayurveda hospitals generate biomedical wastes (BMW). However, details on composition, quantities and characteristics are very scarce, details which are important to formulate a proper waste management plan for subsequent implementation and continual improvement. Therefore, this article presents a mini review of the composition, quantities and characteristics of BMW generated from Ayurveda hospitals. Additionally, this article presents some best possible treatment and disposal procedures. Most of the information was gleaned from peer-reviewed journals, although some information was collected by the author and from grey literature available to the author; 70-99% (by wet weight) of the solid waste is non-hazardous; biodegradables contributing to 44-60% by wet weight due to more used Kizhi (medicinal bags for fomentation) and other medicinal/pharmaceutical wastes (excluding waste medicated oils, which is 12-15% of the liquid medicinal waste stream and are not readily biodegradable) largely derived from plants. The hazardous waste component includes infectious wastes, sharps, blood as pathological wastes (from Raktamoksha - bloodletting), heavy metal containing pharmaceutical wastes, chemical wastes and heavy metal rich wastes. Quantities of infectious wastes followed by sharps and blood form a major portion of hazardous wastes. Most of the infectious waste material contaminated with blood or other body fluids and sharps from Raktamoksha are very similar (appearance, moisture content and bulk density) to what is generated from hospitals practicing Western medicine. However, hospital-specific waste studies are required in future to better understand the sources, areas of generation, types, quantities and characteristics of BMW, and hence to formulate more accurate waste management plans.

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.

Current status of biomedical waste management practices and barriers among private Jordanian dental clinics: A cross-sectional investigation of the capital Amman.

Biomedical waste management (BMWM) is vital in facilitating safe providing of healthcare. Developing countries suffer from the impact of mishandled biomedical waste (BMW) on the general public in addition to healthcare practitioners. Thus, this study aims to investigate the awareness and compliance of dental facilities to BMW regulations. Through a questionnaire designed as per the WHO guidelines on BMWM, we randomly recruited a total of 421 dental facilities representative of Jordan's capital. Mean BMWM practice scores were relatively high for the studied sample (0.748 ± 0.12). Nonetheless, while collection, transportation and storage standards were acceptable, those pertaining to segregation and disposal demonstrated lack of compliance to BMWM safety measures. An alarming number of participants dispose of infectious waste (40%), extracted teeth (48.5%), expired pharmaceuticals (44.4%), liquid chemicals (53.2%), X-ray films (35.0%) and solutions (48.7%) in the general trash or draining system. Such is attributed to either lack of resources, lack of proper equipment or poor awareness with BMWM guidelines. Moreover, it appears that location of the clinic (p < 0.001), occupation (p = 0.026) and presence of regulatory instructions (p = 0.048) were associated with higher BMWM scores. Overall, dental practitioners require proper training in terms of handling hazardous dental, chemical and radioactive wastes. Moreover, regulatory bodies should actively enforce regulations and monitoring, update current compliance legislations and subsidize eco-friendly practices.

Assessment of Biomedical Waste Generation in Dialysis Units: A Prospective Observational Study-Is it Time for "Green Dialysis"?

Introduction: Chronic kidney disease and as a consequence end-stage kidney disease (EKSD) is increasing globally. More and more people across the world are requiring hemodialysis (HD). The HD procedure produces a large quantity of biomedical waste. In addition, HD consumes a large quantity of water. In this study, we estimated the waste generated from our government-funded HD unit. Materials and methods: It is a prospective study that was carried out in the dialysis unit in the nephrology department over a period of 1 year. The daily dialysis waste generated by the unit was measured using a spring balance. The proportion of plastic and nonplastic waste was determined. The quantity of biomedical waste generated per person in 1 year was calculated. Water input to the dialysis unit was noted. Water consumption per dialysis was calculated. Liquid chemical waste consumed was determined. Electricity consumed by the unit was measured by the electricity meter. The cost of waste disposal was calculated. The cost of electricity consumption and water consumption was also calculated. Results: The approximate weight of waste disposables generated in one dialysis was 0.75 kg. Approximately each person generates 1.29 kg of waste per dialysis. Each dialysis required 125 L of reverse osmosis (RO) water and to generate 125 L of RO water 250 L of raw water was used. This happens as 125 L of water are rejected during the generation of 125 L of RO water. Thus, the net water consumption for each dialysis was 250 L. Chemical waste generated per dialysis includes 90 mL citric acid per dialysis and 130 mL bleach. Each dialysis consumes 3 kWh (three units) of electricity. The cost of electricity for each dialysis was 25.5 INR and the cost of water was 25 INR per dialysis. The cost of waste disposal for each dialysis bed was 6 INR. Discussion: Each dialysis patient produced 1.29 kg of waste per dialysis which was like other studies. Unlike other studies, the waste was not being reprocessed or recycled. Conclusion: Hemodialysis produces substantial biomedical waste. Proper waste disposal techniques and policies to promote reduction, reuse, and recycling will go a long way toward promoting green dialysis and reducing environmental as well as economic burdens. How to cite this article: Sahay M, Sahay RK, Seshadri B, et al. Assessment of Biomedical Waste Generation in Dialysis Units: A Prospective Observational Study-Is it Time for "Green Dialysis"? J Assoc Physicians India 2023;71(10):49-52.

A Comparative Analysis of Hazardous Medical Waste Management Compliance Before (2019) and During (2020) the COVID-19 Pandemic in Indonesia.

Background: As a producer of hazardous waste, hospitals have the responsibility to manage the waste they produce. Hospital non-compliance in managing hazardous waste can have a negative impact on the environment and public health, especially during the COVID-19 pandemic, when the amount of hazardous waste produced by healthcare facilities is increasing. To protect the environment and public health from the negative impact of hazardous medical waste, this study was conducted to determine the level of compliance of hazardous waste management in hospitals in Indonesia before and during the COVID-19 pandemic, from 2019 to 2020. Study design: Cross-sectional. Methods: This study was conducted at 343 hospitals in Indonesia using secondary data obtained from Sikelim (Medical Waste Management Information System), which is owned and operated by the Ministry of Health. The data have been analyzed using chi-square tests and logistic regressions of the determinant model. Results: There was an increase in the level of compliance of hazardous waste management in hospitals from 82% to 86% during the pandemic. Furthermore, the availability of environmental documents and environmental health units were determinant factors of hazardous waste management compliance by hospitals before the pandemic in 2019. The only factor in 2020 was the availability of environmental health units. Conclusions: Despite the good level of compliance, additional efforts are needed to increase the activities of the treatment of hazardous medical waste by hospitals, as before the pandemic (i.e., in a normal situation) only 8% of hospitals was able to independently manage hazardous medical waste using authorized incinerators, a percentage that was reduced to 6% during the pandemic.

Biomedical waste management associated with infectious diseases among health care professionals in apex hospitals of a typical south asian city.

Biomedical waste from healthcare activities poses a higher hazard of infection and damage than other types of trash. The main objective of the study was to assess the awareness knowledge and practices of biomedical waste management (BMWM) among health care professionals in the health care units. The cross-sectional study was carried out to access the awareness, knowledge and practices of health care professionals for BMWM. Using a qualitative approach, the study was escorted in two Apex hospitals i.e. the Allied Hospital and the District Head Quarter Hospital, Faisalabad, Pakistan from August 5, 2019 to October 15, 2019. More than 90% of respondents knew the phrase BMWM, but just 35.4% had awareness about biomedical waste regulations. About 71.6% of the respondents were familiar with biomedical waste's color-coding segregation. The study concludes gap in the awareness, knowledge and practices for BMWM. The sanitary workers of the hospitals had no knowledge about BMWM and the BMWM/healthcare waste management rule 2005 established in Pakistan due to the lack of training regarding waste management and the segregation process. Some of the staff members were aware of the BMWM practices under the rules and regulations of Pakistan but were unable to implement at their work place. It is necessary to dispose of the biomedical waste according to the established terms and conditions of BMWM rules (2005) of Pakistan. Weak structure of BMWM was observed at the study sites due to the lack of training, liabilities and absence of penalties against improper biomedical waste disposal as violation of the rules and regulations. It's a dire need of the time to consider the biomedical waste as hazardous waste and make policies for its safe disposal and ensure the implementation of the policies in all the medical centers of Pakistan.

Review and assessment of drug disposal state statutes in the United States, 2022.

BACKGROUND: Ensuring opportunities exist to dispose of unused or unwanted drugs that are appropriate, accessible, and affordable is critical to avoid misuse and lasting harm to the environment. OBJECTIVE: The objectives of this study were to identify state statutes promulgated in all 50 states and the District of Columbia (DC) facilitating disposal of unused or unwanted drugs in the community setting and assess their characteristics. METHODS: A retrospective review of state statutes in all 50 U.S. states and DC between October 2020 and May 2022 was conducted. Statutes using terms "drug and disposal or collection" and that were intended to facilitate disposal of unused or unwanted drugs were included. Drug donation programs or repositories, drug returns to the pharmacy, charitable clinics, and others not intended to dispose or unused or unwanted drugs were excluded. Publicly available resources and Westlaw, a legal resource, were used to identify state statutes. Descriptive statistics were used to describe the findings. RESULTS: Of the 50 U.S. states and DC, we found that most states enacted a statute pertaining to drug disposal (63%; n = 32) as of May 2022. Of states with a drug disposal statute, few had funding mechanisms or required pharmacy participation. Most statutes specified the type of product that may be accepted for disposal, what site may accept them, and who may dispose of the product. Few states specified which health care provider or other individual may accept the product(s) for disposal. CONCLUSION: Most states have enacted statutes facilitating drug disposal, but their characteristics varied widely. Opportunities may exist at the state level to further incentivize proper drug disposal, and further research is needed to measure possible effects of these state statutes.

An assessment of hospital wastewater and biomedical waste generation, existing legislations, risk assessment, treatment processes, and scenario during COVID-19.

Hospitals release significant quantities of wastewater (HWW) and biomedical waste (BMW), which hosts a wide range of contaminants that can adversely affect the environment if left untreated. The COVID-19 outbreak has further increased hospital waste generation over the past two years. In this context, a thorough literature study was carried out to reveal the negative implications of untreated hospital waste and delineate the proper ways to handle them. Conventional treatment methods can remove only 50%-70% of the emerging contaminants (ECs) present in the HWW. Still, many countries have not implemented suitable treatment methods to treat the HWW in-situ. This review presents an overview of worldwide HWW generation, regulations, and guidelines on HWW management and highlights the various treatment techniques for efficiently removing ECs from HWW. When combined with advanced oxidation processes, biological or physical treatment processes could remove around 90% of ECs. Analgesics were found to be more easily removed than antibiotics, ß-blockers, and X-ray contrast media. The different environmental implications of BMW have also been highlighted. Mishandling of BMW can spread infections, deadly diseases, and hazardous waste into the environment. Hence, the different steps associated with collection to final disposal of BMW have been delineated to minimize the associated health risks. The paper circumscribes the multiple aspects of efficient hospital waste management and may be instrumental during the COVID-19 pandemic when the waste generation from all hospitals worldwide has increased significantly.