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.

Impact of medical waste bin on contamination of patient's environment: an experimental study.

BACKGROUND: Medical waste bins are potential source of microbial contamination in hospital environment, while there is no clear guidance for the management of them. We aimed to assess the impact of medical waste bins on patient's environment. METHODS: This experimental study simulated microbial contamination by performing medical procedures on a patient model with fluorescent lotion. The waste bin was set as initially empty or two-thirds filled with waste, open or with a lid. The percentage of fluorescent contaminated area in designated patient's environments was analyzed by two independent observers. RESULTS: Among a total of 120 experiments, the sides of the bins were more contaminated in open-occupied bins compared to open-empty bins and in open-occupied bins compared to lid-occupied bins (median 1.9175% vs. 0.0916% [P=0.001] and 1.9175% vs. 0.0899% [P=0.003], respectively). The top of bedside equipment trolley for preparing medical procedure was more contaminated in lid-occupied bins than open-occupied bins (median 0.0080% vs. 0.0040%, P=0.013). DISCUSSION: In addition to reducing contamination of bin itself, the manually operated lid had potential risk of contributing microbial transmission by contaminating equipment trolley. CONCLUSIONS: Medical waste bin should be kept no more than two-thirds full, and cautions should be taken when using manually operated lid, to avoid cross-contamination.

Evaluating the effect of the COVID-19 pandemic on medical waste disposal using preference selection index with CRADIS in a fuzzy environment.

The COVID-19 pandemic has caused a surge in essential medical supplies usage, leading to a notable increase in medical waste generation. Consequently, extensive research has focused on sustainable disposal methods to handle used medical equipment safely. Given the necessity to evaluate these methods considering qualitative and quantitative criteria, this falls within the realm of multi-criteria decision-making (MCDM). This study introduces a framework for selecting the most suitable medical waste treatment methods, taking into account economic, technological, environmental, and social aspects. Sixteen criteria were assessed using the Fuzzy Preference Selection Index (F-PSI) to determine the optimal waste disposal approach. Additionally, the Fuzzy Compromise Ranking of Alternatives from Distance to Ideal Solution (F-CRADIS) method was employed to evaluate nine technologies for medical waste disposal. Notably, disinfection efficiency emerged as the most crucial criterion, with autoclaving identified as the preferred method for medical waste treatment. A practical case study conducted in Sivas, Turkey, validates the feasibility of these strategies. Multiple sensitivity analyses were performed to ensure the stability and reliability of the proposed approach.

Medical waste incineration fly ash-based magnesium potassium phosphate cement: Calcium-reinforced chlorine solidification/stabilization mechanism and optimized carbon reduction process strategy.

The traditional solidification/stabilization (S/S) technology, Ordinary Portland Cement (OPC), has been widely criticized due to its poor resistance to chloride and significant carbon emissions. Herein, a S/S strategy based on magnesium potassium phosphate cement (MKPC) was developed for the medical waste incineration fly ash (MFA) disposal, which harmonized the chlorine stabilization rate and potential carbon emissions. The in-situ XRD results indicated that the Cl- was efficiently immobilized in the MKPC system with coexisting Ca2+ by the formation of stable Ca5(PO4)3Cl through direct precipitation or intermediate transformation (the Cl- immobilization rate was up to 77.29%). Additionally, the MFA-based MKPC also demonstrated a compressive strength of up to 39.6 MPa, along with an immobilization rate exceeding 90% for heavy metals. Notably, despite the deterioration of the aforementioned S/S performances with increasing MFA incorporation, the potential carbon emissions associated with the entire S/S process were significantly reduced. According to the Life Cycle Assessment, the potential carbon emissions decreased to 8.35 × 102 kg CO2-eq when the MFA reached the blending equilibrium point (17.68 wt.%), while the Cl- immobilization rate still remained above 65%, achieving an acceptable equilibrium. This work proposes a low-carbon preparation strategy for MKPC that realizes chlorine stabilization, which is instructive for the design of S/S materials.

An application of BWM for risk control in reverse logistics of medical waste.

The pollution posed by medical waste complicate the procedures of medical waste logistics (MWL), and the increasingly frequent occurrence of public health emergencies has magnified the risks posed by it. In this study, the authors established an index of the factors influencing the risks posed by MWL along five dimensions: the logistics business, emergency capacity, equipment, personnel, and management. The best-worst case method was used to identify the critical risk-related factors and rank them by importance. Following this, we assessed the risk posed by MWL in four major cities in China as an example and propose the corresponding measures of risk control. The results showed that the linking of business processes was the most important factor influencing the risk posed by MWL. The other critical risk-related factors included the location of the storage site, the capacity for emergency transportation, measures to manage emergencies, and the safety of packaging. Of the cities considered, Beijing was found to be a high-risk city, and its MWL needed to be improved as soon as possible in light of the relevant critical risks. Shanghai, Guangzhou, and Shenzhen were evaluated as general-risk cities, which meant that the risks of MWL were not a priority in these areas, and the other goals of urban development should be comprehensively considered during the long-term planning for MWL in these municipalities.

The evolutionary path of medical waste management research: Insights from co-citation and co-word analysis.

Over the past decades, medical waste management (MWM) has evolved into a paramount global challenge, intertwining environmental sustainability and public health dimensions. This manuscript traces the paradigm shift from the foundational Basel Convention of 1989 to the significant sway of World Health Organization publications on contemporary debates. Utilizing a mixed approach strategy that blended qualitative and quantitative techniques, the research employed extensive literature review, co-citation and co-word analysis methodologies to ascertain the direction of contemporary trends in MWM. Within the scope of the research findings, current strategies reveal noticeable gaps, especially those that lack sound policy structures, comprehensive insights and effective operational frameworks. Co-citation evaluations spotlight predominant themes in academic references. Foremost among them are the socioeconomic factor, environmental significance, medical waste (MW) stabilization and sustainable society, sequenced by cluster magnitude. Co-word analysis unveils that, despite the long-standing presence of incineration plants, pyrolysis has, since 2016, prioritized environmental considerations. The recycling ethos peaked in 2014, but the sustainability paradigm burgeoned in 2020, with the 'circular economy' gaining momentum in 2021. Emerging trend analysis underscores the mounting significance of circular waste technologies and sustainability as indispensable solutions. Results demonstrate MW advancements and highlight emerging trends shaping the future of the field. The research concludes by accentuating the necessity of global collaborative efforts, integrating cutting-edge technologies and infusing sustainability and circularity tenets into societal frameworks to navigate MWM's intricate landscape. Future research trajectories, including wastewater governance, novel mobile waste disposal strategies and a cyclic waste classification paradigm, are proposed.

Dioxins emissions from bio-medical waste incineration: A systematic review on emission factors, inventories, trends and health risk studies.

COVID-19 has aggravated the biomedical waste generation all over the world and the concern for its safe disposal is on the rise. The vast majority of healthcare systems employ incineration as their treatment method considering its agility to reduce the waste volume by up to 95-96% and high-temperature inactivation of infectious biological materials. However, incinerator emission is a significant contributor of polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and dioxin-like polychlorinated biphenyls (dl-PCBs) according to various national inventories across the globe. Bio-Medical Waste Incinerators (BMWIs) are the dominant form of incinerator plants in developing nations and hence BMWI emissions were found to contribute lion's share of national dioxins inventories in most of these countries. The Stockholm Convention on POPs played a key role in imbibing significant urge on the dl-POPs monitoring studies of incinerators internationally and on controlling the average incinerator emission levels. Though many national/international agencies endorse a stringent incinerator stack emission standard of 0.1 ngTEQ/Nm3, there are some differences observed in nation-to-nation regulatory scenarios. This paper reviews and reports on the dioxins emission and health risk studies associated with bio-medical waste incineration over the last three decades (1990-2020) with a comprehensive spatial and temporal emission trend analysis. An overview of important national and international regulations, national inventories and emission factors for the biomedical waste incineration sector is also reviewed in detail. The study observes that continuous regulatory monitoring and logical relaxations can enhance the performance of the existing facilities ensuring low emissions and minimal risk.

Reflections on COVID-19 pandemic and waste management in developing countries: A case study in São Paulo city, Brazil.

COVID-19 pandemic has changed several aspects in human behaviour, whereas population mobility patterns have been strongly affected by social distancing. In parallel, changes in solid waste generation patterns have been reported worldwide. This work assessed the influence of the COVID-19 pandemic on waste generation and collection in São Paulo city, Brazil, the largest city of Latin America. Data on nine types of wastes collected between 2013 and 2021 were obtained, and the quantities of wastes collected before and during the pandemic were compared. These data were also discussed in light of data on COVID-19 cases and rates of social distancing and mobility. An increase in the amount of recyclables collected during the first wave of COVID-19 (March to September 2020) was observed. Decreases in the quantities of construction, demolition and bulky wastes (first wave of COVID-19) and farmers market wastes (second wave - October 2020 to February 2021) were also evidenced. The quantities of medical wastes collected during the pandemic significantly increased. The amount of residential wastes was lower than the mean for the pre-pandemic period during the first months of COVID-19. Thus, changes in lifestyle and consumption patterns of the population of São Paulo city seem to have affected solid waste generation during the pandemic, which reinforces the need of implementing solid waste management policies based on a diagnostic that characterise and consider these changes.

Does medical waste research during COVID-19 meet the challenge induced by the pandemic to waste management?

The COVID-19 pandemic has resulted in an unprecedented amount of medical waste, presenting significant challenges for the safe disposal of hazardous waste. A systematic review of existing research on COVID-19 and medical waste can help address these challenges by providing insights and recommendations for effective management of the massive medical waste generated during the pandemic. This study utilized bibliometric and text mining methods to survey the scientific outcomes related to COVID-19 and medical waste, drawing on data from the Scopus database. The results show that the spatial distribution of medical waste research is unbalanced. Surprisingly, developing countries rather than developed countries lead research in this area. Especially, China, a major contributor to the field, has the highest number of publications and citations, and is also a centre of international cooperation. The main study authors and research institutions are also mainly from China. And the research on medical waste is a multidisciplinary field. Text mining analysis shows that COVID-19 and medical waste research is mainly organized around four themes: (i) medical waste from personal protective equipment; (ii) research on medical waste in Wuhan, China; (iii) threats of medical waste to the environment and (iv) disposal and management of medical waste. This would serve to better understand the current state of medical waste research and to provide some implications for future research.

Environmental and economic assessments of industry-level medical waste disposal technologies - A case study of ten Chinese megacities.

Medical waste (MW) is exploding due to the COVID-19 pandemic, posing a significant environmental threat, and leading to the urgent requirement for affordable and environmentally friendly MW disposal technologies. Prior research on individual MW disposal plants is region-specific, applying these results to other regions may introduce bias. In this study, major MW disposal technologies in China, i.e., incineration technologies (pyrolysis incineration and rotary kiln incineration), and sterilization technologies (steam sterilization, microwave sterilization, and chemical disinfection) with residue landfill or incineration were analyzed from an industry-level perspective via life cycle assessment (LCA), life cycle costing (LCC) and net present value (NPV) methods. Life cycle inventories and economic cost data for 4-5 typical companies were selected from 128 distinct enterprises and academic sources for each technology. LCA results show that microwave sterilization with residue incineration has the lowest environmental impact, emitting only 480 kg CO2 eq. LCC and NPV analyses indicate that steam sterilization with landfilling is the most economical, yielding revenues of 1,210 CNY/t and breaking even in the first year. Conversely, pyrolysis and rotary kiln incineration break even between the 4th and 5th years. Greenhouse gas emissions from the MW disposal in ten cities with the largest MW production in 2020 increased by 7% over 2019 to 43,800 tons and other pollutants increased by 6% to 12%. Economically, Shanghai exhibits the highest cost-effectiveness, while Nanjing delivers the lowest. It can be observed that the adoption of optimal environmental technologies has resulted in a diminution of greenhouse gas emissions by 279,000 tons and energy conservation of 1.76 billion MJ.

Reducing Overuse of 3-Day Repeat Type and Screen Testing across an 11-Hospital Safety Net System.

BACKGROUND: According to the American Association of Blood Banks, a Type and Screen (T&S) is valid for up to three calendar days. Beyond a limited number of clinical indications such as a transfusion reaction, repeat T&S testing within 3 days is not warranted. Inappropriate repeat T&S testing is a costly medical waste and can lead to patient harm. OBJECTIVE: To reduce inappropriate duplicate T&S testing across a large, multihospital setting. SETTING: The largest urban safety net health system in the USA, with 11 acute care hospitals. INTERVENTIONS: Our first intervention involved adding the time elapsed since the last T&S order into the order and the process instructions that described when a T&S was indicated. The second intervention was a best practice advisory that triggered when T&S was ordered before the expiration of an active T&S. MAIN MEASURES: The primary outcome measure was the number of duplicate inpatient T&S per 1000 patient days. KEY RESULTS: Across all hospitals, the weekly average rate of duplicate T&S ordering decreased from 8.42 to 7.37 per 1000 patient days (12.5% reduction, p < 0.001) after the first intervention and to 4.32 per 1000 patient days (48.7% reduction, p < 0.001) after the second intervention. Using linear regression to compare pre-intervention to post-intervention 1, the level difference was - 2.46 (9.17 to 6.70, p < 0.001) and slope difference was 0.0001 (0.0282 to 0.0283, p = 1). For post-intervention 1 to post-intervention 2, the level difference was - 3.49 (8.06 to 4.58, p < 0.001) and slope difference was - 0.0428 (0.0283 to - 0.0145, p < 0.05). CONCLUSIONS: Our intervention successfully reduced duplicate T&S testing using a two-pronged electronic health record intervention. The success of this low effort intervention across a diverse health system provides a framework for similar interventions in various clinical settings.

Waste management in primary healthcare centers in Saudi Arabia: a policy analysis.

Medical waste poses high risks to healthcare workers, patients, the environment, and public health. Governments have adopted measures and enacted policies to ensure proper medical waste management. Through a retrospective policy analysis, we analyzed the waste management policy for primary healthcare centers in Saudi Arabia. By adopting Walt and Gilson's health policy analysis framework, we conducted a thematic analysis of documents to analyze the policy context, process, actors, and content. Contextual factors including accreditation, the Saudi Vision-2030 and the healthcare transformation plan contributed to the development of the policy. The policy was adapted from a regional policy that was enacted about 15 years ago. The policy content overlooked components relevant to the specific context of primary healthcare centers. Lack of training and cooperation among stakeholders challenged successful implementation and thus compliance with the policy. Respective stakeholders must take further actions to ensure implementation fidelity and sustainability of the policy.

Assessment of knowledge and disposal practices of unused and expired household medicines in a community in Liberia.

Background: Expansion of pharmaceutical industries and improved availability of pharmaceuticals across the world have contributed to an increase in drug usage and accumulation in homes. Improper disposal of expired and unused medications has several consequences such as environmental pollution, and childhood poisoning. Objectives: The aim of the study was to assess the knowledge on disposal as well as disposal practices of unused and expired household medicines in the Parker Corner Road Community in Brewerville, Liberia. Methods: This study was a cross-sectional survey conducted among 162 residents of Parker Corner Road Community using face-to-face interviews. Outcomes measured were knowledge of disposal as well as disposal practices of unused and expired household medicines. The data collected were analysed using descriptive statistics. Results: Majority of respondents (55.6%) were female and 23.5% had university education. 71% of the respondents reported that they had not received any information on safe disposal practices while 64.2% admitted that they often did not read and follow disposal instructions. The most popular disposal practices were disposal of the drugs along with household waste (61.1%) and flushing them down the toilets or sinks (25.3%). Majority of the respondents (82.1%) were aware of the health effects arising from improper disposal of unused and expired medicines while 64.2% usually read medicine disposal instruction on the package. Only about 3% of them knew of expired medication take-back system and 33.3% knew nothing about medication expiration date. Conclusion: The study revealed insufficient knowledge as well as inappropriate disposal practices of unused and expired medicines among residents of Parker Corner Road Community in Brewerville. There is need to organize a public enlightenment programme on safe, appropriate use, as well as disposal of unused and expired medicines.

An innovative medical waste management system in a smart city using XAI and vehicle routing optimization.

Background: The management of medical waste is a complex task that necessitates effective strategies to mitigate health risks, comply with regulations, and minimize environmental impact. In this study, a novel approach based on collaboration and technological advancements is proposed. Methods: By utilizing colored bags with identification tags, smart containers with sensors, object recognition sensors, air and soil control sensors, vehicles with Global Positioning System (GPS) and temperature humidity sensors, and outsourced waste treatment, the system optimizes waste sorting, storage, and treatment operations. Additionally, the incorporation of explainable artificial intelligence (XAI) technology, leveraging scikit-learn, xgboost, catboost, lightgbm, and skorch, provides real-time insights and data analytics, facilitating informed decision-making and process optimization. Results: The integration of these cutting-edge technologies forms the foundation of an efficient and intelligent medical waste management system. Furthermore, the article highlights the use of genetic algorithms (GA) to solve vehicle routing models, optimizing waste collection routes and minimizing transportation time to treatment centers. Conclusions: Overall, the combination of advanced technologies, optimization algorithms, and XAI contributes to improved waste management practices, ultimately benefiting both public health and the environment.

Research on transportation management model of COVID-19 medical waste: a case study in Beijing, China.

During the COVID-19 pandemic, disposable masks, protective clothing, gloves, and nasopharyngeal swabs collected by nucleic acid testing formed a large amount of medical waste. Medical waste has strict temporary storage time requirements in hospitals, which need to be transported to medical waste disposal plants within the specified time. However, as most of disposal plants are far away from downtown, they also need to be responsible for the transportation and disposal of medical waste in many hospitals, and put forward higher requirement for transportation routes. Rapid and safe disposal of all types of medical waste generated by COVID-19 is crucial to the prevention and control of the epidemic. This paper designs the transportation route optimization model using Anylogic simulation software based on the regional distribution of 118 tertiary hospitals and 2 large medical waste disposal plants in Beijing, China. At the same time, transportation routes of 118 tertiary hospitals in the morning peak, evening peak, all-day, and ordinary periods were simulated based on the Beijing traffic index in 2017. On this basis, through the analysis of the simulation data, the selection of medical waste transport routes for 118 tertiary hospitals in the morning peak, evening peak, all day, and ordinary periods is further clarified, so as to ensure that medical waste can be transported to the medical waste disposal plant in the shortest time. The shortest path and fastest speed transport mode, medical waste transport data set, and the selection of transport mode of 118 tertiary hospitals formed by this research provide certain reference experience for the rapid and safe transport of medical waste during the epidemic period, and also provides corresponding data support for medical waste transportation management in the post-epidemic era and medical waste transportation decision-making when facing major public health problems.

Event-related potentials for investigating the willingness to recycle household medical waste.

Household medical waste (HMW) recycling in the reverse supply chain has become a primary channel for infectious, toxic, or radioactive substances for environmental protection and a circular economy. Recycling managers need to understand the recycling decision-making mechanisms of households to improve the intention-behavior gap and recycling participation rate, especially in cognitive neuroscience. This study designed an event-related potential (ERPs) experiment to explore the differences in ERPs components between the willingness and unwillingness to make recycling decisions. Our findings confirmed that willingness and unwillingness to recycle can lead to a significant difference in the P300 and N400 scores. A larger P300 was evoked by willingness rather than unwillingness in the prefrontal, frontal, and frontal-temporal regions. This indicates that willingness to recycle results from a rational choice in the decision-making process. However, a larger N400 was evoked by unwillingness rather than willingness in the parietal, parietal-occipital, and occipital regions. A negative wave was evoked in households unwilling to recycle because they thought it was dangerous and unsanitary, causing a higher conflict with intrinsic cognition. The combination of HMW recycling decisions and neurology may accurately measure pro-environmental decision-making processes through brain science. Advancing the knowledge of psychological and brain mechanism activities for understanding pro-environmental choices. In turn, this can help recycling managers to accurately understand household demands for increasing the recycling intention and designing effective HMW take-back systems to solve the intention-behavior gap related to the global recycling dilemma.