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1.
BMC Health Serv Res ; 19(1): 591, 2019 Aug 22.
Artículo en Inglés | MEDLINE | ID: mdl-31438959

RESUMEN

BACKGROUND: The key to the effective management of healthcare wastes is segregation of the waste at the point of generation; no matter what final strategy for treatment and disposal of wastes is selected, it is critical that waste streams are separated. In Ethiopia, healthcare waste segregation practice among healthcare workers is overlooked and scarcely addressed in the scientific literature. This hospital-based cross-sectional study was, therefore, conducted to assess healthcare waste segregation practice and its correlate among healthcare workers in Bale zone, southeast Ethiopia. METHODS: All five hospitals found in Bale zone were included and the study participants were selected using a systematic sampling technique from each hospital. Data were collected through interview using structured questionnaires. Descriptive statistics were computed. Bivariate and multivariable logistic regression analyses were employed to identify factors that correlate with healthcare waste segregation practice. RESULTS: A total of four hundred and nine healthcare workers participated in the study, for a response rate of 97.4%. Of these, 220(53.8%) (95% CI: 49.1-58.9) of healthcare workers were found to have reported good healthcare waste segregation practice. Being male gender (AOR = 1.70, 95%CI: 1.04-2.78), less than 30 years of age (AOR = 2.02, 95%CI: 1.06-3.84), less than 2 years work experience (AOR = 2.95, 95%CI: 1.39-6.26), having good self-reported standard precaution practice (AOR = 8.47,95%CI:4.98-14.42), and working in a department with an on-site healthcare waste segregation container (AOR = 2.10, 95%CI:1.24-3.55) were factors that correlated with self-reported healthcare waste segregation practice. CONCLUSION: Overall, only half of the healthcare workers had good healthcare waste segregation practice, which is low and unsatisfactory. Less service year, having good standard precaution practice, and the presence of onsite waste segregation container were the most important variables that correlate with self-reported healthcare waste segregation practice. Therefore, to improve healthcare waste segregation practice health authorities should focus on sufficient allocation of onsite waste receptacles. In addition, periodic training on standard precaution will improve compliance with segregation practice.


Asunto(s)
Cuerpo Médico de Hospitales/normas , Eliminación de Residuos Sanitarios/normas , Práctica Profesional/normas , Adulto , Anciano , Estudios Transversales , Etiopía , Femenino , Hospitales , Humanos , Masculino , Cuerpo Médico de Hospitales/estadística & datos numéricos , Eliminación de Residuos Sanitarios/métodos , Persona de Mediana Edad , Autoinforme , Encuestas y Cuestionarios , Adulto Joven
2.
Int J Health Care Qual Assur ; 32(1): 34-44, 2019 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-30859864

RESUMEN

PURPOSE: Mercury is widely used in medical and healthcare facilities as dental amalgam, mercury-added medical devices, thiomersal-containing vaccines, laboratory analysis and for other general applications despite the hazards. Various agencies consistently promote mercury-free medical facilities through mercury-free alternatives and better management practices, which are in line with the Minamata Convention on Mercury that aims to protect human health and environment from anthropogenic mercury release. The paper aims to discuss these issues. DESIGN/METHODOLOGY/APPROACH: The authors conducted a gap analysis on recommended practices gathered from the literature and current practices gathered through semi-structured interviews with Malaysian medical personnel. A life cycle approach was adopted covering mercury use: input, storage, handling, accident, waste disposal and governance phases. FINDINGS: The authors found that there are significant gaps between recommended and current mercury management practices. Analysis indicates improper mercury management as the main contributor to these gaps. The authors found from recommended practices that core components needing improvement include: mercury management action plan, mercury use identification team, purchasing policy, proper guidelines and monitoring systems. PRACTICAL IMPLICATIONS: This study helps us to understand mercury management practices and suggests essential steps to establish a mercury-free medical facility. ORIGINALITY/VALUE: This study explored the gaps between recommended and current mercury management practices in a medical facility and contributes to the Minamata Convention on Mercury aspirations.


Asunto(s)
Accidentes de Trabajo/prevención & control , Instituciones de Salud/normas , Eliminación de Residuos Sanitarios/normas , Mercurio/efectos adversos , Seguridad del Paciente , Administración de la Seguridad/organización & administración , Países en Desarrollo , Femenino , Política de Salud , Hospitales de Enseñanza , Humanos , Malasia , Masculino , Evaluación de Necesidades , Formulación de Políticas
4.
Rev. pesqui. cuid. fundam. (Online) ; 11(1): 1-10, jan.-mar. 2019.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-968461

RESUMEN

Objetivo: Descrever como é realizado o descarte de medicamentos; avaliar o conhecimento de profissionais que atuam em Unidades de Saúde da Família a respeito do descarte de medicamentos. Método: Pesquisa qualitativa, exploratória, descritiva, realizada com 16 profissionais em quatro Unidades de Saúde da Família de um município do sul do Brasil. A coleta ocorreu por meio de entrevistas semiestruturadas. A análise dos dados foi por meio da análise textual discursiva. Resultados: Os trabalhadores não cumprem os passos do descarte correto. A maioria desconhece a legislação vigente. Os profissionais identificaram a contaminação do meio ambiente, uso indevido dos medicamentos descartados incorretamente e resistência bacteriana aos medicamentos como as principais consequências do descarte incorreto. Conclusão: Esta pesquisa pode contribuir na gestão e na assistência, fazendo com que gestores, profissionais e usuários repensem o seu fazer, melhorando a saúde das pessoas e do meio ambiente


Objectives: Describe how the disposal of drugs is carried out; To evaluate the knowledge of professionals working in Family Health Units regarding drug disposal. Methods: Qualitative, exploratory, descriptive research, carried out with 16 professionals in four Family Health Units of a municipality in the south of Brazil. The collection took place through semi-structured interviews. The analysis of the data was through discursive textual analysis. Results: Workers do not follow the steps of the correct disposal, most are unaware of the current legislation, the professionals identified the contamination of the environment, misuse of incorrectly discarded drugs and bacterial resistance to medications as the main consequences of incorrect disposal. Conclusions: This research can contribute to the management and assistance, making managers, professionals and users rethink their doing, improving the health of people and the environment


Objetivos: Describir como es realizado lo descarte de medicamentos; evaluar el conocimiento de profesionales que actúan en Unidades de Salud de la Familia acerca del descarte de medicamentos. Métodos: Investigación cualitativa, exploratório, descriptiva, realizada con 16 profesionales en cuatro Unidades de Salud de la Familia de un municipio del sur del Brasil. La recolección ocurrió por medio de entrevistas semi-estructuradas. El análisis de los datos fue por medio del análisis textual discursiva. Resultados: Los trabajadores no cumplen los pasos del descarte correcto, la mayoría desconoce la legislación vigente, los profesionales identificaron la contaminación del medio ambiente, uso indebido de los medicamentos descartados incorrectamente y resistencia bacteriana a los medicamentos como las principales consecuencias del descarte incorrecto. Conclusiones: Esta investigación puede contribuir en la gestión y en la asistencia haciendo con que, gestores, profesionales y usuarios replanteen su hacer, mejorando la salud de las personas y del medio ambiente


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Eliminación de Residuos Sanitarios/instrumentación , Eliminación de Residuos Sanitarios/normas , Ambiente/efectos adversos , Estrategia de Salud Familiar
5.
PLoS One ; 13(12): e0207572, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30517128

RESUMEN

OBJECTIVES: Injection safety during anesthesia is a challenging health care issue in Iranian hospitals. Anesthesia is one of the most medication-intensive procedures in healthcare and injecting patients are an integral part of that care. The present study aimed to assess the status of medication injection safety practice in a teaching center. DESIGN, SETTING, PARTICIPANTS: A prospective cross-sectional study was done in 2014-2015 at a 500-bed secondary level teaching hospital affiliated with Urmia University of Medical Sciences, Iran. The study population included providers of anesthesia in two groups of operating rooms (ORs) with different types of surgeries at the center. Data were collected using valid and reliable observation and a questionnaire instruments in two consecutive phases. Mann-Whitney U, Kruskal-Wallis, and Spearman correlation tests were used for data analyses. RESULTS: A total of 345 injections were observed and recorded during the study period, 53% in group A ORs, and 47% in group B ORs. Eighty-two questionnaires were completed (96.5% response rate) to determine hospital injection practices and personal knowledge of injection safety. Adherence to safety requirements was observed in 58.5% of injections. Fifty five percent of respondents knew that hepatitis B, C, and HIV are blood borne diseases. Observed compliance with injection safety requirements was determined significant by OR groups (P = 0.00). Correlation was significant between observed injection safety practices by age and work experience (P = 0.00). The Kruskal-Wallis test showed a significant difference (P = 0.000) in observed safe injection practices among four job groups but not in reported adherence. Knowledge of respondents was significant by job groups about blood borne diseases and receiving three doses of hepatitis B vaccine. CONCLUSIONS: The study revealed that some of safe injection procedures were well carried out in our ORs, but that others were not. The reported adherence of staff was acceptable but their actual practices were unsafe. It is suggested to implement audits, provide safer supplies, and complete Hepatitis B vaccination of injection providers.


Asunto(s)
Anestesia/métodos , Inyecciones/efectos adversos , Inyecciones/métodos , Adulto , Anestesiología , Patógenos Transmitidos por la Sangre , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Humanos , Control de Infecciones/métodos , Control de Infecciones/normas , Irán , Masculino , Eliminación de Residuos Sanitarios/métodos , Eliminación de Residuos Sanitarios/normas , Lesiones por Pinchazo de Aguja , Estudios Prospectivos , Encuestas y Cuestionarios
6.
Rev Bras Enferm ; 71(5): 2367-2375, 2018.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30304164

RESUMEN

OBJECTIVE: to describe the knowledge of nurses on Health-Care Waste Management (HCW) in Family Health Units (FHU) of São Carlos city, São Paulo State. METHOD: exploratory, descriptive and quantitative approach. The research was carried out with nurses of 16 FHU of the municipality of São Carlos-SP. Data were collected through an interview using a tool validated and analyzed using descriptive statistics. RESULTS: it is noteworthy that 68.7% (11) of the nurses did not know how to describe how chemical waste was sorted. In addition, regarding the treatment of HCW, 50.0% (8) of the nurses did not know if the general waste were subjected to some type of treatment. CONCLUSION: the HCW management can be considered a challenge in the nurses' agenda inserted in the Primary Care services, which refers to the need to implement periodic training on the management of this waste.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Eliminación de Residuos Sanitarios/métodos , Eliminación de Residuos Sanitarios/normas , Enfermeras y Enfermeros/normas , Brasil , Competencia Clínica/normas , Humanos , Enfermeras y Enfermeros/estadística & datos numéricos , Enfermería de Atención Primaria/normas
8.
Asia Pac J Public Health ; 30(7): 644-654, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30256653

RESUMEN

Water hygiene, sanitation, and proper management of health care wastes at health care facilities are important in preventing infections and improving health and the environment. This article describes the access to safe water and sanitation facilities and the disposal of medical wastes at commune health centers (CHCs) in Vietnam. Data was extracted from the 2015 World Bank Vietnam District and Commune Health Facility Survey. Bivariate and multivariate logistic regression was applied to identify associations of CHCs' access to improved water and sanitation and their medical waste management. Overall, 72.76% CHCs had access to both improved water and sanitation facilities, and better access was found in the richest communes. Rural CHCs had higher prevalence of appropriate wastewater treatment. The majority of CHCs combusted medical solid wastes by specialized incinerations, contracted out with sanitation companies, or transported them to district health centers. However, the data was insufficient to give in-depth analysis and conclusion on water and sanitation conditions and the management of medical wastes at CHCs. More information should be collected for further analysis and conclusion.


Asunto(s)
Eliminación de Residuos Sanitarios/normas , Servicios de Salud Rural/estadística & datos numéricos , Saneamiento/normas , Abastecimiento de Agua/normas , Humanos , Vietnam
9.
Int J Med Inform ; 118: 5-15, 2018 10.
Artículo en Inglés | MEDLINE | ID: mdl-30153921

RESUMEN

BACKGROUND: Proper Health-Care Waste Management (HCWM) and integrated documentation in this sector of hospitals require analyzing massive data collected by hospital's health experts. This study presented a quantitative software-based index to assess the HCWM process performance by integrating ontology-based Multi-Criteria Group Decision-Making techniques and fuzzy modeling that were coupled with data mining. This framework represented the Complex Event Processing (CEP) and Corporate Performance Management (CPM) types of Process Mining in which a user-friendly software namely Group Fuzzy Decision-Making (GFDM) was employed for index calculation. FINDINGS: Assessing the governmental hospitals of Shiraz, Iran in 2016 showed that the proposed index was able to determine the waste management condition and clarify the blind spots of HCWM in the hospitals. The index values under 50 were found in some of the hospitals showing poor process performance that should be at the priority of optimization and improvement. CONCLUSION: The proposed framework has distinctive features such as modeling the uncertainties (risks) in hospitals' process assessment and flexibility enabling users to define the intended criteria, stakeholders, and number of hospitals. Having computer-aided approach for decision process also accelerates the index calculation as well as its accuracy which would contribute to more willingness of hospitals' experts and other end-users to use the index in practice. The methodology could efficiently be employed as a tool for managing hospitals' event logs and digital documentation in big data environment not only for the health-care waste management, but also in other administrative wards of hospitals.


Asunto(s)
Toma de Decisiones , Técnicas de Apoyo para la Decisión , Lógica Difusa , Administración Hospitalaria/normas , Eliminación de Residuos Sanitarios/normas , Administración de Residuos/métodos , Consenso , Humanos , Eliminación de Residuos Sanitarios/métodos , Programas Informáticos
10.
J Environ Public Health ; 2018: 6879751, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30151013

RESUMEN

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.


Asunto(s)
Eliminación de Residuos Sanitarios/instrumentación , Eliminación de Residuos Sanitarios/métodos , Bangladesh , Ciudades , Incineración , Eliminación de Residuos Sanitarios/normas
11.
East Mediterr Health J ; 24(5): 443-450, 2018 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-30043963

RESUMEN

Background: Hospital waste management (HWM) rules in Pakistan were issued in 2005. Despite a decade of enactment, adherence to HWM 2005 rules has been inconsistent and systematic assessment of adherence using a World Health Organization (WHO)-recommended questionnaire has not been done in all teaching hospitals of Peshawar District. Aims: This study assessed the adherence to HWM 2005 rules by tertiary care teaching hospitals of Peshawar District with respect to HWM personnel, policy and practices. Methods: Pretested structured questionnaires based on WHO recommendations were used to survey all teaching hospitals of Peshawar District from January to March 2015. Data were also collected on HWM infrastructure and processes from 1 randomly selected medical, surgical, paediatric, and obstetrics/gynaecology unit in each hospital. Besides descriptive statistics, public and private hospitals were compared using Fisher's exact and Wilcoxon rank-sum tests. Results: Most surveyed hospitals lacked formal HWM plans (70%), written procedures (80%), related job descriptions (80%) or records (90%). Many hospitals neither had trained HWM supervisors (56%) nor did they organize formal HWM trainings for new staff (40%). None of the hospitals followed waste segregation and colour coding. When compared to national HWM 2005 rules, multiple gaps in appropriate transportation, storage and disposal were found with no statistically significant difference between public and private hospitals. Conclusions: Serious gaps in adherence to HWM 2005 rules exist in surveyed hospitals. With recent devolution of environmental function, the Government of Khyber Pakhtunkhwa should enact provincial HWM rules (and ensure their implementation) to facilitate effective HWM practice across provincial healthcare facilities.


Asunto(s)
Hospitales de Enseñanza , Eliminación de Residuos Sanitarios/normas , Humanos , Política Organizacional , Pakistán , Encuestas y Cuestionarios , Organización Mundial de la Salud
12.
East Mediterr Health J ; 24(4): 351-359, 2018 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-29972229

RESUMEN

Background: Unsafe injection practices put patients and providers at risk of infectious and noninfectious adverse events. A 2001 Ministry of Health survey on injection practices in Oman indicated that, while overall standards were good, in some areas there was a need for improvement. Aim: We aimed to evaluate injection safety practices to determine whether facilities meet the requirements for practices, equipment, supplies and waste disposal, and to identify unsafe practices. Methods: We conducted a national cross-sectional survey in 2007 using the World Health Organization tool to evaluate injection safety practices. Using 2-stage cluster sampling, 80 government and 61 private health facilities were randomly selected and evaluated. Results: There was no shortage of injection equipment nor evidence of attempts to sterilize disposable devices. Care providers immediately disposed of the used needle/syringe in sharps containers. Phlebotomy devices were taken from sealed packets in 96% of facilities. In private facilities, 66.3% of the care providers were fully immunized against hepatitis B. Wearing a new pair of gloves for phlebotomy was observed in only 46% of government and 38% of private health facilities. Many health facilities lacked alcohol-based handrub. Conclusions: Many injection safety aspects were satisfactory. However there are still opportunities for improvement. Actions are required to make alcohol-based handrub and appropriate sharps containers available and to provide hepatitis B vaccine and training to health care workers in all facilities.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Control de Infecciones/normas , Inyecciones/normas , Eliminación de Residuos Sanitarios/normas , Administración de la Seguridad/normas , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Estudios Transversales , Femenino , Hepatitis B/epidemiología , Hepatitis B/prevención & control , Humanos , Masculino , Omán/epidemiología , Medición de Riesgo , Factores de Riesgo , Encuestas y Cuestionarios
13.
Int J Health Care Qual Assur ; 31(6): 619-630, 2018 Jul 09.
Artículo en Inglés | MEDLINE | ID: mdl-29954260

RESUMEN

Purpose The management of public health risks is a key focus for the European Union. One of the key factors that has been shown to pose a public health risk is that of the management of needles from healthcare facilities. The paper aims to discuss this issue. Design/methodology/approach Using audits of two case study hospitals based in northern Italy, this study sought to examine the key factors that resulted in needle stick injuries amongst staff and suggest measures to minimise these risks. Findings The number of needle stick injuries was influenced by various key factors including the time period during the year, the length of time employed, the location within the site, staff category and working hours. Practical implications Suggestions for overcoming the risk factors, including redesigning working patterns, staff training and awareness building, and the use of safety-engineered devices are outlined. Originality/value This study examined the incidence of needle stick injuries amongst healthcare staff in two Italian hospitals, which was lower than in other countries due to various factors, including recapping of needles not being allowed, the introduction of self-retractable needles and awareness campaigns about the correct disposal procedures of potentially infectious waste.


Asunto(s)
Administración de Instituciones de Salud/normas , Eliminación de Residuos Sanitarios/métodos , Eliminación de Residuos Sanitarios/normas , Lesiones por Pinchazo de Aguja/prevención & control , Salud Pública , Concienciación , Diseño de Equipo , Humanos , Capacitación en Servicio/organización & administración , Italia , Factores de Riesgo , Flujo de Trabajo
14.
Rev. Asoc. Esp. Espec. Med. Trab ; 27(2): 110-117, jun. 2018. tab
Artículo en Español | IBECS | ID: ibc-175320

RESUMEN

El formaldehído (FA) es un químico industrial ampliamente utilizado cuya exposición se asocia con aparición de efectos biológicos como irritación de la vía aérea, efectos genotóxicos e inmunotóxicos, sensibilización y cáncer. La Agencia Internacional para la Investigación del Cáncer clasificó el FA como carcinógeno humano (grupo 1). El objetivo de este artículo es revisar los efectos biológicos descritos en cualquier tipo de exposición laboral y no laboral al FA, y posteriormente valorar la anamnesis, la exploración clínica y las pruebas complementarias a considerar en los trabajadores expuestos a formaldehido, ya que la historia clínico-laboral es fundamental para su seguimiento. Se concluye finalmente sobre la necesidad de revisar los protocolos específicos oficiales de vigilancia de la salud para trabajadores expuestos a formaldehido


Formaldehyde (FA) is a widely used industrial chemical which exposure is associated with the appearance of biological effects such as airway irritation, genotoxic and immunotoxic effects, sensitization and cancer. The International Agency for Research on Cancer classified FA as a human carcinogen (group 1). The aim of this review is to study the biological effects in any type of occupational and non-occupational exposure to FA, and then to analyze the assessment of the anamnesis, the physical exploration and the complementary tests to be considered in the medical-occupational history of employees exposed to formaldehyde, since it is fundamental for its follow-up. In conclusion, we propose the revision of the specific official protocols of health surveillance


Asunto(s)
Humanos , Exposición Profesional/prevención & control , Exposición a Compuestos Químicos , Contención de Riesgos Biológicos , Formaldehído/toxicidad , Vigilancia en Salud Pública , Eliminación de Residuos Sanitarios/normas
15.
Clin J Oncol Nurs ; 22(3): 354-356, 2018 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-29781469

RESUMEN

With the largest body of employees in U.S. health care, the nursing profession is well positioned to tackle the challenges of waste reduction within hospital systems. The healthcare sector generates a massive amount of waste, contributing to environmental issues, such as air and water pollution. By unifying and engaging staff through shared governance models, nurses can reduce the overhead costs associated with waste management and help maintain fiscal integrity. Nurses have the ability to use their trusted skill sets and lead the way for sustainable, healthy communities and environments in which they serve.


Asunto(s)
Contaminación Ambiental/prevención & control , Guías como Asunto , Hospitales/normas , Eliminación de Residuos Sanitarios/normas , Rol de la Enfermera , Administración de Residuos/normas , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos
16.
Am J Infect Control ; 46(2): 133-138, 2018 02.
Artículo en Inglés | MEDLINE | ID: mdl-28958444

RESUMEN

BACKGROUND: The recent Ebola outbreak led to the development of Ebola virus disease (EVD) best practices in clinical settings. However, after the care of EVD patients, proper medical waste management and disposal was identified as a crucial component to containing the virus. Category A waste-contaminated with EVD and other highly infectious pathogens-is strictly regulated by governmental agencies, and led to only several facilities willing to accept the waste. METHODS: A pilot survey was administered to determine if U.S. medical waste facilities are prepared to handle or transport category A waste, and to determine waste workers' current extent of training to handle highly infectious waste. RESULTS: Sixty-eight percent of survey respondents indicated they had not determined if their facility would accept category A waste. Of those that had acquired a special permit, 67% had yet to modify their permit since the EVD outbreak. This pilot survey underscores gaps in the medical waste industry to handle and respond to category A waste. Furthermore, this study affirms reports a limited number of processing facilities are capable or willing to accept category A waste. CONCLUSIONS: Developing the proper management of infectious disease materials is essential to close the gaps identified so that states and governmental entities can act accordingly based on the regulations and guidance developed, and to ensure public safety.


Asunto(s)
Control de Enfermedades Transmisibles/métodos , Enfermedades Transmisibles/transmisión , Eliminación de Residuos Sanitarios/métodos , Eliminación de Residuos Sanitarios/normas , Residuos Sanitarios/clasificación , Recolección de Datos , Brotes de Enfermedades/prevención & control , Servicio de Limpieza en Hospital , Humanos , Proyectos Piloto , Estados Unidos
18.
Waste Manag ; 69: 518-534, 2017 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-28886977

RESUMEN

The objective of this work was to develop an optimization model to minimize the cost of a collection, haul, transfer, treatment and disposal system for infectious medical waste (IMW). The model calculates the optimum locations of the treatment facilities and transfer stations, their design capacities (t/d), the number and capacities of all waste collection, transport and transfer vehicles and their optimum transport path and the minimum IMW management system cost. Waste production nodes (hospitals, healthcare centers, peripheral health offices, private clinics and physicians in private practice) and their IMW production rates were specified and used as model inputs. The candidate locations of the treatment facilities, transfer stations and sanitary landfills were designated, using a GIS-based methodology. Specifically, Mapinfo software with exclusion criteria for non-appropriate areas was used for siting candidate locations for the construction of the treatment plant and calculating the distance and travel time of all possible vehicle routes. The objective function was a non-linear equation, which minimized the total collection, transport, treatment and disposal cost. Total cost comprised capital and operation costs for: (1) treatment plant, (2) waste transfer stations, (3) waste transport and transfer vehicles and (4) waste collection bins and hospital boxes. Binary variables were used to decide whether a treatment plant and/or a transfer station should be constructed and whether a collection route between two or more nodes should be followed. Microsoft excel software was used as installation platform of the optimization model. For the execution of the optimization routine, two completely different software were used and the results were compared, thus, resulting in higher reliability and validity of the results. The first software was Evolver, which is based on the use of genetic algorithms. The second one was Crystal Ball, which is based on Monte Carlo simulation. The model was applied to the Region of East Macedonia - Thrace in Greece. The optimum solution resulted in one treatment plant located in the sanitary landfill area of Chrysoupolis, required no transfer stations and had a total management cost of 38,800 €/month or 809 €/t. If a treatment plant is sited in the most eastern part of the Region, i.e., the industrial area of Alexandroupolis, the optimum solution would result in a transfer station of 23 m3, located near Kavala General Hospital, and a total cost of 39,800 €/month or 831 €/t. A sensitivity analysis was conducted and two alternative scenarios were optimized. In the first scenario, a 15% rise in fuel cost and in the second scenario a 25% rise in IMW production were considered. At the end, a cost calculation in €/t/km for every type of vehicle used for haul and transfer was conducted. Also, the cost of the whole system was itemized and calculated in €/t/km and €/t. The results showed that the higher percentage of the total cost was due to the construction of the treatment plant.


Asunto(s)
Eliminación de Residuos Sanitarios/métodos , Residuos Sanitarios , Modelos Teóricos , Sistemas de Información Geográfica , Grecia , Eliminación de Residuos Sanitarios/normas , Eliminación de Residuos Sanitarios/estadística & datos numéricos , Programas Informáticos , Transportes , Instalaciones de Eliminación de Residuos
19.
BMC Public Health ; 17(1): 740, 2017 09 25.
Artículo en Inglés | MEDLINE | ID: mdl-28946876

RESUMEN

BACKGROUND: Adequate management of healthcare waste (HCW) is a prerequisite for efficient delivery of healthcare services. In Nigeria, there are several constraints militating against proper management of HCW. This is raising some environmental concerns among stakeholders in the health sector. In this study, we analyzed the practices of HCW management and determinants of risky/safe indices of HCW disposal. METHODS: The study used the 2013/2014 Service Delivery Indicator (SDI) data that were collected from 2480 healthcare facilities in Nigeria. Descriptive statistics, Principal Component Analysis (PCA) and Ordinary Least Square (OLS) regression were used to analyze the data. RESULTS: The results showed that 52.20% and 38.21% of the sampled healthcare facilities from Cross River and Bauchi states possessed guidelines for HCW management, respectively. Trainings on management of HCW were attended by 67.18% and 53.19% of the healthcare facilities from Cross River and Imo states, respectively. Also, 32.32% and 29.50% of healthcare facilities from rural and urban areas previously sent some of their staff members for trainings on HCW management, respectively. Sharp and non-sharp HCW were burnt in protected pits in 45.40% and 45.36% of all the sampled healthcare facilities, respectively. Incinerators were reported to be functional in only 2.06% of the total healthcare facilities. In Bauchi and Kebbi states, 23.58% and 21.05% of the healthcare facilities respectively burnt sharp HCW without any protection. Using PCA, computed risky indices for disposal of sharp HCW were highest in Bayelsa state (0.3070) and Kebbi state (0.2172), while indices of risky disposal of non-sharp HCW were highest in Bayelsa state (0.2868) and Osun state (0.2652). The OLS results showed that at 5% level of significance, possession of medical waste disposal guidelines, staff trainings on HCW management, traveling hours from the facilities to local headquarters and being located in rural areas significantly influenced indices of risky/safe medical waste disposal (p < 0.05). CONCLUSION: The study concluded that there was low compliance with standard HCW management. It was recommended that possession of HCW management guidelines, staff training on HCW disposal and provision of requisite equipment for proper treatment of HCW would promote environmental safety in HCW disposal.


Asunto(s)
Instituciones de Salud/estadística & datos numéricos , Eliminación de Residuos Sanitarios/métodos , Eliminación de Residuos Sanitarios/normas , Administración de la Seguridad/normas , Guías como Asunto , Personal de Salud/educación , Humanos , Incineración/estadística & datos numéricos , Nigeria
20.
Int J Health Care Qual Assur ; 30(7): 645-655, 2017 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-28809593

RESUMEN

Purpose The purpose of this paper is to determine water availability, sanitation and hygiene (WSH) services, and healthcare waste management in Jordan healthcare facilities. Design/methodology/approach In total, 19 hospitals (15 public and four private) were selected. The WSH services were assessed in hospitals using the WSH in health facilities assessment tool developed for this purpose. Findings All hospitals (100 percent) had a safe water source and most (84.2 percent) had functional water sources to provide enough water for users' needs. All hospitals had appropriate and sufficient gender separated toilets in the wards and 84.2 percent had the same in outpatient settings. Overall, 84.2 percent had sufficient and functioning handwashing basins with soap and water, and 79.0 percent had sufficient showers. Healthcare waste management was appropriately practiced in all hospitals. Practical implications Jordan hospital managers achieved major achievements providing access to drinking water and improved sanitation. However, there are still areas that need improvements, such as providing toilets for patients with special needs, establishing handwashing basins with water and soap near toilets, toilet maintenance and providing sufficient trolleys for collecting hazardous waste. Efforts are needed to integrate WSH service policies with existing national policies on environmental health in health facilities, establish national standards and targets for the various healthcare facilities to increase access and improve services. Originality/value There are limited WSH data on healthcare facilities and targets for basic coverage in healthcare facilities are also lacking. A new assessment tool was developed to generate core WSH indicators and to assess WSH services in Jordan's healthcare facilities. This tool can be used by a non-WSH specialist to quickly assess healthcare facility-related WSH services and sanitary hazards in other countries. This tool identified some areas that need improvements.


Asunto(s)
Hospitales/normas , Higiene/normas , Saneamiento/normas , Abastecimiento de Agua/normas , Agua Potable/normas , Desinfección de las Manos/normas , Humanos , Jordania , Eliminación de Residuos Sanitarios/normas , Cuartos de Baño/normas
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